Passmed Flashcards
1
Q
If a patient with AF has a stroke or TIA, the anticoagulant of choice should be?
A
Warfarin or a direct thrombin or factor Xa inhibitor
2
Q
What can cause gingival hyperplasia?
A
Phenytoin, ciclosporin, calcium channel blockers and AML
3
Q
Hypokalaemia on an ECG?
A
Prolonged PR interval, inverted T waves, and prominent U waves
4
Q
What may be seen on the full blood count as a long-term result of COPD?
A
Polycythaemia; inc. conc of haematocrit
5
Q
Holmes ADIe pupil
A
DIlated pupil, females, absent leg reflexes
6
Q
What is the purpose of studies where they focus on testing patients with the condition for which the drug is intended to treat?
A
The purpose of phase 2 studies is to assess the efficacy of drugs or devices
7
Q
What is the most appropriate initial investigation to confirm a diagnosis of ankylosing spondylitis?
A
Plain radiography of pelvis: sacro-ilitis
8
Q
What’s first-line for knee osteoarthritis?
A
Topical NSAIDs e.g. diclofenac
9
Q
If renin is high then is it primary or secondary aldosteronism?
A
Secondary e.g. renal artery stenosis
10
Q
A blood film shows crescent-shaped red blood cells and schistocytes.
A
Sickle cell
11
Q
Bg of sickle cell.
Acutely painful right arm
Vomiting
Can’t eat or drink.
Apyrexial.
Anaemic, normal platelets.
DDx?
A
Thrombotic crises in sickle cell can be precipitated by infection, dehydration or deoxygenation
12
Q
In X-linked recessive conditions, if there is an affected male then can he pass the condition onto a son?
A
No, but daughters may be carriers
13
Q
How to calculate likelihood ratio for a positive test result?
A
Sensitivity / (1 - specificity)
14
Q
Pt has first VTE and diagnosed with antiphospholipid syndrome. What’s the most appropriate long-term anticoagulation strategy?
A
Lifelong warfarin.
15
Q
High-risk paracetamol overdose because of what factors?
A
Chronic alcohol, HIV, anorexia, P450 inducers
16
Q
Proteinuric CKD and no diabetes. what drug to give?
A
Dapagliflozin (SGLT2 inhibitors) even if not diabetic
17
Q
Ptosis + dilated pupil =
A
CNIII palsy
18
Q
Ptosis + constricted pupil =
A
Horner’s
19
Q
Persistent ST elevation in precordial leads after MI. Bibasal crackles, S3 and S4.
A
Left ventricular aneurysm
20
Q
Post MI - 2 days - mitral regurgitation, hypotensive, pulmonary oedema.
A
Papillary muscle rupture.
21
Q
Post MI - 24 hrs - Chest pain worse on lying flat
A
Pericarditis
22
Q
What is brugada syndrome?
A
Genetic mutation
ST elevation in some leads, inverted T waves
Documented VF episode
Sudden cardiac death in relative
Nocturnal agonal breathing
23
Q
Tear drop poikilocytes on blood film indicate:
A
Myelofibrosis
24
Q
Abdominal pain + ascites + tender hepatomegaly =?
A
Budd-Chiari syndrome
25
Renal impairment, resp symptoms, joint pain, systemic features:
ANCA associated vasculitis
26
Do we give platelet transfusion?
Bleeding + 29 platelet count
Give (under 30)
27
When to give platelet transfusion:
Not bleeding + 11 platelet count
No (under 10)
28
Ciclosporin side effects:
Everything increased - fluid, BP, K+, hairy, gums, glucose
29
What anaesthetic should be used in caution with a pneumothorax?
Nitrous oxide
30
SIADH treatment?
Fluid restriction
31
SACD presentation:
Distal sensory loss
Tingling
Absent ankle jerks
Extensor plantars
Romberg's positive
32
Widened QRS?
>100ms --> inc. risk seizures
>160ms --> inc. risk ventricular arrhythmias
33
Secondary prevention for MI?
ACEi + beta-blocker + statin + aspirin + ticagrelor
34
Animal bite abx?
