PassMed 3 Flashcards
1
Q
Weakened dorsiflexion, inversion and eversion of the ankle indicates
A
an L5 lesion not a common peroneal nerve lesion
2
Q
Mx of Bells palsy
A
- give oral pred within 72 hrs
- eye care to prevent exposure keratopathy
- if no improvement in 3 weeks, refer to ENT
3
Q
‘empty delta sign’ seen on venography
A
saggital sinus thrombosis
4
Q
empty sella on MRI venography
A
IIH
5
Q
carotid endarterectomy is considered when
A
a patient who has had a TIA with carotid artery stenosis exceeding 50% (NASCET criteria) on the side contralateral to the symptoms
6
Q
important aspect of LT PD Mx
A
regular med reviews
7
Q
what is the most important side of ondansteron action
A
MO, 5-HT3 antagonist
8
Q
how long does a cluster headache last
A
15 m - 2 hrs
9
Q
Generalised tonic-clonic seizures in males:
A
Sodium valproate
10
Q
Localising in GCS
A
To be counted as localising, the arm must be brought above the clavicle, else it should be scored as ‘flexing’
11
Q
driving after a TIA
A
- if symptom free: can drive after a month
- no need to inform DVLA
12
Q
Dorsal column lesion
A
fine touch, proprioception, vibration sense
13
Q
common peroneal nerve palsy
A
weakness of foot dorsiflexion and foot eversion
14
Q
acromegaly visual field defect
A
bitemporal hemianopia
15
Q
Which one of the following features would suggest a diagnosis of essential tremor rather than Parkinson’s disease?
A
tremor worsened when the arms are outstretched
16
Q
Essential tremor
A
- worse when doing something (doing the activities essential to life)
- improved by alcohol and rest
17
Q
Mx of essential tremor
A
propanolol 1st
18
Q
Mx of IIH
A
- acetazolamide (CA inhibitor)
- topiramate (also causes WL)
19
Q
A man suddenly stares into space and is non-responsive. He then repeatedly smacks his lip and appears to be chewing. This lasts for around 1 minute
A
focal impaired awarness seizure
20
Q
sensory change in BP
A
loss of taste of the anterior two-thirds of the tongue (on the same side as the facial weakness) may occur
21
Q
Pinpoint pupils in a stroke point to
A
pontine haemorrhage (Pinpoint Pupils points to pons)
22
Q
facial weakness with forehead aparing ->
A
UMN lesion e.g. stroke
23
Q
facial weakness with forehead involvement
A
- LMN lesion
24
Q
which facial nerve is affected in BP
A
facial nerve contralateral to the symptoms
25
what favours multi system atrophy over PD
Parkinsonism with associated autonomic disturbance (atonic bladder, postural hypotension) points towards Multiple System Atrophy
26
CT: rim enhancing lesion with a central cavity and surrounding oedema
brain abscess
27
juvenile myoclonic epilepsy
- associated with seizures in the morning/ following sleep deprivation
28
benign rolandic epilepsy
characterised by partial seizures occurring at night, typically paraesthesias affecting the face.
29
progressive supranuclear palsy
- postural instability
- impairment of vertical gaze
- parkinsonism
- frontal lobe dysfunction
30
webers syndrome =
form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis
31
how are acoustic neuromas best visualsied
MRI of the cerebellopontine angle
32
unilateral SN deafness or tinnitus ->
acoustic neuroma
33
Wernicke's aphasia
- sentences that make no sense, word substitution and neologisms
- speech remains fluent
- word salad
- impaired comprehension
34
WE involves damage to
superior temporal gyrus
35
Brocas aphasia
- expressive
- Speech is non-fluent, laboured, and halting. Repetition is impaired
- Comprehension is normal
36
Brocas - where is the lesion
lesion in the inferior frontal gyrus
37
conduction aphasia =
- Speech is fluent but repetition is poor. Aware of the errors they are making
-Comprehension is normal
38
conduction aphasia is typically from
stroke affecting the arcuate fasiculus (connection between wernickes and brocas)
39
global aphasia =
- large lesion affected all 3 areas
- severe expressive and receptibe aphasia
40
All TIA patients should have an urgent
carotid doppler unless they are not a candidate for carotid endarterectomy
41
If a patient has had a suspected TIA, they should be given ? whilst awaiting specialist review, unless contraindicated
aspirin 300mg
42
A woman suddenly has the sensation of smelling roses whilst at work. She is conscious throughout
focal aware seizure
43
A wide-based gait with loss of heel to toe walking is called =
ataxic gait
44
1st lines for spasticity in MS
- baclofen and gabapentin
- patitnes may describe this as tightness and stiffness
45
why does ulnar nerve damage cause loss of thumb adduction
Adductor pollicis is innervated by ulnar nerve and therefore, damage to ulnar nerve results in loss of thumb adduction
46
Mx of epilepsy in males
- generalised seizure: sodium valproate
- focal seizure: lamotrigine or levetiracetam
47
Mx of generalised tonic clonic seizures in females
lamotrigine or levetiracetam
48
Mx of focal seizures
- first line: lamotrigine or levetiracetam
- second line: carbamazepine, oxcarbazepine or zonisamide
49
Mz of absence seizures first line
ethosuximide
50
Second line for absence seizures
- male: SV
- female: lamotrigene or levetiractam
51
what can make absence seizures worse
carbamazepine
52
Mx of myoclonic seizures
- males: sodium valproate
- females: levetiracetam
53
Mx of tonic or atonic seizures
- males: sodium valproate
- females: lamotrigine
54
Raised ICP Mx
Mannitol
55
Mx of brain mets -> cerebral oedema
dexameth
56
MEN-2a condiions
- medullary thyroid cancer
- hypercalcaemia
- phaechromocytoma
57
Mx of meningitiis
3 months - 60 years: ceftriaxone
58
Mx of meningitis in under 3 months or over 60
ceftriaxone + amoxicillin (or ampicillin) (to cover for listeria)
59
what should be added for meningitis following f recent prolonged/multiple antibiotic use or travel to areas with highly resistant pneumococci
IV vancomycin
60
Patients with raised ICP may exhibit Cushing's triad:
- widening pulse pressure
- bradycardia & HTN
- irregular breathing
61
Ix of choice for NHL
Excisional node biopsy
62
Monitoring of BG for T1DM
In type 1 diabetics, recommend monitoring blood glucose at least 4 times a day, including before each meal and before bed
63
CML drug Tx
imatinib = tyrosine kinase inhibitor
64
first-line in the management of patients with warm autoimmune haemolytic anaemia
steroids (+/- rituximab)
65
thyrotoxic storm Tx
- BB
- PTU
- hydrocotisone
66
prophylaxis of cluster headaches
verapamil
67
gait ataxia is caused by
cerebellar vermis lesions
68
Defective downward gaze and vertical diplopia
trochlear nerve
69
A raised pCO2 > 6.0 kPa indicates
Near fatal asthma
70
TD2M: if a triple combination of drugs has failed to reduce HbA1c then switching one of the drugs for a ? is recommended, particularly if the BMI > 35
GLP mimetic - e.g. liraglutide
71
Omeprazole electrolute abn
- hypomag
- hyponatraemia
72
common side effect of antipsychotics
parkinsonian sx
73
how is cellulitis dx
clinically - no Ix needed.
