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pack 1 Flashcards

1
Q

Hydroxychloroquine adverse side effect

A

Retinopathy - can result in severe and permanent visual loss

therefore need to monitor visual acuity

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2
Q

Hypercalcaemia:

bones, stones, groans, moans

A
  • Painful bones
  • Renal stones
  • Abdo GI nausea, vomiting, constipation
  • Psychosis, memory loss, lethargy
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3
Q

Hypocalcaemia:

CATS go numb

A

Convulsions
Arrhythmias
Tetany
Spasms (trousseau’s and chvostek’s sign) and stridor

Numbness in the fingers

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4
Q

Which has mucosal involvement i.e. mouth/vulva:

  • bullous pemphigoid
  • pemphigus vulgaris
A

pemphigus vulgaris

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5
Q
  • Itchy, tense blisters
  • Blisters heal without scarring
  • No mucosal involvement
A

Bullous pemphigoid

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6
Q

5 causes of massive splenomegaly

A
  • myelofibrosis
  • CML
  • visceral leishmaniasis (kala-azar)
  • malaria
  • Gaucer’s syndrome
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7
Q

philadelphia chromosome t(9:22) BCR-ABL gene, is present in patients with what ?

A

Chronic myeloid leukaemia CML

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8
Q

First line treatment for chronic myeloid leukaemia

A

Imatinib

(tyrosine kinase inhibitor)

second line: hydroxyurea, IFN-a, allogenic bone marrow transplant

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9
Q

Head injury with a lucid interval, what haemorrhage

A

Extradural haemorrhage

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10
Q

Convex/lens-shaped haemorrhage on CT

A

Extradural haemorrhage

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11
Q

Concave/crescent moon shaped haemorrhage on CT

A

Subdural haemorrhage

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12
Q
  • Bone-spicule pigmentation on fundoscopy
  • Worsening tunnel vision
  • Night blindness
A

Retinitis pigmentosa

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13
Q

Diagnostic test for glandular fever/Epstein Barr virus

A

Monospot test

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14
Q

Sore throat
Pyrexia
Cervical lymphadenopathy

classic triad of what infection

A

Epstein barr virus HHV4

Glandular fever, infectious mononucleosis

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15
Q

classical triad of renal cell carcinoma

A

haematuria
loin pain
abdominal mass

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16
Q

The Cushing reflex is a physiological nervous system response to increased intracranial pressure (ICP) that results in…

A

Bradycardia
Hypertension
Wide pulse pressure

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17
Q

Acute and PAINFUL swelling to the thyroid gland with raised TSH

A

Subacute (De Quervain’s) thyroiditis

  • likely preceded by viral infection
  • initially hyperthyroid, then hypothyroid, then euthyroid
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18
Q

Grave’s disease autoimmune disease has what antibodies

A

TSH receptor antibodies

  • goitre is PAINLESS
  • proptosis, pretibial myxoedema, hyperthyroid picture
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19
Q

what is the most common well-differentiated thyroid cancer

A

papillary carcinoma

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20
Q

triad of Behcets disease

A

oral ulcers
genital ulcers
uveitis

+ venous thromboembolism

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21
Q

Lymphogranuloma venereum (LGV) is caused by what pathogen

A

chlamydia trachomatis

  1. small painless pustule that forms an ulcer
  2. painful inguinal lymphadenopathy
  3. proctocolitis
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22
Q

what is treatment for Lymphogranuloma venereum (LGV) - caused by chlamydia

  1. small painless pustule that forms an ulcer
  2. painful inguinal lymphadenopathy
  3. proctocolitis
A

Doxycycline

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23
Q

A 23-year-old man presents with an ulcer on the coronal sulcus of the penis. The ulcer is not causing him any discomfort. On examination an ulcer with an erythematous border and a clean base is found. What STI is the cause?

A

Syphilis

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24
Q

Treatment of provoked PE vs unprovoked PE

A

Provoked = 3 months of DOAC e.g. apixaban

Unprovoked = 6 months

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25
Q

first line treatment for scabies

A

permethrin

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26
Q

what is a normal ankle-brachial pressure index value (ABPI)

A

0.9-1.2

<0.9 = arterial disease
>1.3 = disease with calcification
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27
Q

what autoantibody has the highest specificity for rheumatoid arthritis

A

anti-CCP

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28
Q

Management of venous ulceration

A
  1. Compression bandage

2. Oral pentoxifylline

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29
Q

treatment for gonnorrhoea

A

IM ceftriaxone

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30
Q

treatment for chlamydia

A

oral doxycycline

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31
Q

treatment for BV and trichomonas

A

oral metronidazole

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32
Q

4 main features of PTSD

A
  1. Avoidance
  2. Hyperarousal/vigilance
  3. Emotional numbing
  4. Flashbacks/nightmares
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33
Q

COPD patients if they are non-smokers, optimised all other therapy and have any of:

  • frequent exacerbations with sputum
  • prolonged exacerbations
  • hospitalisations from exacerbations

can have what medication for prophylaxis?

