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Finals Revision > PassMed October > Flashcards

PassMed October Flashcards

1
Q

What is the commonest cause of encephalitis in adults?

A

HSV

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2
Q

How do you manage rectal tumours surgically?

A

High/mid rectal tumours = anterior resection
Low rectal tumour = abdoperitoneal excision

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3
Q

Where are the ECG changes in anteroseptal MI? Which artery has been affected?

A

V1-V4
LAD artery

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4
Q

Where are the ECG changes in inferior MI? Which artery has been affected?

A

II, III and aVF
Right coronary artery

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5
Q

Where are the ECG changes in anterolateral MI? Which artery has been affected?

A

V3-V6, I and aVL
LAD or Left circumflex artery

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6
Q

Where are the ECG changes in lateral MI? Which artery has been affected?

A

I, aVL +/- V5 & V6
Left circumflex artery

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7
Q

Where are the ECG changes in posterior MI? What additional changes are seen? Which artery has been affected?

A

V1-V3
Horizontal ST depression, tall, broad R waves, upright T waves and dominat R wave in V2
Left circumflex and/or Right coronary

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8
Q

What may a new LBBB point towards?

A

ACS

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9
Q

What is a normal anion gap?

A

8-14

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10
Q

Name the main causes of metabolic acidosis with normal anion gap?

A

GI loss
Renal tubular acidosis
Drugs (e.g. Acetazolamide)
Addison’s disease

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11
Q

Name the main causes of metabolic acidosis with riased anion gap?

A

Due to lactate = shock/hypoxia
Due to ketones = DKA/alcohol
Due to urate = renal failure
Acid poisoning (with methanol or salicylates)
Chronic paracetamol use

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12
Q

What does a positive Rinne’s test mean?

A

Normal test
Air conduction > bone conduction

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13
Q

How long must patients trial hearing aids before consideration for cochlea implants?

A

> 3 months

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14
Q

How do we measure which area of the brain has been affected by ischaemia in TIA?

A

MRI brain with diffusion-weighted imaging

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15
Q

What is Parazosin?

A

An alpha blocker used to help with urinary retention secondary to BPH

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16
Q

True or false, antihistamines can lead to urinary retention?

A

True!

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17
Q

What will urine sodium and urine osmolality be like in pre-renal disease?

A

Urine sodium <20
Urine osmolality >500

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18
Q

How does Amiodarone affect Warfarin and Digoxin?

A

Decreases the effect of warfarin and increases the affect of digoxin

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19
Q

What must you monitor in patients on long term amiodarone?

A

LFTs and TFTs every 6 months

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20
Q

Which drugs should be used 1st line in the management of HTN in those with T2DM?

A

ACEis or ARBs

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21
Q

Above which home and ambulatory blood pressure readings is BP treatment indicated?

A

<80 years = 140/90 in clinic or 135/85 ABPM
>80 years = 150/90 in clinic or 145/85 ABPM

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22
Q

Which nerve root comes out below the vertebrae? Which vertebrae does it come out below?

A

C8
Comes out below C7

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23
Q

What are the symptoms of diverticulitis?

A

Lower left quadrant abdo pain & guarding, fever, bloating, rectal bleeding & constipation

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24
Q

How does hypokalaemia appear on ECG?

A

U waves, flattened T waves, borderline elongated PR interval

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25
Q

What defines mild-moderate UC flare up, how should you treat?

A

Up to 6 loose stools/day
Mx = rectal mesalazine, if this fails add oral mesalazine

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26
Q

What is Benign Rolandic Epilepsy? What is seen on EEG?

A

Partial seizures which occur at night in otherwise healthy children.
EEG shows centro-temporal spikes

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27
Q

What can constipation cause in cirrhotic patients?

A

Decompensated liver disease

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28
Q

What is pituitary apoplexy, how does it present and how should we investigate/treat?

A

Sudden enlargement of a pituitary tumour
Sx = sudden onset headache, vomiting, neck stiffness, hyponatraemia, hypotension, bitemporal visual defect and extra ocular nerve palsy
Ix = MRI
Tx = Urgent steroids

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29
Q

How do you manage complete heart block with broad QRS which does not respond to Atropine or transcutaneous pacing?

A

transvenous pacing

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30
Q

Which nerve controls thumb opposition and hand pronation?

A

Median nerve

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31
Q

Which nerve is commonly damaged in axillary dissection? How does this present?

A

Intercostobrachial nerves
Presents with numbness in the axillae

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32
Q

What are the normal post void volumes in the bladder?

A

In under 65s = <50mls
In over 65s = <100mls

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33
Q

What should you test for in those with recurrent vaginal candidaisis?

A

Diabetes with HbA1c

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34
Q

Where is the axillary nerve commonly damaged? What are its nerve roots and what is the affect of damage?

A

Surgical neck of the Humerus
C5/C6
Affected in # or shoulder dislocation leading to loss of abduction beyond 15 degrees

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35
Q

What is Klumpke’s paralysis?

A

Paralysis of C8 and T1 in traction injuries or delivery leading to weakness of the intrinsic muscles of the hand (causes clawing) +/- horner’s syndrome

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36
Q

What is Erb’s paralysis?

A

Paralysis of C5/C6` in falls or shoulder dystocia leading to pronation and medial rotation of the arm, aka waiter’s tip presentation

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37
Q

The aldosterone:renin ratio is raised in a hyperaldosteronism patient. What does this imply about the cause and what further tests should be done?

A

It is a primary hyperaldosteronism
Perform CT abdomen then adrenal venous sampling

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38
Q

Which gene mutation is HNPCC associated with?

A

MSH2 and MHLH1

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39
Q

What is the most common cause of primary hyperaldosteronism?

A

Bilateral idiopathic adrenal hyperplasia

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40
Q

What is the emergency management of acute angle closure glaucoma?

A

Direct parasympathomiemetric, Beta blockers and alpha-2 agonist eye drops OR
IV acetazolomide

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41
Q

How can we measure the response of colon cancer to treatment?

A

CEA testing

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42
Q

What is used to treat DIC?

A

Fresh frozen plasma

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43
Q

What symptoms are characteristic of Lewy Body Dementia?

A

Fluctuating cognition, visual hallucinations, parkinsonism and REM sleep disorder

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44
Q

What blood results are characteristic of PMR?

A

Raised WCC, ESR and CRP with a normal CK

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45
Q

Sx and Mx of Meniere’s disease?

A

Recurrent vertigo, tinnitus and sensorineural hearing loss with a feeling of fullness in the ear
Mx = ENT review, prochlorperazine for acute attack and betahistine for prevention

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46
Q

What is the causative organism and Sx in Roseola Infantum? How long is school exclusion required for?

A

HHV6
Fever, maculopapular rash, nagayama spots on the soft palate/uvula and sometimes febrile convulsions
School exclusion not required

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47
Q

What should you always do in suspected cases of rubella in pregnancy?

A

Discuss it with the local health protection unit

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48
Q

When should you administer the MMR vaccine to women who are pregnant or trying to concieve?

A

You should not!
Give the vaccine only in the post-natal period

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49
Q

What is the major dose limiting side effect of magnesium salts?

A

Diarrhoea

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50
Q

What is Disulfiram?

A

Used to treat alcoholics, it causes unpleasant side effects immediately after consuming alcohol

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51
Q

What is Herpes Zoster Opthalmicus? What is Hutchinson’s sign?

A

Shingles (reactivation of VZV) around the eye
Hutchinson’s sign is rash on the tip or side of the nose and is a strong RF for ocular involvement.

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52
Q

How do you manage Herpes Zoster Opthalmicus?

A

Oral aciclovir for 7-10 days, offer within 72 hours of Sx onset

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53
Q

What is Takayasu’s Arteritis? How does it present and how do we treat?

A

Large cell arteritis occurring in young asian women.
Presents with unequal BPs, weak/absent peripheral pulses, limb claudication and renal artery stenosis
Mx = steroids

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54
Q

How should IgG and IgM be interpreted when testing pregnant women for Parovirus B19?

A

IgG +ve and IgM -ve = immune, no action required
IgG -ve and IgM +ve = non-immune, infection within the last 4 weeks, refer to foetal medicine
IgG -ve and IgM -ve = repeat in 4 weeks

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55
Q

Sx and Mx of Still’s Disease?

