PassMed October Flashcards
What is the commonest cause of encephalitis in adults?
HSV
How do you manage rectal tumours surgically?
High/mid rectal tumours = anterior resection
Low rectal tumour = abdoperitoneal excision
Where are the ECG changes in anteroseptal MI? Which artery has been affected?
V1-V4
LAD artery
Where are the ECG changes in inferior MI? Which artery has been affected?
II, III and aVF
Right coronary artery
Where are the ECG changes in anterolateral MI? Which artery has been affected?
V3-V6, I and aVL
LAD or Left circumflex artery
Where are the ECG changes in lateral MI? Which artery has been affected?
I, aVL +/- V5 & V6
Left circumflex artery
Where are the ECG changes in posterior MI? What additional changes are seen? Which artery has been affected?
V1-V3
Horizontal ST depression, tall, broad R waves, upright T waves and dominat R wave in V2
Left circumflex and/or Right coronary
What may a new LBBB point towards?
ACS
What is a normal anion gap?
8-14
Name the main causes of metabolic acidosis with normal anion gap?
GI loss
Renal tubular acidosis
Drugs (e.g. Acetazolamide)
Addison’s disease
Name the main causes of metabolic acidosis with riased anion gap?
Due to lactate = shock/hypoxia
Due to ketones = DKA/alcohol
Due to urate = renal failure
Acid poisoning (with methanol or salicylates)
Chronic paracetamol use
What does a positive Rinne’s test mean?
Normal test
Air conduction > bone conduction
How long must patients trial hearing aids before consideration for cochlea implants?
> 3 months
How do we measure which area of the brain has been affected by ischaemia in TIA?
MRI brain with diffusion-weighted imaging
What is Parazosin?
An alpha blocker used to help with urinary retention secondary to BPH
True or false, antihistamines can lead to urinary retention?
True!
What will urine sodium and urine osmolality be like in pre-renal disease?
Urine sodium <20
Urine osmolality >500
How does Amiodarone affect Warfarin and Digoxin?
Decreases the effect of warfarin and increases the affect of digoxin
What must you monitor in patients on long term amiodarone?
LFTs and TFTs every 6 months
Which drugs should be used 1st line in the management of HTN in those with T2DM?
ACEis or ARBs
Above which home and ambulatory blood pressure readings is BP treatment indicated?
<80 years = 140/90 in clinic or 135/85 ABPM
>80 years = 150/90 in clinic or 145/85 ABPM
Which nerve root comes out below the vertebrae? Which vertebrae does it come out below?
C8
Comes out below C7
What are the symptoms of diverticulitis?
Lower left quadrant abdo pain & guarding, fever, bloating, rectal bleeding & constipation
How does hypokalaemia appear on ECG?
U waves, flattened T waves, borderline elongated PR interval
What defines mild-moderate UC flare up, how should you treat?
Up to 6 loose stools/day
Mx = rectal mesalazine, if this fails add oral mesalazine
What is Benign Rolandic Epilepsy? What is seen on EEG?
Partial seizures which occur at night in otherwise healthy children.
EEG shows centro-temporal spikes
What can constipation cause in cirrhotic patients?
Decompensated liver disease
What is pituitary apoplexy, how does it present and how should we investigate/treat?
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
How do you manage complete heart block with broad QRS which does not respond to Atropine or transcutaneous pacing?
transvenous pacing
Which nerve controls thumb opposition and hand pronation?
Median nerve
Which nerve is commonly damaged in axillary dissection? How does this present?
Intercostobrachial nerves
Presents with numbness in the axillae
What are the normal post void volumes in the bladder?
In under 65s = <50mls
In over 65s = <100mls
What should you test for in those with recurrent vaginal candidaisis?
Diabetes with HbA1c
Where is the axillary nerve commonly damaged? What are its nerve roots and what is the affect of damage?
Surgical neck of the Humerus
C5/C6
Affected in # or shoulder dislocation leading to loss of abduction beyond 15 degrees
What is Klumpke’s paralysis?
