Passmed Knowledge Flashcards
(555 cards)
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
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.
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
4
Q
What are the symptoms of fibroids
A
Menorrhagia, bulky symptoms (urinary, bloating), abdo pain, fatigue
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
6
Q
How do you treat post partum thyrotoxicosis
A
With propanolol alone
7
Q
What drugs do you avoid in breastfeeding
A
Aspirin
Antibiotics (ciprofloxacin, tetracycline, chloramphenicol)
Psych (Lithium, benzos, clozapine
Methotrexate
Carbimazole
Sulfonylureas or sulfonamides
8
Q
What are the symptoms of androgen insensitivity syndrome
A
Primary amenorrhoea, no pubic/axillary hair, undescended testes (+++ testosterone)
9
Q
How and when do you test for ovulation?
A
7 days after ovulation, progesterone peaks
7 days before end of cycle!
10
Q
Where is the most common place for ectopic pregnancies
A
Ampulla of the fallopian tube
11
Q
Where are ectopic pregnancies most associated with rupture
A
Isthmus
12
Q
How does LMWH work
A
Factor Xa inhibitor
13
Q
What anticoagulation should be avoided in pregnancy
A
DOACs
Warfarin
14
Q
How does warfarin work
A
Inhibits vit K
Reduces II, VII, IX, X
15
Q
Give examples of DOACs
A
Apixaban
Rivaroxaban
16
Q
What is the incubation period for Staph. aureus
A
6 hrs
17
Q
What is the incubation period for Bacillus cereus
A
6 hrs
18
Q
What is the incubation period for Salmonella
A
12-48 hrs
19
Q
What is the incubation period for E. coli
A
12-48 hrs
20
Q
What is the incubation period for Shigella
A
48-72 hrs
21
Q
What is the incubation period for Campylobacter
A
48-72 hrs
22
Q
What is the appearance of lichen planus
A
Purple, polygonal, pruritic, papular, planar (flat top)
23
Q
What is the appearance of lichen sclerosis
A
Itchy white spots typically on vulva
24
Q
Where does lichen planus typically affect?
A
palms, soles, genitals, flexor surfaces of arms
25
What is the appearance of psoriasis
Scaly, shiny, red, itchy
26
What is the appearance of eczema
Red, dry, itchy
27
What is the difference in appearance of eczema and psoriasis
Eczema = dry, red, itchy
Psoriasis = scaly, shiny, red, itchy
28
What structures does anterior uveitis affect
Iris and ciliary body
29
What are the features of anterior uveitis
Sudden onset, painful red eye
Changes in vision + photophobia
Small pupil
Double vision
Assoc. w inflammatory conditions
30
What is the first line management of anterior uveitis
Urgent referral to ophthalmology
Cycloplegics (atropine, cyclopentolate) = dilate pupil
Steroid eye drops
31
What causes torsades de pointes
Long QT - hypothermia, antiarrhythmetics, antipsychotics, tricyclics
Hypo Electrolytes - hypocalcaemia, hypomagnesaemia, hypokalaemia
32
How do you manage torsades de pointes
IV magnesium sulfate
33
What are the congenital cyanotic heart diseases?
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)
34
What are the acyanotic congentical heart diseases
VSD
ASD
Patent ductus arteriosus
Coartcation of aorta
Aortic stenosis
35
What is the complication of an intracapsular femur fracture
Avascular necrosis of femoral head
36
When should activated charcoal be given in a paracetamol overdose
Only useful if they present within the first hour
37
When should acetylcysteine be given immediately?
If paracetamol overdose was staggered over 1 hour
If overdose was taken 8-36 hours before
If uncertain about time but toxic dose
38
What are the symptoms of dermatomyositis
Dermato - rash - knuckles, heliotrope (around eyes)
Myositis - prox muscle weakness
39
What causes dermatomyositis?
Idiopathic
Inflammatory tissue disorders
Underlying malignancy (always check!)
40
What is the first line antibiotic for UTI
Trimethoprim
Nitrofurantoin
41
If someone is taking methotrexate, what UTI antibiotic is contraindicated and why?
Trimethoprim causes bone marrow suppression
*Never prescribe 2 meths together*
42
What are the complications of PPIs (eg. omeprazole)
Hyponatraemia
Osteoporosis
Colitis
C Diff.
43
What are the symptoms of a temporal lobe seizure
Automatisms
Hallucinations
44
What are the symptoms of an occipital lobe seizures
Visual symptoms
45
What are the symptoms of a parietal lobe seizure
Paraesthesia
46
What are the symptoms of a frontal lobe seizure
Motor symptoms with post-ictal weakness
Jacksonian march
47
What medication increases the risk of necrotising fascitits (2ndary bacterial infection) in chicken pox
NSAIDS increase the risk of secondary bacterial infections (group A strep.)
48
What is the threshold for blood transfusion?
70g/L in patients without ACS
49
What is the threshold for blood transfusion in patients with ACS?
80g/L
50
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?
Clang associations
51
What is the risk of cardioversion and when should it be avoided
Thrombus being thrown off to stroke
Avoid cardioversion if long duration of symptoms and/or not anticoagulated
52
What is the criteria called for infective endocarditis
Duke's criteria
53
Describe the criteria for infective endocarditis
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
54
What is the criteria for sleep apnoea tiredness
Epworth sleepiness scale
How much do you sleep in different situation
55
In what condition is the Sokolov-Lyon criteria used
Left ventricular hypertrophy (voltage + non-voltage criteria)
56
What is metabolic syndrome
diabetes, HTN, obesity
57
What is the first line treatment for ulcerative colitis
Mesalazine
58
What is the first line treatment for Crohns
Azathioprine
59
What are the complications associated with azathioprine
non-melanoma skin cancer
bone marrow suppression
pancreatitis
60
What are the side effects of steroids
Psychosis
Infection
Cushing's
Diabetes
Osteoporosis
Acne
61
How do you treat acute severe colitis
Hospital admission: 3 days of steroids
If not better then surgery
62
What is the criteria for assessing the severity of ulcerative colitis and what does it include
# bowel movements per day
Truelove Witts Severity Index
no. times a day
blood in stool
pyrexia
pulse >90
Hb - anaemia
ESR/CRP
63
What is the age of onset for inflammatory bowel disease
Bimodal distribution
One peak in teenage years
Another in 60s
64
How do you treat DIC
Treat underlying cause
FFP + cryoprecipitate
Platelets if active bleeding
65
What can cause DIC
TOASTS
Trauma, obstetric complications, acute pancreatitis, sepsis, tumour, snakebite
66
What do you see on blood film for iron deficiency anaemia
Hypochromic, pencil poikilocytes cells
Dimorphic film
Target cells
67
What do you see on a blood film in hyposplenism
Target cells
Howell-jowell bodies
siderotic granules
pappenheimer bodies
acanthocytes
68
What do you see on a blood film in G6PD
Heinz bodies
69
What do you see on a blood film for intravascular haemolysis
Schistocytes
70
Give examples of sulfonylureas
Gliclizide
Glipizide
Tolbutamide
71
Give 3 examples of sodium channel blockers
Lidocaine
Flecainide
Quinidine
72
What are the contraindications of beta-blockers
Asthma
AV heart block
Hypotension
Bradycardia
Heart failure
73
What are the side effects of beta blockers
hypotension
bradycardia
cold peripheries
dizziness
fatigue
erectile dysfunction
sleep disturbance
74
What are the contraindications for ARBs
Afro-Caribbean
low eGFR
renal artery stenosis
75
What are the effects of beta blockers in pregnancy and which are safe to use
Intrauterine growth restriction
Neonatal hypoglycaemia, bradycardia
Labetalol
76
What are the contraindications of calcium channel blockers
Unstable angina
Pregnancy
77
What are the contraindications of thiazide diuretics
Hyponatraemia, hypokalaemia, hypercalcaemia
Addisons,
Diabetes,
Gout
78
How do thiazide diuretics affect electrolytes?
Increase excretion of sodium and potassium
Decrease excretion of calcium
79
What are the side effects of thiazide diuretics
Electrolyte disturbance
Dizziness, fatigue
Erectile dysfunction
Photosensitivity
Agranulocytosis, aplastic anaemia
80
Give 2 examples of thiazide diuretics
bendroflumethiazide
hydrochlorothiazide
81
Give an example of a thiazide like diuretic
indapamide
82
What are the side effects of calcium channel blockers
peripheral oedema
flushing
erectile dysfunction
dizziness, fatigue
83
What are the side effects of ACE inhibitors
Alopecia
Vertigo
Tinnitus
Dizziness
84
What are the contraindications of ACE inhibitors
Afro-Caribbean
Reduced eGFR
Diabetics
85
Give examples of 3 opiods
Morphine
Codeine
Oxycodone
86
What are the 3 classess of drugs + examples that can be used to treat gastric/peptic reflux
PPI - lanzoprazole, omeprazole
Alginate-forming - gaviscon
H2 - ranitidine
87
What scoring tool is used to assess depression
PHQ-9
88
What are the classes of antiarrhythmetic drugs
Na+ channel blockers
Beta blockers
K+ channel blockers
Ca2+ channel blockers
89
What drugs can be given to control gout
Allopurinol
Colchicine
90
What are the causes of macrocytosis
Alcohol excess
B12, folate deficiency
Hypothyroidism
91
How long before an H Pylori test should you stop a PPI
2 weeks
92
Give 3 examples of potassium channel blockers
Amiodarone
Dofetilide
Sotalol (beta and K+)
93
Give an example of a long acting beta agonist
Fometerol
94
What are the complications of PPI use
Osteoporosis
Renal impairment
Hyponatraemia
95
Give examples of SGLT2 inhibitors
Flozins
Empagliflozin
Dapalifloxin
Canagliflozin
96
How do DPP4 inhibitors work
They inhibit the breakdown of GLP-1
This slows gastric emptying, increases glucose, decreases glucagon
97
Give examples of DPP4 inhibitors
Gliptins
Saxagliptin
Alogliptin
Vildagliptin
98
What causes a holosystolic murmur
Mitral or tricuspid regurg
99
What is a Baker's cyst and why do you get it
A popliteal cyst
Secondary to arthritis or to meniscus tear
100
Give examples of steroid creams from mild, moderate, potent and very potent
hydrocortisone
betnovate
beclometasone
dermovate
101
What is Evan's syndrome
Immune thrombocytopaenia + autoimmune haemolytic anaemia (simultaneous or sequential)
102
What antibody is implicated in cold autoimmune haemolytic anaemia
IgM
103
What antibody is implicated in warm autoimmune haemolytic anaemia
IgG
104
What are the features of haemolytic anaemia on a blood test
Decreased haptoglobin
increased reticulocytes
anaemia
increased LDH (haemolysis)
increased unconjugated bilirubin
105
What is the first line antibiotic in neutropaenic sepsis
Tazocin = tazobactam + pipperacillin
106
What is the likely causative organism in neutropaenic sepsis
Staph. epidermidis (think from an indwelling line, chemo)
107
Give 3 examples of sleeping aides
Melatonin, diphenhydramine, promethazine
108
Where in the nephron do SGLT2 inhibitors act
PCT
109
How do sulfonylureas work
Increase plasma insulin
110
What is the prophylaxis for neutropaenic sepsis and when should it be given
Fluoroquinolone
<0.5 x10^9
111
What is seen on a blood film for myelofibrosis
'tear-drop' poikilocytes
112
Give an example of a non sedating antihistamine
Loratadine
113
What are the diagnostic criteria for pre-eclampsia
BP> 140/90 after 20 wks
Proteinuria or organ dysfunction
114
When do you admit a woman with pre-eclampsia into hospital
BP > 160/110
115
What is the first line management for pre-eclampsia
Labetalol
Nifedipine if asthmatic
116
A deficiency in which immunoglobulin increases the risk of anaphylactic reactions following transfusions
IgA
A deficiency means there will be increased anti-IgA, causing the anaphylactic reaction in transfusion
117
What is the first line treatment for atrioventricular node re-entrant tachycardia (AVNRT)
Adenosine
118
What are the adverse effects of adenosine
Chest pain
Bronchospasm (avoid in asthmatics)
Transient flushing
119
What opiate is most appropriate in patients who have mild-moderate renal impairment
Oxycodone
120
In palliative care how do you prescribe opiates for breakthrough pain
1/6th of the daily dose for breakthrough pain
121
What opiate is most appropriate in patients who have severe renal impairment
fentanyl, buprenorphine, alfentanil
122
What side effects of opiates should patients be informed about
Constipation (prescribe laxative)
Nausea (usually transient, prescribe anti-emetic if not)
Drowsiness (usually transient, adjust dose of opiate if not)
123
What drugs cause gingival hyperplasia
Phenytoin
Ciclosporin
CCB (esp. nifedipine)
124
What are the indications for an urgent referral for patients with dyspepsia
Dysphagia
upper abdominal mass
weight loss
125
What are the indications for a non urgent referral for patients with dyspepsia
Haematemesis
treatment resistant dyspepsia
126
What are the features of yellow fever
Initial flu like illness that resolves
Then after 48 hours deteriorates: jaundice, fever, vomiting, pain
127
What marker us used to monitor the progression of colon cancer
CEA = carcinoembryonic antigen
128
What conditions cause an underestimate of HbA1C
Reduced lifespan of RBCs:
Sickle cell
G6PD
Spherocytosis
Dialysis
129
What conditions cause an overstimate of HbA1C
Increased lifespan of RBCs:
b12, folate, iron deficiency
splenectomy
130
What are the adverse effects of methotrexate
mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis
131
How long should a woman avoid pregnancy for after taking methotrexate
6 months
132
How often is methotrexate taken
once weekly
133
What should be prescribed with methotrexate
Folic acid 5mg
134
What prophylaxis should be given to contacts of a patient with meningococcal meningitis
Ciprofloxacin or rifampicin
135
How do you image a perianal fistula
MRI pelvis
136
How do you treat status epilepticus, pre hospital and hospital
Airway, oxygen, glucose
benzos prehospital - PR diazepam or buccal midazolam
In hospital start with IV lorazepam can be given twice
137
According to the WHO surgical safety checklist, what are the three phases of an operation and when do they occur?
1: before induction of anaesthesia (sign in)
2: before incision (time out)
3: before patient leaves operating room (sign out)
138
What are the first and second line antibiotics for cellulitis + what do you use in pregnancy
Flucloxacillin
If allergic: clarithromycin + if pregnant: erythromycin
139
What is the classification system for cellulitis
Eron classification system
1-4
140
How do you tell the difference between a TIA and a stroke
Based on imaging
141
How do you manage a patient with TIA
Secondary prevention: Anti-platelet (clopidogrel/aspirin 75mg bd) + statin (atorvastatin 20-80mg od)
Carotid artery endarterectomy if carotid stenosis >70%
142
What antibodies do you test for SLE
ANA positive (sensitive)
anti-dsDNA, anti-Smith (specific)
143
How do you monitor SLE flares
In an SLE flare complement levels are low; ESR
144
What is the drug of choice for oestrogen receptor positive breast cancer
Pre-menopausal: Tamoxifen
Post-menopausal: Anastrozole (aromatase inhibitors)
145
What are the adverse effects of tamoxifen
Menstrual disturbance
Hot flushes
VTE
Endometrial cancer
146
What are the adverse effects of anastrazole
Osteoporosis (needs DEXA)
hot flushes
arthralgia/myalgia
insomnia
147
What is the drug therapy for angina pectoris
Aspirin + statin
Beta-blocker or calcium channel blocker (prevention)
Short acting nitrate (abort attacks)
148
What does bull's eye maculopathy on fundoscopy indicate
Retinopathy due to hydroxychloroquine
149
What are the anterior leads on ECG
V2-V4
150
What artery is covered by V2-V4
LAD
151
What artery is covered by V3-V6 + I, aVL
LAD, circumflex
152
What are the inferior leads on ECG
II, III, aVF
153
What artery is covered by II, III, aVF
RCA
154
What are the lateral leads on ECG
I, aVL, V5, V6
155
What artery is covered by I, aVL, V5, V6
Circumflex
156
When are Q waves pathological
When they are more than 25% of the amplitude of the R wave
When they last more than 40ms
157
What causes transudative pleural effusions
Heart failure, cirrhosis, kidney failure
158
Describe fluid for a transudative pleural effusion
clear
low protein
low LDH
159
What causes exudative pleural effusions
Infection
PE
malignancy
autoimmune diseases
160
Describe fluid in an exudative pleural effusion
cloudy/turbid
high protein
high LDH
161
What criteria differentiates between exudative and transudative pleural effusion
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.
162
What procedure is used to remove fluid from pleural space
thoracentesis
163
What is the most common cause of hyperthyroidism
Grave's disease
164
What features are specific to Grave's disease but not other causes of thyrotoxicosis
Exophthalmos
Pretibial myxoedema
TSH antibodies
TPO antibodies
165
What are the features of hyperkalaemia on ECG
Tall-tented T waves
loss of p waves
broad QRS
sinusoidal wave
166
How do you treat hyperkalaemia
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
167
What is the most common cause of death following MI
Ventricular fibrillation
168
What are the features of Dressler's syndrome
Pericarditis 2-6 weeks after MI.
Fever pleuritic chest pain, pericardial effusion and raised ESR
169
How do you treat Dressler's syndrome
NSAIDS
170
What does a VSD sound like on auscultation
Pansystolic murmur
171
What are the complications of an MI
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)
172
What drugs can cause thrombocytopaenia
Quinine (antimalarial)
Abciximab
NSAIDs
Furosemide
Abs: Penicillin, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin
173
What is the pathophysiology, features and distribution of dermatitis herpetiformis?
IgA deposition in the dermis; associated with coeliac disease
Itchy vesicular skin lesions on extensor surfaces
174
How do you treat plantar warts (verruca)
Topical salicylic acid, daily for 12 weeks
175
What is an erythematous patch of rough itchy scaly skin lesion on sun exposed area and how do you treat it
Actinic keratosis
Topical diclofenac
176
What can be given to treat head lice
Malathion
177
Why are oesophageal varices caused by chronic liver disease
Vessels are dilated because of increased portal/splanchnic pressure
Haemorrhage common due to lack of clotting factors (synthetic capacity of liver reduced)
178
How do you acutely manage oesophageal varices
ABC
Correct clotting (FFP, Vit K, platelets)
Terlipressin
& Antibiotics
179
What is the pattern of inheritance for the genes involved in hypertrophic obstructive cardiomyopathy
Autosomal dominant
180
How do you manage hypertrophic obstructive cardiomyopathy
Amiodarone
Beta-blockers/verapamil
Cardioverter defib
Dual chanber pace-maker
Endocarditis prophylaxis
181
What drugs should be avoided in hypertrophic obstructive cardiomyopathy
Nitrates
ACE-inihibitors
Inotropes
As they reduce afterload, in the context of obstruction this can worsen outflow
182
What are the symptoms of SSRI discontinuation
FIRMSTOP
Flu like Sx
Insomnia
Restlessness
Mood swings
Sweating
Tummy problems (pain, cramps, D+V)
Off balance
Parasthaesia
183
What are the side effects of SSRIs in pregnancy
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
184
What SSRI increases the QT interval
Citalopram
185
What is the first line management for TIA
300mg aspirin
unless contraindicated, already on it, or anticoagulated
186
What drugs cause acute interstitial nephritis
Penicillin
Rifampicin
NSAIDs
Allopurinol
Furosemide
187
What diseases are associated with acute interstitial nephritis
SLE, Sjogrens, sarcoidosis
188
What is the pathophysiology of acute interstitial nephritis
Inflammatory infiltrates and oedema in interstitium with acute deterioration of renal function.
189
What are the symptoms of acute interstitial nephritis
Fever
Rash
Arthralgia
190
What do you see on urine dip in acute interstitial nephritis
Sterile pyuria = WBCs no bacteria
191
When is the cremasteric reflex absent with tender teste
Testicular torsion of spermatic cord
192
When is the cremesteric reflex present with tender superior pole of teste
When it is torsion of the testicular appendage
193
What drug may cause epididymitis
Amiodarone
194
What is posterior vitreous detachment and when does it occur
Separation of vitreous membrane from retina posteriorly
Occurs typically after 65, in short sighted
195
What are the symptoms of posterior vitreous detachment
Sudden floaters
Flashing lights
Blurred vision
196
What sign on ophthalmoscopy is associated with vitreous membrane detachment
Weiss ring
197
How do you manage a posterior vitreous detatchment
Urgent referral to ophthalmology to rule our retinal detachment
Symptoms should gradually improve over 6 months therefore no treatment is necessary
198
What is the target for HbA1c and when should you add another drug
Target is 48mmol/mol
Add drug at 58 mmol/mol
199
When should SGLT-2 inhibitors be given in type 2 diabetes
Monotherapy if metformin is contraindicated
With metformin if there is CVD
200
What is second line therapy for type 2 diabetes
Metformin + DPP4/pioglitazone/sulfonylurea
Metformin + SGLT2 if CVD risk
201
How does pioglitazone work?
