PASSMED APRIL Flashcards
What causes a tender nodularity in the posterior vaginal fornix?
Endometriosis
Gold standard investigation for endometriosis?
Laparoscopy
Indication for a skin patch test?
Contact dermatitis i..e type 4 hypersensitivity
Indication for a skin prick test?
Type 1 hypersensitivity reactions e.g. food or respiratory allergies
What virus causes molluscum contagiosum/
Pox virus
When after pregnancy can IUD and IUS be inserted?
Within 48 hours or >4 weeks
What is a type 1 error?
Rejecting H0 when it is true - a false positive
What complication can occur when giving rapid fluid resuscitation in patients with hyponatraemia?
Osmotic demyelination syndrome
What are grade 3 haemorrhoids?
Haemorrhoids that prolapse during bowel movements and require manual reduction
What is the adverse effect of isioniazid and what do we give to prevent it?
Peripheral neuropathy
Pyridoxine
Treatment for Wilson’s disease?
Penicillamine
What are the 3 stages of postpartum thyroiditis?
- Thyrotoxicosis
- Hypothyroidism
- Normal thyroid function
What virus can cause eczema herpeticum?
HSV 1 or 2
Uncommonly it can be caused by coxsackievirus
Which drug combined with azathioprine can lead to myelosuppression and neutropenic sepsis?
Allopurinol
(. Azathioprine is a prodrug, meaning it is metabolised to its active form, 6-mercaptopurine, which causes immunosuppression (prevents kidney rejection in this patient). The active 6-mercaptopurine is subsequently metabolised by xanthine oxidase to inactive this uric acid which is excreted. As allopurinol inhibits xanthine oxidase, the combination of the two drugs can lead to excessive myelosuppression)
A 44-year-old woman who is normally fit and well presents to the GP with difficulty hearing for the past 2 months. On examination, Rinne’s test is positive on her right ear but negative in her left ear. Weber’s test reveals sound localising to the left side.
What type of hearing loss does this patient have?
Left sided conductive hearing loss q
What should you do if you see a pt with an organic FB in their eye?
Refer immediately to ophthalmology for assessment due to the infection risk
Maximum rate of IV K+ infusion?
10mmol/hour
What second pharmacological agent after metformin should be added in treatment of diabetes type 2?
SGLT2 inhibitor if any risk of CVD, established CVD or chronic HF
Otherwise: DPP-4 inhibitor, pioglitazone, sulfonylurea
What are “large multinucleate cells with prominent eosinophilic nucleoli”
Reed-sternberg cells
What is the main complication with turner syndrome later in life?
Aortic dissection (as they pt are at risk of being born with a bicuspid aortic valve which can alter blood flow patterns and cause stress on the aortic wall)
What type of melanoma has these characteristics: red/black lump that bleeds in a chronically sun-exposed area e.h. Head/neck
Nodular melanoma
What is the most common type of malignant melanoma?
Superficial spreading
Second line investigation for ?subarachnoid haemorrhage?
If a CT head was done within 6 hours of symptom onset and was normal- do not do an LP and consider another diagnosis
If a CT head was not done within 6 hours of symptom onset and was normal-do an LP at least 12 hours after symptoms to allow the development of xanthochromia
What is CKD stage 1?
EGFR >90 with some sign of kidney damage on other tests e.g. proteinuria (if no other sign of kidney damage then not CKD for stages 1&2!!)
What is CKD stage 2?
EGFR 60-90 with some sign of kidney damage e.g. proteinuria (if no other sign of kidney damage then not CKD for stages 1&2!!)
What condition causes distortion of straight lines and reduced visual acuity?
Macular degeneration
How should you manage gastric MALT lymphoma?
H.pylori eradication - 95% have an associated H.pylori infection
Outline the pathophysiology of hyperosmolar hyperglycaemic state?
Hyperglycaemia increases serum osmolality and therefore causes osmotic diuresis and severe volume depletion
Clinical features of HHS?
Over many hours…
Dehydration, polyuria, polydypsia
Lethargy
N&V
Altered level of consiousnesss
Focal neurological deficits
Hyperviscocity of blood -> MI, stroke, thrombosis
What medication is used for secondary prevention for TIA?
