Pass med questions Flashcards
Common side effects of amlodipine?
Headache and oedema
Who should you not use HRT in?
Established heart disease
First line med management for angina?
Usually beta blocker
Angina not controlled on beta blocker what can you add?
Calcium channel blocker
When to consider nitrate in angina?
If mono therapy does not control and other option contraindicated or if cab and bb used and has symptoms but is waiting for revacularisation.
p450 inducers?
Phenytoin, carbamazepine , rifamp, st johns alcohol phenobarbitone griseofulvin
CRAP GPS
Holmes adie pupil?
Unilateral sluggish often absent ankle reflexes
Causes of hypoglycaemia? (EXPLAIN)
E- exogenous drugs P- pituitary insufficiency L- liver failure A- Addison’s I-islet cell tumours N- non pancreatic neoplasms
Rapid correction of hyponatraemia?
Osmotic demyelination
What is osmium second?
ASD most common 70% ECG RBBB and RAD
Diabetic nephropathy investigation?
Albumin:creatinine ratio early morning sample. high ratio bad
SGLT2 inhibitor may cause what infection?
Thrush
Persistent ST elevation after MI suggestive of?
Left ventricle aneurysm
Acute management of renal colic meds?
IM Diclofenac
Brown sequared syndrome symptoms?
Paralysis and proprio loss one side pain and temp loss another. Hemisection on side of paralysis
Recent ERCP presents with pain?
Pancreatitis
Abdo pain and distension, vomiting recent cholecystitis?
Gallstone Ileus
Churg Strauss (eosinophilic polyangitis) related to which autoantibody?
pANCA
Pioglitazone contraindicated in patients with what?
HF and also bladder cancer
morning stiffens in proximal limb muscles, polyarthralgia, lethargy, low grad
fever, night sweats and? Blood results?
CK normal ESR >40 PMR diagnosis
cloudy low glucose, high protein polymorphs in CSF?
Bacterial
Viral CSF?
Clear or cloudy, 60-80% glucose plasma
normal or raised protein, lymphocytes
TB CSF?
Cloudy fibrin, Low glucose, high protein, lymphocytes
Lambert eaton syndrome? Which cancer?
Weakness in proximal arms and legs-worse often neoplastic problems precipitated
Small cell
Muscle weakness increased strength after use?
Lambert eaton
Muscle fatigue in myasthenia gravis?
Muscle tires after use becomes weaker.
Fatty stool and unwell?
Giardia
Metformin may treat which female condition?
PCOS
Aortic stenosis SAD?
Syncope, angina, exertion
Narrow pulse pressure, absent s2 ?
Aortic stenosis
Parkinson’s may cause which skin condition?
Seborrhoeic dermatitis
Female <30 non tender fully mobile breast lump?
Fibroadenoma
Elevated JVP but persistent hypotension despite fluids?
Cardiac tamponade
Post menopausal women oestrogen positive cancer use what?
Anastrozole
Haemochromatosis bloods?
Raised transferrin, and ferritin with low iron binding capacity
Male bronze, impotent?
Haemochromatosis
Aplastic crisis may happen following what in what disease?
Parvo infection in sickle cell
Eosinophillic cast sign of what ?
Tubulointerstitial nephritis
Muscle tone sustained may affect vocal chords FHx?
Essential tremor
Hashimotos thyroiditis symptoms and bloods?
Painless goitre and anti thyroid peroxidase
First line treatment of HTN in diabetes?
Ace inhibitors
Hypokalaemia ecg features?
U waves, small t waves
Bloods in upper GI bleed?
low HB and rise in urea due to breakdown of blood
Phaeocromocytoma HTN treatment?
Phenoxybenzamine
Kidney transplant increased risk which cancer?
SCC
Extradural haematoma features?
Lucid interval often hit to side of head Extra-lentis (lentiform)
Treatment of idiopathic intracranial HTN?
Acetazolomide
Apical fibrosis typical in?
Anklylosing spondylitits
Schobers
<5cm
TNF alpha may activate?
TB
Venous ulceration where?
Above medial malleolus
Mydriatic drops can precipitate?
angle closure glaucoma
Diverticula found where?
Sigmoid usually
Angioedema drug induced cause?
ACEi
Mcmurrays test for what?
meniscal tear
Xray finding on RA?
Loss of joint space, soft tissue, articular osteoporosis, sparing of DIPS
Grossly elevated APTT?
Haemophillia B
Transient elastography uses?
Cirrhosis screening
Night blindness and tunnel vision progressive?
retinitis pigmentosa
True love and witts ?
UC
Diagnose and to treat BPPV?
Dix-hallpike diag
epley to treat
Exerting arm and dizziness and vertigo?
Subclavian steal
Dermatomyositis can cause what lungs which antibody?
Anti jo fibrosis
Compression of optic chasm by what can cause what?
Bitemporal upper hemianopia
AF and which endocrine problem?
Hyperthyroid
ABX for meningitis prophylaxis?
Cipro
Peripheral arterial disease which antiplatelet?
Clopidogrel
Rest pain in foot for >2 weeks or ulceration or gangrene?
Critical ischaemia
Facial rash, raised calcium and lymphadenopathy?
Sarcoid
Antidepressant that may cause retention?
Amitriptyline
Acute flare of crohns treatment?
IV Hydrocortisone for 5 days if not working consider infliximab
02 target in CO poisoning?
100%
Seizure drug causing aplastic anaemia?
Phenytoin
IVDU with back pain?
Consider psoas abscess
Most common type of hodgkins?
Nodular sclerosing
Nail fungal severe?
Terbinafine
When to give LTOT ion COPD?
pa02 <7.3 twice 3 weeks apart or <8 with functional problems polycythaemia or heart failure
urinary antigen for ?
Legionella
Pneumonia with weird signs and rashes?
Mycoplasma
Leptospirosis in who what symptoms?
farmers, vets, sewage workers. Fever flu like symptoms, renal failure, jaundice, - doxy and ben pen
Treat torsades de pointes?
Magnesium for wide polymorphic complex
First line migraine prophylaxis for asthmatic?
Topirimate
Hypothermia can cause…
pancreatitis
Lung cancer most associated with smoking?
SCC
Anti cardioliptin?
Antiphospholipid syndrome
Schistosomiasis associated with?
SCC bladder
Restless legs treatment?
Ropinirole
Tricep reflex?
C7-8
L3 L4 reflex?
Knee 3 4 kick door
Ankle reflex?
S1 S2 buckle shoe?
Gliclazide side effects?
Hypoglycaemia and weight gain
Long term steroid use myopathy?
Proximal
Beta blockers, adenosine and said contra in this disease?
Asthma
Psoriasis exacerbated by?
trauma, alcohol, beta blockers, lithium and ACEi
Pain relief for kidney diseased individuals?
Fentanyl good
Empyema values?
Turbid, pH<7.2 low glucose and raised LDH
Guttate psoriasis may be precipitated by?
Strep throat
Metabolic acidosis, high bicarb and abdo pain?
Mesenteric ischaemia
Malignant otitis externa organism?
Pseudomonas
Organism most likely in bronchiectasis?
Pseudomonas
VSD will cause murmur and where?
Pansystolic loudest left sternal edge
Low platelets, Prolonged bleeding, and APTT plus PT and degradation products?
DIC
When to offer carotid edarterectomy?
> 70% occlusion
Chronic alcoholism can cause which electrolyte disturbance?
Hypomagnesaemia
Stable chest pain angina first line investigation?
CT angiogram
When would you consider NIV in COPD patient?
pH 7.25-7.35 also medical management has failed for 60mins but if severe offer anyway
What should FRAX score be greater than to offer a DEXA?
10%
What improvement in post bronchodilator indicates asthma?
> 12%
Diurnal peak flow variations % difference asthma?
20%
Signs and symptoms of optic neuritis?
Unilateral decrease in visual acuity over hours or days, red desaturated, pain worse on eye movement, central scotoma
Dilated cardiomyopathy common which group of patients?
Alcoholic
Low sodium and rasied urea points to what cause of AKI?
Pre-renal
Blood tests in primary biliary cholangitis? Treatment?
↑ALP and ↑GGT use cholestyramine
SSRI use and pregnancy?
Avoid
Galactocele?
women who have recently stopped breastfeeding, build up of milk creates a cyst— no systemic
signs and painless
What leaking causes subdural haemorrhage?
Bridging veins
Extradural haematoma what has ruptured?
Middle meningeal
Severe hyperglycaemia, dehydration and renal failure and mild/absent
ketonuria?
HHS
Otitis media organism?
Haemophillus
Causes of spider naeviua (3)
Liver, Preg, COCP
Most common side for varicocele and problem if on other side?
usually left right can indicate renal tumour
What to check before starting amiodarone?
TFT and LFT
Bloods before methotrexate?
FBC U+E and LFT
Supracondylar fractures of humerus which nerve damaged? Signs?
Ulnar ring and little finger altered sensation
Mid shaft humerus damage which nerve and which sign?
Radial wrist drop
Investigation of haematuria?
Usually cystoscopy
Azathioprine bloods?
thiopurine methyltransferase deficiency
DAS 28?
RA severity
What is the anterior draw test also known as and what does it test?
Lachman tests anterior cruciate
Question mentions indian ink staining ?
Cryptococcus neoformans
Post thyroid stridor?
Remove clips
Pulmonary fibrosis signs?
Clubbing and fine end expiratory crackles
Three resp causes of clubbing?
Fibrosis, CF/Bronchiectasis, malignancy
Solitary hot nodule on thyroid?
Toxic adenoma
ABX when for otitis media?
symptoms >4 days, immunocompromised, younger than 2 with bilateral or with
perforation
Endocrine and vitiligo?
Addisons
Causes of lambert eaton mysathenic?
Small cell lung cancer
Strongest indication for thrombolysis in PE?
Hypotension
Knee arthroplasty can cause damage to what and what symptoms?
Common peroneal - dorsiflexion affected
URTI and haematuria?
Usually IgA nepohropathy
Heart failure antiemetic caution?
Cyclizine
Cypropterone acetate prescribed with goserelin why?
Prevent tumour flare as testosterone can ↑ at first
Raindrop skull xray?
Multiple myeloma
When to stop PPI before endoscopy?
2 weeks
What may CLL transform to?
Non Hodgkins
Intracapsular mobile treatment?
Total
Intracapsular not mobile?
Hemiarthro
Trochanteric fracture?
Hip screw
Subtreochanteric fracture?
Intramedullary
Acute glaucoma treatment?
carbonic anhydrsse and betablockers or pilocarpine
Weakness improving after exercise?
Lambert eaton
What can be seen on dry macular degeneration?
Drusen
Sarcoid may cause which skin change?
Erythema nodosum
Reactive arthritis symptoms?
Conjunctivitis
Nongonococcal urethritis
Asymmetric oligoarthritis
Keratoderma blennorrhagicum (less common)
Reactive arthritis usually follows what? Common in who?
HLA-B27 genotype and preceding chlamydial or GI infection.
more males
Vitiligo common in what types of disease?
Autoimmune
Fever in well patient post op (24hrs)?
Physiological usually
How to feed post oesophagectomy?
Jejunostomy
Signs of gastic volvulus?
vomiting, pain and failed attempts to pass an NG
Shortened internally rotated leg?
Posterior dislocation of hip
What do you see in acute tubular necrosis, microscope?
Muddy casts
Alternating days fever?
Malaria
Adult maintenance fluids ml/kg?
30ml
Test for addisons?
Short synacthen
Prolactinoma drug treatment?
Bromocriptine
Malignancy associated with acanthosis nigrans?
GI/ gastric
Struvite/staghorn associated with which bacteria?