Co-amoxiclav
35
Photosensitivity, macular rash, heliotrope rash, Gottron's papules, Raynaud's
Diagnosis and antibody?
Dermatomyositis is associated with the anti-Jo-1 antibody
36
Hartmann's is what
Sigmoid colectomy + formation of end colostomy
37
Which meds should be avoided in myasthenia gravis?
Beta-blockers
38
High pulmonary capillary wedge pressure means:
Backlog into the veins --> cardiac failure
39
TRALI vs ARDS
TRALI is ARDS within 6 hours of transfusion
40
A patient presents with numbness and tingling along the ulnar border of his wrist and forearm. On examination you also note weak flexion of all the digits including the thumb.
C8 radiculopathy
41
AF + QRS 130ms
AF with bundle branch block
42
Post MI - 1 week - acute heart failure, cardiac tamponade
Left ventricular free wall rupture
43
MMSE score of below 26 indicates?
Cognitive impairment --> complete blood screen
44
If G6PD deficiency, which antibiotic is contraindicated?
Ciprofloxacin
45
Highly specific test for SLE?
Anti-dsDNA
46
Management of Perthes' disease
Reassurance and follow-up
47
HIV, neuro symptoms, multiple brain lesions with ring enhancement
Toxoplasmosis
48
Rheumatoid arthritis, splenomegaly, low WCC
Felty's syndrome
49
What is a type II error?
Failure to reject the null hypothesis (that there is no difference between mindfulness and no intervention) when it is false.
50
Lithium toxicity can be precipitated by...
Dehydration
Renal failure
Diuretics
ACEi/ARBs
NSAIDs
Metronidazole
51
20M with acute swelling and tense knee joint. No other features and no signs of injury, plain X-R show no fracture.
Likely explanation?
Haemophilia A or B
52
First line for neuropathic pain?
amitriptyline, duloxetine, gabapentin or pregabalin
53
Pincer grip?
12 months
54
Corneal abrasion management?
Topical antibiotics should be given to prevent secondary bacterial infection
55
A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination
Ventricular septal defect
56
Switching from fluoxetine to another SSRI
withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low dose of the alternative SSRI
57
Stereotypical features of Legionella
flu-like symptoms and a dry cough, relative bradycardia and confusion. Blood tests may show hyponatraemia
58
Acute heart failure not responding to treatment. What should we consider?
Consider CPAP
59
ADPKD is a risk factor for SAH or bacterial meningitis?
SAH
60
What is the most common presentation of ALS?
Asymmetric limb weakness
61
First-line treatment for most patients with a pituitary tumour causing acromegaly
Trans-sphenoidal surgery
62
Increased risk of placental abruption is associated with
increasing maternal age, multiparity and maternal trauma
63
potential complication of panretinal photocoagulation
A decrease in night vision
64
Horner's syndrome
miosis + ptosis + enophthalmos +/- anhydrosis
65
Notching of the inferior border of the ribs indicates what condition?
Notching of the inferior border of the ribs is present in around 70% of adults with coarctation of the aorta
66
What is management of intracapsular (subcapital) and displaced hip injury?
Total hip replacement
67
What is management of extracapsular (trochanteric or subtrochanteric) hip injury?
- intertrochanteric → dynamic hip screw
- subtrochanteric → intramedullary nail
68
What is management of intracapsular (subcapital) and NOT displaced hip injury?
internal fixation (cannulated hip screw) (fit)
- hemiarthroplasty (unfit)
69
Pregnancy-induced HTN does not happen before what gestational age?
20 weeks
70
Patients with NHPCC (Lynch syndrome) are at a high risk of developing which cancers:
Inherited colon cancer (mostly proximal)
Endometrial cancer
71
Which inheritance pattern has no male-to-male transmission?
X-linked recessive or dominant
72
Which type of inheritance is not typically seen in every generation of an affected family?
Autosomal recessive
73
Which inheritance pattern causes all offspring to be carriers if one affected and one unaffected reproduce?