Clopidogrel
High intensity statin
Goitre vs thyroglossal cyst?
moves up just on swallowing = goitre
moves up on tongue protrusion = thyroglossal cyst
Differences between branchial cysts and cystic hygromas?
Cystic hygromas transilluminate and branchial cysts do not
Cystic hygromas present by 2 years and branchial cysts present in early adulthood
Cystic hygromas tend to be in posterior triangle of neck and branchial cysts in anterior triangle between sternocleidomastoid muscle and pharynx
What is the diagnostic investigation of choice for suspected non-Hodgkin lymphoma?
Excisional node biopsy
Combined screening test results for Down’s syndrome?
Increased HCG
Decreased PAPP-A
Thickened nuchal translucency
Reduced AFP, unconjugated oestriol
Increased inhibin A
A mother brings her 8-month-old infant to the GP due to the development of a nappy rash. On examination an erythematous rash with flexural sparing is seen. What is the most likely cause?
Irritant dermatitis - nappy rash
What does coeliac disease cause deficiencies in?
Iron
Folate
And slightly less common,y B12
What should you do if a semen analysis results show an abnormality?
Repeat the sample:
If mild oligospermia - repeat in 3 months
If azoospermia or severe oligospermia <5 - repeat immediately
What drugs can cause raised prolactin?
Metoclopramide
Domperidone
Phenothiazines
Haloperidol
If a pt has AF and their CHA2DS2-VASc score suggests no need for anticoagulation, what investigations if needed to inform whether they will require anticoagulation?
A transthoracic echocardiogram to exclude valvular heart disease
How often is methotrexate given in RA?
Weekly
What are c-peptide levels like in T1DM?
Low
Management of APS after a first VTE?
Lifelong warfarin
What is the probability of having a PE if PERC criteria is negative?
<2%
What is the commonest variant of syringomyelia?
Arnold- Chiari malformation in which the cystic cavity within the spinal cord connects with a congenital malformation affecting the cerebellum
How does syringomyelia most commonly present?
Usually it spares the dorsal columns and medial lemniscus and affecting only the spinothalamic tract with loss of pain and temperature sensation B/L
What causes brown-sequard syndrome?
Hemisection of the spinal cord e.g. stab injuries
How does Brown-Sequard syndrome present?
Ipsilateral paralysis (pyramidal tract) and loss of proprioception and fine discrimination (DCML)
Contralateral loss of pain and temperature (spinothtlamic)
What is cushing’s triad?
Hypertension
Bradycardia
Tachpnoea with signs of Cheyne-stokes breathing
ECG findings in raised ICP?
Global T wave inversion
QT prolongation
Bradycardia
What is a very important side effect of clindamycin to warn pt about?
Diarrhoea as it can cause c.diff
What type of hypersensitivity if SLE?
Type 3
Cause of abdominal pain, bloating and vomiting following bowel surgery?
Post op ileus
How should you manage subclinical hypothyroidism if pt is <65, has a TSH level of 5.5-10.0 and the TSH has remained high on 2 separate occasion as 3 months apart and the pt has symptoms?
6 month trial of thyroxine
What is Münchausen’s syndrome?
the intentional production of physical or psychological symptoms
Aka factitious disorder
MOA of COCP?
Inhibits ovulation by acting on the hypothtlamo-pituitary-ovarian axis to reduce LH and FSH
MOA of progesterone-only implant?
Prevents ovulation
Can also alter cervical mucus and possibly prevent implantation by thinning the endometrium
MOA of copper IUD?
Decreases sperm motility and survival
MOA of IUS?
Prevents endometrial proliferation and thickens cervical mucus
First line treatment for peripheral neuropathy?
Amitriptyline, duloxetine, gabapentin or pregabalin
Outline the NYHA classification for HF?
1 - no symptoms and limitations
2 - mild symptoms with slight limitation of physical activity
3 - moderate symptoms, comfortable at rest but less than ordinary activity results in symptoms
4 - severe sympotms unable to carry out any activity without discomfort, symptoms present at rest
Causes of non-immune acquired haemolytic anaemia?