74
Contact lens wearers who present with a red painful eye should be referred to eye casualty to exclude
microbial keratitis - same day referral
75
pronosis of wet vs dry macular degeneration
wet is worse prognosis wise than dry
76
There are 6 tests to confirm brain death;
pupillary reflex, corneal reflex, oculo-vestibular reflex, cough reflex, absent response to supraorbital pressure, and no spontaneous respiratory effort
77
MDMA (Ecstasy) poisoning is associated with
hyponatraemia
78
Low serum calcium, low serum phosphate, raised ALP and raised PTH -
osteomalacia
79
? is classically impaired in adhesive capsulitis
external rotation (active an passive) - hence why patients struggle to do up their bra
80
which type of visual field loss is seen with macular degeneration
central
81
visual field loss with primary open angle glaucoma
peripheral
82
what feature of an AAA means it needs to be urgently repaired
symptomatic or size > 5.5cm or growing more than 1cm/ year
83
iron profile in haemachromatosis
Raised transferrin saturation and ferritin, with low TIBC
84
First line for diarrhoea in IBS
- Lperamide
85
pain, cramping and bloating Mx in IBS
antispasmodic agents (e.g. mebeverine)
86
Oslers nodes =
painful red lesions on hands and feet (assoc w endocarditis)
87
Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes → ?
silicosis
88
The majority of patients with suspected shingles should be treated with antivirals within ? onset
72 hours of
89
Mx of chlamydia
- doxy 7 day course
- if pregnant: azithromycin, erythromycin or amoxicillin
90
Painless genital ulcer
syphilis, caused by treponema pallidum
91
first line in GAD
sertaline
92
confusion in asthma classifies it as
life threatening
93
what can be used to determine whether an episode was anaphlyaxis
serum tryptase
94
centrally depressed lesion with a rolled edge
BCC
95
Anaemia in CKD:
START IRON BEFORE EPO
96
typical x-ray features in psoriatic arthritis
plantar spur and pencil in cup
97
diabetic foods
not recommended by NICE. eat normally and focus on overall carbs
98
inheritance of mitochondrial disease
no children will inherit it from a man. All children of a woman will
99
Legionella pneumophilia is best diagnosed by
urinary antigen test
100
Mx of BV in pregnancy
metronidazole - same as non pregnant
101
T2DM with abnormal LFTs - ?
NAFLD
102
MAO of pyridostigmine
long-acting acetylcholinesterase inhibitor
103
asthma - cant complete sentences
severe
104
Tx of choice for biliary colic
elective lap chole
105
syphilis mneumonic
- primary penis: painless chancre
- secondary syphilis: systemic features
106
stepping down asthma mx
aim for a reduction of 25-50% in the dose of inhaled corticosteroids
107
anterior packing
is the most suitable management option for epistaxis where the bleed site is difficult to localise
108
dresslers syndrome =
pericarditis 4 weeks after MI
109
Which arrest rhythm is seen with tension pneumothorax
PEA
110
VSD Sx
- Heart failure after a few weeks or asymptomatic,
- pansystolic murmur at lower left sternal edge and
- louder P2
111
Persistent ST elevation following recent MI, no chest pain -
left ventricular aneurysm
112
aetiology for pericarditis
- viral infections (Coxsackie)
tuberculosis
uraemia
- following MI
- malignanccy
113
what should be given after 3 shocks in VF/ puleless VT
IV amiodarone 300 mg
114
Mx of cardiac tamponae
urgent pericardiocentesis
115
third heart sound is caused by
- rapid filling of venticles
- can happen in dilated cardiomopathy
116
pulm oedema following MI
- rupture of papillary muscle -> acute mitral regurg -> widespread systolic murmur, hypotension, pulm oedema
- P MUSCLE RUPTURE
117
what can lead to long QT
hypokalaemia
118
oral -> subcut morphine conversion
divide by 2
119
AK vs Chondrodermatitis nodularis helicis
Chondrodermatitis nodularis helicis is painful
120
when should a SGLT2 inhibitor be added for diabetes
SGLT-2 inhibitors should be used in addition to metformin as initial therapy for T2DM if CVD, high-risk of CVD or chronic heart failure
121
AKPD is associated with which valvular problem
MVP
122
A young boy is noted to have learning difficulties, macrocephaly, large ears and macro-orchidism
fragile X
123
Drusen on fundoscopy
macular degen
124
people with turners may develop
- X linked recessive conditions that usually only males would get bc they only have 1 X chromosome
- e.g. haemophilia
125
Otitis externa in diabetics: treat with
ciprofloxacin to cover for pseudomonas
126
prognosis of CMPA
Most resolve by 5
127
Anaphylaxis - adult adrenaline dose =
500 mcg (0.5 ml of 1 in 1,000)
128
Eye sign associated with raised ICP
down and out - third nerve oalsy
129
mx of alc hepatitis
- pred
- diagnosed as AST: ALT ratio of 2:1.