Autosomal recessive
74
Acute graft rejection
within months, is usually asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria
75
Monteggia fracture
A Monteggia fracture involves dislocation of the proximal radioulnar joint in association with an ulnar fracture
76
Loss of corneal reflex with vertigo, tinnitus and unilateral sensorineural hearing loss
Acoustic neuroma
77
Conductive hearing loss in the affected ear. Disturbance in balance and vertigo.
Cholesteatoma
78
Acute vertigo, prolonged in the first few days and then eases.
Viral labyrinthitis
79
Tinnitus, vertigo and sensorineural hearing loss. Relapsing and remitting vertigo.
Meniere's disease
80
Progressive, bilateral conductive hearing loss.
Otosclerosis
81
What is a normal anion gap?
10-18 mmol
82
What kind of anion gap does diarrhoea cause?
Normal anion gap (loss of bicarbs but inc. Cl- in the kidney compensates)
83
What kind of anion gap does DKA cause?
Raised anion gap (accumulation of ketotic acid)
84
What kind of anion gap does renal failure cause?
Raised anion gap (accumulation of uric acid)
85
What kind of anion gap does salicylate poisoning cause?
Raised anion gap (accumulation of salicylic acid)
86
What kind of anion gap does septic shock cause?
Raised anion gap (accumulation of lactic acid)
87
Which drugs can cause pancreatitis?
Azathioprine
Mesalazine
Didanosine
Bendroflumethiazide
Furosemide
Pentamidine
Steroids
Sodium valproate
88
Contralateral hemiparesis and sensory loss, lower extremity > upper
Anterior cerebral artery
89
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Middle cerebral artery
90
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Posterior cerebral artery
91
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Weber's syndrome (branches of the posterior cerebral artery that supply the midbrain)
92
Ipsilateral: facial pain and temperature loss, cranial nerve palsy e.g. Horner's
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
93
Symptoms are similar to Wallenberg's (see above), but:
Ipsilateral: facial paralysis and deafness
Anterior inferior cerebellar artery (lateral pontine syndrome)
94
Sudden, painless vision loss in one eye that lasts seconds to minutes, often described as a "shade" or "curtain" descending over the visual field.
Amaurosis fugax due to retinal/ophthalmic artery
95
'Locked-in' syndrome
Basilar artery
96
This condition presents with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
PMHx HTN
Lacunar stroke
97
Impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficulty reading or descending stairs)
Parkinsonism
Falls
Slurring of speech
Cognitive impairment
PSP
98
What's long-term prevention for cluster headaches?
Verapamil
99
Wet, wacky, wobbly
i.e. urinary incontinence, dementia, gait disturbance
Normal pressure hydrocephalus
100
Combo of UMN + LMN
Limb-onset or bulbar-onset
ALS
101
PLS is upper or lower?
Upper
102
PMA is upper or lower?
Lower
103
Normal power on resisted movements of shoulder and hip
Morning stiffness
Severe tiredness
Shoulder and hip muscle pain
Polymyalgia rheumatica
104
Multiple myeloma without metastasis bone profile results?
High calcium
Normal phosphate
Normal ALP
105
All invasive diarrhoeas are treated with ciprofloxacin, except __ which is treated with ___
Campylobacter treated with clarithromycin
106
Slow growing, painless, mobile lump in parotid gland of older female
Pleomorphic adenoma
107
Otitis externa in diabetics. What Mx?
Ciprofloxacin to cover Pseudomonas
108
MEN type I
3Ps
Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
Pituitary (70%)
Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
Also: adrenal and thyroid
MEN1 gene
Most common presentation = hypercalcaemia
109
MEN type IIa
Medullary thyroid cancer (70%)
2 P's
Parathyroid (60%)
Phaeochromocytoma
RET oncogene
110
MEN type IIb
Medullary thyroid cancer
1 P
Phaeochromocytoma
Marfanoid body habitus
Neuromas
111
Cutaneous features
depigmented 'ash-leaf' spots which fluoresce under UV light
roughened patches of skin over lumbar spine (Shagreen patches)
adenoma sebaceum (angiofibromas): butterfly distribution over nose
fibromata beneath nails (subungual fibromata)
cafe-au-lait spots* may be seen
Neurological features
developmental delay
epilepsy (infantile spasms or partial)
intellectual impairment
Also
retinal hamartomas: dense white areas on retina (phakomata)
rhabdomyomas of the heart
gliomatous changes can occur in the brain lesions
polycystic kidneys, renal angiomyolipomata
lymphangioleiomyomatosis: multiple lung cysts
Tuberous sclerosis
112
Cafe-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas
Neurofibromatosis I
113
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, meningiomas and ependymomas
Neurofibromatosis II
114
What investigation is most useful in investigating multiple myeloma?