TTP/HUS, DIC, maliganncy, pre-eclampsia
Prosthetic heart valve;lives
Paroxysmal nocturnal haemoglobinuria
Malaria
Hereditary causes of haemolytic anaemia?
Hereditary spherocytosis and elliptocytosis
G6PD deficiency
Sickle cell and thalassaemia
Most common causes of aortic stenosis?
Most commonly in pt >65 is degernative calcification
Most common in pt <65 is bicuspid aortic valve
Williams syndrome
Post-rheumatic disease
HCOM
What can precipitate lithium toxicity?
Dehydration, renal failure, drugs (thiazides, ACEi, ARBs, NSAIDs, metronidazole)
Complications of COPD?
Reduced QOL and increased morbidity/mortality
Depression and anxiety
Cor pulmonale
Frequent chest infections
Secondary polycythemia
Respiratory failure
Pneumothorax
Lung cancer
Muscle wasting/cachexia
Which cause of pneumonia may cause hyponatraemia?
Legionella pneumoniae
What are symptoms of pernicious anaemia?
Anaemia Sx
Neurological - peripheral neuropathy mostly symmetrical legs, subacute combined degeneration of the cord, neuropsychiatric features
Mild jaundice
Glossitis
What is the most common cause of a transaminitis in the 10,000s?
Paracetamol overdose
Is AST or ALT higher in alcoholism?
AST
Which MI most common causes acute mitral regurgitation?
Infero-posterior infarction - causes ischaemia/rupture of the papillary muscles
How does acute mitral regurgitation following an MI present?
Acute hypotension, pulmonary oedema, early-to-mid systolic murmur
What are the Kocher criteria for diagnosing septic arthritis?
Fever >38.5
Non-weight bearing
Raised ESR
Raised WCC
When should Liraglutide be considered for pre-diabetic pts?
When they have a BMI >35 as this can be used as an adjunct for weight loss
Post-splenectomy blood film features?
Howell-jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes
Paraneoplastic features of squamous cell lung cancer?
PTH-rp secretion
Clubbing
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism due to ectopic TSH
Routine antenatal care: when is an early scan to confirm dates done?
10-13+6 weeks
Routine antenatal care: when is the first screen for anaemia and atypical red cell alloantibodies done?
8-12 weeks
Routine antenatal care: when is the first dose of anti-D prophylaxis for rhesus negative women done?
28 weeks
Symptoms of meckels diverticulum?
Abdominal pain mimicking appendicits
Painless massive GI bleeding
Intestinal obstruction
Symptoms of Mittelschmerz?
Ovulationpain - dull pain or sharp sudden twinges that last for a few mins to 1-2 days. Happens about 2 weeks before a period. Unilateral and switched side each time.
A 9-month-old baby is brought to the emergency department with a swollen finger. He appears to be in a lot of pain and is crying and writhing around. His past medical history is significant for a diagnosis of sickle cell disease.
On examination, his left ring finger is hot, tender and swollen. His vital signs are stable.
What is needed to confirm the likely diagnosis in this patient?
None - its an acute painful vaso-occlusive crisis that can e diagnosed clinically
How does biliary colic present?
Colicky RUQ pain, worse postprandially and after fatty foods, may radiate to R shoulder
N&V
What is the most sensitive test to investigate TB?
Sputum culture (this is the gold standard investigation)
What is the likely ABPI for the following case:
A 73-year-old lifelong heavy smoker presents to the vascular clinic with symptoms of foot ulceration and rest pain. On examination her foot has areas of gangrene and pulses are impalpable.
0.3 - critical limb ischaemia
Thw gangrene suggests this
What is the likely ABPI for the following case:
A 63-year-old man presents with a claudication distance of 15 yards. He is a lifelong heavy smoker. On examination his foot is hyperaemic and there is a small ulcer at the tip of his great toe.
0.3-0.5 - severe vascular disease
What is the likely ABPI for the following case:
A 77-year-old morbidly obese man with type 2 diabetes presents with leg pain at rest. His symptoms are worst at night and sometimes improve during the day. He has no areas of ulceration.