Reduced peripheral insulin resistance
202
When should a statin be given as primary prevention (and which one/dose)
QRISK2>10%
Atorvastatin 20mg
203
When should statin be given as secondary prevention (and which one/dose)
Hx of ischaemic heart diease, cerebrovascular disease, peripheral artieral disease
Atorvastatin 80mg
204
What UTI antibiotic should be avoided in pregnancy
Trimethoprim is teratogenic in the first trimester
205
How long should you prescribe an antibiotic for an UTI in pregnant women vs non pregnant women
3 days if not pregnant
7 days if pregnant
206
What are the first and second line antibiotics to be used in UTI in pregnancy
1: nitrofurantoin
2: amoxicillin/cefalexin
207
What antibiotic should be avoid near term in pregnancy
Nitrofurantoin
208
What are the features of myesthenia gravis
Diplopia
Proximal muscle weakness
Ptosis
Dysphagia
209
What investigations should be carried out for myesthenia gravis
Single fibre electromyography (neuromuscular junction)
CT thorax
Antibodies to aceylcholine receptors
210
How do you manage myasthenia gravis
Pyridostigmine (long acting acetylcholinesterase inhibitor)
Prednisolone
Azathioprine
Thymectomy
211
How do you manage a myasthenic crisis
Plamapheresis
IVIGs
212
How does the contraceptive implant work
Inhibits ovulation by releasing progesterone
Inhibits the release of FSH and LH
Also increases cervical mucus thickness
213
How does the COCP work
Inhibits ovulation
214
How does the POP work
Thickens cervical mucus
215
How does the injectable contraceptive (medroxyprogesterone acetate) work
Inhibits ovulation by releasing progesterone
Inhibits the release of FSH and LH
Also increases cervical mucus thickness
216
How does the IUD work
Decreases sperm motility and survival
217
How does the IUS work
Prevents endometrial proliferation
Thickens cervical mucus
218
What can cause rhabdomyolysis
Seizure
Collapse
Ecstacy
Crush injury
Statins + esp. w clarithromycin
219
How high does CK have to be to indicate rhabdomyolysis
At least 5 times upper limit
220
What are the features of rhabdomyolysis
Myoglobinuria = brown urine
Hypocalcaemia, bound by myoglobin
Hyperkalaemia, high phosphate - released from muscle cells
Metabolic acidosis
221
How do you manage rhabdomyolysis
IV fluids - urine output
222
How does spirinolactone work
Aldosterone antagonist actingin in cortical collecting duct
223
What are the adverse effects of spirinolactone
Hyperkalaemia
Gynaecomastia
224
What is the first line anticoagulant of choice in AF
DOAC
225
What is the second line anticoagulant of choice in AF
Warfarin if DOAC is CI's or not tolerated
226
What is the most common skin disorder in pregnancy
Atopic eruption of prenancy
227
Describe an atopic eruption of pregnancy
Eczematous, itchy red rash
No treatment needed
228
Describe a polymorphic eruption of pregnancy
Pruritic rash
Last trimester
229
How do you treat a polymorphic eruption of pregnancy
Emollients
Topical steroids
Oral steroids
230
What is the look of pemphigoid gestationis, its distribution, and treatment
Pruritic, blistering lesions
2nd or 3rd trimester
Peri-umbillical, then trunk and arms
Oral steroids
231
What cancer does CA125 track
Ovarian cancer
232
What cell type is the most common ovarian cancer
Serous carcinoma
233
What are the risk factors for ovarian cancer
early menarche, late menopause, nulliparity
234
What are the symptoms of ovarian cancer
Abdominal distension and bloating
Abdo/pelvic pain
Urinary symptoms (urgency)
Early satiety
Diarrhoea
235
What conditions may raise CA125
Ovarian cancer
endometriosis
menstruation
benign ovarian cysts
236
How you investigate suspected ovarian cancer
CA125 - if raised then do abdo/pelvic ultasound
237
How is ovarian cancer treated
Surgery
Platinum based chemotherapy
238
What is the first line management for renal colic pain
NSAIDs
239
What are the contraindications of NSAIDs
Peptic ulcer bleeds, IBD
Allergy
Heart failure, thrombotic disease
Elderly
240
How do you treat renal stones
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
What are the types of systemic sclerosis
Limited cutaneous
Diffuse cutaneous
Scleroderma
242
What are the features of limited cutaneous systemic sclerosis
Raynauds
Scleroderma in face and distal limbs
CREST: calcinosis, raynauds, oesophageal dysmotility, sclerodactyly, telangiectasia
243
What are the features of diffuse cutaneous systemic sclerosis
Scleroderma trunk and prox limbs
interstitial lung disease
renal disease
hypertension
244
What is scleroderma
Tightening, fibrosis of skin
245
What antibody is associated with systemic sclerosis
ANA
246
What is the most specific antibody for diffuse cutaneous systemic sclerosis
Anti-Scl-70
247
What drug causes nephrogenic diabetes insipidus
lithium
desensitises kidney to ADH
248
What is Stokes-Adams syndrome
LOC with sudden drop in cardiac output
Think heart block
249
How do you differentiate between sensorineural and conductive hearing loss on audiogram
In SN: hearing loss in both air and bone conduction
In conductive: hearing loss in air
In mixed: both but worse in air
250
What is Perthes disease
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
What causes transient sinovitis
Viral infection in children
Most common cause of hip pain in children
252
What do you see on X ray for Perthes disease
Widening of joint space
Flattening of femoral head
253
What makes a death a notifiable death
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
What is biliary atresia and when does it present
Neonatal condition in biliary tree does not form - obstruction of flow of bile
Presents in the first 2-8 weeks of life
255
What are the features of biliary atresia
2-8 wks old
Jaundice
dark urine + pale stool
bad feeding
256
How do you treat biliary atresia
Surgical dissection of abnormal biliary tract
257
How is Alport's syndrome typically inherited
X linked dominant
258
What is Alport's syndrome
Defect in type IV collagen gene leading to an abnormal glomerular basement membrane
259
What are the features of Alport's syndrome
Microscopic haematuria
Renal failure
Bilateral sensorineural deafness
Splitting of lamina densa on electron microscopy of renal biopsy
260
What do you see on electron microscopy of renal biopsy in patients with Alport syndrome
Splitting on lamina densa of glomerular membrane - 'basket-weave appearance'
261
What are the primary features of syphilis
Chancre - painless ulcer at site of sexual contact
Local non tender lymphadenopathy
262
What are secondary features of syphilis
Fever, systemic lymphadenopathy
rash on trunk, palms, soles
263
Where does syphilis cause a rash
Trunk, palms, soles
264
What are the tertiary features of syphilis
Gumma = granulomatous lesion
Aortic aneurysm
Argyll-Robertson pupil (do not constrict on bright light; but do on a nearby object)
265
What is used to fix an extracapsular NOF fracture
Intramedullary device
266
When is a total hip replacement indicated
Displaced intracapsular fracture
267
When is a hemi-arthroplasy indicated
Intracapsular fracture in patients with poor pre-morbid status
268
When is internal fixation suitable for NOF fracture
Intracapsular, undisplaced fracture in patients with good pre-morbid status
269
What procedure is most appropriate for an undisplaced intracapsular NOF fracture
Internal fixation
if poor pre-morbid status then hemi-arthroplasty
270
What procedure is most appropriate for a displaced intracapsular NOF fracture
total hip replacement
if poor pre-morbid status then hemi-arthroplasty
271
What does a coffee bean sign on x-ray indicate
sigmoid volvulus
272
How do you manage a sigmoid volvulus
decompression with rigid sigmoidoscopy and flatus tube insertion
second line is percutaneous decompression
273
How do you manage a caecal volvulus
right hemi-colectomy
274
What is a Hartmann's procedure
proctosigmoidectomy
275
If a woman is treated for cervical intraepithelial neoplasia (CIN) how long after this should she be followed up for test of cure
6 months
276
Describe the stages of cervical screening
HPV first
then if +ve; ctytology
then if abnormal; colposcopy
277
On cervical screening a patient is HPV+ve
The cytology is normal, when should the test be repeated?
