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Passmed Knowledge Flashcards

1
Q

What are UKMEC 3 criteria

A

Risks>benefits
35 y/o + smokes <15/day
Fhx thromboembolic disease
wheelchair use
BMI >35
Controlled HTN

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2
Q

What are UKMEC 4 criteria

A

Absolutely contraindicated
Migraine w aura
Active malignancy
35 y/o smokes >15 day
Hx cancer
Hx stroke etc.

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3
Q

What are the degrees of perineal tears and what treatment is required

A

1: small tear, muscle ok, no repair needed
2: tear in perineal muscle - suture by midwife
3: tear in perineal muscle + anal sphincter complex - repair in theatre
4: tear in perineal muscle + anal sphincter complex + rectum - repair in theatre

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4
Q

What are the symptoms of fibroids

A

Menorrhagia, bulky symptoms (urinary, bloating), abdo pain, fatigue

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5
Q

How do you treat fibroids

A

If they do not distort the uterine cavity: IUD w levenogestrel
If they do distort the uterine cavity then laparascopic or ablation

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6
Q

How do you treat post partum thyrotoxicosis

A

With propanolol alone

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7
Q

What drugs do you avoid in breastfeeding

A

Aspirin
Antibiotics (ciprofloxacin, tetracycline, chloramphenicol)
Psych (Lithium, benzos, clozapine
Methotrexate
Carbimazole
Sulfonylureas or sulfonamides

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8
Q

What are the symptoms of androgen insensitivity syndrome

A

Primary amenorrhoea, no pubic/axillary hair, undescended testes (+++ testosterone)

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9
Q

How and when do you test for ovulation?

A

7 days after ovulation, progesterone peaks
7 days before end of cycle!

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10
Q

Where is the most common place for ectopic pregnancies

A

Ampulla of the fallopian tube

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11
Q

Where are ectopic pregnancies most associated with rupture

A

Isthmus

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12
Q

How does LMWH work

A

Factor Xa inhibitor

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13
Q

What anticoagulation should be avoided in pregnancy

A

DOACs
Warfarin

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14
Q

How does warfarin work

A

Inhibits vit K
Reduces II, VII, IX, X

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15
Q

Give examples of DOACs

A

Apixaban
Rivaroxaban

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16
Q

What is the incubation period for Staph. aureus

A

6 hrs

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17
Q

What is the incubation period for Bacillus cereus

A

6 hrs

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18
Q

What is the incubation period for Salmonella

A

12-48 hrs

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19
Q

What is the incubation period for E. coli

A

12-48 hrs

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20
Q

What is the incubation period for Shigella

A

48-72 hrs

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21
Q

What is the incubation period for Campylobacter

A

48-72 hrs

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22
Q

What is the appearance of lichen planus

A

Purple, polygonal, pruritic, papular, planar (flat top)

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23
Q

What is the appearance of lichen sclerosis

A

Itchy white spots typically on vulva

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24
Q

Where does lichen planus typically affect?

A

palms, soles, genitals, flexor surfaces of arms

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25
Q

What is the appearance of psoriasis

A

Scaly, shiny, red, itchy

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26
Q

What is the appearance of eczema

A

Red, dry, itchy

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27
Q

What is the difference in appearance of eczema and psoriasis

A

Eczema = dry, red, itchy
Psoriasis = scaly, shiny, red, itchy

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28
Q

What structures does anterior uveitis affect

A

Iris and ciliary body

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29
Q

What are the features of anterior uveitis

A

Sudden onset, painful red eye
Changes in vision + photophobia
Small pupil
Double vision
Assoc. w inflammatory conditions

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30
Q

What is the first line management of anterior uveitis

A

Urgent referral to ophthalmology
Cycloplegics (atropine, cyclopentolate) = dilate pupil
Steroid eye drops

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31
Q

What causes torsades de pointes

A

Long QT - hypothermia, antiarrhythmetics, antipsychotics, tricyclics

Hypo Electrolytes - hypocalcaemia, hypomagnesaemia, hypokalaemia

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32
Q

How do you manage torsades de pointes

A

IV magnesium sulfate

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33
Q

What are the congenital cyanotic heart diseases?

A

Truncus arteriosus (pulm and aorta connect into 1)
Transposition of (2) great arteries
Tri(3)cuspid atresia
Tetra(4)logy of fallot
Total anomalous pulmonary venous return (5)

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34
Q

What are the acyanotic congentical heart diseases

A

VSD
ASD
Patent ductus arteriosus
Coartcation of aorta
Aortic stenosis

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35
Q

What is the complication of an intracapsular femur fracture

A

Avascular necrosis of femoral head

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36
Q

When should activated charcoal be given in a paracetamol overdose

A

Only useful if they present within the first hour

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37
Q

When should acetylcysteine be given immediately?

A

If paracetamol overdose was staggered over 1 hour
If overdose was taken 8-36 hours before
If uncertain about time but toxic dose

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38
Q

What are the symptoms of dermatomyositis

A

Dermato - rash - knuckles, heliotrope (around eyes)
Myositis - prox muscle weakness

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39
Q

What causes dermatomyositis?

A

Idiopathic
Inflammatory tissue disorders
Underlying malignancy (always check!)

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40
Q

What is the first line antibiotic for UTI

A

Trimethoprim
Nitrofurantoin

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41
Q

If someone is taking methotrexate, what UTI antibiotic is contraindicated and why?

A

Trimethoprim causes bone marrow suppression
Never prescribe 2 meths together

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42
Q

What are the complications of PPIs (eg. omeprazole)

A

Hyponatraemia
Osteoporosis
Colitis
C Diff.

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43
Q

What are the symptoms of a temporal lobe seizure

A

Automatisms
Hallucinations

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44
Q

What are the symptoms of an occipital lobe seizures

A

Visual symptoms

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45
Q

What are the symptoms of a parietal lobe seizure

A

Paraesthesia

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46
Q

What are the symptoms of a frontal lobe seizure

A

Motor symptoms with post-ictal weakness
Jacksonian march

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47
Q

What medication increases the risk of necrotising fascitits (2ndary bacterial infection) in chicken pox

A

NSAIDS increase the risk of secondary bacterial infections (group A strep.)

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48
Q

What is the threshold for blood transfusion?

A

70g/L in patients without ACS

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49
Q

What is the threshold for blood transfusion in patients with ACS?

A

80g/L

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50
Q

A patient is very talkative and makes odd statements such as ‘my mini mouse might make me mumble’ and ‘aspirin is an amazing antidote’.

What thought disorder is this?

A

Clang associations

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51
Q

What is the risk of cardioversion and when should it be avoided

A

Thrombus being thrown off to stroke
Avoid cardioversion if long duration of symptoms and/or not anticoagulated

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52
Q

What is the criteria called for infective endocarditis

A

Duke’s criteria

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53
Q

Describe the criteria for infective endocarditis

A

Both major: blood cultures positive (x2), echo positive for IE

or all 5 Minor: IVDU or heart condition, fever, vascular phenomena (septic emboli, haemorrhage), immunologic phenomena, microbiological evidence

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54
Q

What is the criteria for sleep apnoea tiredness

A

Epworth sleepiness scale

How much do you sleep in different situation

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55
Q

In what condition is the Sokolov-Lyon criteria used

A

Left ventricular hypertrophy (voltage + non-voltage criteria)

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56
Q

What is metabolic syndrome

A

diabetes, HTN, obesity

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57
Q

What is the first line treatment for ulcerative colitis

A

Mesalazine

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58
Q

What is the first line treatment for Crohns

A

Azathioprine

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59
Q

What are the complications associated with azathioprine

A

non-melanoma skin cancer
bone marrow suppression
pancreatitis

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60
Q

What are the side effects of steroids

A

Psychosis
Infection
Cushing’s
Diabetes
Osteoporosis
Acne

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61
Q

How do you treat acute severe colitis

A

Hospital admission: 3 days of steroids
If not better then surgery

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62
Q

What is the criteria for assessing the severity of ulcerative colitis and what does it include

A

bowel movements per day

Truelove Witts Severity Index
no. times a day
blood in stool
pyrexia
pulse >90
Hb - anaemia
ESR/CRP

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63
Q

What is the age of onset for inflammatory bowel disease

A

Bimodal distribution
One peak in teenage years
Another in 60s

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64
Q

How do you treat DIC

A

Treat underlying cause
FFP + cryoprecipitate
Platelets if active bleeding

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65
Q

What can cause DIC

A

TOASTS
Trauma, obstetric complications, acute pancreatitis, sepsis, tumour, snakebite

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66
Q

What do you see on blood film for iron deficiency anaemia

A

Hypochromic, pencil poikilocytes cells
Dimorphic film
Target cells

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67
Q

What do you see on a blood film in hyposplenism

A

Target cells
Howell-jowell bodies
siderotic granules
pappenheimer bodies
acanthocytes

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68
Q

What do you see on a blood film in G6PD

A

Heinz bodies

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69
Q

What do you see on a blood film for intravascular haemolysis

A

Schistocytes

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70
Q

Give examples of sulfonylureas

A

Gliclizide
Glipizide
Tolbutamide

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71
Q

Give 3 examples of sodium channel blockers

A

Lidocaine
Flecainide
Quinidine

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72
Q

What are the contraindications of beta-blockers

A

Asthma
AV heart block
Hypotension
Bradycardia
Heart failure

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73
Q

What are the side effects of beta blockers

A

hypotension
bradycardia
cold peripheries
dizziness
fatigue
erectile dysfunction
sleep disturbance

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74
Q

What are the contraindications for ARBs

A

Afro-Caribbean
low eGFR
renal artery stenosis

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75
Q

What are the effects of beta blockers in pregnancy and which are safe to use

A

Intrauterine growth restriction
Neonatal hypoglycaemia, bradycardia

Labetalol

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76
Q

What are the contraindications of calcium channel blockers

A

Unstable angina
Pregnancy

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77
Q

What are the contraindications of thiazide diuretics

A

Hyponatraemia, hypokalaemia, hypercalcaemia
Addisons,
Diabetes,
Gout

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78
Q

How do thiazide diuretics affect electrolytes?

