Paper 1 Flashcards
Which virus causes measles?
RNA paramyxovirus
Give the values for M+F for prolonged QTc
Males >440, Females >470
What can be given for gynaecomastia in bicalumide prostate treatment?
Tamoxifen
What is given for hot flushes in goserelin (LHRH) treatment?
Methoxyprogesterone acetate
How many months is TB treatment?
6 months -> 2 months isoniazid, rifampicin, pyrazinamide, ethambutol + 4 months isoniazid and rifampicin
Which score is used for melanoma?
Glasgow 7 point (major = size, colour and shape)
Which diabetic drug is given if triple therapy has failed and BMI >35?
GLP-1 analogue (e.g. exenatide)
What is first line for mild-moderate acne?
Topical retinoid
Is long-sightedness or short-sightedness a risk factor for retinal detachment?
Short
Which drug is associated with skin necrosis?
Warfarin and heparin
Which drugs can induce SLE?
Tetracyclines, hydralazine, procainamide
What is the most common + aggressive malignant melanoma?
Superficial spreading + Nodular
Which heart defects are paradoxical embolisms associated with?
ASD and VSD -> embolus migrates to systemic circulation leading to cerebrovascular events
Describe Kernig’s Sign + associated conditon
Flexion of hip and knee to 90 degrees before straightening -> meningeal irritation + meningitis
How should long acting insulin dose be corrected during surgery? (%)
80% to prevent rebound hyperglycaemia upon referring
What is the most common source of UTIs?
GIT to urethra
What is first line ORAL + TOPICAL AB for acne?
Oral -> tetracycline (doxycycline)
Topical -> macrolide (clindamycin)
Define serial ECGs in ACS
ECG every 10 minutes
What is the first marker to rise and fall in ACS?
Myoglobin
Give MONA for ACS
Morphine
O2 (if hypoxic)
Nitrates (GTN)
Antiplatelet therapy (aspirin + clopidogrel -> both 300mg)
What is the difference between LMWH and unfractionated heparin in terms of half life?
LMWH has a longer half life -> unfractionated used when wanting to move to Cath labs
Which organ impairment would indicate unfractionated heparin?
Renal impairment
What is Tirifoban an example of? (NSTEMI)
Glycoprotein IIb/IIIa (acts on another coagulation pathway compared to other drugs)
What is the cause of a mitral regurgitation post-MI?
Papillary muscle rupture
What is the most common cause of glandular fever?
EBV
What is the anatomy of a Type A Stanford aortic dissection?
Proximal to left subclavian artery
What is the initial management for an aortic dissection? + First line?
500mL bolus to see if they are fluid responsive + crossmatch and transfuse blood
What does an intimal flap indicate on chest CT?
Aortic dissection
What is the blood pressure control drug for aortic dissection? + Target BP?
IV labetalol -> 100-120mmHg
Which murmur could occur as a complication if a Type A aortic dissection extends proximally?
Mid-diastolic high pitched murmur (aortic regurgitation)
Which complicate triad can an aortic dissection cause?
Becks -> muffled heart sounds, high JVP, hypotension
Which hep is more common in MSM without recent travel?
Hep B
Which type of disease does pseudoxanthoma elasticum (knees, antecubital fossa) appear?
Early coronary artery disease
Alcoholic, pain shortly after eating, elevated AST and ALT, epigastric pain spreading to the back, elevated serum amylase -> what is the likely underlying cause?
Acute pancreatitis secondary to gallstones
How does acute pancreatitis cause hypocalcaemia?
Fat necrosis and chelation of calcium salts
Which type of pancreatitis is seen as a complication of acute pancreatitis and shows as variable contrast enhancement on CT?
Necrotic pancreatitis
Biopsy shows mononuclear cell infiltrates with multinucleated giant cells -> diagnosis?
GCA
Give the 369 rule for bowel obstructions
Small bowel >3cm
Large bowel >6cm
Caecum >9cm
What is a common immediate ileostomy complication to be aware of?
High output stoma (>1.5) -> dehydration and electrolyte abnormalities -> replace fluids and can use anti motility (e.g. loperamide and codeine phosphate)
Where does somatostatin and dopamine act in the growth hormone axis?
Acts on the pituitary to reduce GH secretion -> give dopamine agonist to treat acromegaly
Give the first line management for acromegaly + prolactinoma
Acromegaly (surgical) -> transphenoidal resection
Prolactinoma (medical) -> cabergoline (long acting dopamine agonist)
What type of tumour is choriocarcinoma?
Germ cell
Testicular lump, elevated T4, palpitations -> diagnosis?
Choriocarcinoma -> bHCG -> increases release of thyroid hormone
What is the cause of toxic multi nodular goitre?
Iodine deficiency
How does iodine deficiency cause toxic multi nodular goitre
Compensatory TSH -> hyperplasia -> nodule formation -> mutations over time -> becomes independent of TSH
Which antibody other than anti-TSH can be found in Graves?
Anti-microsomal (anti-TPO)
What is bicuspid aortic valve and hypo plastic aortic arch associated with?
Coarctation of the aorta
How does ciprofloxacin affect warfarin? (e.g. while used in Antiphospholipid syndrome)
Increases INR
What is the management for subclinical hypothyroidism at first appointment?
Repeat TSH in 3 months (2 results required before treatment)
In overt hypothyroidism -> how is levothyroxine dose changed in IHD and pregnancy?
IHD -> reduce due to stimulant effects of thyroxine
Pregnancy -> increase dose due to increased metabolic rate
What is first line long acting insulin?
Levemir (then Lantus)
Which regimen is given if unable to tolerate basal-bolus?