12 months
278
On cervical screening, the patient is hrHPV -ve. When should the test be repeated?
Return to normal recall
3-5 years depending on age
279
On cervical screening, the sample is inadequate, when should the test be repeated?
3 months
280
At what age should a child smile
10 weeks
281
At what age should a child sit unsupported
12 months
282
At what age should a child begin to walk
18 months
283
What early sign in infants may indicate cerebral palsy, and what should be done
Hand preference before 12 months
Urgent MDT referral
284
What does painless jaundice and palpable RUQ mass indicate
Pancreatic cancer
285
What is the age of onset for temporal arteritis
Peak 70
286
How do you investigate temporal arteritis
ESR ++
CRP
Temporal artery biopsy (?skip lesions)
Make sure there are no visual changes
287
How do you treat temporal arteritis
High dose glucocorticoids stat
If no evolving visual loss - prednisolone
If evolving visual loss then IV methylprednisolone
Bone protection with bisphosphonates
288
What is the first hearing test a baby will have
Otoacoustic emission test
289
What is the test given to babies that have an abnormal otoacoustic emission test
Auditory brainstem response test
290
What are the symptoms of Addisonian crisis
Low BP
hyperkalaemic met acidosis
Pain in legs and abdomen
Diarrhoea
Vomiting
291
How do you manage an Addisonian crisis
hydrocortisone 100mg IV/IM
fluids
292
What are the criteria for a non urgent referral for a breast lump
Non urgent referral for those under 30 with breast lump with or without pain
293
What are the criteria for an urgent referral for a breast lump
Age 30 or over with breast lump, axilla lump
Age 50 or over with unilateral nipple/skin changes
294
What does CA 19-9 measure
Cholangiocarcinoma
295
What is first line to treat peri-arrest bradycardia
Atropine 500 mcg IV
296
What antibody is associated with rheumatoid arthritis
Anti-CCP
297
What is the first line investigation for endometrial cancer
Transvaginal ultrasound
298
What are the signs of radial nerve damage
Wrist drop (can't extend)
Sensory loss at 1st and 2nd metacarpal dorsal surface
299
What are the signs of axillary nerve damage
Tricep paralysis (can't extend elbow)
300
How do you treat anaemia in CKD
First optimise iron
Then EPO
301
What is the first line antibiotic for tonsilitis
Phenoxymethylpenicillin
Clarithromycin
302
What is the Centor criteria
Likelihood sore throat is caused by Strep
presence of tonsillar exudate
cervical lymphadenopathy
fever
no cough
303
When should antibiotics be given for a sore throat
When the Centor criteria is > 3
Immunodeficiency
Systemically unwell
304
What may cause reactivation of TB
Immunosuppression: HIV, steroid therapy, malnutrition
305
What is a strawberry cervix
Punctated and erythematous - trichomonas vaginalis
306
What are the symptoms of trichomonas vaginalis
Green/yellow discharge
Vulvovaginitis
Strawberry cervix (punctated, erythematous)
307
How you treat trichomonas vaginalis
Oral metronidazole
308
What is the legal framework used to treat patients who refuse treatment in emergency scenarios
Common law
309
What the pathophysiology of red degeneration of fibroids
Fibroids are sensitive to oestrogen so grow during pregnancy, so fast they outstrip their blood supply
310
What are the symptoms of red degeneration of fibroids
Fever
Pain
Vomiting
311
How do you manage red degeneration of fibroids
Conservatively, should resolve in 4-7 days
312
What is Richter's transformation and what are the symptoms
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
What are the symptoms of Addisons disease
Hyponatraemia (confusion)
Hyperpigmentation (ACTH excess)
Low blood pressure
High potassium
314
How do you prevent/treat seizures in pre-eclampsia
Magnesium sulphate
315
How do you treat magnesium sulphate induced respiratory depression
Calcium gluconate
316
What should you monitor when giving magnesium sulphate for eclampsia
Resp rate (risk of respiratory depression)
Urine output, oxygen
Reflexes
317
When should anticoagulation for AF start after a TIA/stroke
After TIA - anticoagulate immediately
After stroke - antiplatelet immediately, anticoagulate after 2 weeks
318
What is the dose of adrenaline used in anaphylaxis
IM 0.5mg adrenaline 1:1000 every 5 mins x2
319
In colorectal surgery, why is epidural analgesia better than IV/PO
Faster return to normal bowel function
320
What scan is most appropriate for MS
MRI contrast CNS demyelination
321
What are the features of MS
Relapsing remitting
Visual (optic neuritis)
Sensory symptoms
Leg weakness
Cerebellar symptoms
Urinary/sexual symptoms
322
How do you treat MS
In relapse - steroids reduce length of relapse
Disease modifying drugs can be given if people keep relapsing
323
What organism causes eczema herpeticum
Herpes simplex virus 1 or 2
324
How does eczema herpeticum present
Rapidly progressing painful rash in children with atopic eczema
325
How do you treat eczema herpeticum
Life threatening
Admit for IV aciclovir
326
What is the first line treatment for the first episode of C Diff infection
Oral vancomycin
327
How do you treat a life-threatening C Diff infection
Oral vancomycin + IV metronidazole
328
How do you treat C diff if recurrent episode occurs within 12 weeks of symptom resolution
Fidaxomicin
329
How do you treat C diff if a reccurent episode occurs after 12 weeks of symptom resolution
Fidaxomicin or vancomycin
330
How do you treat spasticity in MS
Baclofen or gabapentin
331
How do you treat oscillopsia in MS
gabapentin
332
What are the symptoms associated with L3 nerve root compression
Sensory loss of anterior thigh
Weak hip flexion, knee extension, hip adduction
Reduced knee reflex
Positive femoral stretch test
333
What are the symptoms associated with L4 nerve root compression
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
334
What are the symptoms of L5 nerve root compression
Sensory loss in dorsum of foot
Weakness in foot and big toe dorsiflexion
Positive sciatic nerve stretch test
335
What are the symptoms of S1 nerve root compression
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
What is the femoral stretch test
Patient on abdomen, flex knee, cause pain
337
What is the sciatic nerve stretch test
Patient on back, flex hip, cause pain
338
How do you treat MSK lower back pain
NSAIDs with PPI
339
What are the reversible causes of cardiac arrest
4 H's, 4 T's
Hypoxia, hypothermia, hyper/hypokalaemia, hypovolaemia
Thrombosis, tension pneumothorax, tamponade, toxins
340
In life support, what is the first medication given for pulseless electrical activity
1mg IV adrenaline
Non-shockable
341
What are the shockable rhythms
Ventricular fibrillation
Pulseless ventricular tachycardia
342
What are the non-shockable rhythms
Asystole
Pulseless electrical activity (PEA)
343
What symptoms are associated with Behcet's syndrome
Anterior uveitis
Oral ulcers
Genital ulcers
Autoimmune-mediated
344
What vitamins does pabrinex have
Pabrinex contains B and C
345
What are the symptoms of osteomalacia and what causes it
Bone pain, tenderness, proximal myopathy
Low vit D -> softening of bones -> increased ALP, low calcium, low phosphate, increased PTH
346
What are the characteristics of Paget's disease
Older male, isolated bone pain, rise in ALP only
347
What are stag-horn calculi made of and where are they
They form in the renal pelvis - hence their shape
The are composed of struvite
348
How long after symptom onset can mechanical thrombectomy be offered
Up to 6 hours after symptom onset
349
How long after symptom onset can thrombolysis be offered
Up to 4.5 hours after symptom onset
350
Which patients should be offered thrombectomy and when
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
What are the indications for a head CT within 8 hours in patients with a head injury
Age 65 or older
anticoagulation
30 mins retrograde amnesia
RTA
352
What are the indications for a head CT within 1 hour in patients with a head injury
More than one episode of vomiting
Seizure