A

Arthralgia, salmon pink maculopapular rash, fever which worsens at night and is associated with worsening of other Sx, lymphadenopathy
Mx = NSAIDs and steroids

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56
Q

Sx, Ix and Mx of Benign Paroxysmal Positional Vertigo?

A

Vertigo triggered by change in head position with nausea
Ix = Dix-Hallpike manoeuvre
Mx = Epley manoeuvre

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57
Q

What are the degrees of perineal tear?

A

1st degree = superficial tear, not involving the muscle
2nd degree = injury to the perineal muscle but not involving the anal sphincter
3rd degree = injury to perineal muscle and anal sphincter complex but not involving the rectal mucosae
4th degree = injury to perineal muscle, anal sphincter and rectal mucosae

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58
Q

What is the 1st and 2nd line Mx of HF with reduced EF?

A

1st line = ACEi and Beta blockers with loop diuretic if fluid overload
2nd line = Aldosterone antagonists

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59
Q

How do you manage HF with preserved EF?

A

Loop diuretic to relieve fluid overload

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60
Q

What is the most important imaging investigation to conduct in ?cauda equina?

A

Urgent MRI spine

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61
Q

How quickly should you give 1 unit of RBCs in non-urgent scenarios?

A

Over 90-120 mins

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62
Q

What is the most common electrolyte imbalance following SAH? Why does this occur?

A

Hyponatraemia
Occurs as there is new SIADH

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63
Q

How do you manage gestational diabetes?

A

Diet/lifestyle -> Metformin -> short acting SC insulin
If fasting glucose >7 consider starting immediatley

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64
Q

A patient has uncontrolled HTN but is already taking ACEis, CCBs and thiazide like diuretics. What should you prescribe next? What must the K+ be to allow us to prescribe this drug?

A

Alpha or beta blocker if K+ >4.5
Low dose spironolactone if K+ =<4.5

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65
Q

What is the first line management of anti-freeze poisoning?

A

Fomepizole

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66
Q

What imaging should you perform in ? osteoporotic spinal #

A

X-ray spine

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67
Q

Which drugs are an absolute contraindication to sildenafil (Viagra)

A

Nitrates and Nicorandil

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68
Q

How does De Quervian’s (sub-acute) thyroiditis present?

A

Primary Hyperthyroidism with painful goitre, raised ESR and globally reduced uptake on iodine-131 scan

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69
Q

Sx, Ix and Mx of minimal change disease?

A

Most common cause of nephrotic syndrome in children!
Sx = proteinuria, low serum albumin and oedema
Ix = biopsy and microscopy - this will normally appear normal
Mx = oral steroids, cyclophosphamide if steroid resistant

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70
Q

What is the investigation of choice in avascular necrosis?

A

MRI

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71
Q

How can we identify bowel perforation on imaging?

A

Erect chest x-ray

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72
Q

How does nasopharyngeal carcinoma commonly present?

A

Painless lymphadenopathy (as it spreads early)

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73
Q

Sx of Salmonella Typhi (typhoid) and Salmonella Paratyphi (paratyphoid)?

A

Systemic upset, relative bradycardia, abdo pain and distension and constipation.
Rose spots on the trunk point to paratyphoid

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74
Q

Which part of the chest should you compress during CPR in children or infants?

A

Children = Compress the lower half of the sternum
Infants = use two thumb encircling technique

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75
Q

Which type of murmur is Turner’s syndrome associated with? What causes it?

A

Systolic murmur
Aortic Coarctation

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76
Q

What is the classical presentation of paget’s disease of bone?

A

Bone pain in an older male (typically affecting skull, spine/pelvis and lower limb long bones), isolated raised ALP and if untreated bowing of the tibia and bossing of the skull

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77
Q

Mx of paget’s diease of bone?

A

Oral risedronate or IV zoledronate (bisphosphonates)

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78
Q

Mx of Acne Vulgaris?

A

1st line = topical retinoids e.g. isotretinoin OR topical benzoyl peroxide
2nd line = oral Abx
3rd line = oral contraceptive (if female) OR oral retinoid e.g. isotretinoin

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79
Q

What additional condition should you think about in any female presenting with an X-linked recessive condition such as Haemophilia?

A

Turner’s syndrome - they only have 1 X chromasome

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80
Q

How often should you do a rhythm check in ALS?

A

Every 2 mins

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81
Q

Describe the meaning of the different T-score values?

A

> -1.0 = normal
-1.0 to -2.5 = osteopenia
<-2.5 = osteoporosis

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82
Q

What is seen in a bifasicular and trifasicular block respectivley?

A

Bifasicular = RBBB and Left axis deviation
Trifasicular = RBBB, Left axis deviation and first degree heart block

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83
Q

Mx of bacterial conjunctivits?

A

2-3 hourly chloramphenicol drops OR chloramphenicol ointment QDS
Topical fusidic acid in pregnant women

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84
Q

What is Dressler’s syndrome? Sx?

A

Autoimmune response to damage of the myocardium or pericardium (e.g. following MI)
Sx = fever, pericarditis, pleuritic pain +/- pericardial effusion

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85
Q

Which type of eye drops may cause corneal ulceration?

A

Steroid eye drops as they can lead to fungal infection of the cornea

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86
Q

What are the 2 types of aortic dissection. How do they differ clinically?

A

Type A = ascending aorta is dissected. Sx = chest pain
Type B = descending aorta is dissected. Sx = upper back pain

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87
Q

What may patients taking Levodopa experience at its dosage peak?

A

Dyskinesias
Dystonia, chorea and athetosis (involuntary writing movements)

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88
Q

Which beta blocker is associated with QTc prolongation?

A

Satalol

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89
Q

What can occur in trauma patients who are on long term mechanical ventialtion?

A

Oesophageal fistula formation

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90
Q

What is the dosage of Amiodarone that should be given in ALS of shockable rhythms?

A

Initially 300mg (after 3 shocks), then if VF/Pulseless VT continues give 150mg after the 5th shock

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91
Q

What is Congenital Nasolacrimal Duct Obstruction? Sx? Mx?

A

Blockage of the tear ducts. Commonest cause of recurrent sticky or watery eye in neonates.
Mx = reassurance, should resolve by 1 year

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92
Q

How will the CO2 appear in life threatening asthma attack? What does this indiacte?

A

Normal or raised
Indicates exhaustion

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93
Q

What is Chancroid? How does it present?

A

Genital ulcers caused by Haemophillus Ducreyi
Casues painful genital ulcers and unilateral inguinal lymphadenopathy. Seen in tropical countries

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94
Q

What are the Sx of portal hypertension? What should you worry about if this occurs alongside lower GI bleed?

A

Ascites, splenomegaly, caput medusae (abdo vein distension)
Rectal varices

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95
Q

What is the commonest cause of portal hypertension? How will it affect blood tests?

A

Cirrhosis
Raised ALT and AST and reduced Albumin

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96
Q

Define the parameters for severe asthma attack?

A

HR >110, RR>25, PEFR 33-50% and can not complete full sentences

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97
Q

What blood tests should be done when we think a diagnosis of dementia is likely?

A

FBC, U&Es, LFTs, Ca2+, Glucose, ESR/CRP, TFTs, Vit B12 and Folate

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98
Q

What is the purpose of adrenal venous sampling?

A

Allows us to differentiate between unilateral adenoma and bilateral adrenal hypoplasia

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99
Q

You see an arrhythmia which is consistent with broad complex tachycardia. How does the shape of the QRS affect the exact diagnosis?

A

QRS is polymorphic = Torsades de Points
QRS is monomorphic = VT

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100
Q

A patient with poorly controlled COPD presents with Torsades de Point. What type of drugs should now be stopped, which one specifically in this patient? What type of drug should be started?

A

Drugs which cause QTc prolongation.
Azithromycin - used prophylactically in COPD.
Start a beta blocker

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101
Q

Which blood disorder can glucocorticoids introduce?

A

Neutrophilia

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102
Q

Mx and prevention of high altitude cerebral oedema?