Mixed insulin regimen
Give examples of rapid + short + intermediate + long acting insulin
Rapid (2-5h) -> novorapid, humalog
Short (5-9h) -> humulin S, actrapid
Intermediate (12-24h) -> humbling I, Insulinatard
Long (16-42h) -> Levemir, Lantus
What happens if 1L NaCl 0.9% stat is given above systolic 90?
Central pontine myelinolysis
Cerebral oedema
Which 2 drugs are indicated in pregnant diabetes?
Insulin, metformin
After metformin -> what is the HbA1C threshold before starting another diabetic drug?
58mmol/L
Most common cause of SBO?
Adhesions (following previous surgery)
What is the first line diagnostic + staging investigation for oesophageal cancer?
Diagnostic -> endoscopy and biopsy
Staging -> CT CAP
3 months haematuria, flank pain, mass, dragging feeling in testicle -> diagnosis + why does it cause dragging sensation?
RCC -> left RCC due to varicocoele formation -> left RCC invades renal vein causing back pressure -> varicocele (right sided drain into IVC and does not cause varicocele)
How does GCA cause vision loss?
Invasion into short ciliary arteries -> anterior ischaemic optic neuropathy
Give the first line for extracapsular NOF for subtrochanteric + intertrochanteric
Intertrochanteric -> Dynamic hip screw
Subtrochanteric -> IM nail
Asymptomatic gallstones -> diagnosis?
Reassurance
Which enzyme is produced by vibrio cholera? + how does this cause watery diarrhoea?
Adenylate cyclase -> adenylate cyclase -> increase in cAMP -> inhibits chloride secretion + sodium reabsorption in intestinal lumen -> watery diarrhoea
Struvite crystals, urine pH >7 -> which renal pathology? + which bacteria?
Urease producing bacteria -> stag horn calculi
Which 2 genes are associated with coeliac?
HLA-DQ2
HLA-DQ8
Which drug class is most associated with ATN?
Sulfa- drugs
Which ACR ratio indicates CKD?
ACR >3, 2 eGFR reading 3 months apart
As part of a renal transplant -> tacrolimus -> what is a common peripheral side effect?
Tac flap
Which electrolyte disturbance is commonly seen in AKI?
Hyperkalaemia
what is the leading cause of death in CKD?
Cardiovascular disease
Give the triad for Alport’s Syndrome + inheritance pattern
Frank haematuria, ophthalmology, sensorineural hearing loss + X-linked
Which nephritic pathology does heroin use increase the risk of?
Focal segmental glomerulosclerosis
Hypocomplementenemia + tram track on microscopy, BBV, SLE -> which nephrotic pathology? + type
Type 1 membranoproliferative glomerulonephritis
How does nephrotic syndrome affect calcium?
Hypocalcaemia -> loss of albumin (main calcium transporter) = less circulating calcium
Which bacteria is associated with aspiration pneumonia?
Klebsiella
Give the NT-proBNP thresholds for ECHO in HF
> 400 -> 6 weeks
2000 -> 2 weeks
First line infective endocarditis AB
Amoxicillin
Give the empirical AB for native + prosthetic valve
Vanc
Gent
Rifampicin
Give the ABPI range for PAD
0.5-0.9
Which electrolyte is deficient in hyperthyroidism?
Calcium
Which investigations after thyroid antibodies?
Technecium uptake scan
Heterogenous uptake on technecium scan suggests which type of hyperthyroidism?
Toxic multi nodular goitre
Which liver marker is elevated in hyperthyroidism?
ALP
During a thyroidectomy -> inferior thyroid artery is ligated -> what is this a branch of?
Thyrocervical trunk
Give the management for cerebral toxoplasmosis in HIV
Pyrimethamine
Sulfadiazine
Which cancer is associated with AIDS?
Anal
Which vaccination is safe in HIV?
MEN ACWY
Which GI pathology is crypt hyperplasia associated with?
Coeliac
Which GI pathology is associated with reduced goblet cells on microscopy?
UC
Which guideline is used for severity of UC? + Give range for mild + moderate/severe
Truelove + Witts
Mild: >4 (Rectal mesalazine)
Moderate/Severe: 4-6 (IV corticosteroids to induce remission)
4 Weeks have passed since starting rectal mesalazine for a UC flare -> there has been no improvement -> what can be added as second line?
Rectal corticosteroids
Which derm condition is associated with mother/herald patch?
Pityriasis rosea
What do Kerley B lines represent?
Interstitial oedema
What does a globular heart represent?
Pericardial effusion
Which syndrome is montelukast associated with?
Churg-Strauss (eosinophilia, vasculitic rash, peripheral neuropathy, respiratory symptoms)
Give the mechanism of carvedilol
alpha and beta receptor antagonist
Give an example of an angiontensin 2 inhibitor
Losartan
Which complement is low in MPGN?
C3 Complement
Which syndrome starting with R causes thyroid hormone resistance?
Refetoff Syndrome
Which vitamin deficiency can lead to an accumulation of undifferentiated kertinocytes in striatum spinosum?
Vitamin A
Clusters of gram positive cocci -> which organism?
Staph aureus
Why is metoclopramide avoided in Parkinson’s?
It is a D2 receptor antagonist -> worsen Parkinson motor
Vision loss, dementia, cherry red macula, GM2 gangliosides -> diagnosis
Tay-Sachs Syndrome
Dementia, myoclonus, prion -> diagnosis
Creutzfeld-Jakob Disease
SLE/Sjogrens/systemic sclerosis, mottled skin, reticulated patches, worse in cold -> diagnosis
Lived reticular
Give the class of bromocriptine + how does it affect prolactin
Dopamine agonist -> decreases prolactin
Which side BBB + axis deviation means right heart disease?