A

Increase excretion of sodium and potassium
Decrease excretion of calcium

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79
Q

What are the side effects of thiazide diuretics

A

Electrolyte disturbance
Dizziness, fatigue
Erectile dysfunction
Photosensitivity
Agranulocytosis, aplastic anaemia

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80
Q

Give 2 examples of thiazide diuretics

A

bendroflumethiazide
hydrochlorothiazide

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81
Q

Give an example of a thiazide like diuretic

A

indapamide

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82
Q

What are the side effects of calcium channel blockers

A

peripheral oedema
flushing
erectile dysfunction
dizziness, fatigue

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83
Q

What are the side effects of ACE inhibitors

A

Alopecia
Vertigo
Tinnitus
Dizziness

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84
Q

What are the contraindications of ACE inhibitors

A

Afro-Caribbean
Reduced eGFR
Diabetics

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85
Q

Give examples of 3 opiods

A

Morphine
Codeine
Oxycodone

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86
Q

What are the 3 classess of drugs + examples that can be used to treat gastric/peptic reflux

A

PPI - lanzoprazole, omeprazole
Alginate-forming - gaviscon
H2 - ranitidine

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87
Q

What scoring tool is used to assess depression

A

PHQ-9

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88
Q

What are the classes of antiarrhythmetic drugs

A

Na+ channel blockers
Beta blockers
K+ channel blockers
Ca2+ channel blockers

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89
Q

What drugs can be given to control gout

A

Allopurinol
Colchicine

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90
Q

What are the causes of macrocytosis

A

Alcohol excess
B12, folate deficiency
Hypothyroidism

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91
Q

How long before an H Pylori test should you stop a PPI

A

2 weeks

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92
Q

Give 3 examples of potassium channel blockers

A

Amiodarone
Dofetilide
Sotalol (beta and K+)

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93
Q

Give an example of a long acting beta agonist

A

Fometerol

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94
Q

What are the complications of PPI use

A

Osteoporosis
Renal impairment
Hyponatraemia

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95
Q

Give examples of SGLT2 inhibitors

A

Flozins
Empagliflozin
Dapalifloxin
Canagliflozin

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96
Q

How do DPP4 inhibitors work

A

They inhibit the breakdown of GLP-1
This slows gastric emptying, increases glucose, decreases glucagon

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97
Q

Give examples of DPP4 inhibitors

A

Gliptins
Saxagliptin
Alogliptin
Vildagliptin

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98
Q

What causes a holosystolic murmur

A

Mitral or tricuspid regurg

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99
Q

What is a Baker’s cyst and why do you get it

A

A popliteal cyst
Secondary to arthritis or to meniscus tear

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100
Q

Give examples of steroid creams from mild, moderate, potent and very potent

A

hydrocortisone
betnovate
beclometasone
dermovate

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101
Q

What is Evan’s syndrome

A

Immune thrombocytopaenia + autoimmune haemolytic anaemia (simultaneous or sequential)

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102
Q

What antibody is implicated in cold autoimmune haemolytic anaemia

A

IgM

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103
Q

What antibody is implicated in warm autoimmune haemolytic anaemia

A

IgG

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104
Q

What are the features of haemolytic anaemia on a blood test

A

Decreased haptoglobin
increased reticulocytes
anaemia
increased LDH (haemolysis)
increased unconjugated bilirubin

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105
Q

What is the first line antibiotic in neutropaenic sepsis

A

Tazocin = tazobactam + pipperacillin

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106
Q

What is the likely causative organism in neutropaenic sepsis

A

Staph. epidermidis (think from an indwelling line, chemo)

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107
Q

Give 3 examples of sleeping aides

A

Melatonin, diphenhydramine, promethazine

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108
Q

Where in the nephron do SGLT2 inhibitors act

A

PCT

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109
Q

How do sulfonylureas work

A

Increase plasma insulin

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110
Q

What is the prophylaxis for neutropaenic sepsis and when should it be given

A

Fluoroquinolone
<0.5 x10^9

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111
Q

What is seen on a blood film for myelofibrosis

A

‘tear-drop’ poikilocytes

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112
Q

Give an example of a non sedating antihistamine

A

Loratadine

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113
Q

What are the diagnostic criteria for pre-eclampsia

A

BP> 140/90 after 20 wks
Proteinuria or organ dysfunction

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114
Q

When do you admit a woman with pre-eclampsia into hospital

A

BP > 160/110

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115
Q

What is the first line management for pre-eclampsia

A

Labetalol
Nifedipine if asthmatic

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116
Q

A deficiency in which immunoglobulin increases the risk of anaphylactic reactions following transfusions

A

IgA
A deficiency means there will be increased anti-IgA, causing the anaphylactic reaction in transfusion

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117
Q

What is the first line treatment for atrioventricular node re-entrant tachycardia (AVNRT)

A

Adenosine

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118
Q

What are the adverse effects of adenosine

A

Chest pain
Bronchospasm (avoid in asthmatics)
Transient flushing

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119
Q

What opiate is most appropriate in patients who have mild-moderate renal impairment

A

Oxycodone

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120
Q

In palliative care how do you prescribe opiates for breakthrough pain

A

1/6th of the daily dose for breakthrough pain

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121
Q

What opiate is most appropriate in patients who have severe renal impairment

A

fentanyl, buprenorphine, alfentanil

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122
Q

What side effects of opiates should patients be informed about

A

Constipation (prescribe laxative)
Nausea (usually transient, prescribe anti-emetic if not)
Drowsiness (usually transient, adjust dose of opiate if not)

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123
Q

What drugs cause gingival hyperplasia

A

Phenytoin
Ciclosporin
CCB (esp. nifedipine)

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124
Q

What are the indications for an urgent referral for patients with dyspepsia

A

Dysphagia
upper abdominal mass
weight loss

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125
Q

What are the indications for a non urgent referral for patients with dyspepsia

A

Haematemesis
treatment resistant dyspepsia

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126
Q

What are the features of yellow fever

A

Initial flu like illness that resolves
Then after 48 hours deteriorates: jaundice, fever, vomiting, pain

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127
Q

What marker us used to monitor the progression of colon cancer

A

CEA = carcinoembryonic antigen

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128
Q

What conditions cause an underestimate of HbA1C

A

Reduced lifespan of RBCs:
Sickle cell
G6PD
Spherocytosis
Dialysis

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129
Q

What conditions cause an overstimate of HbA1C

A

Increased lifespan of RBCs:
b12, folate, iron deficiency
splenectomy

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130
Q

What are the adverse effects of methotrexate

A

mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis

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131
Q

How long should a woman avoid pregnancy for after taking methotrexate

A

6 months

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132
Q

How often is methotrexate taken

A

once weekly

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133
Q

What should be prescribed with methotrexate

A

Folic acid 5mg

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134
Q

What prophylaxis should be given to contacts of a patient with meningococcal meningitis

A

Ciprofloxacin or rifampicin

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135
Q

How do you image a perianal fistula

A

MRI pelvis

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136
Q

How do you treat status epilepticus, pre hospital and hospital

A

Airway, oxygen, glucose

benzos prehospital - PR diazepam or buccal midazolam
In hospital start with IV lorazepam can be given twice

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137
Q

According to the WHO surgical safety checklist, what are the three phases of an operation and when do they occur?