A

Mx = descent, oxygen and dexamethasone
Prevention = acetazolomide

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103
Q

Who can LTOT be offered to in COPD patients?

A

pO2<7.3 or pO2 7.3-8 with one of:
- Secondary polycythaemia
- Peripheral oedema
- Pulmonary HTN

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104
Q

In children acute illness, Down’s Syndrome and Prada Willi Syndrome can all cause hyper- or hypo- tonia?

A

Hypotonia!

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105
Q

Sx of Granulomatosis with Polyangitis?

A

Haemoptysis, dyspnoea, renal impairment, epistaxis, ear issues and a flat/saddle nose

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106
Q

Sx of Good Pasture’s Syndrome?

A

Haemoptysis, fever, nausea and glomerulonephritis

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107
Q

Sx of aspergillioma?

A

Haemoptysis and CXR with rounded opacity in a patient know to have had TB

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108
Q

What is the murmur in mitral stenosis? What is the most common cause?

A

Low-pitched mid-late diastolic murmur
Rheumatic fever

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109
Q

What has likely happened in an elderly patient who has fallen and now has raised CK?

A

Rhabdomyolysis
This then leads to acute tubular necrosis

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110
Q

What is often seen in pernicious anaemia?

A

B12 deficiency leading to pancytopenia.
Mainly in women with previous autoimmune diseases

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111
Q

Where should you definitely NOT cannulate in a known diabetic?

A

Feet!

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112
Q

A patient has presented with severe asthma that has not responded to bronchodilators. What should you do with them?

A

Admit!

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113
Q

Can you give the influenza vaccine to an ill person?

A

No, postpone until they are well!

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114
Q

Acute Tubular Necrosis is the commonest renal cause of AKI. How will the urine osmolality and sodium appear?

A

Urine osmolality will be low, urine sodium will be raised

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115
Q

What does a positive lachman test indicate?

A

ACL injury

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116
Q

VSD can occur secondary to an MI. How will it present?

A

Acute HF and a pansystolic murmur

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117
Q

What is the risk with a scaphoid fracture, how do we mitigate this?

A

Risk of avascular necrosis
Refer patients to ortho!

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118
Q

What ECG changes are seen in pericarditis?

A

PR depression and saddle shaped ST elevation

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119
Q

What is Sheehan’s syndrome?

A

Occurs after a severe PPH. Can cause hypopituitarism leading to amenorrhoea and lack of milk production

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120
Q

What is Asherman’s syndrome?

A

Pain and oligomenorrhoea occurring secondary to uterine adhesions/fibrosis (normally after multiple surgeries)

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121
Q

What is a renal complication of compartment syndrome?

A

Acute tubular necrosis

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122
Q

Which nerve supplies finger extension?

A

Radial nerve

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123
Q

Which nerve supplies finger adduction?

A

Ulnar nerve

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124
Q

What is the Hep A incubation period? Is it RNA or DNA?

A

2-4 weeks
RNA

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125
Q

Mx of GCA?

A

If no visual changes = high dose oral prednisolone
If visual changes = IV methylprednisolone

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126
Q

What should you do if there is still ketonaemia and acidosis 24 hours after starting DKA treatment?

A

Speak to a senior endocrinologist

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127
Q

A patient is newly diagnosed with T2DM. They have (or are at high risk of CVD) or HF. What treatment should you start them on?

A

Metformin, once established add an SGLT-2 inhibitor

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128
Q

What is the aim of treatment in acute open angle glaucoma?

A

Reduce aqueous secretions and induce pupillary vasoconstriction

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129
Q

At what age should children play alone, alongside others and with others?

A

Alone = 18 month
Alongside others = 2 years
With others = 4 years

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130
Q

A pulseless sinus tachycardia is what?

A

PEA!

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131
Q

How can we treat the bilateral tremor of drug induced parkinsonism?

A

Procyclidine

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132
Q

Which parkinson’s drug is associated with pulmonary fibrosis?

A

Cabergoline

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133
Q

What will the serum sodium and osmolality and the urine be like in SIADH. What are the drug causes?

A

Serum sodium is reduced, osmolality is low, urine is concentrated.
Drugs = carbamazepine, sulfonylureas, SSRIs and tricyclics

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134
Q

How do you treat choking?

A

Encourage cough if they can speak
5xback blows -> 5xabdo thrusts

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135
Q

How should you treat new onset AF if the patient is haemodynamically unstable?

A

DC cardioversion

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136
Q

What abnormality is suggested in a child who has loss of internal rotation of the leg when in flexion?

A

SUFE

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137
Q

Name 2 features that suggest the ulcer is arterial?

A

Painful ulcer with an ABPI of <0.5

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138
Q

What is the timescale of alcohol withdrawal?

A

Symptoms = 6-12 hours
Seizures = 36 hours
Delirium tremens = 72 hours

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139
Q

A patient has a ?TIA. What should you do if they are on warfarin, a DOAC or have a bleeding disorder?

A

Admit to image and exclude haemorrhage

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140
Q

Mx of cluster headaches?

A

Acute = SC Sumatriptan
Prophylaxis = Oral Verapamil

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141
Q

Which murmur is often noted in infective endocarditis? What is the causative organism?

A

Early diastolic murmur (aortic regurg)
Strep. Pyogenes

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142
Q

What is VSD associated with increased risk of?

A

IE

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143
Q

How does acute alcoholic hepatitis appear on LFTs? Which drug can we give these patients?

A

AST:ALT >2
Raised GGT
Prednisolone

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144
Q

How will LFTs appear in cholestasis, how does this change over time?

A

ALP and GGT raised
Over time liver damage occurs so AST and ALT will start to rise

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145
Q

What does and AST or ALT of >1000 indicate?

A

Ischaemic hepatitis or paracetamol OD

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146
Q

How should chronic Sub-dural haemorrhage be managed?

A

Symptomatic = burr hole evacuation
Asymptomatic = conservative management

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147
Q

What is Felty’s syndrome?

A

Rheumatoid Arthritis with splenomegaly and low WCC

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148
Q

What is seen in CNIII palsy?

A

Ptosis, mydriasis and down & outwards deviation of the eye.
If mydriasis do an urgent CT head

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149
Q

What is Propylthiouracil?

A

Can treat hyperthyroidism and is preferred to carbimazole if patient is breastfeeding

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150
Q

Sx and Mx of Thyroid storm?

A

Sx = fever, tachycardia, nausea and vomiting, HTN, HF, confusion/agitation and deranged LFTs with jaundice
Mx = Beta-blockers, Propylthiouracil and hydrocortisone

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151
Q

What can we use to shrink fibroids prior to surgery?

A

GnRH agonists

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152
Q

Mx of a chemotherapy patient with a fever?

A

Immediate IV Abx e.g. Tazobactan

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153
Q

Above what BP are pregnant women required to be admitted for observation even if asymptomatic?

A

> 160/110

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154
Q

What are the rate limiting drugs which should be used in AF?

A

1st line = beta blockers or CCBs
2nd line = Digoxin

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155
Q

You are a doctor. A child appears unwell to you. What should you do?

A

Refer immediately to hospital.
Appearing unwell to a healthcare professional is a red flag symptom!

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156
Q

When should you do thrombolysis and thrombectomy in a stroke?

A

In a large ischaemic stroke which symptoms started <4.5 hours ago

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157
Q

Sx and Mx of Motor Neurone Disease?

A

Upper and lower motor neurone symptoms with no sensory issues and eye movements maintained.
Mx = Riluzole, BiPAP at night and PEG feeding

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158
Q

What are the risks of benzos in pregnancy?

A

1st trimester = cleft lip
3rd trimester = floppy baby syndrome

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159
Q

Should you give amiodarone in Torsades de Points caused by QTc prologation?

A

NO
Amiodarone with further prolong QTc

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160
Q

When can we use IV magnesium in ALS?

A

In VT or torsades de point do stabilise the myocardium

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161
Q

Should we treat asymptomatic bacteriuria in pregnancy?

A

YES!

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162
Q

Sx of Henoch-Scholein Purpura?

A

Purpura on the legs and buttocks, arthralgia/arthritis, abdo pain, proteinuria and haematuria

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163
Q

What can we give as a pharmacological weight loss treatment? Who can we give it to?