Focal neurological deficit
Basal skull fracture
GCS < 13 initially
GCS < 15 2 hours post injury
353
What are the signs of a basal skill fracture
Haemotympanum
Panda eyes
Battle's sign (brusing behind mastoid process)
CSF leaking from ear or nose
354
What is the most effective form of emergency contraception
Copper IUD
355
How long after unprotected sex can the copper IUD be used as emergency contraception
5 days
356
How long after unprotected sex can levonorgestrel be used as emergency contraception
3 days
357
Describe impetigo
Golden crusted lesions typically found around the mouth
Very contagious
358
How do you treat impetigo
If limited + localised: 1% hydrogen peroxide cream
If extensive flucloxacillin or erythromycin
359
What is the pattern of inheritance of Kallman's syndrome
X-linked recessive
360
What are the features of Kallman syndrome
Anosmia
Tall
Delayed puberty
Low testosterone
Hypogonadotropic hypogonadism (no GnRH)
361
What is the karyotype of Klinefelter syndrome
47 XXY
362
What are the features of Klinefelter syndrome
Tall
Delayed puberty
Lack of secondary sexual characteristics
Hypergonadotropic hypogonadism
363
What is the definition of pre-eclampsia
New onset high blood pressure > 140/90 after week 20 of pregnancy + proteinuria or organ involvement
364
What are the causes of spontaneous subarachnoid haemorrhage
Intracranial saccular (berry) aneurysm
AV malformation
No trauma if 'spontaneous'
365
What are the conditions associated with saccular (berry) aneurysms
HTN
Polycycstic kidney disease
Ehlers-Danlos
Coarctation of aorta
366
A patient had a normal head CT following ?subaracnoid haemorrhage. How long do you wait to do a lumbar puncture and why?
Wait until 12 hours after symptom onset to differentiate between blood from haemorrhage and the blood caused from LP trauma
367
What is the first line investigation for subarachnoid haemorrhage and what will you see
Non contrast CT
hyperdense region of haemorrhage
368
How do you prevent vasospasm in subaracnoid haemorrhage
Nimodipine
369
What organism is responsible for acute epiglottitis
Haemophilus influenzae type B
370
What are the features of acute epiglottitis
Stridor
Fever
High temp
Rapid onset
Drooling of saliva
371
What is Stevens-Johnson syndrome
Severe systemis drug reaction - maculopapular rash with target lesions
Nikolsy sign positive
Mucosal involvement
Fever arthralgia
372
What drugs cause Stevens Johnson syndrome
Penicillin
Sulphonamides
Anticonvulsants: lamotragine, carbamazepine, phenytoin
Allopurinol
NSAIDs
COCP
373
What is Nikolsky sign
Blisters and erosions appear when skin is rubbed gently
374
How do you treat fungal nail infection
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
What is the most common cause of COPD infective exacerbations
Haemophilus influenzae
376
How do you manage chickenpox exposure in pregnancy
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
What is the difference between type 1 and type 2 bipolar disorder
Type 1: mania
type 2: hypomania
378
What are the features of reactive arthritis
Urethritis, conjunctivitis, arthritis
Following dysenteric illness
379
How do you manage reactive arthritis
NSAIDs
Intra-articular steroids if not working
380
How do you treat alcohol withdrawal
Long-acting benzodiazepines (chlordazepoxide, diazepam)
381
How do you manage a patient on warfarin who has major bleeding
Stop warfarin
Vit K 5mg
Prothrombin complex
382
How do you manage a patient with on warfarin with minor bleeding
Target INR for <5.0
Stop warfarin
Give vitamin K 1-3 mg PO
Repeat in 24 hours if still too high
383
How do you test for acromegaly
First: IGF-1 level
If raised then do oral glucose tolerance test. In which there will be no suppression of GH with hyperglycaemia
384
What are the features of SIADH
Hyponatraemia due to dilutionary effect of ADH
385
What are the causes of SIADH
Malignancy (small cell, pancreas, prostate)
Neurological (stroke, haemorrhage)
Infectious (TB, pneumonia)
Drugs
386
When are HIV antibodies found after exposure
4-6 weeks in most
99% after 12 weeks
387
What do you see on ABG for pyloric stenosis in babies
Hypochloremic hypokalaemic metabolic alkalosis
388
When is meningitis B vaccine given
2, 4 and 12 months
389
What is the first line antiplatelet in peripheral arterial disease
Clopidogrel
390
How you treat peripheral arterial disease
Smoking cessation
Treat hypertension, DM, obesity
Give statin
Exercise training
If severe (ischaemia) then surgery
391
What surgery is used to treat colon cancer in the caecal, ascending/prox transverse colon
Right hemi colectomy
392
What surgery is used to treat colon cancer in the distal transverse or descending colon
Left hemi colectomy
393
What surgery is used to treat colon cancer in the sigmoid colon
High anterior resection
394
What surgery is used to treat colon cancer in the rectum
Anterior resection
395
What is the surgery used to treat colon cancer in the anal verge
abdomino-perineal excision of rectum
396
What is the Hartmanns procedure and when is it used
Resection of the sigmoid colon
Bowel perforation
397
What are the serology markers for acute hep B infection
HBsAg +ve
Anti-HBs -ve
IgM anti-HBc +ve
398
How do you tell the difference between chronic and acute Hep B infection
Anti-HBs (immunity) - chronic
IgM anti-HBc is acute
399
What would serology show for someone vaccinated against Hep B
Anti-HBs is positive
Ag neg
IgM neg
400
What is the pathophysiology of immune thrombocytopaenia
Antibodies produced in infection target platelet proteins
401
What are the features of immune thrombocytopaenia
Thrombocytopaenia symptoms: petichiae, purpura, bleeding
Following infection
402
What is the management of immune thrombocytopaenia
Oral prednisolone
403
What is the pattern of inheritance for acute intermittent porphyria
Autosomal dominant
404
What are the symptoms of acute intermittent porphyria
Abdominal (pain, vomiting)
Neuropathy
Psychiatric
405
How do you diagnose acute intermittent porphyria
Raised urinary and serum porphobilinogen
406
How do you treat acute intermittent porphyria
Avoid triggers
To treat acute attacfk: IV haematin/haem arginate
IV glucose if not available
407
What is Ebstein's anomaly and what causes it
congenital heart defect - low tricuspid = large atrium, small ventricle
Caused by lithium exposure in utero
408
How does the treatment of rosacea change with severity of pustules
Ivermectin first line
Add doxycycline if severe
409
What are the features of a subdural haematoma
Slow onset of symptoms
Fluctuating confusion
Motor symptoms
410
What are the features of a subarachnoid haemorrage
Sudden onset occipital headache
411
What organism causes roseola infantum
Human herpes virus 6
412
What are the features of roseola infantum
high fever
maculopapular rash
febrile convulsions
diarrhoea, cough
413
What are the features of typhoid fever
Bradycardia
Fever
Flu like symptoms first then abdo (pain, constipation, diarrhoea)
Rose spots = maculopapular spots on torso
414
What are the features of an acetabular labral tear
Post trauma
Hip/groin pain
Snapping/locking sensation
415
How do you treat vaginal candidiasis, how does this change in preganancy
Oral fluconazole
Oral treatments CI'd in preg - pessary clotrimazole or cream used
416
How do you treat worsening COPD in patients without asthmatic features
No asthmatic features = no steroid responsiveness
LABA + LAMA
417
How do you treat worsening COPD in patients with asthmatic features
Asthmatic features = steroid responsiveness
LABA + ICS
418
What should you use to clean a wound up to 48 hours after surgery
Sterile saline
419
What anticoagulation should be used in patients with a mechanical heart valve
Warfarin
420
What is the diagnostic test for Addisons disease
ACTH synacthen test
421
Describe the rash for molluscum contagiosum
Well-demarcated papules with umbilicated centre
422
What causes molluscum contagiosum
Pox virus
423
How do you treat molluscum contagiosum
Self limiting
Hygiene advice (don't share towels etc.)