A

azithromycin

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34
Q

FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced <70%

What is the cause

A

Obstructive disease e.g. COPD, asthma

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35
Q

FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased >70%

What is the cause

A

Restrictive disease e.g. fibrosis

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36
Q

Background retinopathy features

A
  • microaneurysms (dots)
  • blot haemorrhages
  • hard exudates
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37
Q
  • Cotton wool spots (soft exudates)
  • > 3 blot haemorrhages
  • Cluster haemorrhages
A

Pre-proliferative retinopathy

treat with laser photocoagulation

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38
Q
  • Retinal neovascularisation
  • Vitreous haemorrhage
  • Fibrous tissue forming
A

Proliferative retinopathy

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39
Q
  • Hard exudates

- Background changes on macula

A

Maculopathy

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40
Q

Adrenaline IM dose for anaphylaxis

A

500 micrograms (0.5mg)

0.5ml 1:1000

can be repeated every 5 mins

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41
Q

coeliac disease genes

A

HLA-DQ2

HLA-DQ8

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42
Q

coeliac disease auto-antibodies

A

IgG anti-endomysial
IgG anti-gliadin
IgA tissue transglutaminase

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43
Q

Central retinal artery occlusion causes sudden unilateral visual loss. It is due to …

A
  1. thromboembolism (from atherosclerosis); or

2. arteritis e.g. temporal arteritis

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44
Q

Afferent pupillary defect
Cherry red spot on pale retina
Unilateral sudden visual loss

What is the diagnosis

A

Central retinal artery occlusion

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45
Q

Acute management of SVT (haemodynamically stable)

A
  1. Vagal manoeuvres
  2. IV adenosine 6mg -> 12mg -> 12mg
  3. Electrical cardio version

n.b adenosine is contraindicated in asthmatics so verapamil is used

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46
Q

Most common type of peptic ulcer and epigastric pain relieved by eating

A

Duodenal ulcer

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47
Q

Most common cause of travellers diarrhoea

A

E coli

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48
Q

what antibiotic can cause long QT interval

A

erythromycin

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49
Q

what medication exacerbates plaque psoriasis

A 
beta-blockers
lithium
antimalarials
NSAIDs
ACE inhibitors
infliximab
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50
Q

what antibiotics should be avoided in patients on methotrexaate

A

trimethoprim

co-trimoxazole

51
Q

fluctuating reduction in visual acuity, especially at night, with druse - small accumulations of extracellular material between Bruch’s membrane and retinal pigment epithelium of the eye.

What is the diagnosis

A

DRY age-related macular degeneration

wet = has choroidal neovascularisation

52
Q

Presbyopia

A

lack of eye accommodation with age, cannot focus on close objects

53
Q

Ankylosing spondylitis features - the six ‘A’s

A
  1. apical fibrosis
  2. anterior uvetitis
  3. aortic regurg
  4. achilles tendonitis
  5. AV node block
  6. amyloidosis
54
Q

What is the genotype positive in 90% of ankylosing spondylitis patients

A

HLA-B27

55
Q

what is 1st line management for ankylosing spondylitis

A

Exercise regimes
NSAIDs e.g. meloxicam

If these don’t work then adalimumab

56
Q

post-herpetic neuralgia treatment

A

amitriptyline

or gabapentin

57
Q

1st and 2nd line treatment for c diff

A
  1. vancomycin

2. fidaxomicin if the above does not work

58
Q

what section allows treatment up to 6 months

A

Section 3

section 2 = 28 days

59
Q

72 hour assessment order section for a patient NOT in hospital

A

section 4

60
Q

police mental health act order at home vs in public

A

section 135 - home

section 136 - public

61
Q

what section allows treatment up to 28 days

A

section 2

section 3 = 6 months

62
Q

haematoma between the dura and arachnoid

A

subdural haematoma

  • concave shaped
63
Q

Palpating under the right costal margin causes her to catch her breath with cholecystitis is what sign

A

Murphy’s sign

64
Q

Ascending cholangitis triad

A
  1. fever
  2. RUQ pain
  3. jaundice
65
Q

Constipation in children first line medication

A

movicol

66
Q

Primary pneumothorax treatment if:

(a) <2cm /no SOB
(b) >2cm

A

(a) Discharge or aspiration

(b) Chest drain

67
Q

Secondary pneumothorax treatment if:

(a) <2cm
(b) >2cm/SOB/ older than 50

A

(a) Aspiration - or chest drain if fails

(b) Chest drain

68
Q

toxoplasmosis treatment in:

(a) immunocompromised
(b) normal immune system

A

(a) pyrimethamine

(b) no treatment needed

69
Q

what diabetic meds bind to ATP-dependent potassium channels on pancreatic b-cells to increase insulin release?