RBBB + LAD
Which hep is porphyria cutanea tarda, lichen plants, cryoglobulinaemia, B cell lymphoma associated with?
Hep C (Cryo)
Which 2 catecholamines can nerve endings make?
Noradrenaline
Dopamine
Which hep is associated with polyarteritis nodosa?
Hep B
Which arteritis affects the aortic arch and branches?
Takayasu’s
Which type of haemorrhage is seen in shaken baby syndrome?
Subdural haemorrhage
How does secondary hypothyroidism (e.g. pituitary adenoma) affect follicular cells?
Atrophy due to decreased production of TSH
Which type of liver disease are Mallory bodies seen in?
Alcoholic liver disease
What does absent GAD and low C-peptide (what does this mean?) indicate?
T1D -> low C-peptide due to decreased endogenous production of insulin
How does urease-producing bacteria affect urine?
Proteus mirabilis -> urease hydrolyses urea to ammonia and CO2 -> increases pH of urine -> growth of struvite crystals
Which type of nephropathy are Kimmelsteil-Wilson lesions associated with?
Diabetic nephropathy
Diffuse alveolar infiltrate, pink frothy sputum, chest pain
Legionella pneumophilia
Which stone is the most radio-opaque? + Common?
Calcium phosphate
Calcium oxalate
Give the values for high + low SAAG + examples of each
> 11g/dL -> constrictive pericarditis
<11g/dL -> pancreatitis, malignancy
Give the criteria for asthma exacerbation discharge
PERF >75%
Review inhaler technique
Review take home plan
Inform GP for community review within 48 hours
Hyperinflated lung fields on CXR -> Which resp?
COPD
What is the mechanism of GLP-1 Mimetics?
Mimics incretin -> incretin’s target tissue is beta cells in the pancreas -> stimulate insulin release
What is the mechanism of DPP4-inhibitor?
Inhibits DPP4 (breaks down incretin) to allow for incretin’s action on increasing insulin production
What is the first line for COPD? + Give mechanism
Ipratroprium bromide (bronchodilator) -> inhibits ACh at muscarinic receptors -> decrease cGMP -> dilates vessels in airways by decreasing smooth muscle
Which antibiotics is used in MRSA in renal insufficiency?
Linezolid
Which nerve innervates soft palate, pharynx, larynx? + Which side is the lesion if the uvula is deviated to the right?
Vagus
Left
Define Marjolin ulcer
Malignant change in a longstanding wound/scar
Give the electrolyte disturbance in RFS
Hypophosphataemia, hypokalaemia, hypomagnesaemia
Which deficiency causes wet beriberi? + Give pathophysiology
Thiamine deficiency
Affects CVS -> high CO despite RVF
Which peripheral sign can indicate Peutz-Jeghers?
Hyperpigmented lips, mouth and other areas
What is Curschmann’s spiral pathognomic for?
Asthma
Which organism is linked with CF TB?
Pseudomonas aeruginosa
Which tumour arises from the dura mater? + which histology feature?
Meningioma
Psammoma body
Which type of renal malignancy is associated with schistosomiasis?
Squamous cell carcinoma
Which malignancy can a mutation in CDK2A cause?
Malignant melanoma
Which murmur can an aortic dissection cause?
Aortic regurgitation if the dissection extends proximally to involve the aortic valve
Which complement is involved in membranoproliferative glomerulonephritis Type II?
C3
What is the most common secondary cause of FSGS?
HIV
Which vasculitic disease is associated with c-ANCA?
Granulomatosis w/polyangiitis
How does a PPI affect Cl- production in the gastric lumen?
PPI decreases H+ exchange through Na+/K+ ATPase -> more Cl- available and not used for HCl production -> less Cl secretion through negative feedback
Which area of the GIT is the most common for spontaneous perforation?
Duodenum, usually due to ulceration
What is the most common subtype of prostate cancer?
Testicular lymphoma
Which neurotransmitter is linked with Alzheimers?
Low levels of acetylcholine
What is first line for pertussis?
Erythromycin
Which antibiotic can cause a metallic taste?
Metronidazole
What is firs line for HF?
NT-ProBNP
Give an example of Vaughn-William I + II
I -> sodium channel blocker
II ->
Cerebellar symptoms, quadriparesis/hemiparesis, reduced consciousness -> which artery?
Vertebrobasilar
Which vision loss is seen with PCA stroke?
Contralateral homonymous hemianopia with macular sparing
Which diabetic drug can be a rare cause of pancreatitis?
DPP4-inhibitor (e.g. sitagliptin)
Give the Ig status for acute + chronic Hep B infection
Acute IgM > IgG
Chronic IgG > IgM
What is a congenital cause of aortic stenosis? + which other heart pathology is this associated with?
Bicuspid valve
Co-arctation of aorta
Give the 2 most common organisms in acute cholangitis
E.coli
Klebsiella
Give first line for ascending cholangitis
IV Co-amoxiclav (or cefuroxime/metronidazole) for 5-7 days then ERCP 48h after starting AB to clear any obstructions
If ERCP is not available -> what is second line?
Percutaneous transhepatic cholangiography
Most common organism in bronchiectasis
H. influenzae
Which enzyme can lead to emphysema?
Alveolar macrophages and neutrophils release macrophages which releases elastase -> if uncontrolled (e.g. through smoking) -> alveolar destruction -> dilatation of air sacs and destruction of alveolar walls
Severe psoriatic exacerbation, febrile, 90% scale red patches -> treatment?
Methotrexate
What is mandatory prior to starting isotretinoin in females?
Contraception due to teratogenicity
Give the criteria for surgery in EDH
Midline shift >5mm
Volume >30cm3
EDH thickness >15mm
GCS<8
Neurological deterioration
What does aspirin inhibit? + what does this mediate?
Inhibits COX1 predominantly -> medicates thromboxane A2 -> disrupts TXA2-mediated platelet aggregation
Give the effects of carbamazepine on U+E
Hyponatraemia
SIADH
Which type of bacteria poses the most risk for patients with hyposplenism
Encapsulated
5-HIAA, facial flushing, diarrhoea, bronchospasm -> diagnosis? + Which heart valve pathology is most common?
Carcinoid tumour
Tricuspid regurgitation
Which syndrome demonstrates necrolytic migratory erythema which is pathognomic?
Glucagonoma Syndrome (pancreatic tumour that overproduces glucagon)
Associated with mild diabetes, anaemia
Give the pathology of diabetic nephropathy starting from hyperglycaemia
Hyperglycaemia promotes the glycosylation of efferent arteriole surface -> hyaline arteriole sclerosis -> hyperfiltration in the glomerulus and mesangial cell expensation -> over time leads to reduced filtration and leakiness
Which cells are preferentially lost during cerebellar degeneration from chronic alcohol abuse?
Purkinje cells
Which agent can be given in beta blocker overdose?
Glucagon
+ IV fluids for hypotension, atropine for bradycardia
Which meningitis is common in immunocompromised patients? + Which staining is used?
Cryptococcal (TB or fungi)
India ink negative stain -> encapsulated organisms
Young, ophthalmological pathologies, frank haematuria -> which syndrome? + Which gene and inheritance pattern?
Alport Syndrome
COL4A5
X-linked
Young, episodic chest pain at rest and night -> diagnosis?
Prinzmental angina
Meningitis with hyponatraemia and hyperkalaemia, adrenal haemorrhage on imaging -> diagnosis?
Waterhouse-Friedrichsen Syndrome
How long to wait before H. pylori test after PPI trial?
2 weeks
Which blood group increases the risk of peptic ulcers?
O
How do NSAIDs cause gastric ulcerations?
Inhibit COX-1 -> reduction in prostaglandins -> reduction in gastric mucus secretion
Ataxia, dysarthria, loss of reflexes, kyphoscoliosis, positive Babinski, young, autosomal recessive, GAA repeat mutation in FXN -> diagnosis?
Friedrich’s Ataxia
What is the most common cause of death in Friedrich’s?
HOCM
Herald patch, previous sore throat, widespread rash -> diagnosis?
Pityriasis rosea
Which organism is most associated with pityriasis rosea?
HHV 6/7
What is start if stroke symptoms has an onset <4.5h? + what must be ruled out? + target BP?
Thrombolysis
Non-contrast CT to rule out haemorrhage
180/110
Is aspirin 300mg or thrombolysis given first?
If thrombolysed -> give aspirin and anti platelet therapy the following day
Give the time period for thrombectomy + two stroke areas indicating thrombectomy
<24h
Proximal anterior
Posterior circulation stroke
Which monoclonal antibody is used for recurrent C.diff?
Bezlotoxumab
What should be suspended from C.diff infection?
PPI
Which carcinoma arises from Kulchistsky cells?
SCLC
Give some autonomic dysregulation symptoms in LES
ED, postural hypotension, dry mouth
Give the NT-proBNP values for transthoracic ECHO in 2w + 6w
> 2000 pmol/L -> 2 weeks
400 pmol/L -> 6 weeks
Give the ABCDE CXR in HF
Alveolar oedema
B lines (Kerley)
Cardiomegaly
Dilated upper lobe vessels
Effusion
Why is bisoprolol preferred over atenolol?
Bisoprolol is more cardioselective and results in better outcomes in HF patients
As 3rd line therapy -> when can’t ivabradine be used?
HR <75
What % reduction is acceptable in CKD when using ACEI?
25
First line test for female + male gonorrhoea + chlamydia + trichomoniasis
Male -> FVU, NAAT chlamydia, gonorrhoea, culture trich
Fem -> Swab
Which arthritis is more commonly associated with chlamydia?
Reactive -> can’t see, pee or climb a tree
What is the most common renal manifestation of SLE?
Type IV diffuse proliferative glomerulonephritis
Intense thirst, polyuria, weakness, takes lithium for Bipolar -> diagnosis?
Nephrogenic DI from chronic lithium use
Which clinical sign is a strong indication of lithium toxicity?
Hyperreflexia
Which cancer can haemodialysis cause?
RCC
How can RCC cause vaircoele? + which side?
Left sided varicoele from left RCC compression of the left renal vein
Which type of effusion does HF cause?
Transudative
Which triad is seen in asthma-exacerbated respiratory disease?
Samter’s Triad -> aspirin sensitivity, nasal polyps, bronchial asthma
What is ninetadanib and perfenidone used for? + Give FVC requirements for perfenidone
Both are anti-fibrotic for IPF
FVC 50-80%
What is the most common type of MODY? + Which gene is affected?
Type 3
Hepatocyte nuclear factor-1-alpha
Which hypersensitivity is Grave’s disease?
Type 2
Specific antibody against antigen
What is sacubitril valsartan indicated for? + What does it replace in therapy?
3rd line option for HF (along with ivabradine and digoxin [with AF])
Replaces ACEI when used
Give the first line for GBS
IVIG for 5 days
Give the 3 times to take a serum tryptase after an anaphylactic reaction
Immediately
1h
24h
What is given after an anaphylactic for patients to take home?
2 adrenaline autoinjectors
Give the tests for contact and food reactions
Contact -> patch
Prick - food
Give 3 criteria for blood transfusion in context of anaemia
Hb <70
Hb <80 + cardiac
Active bleeding
Which staging is used for colorectal carcinoma?