130
Axillary freckles are indicative of
NF type 1
131
Higher gleason score means
more aggressive prostate cancer
132
NG tube aspirate pH
- if under 5.5: safe to use
- if > 5.5: request CXR to confirm position
133
Epigastric pain + steatorrhoea → ?
chronic panc
134
what form of PCI is preferred
drug eluting stent
135
Mx of HIV
2 NRTI and PI as soon as HIV is diagnosed
136
Kallman's syndrome
LH & FSH low-normal and testosterone is low
137
which chemo drug is assoc w peripheral neuropathy
vincristine
138
diagnoising hereditary spherocytosis
EMA binding test
139
how does TGA present
- no murmur but loud S2
- prominent right venticular impulse
140
Use rhythm control to treat AF if
- co-existing HF
- first onset AF
- obv reversable cause
141
Mx of pts with malignant obstructive jaundice
- stent
142
RF for biliary colic
- 4Fs: fat, female, fertile, forty
- DM
- crohns disease
- rapid weight loss
143
Sx of biliary colic
- colicky RUQ pain, worse postprandially after fatty foods
- the pain may radiate to the right shoulder/interscapular region
- in contrast to other gallstone-related conditions, in biliary colic there is no fever and liver function tests/inflammatory markers are normal
144
Ix for gallstones
US
145
comp of cholesystectomy - bile leak =
(pain, fever, bilious drainage from a surgical drain),
146
post cholecystectomy syndrome
- abdo pain and dyspepsia following cholesystectomy
147
what can cause ongoing pain and jaundice following cholesytectomy for gallstones
gallstones in CBD - choledocholithiasis
148
features of acute cholecystitis
- RUQ pain, may radiate to right shoulder
- fever + systemic upset
- murphys +
- LFTs normal
149
murphys sign
: inspiratory arrest upon palpation of the right upper quadrant
150
Mirrizi syndrome
acute cholesystitis + abn LFTs -> a gallstone impacted in the distal cystic duct causing extrinsic compression of the common bile duct
151
Mx of acute cholesytitis
- IV ab
- cholesytectomy - early lap chole within 1 week of diagnosis (risk of ascending cholangitis)
152
charcots triad
- fever, RUQ pain, jaundice
153
reynolds pentad
- fever, ruq pain, jaundice
- hypotension + confusion
154
Mx of ascending cholangitis
- ERCP to remove the stone
- IV ab
155
which imaging technique is used for all hepatobiliary dx
US
156
rf for renal stones
- dehydration
- hypercalcuria, hypercalcaemia
- high dietary oxalate
- medually spone kidney, PKD
157
RF for urate kidney stones
- gout
- ileostomy: loss of bicarbonate and fluid results in acidic urine, causing the precipitation of uric acid
158
what can be used to prevent calcium stones
thiazide diuretics & potassium citrate
159
what can inc risk of calcium stones
loop diuretics, steroids, acetazolamide, theophylline
160
Opaque renal stones
- calcium stones and phosphate stones
161
Radiolucent stones
- urate
-xanthine
- radioluxcent
162
semi opaque stone =
cystiene, with a ground glass appearane
163
pain Mx in renal stones
- Diclofenac IM first line
- if NSAIDs CI/ not enough = IV paracetamol
164
Medical therapy for renal stones to promote passage
- alpha blockers - promote dilatation of the ureter
- recommended for distal ureteric stones less than 10mm
165
Imaging for renal stones
- CT KUB for all patients - non contrast
- US for pregnant women and kids
166
renal stones with obs + infection ->
urgently decompress - nephrostomy tube placement, insertion of ureteric catheters or ureteric stent
167
preventing oxolate stones
cholestyramine and pyridoxine prevent urinary oxalate secretion
168
preventing uric acid stones
allopurinol and urinary alkalization e.g. oral bicarb
169
key feature of TCA OD
QRS widening
170
which rec drug interacts with SSRIs to cause serotonin syndrome
MDMA
171
Which cardiac drug causes sleep disturbance
BB - insomnia and vivid nightmares
172
? co-prescribed with SSRIs is a common cause of serotonin syndrome
tramadol
173
tamoxifen SE
- endometrial cancer
- VTE
174
slidenafil is CI by concurrent use of
nitrates e.g. isosorbide and nicronadil - can potentiate vasodilating effects
175
Ethylene glycol toxicity management -
- fomepiazole
- also ethanol/ haemodialysis alt
176
LSD intoxication causes
colourful visual hallucinations, depersonalisation , psychosis and paranoia
177
? poisoning first causes respiratory alkalosis
salicylate
178
HRT - mirena coil
- licensed for 4 years for progesterone component
179
best HRT for VTE tisk
transdermal
180
rifampicin SE
- hepatitis, orange secretions
- flu like symptoms
181
isoniazid MAO
- peripheral neuropathy: prevent - with pyridoxine (Vitamin B6)
- hepatitis, agranulocytosis
- liver enzyme inhibitor
182
Isoniazid MAO
Inhibits mycolic acid synthesis
183
Pyrazindamide MAO
mechanism of action: converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I
184
Pyrazinamide SE
- hyperuricaemia causing gout
arthralgia, myalgia
hepatitis
185
Ethambutol MAO
: inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan
186
Ethambutol
- optic neuritis: check visual acuity before and during treatment
- dose needs adjusting in patients with renal impairment
187
? predisposes patients to digoxin toxicity
hypokal
188
BB ovdrdose Mx
Atropine to manage the bradycardia
189
when correcting Mg and Ca deficiency
correct Mg first
190
when is metformin CI
< GFR < 30
- use linagliptin insstead
191
metformin & CT
discontinye metformin for 48 hrs post contrast CT due to ris pf lactic acidosis
