Passmed knowledge

Question 1

antibiotic for syphallis

Answer 1

benzathine benzylpenicillin

Question 2

how to manage migraine ?

Answer 2

Migraine
acute: triptan + NSAID or triptan + paracetamol

prophylaxis: topiramate or propranolol

(be careful no beta blocker for asthma patient)

Question 3

Why can’t asthmatics have propanolol?

Answer 3

propanolol = beta blockers

The β2 receptors in the lungs help relax the smooth muscle of the airways, promoting bronchodilation.

Therefore, beta blockers conversely promote bronchoconstriction and also bronchospasm.

They also act in opposition to drugs like salbutemol (short-acting β2-adrenergic receptor agonist (SABA))

Question 4

why do COPD patients have lower target o2 sats?

Answer 4

COPD patients are chronic CO2 retainers.

Physiologically, breathing is driven by CO2 levels picked up in the brains central chemoreceptors.

But these patients the body becomes less sensitive to CO2 over time. They loose their hypercapnic drive.

Instead these patients rely on hypoxia to influence their breathing rate (hypoxic drive).

Giving these patients high levels of oxygen can reduce their stimulus to breath.

The goal is to provide just enough oxygen to maintain adequate tissue oxygenation without suppressing the hypoxic drive or causing excessive CO2 retention.

Question 5

If about to have OGD what should happen with PPI meds?

Answer 5

Proton pump inhibitors should be stopped 2 weeks before an upper GI endoscopy

Question 6

what is a normal LVEF?

Answer 6

Normal LVEF is 45%-60%

therefore reduced is less than 45

Question 7

first line for heart failure management ?

Answer 7

The first-line treatment for all patients is both an ACE-inhibitor and a beta-blocker

generally, one drug should be started at a time. NICE advise that clinical judgement is used when determining which one to start first

beta-blockers licensed to treat heart failure in the UK include bisoprolol, carvedilol, and nebivolol.

ACE-inhibitors and beta-blockers have no effect on mortality in heart failure with preserved ejection fraction

Question 8

double duct sign?

Answer 8

pancreatic cancer

dilation of common bile duct and and pancreatic duct

Question 9

which med for secondary prevention of iscaemic stroke ?

Answer 9

clopidogrel 75mg OD

Question 10

which med for secondary prevention of TIA ?

Answer 10

clopidogrel 75mg OD

Question 11

which valve is affected in infective endocarditis ?

Answer 11

In infective endocarditis, the mitral valve is most commonly affected

Question 12

which valve in IE for IV drug users?

Answer 12

tricuspid valve

Question 13

preceding influenza predisposes to which organism for pneumonia ?

Answer 13

S aureus

Question 14

how to calc alcohol lunits ? 1

Answer 14

Alcohol units = volume (ml) * ABV / 1,000

Question 15

why ACE-i bad for AKI but reno-protective in CKD?

Answer 15

RAAS

IN AKI, there is often hypoperfusion of kidney. Therefore RAAS activated -> vasocontriction of efferent arteriole. maintains filtrations despite low renal blood flow. ACE-i blocks this system and doesn’t allow kidney to be well perfused.

In CKD, RAAS contributes to glomerular hypertension, fibrosis, and proteinuria. Therefore, blocking this is good.

Question 16

what acid base in cushings?

Answer 16

Cushing’s syndrome - hypokalaemic metabolic alkalosis

Question 17

scoring system to assess bleeding risk ?

Answer 17

ORBIT scoring system

Question 18

apixaban mechanism (what does it iniibibt?

Answer 18

factor Xa inhibitor

Question 19

when to send a urine culture in UTI (MSU)?

Answer 19

non-pregnant women = over 65, visible or non visible haemturia
pregannt women = alwsys
men = always

Question 20

tool for preidtcing chance of getting cardiovascular disease ?

Answer 20

QRISK

this is 10 year risk. given as a percentage. 10% is cut off for statin therapy and also SGLT-2 tx in t2dm

Question 21

pneumonia + traget lesion ? also what is target lesion?

Answer 21

mycoplasma pneumoniae

target lesion = erythema multiforme

Question 22

bacterial vaginosis organism ?

Answer 22

Bacterial vaginosis - overgrowth of predominately Gardnerella vaginalis

Question 23

breast cancer marker

Answer 23

ca 15-3

CA125 = ovarian
CA19-9 = pacnreatic cancer

Question 24

how long are tthe clusters of cluster headacehs

Answer 24

Clusters’ of cluster headaches typically last from 4 to 12 weeks

Question 25

extra dural vs subdural haematoma on CT

Answer 25

exdural = bi-convex = lemon shaped, midline shift, brainstem herniation. this is arterial
The majority are caused by rupture of the middle meningeal artery

subdural = Crescent “banana-shaped” mass
An acute SDH will have a hyperdense (bright white) appearance
A chronic SDH will have a hypodense (black/grey) appearance
rupture of the bridging cranial veins after a blow to the temporal side of the head

Question 26

management for GCA

Answer 26

urgent high-dose glucocorticoids should be given as soon as the diagnosis is suspected and before the temporal artery biopsy
if there is no visual loss then high-dose prednisolone is used
if there is evolving visual loss IV methylprednisolone is usually given prior to starting high-dose prednisolone

Question 27

cluster headaches management ?

Answer 27

NICE recommend seeking specialist advice from a neurologist if a patient develops cluster headaches
acute
100% oxygen (80% response rate within 15 minutes)
subcutaneous triptan (75% response rate within 15 minutes)
prophylaxis
verapamil is the drug of choice
there is also some evidence to support a tapering dose of prednisolone

Question 28

ix for bladder cancer ?

Answer 28

Gold standard for bladder cancer diagnosis is cystoscopy

Question 29

what to do with insulin in DKA for a known type 1 ?

Answer 29

In the acute management of DKA, insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin

This patient has diabetic ketoacidosis (DKA). The management of DKA involves starting fixed-rate insulin, continuing regular long-acting insulin, and stopping regular short-acting insulin. Fixed-rate insulin is safer than variable-rate insulin in patients with DKA as a fixed, smaller dose of insulin is less likely to result in hypoglycaemia and hypokalaemia. The patient’s regular long-acting insulin is continued to prevent rebound hyperglycaemia when intravenous treatment is stopped. Short-acting insulin is not necessary in addition to the fixed-rate insulin and would risk causing hypoglycaemia.

Question 30

lung cancer and paraneoplastic syndromes

Answer 30

Small cell = ADH / ACTH

Squamous cell = PTH-rp (hypercaclaemia)

Question 31

PCR vs ACR

Answer 31

ACR is more specific to detecting early kidney damage, particularly in diabetes or hypertension, where microalbuminuria is a concern.

PCR is broader and used when significant proteinuria is suspected, often for more advanced kidney disease or systemic conditions (glomerular or tubular kidney disease)

Question 32

cavitating pnuemonia in upper lobes?

Answer 32

Klebsiella most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics