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year 3 > Pass med and general > Flashcards

Pass med and general Flashcards

1
Q

Fungal meningitis in immunosuppressed

A

Cryptococcal meningitis - yeast encapsulating - sex worker

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2
Q

Examination findings constitant with ankylosing spondylitis

A

Schober’s test <5cm

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3
Q

Investigation findings for SLE

A

Positive Anti-dsDNA and anti-smith antibodies, Low levels for C3 and C4

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4
Q

Genetic cause of Marfans syndrome and hw do you monitor

A

Marfan’s syndrome is an autosomal dominant connective tissue disorder. It is caused by a defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1. It affects around 1 in 3,000 people.

Monitor via regular echo

Give BBlocker and Losartan for ACE-I as it decreases TGF-B

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5
Q

What does chest pain with ECG changes in all leads and a small rise in troponin mean?

A

All coronary territories points away from ACS.

Small rise in troponin points to pericarditis

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6
Q

What type of pericarditis does ureamia cause?

A

fibrinous pericarditis

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7
Q

Specific ECG changes in pericarditis

A

widespread ‘saddle-shaped’ ST elevation

PR depression: most specific ECG marker for pericarditis

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8
Q

Imaging in non massive PE, with no renal failure

A

Computed tomographic pulmonary angiography (CTPA)

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9
Q

Periarticular erosions are seen in

A

rheumatoid arthritis

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10
Q

X-ray changes of osteoarthritis

A

decrease of joint space
subchondral sclerosis
subchondral cysts
osteophytes forming at joint margins

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11
Q

Electrolyte imbalance associated with sertraline

A

SSRIs are associated with hyponatraemia

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12
Q

What are the shockable rhythms in cardiac arrest?

A

VF and pulsless VT pVT - If VF/pVT persists, only after a third shock should adrenaline 1 mg IV and amiodarone 300 mg IV be administered.

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13
Q

How long before surgery should warfarin be stopped?

A

Five days in general - INR has to be bellow 1.5

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14
Q

Ankylosing spondylitis features

A 
Ankylosing spondylitis features - the 'A's 
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
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15
Q

TB drug that can induce lupus

A

Isoniazid

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16
Q

confusion and pink mucosae are typical features of

A

carbon monoxide poisoning

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17
Q

What drugs decrease lithium levels?

A

sodium bicarbonate and aminophylline

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18
Q

Common side effects of bisphosphonates

A

Eosophageal problems

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19
Q

… can be added as a second line treatment for rate control in atrial fibrillation

A

Digoxin

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20
Q

Diagnosis of Orthostatic hypotension

A

Orthostatic hypotension can be diagnosed when there is a drop in SBP of at least 20 mmHg and/or a drop in DBP of at least 10 mmHg within 3 minutes of standing

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21
Q

Patient taking antibiotics with new onsent of An ECG shows polymorphic ventricular tachycardia (torsades de pointes).

A

Clarithromycin can cause QT interval prolongation and therefore may trigger polymorphic ventricular tachycardia, particularly in patients with an underlying channelopathy.

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22
Q

Penicillamine can cause what in a patietn with wilsons disease

A

membranous glomerulonephropathy and therefore prominent bilateral leg swelling and periorbital oedema.

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23
Q

Fever on alternating days

A

Malaria

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24
Q

Four myxoedemic coma signs

A

Hypothermia, hyporeflexia, bradycardia and seizures, think

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25
Q

Renal disease caused by penicillin

A

acute interstitial nephritis

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26
Q

Eosinophilic casts in urine are a sign of … usually caused by ….

A

tubulointerstitial nephritis, usually caused by drug reactions

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27
Q

Antibiotics that cause Rhabdomyolysis o

A

erythromycin

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28
Q

High anion gap means high which type of acid?

A

Organic acid

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29
Q

What type of acidosis is anion gap useful in?

A

Metabolic

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30
Q

What are the causes of high ion gap acidosis?

A

Lactic acidosis(Shock, salicylate), ketoacidosis, methanol poisoning, ethylene glycol poisoning

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31
Q

What are the causes of a normal ion gap acidosis?

A

Renal Tubular acidosis and diarrhoea

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32
Q

What can a normal ion gap acidosis be referred to?

A

Hyperchloraemic acidosis

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33
Q

Anti psychotic most linked to prolong QT

A

Halaperidol

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34
Q

Clozapine adverse effect

A

agranulocytosis

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35
Q

Acronym for mechanism of benzos and barbituates

A

Frequently Bend - during barbecues

  • Benzos increase frequency of chloride
    Barbiturates increase duration of chloride
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36
Q

Starting Fluoxetine from another SSRI

A

Stop SSRI and then start, if moving from fluoxetine wait seven days on nothing.

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37
Q

ECT side effects

A 
headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia
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38
Q

Side effects of lithium

A

nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension

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39
Q

Lithium levels required

A

0.4-1.0 mmol/L

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40
Q

What two organs are effected by lithium

A

kidneys and thyroid - hypothyroid

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41
Q

Mirtazapine side effects and what patients you give it to

A

sedative and increased apatite. Good for elderly patients. a2 antagonist

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42
Q

Non-selective monoamine oxidase inhibitors side effect

A

Cheese reaction - avoid tyramine

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43
Q

Bromocriptine is a treatment for

A

galactorrhoea

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44
Q

According to current NICE guidelines on the management of DKA, the infusion of insulin should be

A

0.1 unit/kg/hr

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45
Q

Thiazolidinediones are absolutely contraindicated in

A

Heart failure`

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46
Q

prolactinoma first line medical treatment

A

Dopamine agonist such as bromocriptine

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47
Q

optimal treatment in HNF1A-MODY

A

Sulfonylureas

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48
Q

Atrial fibrillation cardioversion drugs

A

amiodarone + flecainide

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49
Q

Progressive multifocal leukoencephalopathy is caused by

A

the JC virus or BK virus

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50
Q

Factor V Leiden mutation results in

A

activated protein C resistance

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51
Q

Gait ataxia is caused by

A

cerebellar vermis lesions

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52
Q

Myelodysplasia may progress to

A

acute myeloid leukaemia

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53
Q

Antibiotics for acites with protein of 15 or less

A

oral ciprofloxacin

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54
Q

Large vessel arteritis in woman

A

Takayasu’s arteritis

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55
Q

What respiratory drug increases lactate?

A

salbutamol

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56
Q

How to differential left and right heart failure?

A

You only get pulmonary oedema in Left sided heart failure, although chronic pulmonary oedema can then cause right sided heart failure think cor pulmonale

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57
Q

Where is BNP made?

A

Ventricles

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58
Q

Referral for BNP between 400-2000

A

six week cardiology

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59
Q

Referral for BNP over 2000

A

Two week wait cardiology

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60
Q

What can you use as a substitute for spironolactone

A

Eplerenone

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61
Q

Side effects of ACE- I

A

cough due to bradykinin, postural hypotension and angioedema which can look like anaphylaxis

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62
Q

Drug if patient in AF with HF

A

Digoxin

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63
Q

Blood cultures or antibiotics first if septic?

A

Blood cultures if you can still give antibiotics within an hour

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64
Q

What type of organisms normally cause UTIs and Pylionephritis

A

Gram negative rods e.g e. coli

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65
Q

How to protect kidneys if giving contrast

A

Give fluids

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66
Q

ALL triad

A

Bruised, tired and pale

67
Q

Most common paediatric tumour

A

osteocytoma

68
Q

Common SOL if someone had childhood radiotherapy

A

meningioma

69
Q

Posterior rib fracture in kids

A

non accidental injury

70
Q

Kid with lots of burns that look like NAI

A

Staph A blisters

71
Q

most common cause of macropituitaryism

A

prolactinoma

72
Q

mechanism of hyperpigmintation in addisons

A

ACTH binds to melanocortin 1 receptor

73
Q

White sputum often means

A

COPD

74
Q

Gout histological findings

A

negatively birefringent needle shaped crystals

75
Q

Drug that causes gout

A

Bendroflumethiazide

76
Q

Multiple Myeloma urinary protein

A

bence jones

77
Q

Leads that change in a right sided MI

A

II, III, AVF

78
Q

What artery normally supplies both the SA and AV node?

A

right coronary artery

79
Q

Acute pancreatitis Blood test

A

amylase

80
Q

Chronic pancreatitis test

A

stool elastase

81
Q

Thyroid problem that causes a raised calcitonin?

A

Medullary thyroid cancer - can be part of MEN 2

82
Q

Charcot’s triad

A

RUQ pain, jaundice, fever

83
Q

What does anti cardiolipin indicate?

A

Antiphospholipid

84
Q

Most sensitive marker for lupus

A

ANA - 90%, double stranded DNA more spesific but only in 60%

85
Q

Industrial cause of transitional cell carcinoma of the bladder

A

Alanine dyes

86
Q

Risk factors for squarmous cell carcinoma of the bladder

A

smoking and schistosomiasis

87
Q

TB staining

A

Acid Fast

88
Q

pneumonia urinary tests

A

pneumococcal and legionella

89
Q

serum ceoliac test

A

Anti TTG

90
Q

what happens to lipids in nephrotic syndrome

A

Hyperlipidaemia

91
Q

Coffee bean sign

A

Sigmoid Volvulus

92
Q

Meningitis and rash

A

meningicoccal septicaemia

93
Q

Hyperkalaemia ECG changes

A

Tall T, Broad QRS, flat P

94
Q

what part of brain circulation are the legs supplied from?

A

anterior circulation

95
Q

Treatment for status epilepticus

A

lorazapam

96
Q

TB treatment algorithm

A

2 weeks of RIPE, four weeks of RI

97
Q

Middle aged woman who wears a head scarf and breaks her hip

A

Vit D deficiency

98
Q

Pin point pupils overdose

A

opioids

99
Q

Young girl, wide QRS, long QT overdose

A

Tricyclics, give bicarbonates

100
Q

Benzo overdose signs and treatment

A

Flumazenil, but only if very bad as lover the siuzuire threshold

101
Q

Heparin overdose treatment

A

Protamine sulphate

102
Q

Beta blocker overdose treatment

A

Atropine if brady, glucagon if resistant

103
Q

Wrist drop after a bender

A

radial nerve palsy

104
Q

Treatment for oesophageal candida

A

fluconazole

105
Q

AIDs diarrhoea

A

cryptosporidium

106
Q

HIV penumonia

A

P Jiroveci, give co trimoxazole

107
Q

HIV and rash

A

Kaposi’s sarcoma

108
Q

HIV focal neurological lesions

A

Toxoplasmosis

109
Q

Meningitis in HIV

A

Cryptococcus

110
Q

HIV eye disease

A

CMP retinitis

111
Q

GORD associated cancer

A

adenocarcinoma of the oesophagus

112
Q

Smoking and oesophagus cancer

A

squamous cell carcinoma

113
Q

treatment for PE but anticoagulation contraindicated

A

IVC filter

114
Q

gold standard investigation for achalasia

A

Manometry

115
Q

Two muscles that a pharangeal pouch is made in

A

between thyopharyngeus and cricopharangeus

116
Q

Systemic sclerosis symptoms and treatment

A

Raynaud’s and scleroderma, in CREST Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia. Associated with anti centromere antibodies

117
Q

diffuse cutaneous systemic sclerosis test

A

scl-70 antibodies

118
Q

GI cause of high urea

A

Upper GI bleed

119
Q

Peptic ulcer sign and treatment

A

Pain on eating, H pylori, triple therapy for PPI two months, amox and clarithro

120
Q

Multiple gastric ulcers and no H Pylori

A

Zollinger Elison syndrome

121
Q

Calcified pancreas

A

Chronic pancreatitis

122
Q

IBD with granuloma

A

Always crohns

123
Q

Albumin in IBD

A

Low as chronic inflamation

124
Q

Crohns treatment

A

Azathioprin

125
Q

Side effect of TNF-alpha inhibitors

A

reactivation of TB. Example: infliximab

126
Q

Gold standard investiagtion of ceoliac

A

Jejunal biopsy - can get dermatitis hepetiformis and deranged LFTs

127
Q

HNPCC inheritance

A

autosomal dominant

128
Q

What can you give for IBS pain

A

mebeverine

129
Q

Complication of compylobacter jejuni

A

Guillan barrie

130
Q

If Salmonella, diiarrhoea and rose rash

A

typhoid fever

131
Q

Acute liver injury and blood

A

in acute liver injury clotting will be off

132
Q

If AST:ALT is greater than 2

A

Alcohol

133
Q

NASH and LFTs

A

ALT higher than AST

134
Q

Paget’s and LFTs

A

rise in ALP

135
Q

Thyroid cancer that secretes calcitonin

A

Medullary tumour, cancer of parafolicular C cells, secretes calcitonin as part of MEN 2

136
Q

Thyroid cancer associated with hashimotos

A

lymphoma

137
Q

Most common thyroid cancer

A

papilliary

138
Q

commonest type of ovarian cyst

A

follicular cyst - gets smaller after several mestrual cycles

139
Q

Yoke sac tumours secrete

A

AFP

140
Q

High AFP in pregnancy

A

nural tube defect

141
Q

Low AFP in pregnancy

A

Trisomy 21

142
Q

Ovarian tumour that secretes hCG

A

choriocarcinoma - often malignant

143
Q

Time window for stroke thrombolysis

A

4.5 hours, if over 300mg aspirin

144
Q

Valoprate and enzymes

A

Enzyme inhibitor - think of trading inhibitions

145
Q

Migraine treatment and migraine prophylaxis

A

Treatment Triptan (T), Prophylaxis Propanolol or topiramate

146
Q

Suspected or known lung cancer from CXR

A

contrast enhanced CT before biposy

147
Q

Hyperaldosteronism blood gas

A

metabolic alkalosis

148
Q

When is pioglitazone contraindicated?

A

Bladder cancer and high weight

149
Q

What drugs to avoid in CKD

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

150
Q

When should warfarin be stopped before surgery?

A

5 days before, INR below 1.5

151
Q

Inferior MI and aortic regurg

A

Proximal aortic dissection

152
Q

Downsloping ST depression

A

digoxin toxicity

153
Q

Deep T wave inversion or biphasic T waves in V2-V3

A

ritical stenosis of the left anterior descending artery

154
Q

Prophylaxis of cluster headaches

A

Verapamil

155
Q

Prophylaxis of migranes

A

propanolol

156
Q

Condition associated with temporal arteritis

A

polymyalgia rheumatica,

157
Q

Side effects of bisphosphonates

A

oesophagus problems

158
Q

NOAC that can be used to prevent ischemic stroke in AF

A

Dabigatran

159
Q

unprovoked DVT wafarin treatment time

A

6 months

160
Q

Hypercalcaemia, renal failure, high total protein =

A

myeloma

161
Q

Hereditary spherocytosis aplastic cause

A

precipitated by parvovirus infection

162
Q

What is Cryoprecipitate

A

Factor VIII, fibrinogen, vWF and factor XIII

163
Q

Myloma CRAB:

A

high Calcium, Renal impairment, Anaemia and Bone pain

year 3 (26 decks)

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