192
what to do before starting flecanide
echo to look for structural HD
193
If metformin is not tolerated due to GI side-effects, try
Modified release formulation before second line therapies
194
features of lithium toxicity
- polyuria
- coarse tremor (fine is seen in therapeutic levels)
- hypereflexi
195
Activated charcoal can be used within an hour of
aspirin or paracetamol OD
196
what poisoning is assoc w hyponatramie
mdma
197
tinitius in OD ->
salicyclate
198
adrenaline doses
- anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
- cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
199
diabetes drug -> sIADH
Glimeperide
200
diabetic drug -> fluid retention
pioglitazone
201
which drug can cause postural hypotension
doxazosin
202
Codeine to morphine - divide
BY 10
203
Appearance of a leg with posterior hip dislocation
shortened and internally rotated
204
? therapy can cause corneal opacities and optic neuritis
amiodarone
205
unilateral blurry vision and halos surrounding light sources
cataracts
206
water deprivation - nephrogenic diabetes
- urine osmolality after fluid deprivation: low
- urine osmolality after desmopressin: low
207
scabies =
widespread pruritus, particularly at night, and linear erythematous lesions between his fingers are classic features of scabies
208
Infant < 8 weeks, presents with milky vomits after feeds, often after being laid flat, excessive crying → ?
GORD
209
Which type of NIV tends to be used in resp failure
BIPAP
210
NIV simplified
type 1 resp failure (low O2 but normal CO2) -> CPAP
type 2 resp failure (low O2 AND high CO2) -> BiPAP
c has 1 letter and bi has 2
211
BPD is associated with
is associated with a history of recurrent self-harm and intense interpersonal relationships that alternate between idealization and devaluation
212
Tx of EUPD
DBT
213
Bishop score >8
A Bishop's score of ≥ 8 indicates that the cervix is ripe, or 'favourable' - there is a high chance of spontaneous labour, or response to interventions made to induce labour
214
? is generally used first-line to manage secretions in a palliative care setting
Hyosciene hydrobromide or hyoscine butlybromide
215
HGV licence and diabetic on insulin
can hold a HGV licence if they meet strict DVLA criteria
216
PPH =
blood loss of 500 ml after a vaginal delivery
217
Which analgesics are used in palliative pts with severe renal impairment
- buprenorphine
- fentanyl
218
Asthma: adults not controlled on moderate-dose MART
- if FenO or blood eosinphils raised -> refer to respiratory
219
Auspitz sign
- psoriasis
- erythematous plaques covered in a silvery-white scale that, when removed, exposes an underlying red membrane that can bleed
220
L5 lesion features = l
loss of foot dorsiflexion + sensory loss dorsum of the foot
221
OCD - mild functional impairment Tx
- CBT and ERP
- is insufficient: SSRI
222
moderate functional impairment OCD
- SSRI or CBT with ERP
- consider clomipramine (as an alternative first-line drug treatment to an SSRI) if the person prefers clomipramine or has had a previous good response to it, or if an SSRI is contraindicated
223
what is the best ssri for body dysmprhic disorder
fluoxetine
224
OCD - severe functional impairment
- refer to the secondary care mental health team for assessment
whilst awaiting assessment
- offer combined treatment with an SSRI and CBT (including ERP) or consider clomipramine as an alternative
225
OCD - if SSRI Tx is effective then
- continue for at least 12 m to prevent relapse
226
OCD vs depression - SSRI
compared to depression, the SSRI usually requires a higher dose and a longer duration of treatment (at least 12 weeks) for an initial response
227
Hypercalcaemia + bilateral hilar lymphadenopathy → ?
Sarcoid
228
which drug class can cause QTC prolongation
- macrolides - clarithromycin
229
asymmetrical swollen small joints ->
psoriatic > RA. Dactylisis a.k.a sausage fingers
230
Women who suffer regular urinary tract infection following sexual intercourse can be offered
post-coital prophylaxis
231
which muscle relaxant is contraindicated for patients with penetrating eye injuries or acute narrow angle glaucoma
suxamethonium -increases intra-ocular pressure
232
bacterial vaginosis
- gardenella vaginalis overgrowth
- Mx: oral metronidazole for 5-7 days - same Tx if pregnant
233
Women who have a 'higher chance' combined or quadruple tests result are offered
further screening (NIPT) or diagnostic tests (amniocentesis, CVS)
234
osteomyelitis imaging modality
MRI
235
Hyponatreamia, hyperkalaemia and WL ->
Addisons. Diagnose with Synacthen test
236
First line form of renal replacement
1) peritoneal
2) haemodialysis
237
when is peritoneal dialysis CI
crohns
238
mx of eczema herpeticum
aciclovir
239
what must be done before a patient can be treated under the MCA
Document in the notes that they lack capacity
240
what is the only test that can be done for H pylori eradication
urea breath test
241
most common cause of travellers diarhoea
e coli
242
Mx of preterm rupture of membranes
- IV steroids to reduce NRDS
- give oral erythromycin for 10 days or until labour is established
- consider IV magnesium sulphate for fetal neuroprotection if < 30 weeks and birth is imminent
- delivery is generally recommended at 37 weeks of gestation if there are no other indications for earlier delivery (e.g. chorioamnionitis, fetal compromise).