Serum protein electrophoresis
115
Tetracycline side effects
Photosensitivity
Discolouration of teeth in children and during pregnancy
Hepatotoxicity
Renal impairment
116
What is an important cause of visual impairment in babies born before 32 weeks gestation?
Retinopathy of prematurity
117
Chronic insomnia diagnostic criteria
may be diagnosed after three months, if a person has trouble falling asleep or staying asleep at least three nights per week
118
AKI diagnostic criteria in adults
↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours
119
Tender, purple/red raised lesions with a pale centre. These lesions occur as a result of immune complex deposition.
Osler nodes
120
Patients typically present with hard, painless nodules at the DIP joints. These nodes can be bilateral and may lead to decreased range of motion and functional impairment over time.
Heberdens nodes
121
17M
Soft, fluctuant swelling on the dorsal aspect of the hand, it is most obvious on making a fist.
Ganglion
122
Non-functioning pituitary tumours present with...?
hypopituitarism and pressure effects
123
Marfan's syndrome is caused by a mutation in what?
Fibrillin-1
124
Types of nephrotic syndromes
Focal segmental glomerulosclerosis
Minimal change disease
Membranous nephropathy
Diabetic nephropathy
125
Major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage)
Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*
126
INR > 8.0
Minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0
127
INR > 8.0
No bleeding
Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0
128
INR 5.0-8.0
Minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0
129
INR 5.0-8.0
No bleeding
Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose
130
Posterior Mi presents with what on ECG
Tall R waves V1-V2
131
Types of nephritic syndrome?
IgA nephropathy
Membranoproliferative glomerulonephritis
Rapidly progressive glomerulonephritis
132
Transudative causes of pleural effusions?
Transudate (< 30g/L protein)
heart failure (most common transudate cause)
hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption
hypothyroidism
Meigs' syndrome
133
Exudative causes of pleural effusions?
Exudate (> 30g/L protein)
infection
pneumonia (most common exudate cause),
tuberculosis
subphrenic abscess
connective tissue disease
rheumatoid arthritis
systemic lupus erythematosus
neoplasia
lung cancer
mesothelioma
metastases
pancreatitis
pulmonary embolism
Dressler's syndrome
yellow nail syndrome
134
Acute pancreatitis can cause what kind of mineral imbalance?
Hypocalcaemia
135
Which two drugs together may cause bone marrow suppression and severe or fatal pancytopaenia?
Methotrexate and trimethoprim
136
CN I
Olfactory
137
CN II
Optic
138
CN III
Oculomotor
139
CN IV
Trochlear
140
CN V
Trigeminal
141
CN VI
Abducens
142
CN VII
Facial
143
CN VIII
Vestibulocochlear
144
CN IX
Glossopharyngeal
145
CN X
Vagus
146
CN XI
Accessory
147
CN XII
Hypoglossal
148
Function of CN I
Smell
149
Function of CN II
Vision
150
Function of CN III
Eye movement and blinking
151
Function of CN IV
Superior oblique muscle -->
Up and down and back and forth eye movements
152
Function of CN V
Facial sensations, muscles of mastication
153
Function of CN VI
Lateral rectus muscle -->
Eye movements
154
Function of CN VII
Expression and sense of taste
155
Function of CN VIII
Hearing and balance
156
Function of CN IX
Taste and swallowing
157
Function of CN X
Heart rate and digestion
158
Function of CN XI
Neck and shoulder movement
159
Function of CN XII
Tongue movement
160
First line for primary biliary cholangitis?