Proteus
Duct ectasia discharge?
Green
Periductal mastitis in who?
Smokers indurated area
Stage IV retinopathy?
Pappiloedema
Stage III retinopathy?
Cotton woll and flame and blot
Just had influenza and get pneumonia organism?
Staph Aureus
What blood results may suggest myeloma?
Renal failure, anaemia and hypercalcaemia
pH <7.25 COPD?
Invasive vent
Rifampicin side effects?
orange fluids, hepatotoxic
TB drugs causing peripheral neuropathy?
Isoniazid
Pyrazinamide may cause ?
Gout and arthralgia
Optic neuritis TB drug?
Ethambutol
Which drugs stopped after 2 months in TB?
Ethambutol and pyrizinamide
Which drugs continued throughout TB treatment?
Rifampicin and isoniazid
HyPOnatraemic, HyPErkalaemic metabolic acidosis?
Addisons
First line investigation in addisonian crisis?
Look at blood and if K high need ECG
Grey skin drug?
Amiodarone
Open angle glaucoma treatment?
prostaglandin analogue (latanoprost) then beta blocker (timolol)
Optic fisc cupping and loss of vision?
Open angle glaucoma
Tumor lysis syndrome prophylaxis?
Allopurinol
Lymphoma and these bloods high potassium and phosphate with a low calcium ?
Tumour lysis
Haemolytic anaemia provoked by malaria prophylaxis in?
g6pd
Renal transplant and infection?
CMV
Multi system atrophy?
Parkinsonism with autonomic dysfunction often told parkinsons first
CCF drugs imnproving mortality?
Spiro, ACEi and BB
Horners syndrome eye signs
Ptosis and MIosis (Mini constricted)
Ptosis and Mydriasis?
CNIII palsy
Role of loop diuretic in heart failure?
Symptomatic only
BP target in diabetes?
End organ damage 130/80 otherwise 140/80
Burkitt lympoma on histology?
Starry night
Most common cause of hirsutism?
PCOS
Muscarinic agonist example?
Pilocarpine
Which diuretic in ascites?
Spiro
Most common lymphoma?
Diffuse large B cell
PSC which cancer?
Cholangiocarcinoma
Pityriasis rosacea follows/
Viral disease
Renal AKI cause?
Acute tubular necrosis
Genital warts which viruses/
6 and 11
Painkiller causing serotonin syndrome?
Tramadol
Amouris fugax with headache?
GCA
Mitral regurg murmur type?
Pansystolic
Long term steroid use issue?
Avascular necrosis
Complication of femoral hernia?
↑risk strangulation
ECG cor pulmonale?
R axis deviation
Aortic stenosis pulse finding?
Narrow pressure slow rising
PSA delayed how long after prostatitis?
4 weeks
INR 5-8 no bleeding?
Withhold 2 doses
ECG hypothermia?
J waves
SIADH and lung?
Paraneoplastic feature of small cell
Primary hyperparathyroidism bloods?
PTH ↑
Ca2+↑
PO4↓
Secondary hyperparathyroidism bloods?
PTH↑
Ca2+↓
PO4↑
Causes of secondary hyperparathyroidism?
CKD usually
Primary hyperparathyroidism causes?
Adenoma usually
CRAB for myeloma?
Hypercalc, renal insufficiency, anaemia, bone pain, buttock pain
IHD and migraines?
No triptans
Gout and IHD ?
Colchicine
Acoustic neuroma symptoms?
Unilateral progressive hearing loss
Hypercalcaemia ecg problem?
Short QT
What replacement can cause lack of levothyroxine absorption?
Iron
Prolonged APTT, low platelets and miscarriages?
Antiphospholipid
Worst melanoma?
Nodular
LAck of dorsiflexion and foot eversion?
Common peroneal
Strongest risk for bells palsy?
Pregnancy
Old man bone pain and raised ALP normal calcium?
Pagets
Anti centromere elevated?
Limited scleroderma
What back pain is red flag?
Thoracic
Autosomal dominant cause of deafness affecting young adults?
Otosclerosis
Falsely high Hba1c?
Splenectomy
Trigger of liver decompensation?
Constipation
Prophylaxis of SBP?
Cipro
Diabetic patient and operating list?
Put first
Classify rapidly enlarging AAA and when to repair at any time?
> 1.2cm repair at >5.5 unless symptoms
↓Na after TURP?
TURP syndrome
SAH can cause which fluid disturbance?
SIADH
When to shower after operation?
Usually 48hrs
Post h.pylori test?
Urea breath test
Which diabetic drugs stopped in MI?
Metformin due to lactic acidosis (start sliding scale)
Sings of acute angle closure glaucoma?
Red sclera, dilated pupil hazy cornea
Antiemetic in parkinsons?
Domperidone
Upper lobe cavitating which organism?
Klebsiella
Wernickes triad?
Confusion, ataxia and nystagmus
Modifiable factor for thyroid eye disease?
Smoking
Idiopathic pulmonary fibrosis which investigation?
High res CT
Posterior dislocation of hipo which nerve?
Sciatic
Acromegaly associated with?
Cardiomyopathy
Coughing up what in klebsiella?
Red currant jelly
Metformin guidelines egfr?
<30 stop 30-45 caution and do not start only keep if already on
Schobers test
<5cm
Bone protection in long term steroids?
immediately bisphos and vitD and calc
Steroids safe in breast feeding?
Yes
Classification for NOF?
Garden
Describe lichen planus?
itchy papular rash most commonly on palms, soles and flexor surfaces (polygonal flat topped
papular lesions
1st line anti HTN diabetic?
ACEi
Which ABX idiopathic intracranial HTN?
Tetracyclines
True vs pseudo seizure test?
Prolactin
Most common lung cancer non smoker?
Adeno
Pigmented gallstones?
Sickle cell
Being a smoker classifies as what ASA?
II
Anal fistula imaging?
MRI
BP target clinic <80 years?
140/90
Lead or drainpipe colon?
UC
Synthetic function of liver deranged?
PT time and albumin
How long after EBV to resume contact sports?
8 weeks
Antiplatelets in stroke?
300mg first 14 days then clopidogrel 75mg therafter
Cervical myelopathy gold standard?
MRI
Weakly positive bifringent rhomboid crystals?
Pseudogout
Negatively bifringent needles?
Gout
Symptoms implying negative prognosis in lymphoma?
B symptoms
Increased goblet cells?
Crohns
MS brain MRI?
Areas of demyelination
Anti CCP?
RA
Ra can cause which nerve problem?
Carpal tunnel
> 90% of ↑Ca2+ is?
HPT or malignancy
Causative organism lyme disease?
Borrelia burgdorferi
Central retinal artery occlusion symptoms?
Red spot pale opaque retina
Gastroenteritis >3 weeks?
Giardia?
Hypokalaemia can lead to ?
Long QT and U waves
ABX for animla and human bites/
Co-amox
Suspect phaeochromocytoma?
24hr metanephrines
Roughened patches over lumbar spine?
Tuberous sclerosis
High risk wound eg: soil in what to do?
Give tetanus immunoglobulin regardless of immunisation status
Parallel line shadows Xray?
Bronchiectasis
Subclinical hypothyroidism bloods?
High TSH normal T4
Scleroderma antibody?
Anti centromere
Hep A treatment?
Supportive no ↑risk of liver cancer
Hairy black tongue?
Tetracyclines
PSC associated with?
UC
Immunocompromised patients pneumonia other than PCP?
Aspergillosis CXR shows small round mass soft tissue like but with air level
When to start allopurinol?
2-3 weeks after acute attack
Occult hip fracture imaging gold standard ?
MRI
Where is lesion for autonomic dysreflexia?
Above T6
Superficial thrombophlebitis treatment?
Naproxen
Anticoagulation with mechanical heart valve?
Warfarin