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
What is Erb’s paralysis?
Paralysis of C5/C6` in falls or shoulder dystocia leading to pronation and medial rotation of the arm, aka waiter’s tip presentation
The aldosterone:renin ratio is raised in a hyperaldosteronism patient. What does this imply about the cause and what further tests should be done?
It is a primary hyperaldosteronism
Perform CT abdomen then adrenal venous sampling
Which gene mutation is HNPCC associated with?
MSH2 and MHLH1
What is the most common cause of primary hyperaldosteronism?
Bilateral idiopathic adrenal hyperplasia
What is the emergency management of acute angle closure glaucoma?
Direct parasympathomiemetric, Beta blockers and alpha-2 agonist eye drops OR
IV acetazolomide
How can we measure the response of colon cancer to treatment?
CEA testing
What is used to treat DIC?
Fresh frozen plasma
What symptoms are characteristic of Lewy Body Dementia?
Fluctuating cognition, visual hallucinations, parkinsonism and REM sleep disorder
What blood results are characteristic of PMR?
Raised WCC, ESR and CRP with a normal CK
Sx and Mx of Meniere’s disease?
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
What is the causative organism and Sx in Roseola Infantum? How long is school exclusion required for?
HHV6
Fever, maculopapular rash, nagayama spots on the soft palate/uvula and sometimes febrile convulsions
School exclusion not required
What should you always do in suspected cases of rubella in pregnancy?
Discuss it with the local health protection unit
When should you administer the MMR vaccine to women who are pregnant or trying to concieve?
You should not!
Give the vaccine only in the post-natal period
What is the major dose limiting side effect of magnesium salts?
Diarrhoea
What is Disulfiram?
Used to treat alcoholics, it causes unpleasant side effects immediately after consuming alcohol
What is Herpes Zoster Opthalmicus? What is Hutchinson’s sign?
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.
How do you manage Herpes Zoster Opthalmicus?
Oral aciclovir for 7-10 days, offer within 72 hours of Sx onset
What is Takayasu’s Arteritis? How does it present and how do we treat?
Large cell arteritis occurring in young asian women.
Presents with unequal BPs, weak/absent peripheral pulses, limb claudication and renal artery stenosis
Mx = steroids
How should IgG and IgM be interpreted when testing pregnant women for Parovirus B19?
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
Sx and Mx of Still’s Disease?
Arthralgia, salmon pink maculopapular rash, fever which worsens at night and is associated with worsening of other Sx, lymphadenopathy
Mx = NSAIDs and steroids
Sx, Ix and Mx of Benign Paroxysmal Positional Vertigo?
Vertigo triggered by change in head position with nausea
Ix = Dix-Hallpike manoeuvre
Mx = Epley manoeuvre
What are the degrees of perineal tear?
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
What is the 1st and 2nd line Mx of HF with reduced EF?
1st line = ACEi and Beta blockers with loop diuretic if fluid overload
2nd line = Aldosterone antagonists
How do you manage HF with preserved EF?
Loop diuretic to relieve fluid overload
What is the most important imaging investigation to conduct in ?cauda equina?
Urgent MRI spine
How quickly should you give 1 unit of RBCs in non-urgent scenarios?
Over 90-120 mins
What is the most common electrolyte imbalance following SAH? Why does this occur?
Hyponatraemia
Occurs as there is new SIADH
How do you manage gestational diabetes?
Diet/lifestyle -> Metformin -> short acting SC insulin
If fasting glucose >7 consider starting immediatley
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?
Alpha or beta blocker if K+ >4.5
Low dose spironolactone if K+ =<4.5
What is the first line management of anti-freeze poisoning?
Fomepizole
What imaging should you perform in ? osteoporotic spinal #
X-ray spine
Which drugs are an absolute contraindication to sildenafil (Viagra)
Nitrates and Nicorandil
How does De Quervian’s (sub-acute) thyroiditis present?