T2DM can cause vessel calcification
This pain is usually neuropathic
What further investigations should you do of you find a complex ovarian cyst on TVUS?
CA125
AFP
BHCG
Biopsy - cystectomy rather than aspiration due to risk of recurrence and spillage into peritoneal cavity which can disseminate possible malignant cells
After taking ulipristal acetate, when can women restart their regular hormonal contraception?
5 days
What is the most common cause of puerperal pyrexia?
Endometritis
Why should meds such as opioids be stopped during a c.diff infection>
Anti-peristaltic drugs such as opioids can predispose to toxic megacolon by slowing the clearance of the Clostridium difficile toxin.
When in the menstrual cycle should you take the serum progesterone?
7 days before next expected period
When pts have an MI secondary to cocaine use, what should be given in addition to normal ACS Tx?
IV benzodiazepines
It reduce CNS sympathetic outflow, ameliorating the toxic effects of cocaine, and drastically improving myocardial ischaemia, particularly in the context of vasospasm
Which nerve root is likely to be compressed:
A 52-year-old woman develops pain shooting down the posterior aspect of the left leg. On examination she has reduced sensation on the lateral aspect of the left foot and weakness of left foot plantar flexion.
S1
Which nerve root is likely to be compressed:
A 44-year-old man complains of pain radiating from his left hip to foot for the past week. On examination all reflexes are intact and the only positive finding is weak dorsiflexion of the left big toe
L5
What is thyroid acropachy?
A triad of digital clubbing, soft tissue swelling of the hands and feet, and periosteal new bone formation.
What is this:
A 45-year-old woman has dizziness upon waking that started this morning. She describes it as a sensation of the room spinning, which is constant but worsens with head movement. There is no hearing loss or tinnitus. Her history includes a recent cold two days prior and otitis externa treated with topical gentamicin in her twenties. She worries about having developed the same condition as her 72-year-old father, who has intermittent dizziness triggered by turning his head.
Otoscopy is normal, but unilateral horizontal nystagmus is seen.
Vestibular neuronitis
After what time period should you titrate metformin up after a dose change?
At least 1 week
Which 3 drugs are best for motion sickness in order?
Hyoscine > Cyclizine > promethazine
What are P450 enzyme inducers?
AEDs: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking
What are P450 enzyme inhibitors?
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
What electrolyte abnormality is associated with MDMA poisoning?
Hyponatraemia - causes SIADH or excessive water intake
Which NSAID is contraindicated with any form of cardiovascular disease?
Diclofenac
What drugs are contraindicated in pts with G6PD deficiency due to haemolysis risk?
Quinolones
Dapsone and other sulfones
Methylthioninium chloride
Nitrofurantoin
Primaquine
Rasburicase
Sulfonamides (including co-trimoxazole)
Which drugs can preciptate lithium toxicity?
Diuretics - esp thiazides
ACEi or ARBs
NSAIDs
Metronidazole
What is the first line investigation for suspected primary hyperaldosteronism?
Plasma aldosterone:renin
What is the most common cause of primary hyperaldosteronism?
Bilateral idiopathic adrenal hyperplasia
What investigations is done to differentiate between unilateral and bilateral sources of aldosterone excess in primary hyperaldosteronism?
High-resolution CT abdomen and adrenal vein sampling
What is the most common cause of bilious vomiting in the first few days of life?
Duodenal atresia
Complications of an aneurysmal subarachnoid haemorrhage?
Rebleeding
Hydrocephalus
Vasospasm
Hyponatraemia due to SIADH
Seizures
How to calculate PPV?
TP/TP +FP
What can cause fever, abdominal pain and shock after a transfusion?
Acute haemolytic transfusion reaction
How do you confirm a diagnosis of acute haemolytic reaction after a blood transfusion?
Check the blood and pt identity
Send blood for direct Coombs test
Repeat typing and cross-matching
In an NSTEMi, a GRACE score above what should have a coronary angiography? And within what time period should this be done?
> 3%
Within 72 hours of admission
Symptoms of acute cholecystitis?
Fever
Murphys sign positive - arrest of inspiration on palpation of RUQ
Continuous RUQ pain
May have Hx of gallstone symptoms