424
What is Beck's triad
Low BP
High JVP
Muffled heart sounds
Cardiac tamponade
425
What is the most common malignancy of the lip
Squamous cell carcinoma
426
How do you treat squamous cell carcinoma of the skin
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
What is HLA-B27 associated with
Spondyloarthropathy
428
What is HLA-B51 associated with
Behcets disease
429
What is anti-cardiolipin associated with
Antiphospholipid syndrome
430
What is anti-jo 1 associated with
Polymyositis
431
What effect on development does CMV exposure have to babies
Hearing loss
Low birth weight
Petechial rash
Microcephaly
Seizures
432
What anti-epileptic drug is safe in breastfeeding
Lamotrigine
433
What do you give Parkinsons patients who cannot take levodopa orally
Dopamine agonist patch
434
What size abdominal aortic aneurysm needs repaired
5.5cm
435
What are the features of roseloa infantum
3-5 days high fever
2 day maculopapular rash on chest which spreads to limbs
Caused by Herpes virus 6
436
What organism causes slapped cheek syndrome
Parvovirus B19
437
What age is affected by roseola infantum
6 months to 2 years
438
When should a baby be able to sit without support
8 months
439
What is first line antihypertensive for type 2 diabetic patients, or patients under 55
ACEi or ARB
440
What is the first line antihypertensive for patients > 55, or Afro-Caribbean patients
Calcium channel blocker
441
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
Spirinolactone
442
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
Alpha or beta-blocker
443
What are the complications of acute pancreatitis and what are the prognoses
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
What is Grey Turner's sign and what does it indicate
Flank bruising - pancreatic necrosis with intra/retroperitoneal haemorrhage
445
What is Cullen's sign and what does it indicate
Peri-umbillical bleeding - pancreatic necrosis with intra/retroperitoneal haemorrhage
446
What are the features of Meckel's diverticulum
Abdominal pain like appendicitis
Rectal bleeding
Obstruction
447
How do you treat Meckel's diverticulum
Removal if symptomatic
448
How do you manage a suspected DVT
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
What anticoagulation should be given to patients with DVT and active malignancy
DOAC
450
What anticoagulation should be given to patients with severe renal impairment (<15/min)
LMWH
451
How long should a patient be anticoagulated for following a DVT
Unprovoked - 6 months
Provoked - 3 months
452
How do you treat pain in endometriosis
1: OTC analgesia
2: COCP
3: surgery
453
What test confirms chronic/acute hep B infection
HBs-Ag
454
What are the features of renal cell cancer
Haematuria
Loin pain
Abdominal mass
Pyrexia
Endocrine effects (EPO -> polycythaemia; ACTH; PTH)
455
How does the size of a renal cell carcinoma affect management
<7cm partial nephrectomy
>7cm radical nephrectomy
456
How long should eclampsia be treated for
MGSO4 for 24 hours after last seizure or delivery
457
What is first line treatment for heart failure with reduced ejection fraction
Beta blocker and ACEi
458
What is the second line therapy for heart failure with reduced ejection fraction
(Beta blocker and ACEi)
Add aldosterone antagonist = spironolactone
459
What is the third line therapy for heart failure with reduced ejection fraction
(Beta blocker, ACEi, spironolactone)
Specialist input - ivabradine
460
What is the appropriate investigation for a PE with renal impairment
V/Q scan
CTPA contrast would worsen renal function
461
What does the BCG vaccine protect against
TB meningitis in children
462
Where is damaged in the case of spastic cerebral palsy
Upper motor neurons
463
Where is damaged in the case of dyskinetic cerebral palsy
Basal ganglia and substantia nigra
464
Where is damaged in the case of ataxic cerebral palsy
Cerebellum
465
What criteria should be met to perform needle aspiration in primary pneumothorax
SOB or rim of air >2cm
466
What is laryngomalacia
Congenital abnormality of the larynx
Benign cause of stridor in infants
Usually self resolves by 2 years
467
What is the discharge associated with bacterial vaginosis
Thin, fishy, white/clear, homogenous
468
What is the discharge associated with candida albicans
White, non-offensive, itchy
469
What is the discharge associated with gonorrhoea
Thick, green
470
What is the discharge associated with Trichonoma vaginalis infection
Frothy, yellow
471
What is a Colles' fracture
Transverse fracture of radius
1 inch prox to radio-carpal joint
Doral displacement and angulation
472
What is a Smith's fracture
Angulation of distal radius fragment
473
What is a Bennett's fracture
Fracture at the base of the thumb metacarpal, triangular fragment on X ray
474
What is a Monteggia's fracture
Dislocation of proximal radio-ulnar joint with ulna fracture
475
What is a Galeazzi fracture
Radial shaft fracture with dislocation of distal radioulnar joint
476
What is a Barton's fracture
Distal radius fracture (Colles'/Smith's) with radiocarpal dislocation
477
What is the most common carpal fracture
scaphoid fracture
478
What are the features of a scaphoid fracture
Pain and swelling of anatomical snuff boc
Pain moving wrist and longitudinal compression of thumb
479
What is first line treatment for an open fracture
Open fractures can only be definitively managed when the soft tissues have been debrided. Give IV antibiotics
480
When do diabetics need to surrender their driving license and inform the DVLS
After two hypoglycaemic episodes
481
What is the DEXA definition of osteoporosis
DEXA score < -2.5
482
How do you treat osteoporosis
Give bisphosponates
Correct calcium and vitamin D first so as not to worsen hypocalcaemia
483
What are the symptoms of hypomagnesaemia
Nausea
Muscle cramps
Tremors
Hyper-reflexia
Tetany
Long QT
484
What is the largest risk factor for anal cancer
HPV infection
485
What are the symptoms of testicular cancer
Non-tender lump
Hydrocele
Gynaecomastia
486
How do you investigate suspected testicular cancer
ultrasound
487
What are the side effects of loop diuretics like furosemide
Hypotension
Ototoxicity
Hypo Na, K, Mg, Ca
Renal impairment
Gout
488
What cancer is associated with Coeliac disease
T-cell lymphoma of small intestine
489
What are the complications of Coeliac disease
Anaemia (b12, folate, iron deficiency)
Osteoporosis and osteomalacia
Lactose intolerance
T-cell lymphoma
490
How do you manage aortic stenosis
Asymptomatic - observe
Symptomatic - valve replacement or baloon valvuloplasty if not fit
491
How do you manage an anal fissure
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