A

1: before induction of anaesthesia (sign in)
2: before incision (time out)
3: before patient leaves operating room (sign out)

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138
Q

What are the first and second line antibiotics for cellulitis + what do you use in pregnancy

A

Flucloxacillin
If allergic: clarithromycin + if pregnant: erythromycin

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139
Q

What is the classification system for cellulitis

A

Eron classification system
1-4

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140
Q

How do you tell the difference between a TIA and a stroke

A

Based on imaging

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141
Q

How do you manage a patient with TIA

A

Secondary prevention: Anti-platelet (clopidogrel/aspirin 75mg bd) + statin (atorvastatin 20-80mg od)
Carotid artery endarterectomy if carotid stenosis >70%

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142
Q

What antibodies do you test for SLE

A

ANA positive (sensitive)
anti-dsDNA, anti-Smith (specific)

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143
Q

How do you monitor SLE flares

A

In an SLE flare complement levels are low; ESR

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144
Q

What is the drug of choice for oestrogen receptor positive breast cancer

A

Pre-menopausal: Tamoxifen
Post-menopausal: Anastrozole (aromatase inhibitors)

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145
Q

What are the adverse effects of tamoxifen

A

Menstrual disturbance
Hot flushes
VTE
Endometrial cancer

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146
Q

What are the adverse effects of anastrazole

A

Osteoporosis (needs DEXA)
hot flushes
arthralgia/myalgia
insomnia

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147
Q

What is the drug therapy for angina pectoris

A

Aspirin + statin
Beta-blocker or calcium channel blocker (prevention)
Short acting nitrate (abort attacks)

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148
Q

What does bull’s eye maculopathy on fundoscopy indicate

A

Retinopathy due to hydroxychloroquine

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149
Q

What are the anterior leads on ECG

A

V2-V4

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150
Q

What artery is covered by V2-V4

A

LAD

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151
Q

What artery is covered by V3-V6 + I, aVL

A

LAD, circumflex

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152
Q

What are the inferior leads on ECG

A

II, III, aVF

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153
Q

What artery is covered by II, III, aVF

A

RCA

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154
Q

What are the lateral leads on ECG

A

I, aVL, V5, V6

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155
Q

What artery is covered by I, aVL, V5, V6

A

Circumflex

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156
Q

When are Q waves pathological

A

When they are more than 25% of the amplitude of the R wave
When they last more than 40ms

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157
Q

What causes transudative pleural effusions

A

Heart failure, cirrhosis, kidney failure

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158
Q

Describe fluid for a transudative pleural effusion

A

clear
low protein
low LDH

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159
Q

What causes exudative pleural effusions

A

Infection
PE
malignancy
autoimmune diseases

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160
Q

Describe fluid in an exudative pleural effusion

A

cloudy/turbid
high protein
high LDH

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161
Q

What criteria differentiates between exudative and transudative pleural effusion

A

Light’s criteria, one of the following

Pleural fluid protein-to-serum protein ratio > 0.5.
Pleural fluid LDH-to-serum LDH ratio > 0.6.
Pleural fluid LDH > two-thirds of the upper limit of normal for serum LDH.

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162
Q

What procedure is used to remove fluid from pleural space

A

thoracentesis

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163
Q

What is the most common cause of hyperthyroidism

A

Grave’s disease

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164
Q

What features are specific to Grave’s disease but not other causes of thyrotoxicosis

A

Exophthalmos
Pretibial myxoedema
TSH antibodies
TPO antibodies

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165
Q

What are the features of hyperkalaemia on ECG

A

Tall-tented T waves
loss of p waves
broad QRS
sinusoidal wave

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166
Q

How do you treat hyperkalaemia

A

Stabilisation of cardiac membrane with calcium gluconate

Move K into cells: insulin/dextrose, nebulised salbutamol

Remove from body: calcium resonium (enema better than oral); loop diuretics

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167
Q

What is the most common cause of death following MI

A

Ventricular fibrillation

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168
Q

What are the features of Dressler’s syndrome

A

Pericarditis 2-6 weeks after MI.
Fever pleuritic chest pain, pericardial effusion and raised ESR

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169
Q

How do you treat Dressler’s syndrome

A

NSAIDS

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170
Q

What does a VSD sound like on auscultation

A

Pansystolic murmur

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171
Q

What are the complications of an MI

A

Cardiac arrest
Heart failure
VF, AV block
Pericarditis (<48 hours)
Dressler’s (2-6 weeks)
LV aneurysm
LV wall rupture (tamponade) (1-2 weeks)
VSD (<1 week)
Acute mitral regurgitation (ischaemia of papillary muscle)

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172
Q

What drugs can cause thrombocytopaenia

A

Quinine (antimalarial)
Abciximab
NSAIDs
Furosemide
Abs: Penicillin, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin

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173
Q

What is the pathophysiology, features and distribution of dermatitis herpetiformis?

A

IgA deposition in the dermis; associated with coeliac disease

Itchy vesicular skin lesions on extensor surfaces

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174
Q

How do you treat plantar warts (verruca)

A

Topical salicylic acid, daily for 12 weeks

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175
Q

What is an erythematous patch of rough itchy scaly skin lesion on sun exposed area and how do you treat it

A

Actinic keratosis
Topical diclofenac

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176
Q

What can be given to treat head lice

A

Malathion

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177
Q

Why are oesophageal varices caused by chronic liver disease

A

Vessels are dilated because of increased portal/splanchnic pressure
Haemorrhage common due to lack of clotting factors (synthetic capacity of liver reduced)

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178
Q

How do you acutely manage oesophageal varices

A

ABC
Correct clotting (FFP, Vit K, platelets)
Terlipressin
& Antibiotics

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179
Q

What is the pattern of inheritance for the genes involved in hypertrophic obstructive cardiomyopathy

A

Autosomal dominant

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180
Q

How do you manage hypertrophic obstructive cardiomyopathy

A

Amiodarone
Beta-blockers/verapamil
Cardioverter defib
Dual chanber pace-maker
Endocarditis prophylaxis

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181
Q

What drugs should be avoided in hypertrophic obstructive cardiomyopathy

A

Nitrates
ACE-inihibitors
Inotropes
As they reduce afterload, in the context of obstruction this can worsen outflow

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182
Q

What are the symptoms of SSRI discontinuation

A

FIRMSTOP
Flu like Sx
Insomnia
Restlessness
Mood swings
Sweating
Tummy problems (pain, cramps, D+V)
Off balance
Parasthaesia

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183
Q

What are the side effects of SSRIs in pregnancy

A

In first trimester there is a small increased risk of congenital heart defects
In third trimester there can be persistent pulmonary hypertension of the newborn

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184
Q

What SSRI increases the QT interval

A

Citalopram

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185
Q

What is the first line management for TIA

A

300mg aspirin
unless contraindicated, already on it, or anticoagulated

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186
Q

What drugs cause acute interstitial nephritis

A

Penicillin
Rifampicin
NSAIDs
Allopurinol
Furosemide

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187
Q

What diseases are associated with acute interstitial nephritis

A

SLE, Sjogrens, sarcoidosis

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188
Q

What is the pathophysiology of acute interstitial nephritis

A

Inflammatory infiltrates and oedema in interstitium with acute deterioration of renal function.

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189
Q

What are the symptoms of acute interstitial nephritis

A

Fever
Rash
Arthralgia

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190
Q

What do you see on urine dip in acute interstitial nephritis

A

Sterile pyuria = WBCs no bacteria

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191
Q

When is the cremasteric reflex absent with tender teste

A

Testicular torsion of spermatic cord

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192
Q

When is the cremesteric reflex present with tender superior pole of teste

A

When it is torsion of the testicular appendage

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193
Q

What drug may cause epididymitis

A

Amiodarone

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194
Q

What is posterior vitreous detachment and when does it occur

A

Separation of vitreous membrane from retina posteriorly
Occurs typically after 65, in short sighted

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195
Q

What are the symptoms of posterior vitreous detachment

A

Sudden floaters
Flashing lights
Blurred vision

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196
Q

What sign on ophthalmoscopy is associated with vitreous membrane detachment

A

Weiss ring

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197
Q

How do you manage a posterior vitreous detatchment

A

Urgent referral to ophthalmology to rule our retinal detachment
Symptoms should gradually improve over 6 months therefore no treatment is necessary

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198
Q

What is the target for HbA1c and when should you add another drug

A

Target is 48mmol/mol
Add drug at 58 mmol/mol

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199
Q

When should SGLT-2 inhibitors be given in type 2 diabetes

A

Monotherapy if metformin is contraindicated
With metformin if there is CVD

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200
Q

What is second line therapy for type 2 diabetes

A

Metformin + DPP4/pioglitazone/sulfonylurea

Metformin + SGLT2 if CVD risk

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201
Q

How does pioglitazone work?