243
which NM blocker is CI in burn patients with hyperkal
suxamethonium
244
most common cause of SA in young adults
gonorrhoea
245
Mx of HIV with CD4 below 200
- ART
- co-trimxazole -> protects against pneumocytitis jiroveci pneumonia
246
which 2 drug classes should never be combined (SS risk)
MAOI e.g. rasagiline + SSRI
247
Following elective DC cardioversion for AF, anticoagulation
AC should be continued lifelong even if sinus rhythm is maintained
248
reversal agent of dabigatran
idarucizumab
249
findings in pagets dx
isolated rise in ALP. normal calcium, P and vitamin D
250
MXx of toxoplasmosis
- no Tx unless IC
- Pyrimethamine and sulphadiazine if IC
251
What sign can be seen in acute panc
Chvosteks sign - hypocalcaemia
252
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller → ?
dengue fever
253
Ptosis + dilated pupil =
Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil = Horner's
254
the only effective treatment for large fibroids causing problems with fertility is
myomectomy
255
asymptomatic bacteria in catheterised patients
do not treat
256
erythema migricans
- seen in lyme disease
- bulls eye rash
257
Mx of lyme disease
- remove tick with tweezers
- 1st: doxy
- 2nd: amox
258
how long should AD be continued after remission
6 months
259
mx of jaundice in first 24 hrs
- measure and urgently record serum bilirubin
-
260
crescent sign on pelvic XR
avascular necrosis
261
Persistent productive cough +/- haemoptysis in a young person with a history of respiratory problems → ?
bronchiectasis
262
drug of choice in ectopic pregnancy
methotrexate
263
which type of lung cancer causes siADH
small cell
264
poor prognostic factors with ACS
- lung crackles
- cardiogenic shock
- pulm oedema
265
High insulin, High C-peptide =
- High insulin, High C-peptide = Endogenous insulin production → Insulinoma or sulfonylurea use/abuse
266
Ix for insulinoma
- ct abdo with contrast
267
features of mastoiditis
postauricular swelling, erythema, and forward displacement of the auricle
268
mx of acute necrotising ulcerative gingivitis
- paracetamol + oral metronidazole + chlorhexidine mouthwash
- refer to dentist
269
what must be done before sterilisation can be relied on
semen analysis - must demonstrate azoospermia
270
Status epilepticus in the prehospital setting:p
PR diazepam or buccal midazolam
271
symmetrical swelling in DIP joints ->
psoriatic arthritis - RA does not usually affect DIPs
272
Ix for hydronephrosis
- US renal tract
- stone + ballotable mass -> hydronephrosis
273
which drug causes postural hypotension
doxazosin
274
when is indomethacin/ ibuprofen given for PDA
buprofen/indomethacin is given to the neonate in the postnatal period, not to the mother in the antenatal period - if echo shows PDA 1 week after deluvery
275
As a first line investigation, all people with iron deficiency anaemia should be screened for
coeliac
276
reducing nephrotoxicity from contrast CT in renal patients
give 0.9% sodium chloride before and after
277
Mx delirium in palliative pts
1st: oral haloperidol
2nd: chlorpromazine, levomepromazine
278
terminal illness: agitation/ restlessness Mx
midazolam
279
what delays bone healing
- NSAIDs
- steroids
- IS
280
Mx of prostatitis
- ciproflox for 14 days
281
prostatitis features
- usually E coli
- back, perineum, penis, rectal pain
- fevers & rigors
- boggy prostate glan
282
VTE prophylaxis + CKD
UFH heparin which is preferred to LMWH
283
chondromalacia patellae PAIN
- Teen girl
- knee pain on walking down stairs and standing still
- wasting & pseudolocking of he knee on exam
284
Mx of meningitis > 60
IV ceftriazone + IV amoxicillin
285
What is raised in anorexia
- most things low
- G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
286
metformin dosage in ramadan
1/3 at suhoor, 2/3 at sunset
287
alcohol withdrawal timeline
- symptoms: 6-12 hours
- seizures: 36 hours
- delirium tremens: 72 hours
288
In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of
40% WITHIN 3 MONTHS
289
Drugs to avoid in renal failure
- antibiotics: tetracycline,
-nitrofurantoin
- NSAIDs
- lithium
- metformin
290
AST: ALT in alc hepatitis
2:1
291
first line for severe digoxin toxicity
digibind
292
Clinical features of digoxin toxicity
- GIT: nausea, vomiting, anorexia, diarrhoea
- Visual: blurred vision, yellow/green discolouration, haloes
- CVS: palpitations, syncope, dyspnoea
- CNS: confusion, dizziness, delirium, fatigue
293
sarcoid - prognosis
most pts get better without Tx
294
Glicazide monitoring
no routine monitoring req
295
Azathioprine monitoring
FBC and LFT
296
Simvastatin monitoring
LFT
297
Mx of endo
- NSAIDs + paracetamol
- COCP or POP
- GnRH analogues to induce pseudomenopause
- surgery
298
surgical option recommended in endo for women wanting to conceieve
- lap excision or ablation of endometriosis + adhesiolysis
299
Mx of a tension pneumothorax
urgent needle decompression e 5th intercostal space at the mid-axillary line on the affected side using a large-bore cannula
300
Progestogen only pill + antibiotics -
no need for extra precautions. Only p450 inducers like rifampcin do
301
most common cause of central line infections
staph epidermis
302
features of myeloid dysplasia
- anaemia, neutropaenia and thrombocytopaenia.