Ursodeoxycholic acid
160
Management of bilateral adrenocortical hyperplasia
Primary hyperaldosteronism: Spironolactone
161
All patients with PAD should take what?
Clopidogrel and atorvastatin
162
Rheumatoid arthritis x-ray changes
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation
163
Heberden's nodes and Bouchard's nodes for what?
Osteoarthritis
164
First-line management in patients with hypercalcaemia
IV fluid
165
If known COPD pt has a normal CO2 on ABG, what's their target O2 sat?
90-94%
166
Paracetamol poisoning Mx?
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation
167
Salicylate poisoning Mx?
Urinary alkalinization with IV bicarbonate
haemodialysis
168
Opioid/opiates poisoning Mx?
Naloxone
169
Benzodiazepine poisoning Mx?
Flumazenil
The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil. It is generally only used with severe or iatrogenic overdoses.
170
Tricyclic antidepressants overdose Mx?
IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity
arrhythmias: class 1a (e.g. Quinidine) and class Ic antiarrhythmics (e.g. Flecainide) are contraindicated as they prolong depolarisation. Class III drugs such as amiodarone should also be avoided as they prolong the QT interval. Response to lignocaine is variable and it should be emphasized that correction of acidosis is the first line in management of tricyclic induced arrhythmias
dialysis is ineffective in removing tricyclics
171
Lithium poisoning Mx?
mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion
172
Warfarin poisoning Mx?
Vitamin K, prothrombin complex
173
Heparin poisoning Mx?
Protamine sulphate
174
Beta-blockers overdose Mx?
if bradycardic then atropine
in resistant cases glucagon may be used
175
Ethylene glycol overdose Mx?
Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol
haemodialysis also has a role in refractory cases
176
Methanol poisoning Mx?
fomepizole or ethanol
haemodialysis
177
Organophosphate insecticides poisoning Mx?
atropine
the role of pralidoxime is still unclear - meta-analyses to date have failed to show any clear benefit
178
Digoxin poisoning Mx?
Digoxin-specific antibody fragments
179
Iron overdose Mx?
Desferrioxamine
180
Lead poisoning Mx?
Dimercaprol, calcium edetate
181
Carbon monoxide poisoning Mx?
Management
100% oxygen
hyperbaric oxygen
182
Cyanide poisoning Mx?
Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate
183
Scarlet fever school exclusion?
24 hours after starting Abx
184
Whooping cough school exclusion?
2 days after starting Abx
or 21 days after Sx onset if no Abx
185
Measles school exclusion?
4 days after rash
186
Rubella school exclusion?
5 days after rash
187
Chickenpox school exclusion?
Until lesions crusted over
188
Mumps school exclusion?
5 days from onset of swollen glands
189
D+V school exclusion?
Until settled for 48hrs
190
Impetigo school exclusion?
Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment
191
Scabies school exclusion?
Until treated
192
Influenza school exclusion?
Until recovered
193
Which drugs are contraindicated in aortic stenosis?
Nitrates
194
Abdominal pain, diarrhoea and flushing triad is?
Carcinoid syndrome
195
Likelihood ratio of a positive test result
Sensitivity/(1-Specificity)
196
Likelihood ratio of a negative test result
(1-Sensitivity)/Specificity
197
Over-replacement with thyroxine causes what
Osteoporosis
198
* Raynaud's may be the first sign
* Scleroderma affects face and distal limbs predominately
* Associated with anti-centromere antibodies
* A subtype of it is CREST syndrome.
* Anti-centromere antibodies
Limited cutaneous systemic sclerosis
199
Scleroderma affects trunk and proximal limbs predominately
associated with anti scl-70 antibodies
the most common cause of death is now respiratory involvement, which is seen in around 80%: interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH)
other complications include renal disease and hypertension
patients with renal disease should be started on an ACE inhibitor - captopril is typically used due to its rapid onset and short half-life, allowing for dose titration
ACE inhibitors target the underlying mechanism by reducing efferent arteriolar vasoconstriction and limiting renin-angiotensin system activation
poor prognosis
Anti-Scl-70 antibodies
Diffuse cutaneous systemic sclerosis
200
tightening and fibrosis of skin
may be manifest as plaques (morphoea) or linear
Scleroderma without organ involvement
201
CREST syndrome stands for...
Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
202
After an initial negative result when testing for HIV in an asymptomatic patient, offer a repeat test at...
12 weeks
203
AML is characterised by...?
Neutropaenia and thrombocytopaenia
204
Guttate psoriasis Mx?
Reassurance + topical treatment if lesions are symptomatic
205
* asthma
* blood eosinophilia (e.g. > 10%)
* paranasal sinusitis
* mononeuritis multiplex
* renal involvement occurs in around 20%
* pANCA positive in 60%
Eosinophilic granulomatosis with polyangiitis
206
What is the most common cause of traveller's diarrhoea? (non-bloody)
E. coli
207
If you are waiting for a phaeochromocytoma surgery, what medical management do you give first?
Phenoxybenzamine
208
What's the RRR equation?
(Treatment rate - Control rate) / Control rate
209
Pain at rest in leg for greater than 2 weeks, often at night, not helped by analgesia
Critical limb ischaemia
210
Premenstrual syndrome Mx?
Drospirenone-containing COC taken continuously
211
RBC transfusion threshold for patients with ACS is what
80
212
Which meds can cause SJS?
*** Carbamezapine
* Lamotrigine
* Allopurinol
* Sulfonamide
* Phenobarbital**
* Phenytoin
* Salicylates
* Sertraline
* Imidazole antifungal agents
* Nevirapine
213
What should we give a lady with a fibroids who is waiting for surgery?
GnRH agonist e.g. Goserelin
214
If UTI + catheter, no symptoms, what Mx?
NOTHING; DON'T DO ANYTHING.
215
Which cranial nerves are affected in vestibular schwannomas?
V, VII, VIII
216
PID + RUQ pain =
Fitz-Hugh-Curtis Syndrome
217
Type I SH fracture
Fracture through physis (x-r may be normal)
Transverse
218
Type II SH Fracture
Physis and metaphysis
---/
219
Type III SH Fracture
Physis, epiphysis, include joint
|---
220
Type IV SH Fracture
Physis, metaphysis, epiphysis
|
221
Initial Mx for Graves' disease?
Propanolol
222
Rovsings sign in...
Appendicitis
223
Boas sign in...
Cholecystitis
224
Murphy's sign in...
Cholecystitis
225
Cullens sign in...
Pancreatitis
226
Grey-Turners sign in...
Pancreatitis
227
Cardiac tamponade triad
Elevated JVP, hypotension, muffled heart sounds
228
CT within an hour indications?
* GCS <13 now
* <15 after
* Vomiting > 1
* Skull fracture
* Seizures
229
CT within 8 hours
* >= 65
* Anticoagulants
* Dangerous mechanism of injury
230
Tell me pneumothorax guidelines
--
231
What do you not give in a variceal bleed?
PPIs
232
In patients with nephrotic syndrome, you give prednisolone and furosemide. What next?
Prophylactic LMWH e.g. enoxaparin due to inc. risk of VTE
233
What are the contraindications for suxamethonium?
* Penetrating eye injuries
* Acute glaucoma
Because it inc. IOP
234
Pt has features of asthma along with eosinophilia, raised serum IgE and fungal hyphae on sputum examination
allergic bronchopulmonary aspergillosis
235
if 2-level PE Wells score is ≤ 4 and D-dimer is negative then
Stop anticoagulation and consider alternative diagnosis
236
Growth hormone deficiency causes...?
Obesity in children
237
239
Severe hepatitis in a pregnant lady means most likely...
Hepatitis E
240
Red flag symptoms for gastric cancer
* new-onset dyspepsia in a patient aged >55 years
* unexplained persistent vomiting
* unexplained weight-loss
* progressively worsening dysphagia/
* odynophagia
* epigastric pain
241
Causes of lower zone fibrosis?
* R - RA
* A - Asbestosis
* S - SLE, Scleroderma, Sjogren's
* I - IPF
* D - Drugs (Amiodarone, Methotrexate, Bleomycin)
242
What do we do after giving abx and discharging case of pneumonia?
All cases of pneumonia should have a repeat chest X-ray at 6 weeks after clinical resolution
243
Bacterial meningitis Mx
IV ceftriaxone + amoxicillin
244
How do we prevent vasospasm in aneurysmal subarachnoid haemorrhages?
Nimodipine
245
Most sensitive test for TB?
Sputum culture
246
Likelihood ratio for a negative test result equation?
(1-Sensitivity)/Specificity
247
What is a fungal nail infection also known as?
onychomycosis
248
What is the main organism responsible for dermatophyte infections in onychomycosis?
Trichophyton rubrum
249
Name an example of a yeast that can cause onychomycosis.
Candida
250
List some risk factors for developing fungal nail infections.
* Increasing age
* Diabetes mellitus
* Psoriasis
* Repeated nail trauma
251
List some differential diagnoses for onychomycosis.
* Psoriasis
* Repeated trauma
* Lichen planus
* Yellow nail syndrome
252
What investigations are recommended if antifungal treatment is being considered?
Nail clippings +/- scrapings of the affected nail, microscopy and culture
253
What is the recommended treatment for limited involvement of dermatophyte infection?
Topical treatment with amorolfine 5% nail lacquer for 6 months for fingernails or 9-12 months for toenails
254
What is the first-line oral treatment for extensive dermatophyte infections?
Oral terbinafine
255
How long is the therapy needed for fingernail infections with terbinafine?
6 weeks - 3 months
256
How long should toenail infections be treated with terbinafine?
3 - 6 months
257
What is the first-line oral treatment for extensive Candida infections?
Oral itraconazole
258
What type of therapy is recommended for Candida infections?
'Pulsed' weekly therapy
259
What is one of the key risk factors for ischaemic stroke?
Atrial fibrillation
## Footnote
Atrial fibrillation significantly increases the risk of stroke.
260
Why is it important to recognize and treat atrial fibrillation after a stroke or TIA?
To reduce the risk of further strokes
## Footnote
Proper management of atrial fibrillation can prevent subsequent ischaemic events.
261
What must be excluded before starting anticoagulation or antiplatelet therapy after a stroke or TIA?
Haemorrhage
## Footnote
Imaging is necessary to ensure there is no bleeding in the brain.
262
What medication does NICE recommend for long-term stroke prevention in patients with atrial fibrillation?
Warfarin or a direct thrombin or factor Xa inhibitor
## Footnote
These medications help prevent clot formation.
263
When should anticoagulation for atrial fibrillation start following a TIA?
Immediately after excluding haemorrhage
## Footnote
Rapid initiation is crucial for effective stroke prevention.
264
When should anticoagulation therapy be commenced in acute stroke patients in the absence of haemorrhage?
After 2 weeks
## Footnote
Antiplatelet therapy is recommended during the intervening period.
265
What should be given to acute stroke patients in the intervening period before starting anticoagulation?
Antiplatelet therapy
## Footnote
This helps manage stroke risk while waiting to start anticoagulation.
266
What should be done if imaging shows a very large cerebral infarction?
Delay the initiation of anticoagulation
## Footnote
This is to ensure patient safety and avoid complications.
267
What is selection bias?
Error in assigning individuals to groups leading to differences which may influence the outcome
## Footnote
Includes subtypes such as sampling bias and volunteer bias.
268
What is sampling bias?
When the subjects are not representative of the population
## Footnote
Often due to volunteer bias.
269
What is volunteer bias?
When individuals who are at risk of a condition may be more or less likely to participate in a study
## Footnote
Example: prevalence of Chlamydia in the student population.
270
What is non-responder bias?
When surveyed individuals who do not respond may have different characteristics than those who do
## Footnote
Example: poorer diets in non-responders to dietary surveys.
271
What is loss to follow-up bias?
Bias arising when participants drop out of a study, potentially skewing results.
272
What is prevalence/incidence bias (Neyman bias)?
Occurs when a study omits cases characterized by early fatalities or silent cases
## Footnote
Results in missed cases being excluded from calculations.