A

Reduced peripheral insulin resistance

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202
Q

When should a statin be given as primary prevention (and which one/dose)

A

QRISK2>10%
Atorvastatin 20mg

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203
Q

When should statin be given as secondary prevention (and which one/dose)

A

Hx of ischaemic heart diease, cerebrovascular disease, peripheral artieral disease

Atorvastatin 80mg

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204
Q

What UTI antibiotic should be avoided in pregnancy

A

Trimethoprim is teratogenic in the first trimester

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205
Q

How long should you prescribe an antibiotic for an UTI in pregnant women vs non pregnant women

A

3 days if not pregnant
7 days if pregnant

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206
Q

What are the first and second line antibiotics to be used in UTI in pregnancy

A

1: nitrofurantoin
2: amoxicillin/cefalexin

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207
Q

What antibiotic should be avoid near term in pregnancy

A

Nitrofurantoin

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208
Q

What are the features of myesthenia gravis

A

Diplopia
Proximal muscle weakness
Ptosis
Dysphagia

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209
Q

What investigations should be carried out for myesthenia gravis

A

Single fibre electromyography (neuromuscular junction)
CT thorax
Antibodies to aceylcholine receptors

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210
Q

How do you manage myasthenia gravis

A

Pyridostigmine (long acting acetylcholinesterase inhibitor)
Prednisolone
Azathioprine
Thymectomy

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211
Q

How do you manage a myasthenic crisis

A

Plamapheresis
IVIGs

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212
Q

How does the contraceptive implant work

A

Inhibits ovulation by releasing progesterone
Inhibits the release of FSH and LH

Also increases cervical mucus thickness

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213
Q

How does the COCP work

A

Inhibits ovulation

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214
Q

How does the POP work

A

Thickens cervical mucus

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215
Q

How does the injectable contraceptive (medroxyprogesterone acetate) work

A

Inhibits ovulation by releasing progesterone
Inhibits the release of FSH and LH

Also increases cervical mucus thickness

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216
Q

How does the IUD work

A

Decreases sperm motility and survival

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217
Q

How does the IUS work

A

Prevents endometrial proliferation

Thickens cervical mucus

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218
Q

What can cause rhabdomyolysis

A

Seizure
Collapse
Ecstacy
Crush injury
Statins + esp. w clarithromycin

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219
Q

How high does CK have to be to indicate rhabdomyolysis

A

At least 5 times upper limit

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220
Q

What are the features of rhabdomyolysis

A

Myoglobinuria = brown urine
Hypocalcaemia, bound by myoglobin
Hyperkalaemia, high phosphate - released from muscle cells
Metabolic acidosis

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221
Q

How do you manage rhabdomyolysis

A

IV fluids - urine output

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222
Q

How does spirinolactone work

A

Aldosterone antagonist actingin in cortical collecting duct

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223
Q

What are the adverse effects of spirinolactone

A

Hyperkalaemia
Gynaecomastia

224
Q

What is the first line anticoagulant of choice in AF

A

DOAC

225
Q

What is the second line anticoagulant of choice in AF

A

Warfarin if DOAC is CI’s or not tolerated

226
Q

What is the most common skin disorder in pregnancy

A

Atopic eruption of prenancy

227
Q

Describe an atopic eruption of pregnancy

A

Eczematous, itchy red rash
No treatment needed

228
Q

Describe a polymorphic eruption of pregnancy

A

Pruritic rash
Last trimester

229
Q

How do you treat a polymorphic eruption of pregnancy

A

Emollients
Topical steroids
Oral steroids

230
Q

What is the look of pemphigoid gestationis, its distribution, and treatment

A

Pruritic, blistering lesions
2nd or 3rd trimester
Peri-umbillical, then trunk and arms
Oral steroids

231
Q

What cancer does CA125 track

A

Ovarian cancer

232
Q

What cell type is the most common ovarian cancer

A

Serous carcinoma

233
Q

What are the risk factors for ovarian cancer

A

early menarche, late menopause, nulliparity

234
Q

What are the symptoms of ovarian cancer

A

Abdominal distension and bloating
Abdo/pelvic pain
Urinary symptoms (urgency)
Early satiety
Diarrhoea

235
Q

What conditions may raise CA125

A

Ovarian cancer
endometriosis
menstruation
benign ovarian cysts

236
Q

How you investigate suspected ovarian cancer

A

CA125 - if raised then do abdo/pelvic ultasound

237
Q

How is ovarian cancer treated

A

Surgery
Platinum based chemotherapy

238
Q

What is the first line management for renal colic pain

A

NSAIDs

239
Q

What are the contraindications of NSAIDs

A

Peptic ulcer bleeds, IBD
Allergy
Heart failure, thrombotic disease
Elderly

240
Q

How do you treat renal stones

A

NSAIDs/paracetamol
Alpha blockers (dilate ureter)
Non contrast CT KUB
If small <5mm let it pass
If obstructing ureter - surgical emergency + need Abs
Otherwise shockwave lithotripsy, uteroscopy, percutaneous nephrolithotomy

241
Q

What are the types of systemic sclerosis

A

Limited cutaneous
Diffuse cutaneous
Scleroderma

242
Q

What are the features of limited cutaneous systemic sclerosis

A

Raynauds
Scleroderma in face and distal limbs
CREST: calcinosis, raynauds, oesophageal dysmotility, sclerodactyly, telangiectasia

243
Q

What are the features of diffuse cutaneous systemic sclerosis

A

Scleroderma trunk and prox limbs
interstitial lung disease
renal disease
hypertension

244
Q

What is scleroderma

A

Tightening, fibrosis of skin

245
Q

What antibody is associated with systemic sclerosis

A

ANA

246
Q

What is the most specific antibody for diffuse cutaneous systemic sclerosis

A

Anti-Scl-70

247
Q

What drug causes nephrogenic diabetes insipidus

A

lithium
desensitises kidney to ADH

248
Q

What is Stokes-Adams syndrome

A

LOC with sudden drop in cardiac output
Think heart block

249
Q

How do you differentiate between sensorineural and conductive hearing loss on audiogram

A

In SN: hearing loss in both air and bone conduction

In conductive: hearing loss in air

In mixed: both but worse in air

250
Q

What is Perthes disease

A

Condition affecting hip in children, over a couple of weeks
Low blood supply causes change in shape: X ray shows widening of joint and flattening of femoral head

251
Q

What causes transient sinovitis

A

Viral infection in children
Most common cause of hip pain in children

252
Q

What do you see on X ray for Perthes disease

A

Widening of joint space
Flattening of femoral head

253
Q

What makes a death a notifiable death

A

unexpected or sudden deaths

if a death occurs within 24 hours of hospital admission

accidents and injuries

suicide
industrial injury or disease (e.g. asbestosis)

deaths occurring as a result of ill treatment, starvation or neglect

the death occurred during an operation or before recovery from the effect of an anaesthetic

poisoning, including taking illicit drugs

stillbirths - if there is doubt as to whether the child was born alive

prisoner or people in police custody

service disability pensioners

254
Q

What is biliary atresia and when does it present

A

Neonatal condition in biliary tree does not form - obstruction of flow of bile
Presents in the first 2-8 weeks of life

255
Q

What are the features of biliary atresia

A

2-8 wks old
Jaundice
dark urine + pale stool
bad feeding

256
Q

How do you treat biliary atresia

A

Surgical dissection of abnormal biliary tract

257
Q

How is Alport’s syndrome typically inherited

A

X linked dominant

258
Q

What is Alport’s syndrome

A

Defect in type IV collagen gene leading to an abnormal glomerular basement membrane

259
Q

What are the features of Alport’s syndrome

A

Microscopic haematuria
Renal failure
Bilateral sensorineural deafness
Splitting of lamina densa on electron microscopy of renal biopsy

260
Q

What do you see on electron microscopy of renal biopsy in patients with Alport syndrome

A

Splitting on lamina densa of glomerular membrane - ‘basket-weave appearance’

261
Q

What are the primary features of syphilis

A

Chancre - painless ulcer at site of sexual contact
Local non tender lymphadenopathy

262
Q

What are secondary features of syphilis

A

Fever, systemic lymphadenopathy
rash on trunk, palms, soles

263
Q

Where does syphilis cause a rash

A

Trunk, palms, soles

264
Q

What are the tertiary features of syphilis

A

Gumma = granulomatous lesion
Aortic aneurysm
Argyll-Robertson pupil (do not constrict on bright light; but do on a nearby object)

265
Q

What is used to fix an extracapsular NOF fracture

A

Intramedullary device

266
Q

When is a total hip replacement indicated

A

Displaced intracapsular fracture

267
Q

When is a hemi-arthroplasy indicated

A

Intracapsular fracture in patients with poor pre-morbid status

268
Q

When is internal fixation suitable for NOF fracture

A

Intracapsular, undisplaced fracture in patients with good pre-morbid status

269
Q

What procedure is most appropriate for an undisplaced intracapsular NOF fracture

A

Internal fixation
if poor pre-morbid status then hemi-arthroplasty

270
Q

What procedure is most appropriate for a displaced intracapsular NOF fracture

A

total hip replacement
if poor pre-morbid status then hemi-arthroplasty

271
Q

What does a coffee bean sign on x-ray indicate

A

sigmoid volvulus

272
Q

How do you manage a sigmoid volvulus

A

decompression with rigid sigmoidoscopy and flatus tube insertion

second line is percutaneous decompression

273
Q

How do you manage a caecal volvulus

A

right hemi-colectomy

274
Q

What is a Hartmann’s procedure

A

proctosigmoidectomy

275
Q

If a woman is treated for cervical intraepithelial neoplasia (CIN) how long after this should she be followed up for test of cure

A

6 months

276
Q

Describe the stages of cervical screening

A

HPV first
then if +ve; ctytology
then if abnormal; colposcopy

277
Q

On cervical screening a patient is HPV+ve
The cytology is normal, when should the test be repeated?