- The blood film shows anisocytosis, macrocytosis and hyposegmentation of the neutrophils.
- high risk of transformation to AML
303
Mneumonic for TEN and SJS
- -Never Press Skin As (IT) Can Peel
-- NSAIDS, Phenytoin, Sulfa drugs, Allopurinol, (IV immunoglobulin - treatment), Carbamazapine, Penicillins
304
common cause of urinary retention
morphine (& other opiods)
305
sjrogens syndrome
- more common in females
- dry eyes, dry mouth, dry vagina
- Raynaurds
- athralgia
306
Ix for sjoregens
- RF positive
- ANA positive
- anti-RO - sjROgens
307
Test for sjogerns
schirmer test - paper near conjunctival sac to measure tear formation
308
Mx of sjogerns
- artificial saliva and tears
- pilocarpine may be helpful to stimulate saliva production
309
first lines for mild-moderate alz
Donezepil
Galantamine
Rivastigmine - all ACHi
310
second line tx for alz
- mematine - NMDA antagonist
- moderate alz who can't tolerate ACHi
- or monotherapy for severe alz
311
factors which affect GFR
- pregnancy
- muscle mass - amputees, body builder
- eatign red meat before the sample
312
mx of gonorrhoea =
IM ceftriaxone ( gonorrhoea and meningitis are both neisseria and have the same Tx)
313
Mx of vestibular neuronitis
- buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases
- oral prochlorperazine SHORT TERM RELIEF
314
Chronic vest neuronitis Mx
vestibular rehab exerc ises
315
when does otosclerosis tend to occur
- 15-45 often in pregnant
316
mx of symptomatic AS
-surgical AVR for low/medium operative risk patients
- transcatheter AVR for high operative risk patients
317
sinusitis + liver in LUQ
kartagner
318
SV and warfarin
Sodium valproate is an enzyme INhibitor so can INcrease warfarin levels if used concurrently
319
prolactinoma vs acromegaly Mx
- In acromegaly surgery 1st line, drugs if failed.
- In prolactinoma, drugs first line, then surgery if failed.
320
Mx of prolactinomas
- cabergoline and bromocriptine
- 2nD: transphenoidal surgery
321
Chickenpox exposure in pregnancy -if not immune then,
antivirals or VZIG (if available) should be given at days 7-14 post-exposure, not immediately
322
Medical termination of pregnancy
- mifepristone
- then misoprostal 48 hrs after
- multi level pregnancy test 2 weeks after
323
Infective endocarditis with is an indication for emergency valve replacement surgery
causing congestive cardiac failure
324
mx of hypoglycaemia with impaired GCS
IV glucose if access or IM glucagon
325
hand arm vibration syndrome
- occurs after prolonged exposure to vibrating tools
- triad of vascular Sx: raynaurds
- neuro: numbness and tingling
- MSK
326
cause of pneumonia in bird keepers
- chlamydia psittaci
- found in domesticated and exotic bids
- classically causes a respiratory infection as well as an acute or chronic conjunctivitis,
- presentation can range from mild flu-like illness to multi-organ failure.
327
which diabetes drug is CI in GDP6 def
sulfonylureas - glipizide
328
dose of adrenaline for a child 6-11 years olf
300mg (0.3ml)
329
HIV-associated nephropathy (HIVAN) causes
FSGS and usually presents as a nephrotic syndrome
330
H. pylori eradication:
- PPI + amoxicillin + clarithromycin,
- PPI + metronidazole + clarithromycin
331
PF spirometry
- increased FEV1/ FVC
- reduced FVC
- reduced TLCO
332
gradual loss of vision, blurring of small words and straight lines appearing 'curvy' ->
Age related macular denegeration
333
Mx of urticaria
- non-sedating antihistamines (e.g. loratadine or cetirizine) are first-line
- sedating AH e.g. chlorphenamine for night time symptoms
334
Mx of severe/ resistant UC
pred
335
mx of a myxoedema coma
- thyroxine
- hydrocortisone
336
which NSAID is CI in any form of CVD
diclofenac
337
Ix for spinal stenosis
- prescribe analgesia
- do MRI TO CONFIRM DIAGNOSIS
338
pseudogout RF
- haemochromatosis
- hyperparathyroidism
- low magnesium, low phosphate
acromegaly, Wilson's disease
339
: weakly-positively birefringent rhomboid-shaped crystals ->
PSEUDOGOUT
340
remembering gour vs pseudogout
- P ositively birefringent - P seudogout :)
- mGOUT = NN
Negative bifringent, Needle
341
mx of CTS in pregnancy
wrist splint
342
dilated cardiomyopathy findings
- reduced LVEF
- no regional wall abn
- dilated left ventricle
343
mx of lichen planus
- potent steroids
- benzydamine mouthwash for oral LP
344
Mneumonic for upper lobe fibrosis
- C - Coal worker's pneumoconiosis
- H - Histiocytosis/ hypersensitivity pneumonitis
- A - Ankylosing spondylitis
- R - Radiation
- T - Tuberculosis
- S - Silicosis/sarcoidosis
345
DKA ABG
raised anion gap metabolic acidosis
346
Phaeochromocytoma typically presents with
- Sweating
- headaches
- palpitations
- severe headaches
347
diagnosing phaechromocytoma
- 24 hr urinary metanephrines
348
Mx of phaechromocytoma
- surgery deinitive
- Give alpha blocker e.g. phenoxybenzamine then BB e.g. propanolol to stabilise first
349
Use of 0.9% Sodium Chloride for fluid therapy in patients requiring large volumes =
hypercholraemic met acidosis
350
Acute onset of atrial fibrillation: if ≥ 48 hours or uncertain (e.g. patient not sure when symptoms started) →
rate control
351
loss of finger extension ->
radial nerve
352
loss of finger adduction -.