Dukes criteria
Which investigation for suspected bladder cancer?
Cystoscopy
What is 5-fluorouracil used for?
Renal SCC (esp in mets)
Which blood test is used for neuroleptic malignant syndrome?
Serum creatine kinase
What is the initial management for NMS?
Rapid fluid resus to prevent AKI secondary to rhabdomyolysis
What class is dantrolene? + Give 2 conditions it’s used for
Muscle relaxant -> reduces metabolic demand
Malignant hyperthermia
NMS
Stiff shoulder with pain, limited external rotation -> what is a risk factor?
Diabetes
Single unprovoked seizure, type 2 license for work -> how long to stay off the road?
5 years seizure free
Give the class of donepezil
Acetylcholinesterase inhibitor -> boosts cholinergic neurotransmission in Alzheimers (used for symptomatic relief)
Give the histological changes after MI
Neutrophil invasion (6-12h)
Macrophages (24-72h)
Granulation tissue (1-2w)
Give the chelating agent for iron overdose
Desferrioxamine
Give the changes in potassium during rhabdomyolysis
Increases (along with CK)
What are rose spots associated with?
Typhoid (high fever, bloody diarrhoea)
Which vaccine is given coeliac disease?
Pneumococcal due to functional hyposplenism
What is the most common cause of SAH?
Trauma
Which medication is given once SAH is diagnosed?
Nimodipine (CCB) to prevent vasospasm
Generally given for 3 weeks
Which vasopressor + anti-arrhythmic is given during resuscitation + when?
1mg Adrenaline, 300mg amiodarone
End of 3rd CPR cycle
What is first line for cluster headache?
Subcutaneous sumatriptan, high flow O2
Give the mechanism of triptans
5HT-1B/D agonists for vasoconstriction
What is the prophylaxis for cluster headaches?
Verapamil
Give the triad name for iliac artery occlusion giving symptoms of thigh/buttock claudication, absent or reduced femoral pulse, ED
Leriche Syndrome
Which condition has the 3 stages: catarrhal, paroxysmal, convalescent
Whooping coughWhich
Which marker is raised in any germ cell tumour? + When do AFP + bhCG raise?
LDH rises in any tumour
AFP -> Yolk sac, teratomas
bHCG -> seminomas, choriocarcinoma
Which cancer arises from inhibition of p53 and rb TSGs?
HPV inhibits p53 and rb
-> CIN
What is first line treatment for fast AF?
IV fluids
Redcurrant jelly sputum, upper lobe, gram negative rod, incompetent swallow -> which organism pneumonia?
Klebsiella pneumoniae
What is first line for Alport’s (X-linked)?
ACEI
Give first line + second line for stable angina
1 -> bb OR non-dihydropyridine
2 -> beta blocker and dihydropyridine CCB
Give a rate control + rate limiting option for AF in haemodynamically stable patients
Rate control -> BB (bisoprolol)
Rate limiting -> diltiazem
Give the effects on BP + HR from complete section at cervical level + give pathophysiology
Hypotension
Bradycardia
Loss of sympathetic function, unopposed parasympathetic function leading to bradycardia and hypotension
Why is CT chest important in myasthenia gravis?
10% have thymoma, 70% have thymic hyperplasia
Which stains are used for SCC + BCC?
SCC -> EMA
BCC -> Cytokeratin
What is the Leser-Trelat sign associated with?
Seborrheoic keratoses (gastric cancer)
What is first line for CRVO?
Fluorescein angiography
What is first line for CRVO? + flashing floaters after, which complication has occurred?
Intravitreal VEGF inhibitor
Retinal detachment
Which asthma drug can reduce seizure threshold?
Theophylline
What is the most common cause of Addison’s worldwide?
TB
What is the electrolyte disturbance in Addisonion crisis?
Hyponatraemia, hyperkalaemia, metabolic acidosis
How is NMS and SS differentiated by pupils + reflexes
SS -> dilated pupils, hyper-reflexia
NMS -> normal pupils, hypo-reflexia
Which lung cancer is associated with HPOA?
Hypertrophic osteoarthropathy (onion skin on x-ray) -> SCC
Which lung cancer is associated with early metastases to the brain?
SCLC
What is the time criteria for CKD?
3 months
What is first line for UTI in children?
Co-amoxiclav
Cephelexin
Which hep infection is lichen planus associated with?
Hep C
What is the overall most common cause of tonsillitis?
Rhinovirus
(GAS for bacterial cause)
How is aortic sclerosis and stenosis differentiated?
Stenosis has no radiation to the carotids
Which malignancy is lichen planus associated with?
SCC of the skin
Which side of the heart is louder during expiration?
More blood flow in left side as pulmonary flow increases due to less expansion of lungs
What is the most common cause of status epilepticus in children + adults?
Adults -> epilepsy (poor compliance)
Children -> febrile convulsions
When is IM benzylpenicillin given in community for meningitis?
Meningococcal suspected -> rash, signs of sepsis
Give upper zone causes of fibrosis
Sarcoidosis
Coal miner pneumoconiosis
Ankylosing spondylitis
Silicosis
Hypersensitivity pneumonitis
CF
What is the most common cause of fibrosis? + which zone
IPF -> lower zone
Asbestosis
Drugs -> methotrexate, amiodarone, bleomycin
Radiation
Rheumatoid -> SLE, RA
Which organism causes pneumococcal meningitis? + which type of haemolysis?
Strep pneumonia (gram positive coccus)
Alpha
What is first line gastric + oesophageal varices?
Sclerotherapy -> gastric
Band ligation -> Oesophageal
How do burns + raised ICP cause ulcers?