A

12 months

278
Q

On cervical screening, the patient is hrHPV -ve. When should the test be repeated?

A

Return to normal recall
3-5 years depending on age

279
Q

On cervical screening, the sample is inadequate, when should the test be repeated?

A

3 months

280
Q

At what age should a child smile

A

10 weeks

281
Q

At what age should a child sit unsupported

A

12 months

282
Q

At what age should a child begin to walk

A

18 months

283
Q

What early sign in infants may indicate cerebral palsy, and what should be done

A

Hand preference before 12 months
Urgent MDT referral

284
Q

What does painless jaundice and palpable RUQ mass indicate

A

Pancreatic cancer

285
Q

What is the age of onset for temporal arteritis

A

Peak 70

286
Q

How do you investigate temporal arteritis

A

ESR ++
CRP
Temporal artery biopsy (?skip lesions)
Make sure there are no visual changes

287
Q

How do you treat temporal arteritis

A

High dose glucocorticoids stat
If no evolving visual loss - prednisolone
If evolving visual loss then IV methylprednisolone

Bone protection with bisphosphonates

288
Q

What is the first hearing test a baby will have

A

Otoacoustic emission test

289
Q

What is the test given to babies that have an abnormal otoacoustic emission test

A

Auditory brainstem response test

290
Q

What are the symptoms of Addisonian crisis

A

Low BP
hyperkalaemic met acidosis
Pain in legs and abdomen
Diarrhoea
Vomiting

291
Q

How do you manage an Addisonian crisis

A

hydrocortisone 100mg IV/IM
fluids

292
Q

What are the criteria for a non urgent referral for a breast lump

A

Non urgent referral for those under 30 with breast lump with or without pain

293
Q

What are the criteria for an urgent referral for a breast lump

A

Age 30 or over with breast lump, axilla lump
Age 50 or over with unilateral nipple/skin changes

294
Q

What does CA 19-9 measure

A

Cholangiocarcinoma

295
Q

What is first line to treat peri-arrest bradycardia

A

Atropine 500 mcg IV

296
Q

What antibody is associated with rheumatoid arthritis

A

Anti-CCP

297
Q

What is the first line investigation for endometrial cancer

A

Transvaginal ultrasound

298
Q

What are the signs of radial nerve damage

A

Wrist drop (can’t extend)
Sensory loss at 1st and 2nd metacarpal dorsal surface

299
Q

What are the signs of axillary nerve damage

A

Tricep paralysis (can’t extend elbow)

300
Q

How do you treat anaemia in CKD

A

First optimise iron
Then EPO

301
Q

What is the first line antibiotic for tonsilitis

A

Phenoxymethylpenicillin
Clarithromycin

302
Q

What is the Centor criteria

A

Likelihood sore throat is caused by Strep

presence of tonsillar exudate
cervical lymphadenopathy
fever
no cough

303
Q

When should antibiotics be given for a sore throat

A

When the Centor criteria is > 3
Immunodeficiency
Systemically unwell

304
Q

What may cause reactivation of TB

A

Immunosuppression: HIV, steroid therapy, malnutrition

305
Q

What is a strawberry cervix

A

Punctated and erythematous - trichomonas vaginalis

306
Q

What are the symptoms of trichomonas vaginalis

A

Green/yellow discharge
Vulvovaginitis
Strawberry cervix (punctated, erythematous)

307
Q

How you treat trichomonas vaginalis

A

Oral metronidazole

308
Q

What is the legal framework used to treat patients who refuse treatment in emergency scenarios

A

Common law

309
Q

What the pathophysiology of red degeneration of fibroids

A

Fibroids are sensitive to oestrogen so grow during pregnancy, so fast they outstrip their blood supply

310
Q

What are the symptoms of red degeneration of fibroids

A

Fever
Pain
Vomiting

311
Q

How do you manage red degeneration of fibroids

A

Conservatively, should resolve in 4-7 days

312
Q

What is Richter’s transformation and what are the symptoms

A

Leukaemia cells enter lymph node -> change into fast growing non-Hodgkin’s lymphoma

Lymph node swelling
Fever without infection
Weight loss
Night sweats
Nausea, abdo pain

313
Q

What are the symptoms of Addisons disease

A

Hyponatraemia (confusion)
Hyperpigmentation (ACTH excess)
Low blood pressure
High potassium

314
Q

How do you prevent/treat seizures in pre-eclampsia

A

Magnesium sulphate

315
Q

How do you treat magnesium sulphate induced respiratory depression

A

Calcium gluconate

316
Q

What should you monitor when giving magnesium sulphate for eclampsia

A

Resp rate (risk of respiratory depression)
Urine output, oxygen
Reflexes

317
Q

When should anticoagulation for AF start after a TIA/stroke

A

After TIA - anticoagulate immediately
After stroke - antiplatelet immediately, anticoagulate after 2 weeks

318
Q

What is the dose of adrenaline used in anaphylaxis

A

IM 0.5mg adrenaline 1:1000 every 5 mins x2

319
Q

In colorectal surgery, why is epidural analgesia better than IV/PO

A

Faster return to normal bowel function

320
Q

What scan is most appropriate for MS

A

MRI contrast CNS demyelination

321
Q

What are the features of MS

A

Relapsing remitting

Visual (optic neuritis)
Sensory symptoms
Leg weakness
Cerebellar symptoms
Urinary/sexual symptoms

322
Q

How do you treat MS

A

In relapse - steroids reduce length of relapse

Disease modifying drugs can be given if people keep relapsing

323
Q

What organism causes eczema herpeticum

A

Herpes simplex virus 1 or 2

324
Q

How does eczema herpeticum present

A

Rapidly progressing painful rash in children with atopic eczema

325
Q

How do you treat eczema herpeticum

A

Life threatening
Admit for IV aciclovir

326
Q

What is the first line treatment for the first episode of C Diff infection

A

Oral vancomycin

327
Q

How do you treat a life-threatening C Diff infection

A

Oral vancomycin + IV metronidazole

328
Q

How do you treat C diff if recurrent episode occurs within 12 weeks of symptom resolution

A

Fidaxomicin

329
Q

How do you treat C diff if a reccurent episode occurs after 12 weeks of symptom resolution

A

Fidaxomicin or vancomycin

330
Q

How do you treat spasticity in MS

A

Baclofen or gabapentin

331
Q

How do you treat oscillopsia in MS

A

gabapentin

332
Q

What are the symptoms associated with L3 nerve root compression

A

Sensory loss of anterior thigh
Weak hip flexion, knee extension, hip adduction

Reduced knee reflex

Positive femoral stretch test

333
Q

What are the symptoms associated with L4 nerve root compression

A

Sensory loss anterior aspect of knee and medial malleolus

Weak knee extension and hip adduction

Reduced knee reflex

Positive femoral stretch test

334
Q

What are the symptoms of L5 nerve root compression

A

Sensory loss in dorsum of foot

Weakness in foot and big toe dorsiflexion

Positive sciatic nerve stretch test

335
Q

What are the symptoms of S1 nerve root compression

A

Sensory loss in postero-lateral aspect of leg and lateral foot

Weakness in plantar flexion of foot

Reduced ankle reflex

Positive sciatic nerve stretch test

336
Q

What is the femoral stretch test

A

Patient on abdomen, flex knee, cause pain

337
Q

What is the sciatic nerve stretch test

A

Patient on back, flex hip, cause pain

338
Q

How do you treat MSK lower back pain

A

NSAIDs with PPI

339
Q

What are the reversible causes of cardiac arrest

A

4 H’s, 4 T’s

Hypoxia, hypothermia, hyper/hypokalaemia, hypovolaemia

Thrombosis, tension pneumothorax, tamponade, toxins

340
Q

In life support, what is the first medication given for pulseless electrical activity

A

1mg IV adrenaline

Non-shockable

341
Q

What are the shockable rhythms

A

Ventricular fibrillation
Pulseless ventricular tachycardia

342
Q

What are the non-shockable rhythms

A

Asystole
Pulseless electrical activity (PEA)

343
Q

What symptoms are associated with Behcet’s syndrome

A

Anterior uveitis
Oral ulcers
Genital ulcers

Autoimmune-mediated

344
Q

What vitamins does pabrinex have

A

Pabrinex contains B and C

345
Q

What are the symptoms of osteomalacia and what causes it

A

Bone pain, tenderness, proximal myopathy

Low vit D -> softening of bones -> increased ALP, low calcium, low phosphate, increased PTH