A

Orlistat
Those who have tried dietary, exercise and behavioural changes who have:
BMI >30 OR BMI >28 with risk factors

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164
Q

Who can we give cyclical progesterone HRT to?

A

Women who are still having periods

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165
Q

Haemolytic anaemia is the breakdown of red blood cells. What are the symptoms and how can we confirm diagnosis?

A

Sx = anaemia, splenomegaly and jaundice
Ix = normocytic anaemia, schistocytes on blood film and positive direct coombs test

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166
Q

Which electrolytes become deranged in refeeding syndrome?

A

Phosphate, magnesium and potassium

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167
Q

What are Greenstick fractures?

A

Commonly seen in children, these occur when there is a unilateral breech of the cortical surface of the bone

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168
Q

When should you admit a patient with hyperemesis gravidarum?

A

If there is >5% weight loss and/or ketonuria despite treatment with oral antiemetics such as cyclizine.

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169
Q

How should you give TXA in a major haemorrhage?

A

In a rapid bolus and then followed by a slow infusion

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170
Q

What ECG changes can be seen in aortic dissection?

A

Inferior ST elevation

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171
Q

You are a GP and you suspect a patient has Guillane-Barre Syndrome. What should you do?

A

Refer to hospital for a LP and nerve conduction studies

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172
Q

What type of contraceptives are contraindicated by current breast cancer?

A

All hormonal contraceptives!

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173
Q

How should medications be stopped in a medication overuse headache?

A

Simple analgesia and triptans should be stopped immediately
Opioids should be slowly withdrawn

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174
Q

What is the 1st line investigation for intussusception? What do you see?

A

Abdo USS
Bullseye or target sign

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175
Q

What is seen in dilated cardiomyopathy? What conditions is it associated with?

A

HF with reduced ejection fraction, dilated chambers with thin walls and valve regurgitation
Chronic alcoholism, cocaine abuse, hemochromatosis, sarcoidosis, infection and pregnancy

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176
Q

What should we do for patients with a post-tonsillectomy haemorrhage?

A

Refer urgently to ENT

177
Q

How can we clinically differentiate between endometriosis and fibroids?

A

Endometriosis = dysmenorrhoea +/- urinary or bowel symptoms
Fibroids = menorrhagia (+/- pain)

178
Q

Sx and Mx of Bell’s palsy?

A

Unilateral facial weakness with forehead sparring (is a LMN lesion), peri-aural pain and numbness, decreased taste and sound hypersensitivity
Mx = oral prednisolone and artificial tears

179
Q

You have a 3rd cranial nerve palsy in the Left eye. There is a haemorrhage leading to midline shift, on which side is it?

A

Left side!

180
Q

What is the relationship between the COCP and different types of cancer?

A

Increases the risk of breast and cervical cancer
Decreases the risk of endometrial and ovarian cancer

181
Q

What happens to growth hormone levels in anorexia nervosa?

A

They increase

182
Q

Which artery is affected in amaurosis fugax?

A

The central retinal artery or the ophthalmic artery have been occluded

183
Q

What is Diclofenac now contraindicated in?

A

IHD, PAD, CVD and CHF

184
Q

What anti-platelet medications do you use in secondary prevention of MI and stroke?

A

MI = Aspirin life long and Ticagrelor for 12 months
Stroke = life long clopidogrel

185
Q

Which type of contraceptives should be avoided in those with a history of obstetric cholestasis?

A

Those which contain oestrogen

186
Q

Where do varicoceles most commonly occur?

A

Left side of the scrotum

187
Q

Who is primary sclerosing cholangitis most commonly associated with?

A

Males with IBD

188
Q

Name 2 drugs which can cause acute interstitial nephritis

A

NSAIDs and PPIs

189
Q

Name the rotator cuff muscles and their functions?

A

Supraspinatus = first 15 degrees of shoulder abduction
Infraspinatus = external rotation of the humerus
Teres minor = external rotation of the humerus
Subscapularis = internal rotation of the humerus

190
Q

Sx, blood results and Mx of Dematomyositis?

A

Sx = progressive muscle weakness and a violet rash
Blood results = ANA and Anti-M-2 antibodies present
Mx = corticosteroids

191
Q

What is seen on LP of viral encephalitis?

A

Protein/lymphocytes are raised and normal glucose

192
Q

Sx of varicose veins?

A

Aching, itching, varicose eczema, haemodeserin deposits (hyperpigmentation), atrophie blanche (hypopigmentation) and lipodermatosclerosis (hard/tight skin)

193
Q

What is Maddrey’s discriminant function?

A

Uses serum bilirubin and prothrombin time to assess if a patient with acute alcoholic hepatitis would benefit from glucocorticoids

194
Q

Name one common trigger for cluster headaches?

A

Alcohol

195
Q

Can you give Atorvastatin in pregnancy?

A

No - all statins are contraindicated in pregnancy

196
Q

What suggests delirium over dementia?

A

Impairment of consciousness (i.e. reduced GCS), symptom fluctuation and hallucinations

197
Q

How/when should you test pregnant women for gestational diabetes if they have a first degree relative with DM?

A

With an OGTT at 24-28 weeks

198
Q

What is the best management of atypical endometrial hyperplasia?

A

All women = total hysterectomy
Post-menopausal women = + salpingo-oophorectomy

199
Q

What test should you do if there is cortisol excess vs. cortisol deficiency?

A

Cortisol excess (cushing’s syndrome) = CT adrenals
Cortisol deficiency (addison’s disease) = Short Synacthen test

200
Q

What should you do if a new born has transient cyanosis and suboptimal sp02?

A

No management needed - this is common in the 1st 10 mins of life.
Just observe

201
Q

What metabolic abnormality is seen in cushing’s syndrome vs addison’s disease?

A

Cushing’s syndrome - Hypokalaemic metabolic alkalosis
Addison’s disease - Hyperkalaemic metabolic acidosis

202
Q

What is the most common cause of bacterial pneumonia in children?

A

Strep. pneumoniae

203
Q

How do we rate control in AF?

A

Beta-blocker or rate limiting CCB e.g. Verapamil - Amlodipine is NOT rate limiting

204
Q

What are De Musset’s sign and Quincke’s sing? What condition are they seen in?

A

De Musset’s = head bobbing
Quincke’s = nailbed pulsation
Seen in aortic regurgitation

205
Q

What is Swyer Syndrome?

A

In those with 46 XY it is SRY deletion (they will have a female phenotype)
In those with 46 XX it is SRY translocation (they will have a male phenotype)
All are infertile!

206
Q

Sx of PID?

A

Abdo pain, fevers, dyspareunia and vaginal discharge
Fitz-Hugh-Curtis syndrome is a complication leading to right upper quadrant pain, perihepatitis and adhesions between the liver and abdo wall

207
Q

Which other hepatitis variant does Hep B vaccine protect against?

A

Hep D
Hep D requires the presence of Hep B to replicate!

208
Q

Which chemotherapy regimes are used to treat Hodgkin’s and Non-Hodgkin’s lymphoma respectivley?

A

Hodgkin’s = ABVD
Non-Hodgkin’s = R-CHOP

209
Q

What is expressive dysphasia?

A

Damage to broca’s area (dominant frontal lobe - due to superior MCA blockage). Patient can understand language but can’t generate speech

210
Q

What is receptive dysphasia?

A

Damage to wernicke’s area (dominant temporal lobe - due to inferior temporal MCA blockage). Patient can generate speech but can’t understand written or spoken language

211
Q

Sx and Mx of orbital cellulitis?

A

Sx = Erythema, eyelid swelling, proptosis, painful eye movements, fever and changes to (colour) vision
Mx = IV antibiotics

212
Q

Sx and Mx of periorbital cellultiits?

A

Sx = erythema and swelling around the eye. They eye itself is not painful
Mx = oral or IV Abx

213
Q

How long can the mirena coil make up the progesterone part of HRT for women who still have a uterus?

A

For the first 4 years

214
Q

Which type of HRT should we use in those at risk of VTE?

A

Transdermal HRT

215
Q

What are the SSRIs of choice in breastfeeding women?