ulnar nerve
353
regimental stripe sensory loss over deltoid
axillary nerve
354
Mx of beta thalasseamia major
- regular blood transfusions
- with desferrioxamine to prevent iron overload
355
medical Mx of turners
GH therapy - kids often have short statutre
356
salicylate OD ANG
mixed primary respiratory alkalosis and metabolic acidosis
357
Positive HbC indicates
past infection, WILL NOT BE RAISED BY IMMUNISATION
358
Polycythemia ->
AML or pyelofibrosis
359
feature of tricuspid regurg
left parasternal heave
360
blockage where does not cause jaundice
cystic duct
361
Preventing chest infections after a rib F#
chest physio + analgesia
362
anion gap formula
- sodium + K
- minus Cl + HCO3
(Add positive - the negative ions)
363
addisons glucorticoid dosage
2/3 in the morning and 1/3 at evening
364
what is an absolute CI for inducing labour
- classical C section scar
- induction is also not recommened with a breech baby
365
Mx of genital herpes in pregnancy
- oral aciclovir
- red vesicular rash on vula
366
commonest type of malaria
falciparum
367
cellulitis in pregnancy
- erythromycin if allergic to penicillin
- penicillin otherwise
368
alcohol misuse, neuropathy and joint deformity ->
charcots joint
369
Patients with chronic kidney disease should be started on an ? if they have an ACR > 30 mg/mmol
ACE inhibitor
370
all CKD pts should be started on
statin
371
Suspected bacterial meningitis: an LP should be done before IV antibiotics, unless:
- cannot be done within 1 hour
- signs of severe sepsis or a rapidly
- evolving rash
- significant bleeding risk
- signs of raised intracranial pressure
372
cerebellar signs, contralateral sensory loss & ipsilateral Horner's
- lateral meduallry syndrome
- PICA lesion
373
Pain on longitudinal compression of the thumb is a sign of a
Scaphoid f#
373
ECG in Eismengers syndrome
RVH
374
severe TBI + GCS under 8
- CT
- insert ICP monitoring device
375
first line in reduced fetal movements
- do a handheld dopper to confirm fetal heartbeat
- after this can do a TVUS or CTG
376
PIituitary incidentaloma ->
laboratory investigation must be done to determine if it is functional or non-functional
377
what causes LRTI in CF
pseudomonas aerginosa
378
splenectomy and HB1C
Splenectomy can give a falsely high HbA1c level due to the increased lifespan of RBCs
379
Abdominal pain, constipation, neuropsychiatric features, basophilic stippling →
Lead poisoning
380
what is not looked at in APGAR
crt
381
APGAR =
Appearance (colour)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort
382
break between steroid courses for psoriasis
4 week break
383
low ? is a feature of haemolysis
haptoglobin - binds free hb
384
Older patient, progressive exertional dyspnoea, dry cough, clubbing, non-smoker → ?i
IPF
385
rhinorrhoea, watering eyes and is constantly yawning.
Heroin abuse
386
ABG in early stages aspirin OD
resp alkalosis
387
cytotoxic that causes lung fibrosis
bleomycin
388
haem cystitis is a SE of
cyclophosphamide
389
chemo drugs causing peripheral neuropathy
- vinctistine - used in lymphoma
- cisplatin
390
what causes a quieter AS murmur
LVSD
391
Acute epididymo-orchitis in sexually active younger adults is most commonly caused by
Chlamydia
392
first line for PBC
Ursodeoxycholic acid
393
mx of itch in PBC
cholestyramine
394
PBC - bilirubin /> 100
liver transplant
395
tetanus prophylaxis for a wound
- booster vaccine and Ig
- unless wound v minor and < 6 hrs old
396
DIC blood film
schistocytes
397
carpal spasm on inflation of BP cuff to pressure above systolic
trousseaus sign - seen with hypocal
398
phalens sign =
CTS
399
Chvostek's sign
hypocalcaemia, tapping over parotid (CN7) causes facial muscles to twitch
400
Finkelsteins sign =
de quervains
401
froments sign
- ulnar nerve palsy
-
402
Recurrent and/or severe genital herpes can be treated with
Suppressive therapy - valaciclovir often
403
mx of genital herpes
oral acilovir
404
osmolaltity in ATN
< 350
405
? are associated with a significant increase in mortality in dementia patients
antipsychotics
406
when is transdermal> oral HRT used
- increased VTE risk
- obesity > 30 BMI
407
Continuous vs sequential HRT
- cont: > 12 months after last period
- sequential: perimenopausal
408
mx of a secondary pneumothorax - small and asymptomatic
- manage consv and monitor as an inpatient
409
screen for what b4 starting rituximab
hep b
410
Diagnosing vs Tx of BPPV
- diagnosis: dix-hallpike
- Tx: epley manouvre
- Brandt-Daroff exercises at home
411
how is allopurinol prescribed
With an NSAID or colchicine cover
412
TCA e.g. amitriptyline OD
- dilated pupils
- dry skin
- confusion
- urinary retention
- tachycardia
- anti-cholinergic SE
413
Large purple lesion that bleeds at the site of contact, appears at trauma site
pyogenic granuloma
414
skin lesion that resolve itself with scarring after sev months
keratoacanthoma
415
Mx of pityiasis versicolor
- keotonazole shampoo
416
pityraiss rosea mx
none. self resolves by 12 weeks
417
? is the first-line imaging of choice when investigating thyroid nodules
US
418
what is diagnostic for mycoplasma pneumonia
serology
419
Ask 'what' and 'who' questions =
2 yrs
420
combine 2 words
2 yrs - 2 to string 2 words together