346
Q

What are the characteristics of Paget’s disease

A

Older male, isolated bone pain, rise in ALP only

347
Q

What are stag-horn calculi made of and where are they

A

They form in the renal pelvis - hence their shape

The are composed of struvite

348
Q

How long after symptom onset can mechanical thrombectomy be offered

A

Up to 6 hours after symptom onset

349
Q

How long after symptom onset can thrombolysis be offered

A

Up to 4.5 hours after symptom onset

350
Q

Which patients should be offered thrombectomy and when

A

When confirmed proximal anterior circulation occlusion

Offer within 6 hours of symptom onset

Also offer thrombolysis if within 4.5 hours of symptom onset

351
Q

What are the indications for a head CT within 8 hours in patients with a head injury

A

Age 65 or older
anticoagulation
30 mins retrograde amnesia
RTA

352
Q

What are the indications for a head CT within 1 hour in patients with a head injury

A

More than one episode of vomiting
Seizure
Focal neurological deficit
Basal skull fracture
GCS < 13 initially
GCS < 15 2 hours post injury

353
Q

What are the signs of a basal skill fracture

A

Haemotympanum
Panda eyes
Battle’s sign (brusing behind mastoid process)
CSF leaking from ear or nose

354
Q

What is the most effective form of emergency contraception

A

Copper IUD

355
Q

How long after unprotected sex can the copper IUD be used as emergency contraception

A

5 days

356
Q

How long after unprotected sex can levonorgestrel be used as emergency contraception

A

3 days

357
Q

Describe impetigo

A

Golden crusted lesions typically found around the mouth
Very contagious

358
Q

How do you treat impetigo

A

If limited + localised: 1% hydrogen peroxide cream

If extensive flucloxacillin or erythromycin

359
Q

What is the pattern of inheritance of Kallman’s syndrome

A

X-linked recessive

360
Q

What are the features of Kallman syndrome

A

Anosmia
Tall
Delayed puberty
Low testosterone
Hypogonadotropic hypogonadism (no GnRH)

361
Q

What is the karyotype of Klinefelter syndrome

A

47 XXY

362
Q

What are the features of Klinefelter syndrome

A

Tall
Delayed puberty
Lack of secondary sexual characteristics
Hypergonadotropic hypogonadism

363
Q

What is the definition of pre-eclampsia

A

New onset high blood pressure > 140/90 after week 20 of pregnancy + proteinuria or organ involvement

364
Q

What are the causes of spontaneous subarachnoid haemorrhage

A

Intracranial saccular (berry) aneurysm
AV malformation

No trauma if ‘spontaneous’

365
Q

What are the conditions associated with saccular (berry) aneurysms

A

HTN
Polycycstic kidney disease
Ehlers-Danlos
Coarctation of aorta

366
Q

A patient had a normal head CT following ?subaracnoid haemorrhage. How long do you wait to do a lumbar puncture and why?

A

Wait until 12 hours after symptom onset to differentiate between blood from haemorrhage and the blood caused from LP trauma

367
Q

What is the first line investigation for subarachnoid haemorrhage and what will you see

A

Non contrast CT
hyperdense region of haemorrhage

368
Q

How do you prevent vasospasm in subaracnoid haemorrhage

A

Nimodipine

369
Q

What organism is responsible for acute epiglottitis

A

Haemophilus influenzae type B

370
Q

What are the features of acute epiglottitis

A

Stridor
Fever
High temp
Rapid onset
Drooling of saliva

371
Q

What is Stevens-Johnson syndrome

A

Severe systemis drug reaction - maculopapular rash with target lesions

Nikolsy sign positive

Mucosal involvement

Fever arthralgia

372
Q

What drugs cause Stevens Johnson syndrome

A

Penicillin
Sulphonamides
Anticonvulsants: lamotragine, carbamazepine, phenytoin
Allopurinol
NSAIDs
COCP

373
Q

What is Nikolsky sign

A

Blisters and erosions appear when skin is rubbed gently

374
Q

How do you treat fungal nail infection

A

If limited (1 nail, >50%): amorolfine lacquer 6 months for fingernails, 12 months toenails

If extensive (2+ nails): oral terbinafine 3 moths for fingernails, 6 months toenails

375
Q

What is the most common cause of COPD infective exacerbations

A

Haemophilus influenzae

376
Q

How do you manage chickenpox exposure in pregnancy

A

If <20 weeks + not immune = give VZIG up to 10 days after exposure
if >20 weeks + not immune = ZVIG or antivirals 7-14 days after exposure

377
Q

What is the difference between type 1 and type 2 bipolar disorder

A

Type 1: mania
type 2: hypomania

378
Q

What are the features of reactive arthritis

A

Urethritis, conjunctivitis, arthritis

Following dysenteric illness

379
Q

How do you manage reactive arthritis

A

NSAIDs

Intra-articular steroids if not working

380
Q

How do you treat alcohol withdrawal

A

Long-acting benzodiazepines (chlordazepoxide, diazepam)

381
Q

How do you manage a patient on warfarin who has major bleeding

A

Stop warfarin

Vit K 5mg

Prothrombin complex

382
Q

How do you manage a patient with on warfarin with minor bleeding

A

Target INR for <5.0
Stop warfarin
Give vitamin K 1-3 mg PO
Repeat in 24 hours if still too high

383
Q

How do you test for acromegaly

A

First: IGF-1 level

If raised then do oral glucose tolerance test. In which there will be no suppression of GH with hyperglycaemia

384
Q

What are the features of SIADH

A

Hyponatraemia due to dilutionary effect of ADH

385
Q

What are the causes of SIADH

A

Malignancy (small cell, pancreas, prostate)
Neurological (stroke, haemorrhage)
Infectious (TB, pneumonia)
Drugs

386
Q

When are HIV antibodies found after exposure

A

4-6 weeks in most
99% after 12 weeks

387
Q

What do you see on ABG for pyloric stenosis in babies

A

Hypochloremic hypokalaemic metabolic alkalosis

388
Q

When is meningitis B vaccine given

A

2, 4 and 12 months

389
Q

What is the first line antiplatelet in peripheral arterial disease

A

Clopidogrel

390
Q

How you treat peripheral arterial disease

A

Smoking cessation

Treat hypertension, DM, obesity

Give statin

Exercise training

If severe (ischaemia) then surgery

391
Q

What surgery is used to treat colon cancer in the caecal, ascending/prox transverse colon

A

Right hemi colectomy

392
Q

What surgery is used to treat colon cancer in the distal transverse or descending colon

A

Left hemi colectomy

393
Q

What surgery is used to treat colon cancer in the sigmoid colon

A

High anterior resection

394
Q

What surgery is used to treat colon cancer in the rectum

A

Anterior resection

395
Q

What is the surgery used to treat colon cancer in the anal verge

A

abdomino-perineal excision of rectum

396
Q

What is the Hartmanns procedure and when is it used

A

Resection of the sigmoid colon
Bowel perforation

397
Q

What are the serology markers for acute hep B infection

A

HBsAg +ve
Anti-HBs -ve
IgM anti-HBc +ve

398
Q

How do you tell the difference between chronic and acute Hep B infection

A

Anti-HBs (immunity) - chronic
IgM anti-HBc is acute

399
Q

What would serology show for someone vaccinated against Hep B

A

Anti-HBs is positive
Ag neg
IgM neg

400
Q

What is the pathophysiology of immune thrombocytopaenia

A

Antibodies produced in infection target platelet proteins

401
Q

What are the features of immune thrombocytopaenia

A

Thrombocytopaenia symptoms: petichiae, purpura, bleeding

Following infection

402
Q

What is the management of immune thrombocytopaenia

A

Oral prednisolone

403
Q

What is the pattern of inheritance for acute intermittent porphyria

A

Autosomal dominant

404
Q

What are the symptoms of acute intermittent porphyria

A

Abdominal (pain, vomiting)
Neuropathy
Psychiatric

405
Q

How do you diagnose acute intermittent porphyria

A

Raised urinary and serum porphobilinogen

406
Q

How do you treat acute intermittent porphyria

A

Avoid triggers
To treat acute attacfk: IV haematin/haem arginate
IV glucose if not available

407
Q

What is Ebstein’s anomaly and what causes it

A

congenital heart defect - low tricuspid = large atrium, small ventricle

Caused by lithium exposure in utero

408
Q

How does the treatment of rosacea change with severity of pustules

A

Ivermectin first line
Add doxycycline if severe

409
Q

What are the features of a subdural haematoma

A

Slow onset of symptoms
Fluctuating confusion
Motor symptoms

410
Q

What are the features of a subarachnoid haemorrage

A

Sudden onset occipital headache

411
Q

What organism causes roseola infantum

A

Human herpes virus 6

412
Q

What are the features of roseola infantum

A

high fever
maculopapular rash
febrile convulsions
diarrhoea, cough

413
Q

What are the features of typhoid fever

A

Bradycardia
Fever
Flu like symptoms first then abdo (pain, constipation, diarrhoea)
Rose spots = maculopapular spots on torso

414
Q

What are the features of an acetabular labral tear

A

Post trauma
Hip/groin pain
Snapping/locking sensation

415
Q

How do you treat vaginal candidiasis, how does this change in preganancy

A

Oral fluconazole
Oral treatments CI’d in preg - pessary clotrimazole or cream used

416
Q

How do you treat worsening COPD in patients without asthmatic features

A

No asthmatic features = no steroid responsiveness

LABA + LAMA

417
Q

How do you treat worsening COPD in patients with asthmatic features

A

Asthmatic features = steroid responsiveness
LABA + ICS

418
Q

What should you use to clean a wound up to 48 hours after surgery

A

Sterile saline

419
Q

What anticoagulation should be used in patients with a mechanical heart valve

A

Warfarin

420
Q

What is the diagnostic test for Addisons disease

A

ACTH synacthen test

421
Q

Describe the rash for molluscum contagiosum

A

Well-demarcated papules with umbilicated centre

422
Q

What causes molluscum contagiosum

A

Pox virus

423
Q

How do you treat molluscum contagiosum

A

Self limiting
Hygiene advice (don’t share towels etc.)