A

Sertraline and Paroxetine

216
Q

How do we manage an ectopic pregnancy with a foetal heartbeat?

A

Surgery
If they have both tubes do a salpingectomy, if not attempt a salpingotomy

217
Q

When is aspirin contraindicated?

A

Children (unless Kawasaki), pregnancy and breast feeding

218
Q

When should foetal movements be felt by? What do you do if they aren’t felt?

A

24 weeks
If not felt refer to foetal medicine

219
Q

What is the first line investigation in ?acute pancreatitis?

A

USS abdomen

220
Q

You see a peribronchial lung tumour and blood results show a raised PTH hormone related peptide. What type of tumour is present?

A

Squamous cell lung cancer

221
Q

What is the method of action of cyclophosphamide and methotrexate?

A

Cyclophosphamide = alkylating agent
Methotrexate = antimetabolite

222
Q

Sx and imaging seen in osteosarcoma?

A

Sx = bone pain and swelling
Imaging = codman triangle and a sunburst appearance

223
Q

What is the order or management for osteoarthritis?

A

1) Topical analgesia
2) + Paracetamol
3) + NSAID
4) + Steroid injection

224
Q

How does Wolff-Parkinson-White syndrome appear on ECG? What is it associated with?

A

Short PR interval, wide QRS and a delta wave
Increased risk of AF and atrial flutter

225
Q

Tumour lysis syndrome is a complication of chemotherapy commonly seen in lymphoma and leukaemia. What can it cause?

A

Hyperkalaemia, hyperphosphateaemia, hyperuricaemia, hypercalcemia
It can lead to cardiac arrhythmias, seizures and acute renal failure

226
Q

What is seen in Tetralogy of Fallot?

A

Overriding aorta, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary stenosis) and VSD

227
Q

What will iodine-131 studies show in toxic multinodular goitre? What is the definitive management?

A

Multiple hot areas of iodine-131 uptake of varying intensity.
Definitive management = radioiodine therapy

228
Q

What should you do with a 2 year old presenting with a limp, prodromal coryzal symptoms and no fever?

A

Refer for urgent specialist assessment.
Anyone presenting with a limp under 3 years old should be referred regardless of other symptoms

229
Q

What is Holmes Adie Syndrome?

A

Seen in females. Dilated pupil (usually unilateral) which is slowly reactive to accommodation but very poorly (if at all) reacts to light.
Associated with absent ankle/knee reflexes

230
Q

What should you do next with any patient presenting with ?IBS

A

Perform ESR, CRP, FBC and Coeliac serology (anti-tissue transglutimase antibodies)

231
Q

What is considered a high risk AAA?

A

Symptomatic (e.g. pain), >= 5.5cm or rapidly enlarging (>1cm/year)

232
Q

How should you manage renal stones?

A

<5mm is likely to resolve on its own - analgesia only
Ureteric obstruction with fever = urgent surgical decompression
Non urgent but needs to be removed = shockwave lithotripsy or uteroscopy if pregnant

233
Q

What drug class is venlafaxine?

A

Serotonin and noradrenaline reuptake inhibitor

234
Q

How is CKD staged?

A

Stage 1 = eGFR >90, deranged U&Es or proteinuria must be present
Stage 2 = eGFR 60-90, deranged U&Es or proteinuria must be present
Stage 3a = eGFR 45-59
Stage 3b = eGFR 30-44
Stage 4 = eGFR 15-29
Stage 5 = eGFR <15

235
Q

How does Staph. aureus gastroenteritis present?

A

Short incubation period (30mins-8hrs). Causes vomiting which resolves within 2 days

236
Q

How does E.coli gastroenteritis present?

A

3-4 day incubation. Causes bloody diarrhoea and lasts about 1 week

237
Q

How does Salmonella gastroenteritis present?

A

12-72hrs incubation. Causes diarrhoea and a fever and lasts 4-7 days

238
Q

What management is given to those with severe enough bronchiolitis to require hospital admission?

A

Supportive management

239
Q

In intrahepatic cholestasis, when and how should you deliver?

A

Induction of labour at 37 weeks

240
Q

What are the eye symptoms of Myasthenia Gravis? What additional symptoms are seen if there is an associated thyoma?

A

Sx = muscle fatigue, diplopia and ptosis worse at the end of the day
If Thyoma there is an SVC obstruction leading to distended neck veins and facial flushing

241
Q

What Ix is done to diagnose Myasthenia Gravis?

A

Check for antibodies against acetylcholine receptors

242
Q

What is the 1st line Mx of Crohn’s disease

A

Induce remission with glucocorticoids.
Maintain remission with azathioprine or mercaptopurine

243
Q

What is the 1st line Mx of UC?

A

Induce remission with aminosalicylates such as mesalazine
Maintaine remission with aminosalicylates but if severe relapse or >=2 relapses in the last year give azathioprine or mercaptopurine

244
Q

Mx BPH?

A

Alpha 1 antagonist e.g. Tamsulosin or Alfuzosin - if voiding Sx
5-Alpha-Reductase Inhibitors e.g. Finasteride - if significantly enlarged prostate
Antimuscarinic e.g. Tolterodine or Darifenacin - if storage and voiding Sx

245
Q

5-Alpha Reductase Inhibitors can lead to some bothersome side effects. Name 4?

A

Reduced libido, erectile dysfunction, ejaculation problems and gynaecomastia

246
Q

Below what eGFR is metformin contraindicated?

A

Below 30

247
Q

What is a primary pneumothorax? How should you manage?

A

Pneumothorax with NO underlying cause
Air rim <2cm and no SOB - discharge
Air rim >2cm - aspiration and chest drain if failure

248
Q

What is a secondary pneumothorax? How should you manage?

A

Pneumothorax with underlying lung disease
Air rim >2cm or SOB - chest drain
Air rim 1-2cm - aspiration and chest drain if failure
Air rim <1cm - admit for 24 hours and high flow O2

249
Q

What is the gold standard imaging in MS?

A

MRI with contrast

250
Q

How long should antidepressants definitely be taken for?

A

At least 6 months after remission

251
Q

What happens if you correct hyponatraemia too rapidly?

A

Osmotic demyelination syndrome
Spastic quadriparesis, pseudobulbar palsy and emotional liability

252
Q

What is Lateral Medullary Syndrome? What are the symptoms?

A

Posterior Inferior Cerebellar Stroke
Sx = ipsilateral Horner’s syndrome, ipsilateral facial numbness and contralateral body numbness, ipsilateral ataxia

253
Q

What should you suspect has happened in a patient with chronic lymphocytic leukaemia who suddenly becomes more unwell?

A

It has transformed into high grade lymphoma

254
Q

How do benzodiazepines work?

A

Enhance the effect of gamma-aminobutyric acid

255
Q

What is chondrocalcinosis?

A

Calcification of the cartilage seen in pseudogout

256
Q

What is the first line Mx for a massive PE with circulatory failure e.g. hypotension?

A

Thrombolysis

257
Q

Is trimethoprim safe in breastfeeding?

A

YES

258
Q

What is Etoricoxib?

A

An NSAID

259
Q

Sx of Acoustic Neuroma?

A

Vertigo, tinnitus, unilateral sensorineural hearing loss, facial palsy and absent corneal reflex

260
Q

How should you manage VZV exposure in pregnancy?

A

Check maternal antibodies if she is unsure of previous infection
If =< 20 weeks and not immune = VZIG asap
If > 20 weeks and not immune VZIG or antivirals 7-14 days post exposure

261
Q

What is the MELD score?

A

Model of End Stage Liver Disease used to measure severity of liver cirrhosis

262
Q

What is the definitive Mx of acute angle-closure glaucome?

A

Laser iridotomy

263
Q

Anyone aged >= 55 with increased platelets, haematemasis or treatment resistant dyspepsia and any one of what should have a non-urgent OGD to look for dyspepsia?

A
  • Nausea or vomiting
  • Weight loss
  • Reflux
  • Dyspepsia
  • Upper abdominal pain
264
Q

What does venous sinus attenuation on MRI imply?

A

Transverse venous stasis - this is characteristic of Idiopathic intercranial hypertension

265
Q

In ?DVT D-dimer and scan are going to be delayed. What should you do in the meantime?