Burns -> hypovolaemia causes reduced perfusion to stomach lining -> Curling Ulcer
Raised ICP -> increased vagal stimulation -> increased gastric acid secretion -> Cushing ulcer
What is Rigler’s sign indicative of?
Gas on either side of bowel wall -> Large pneumoperitoneum
What is the most common cause of acute pancreatitis?
Gallstones
How do NSAIDs exacerbate asthma?
COX inhibitor -> leukotriene synthesis increases -> bronchoconstriction
Give the treatment for mild + moderate + severe acne rosacea (worsens in sunlight, onset with stress, butterfly distribution, worse with vasodilators (e.g. amlodipine)
Briminodine
Metronidazole
Oxytetracycline
What the medical management of thyroid storm? + which effect does it induce?
Lugol’s solution -> Wolff-Chaikoff effect (contains iodine but inhibits thyroid hormone production by inhibiting iodine organification)
Give the 2 antibiotics given in acute cholecystitis
Cefotaxime
Metronidazole
to cover gram positive, negative and anaerobes
What primary prevention can be given in Lynch syndrome?
Aspirin
Why is flexible sigmoidoscopy not preferred in diverticulitis?
Risk of perforation is increased due to false lumens (diverticulae)
Which arrhythmia can MR cause?
AF
Which medication is given for metallic heart valves?
Vitamin K antagonist -> Warfarin
How do you differentiate orbital cellulitis + peri orbital abscess?
Orbital cellulitis causes visual disturbances
Which imaging is gold standard for optic neuritis?
MRI orbit with contrast
What is P-mitrale associated with?
MR
What is the most common cause worldwide of hypothyroidism?
Iron Deficiency (Hashimoto’s in developed world)
Which type of cells are over expressed in asthma?
T-helper type 2 cells
Which cancer is Hashimoto’s associated with?
Non-Hodgkin’s Lymphoma
How does an ACEI cause a dry cough?
ACE normally breaks down bradykinin (causes bronchoconstriction)
-> ACEI -> reduces degradation and bradykinin accumulates in upper and lower respiratory tracts
What is the most common cause of mesenteric ischaemia?
Embolus in SMA, most due to AF
Give a body part involved in essential tremor + how is ET affected with alcohol and benzodiazepines use?
Head
Improves
Which type of sepsis does agranulocytosis lead to?
Neutropenic
What is the advice for flying post-pneumothorax?
Fly 1 week after post-check CXR
Give the management for both ureteric and renal <5mm stones + ureteric >10mm + renal 10-20 + renal >20mm
Watchful waiting
Uteroscopy
EWSL
PCNL
What is the treatment for active cancer after PE?
LMWH for 6 months
What is the limit for statins before discontinuing?
3x upper limit of ALT/AST
Which shoulder pathology is hypothyroidism a risk factor?
Adhesive capsulitis
Give the 3 phases of adhesive capsulitis
Freezing 2-9 months - pain
Frozen 4-12 months - restricted movement
Thawing 12-24 months - gradual improvements
Which nerve palsy is seen in Lyme disease?
Early disseminated -> facial nerve
Give a cardio manifestation of Lyme disease
AV block
What biologic is first line for metastatic seminoma?
Cisplatin - platinum based therapy
What ECG changes is seen in tricyclic antidepressant?
QRS widening
Give the triad seen in HUS from E.coli O157 shiga toxin
Thrombocytopenia, haemolysis and renal failure
What is the gold standard investigation for bronchiectasis?
CT Thorax
Give the gold standard investigation for bullous pemphigoid (bullae, does not affect mouth)
Skin biopsy with direct immunoflourescence
In DKA -> what are the ranges for K+ for treatment?
> 5.5 nothing
3.5-5.5 40mmol/2h K+
<3.5 -> ITU/HDU consideration
What is the signet ring sign indicative of on a CT chest?
Bronchiectasis from multiple dilated bronchi
What medication change should take place if patient has long term HF not controlled properly and has LVEF <35%
Switch ACEI to ARB
Which type of rash is seen in rheumatic fever?
Erythema marginatum
Give the mechanism of metronidazole + effectiveness on aerobic organisms
Reduced by anaerobic only -> disrupts DNA replication
Ineffective against aerobic
Give 2 investigations for long QT syndrome
ECG
Holter
What is first line for long QT syndrome? + refractory?
Beta blocker and lifestyle
ICD
What is first line for Bell’s palsy?
Oral prednisolone
What the management for:
1) 5-8 INR, no bleeding
2) >8, no bleeding
1) Withold 1-2 doses
2) 1-5mg oral vitamin K
What is the blood test for sarcoidosis?
Serum ACE (elevated)
What is the pathophysiology of hypercalcaemia in sarcoidosis?
Increase in alpha-1-hydroxylase -> activates vitamin D
How do opioids cause respiratory depression?
Mu receptors cause medullary diminished central response to hypercapnia and hypoxia
Give the first line medical treatment for achalasia
Long acting nitrate
CCB (nifedipine)
Which imaging is used in acute diverticulitis?
CT abdo pelvis
What is the metabolic cause of DKA?
Unopposed lipolysis and oxidation of FFAs -> ketoacidosis
What is the most common organism in adult conjunctivitis?
Adenovirus
Diverticulitis -> bubbles in urine -> which complication?
Colovesical fistula
How is retrobulbar optic neuritis differentiated?
Normal optic disc on fundoscopy with eye pain and vision loss
Which supplement is given with methotrexate?
Folic acid
How to differentiate between myxoedema criss + thyroid storm?
Myxoedema -> hypothermia <35.5
Thyroid storm >40
Which antibodies can cross placenta and cause neonatal lupus leading to complete heart block with SLE mother?
Anti-Ro
What is the most common type of renal complication in SLE
Diffuse proliferative glomerulonephritis
What is required immediately if Torsades de Pointes is detected?