424
Q

What is Beck’s triad

A

Low BP
High JVP
Muffled heart sounds
Cardiac tamponade

425
Q

What is the most common malignancy of the lip

A

Squamous cell carcinoma

426
Q

How do you treat squamous cell carcinoma of the skin

A

Surgical excision with 4mm margin if lesion is <20mm

6mm margin if lesion >20mm

Mohs micrographic surgery can be used in cosmetically important sites

427
Q

What is HLA-B27 associated with

A

Spondyloarthropathy

428
Q

What is HLA-B51 associated with

A

Behcets disease

429
Q

What is anti-cardiolipin associated with

A

Antiphospholipid syndrome

430
Q

What is anti-jo 1 associated with

A

Polymyositis

431
Q

What effect on development does CMV exposure have to babies

A

Hearing loss
Low birth weight
Petechial rash
Microcephaly
Seizures

432
Q

What anti-epileptic drug is safe in breastfeeding

A

Lamotrigine

433
Q

What do you give Parkinsons patients who cannot take levodopa orally

A

Dopamine agonist patch

434
Q

What size abdominal aortic aneurysm needs repaired

A

5.5cm

435
Q

What are the features of roseloa infantum

A

3-5 days high fever
2 day maculopapular rash on chest which spreads to limbs
Caused by Herpes virus 6

436
Q

What organism causes slapped cheek syndrome

A

Parvovirus B19

437
Q

What age is affected by roseola infantum

A

6 months to 2 years

438
Q

When should a baby be able to sit without support

A

8 months

439
Q

What is first line antihypertensive for type 2 diabetic patients, or patients under 55

A

ACEi or ARB

440
Q

What is the first line antihypertensive for patients > 55, or Afro-Caribbean patients

A

Calcium channel blocker

441
Q

A patient has uncontrolled hypertension with an ARB, CCB, and thiazide diuretic. Potassium is <4.5 - what is the next drug that can be given

A

Spirinolactone

442
Q

A patient has uncontrolled hypertension with an ARB, CCB, and thiazide diuretic. Potassium is >4.5 - what is the next drug that can be given

A

Alpha or beta-blocker

443
Q

What are the complications of acute pancreatitis and what are the prognoses

A

Acute respiratory distress syndrome - 20% mortality

Peripancreatic fluid collection (25%) - may resolve or develop into pseudocyst or abscess

Pseudocyst - 50% resolve in 12 weeks, otherwise endoscopy or surgery

Pancreatic necrosis - surgery

Pancreatic abscess (infected pseudocyst) - endocscopic or transgastric drainage

Pancreatic necrosis - Grey turners sign, Cullen’s sign

444
Q

What is Grey Turner’s sign and what does it indicate

A

Flank bruising - pancreatic necrosis with intra/retroperitoneal haemorrhage

445
Q

What is Cullen’s sign and what does it indicate

A

Peri-umbillical bleeding - pancreatic necrosis with intra/retroperitoneal haemorrhage

446
Q

What are the features of Meckel’s diverticulum

A

Abdominal pain like appendicitis
Rectal bleeding
Obstruction

447
Q

How do you treat Meckel’s diverticulum

A

Removal if symptomatic

448
Q

How do you manage a suspected DVT

A

Ultrasound within 4 hours, if positive start DOAC, if negative do D dimer.

If ultrasound not in 4 hours do D-dimer and interim DOAC

If scan negative, D-dimer positive stop interim DOAC repeat scan in 1 week

If scan and D-dimer negative then alternative diagnosis should be made

449
Q

What anticoagulation should be given to patients with DVT and active malignancy

A

DOAC

450
Q

What anticoagulation should be given to patients with severe renal impairment (<15/min)

A

LMWH

451
Q

How long should a patient be anticoagulated for following a DVT

A

Unprovoked - 6 months
Provoked - 3 months

452
Q

How do you treat pain in endometriosis

A

1: OTC analgesia
2: COCP
3: surgery

453
Q

What test confirms chronic/acute hep B infection

A

HBs-Ag

454
Q

What are the features of renal cell cancer

A

Haematuria
Loin pain
Abdominal mass
Pyrexia
Endocrine effects (EPO -> polycythaemia; ACTH; PTH)

455
Q

How does the size of a renal cell carcinoma affect management

A

<7cm partial nephrectomy
>7cm radical nephrectomy

456
Q

How long should eclampsia be treated for

A

MGSO4 for 24 hours after last seizure or delivery

457
Q

What is first line treatment for heart failure with reduced ejection fraction

A

Beta blocker and ACEi

458
Q

What is the second line therapy for heart failure with reduced ejection fraction

A

(Beta blocker and ACEi)

Add aldosterone antagonist = spironolactone

459
Q

What is the third line therapy for heart failure with reduced ejection fraction

A

(Beta blocker, ACEi, spironolactone)

Specialist input - ivabradine

460
Q

What is the appropriate investigation for a PE with renal impairment

A

V/Q scan

CTPA contrast would worsen renal function

461
Q

What does the BCG vaccine protect against

A

TB meningitis in children

462
Q

Where is damaged in the case of spastic cerebral palsy

A

Upper motor neurons

463
Q

Where is damaged in the case of dyskinetic cerebral palsy

A

Basal ganglia and substantia nigra

464
Q

Where is damaged in the case of ataxic cerebral palsy

A

Cerebellum

465
Q

What criteria should be met to perform needle aspiration in primary pneumothorax

A

SOB or rim of air >2cm

466
Q

What is laryngomalacia

A

Congenital abnormality of the larynx
Benign cause of stridor in infants
Usually self resolves by 2 years

467
Q

What is the discharge associated with bacterial vaginosis

A

Thin, fishy, white/clear, homogenous

468
Q

What is the discharge associated with candida albicans

A

White, non-offensive, itchy

469
Q

What is the discharge associated with gonorrhoea

A

Thick, green

470
Q

What is the discharge associated with Trichonoma vaginalis infection

A

Frothy, yellow

471
Q

What is a Colles’ fracture

A

Transverse fracture of radius
1 inch prox to radio-carpal joint
Doral displacement and angulation

472
Q

What is a Smith’s fracture

A

Angulation of distal radius fragment

473
Q

What is a Bennett’s fracture

A

Fracture at the base of the thumb metacarpal, triangular fragment on X ray

474
Q

What is a Monteggia’s fracture

A

Dislocation of proximal radio-ulnar joint with ulna fracture

475
Q

What is a Galeazzi fracture

A

Radial shaft fracture with dislocation of distal radioulnar joint

476
Q

What is a Barton’s fracture

A

Distal radius fracture (Colles’/Smith’s) with radiocarpal dislocation

477
Q

What is the most common carpal fracture

A

scaphoid fracture

478
Q

What are the features of a scaphoid fracture

A

Pain and swelling of anatomical snuff boc

Pain moving wrist and longitudinal compression of thumb

479
Q

What is first line treatment for an open fracture

A

Open fractures can only be definitively managed when the soft tissues have been debrided. Give IV antibiotics

480
Q

When do diabetics need to surrender their driving license and inform the DVLS

A

After two hypoglycaemic episodes

481
Q

What is the DEXA definition of osteoporosis

A

DEXA score < -2.5

482
Q

How do you treat osteoporosis

A

Give bisphosponates
Correct calcium and vitamin D first so as not to worsen hypocalcaemia