A

Prescribe treatment dose of a DOAC

266
Q

How can the forehead help us differentiate between an upper and lower motor neurone lesion?

A

Forehead sparing = UMN lesion
Forehead not spared = LMN lesion

267
Q

What should you do if after 3 weeks of steroids treatment there is no improvement in bell’s palsy?

A

Urgent ENT refferal

268
Q

Which opioids should be used in end of life care for patients with severe renal impairment?

A

Buprenorphine and Fentanyl

269
Q

Mx of extracapsular hip fractures?

A

Intertrochanteric = dynamic hip screw
Subtrochanteric = intra medullary nail

270
Q

How long should you stop warfarin before surgery, what is the target INR?

A

5 days before surgery
INR should be <1.5

271
Q

A patient has secondary amenorrhoea with a positive progestin challenge. What does this suggest is the cause?

A

PCOS

272
Q

Which type of MI has occurred if there is new AV node block? Which artery is occluded?

A

Inferior MI
Right coronary artery is occluded

273
Q

What type of scan should we perform in a ?PE where the patient has severe renal impairment?

A

V/Q scan!

274
Q

True or false, spironolactone can cause gynaecomastia?

A

True!

275
Q

What is the 1st line Mx of open angle glaucoma?

A

Prostaglandin analogue eyedrops e.g. Latanoprost

276
Q

What is the most accurate way to assess burns?

A

Lund and Brouder chart

277
Q

Mx of Guillaine-Barre?

A

IV Immunoglobulins

278
Q

Mx of Myasthenia Gravis?

A

Pyridostigmine 1st line, can also add prednisolone

279
Q

Sx of vestibular neuronitis?

A

Vertigo, nausea and vomiting, horizontal nystagmus, no hearing loss or tinnitus!

280
Q

Ix and Mx of vestibular neuronitis?

A

Ix = HiNTs exam to distinguish it from a PCA stroke
Mx = Prochlorperazine

281
Q

What are the characteristic blood results seen in non-metastatic myeloma?

A

Raised calcium, normal or raised phosphate and normal ALP

282
Q

What should you always worry about in a patient presenting with a painful CN III palsy?

A

Posterior communicating artery aneurysm

283
Q

What should you worry about in anyone with a raised urea out of proportion with creatinine?

A

Upper GI bleed e.g. duodenal ulcer
Digested blood produces urea!

284
Q

What symptoms are seen in shaken baby syndrome?

A

Retinal haemorrhages, subdural haemorrhages and encephalopathy

285
Q

What does complement levels indicate in SLE?

A

Complement levels are low in active disease and raised in flares

286
Q

When should a patient start to mobilise following a repair of a hip fracture?

A

Should fully weight bare immediately after!

287
Q

Mx of Cows Milk Protein Allergy?

A

Extensively hydrolysed formula. If this fails switch to amino acid based formula

288
Q

Mx of Meningitis in children?

A

<3 months old = IV Cefotaxime and Amoxicillin
>3 months old = IV Cefotaxime and Dexamethasone

289
Q

When can you do PCI in STEMI what drugs are given before transfer to a PCI centre?

A

If a patient presents within 12 hours of symptom onset and can have PCI done in 120mins
If on oral anticoagulant already = Aspirin and clopidogrel
If not on oral anticoagulant = Aspirin and Prasugrel
Give both unfractionated heparin

290
Q

Which antiemetic should be avoided in bowel obstruction?

A

Metoclopromide

291
Q

What investigation should you offer to all men with erectile dysfuntion?

A

Check their testosterone levels
If low check LH and FSH

292
Q

What should you do if you see an infant with an inguinal hernia?

A

Urgent surgical correction

293
Q

What is the 1st line and long term Mx of Poriasis?

A

1st line = potent corticosteroids and once daily vitamin D (use one in the morning and the other at night)
Long term = topical calcipotriol

294
Q

What is indapamide, which metabolic abnormalities can it cause?

A

Thiazide like diuretic
Hypercalcaemia and hypokalaemia

295
Q

How long can a urinary pregnancy test remain positive for after TOP?

A

4 weeks

296
Q

What should you think of if there is bilateral hilar lymphadenopathy and raised serum ACE. How do you manage?

A

Sarcoidosis
If there is symptoms = steroids

297
Q

When is a IV CCB e.g. verapamil always contraindicated?

A

In VT

298
Q

What is used in the medical management of miscarriage?

A

Vaginal misoprostal

299
Q

What metabolic abnormality can non-small cell lung cancers cause? How does this present on ECG?

A

Hypercalcaemia
Short QTc

300
Q

What is Eplerenone?

A

An aldosterone antagonist

301
Q

HF Mx (with reduced EF)?

A

1st line = ACEi or Beta blocker (+ loop diuretic if fluid overload)
2nd line = aldosterone antagonist

302
Q

How can blood test help you differentiate between the causes of secondary amenorrhoea?

A

Low oestradiol + low LH/FSH = hypothalamic dysfunction
Low oestradiol + high LH/FSH = premature ovarian failure

303
Q

Conn’s syndrome and vomiting both cause the same metabolic abnormalities. What are these abnormalities and how can you tell the difference between them?

A

Metabolic alkalosis and hypokalaemia
Conn’s is associated with a high BP where as vomiting is associated with a low BP

304
Q

What is a Virchow’s node? What is it associated with?

A

A left sided supraclavicular lymph node
Associated with gastric cancer

305
Q

What is seen in duodenal atresia?

A

Double bubble sign and billious vomiting

306
Q

How should you treat those with new onset AF who present within 48 hours or who have co-existing HF?

A

Rhythm control with amiodarone

307
Q

What should you do with a patient presenting with a BP >=180/120?

A

If they have signs or symptoms admit for specialist assessment
If no signs or symptoms do urgent investigations for signs of end organ damage

308
Q

What is the key diagnostic investigation in Guillain Barre Syndrome. What will you see?

A

Lumbar puncture
Shows raised proteins and a normal WCC

309
Q

True or false, anti-epileptic drugs are contraindicated in breast feeding?

A

FALSE!
They are safe!

310
Q

Sx, Ix and Mx of Acute Interstitial Nephritis?

A

Sx = fever, rash, arthralgia, renal impairment, HTN and eosinophilia
Ix = white cell casts seen in the urine and sterile pyuria
Mx = steroids

311
Q

How does calcium levels affect the QTc?

A

Hypercalcaemia = QTc shortening
Hypocalcaemia = QTc prolongation

312
Q

What is a serious skin complication of chicken pox?

A

Group A Streptococcus necrotising fascitits

313
Q

How is the BP, glucose, Na+ and K+ affected in addisons disease? What skin change may be noted?

A

Low BP, Glucose and Na+
High K+
Hyperpigmentation of the skin (especially in the palmar creases)

314
Q

How will PTH, Ca2+, ALP and PO43- be affected in osteoporosis?

A

They will all be normal!

315
Q

Sx of radial nerve damage? What type of # is it associated with?

A

Wrist drop and loss of sensation over the dorsal 1st/2nd metacarpal bones. Humeral shaft #

316
Q

How do you manage DVT? How is this different if the eGFR is <15?

A

DOAC
If eGFR <15 use unfractionated heparin

317
Q

How do you close a PDA? How do you keep a PDA open?

A

Close it with Ibuprofen or Indomethacin
Keep it open with Alprostadil (prostaglandin E1)

318
Q

How can we manage MS?

A

High dose steroids

319
Q

A patient presents with Sx of hyperthyroidism, raised ESR and painful goitre. What is the diagnosis and how can we manage?

A

De Quervian’s thyroiditis
Mx = analgesia. This is a self-limiting condition

320
Q

How do we manage a baby who has lost >10% of its birth weight?

A

If well refer to midwife lead breastfeeding clinic
If unwell admit

321
Q

How can lithium affect the calcium levels?

A

It will cause high calcium as it can lead to hyperparathyroidism

322
Q

How long should UTI be treated for in pregnancy?

A

7 Days

323
Q

Which hormones will be secreted LESS in an acute stress response?

A

Insulin, Oestrogen and Testosterone

324
Q

Sx of Steven-Johnson-Syndrome?