Magnesium sulphate
Which condition affects desmoglein-1?
Staph aureus -> impetigo
Which tumour marker is elevated in non-seminamatous testicular cancer?
APC
What is the most likely complication of chronic pancreatitis?
Oteoporosis
Give the treatment for cellulitis with facial involvement
Co-amoxiclav
or Erythromycin with metronidazole
Which serious skin condition can occur following varicella?
Nec fasc
T1 = polymicerobial
T2 = strep pyogenes
T3 = marine
T4 = fungal
What can a left sided varicoceole indicate?
left sided RCC
Which CT chest finding will you find with RCC?
Canonball metastases
What is intravesical mitomycin C given for?
Post-surgery TURBT for bladder cancer
How to differentiate between CES and spinal cord mets?
CES -> LMN signs only
Which reflex outcomes differentiates CES and CMS
CMS -> knee reflex preserved, ankle lost
CES -> both lost
What is the gold standard for anti-GBM? + What is a key finding?
Renal biopsy
Crescenteric glomerulonephritis
Tender singular goitre -> diagnosis?
Subacute granulomatous goitre (de Quervains)
Give the calculation for estimated serum osmolality
(2*Na) + urea + glucose
Pleural thickening, chest pain, weight loss -> diagnosis?
Pleural mesothelioma
Which bloods is used for diagnosing NMS?
Serum creatine kinase
Which lung cancer is associated with SVCO?
SCLC
Which cancer risk increases in acromegaly?
Colorectal
What is first line for serotonin syndrome?
Cyproheptadine
Give a notable side effect of GLP-1 mimetic and DPPIV-inhibitors
Acute pancreatitis
Which antibiotic is given second line for acne with history of DVT?
Lymecycline
Epigastric pain improves after eating -> where is the location of the ulcer?
Duodenum
Which endocrine complication can occur from use of lithium?
Hypothyroidism
What is the most common organism in encephalitis + first line?
HSV
IV acyclovir
What is first line for SCLC + NSCLC?
Chemotherapy with radiotherapy
Surgical resection
CXR -> cough, dyspnea, lower lung base bullae, young -> diagnosis?
A1AT
What does a testicular blue dot sign indicate?
Torsion of testicular appendage (cremasteric reflex preserved)
How does ARB cause hyperkalaemia?
ARB blocks production of aldosterone -> less excretion of K+
COPD not managed with bronchodilator -> which FEV1 value for next line + What is next line?
<80
Inhaled tiotroprium (LAMA) combined with salmeterol (LABA)
What is the significance of folliculitis on chest with other infective symptoms?
Late stage HIV -> HIV serology
Which cancer is actinic keratoses associated with?
SCC
When is septic shock diagnosed?
Severe sepsis + hypotension + raised lactate despite fluid resus
Which type of glomerulonephritis can IgA develop into?
Rapidly progressive -> loss of eGFR 50% or 50% crescent formation <3M
What prophylaxis is required after splenectomy?
Daily Pen V
What is first line for P.falciparum? + Give the triad + when is step down started?
IV artesunate
Hypotension, hypoglycaemia, parasitaemia >10%
step down to oral at <1%
Which RTA is hypergammaglobulinaemia associated with?
RTA (Type 1) - Fanconi -> distal RTA
Hypokalaemia, hypophosphataemia,
COPD exacerbation, life threatening features -> tried nebulised salbutamol and hydrocortisone -> next steps?
40mg prednisolone, admit to hospital, review in the morning
SIADH -> what is first line?
Fluid restriction
Good response to synacthen test -> what does this rule out?
Addison’s
Bronchiectasis, pseudomonas aeruginosa infections, resistance to fluoroquinolone -> what is the next management?
Trial nebulised colistin and chest physio
Swelling, dull dragging pain in scrotum -> diagnosis?
Varicocoele
Which vitamin D supplement does not require kidney hydroxylation?
Alfacalcidiol (1-hydroxycholecalciferol)
Which endocrine pathology is associated with congestive cardiac failure?
Myoedema (hypothyroidism)
Which HSV is more common in viral meningitis?
HSV2 > HSV1
What is the most common bacterial meningitis in neonates?
GBS
What is contraindicated in ACS if hypotensive?
GTN
How is a posterior STEMI seen on ECG? + Which artery?
Reciprocal only ST depression V1-4
Posterior descending branch of RCA
Painless indurated penile ulcer -> diagnosis?
Syphilis (trepenoma pallidum)
How is primary and secondary Conn’s differentiated?
Primary -> increase aldosterone, negative feedback = low renin
Secondary -> inappropriate activation of RAAS -> increases both
What is Virchow’s node significant for?
Upper GI malignancy
Close contacts with what can cause which parasitic encephalitis?
Toxoplasmosis
Define decubitus angina
Angina symptoms on laying flat
Give the ECG change in prinzmental angina
Transient ST elevation due to coronary artery vasospasm
Which drug can cause coronary artery spasms?
Cocaine
How to know if fibrinolysis has worked?
1 hour ECG afterwards for STEMI
What is a good agent to use to reduce resp rate and breathlessness without causing hypoxia or hypercapnia?
IV morphine
What can ventricular wall aneurysms (persistent ST elevation) lead to?
Stroke due to thrombi formation from turbulent blood flow in ventricle
Give the effect of hypoparathyroidism on phosphate and calcium
Low calcium, high phosphate
Give the BM targets for fasting after waking + before meals
Fasting BM after waking = 5-7
Before meals = 4-7
What is first line septic shock?
IV adrenaline/noradrenaline infusion
After fluid resus, when is insulin given in HHS?
Ketosis
Why is ketosis seen less in HHS?