483
Q

What are the symptoms of hypomagnesaemia

A

Nausea
Muscle cramps
Tremors
Hyper-reflexia
Tetany
Long QT

484
Q

What is the largest risk factor for anal cancer

A

HPV infection

485
Q

What are the symptoms of testicular cancer

A

Non-tender lump
Hydrocele
Gynaecomastia

486
Q

How do you investigate suspected testicular cancer

A

ultrasound

487
Q

What are the side effects of loop diuretics like furosemide

A

Hypotension
Ototoxicity
Hypo Na, K, Mg, Ca
Renal impairment
Gout

488
Q

What cancer is associated with Coeliac disease

A

T-cell lymphoma of small intestine

489
Q

What are the complications of Coeliac disease

A

Anaemia (b12, folate, iron deficiency)
Osteoporosis and osteomalacia
Lactose intolerance
T-cell lymphoma

490
Q

How do you manage aortic stenosis

A

Asymptomatic - observe
Symptomatic - valve replacement or baloon valvuloplasty if not fit

491
Q

How do you manage an anal fissure

A

Acute (<1 week): soften stool with high fibre diet and increased fluid intake; bulk forming laxatives

Chronic (>6weeks): see above + topical glyceryl nitrate

If not effective after 8 weeks then sphincterectomy

492
Q

When do you do surgery for an anal fissure

A

If topical GTN is not effective after 8 weeks

493
Q

Where do anal fissures occur

A

posterior midline

494
Q

What factors correlate with the severity of acute pancreatitis

A

Hypocalcaemia
Hyperglycaemia
Hypoxia
Neutrophilia
High LDH, AST
Age >55

495
Q

What is the distribution of dermatitis herpetiformis

A

Elbows, knees, buttocks§

496
Q

What is postoperative/paralytic ileus

A

Common postoperative complication in which there is reduced bowel peristalsis - pseudo obstruction

497
Q

How do you manage paralytic ileus

A

Nil-by-mouth
NG tube if vomiting
IV fluids and total parenteral nutrition

498
Q

What are convulsions without conscious impairment

A

Pseudoseizure (psychogenic)

499
Q

What is the most common cause of primary hyperaldosteronism

A

Bilateral idiopathic adrenal hyperplasia

500
Q

What are the features of primary hyperaldosteronism

A

Hypertension
Hypokalaemia (muscle weakness)

501
Q

What is the first line investigation for primary hyperaldosteronism

A

Plasma aldosterone/renin ratio
(high aldosterone, low renin)

502
Q

How do you investigate primary aldosteronism

A

1: aldosterone/renin ratio (will be raised)
2: CT abdomen
3: adrenal vein sampling

503
Q

How do you treat primary hyperaldosteronism due to bilateral adrenocortical hyperplasia

A

Aldosterone antagonist = spirinolactone

504
Q

What is iliotibial band syndrome

A

Tenderness 2-3 cm above lateral joint line
1 in 10 people who run have this

505
Q

When do you do a lumbar puncture to investigate a subarachnoid haemorrhage

A

If CT done with 6 hours is normal - do not do LP

If CT done after 6 hours is normal - do a lumber puncture at least 12 hours after onset of symptoms (to allow blood cells to break down and be detected)

506
Q

What is the name for abnormal packflow of urine from bladder into ureter and kidney

A

Vesicoureteric reflux

507
Q

How do you diagnose vesicoureteric reflux

A

Micturating cystouretrogram

508
Q

What complication is associated with vesicoureteric reflux

A

UTI
Renal scarring

509
Q

What is the mode of inheritance for Duchenne muscular dystrophy

A

X-linked recessive

510
Q

What are the features of Duchenne muscular dystrophy

A

Progressive prox muscule weakness
Calf pseudohypertrophy
Gower’s sign positive (using arms to stand up from squat)
Intellectual impairment in 30%

511
Q

What is the definitive investigation for Duchenne muscular dystrophy

A

Genetic testing

512
Q

What id the differential for rheumatoid type symptoms with nail changes

A

Psoriatic arthritis

513
Q

At which week should you refer to an obstetrician for lack of fetal movements?

A

24 weeks

514
Q

How do you investigate children/young people with unexplained bone swelling or pain

A

Urgent X-ray to rule out sarcoma

515
Q

When should someone with a corneal foreign body be urgently referred to opthalmology

A

Penetrating eye injury
Organic material (infection)
Red flags: severe pain, pupil changes, vision changes

516
Q

What is the most sensitive and specific test for acute pancreatitis

A

Lipase

517
Q

How can acute pancreatitis be diagnosed

A

Lipase (best)/ amylase >3x normal

Ultrasound to explain aetiology

518
Q

What are the causes of acute pancreatits

A

I - idiopathic
G - gallstones
E - ethanol
T - trauma
S - steroid use
M - mumps
A - autoimmune
S - scorpion sting
H - hypercalcaemia, hyperglyceridiemia
E - ERCP
D - drugs

519
Q

What are the prognostic factors in acute pancreatitis

A

Age > 55
hypocalcemia
hyperglycaemia
hypoxia
neutrophilia
high LDH, AST

520
Q

How are growth plate fractures classified and what are the categories

A

Salter-Harris
1: physis
2: physis + metaphysis (75%)
3: physis and epiphysis
4: physis + metaphysis + epiphysis
5: physis + crush

521
Q

What electrolyte imbalance is caused by chronic alcohol consumption

A

Hypomagnesaemia

522
Q

What murmur does aortic stenosis cause

A

Ejection systolic louder on expiration

523
Q

What murmur does pulmonary stenosis cause

A

Ejection systolic louder on inspiration

524
Q

What murmur does mitral regurgitation cause

A

Pansystolic, louder on expiration

525
Q

What murmur does tricuspid regurgitation cause

A

Pansystolic, louder on inspiration

526
Q

What murmur does aortic regurgitation cause

A

early diastolic

527
Q

What murmur does mitral stenosis cause

A

mid-late diastolic

528
Q

How do you treat spasticity in MS

A

Baclofen
Gabapentin

529
Q

What is Epstein’s pearl

A

Congential cyst on posterior palate in the midline - white nodule

Spontaneously resolves, no treatment needed

530
Q

How do you treat hyperglycaemic hyperosmolar state

A

Give fluids, monitor potassium
Insulin can be given if glucose stops falling with fluids
VTE prophylaxis dues to hyperviscosity

531
Q

What drugs cause lupus

A

procainamide
hydralazine
isoniazid
minocycline
phenytoin

532
Q

What drugs are given for TB

A

Rifampicin
Isoniazid
Streptomycin
Ethambutamol

(RISE)

533
Q

How do you treat thrush

A

One dose of oral fluconazole

Local treatments (pessary) if pregnancy

534
Q

What are the risk factors for shoulder dystocia

A

Macrosomia
High BMI mum
Diabetes
Prolonged labour

535
Q

What are the features of alcohol withdrawal

A

6-12 hours: tremor, sweating, tachycardia, anxiety
seizures at 36 hours
delirium tremens 48-72 hours

536
Q

What are the symptoms of delirium tremens

A

tremor, confusion, delusions, hallucinations, fever, tachycardia

537
Q

What drugs cause neuroleptic malignant syndrome

A

Antipsychotics

538
Q

What are the symptoms of neuroleptic malignant syndrome

A

Fever
rigidity
HTN, tachycardia, tachypnoea
delirium with confusion

539
Q

Beck’s triad

A

Raised JVP
Muffled heart sounds
Hypotension

540
Q

What does electrical alternans on ECG indicate

A

Pericardial effusion/cardiac tamponade

541
Q

What is Kernig’s sign

A

Flex hip and extend knee = pain = meningitis

542
Q

What causes subacute combined degeneration of the spinal cord

A

B12 deficiency

543
Q

What does stranding of peri-ureteric fat indicate

A

Passed ureteric calculus

544
Q

What is Romberg’s sign

A

Closed eyes when standing to assess balance

545
Q

How do you treat Bell’s palsy

A

Prednisolone and eye care

546
Q

How do you manage severe pain in renal colic

A

IM diclofenac

547
Q

What are the features of Ramsay Hunt syndrome and what causes it?

A

Reactivation of VZ virus
Ear pain, facial nerve palsy, vesicular rash around the ear

548
Q

What is the treatment for Ramsay Hunt syndrome

A

Oral aciclovir and corticosteroids

549
Q

What is the fasting glucose level that defines gestational diabetes

A

7 mmol/L

550
Q

When can women start the progestrogen only pill after birth

A

Immediately

551
Q

Hwen can women start the COCP after birth

A

6 weeks

552
Q

What is the most common causitive organism for septic arthritis

A

Neisseria gonorrhoeae

553
Q

How do you tell the difference between a gastric ulcer and a duodenal ulcer

A

Gastric = pain on eating
Duodenal = pain hours after eating

554
Q

How does tricyclic overdose affect the ECG and what does it mean

A

Widening QRS > 100ms increased risk of seizures
Widening QRS > 160ms -> ventricular arrythmias

555
Q

How and when do you treat a tricyclic overdose

A

QRS >100ms (increased risk of seizures)
IV socium bicarbonate

Finals (2 decks)

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