421
why when how questions =
4 yrs
422
if an irregular broad complex tachy is found ->
seek cardiology input
423
dimple sign =
dermatofibroma - tend to occur after trauma such as insect bites
424
oxybutinin MAO
Anti-muscarinic
425
mx of symp bradycardi
1: IV atropine
- Adrenaline infusion
- transcutaneous pacing
- transvenous pacing with specialist input
426
Familial hypercholesterolaemia
- autosomal dom
- presents with high LDL, tendon xanthomata (pathognomonic for FH), and a strong family history of premature cardiovascular disease
427
CP exposure in pregnancy + no VZ antibodies detected
- antivirals should be given at days 7-14 post-exposure, not immediately
- VZIG can also be given but should be given immediately
428
edwards syndrome qUADRUPE TEST
↓ AFP
↓ oestriol
↓ hCG
↔ inhibin A
429
Torticollis =
type of acute dystonia - wry neck = unilateral neck pain and deviation
430
If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago,
they don't require a booster vaccine nor immunoglobulins, regardless of how severe the wound is
431
rickets XR
widening of joints
432
HCOM - most likely cause of death
vent arrythmia
433
when to do a TVUS for Menorrhagia
if abnormal exam findings, pelvic pain, intermenstrual or postcoital bleeding
434
Mx of FAP
- total proctocolectomy with ileial pouch anal anastamosis
- v high risk of CRC
435
Electrolyte dist seen in refeeding syndrome
- hypophosphateamia
- hypokalaaemia
- hypomg
436
most common cause of peritonitis after dialysis
staph epidermis
437
? is required prior to surgery for patients taking prednisolone
hydrocotisone supplementation
438
mx of cocaine toxicity
- diazepam
- !! avoid beta blockers
439
Schistosomiasis is treated with
praziquantel
440
marfans is assoc w
Aortic regurg
441
diet beneficial in epilepsy
ketogenic
442
Pain on the radial side of the wrist/tenderness over the radial styloid process ?
de quervains tensynovitis
443
leriche syndrome =
- 1. Claudication of the buttocks and thighs
2. Atrophy of the musculature of the legs
3. Impotence (due to paralysis of the L1 nerve)
444
mx of gonorrhoea
1) IM ceftriaxone
2) oral cefixime + oral azithromycin
445
Common features of PTSD
- re-experiencing e.g. flashbacks, nightmares
avoidance e.g. avoiding people or situations
hyperarousal e.g.hypervigilance, sleep problems
446
when to measure digoxin conc if suspecting toxicity
within 8-12 hours after last dose
447
HUS triad
- anaemia
- thrombocytopenia
- acute renal failure
- caused by E coli 0157: h7
448
electrolyte abn after thyroid surgery
- damage to PTH glands -> hypocal -> long QT
449
Postmenopausal women, men age ≥50, who are treated with oral glucocorticoids for ≥7.5 mg/day prednisolone or the next 3 months
- start bisphosphonates at the same time - don't wait for a DEXA scan
450
Any critically ill patient (including CO2 retainers) should initially be treated with
high flow O2 which is then titrated
451
hypercal ECG
short QT
452
Tri vs mi regurg
Tricuspid regurgitation becomes louder during inspiration, unlike mitral regurgitation
453
inguinal hernia in kids =
- urgent surgery
- Inguinal Hernia -> get INto surgery
Umbilical Hernia -> UM I'll wait and see
454
when can POP be relied on
2 days
455
which contraceptives take 7 days before we can rely on them
COC, injection, implant, IUS
456
which contraptive is immediately reliable
IUD
457
Mx of acute closed angle glaucoma
- admit to hosp
- IV acetazolamide and timolol, pilocarpine, and apraclonidine eyedrops
458
ca gluconate
- stabilises cardiac membrane
- no change to electrolyte levels
459
Hemiarthroplasty or total hip replacement is the treatment of choice for all patients with a
displaced hip f#
460
mastoiditis
- severe pain and protrusion of the ear forwards, with a tender, boggy and often reddened mass behind the ear
-> risk of meningitis
461
Lyme disease can be diagnosed clinically if ? is present
Lyme disease can be diagnosed clinically if erythema migrans is present → give antibiotics
462
how long must someone with epilepsy be seizure free in order to quality for a driving licence
- 1 year
- after 5 years would qualify for a till 70 licence
463
flluid resus in hyperemesis
IV saline with added potassium
464
obsessive compulsive PD ->
can be rigid with respect to morals, ethics and values and often are reluctant to surrender work to others
465
remembering parathyroid disorders
hyperparathyroidism = so first off PTH (parathyroid) is always high in either prim/sec/third.
The letter relating to the type and corresponding blood results tells you whats low.
Primary = P for primary, phosphate is low
seConDary = C for calcium, calcium is low, vitamin D is low
TerTiary = viTamin D and phosphaTe are low
466
Paracetamol overdose: if presentation > 24 hours:
acetylcysteine should be continued if the paracetamol concentration or ALT remains elevated whilst seeking specialist advice
467
amoebic liver abscess -> anchovy sauce
entmoeaba histolyca
468
syphyliis
- painless ulcer - chancre
- trponema pallidum
469
Older woman with labial lump and inguinal lymphadenopathy → ?
vulval carcinoma
470
Persistent mouth ulcer → ?
sq cell carcinoma. Urgently refer a non healing ulcer > 3weeks
471