There is more circulating insulin -> drives glucose into cells -> turns off ketotic pathways
What is first line medical management in phaeochromocytoma?
Alpha blocker (phenoxybenzamine) then beta blocker
Give the genetic mutations for MEN1 + MEN2
MEN1
RET
What does the liver increase the production of in compensation for hypoalbuminaemia? + how does this affect the blood?
Clotting factors
Hypercoagulability (plus loss of antithrombin III in urine)
Which type hypersensitivity reaction is acute interstitial nephritis?
Type IV
What causes prinzmental angina?
Coronary spasm
After GTN and non-dihydropyridine CCB -> what is second line? + for asthma?
Switch verapamil to dihydropyridine and BB
Asthma -> avoid beta blockers -> ivabradine
Which histological type carries the worse prognosis and progression to end stage renal disease in FSGS?
Collapsing type
How does CKD cause bone and joint pain with reduced mobility?
CKD -> reduced 1-alpha hydroxylase -> reduced activation of vitamin D (active form = 1,25-dihydrocholecalciferol)
Why is there crepitus on palpation of MRSA severe cellulitis?
Nec fasc from anaerobic organisms causing gas
How would you treat A1AT?
Like COPD
Which 2 enzymes is implicated in A1AT? + Therefore, what does A1AT deficiency lead to?
Inhibit protease
Prevents neutrophil elastase from breaking down elastin
-> Alveolar destruction and emphysema
Which other system can A1AT affect?
Liver -> cirrhosis -> scleral icterus
Which imaging for diagnosing PSC?
MRCP
Are intra or extra hepatic ducts affected in PSC + PBC?
PSC -> inside and outside
PBC -> inside only
Which dermatological pathology is associated with Parkinson’s?
Seborrhoeic dermatitis
How do you differentiate white out in pleural effusion and total lung collapse?
Lung collapse -> towards white out
Pleural effusion -> away
Which blood gas will primary hyperaldosteronism show?
Metabolic alkalosis (from loss of H+ with K+)
What type of diet is required power bowel resection?
High protein
Low fat
What is seen in LHF + Pulmonary hypertension for mPAP + pCWP?
PH -> >20mmHg mPAP, normal pCWP
LHF -> increase both
How does alcohol affect magnesium?
Decreases (which decreases potassium)
How is SJS and TEN differentiated?
SJS <10% skin involvement
TEN >30%
Both have mucosal involvement
If T1D not well controlled, how much is the increase in long acting and short acting?
Both 10%
What is the first line for pancreatic head tumour?
Whipple’s (pancreatoduodenectomy)
Give a dermatological condition associated with otitis externa and blephritis
Seborrhoeic dermatitis
Give the bowel screening programme
Over 60 to 74, every 2 years, qFIT
What can guttate psoriasis turn into?
Plaque psoriasis
What is the reversal agent for beta blockers?
Glucagon
What is given in long term + short term serotonin syndrome?
Long term -> cyproheptadine
Short term -> benzo
Which bundle branch + fascicular blocks causes LAD + RAD?
LAD -> left anterior fascicular block, LBBB + inferior MI
RAD -> left posterior fasciular block + lateral MI
Tonsillitis can cause which type of psoriasis?
Guttate psoriasis
Which derm condition is associated with a herald patch?
Pityriaisis rosea
Give the target + step up targets in diabetes after metformin has not managed?
Target = 53
Step = 58
Which lobe is the most commonly affected by aspiration pneumonia?
RLL
Give the UTI treatment course for non-pregnant + pregnant + male
Non-pregnant - 3 days (7 days if catheterised)
Pregnant and male - 7 days
Give the AB for pyelonephritis in mild-moderate non pregnant + pregnant + severe
Mild-moderate non pregnant -> cefalexin, co-amox
Pregnant - cefalexin
Severe - IV co-amoxiclav +/- gentamicin
Give the timing for CT head for:
GCS<12
GCS<15 in 2 h
Open or depressed skull fracture
Basal skull fracture
>1 vomiting
Focal neurological deficit
+
> 65
Bleeding disorders
Dangerous mechanism
30 minutes retrograde amnesia
1h
8h
Wickhams striae, Koebnar, itchy rash on wrist, URTI, oral mucosal involvement -> diagnosis?
Lichen planus
What is first line for arteriovenous malformation in kidneys?
Embolisation
IgA deposition in dermal cells on immunofluorescence, papules and vesicles -> diagnosis? + management?
Dermatitis herpetiformis
Dapsone
Give the 4 symptoms of pellagra + which vitamin?
B3 (niacin)
Diarrhoea, dermatitis, depression, dementia
Polymorphic VT -> what is first line?
IV magnesium sulphate 2g
What are 2 side effects of oral iron?
Black stools
Constipation
Give 2 complications 24-48h after + before + after 4 weeks pancreatitis
24-48 -> necrotising pancreatitis
Before -> peripancreatic fluid
After -> pseudocyst
How to calculate 24h insulin?
Weight x 0.5-0.75
Which Duke stage requires adjuvant chemotherapy?
Duke C (regional lymph node involvement)
Give the surgical repair for a large direct inguinal hernia + bilateral
Large direct -> open mesh repair
Bilateral -> lap mesh repair
What is the next step if recent stroke/TIA or >75 in massive PE?
Treatment dose LMWH
Diabetic, IVDU, recurrent abscess -> what should be considered when selecting an antibiotic?
MRSA
Younger, fever, rash, gram negative diplococci -> diagnosis?
Gonococcal
What rhythm can chronic MR cause?
AF due to chronic remodelling of LA which disrupts electrical activity of SAN
What does portal hypertension indicate?
Portal hypertension (transudative)