273
What is admission bias (Berkson's bias)?
When cases and controls in a hospital study are systematically different due to exposure and disease occurrence
## Footnote
Increases likelihood of hospital admission.
274
What is healthy worker effect?
Bias that occurs when working populations are healthier than the general population.
275
What is recall bias?
Difference in accuracy of recollections by participants, influenced by their health status
## Footnote
Example: lung cancer patients recalling asbestos exposure.
276
What is publication bias?
Failure to publish results from valid studies, often due to negative or uninteresting outcomes
## Footnote
Important in meta-analyses.
277
What is work-up bias (verification bias)?
Occurs when clinicians are reluctant to order gold standard tests unless new tests are positive
## Footnote
Can distort study results and alter specificity and sensitivity.
278
What is expectation bias (Pygmalion effect)?
A problem in non-blinded trials where observers may subconsciously favor expected outcomes.
279
What is the Hawthorne effect?
Describes a group changing its behavior due to the knowledge that it is being studied.
280
What is late-look bias?
Occurs when information is gathered at an inappropriate time, such as studying a fatal disease long after some patients have died.
281
What is procedure bias?
Occurs when subjects in different groups receive different treatments.
282
What is lead-time bias?
Occurs when a new test diagnoses a disease earlier without affecting the disease outcome.
283
Where are inguinal hernias located?
Above and medial to pubic tubercle
284
Is strangulation common in inguinal hernias?
Rare
285
Where are femoral hernias located?
Below and lateral to the pubic tubercle
286
In which population are femoral hernias more common?
Women, particularly multiparous ones
287
What is the risk associated with femoral hernias?
High risk of obstruction and strangulation
288
What characterises an umbilical hernia?
Symmetrical bulge under the umbilicus
289
What characterises a paraumbilical hernia?
Asymmetrical bulge - half the sac is covered by skin of the abdomen directly above or below the umbilicus
290
Where is an epigastric hernia located?
In the midline between umbilicus and the xiphisternum
291
What is another name for a Spigelian hernia?
Lateral ventral hernia
292
In which population is Spigelian hernia most commonly seen?
Older patients
293
What is the anatomical feature involved in a Spigelian hernia?
Spigelian fascia
294
What characterizes an obturator hernia?
Passes through the obturator foramen
295
In which population is an obturator hernia more common?
Females
296
What is a Richter hernia?
A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect
297
Can Richter's hernia present with strangulation without symptoms of obstruction?
True
298
What is a congenital inguinal hernia?
Indirect hernias resulting from a patent processus vaginalis
299
When should congenital inguinal hernias be surgically repaired?
Soon after diagnosis as at risk of incarceration
300
What characterizes an infantile umbilical hernia?
Symmetrical bulge under the umbilicus
301
Bone pain, tenderness and proximal myopathy (→ waddling gait)
Osteomalacia
302
Proximal muscle weakness with a classical presentation including difficulty climbing the stairs or getting up from a chair. Typically no pain.
Myositis
303
Proximal muscle stiffness and pain, >50 years
PMR
304
Strangulated vs incarcerated hernias
Strangulated = painful, can't be reduced
305
Brain abscess Mx
IV 3rd-generation cephalosporin (ceftriaxone) + metronidazole
306
Hypothermia on ECG shows up as...?
J waves
307
What do you give before beta-blockers in phaeochromocytoma removal surgery?
Phenoxybenzamine
308
What FeNo level is diagnostic for asthma in children aged 5 -16?
>=35
309
Organisms causing post splenectomy sepsis?
* Streptococcus pneumoniae
* Haemophilus influenzae
* Meningococci
310
Low platelet counts and raised FDP
DIC
311
Wernicke's encephalopathy triad?
Ophthalmoplegia, confusion, ataxia
312
Korsakoff syndrome triad?
Anterograde amnesia, retrograde amnesia, confabulation
313
Emotionally cold, lack of desire for companionship
Schizoid
314
Paranoid ideation, odd beliefs
Schizotypal
315
Cellulitis in the mouth?
Ludwig's angina
316
First degree heart block
PR interval > 0.2 seconds
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