A

Prodromal viral URTI Sx then rash not affecting the scalp, palms or soles.
Occurs up to 2 months after starting drug e.g. anti-epileptic

325
Q

What is hyphema? What can it result in?

A

Blood in the anterior chamber of the eye. Can lead to glaucoma

326
Q

Sx and Ix of chronic pancreatitis?

A

Pain 10-30mins after a meal, steatorrhea and DM
Ix = CT and faecal elastase

327
Q

What is the most common cause of COPD exacerbation. How should you manage?

A

Haemophilus Influenzae
5 days prednisolone. Abx if there is purulent sputum or signs of pneumonia

328
Q

True or false NSAIDs can precipitate lithium toxicity?

A

TRUE!

329
Q

What should you do with an adult presenting with a hydrocoele?

A

Urgent US to exclude an underlying cause

330
Q

Can you give Diltiazem (CCB) in heart failure?

A

NO!

331
Q

What are the time limitations for when you can measure PSA?

A

Must be 48 hours after intense exercise, ejaculation and DRE
Must be 1 month after prostatitis

332
Q

True or false, hypoparathyroidism is a RF for gout?

A

False
Hyperparathyroidism is associated with gout

333
Q

True or false, oxycodone can not be given in moderate to end stage renal failure?

A

False!
It can be given in moderate to end-stage renal failure

334
Q

What should you give to reverse respiratory depression occurring secondary to MgSO4?

A

Calcium Gluconate

335
Q

How does total iron binding capacity help us differentiate between iron deficiency anaemia and anaemia of chronic disease?

A

TIBC is high in iron deficiency anaemia and low/normal in anaemia of chronic disease

336
Q

How is the liver affected in ADPKD?

A

ADPKD leads to hepatomegaly

337
Q

What is the cause of a metabolic ketoacidosis where the blood glucose is normal or low?
How do we manage?

A

Alcoholic ketoacidosis
Mx = fluids and thiamine?

338
Q

What is the most common ECG change in PE?

A

Sinus tachycardia

339
Q

How can we manage orthostatic hypotension medically?

A

Fludrocortisone and midodrine

340
Q

Which drug should you NEVER give alongside a beta blocker?

A

Verapamil!

341
Q

Mx of NEC?

A

Nil by mouth and cefotaxime and vancomycin

342
Q

Where do secondary brain tumours most commonly come from?

A

Lung, breast kidney and melanoma

343
Q

Can you give ARBs in renal disease?

A

No! They are contraindicated for the same reason ACEis are

344
Q

What is the preferred method of IOL?

A

Vaginal prostaglandin E2 (give after membrane sweep)
Amniotomy should only be done if the cervix is ripe (bishops score >=7)

345
Q

What signs are found in PDA?

A

Large volume collapsing pulse and a continuous murmur at the left sternal edge

346
Q

What medication should you give in ascites?

A

Spironolactone

347
Q

How can we localise the cause of a bitemporal hemianopia?

A

Mainly upper quadrant affected = inferior compression of the optic chiasm = pituitary adenoma
Mainly lower quadrant affected = superior compression of the optic chiasm = craniopharyngioma

348
Q

What is the most common complication of measles? What is the most common cause of death?

A

Most common = otitis media
Most common cause of death = pnuemonia

349
Q

What is the diagnosis in a patient presenting with abdominal distension, tenderness and fluid/electrolyte loss with a positive fluid balance after abdo surgery?

A

Ileus!

350
Q

What is the SSRI of choice in children or adolecents?

A

Fluoxetine

351
Q

Which drugs can cause rhabdomyolysis when prescribed alongside statins. Sx?

A

Erythromycin or clarithromycin
Dark urine and muscle aches

352
Q

What is seen in dermatomyositis?

A

Symmetrical proximal muscle weakness and gottron’s papules (seen on PIP and DIP joints)

353
Q

When should you offer OGTT in pregnancy?

A

At booking visit if previous gestational diabetes. Otherwise at 24 weeks

354
Q

True or false, UC is associated with increased risk of galls stones?

A

FALSE
Crohn’s is associated with increased risk of gall stones
UC is associated with increased risk of PSC

355
Q

What type of contraceptives are contraindicated in women who have had gastric sleeve, gastric bypass or duodenal switch surgery?

A

Oral contraceptives. This includes emergency oral contraceptives

356
Q

Sx, Ix and Mx in polycythaemia varia?

A

Sx = pruitis, splenomegaly and plethoric complexion
Ix = Raised Hb, haematocrit, platelets and WCC. JAK-2 positive
Mx = Aspirin and venesection

357
Q

How can we manage miscarriage?

A

Expectant
Medical = vaginal misoprostol + antiemetics + analgesia
Surgical = dilation and curettage (vacuum aspiration) or take to theatre

358
Q

Sx in bronchiolitis?

A

Preceding coryzal phase followed by cough, increased WOB an wheeze on chest

359
Q

What does hypertrophic obstructive cardiomyopathy commonly lead to? How does the pulse appear?

A

HF with preserved ejection fraction
Jerky pulse

360
Q

How do thiazide like diuretics affect glucose tolerance?

A

They worsen it so blood glucose will increase

361
Q

Differentiate between cephalohematoma and caput succedaneum?

A

Cephalohematoma presents 2-3 days after birth (instrumental delivery). Swelling does not cross suture lines
Caput Succedaneum presents immediately after birth and does cross the suture lines

362
Q

What will you hear if there is an ASD?

A

Ejection systolic murmur heard loudest on inspiration

363
Q

Mx of reactive arthritis?

A

NSAIDs and intra-articular steroids

364
Q

A patient has a stroke leading to ipsilateral CNIII palsy and a contralateral hemiparesis. Where is the lesion?

A

Posterior cerebral artery stroke aka webber syndrome

365
Q

Cause, Sx and Mx of neurogenic shock?

A

Spinal cord trans-section leading to hypotension, bradycardia and flushing
Mx = vasopressors

366
Q

How long should you use barrier contraception for after being treated with rifampicin?

A

4 weeks

367
Q

Which part of the ear should you visualise in chronic or recurrent discharge?

A

The attic of the eardrum - this is to exclude cholesteatoma

368
Q

What is the most common cardiac defect in turner’s syndrome?

A

Bicuspid aortic valve

369
Q

What is the most common cause of ambiguous genitalia in newborns?

A

Congenital adrenal hyperplasia

370
Q

Can you use paroxetine in pregnancy?

A

No! There is a high risk of congenital malformations

371
Q

When are triptans always contraindicated? Why?

A

In coronary artery disease. They can cause coronary vasospasm

372
Q

Sx and Ix of multiple myeloma?

A

CRAB
hyperCalcaemia, Renal failure, Anaemia (and thrombocytopenia) and Bone fractures/lytic lesions
Ix = monoclonal bands seen on serum electrophoresis

373
Q

Secondary prevention of stroke/TIA?

A

No AF = Clopidogrel
AF = Warfarin or direct thrombin or factor Xa inhibitors (NOAC)

374
Q

Which cancers commonly metastasise to lungs?

A

Breast, colorectal, prostate, renal, bladder

375
Q

What should you suspect if you see multiple, large, round and well circumscribed masses in both lungs on CXR?

A

Cannon ball metastases seen in RCC

376
Q

Mx of mycoplasma pneumoniae?

A

Erythromycin

377
Q

What rheumatological condition are chemotherapy patients more at risk of getting?

A

Gout

378
Q

Which rheumatological condition is rheumatoid arthritis a RF for?

A

Oseteoarthritis

379
Q

What does a sine wave (sinusoidal pattern) on ECG indicate?

A

Suggestive of severe hyperkalaemia

380
Q

What is a patients daily glucose requirement?

A

50-100g/day regardless of weight

381
Q

In what conditions is diclofenac contraindicated?

A

IHD, PAD, CVD and CHF

382
Q

Topical epidermal necrolysis occurs secondary to an acute drug reaction. Sx and Mx?

A

Systemic illness, nikolsky’s sign (epidermis separates from the dermis with mild pressure)
Mx = ICU and IVIG

383
Q

What is a missed miscarriage?