When do you do surgery for an anal fissure
If topical GTN is not effective after 8 weeks
493
Where do anal fissures occur
posterior midline
494
What factors correlate with the severity of acute pancreatitis
Hypocalcaemia
Hyperglycaemia
Hypoxia
Neutrophilia
High LDH, AST
Age >55
495
What is the distribution of dermatitis herpetiformis
Elbows, knees, buttocks§
496
What is postoperative/paralytic ileus
Common postoperative complication in which there is reduced bowel peristalsis - pseudo obstruction
497
How do you manage paralytic ileus
Nil-by-mouth
NG tube if vomiting
IV fluids and total parenteral nutrition
498
What are convulsions without conscious impairment
Pseudoseizure (psychogenic)
499
What is the most common cause of primary hyperaldosteronism
Bilateral idiopathic adrenal hyperplasia
500
What are the features of primary hyperaldosteronism
Hypertension
Hypokalaemia (muscle weakness)
501
What is the first line investigation for primary hyperaldosteronism
Plasma aldosterone/renin ratio
(high aldosterone, low renin)
502
How do you investigate primary aldosteronism
1: aldosterone/renin ratio (will be raised)
2: CT abdomen
3: adrenal vein sampling
503
How do you treat primary hyperaldosteronism due to bilateral adrenocortical hyperplasia
Aldosterone antagonist = spirinolactone
504
What is iliotibial band syndrome
Tenderness 2-3 cm above lateral joint line
1 in 10 people who run have this
505
When do you do a lumbar puncture to investigate a subarachnoid haemorrhage
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
What is the name for abnormal packflow of urine from bladder into ureter and kidney
Vesicoureteric reflux
507
How do you diagnose vesicoureteric reflux
Micturating cystouretrogram
508
What complication is associated with vesicoureteric reflux
UTI
Renal scarring
509
What is the mode of inheritance for Duchenne muscular dystrophy
X-linked recessive
510
What are the features of Duchenne muscular dystrophy
Progressive prox muscule weakness
Calf pseudohypertrophy
Gower's sign positive (using arms to stand up from squat)
Intellectual impairment in 30%
511
What is the definitive investigation for Duchenne muscular dystrophy
Genetic testing
512
What id the differential for rheumatoid type symptoms with nail changes
Psoriatic arthritis
513
At which week should you refer to an obstetrician for lack of fetal movements?
24 weeks
514
How do you investigate children/young people with unexplained bone swelling or pain
Urgent X-ray to rule out sarcoma
515
When should someone with a corneal foreign body be urgently referred to opthalmology
Penetrating eye injury
Organic material (infection)
Red flags: severe pain, pupil changes, vision changes
516
What is the most sensitive and specific test for acute pancreatitis
Lipase
517
How can acute pancreatitis be diagnosed
Lipase (best)/ amylase >3x normal
Ultrasound to explain aetiology
518
What are the causes of acute pancreatits
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
What are the prognostic factors in acute pancreatitis
Age > 55
hypocalcemia
hyperglycaemia
hypoxia
neutrophilia
high LDH, AST
520
How are growth plate fractures classified and what are the categories
Salter-Harris
1: physis
2: physis + metaphysis (75%)
3: physis and epiphysis
4: physis + metaphysis + epiphysis
5: physis + crush
521
What electrolyte imbalance is caused by chronic alcohol consumption
Hypomagnesaemia
522
What murmur does aortic stenosis cause
Ejection systolic louder on expiration
523
What murmur does pulmonary stenosis cause
Ejection systolic louder on inspiration
524
What murmur does mitral regurgitation cause
Pansystolic, louder on expiration
525
What murmur does tricuspid regurgitation cause
Pansystolic, louder on inspiration
526
What murmur does aortic regurgitation cause
early diastolic
527
What murmur does mitral stenosis cause
mid-late diastolic
528
How do you treat spasticity in MS
Baclofen
Gabapentin
529
What is Epstein's pearl
Congential cyst on posterior palate in the midline - white nodule
Spontaneously resolves, no treatment needed
530
How do you treat hyperglycaemic hyperosmolar state
Give fluids, monitor potassium
Insulin can be given if glucose stops falling with fluids
VTE prophylaxis dues to hyperviscosity
531
What drugs cause lupus
procainamide
hydralazine
isoniazid
minocycline
phenytoin
532
What drugs are given for TB
Rifampicin
Isoniazid
Streptomycin
Ethambutamol
(RISE)
533
How do you treat thrush
One dose of oral fluconazole
Local treatments (pessary) if pregnancy
534
What are the risk factors for shoulder dystocia
Macrosomia
High BMI mum
Diabetes
Prolonged labour
535
What are the features of alcohol withdrawal
6-12 hours: tremor, sweating, tachycardia, anxiety
seizures at 36 hours
delirium tremens 48-72 hours
536
What are the symptoms of delirium tremens
tremor, confusion, delusions, hallucinations, fever, tachycardia
537
What drugs cause neuroleptic malignant syndrome
Antipsychotics
538
What are the symptoms of neuroleptic malignant syndrome
Fever
rigidity
HTN, tachycardia, tachypnoea
delirium with confusion
539
Beck's triad
Raised JVP
Muffled heart sounds
Hypotension
540
What does electrical alternans on ECG indicate
Pericardial effusion/cardiac tamponade
541
What is Kernig's sign
Flex hip and extend knee = pain = meningitis
542
What causes subacute combined degeneration of the spinal cord
B12 deficiency
543
What does stranding of peri-ureteric fat indicate
Passed ureteric calculus
544
What is Romberg's sign
Closed eyes when standing to assess balance
545
How do you treat Bell's palsy
Prednisolone and eye care
546
How do you manage severe pain in renal colic
IM diclofenac
547
What are the features of Ramsay Hunt syndrome and what causes it?
Reactivation of VZ virus
Ear pain, facial nerve palsy, vesicular rash around the ear
548
What is the treatment for Ramsay Hunt syndrome
Oral aciclovir and corticosteroids
549
What is the fasting glucose level that defines gestational diabetes
7 mmol/L
550
When can women start the progestrogen only pill after birth
Immediately
551
Hwen can women start the COCP after birth
6 weeks
552
What is the most common causitive organism for septic arthritis
Neisseria gonorrhoeae
553
How do you tell the difference between a gastric ulcer and a duodenal ulcer
Gastric = pain on eating
Duodenal = pain hours after eating
554
How does tricyclic overdose affect the ECG and what does it mean
Widening QRS > 100ms increased risk of seizures
Widening QRS > 160ms -> ventricular arrythmias
555
How and when do you treat a tricyclic overdose
QRS >100ms (increased risk of seizures)
IV socium bicarbonate