A

sulfonylureas

e.g. gliclazide

oral hypoglycaemic drug.

70
Q

treatment for minimal change glomerulonephritis

A

prednisolone steroids

if steroids doesn’t work, biopsy is indicated

71
Q

If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, what is the next step

A

admitted immediately for CT imaging to exclude a haemorrhage

72
Q

The partial horner’s syndrome is actually a fairly common sign seen in what headaches

A

cluster headaches

73
Q

horner’s syndrome signs

A

ptosis - drooping eyelid
miosis - small pupil
anhidrosis

74
Q

Most common complication of measles is…

A

otitis media

+/- pneumonia

75
Q

The most common complication of measles is otitis media.

What are 4 late complications of measles infection:

A
  1. keratoconjunctivitis
  2. encephalitis
  3. subacute sclerosing panencephalitis
  4. pneumonia
76
Q

what is the antibiotic treatment for salmonella

A

ciprofloxacin

77
Q

what pathogen is the most common cause of discitis

A

staph aureus

78
Q

what is gold standard test for degenerative cervical myelopathy

A

MRI spine

XRAY CANNOT DIAGNOSE IT

79
Q

Sudden painless loss of vision
Severe retinal haemorrhages on fundoscopy

What is the diagnosis

A

Central retinal VEIN occlusion

80
Q

Otitis externa can be caused by bacteria (staph aureus, pseudomonas), dermatitis and swimming. It has an itchy discharge ear with red, swollen, eczema canal on otoscopy.

What is the treatment for this

A
  1. Topical antibiotic
  2. With topical steroid

malignant otitis externa is more common in elderly diabetics

81
Q

Malignant otitis externa is the extension of infection into the bony ear canal. What group of patients is it most common in?

A

elderly diabetics

usually needs IV Abx

82
Q

huntington’s disease is a defect in what gene on what Chr

A

Huntingtin gene on Chr 4

83
Q

Pneumocystis jiroveci penumonia treatment

A

co-trimoxazole

in severe cases = IV pentamidine

84
Q

parkinson’s disease - if motor symptoms are affecting patient’s life the most, what treatment

A

L-dopa

85
Q

parkinson’s disease - if motor symptoms are NOT affecting patient’s life, what treatment

A
  1. dopamine agonist (non-ergot derived) e.g. cabergoline, bromocriptine
  2. or levodopa
  3. or MAO-B inhibitor e.g. selegiline
86
Q

Obese, young female with headaches / blurred vision

A

idiopathic intracranial hypertension

87
Q

Obese, young female with headaches and blurred vision has benign idiopathic intracranial hypertension.

What is management

A
  1. Weight loss program
  2. Azetazolamide if abnormal visual findings
  3. Topiramate
  4. Lumbar puncture
  5. Surgery - optic nerve sheath decompression, shunts to reduce intracranial pressure
88
Q

In the UK, men are offered abdominal aneurysm screening at what age with what method …

A

single abdominal ultrasound at 65 years

89
Q

trigeminal neuralgia treatment

A

carbamazepine

90
Q

Guillain-Barre syndrome is classically triggered by which infection

A

Campylobacter jejuni

91
Q

Which pathogen is the most common cause of viral meningitis in adults

A

Coxsackie virus

92
Q

Miller Fisher syndrome is a variant of Guillain-Barre syndrome (but it is descending paralysis rather than ascending). What is the triad

A

Opthalmoplegia
Areflexia
Ataxia

93
Q

Miller Fisher syndrome is a variant of GBS (but it is descending paralysis rather than ascending) with ophthalmoplegia, areflexia and ataxia.

What antibodies are seen in Miller Fisher syndrome?

A

Anti-GQ1b antibodies

94
Q

What 3 criteria exist for urgent endoscopy 2 week cancer wait cancer referral?

A
  1. Dysphagia
  2. Upper abdo mass that feels like stomach cancer
  3. > 55yo with weight loss AND pain, reflux or dyspepsia.
95
Q

The most common organism causing infective exacerbations of COPD is

A

Haemophilus influenzae

96
Q

rifampicin side effects

A

hepatitis
orange secretions

liver inducer

97
Q

isoniazid side effects

A

peripheral neuropathy
hepatitis
agranulocytosis

liver enzyme inhibitor

98
Q

pyrazinamide side effects

A

hyperuricaemia - gout
arthralgia
myalgia
hepatitis

99
Q

ethambutol side effects

A

optic neuritis

renal impairment

100
Q

haematoma between the dura and the skull

A

epidural haematoma

  • convex shape
101
Q

How to differentiate between Erythema multiform major and Steven Johnson’s syndrome?

A
  1. Erythema multiform major has target lesions, usually after INFECTION e.g. herpes
  2. Steven Johnson’s syndrome usually follows DRUG reaction with blistering.
102
Q

Difference between Steven Johnson’s Syndrome and Toxic Epidermal Necrolysis

A

SJS is <10% surface area involvement

TEN >30% involvement

103
Q

areas of darkened and thickened skin in the axillary creases in obese person

A

Acanthosis nigricans

usually associated with Cushing’s syndrome, PCOS, steroids, insulin

104
Q

Hepatocellular carcinoma most common causes:

(a) worldwide
(b) in Europe

A

(a) hep B

(b) hep C

105
Q

Koebner phenomenon (new skin lesions at site of trauma) and polygonal white-line (wickham’s striae) shaped rashes are seen with what skin lesion

A

Lichen planus

usually on palms, soles, genitalia, flexor surfaces of arms

106
Q

The standard HbA1c target in type 2 diabetes mellitus if on metformin/no meds is

A

48mmol/mol

it is 53 if taking sulfonylurea e.g. gliclazide

107
Q

Treatment of lichen planus

A

Topical steroids

Oral lichen plants - benzydamine mouthwash or spray

108
Q

Transferrin (aka TIBC) levels and transferrin saturation levels in iron deficiency anaemia are usually…?

A

Transferrin (TIBC) = high

Transferrin saturation levels = low

109
Q

Carpal tunnel syndrome is the entrapment of which nerve

A

Median nerve

  • thenar muscle wasting
  • parasthesia
  • pain at night
  • weakness of LOAF muscles
110
Q

cutaneous form of T-cell lymphoma that can present like eczema or psoriasis

A

Mycosis fungoides

111
Q

Loss of foot dorsiflexion + sensory loss dorsum of the foot, positive sciatic nerve stretch test - what nerve root is affected

A

L5

112
Q

What is this patient’s audiogram results below suggestive of?

  • Bilateral impairment
  • High-frequency hearing loss
  • Downward-sloping pure tone thresholds
A

presbyacusis

113
Q

Otoscopy would show a greasy, pearly-white lump in the ‘attic’ of the tympanic membrane. An audiogram will show a conductive hearing loss with an ‘air-bone gap’ suggests what diagnosis?

A

Cholesteatoma

114
Q

After acute ischaemic stroke, aspirin 300mg should be given, and then switched to..

A

75mg clopidogrel lifelong

if clopidogrel contraindicated, then aspirin 75mg and MR dipyridamole can be used.

115
Q

This patient is presenting with flashers and floaters which are associated with…

A

retinal/vitreous detachment

  • retinal = starts peripherally, goes centrally, straight lines appear curved
  • vitreous - peripherally
116
Q

Ischaemic optic neuropathy is also known as

A

amaurosis fugax

  • pale swollen optic disc
  • cotton wool spots
  • curtain coming down
  • treat with aspirin 300mg
117
Q

What is step-up management of acne

A
  1. Single topical retinoids/benzoyl peroxide
  2. Combination topical therapy (Abx, BP, retinoid)
  3. Oral Abx with topical retinoid/benzoyl peroxide
  4. COCP in women as an alternative to oral Abx
  5. Oral retinoids
118
Q

Sudden onset sensorineural hearing loss (SSNHL) is caused by what in 80% of cases

A

acoustic neuroma

119
Q

Hearing loss
Vertigo
Tinnitus
ABSENT corneal reflex

Are important signs of…?

A

Acoustic neuroma
- with sudden onset sensorineural hearing loss

Associated with neurofibromatosis type 2

120
Q

What two chromosomes do neurofibromatosis type 1 and type 2 affect?

A

NF1 - Chr 17

NF2 - Chr 22

121
Q

What is the diagnosis with the signs of:

  • cafe-au lait spots
  • CUTANEOUS neurofibromas
  • Lisch nodules - iris hamartomas
A

Neurofibromatosis 1

Chr 17

These are a/w phaeochromocytomas and optic gliomas

122
Q

What is the diagnosis with the signs of:

  • sensorineural hearing loss
  • bilateral acoustic neuroma (vestibular schwanoma)
  • meningiomas
  • cataracts
  • ependynomas
A

Neurofibromatosis 2

Chr 22

123
Q

What topical agent may be used on a long-term basis for psoriasis?

A

Calcipotriol

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