A

Cervical os is closed and the gestational sac remains in the uterus but there is no foetal heart beat

384
Q

What is characteristically seen in psoriatic arthritis?

A

Asymmetrical joint pain of the DIP and PIP joints which is worse in the morning but relieved by use

385
Q

What should you do in a patient with croup and audible stridor at rest?

A

Admit!

386
Q

What should you consider as the cause of primary amenorrhoea with a raised FSH/LH?

A

Primary gonadal dysgenesis e.g. Turner’s syndrome

387
Q

Define obstructive vs restrictive lung disease?

A

Obstructive = very reduced FEV1, mildly reduced/normal FVC, FEV1:FVC <75%
Restrictive = reduced FEV1, very reduced FVC, FEV1:FVC >75%

388
Q

How can we supress lactation when breast feeding is no longer indicated?

A

Cebergoline

389
Q

What is an oculogyric crisis? What are the symptoms and what can cause it?

A

An acute dystonic reaction
Restlessness and agitation.
Involuntary upwards deviation of the eyes.
Causes = antipsychotics, metoclopramide and post-encephalitic Parkinson’s disease

390
Q

Mx of oculogyric crisis?

A

IV benztropine or procyclidine

391
Q

Which type of drugs classically causes acute interstitial nephritis?

A

Antibiotics

392
Q

How does the addition of progesterone to HRT affect risks?

A

Increases the risk of breast cancer and VTE

393
Q

How does HRT affect stroke and ischaemic heart disease risk?

A

All HRT increases the risk of stroke
All HRT increases the risk of IHD if taken >10 years after menopause

394
Q

What is seen in Kallmann syndrome?

A

Low GnRH, Low LH and Low FSH
Primary amenorrhoea with the absence of a sense of smell

395
Q

What is the Mx of an undisplaced scaphoid fracture?

A

Cast for 6-8 weeks

396
Q

What is a mass at the cerebellopontine junction characteristic of? Which cranial nerves are affected?

A

Vestibular schwannoma
CN V, VII and VIII

397
Q

What should you give to all HIV positive patients with a CD4 of <200?

A

Co-trimoxazole (antibiotic prophylaxis)

398
Q

How does pheochromocytoma typically present?

A

Intermittent HTN, paroxysmal palpitations and sweating with tremors/anxiety

399
Q

What is the most common cause of pneumonia in alcoholics?

A

Klebsiella

400
Q

What is the commonest cause of massive painless GI bleed in children? How should you investigate?

A

Meckel’s diverticulum
Technetium scan or mesenteric arteriography if it is severe enough to require transfusion

401
Q

What is HLA-B27 commonly associated with?

A

Autoimmune disorders e.g. ankylosing spondylitis, psoriatic arthritis, reactive arthritis and uveitis

402
Q

When should you commence allopurinol after an acute gout attack? What is given second line?

A

3 weeks after
Febuxostat is second line

403
Q

What should you do in a patient <3 months old presenting with UTI?

A

Immediate referral to paeds

404
Q

How is renal cell carcinoma treated?

A

Radical nephrectomy (it is usually resistant to radio or chemo therapy)

405
Q

How does subacromial impingement present?

A

Painful arc abduction between 90-120 degrees

406
Q

Is a third hear sound normal?

A

Yes if <30 years old. Otherwise no - it is a sign of left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation!

407
Q

How often should women be routinely screened for cervical cancer?

A

25-49 years = every 3 years
50-64 years = every 5 years

408
Q

What should you do if a cervical smear comes back positive for HPV?

A

If there is normal cytology repeat in 12 months. If still positive on the 3rd smear refer for colposcopy regardless of cytology
If there is abnormal cytology refer for colposcopy

409
Q

What should you do if a cervical smear comes back as inadequate sample?

A

Repeat in 3 months, if there are 2 inadequate samples refer for colposcopy

410
Q

Should you do a cervical smear in pregnancy?

A

No. Delay until 3 months post-partum unless there has been a missed screen or previous abnormal screen

411
Q

Which cancers most commonly metastasise to bone in men and women? How does it appear on X-ray?

A

Prostate in men - will appear with sclerotic/blastic lesions
Breast in women - will appear with a mixed pattern of sclerotic and lytic lesions

412
Q

Apart from breast and prostate, which other cancers commonly metastasise to bone? How do they appear?

A

Kidney, thyroid or lung. Will appear as lytic lesions

413
Q

What is seroconversion disorder? How and when does it present?

A

Occurs 3-12 weeks after HIV infection
Can present with a non-specific rash, pharyngitis and fever

414
Q

What should be used in the secondary prophylaxis of hepatic encephalopathy?

A

Lactulose and rifaximin

415
Q

What does meckle’s diverticulum pain commonly mimic?

A

Appendicitis

416
Q

Which type of pneumonia are you predisposed to if you have had a recent influenza infection?

A

Staph. aureus pneumonia

417
Q

How can we differentiate between psoriatic and rheumatoid arthritis?

A

Psoriatic is asymmetrical. It will affect the DIP joints and lead to dactylitis. There may also be nail and skin changes
RA is symmetrical. It classically affects the MCP and PIP joints and anti-CCP will be positive

418
Q

What is the most likely cause of the following pneumonias:
- Normal CAP
- Alcoholic/diabetic patient
- COPD
- Recent Flu

A

Normal CAP = strep. pneumoniae
Alcoholic/diabetic patient = klebsiella pneumoniae
COPD = Haemophilus pneumoniae
Recent flu = staph. aureus

419
Q

What is the emergency management of croup?

A

High flow O2 and nebulised adrenaline

420
Q

Sx and Mx of Pityriasis rosea?

A

Recent infection followed by a herald patch (usually large and found on the trunk) then lots of smaller patches appear
Mx = self limiting, supportive antihistamines or steroids if itch

421
Q

Ix and Mx of Phaeochromocytoma?

A

Ix = 24 hour urinary collection of metanephrines
Mx = Surgery. Before we can do surgery give phenoxybenzamine followed by beta blockers. If not available give labetalol as this blocks alpha and beta

422
Q

What are the X-ray changes seen in psoriatic arthritis?

A

Periarticular erosions and bone resportion

423
Q

What are the X-ray changes seen in gout?

A

Erosions with overhanging edges (rate bite erosions)

424
Q

What are the X-ray changes seen in septic arthritis?

A

Joint effusion

425
Q

What are the X-ray changes seen in osteoarthritis?

A

Loss of joint space, osteophytes and subchondral sclerosis

426
Q

What are the X-ray changes seen in rheumatoid arthritis?

A

Loss of joint space, juxta-articular osteoporosis and soft tissue swelling. Late signs = periarticular erosions and subluxation

427
Q

What are the X-ray changes seen in osteopenia?

A

Widened bulky physeal plates and irregularity

428
Q

How do you treat hypertensive crisis (systolic BP >250) in pheochromocytoma?

A

Phentolamine

429
Q

How do we treat tension pneumothorax?

A

Insertion of 14G cannula into the 2nd intercostal space

430
Q

Mx of a scaphoid fracture which is displaced or with a proximal scaphoid pole fracture?

A

Surgical fixation
If simple fracture splint

431
Q

What is the coffee bean sign on x-ray significant for?

A

Sigmoid volvulus

432
Q

What is the most common type of RCC?

A

Clear cell carcinoma

433
Q

What is gastroschisis? How do we manage?

A

Protrusion of the bowel without a peritoneal covering. Occurs lateral to the umbilical cord
Mx = urgent surgical correction and cling film covering

434
Q

What is exomphalos/omphacoele and how do we maange?

A

Bowel protrusion within the peritoneal covering at the umbilical site
Mx = staged repair with completion at 6-12 months

435
Q

What are the causes of obstructive lung disease?

A

COPD, Asthma, Bronchiectasis and Bronchiolitis obliterans

436
Q

What is a serious complication of TURP?

A

Hyponatraemia due to glycine irrigation

437
Q

What is the normal foetal HR?

A

100-160 bpm

438
Q

What is seen in the blood/urine in osteomalacia?

A

Hypocalcaemia, hypophosphataemia, low vitamin D, raised ALP.
Low urinary calcium

Finals Revision (23 decks)

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