Primary Hyperthyroidism with painful goitre, raised ESR and globally reduced uptake on iodine-131 scan
Sx, Ix and Mx of minimal change disease?
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
What is the investigation of choice in avascular necrosis?
MRI
How can we identify bowel perforation on imaging?
Erect chest x-ray
How does nasopharyngeal carcinoma commonly present?
Painless lymphadenopathy (as it spreads early)
Sx of Salmonella Typhi (typhoid) and Salmonella Paratyphi (paratyphoid)?
Systemic upset, relative bradycardia, abdo pain and distension and constipation.
Rose spots on the trunk point to paratyphoid
Which part of the chest should you compress during CPR in children or infants?
Children = Compress the lower half of the sternum
Infants = use two thumb encircling technique
Which type of murmur is Turner’s syndrome associated with? What causes it?
Systolic murmur
Aortic Coarctation
What is the classical presentation of paget’s disease of bone?
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
Mx of paget’s diease of bone?
Oral risedronate or IV zoledronate (bisphosphonates)
Mx of Acne Vulgaris?
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
What additional condition should you think about in any female presenting with an X-linked recessive condition such as Haemophilia?
Turner’s syndrome - they only have 1 X chromasome
How often should you do a rhythm check in ALS?
Every 2 mins
Describe the meaning of the different T-score values?
> -1.0 = normal
-1.0 to -2.5 = osteopenia
<-2.5 = osteoporosis
What is seen in a bifasicular and trifasicular block respectivley?
Bifasicular = RBBB and Left axis deviation
Trifasicular = RBBB, Left axis deviation and first degree heart block
Mx of bacterial conjunctivits?
2-3 hourly chloramphenicol drops OR chloramphenicol ointment QDS
Topical fusidic acid in pregnant women
What is Dressler’s syndrome? Sx?
Autoimmune response to damage of the myocardium or pericardium (e.g. following MI)
Sx = fever, pericarditis, pleuritic pain +/- pericardial effusion
Which type of eye drops may cause corneal ulceration?
Steroid eye drops as they can lead to fungal infection of the cornea
What are the 2 types of aortic dissection. How do they differ clinically?
Type A = ascending aorta is dissected. Sx = chest pain
Type B = descending aorta is dissected. Sx = upper back pain
What may patients taking Levodopa experience at its dosage peak?
Dyskinesias
Dystonia, chorea and athetosis (involuntary writing movements)
Which beta blocker is associated with QTc prolongation?
Satalol
What can occur in trauma patients who are on long term mechanical ventialtion?
Oesophageal fistula formation
What is the dosage of Amiodarone that should be given in ALS of shockable rhythms?
Initially 300mg (after 3 shocks), then if VF/Pulseless VT continues give 150mg after the 5th shock
What is Congenital Nasolacrimal Duct Obstruction? Sx? Mx?
Blockage of the tear ducts. Commonest cause of recurrent sticky or watery eye in neonates.
Mx = reassurance, should resolve by 1 year
How will the CO2 appear in life threatening asthma attack? What does this indiacte?
Normal or raised
Indicates exhaustion
What is Chancroid? How does it present?
Genital ulcers caused by Haemophillus Ducreyi
Casues painful genital ulcers and unilateral inguinal lymphadenopathy. Seen in tropical countries
What are the Sx of portal hypertension? What should you worry about if this occurs alongside lower GI bleed?
Ascites, splenomegaly, caput medusae (abdo vein distension)
Rectal varices
What is the commonest cause of portal hypertension? How will it affect blood tests?
Cirrhosis
Raised ALT and AST and reduced Albumin
Define the parameters for severe asthma attack?
HR >110, RR>25, PEFR 33-50% and can not complete full sentences
What blood tests should be done when we think a diagnosis of dementia is likely?
FBC, U&Es, LFTs, Ca2+, Glucose, ESR/CRP, TFTs, Vit B12 and Folate
What is the purpose of adrenal venous sampling?
Allows us to differentiate between unilateral adenoma and bilateral adrenal hypoplasia
You see an arrhythmia which is consistent with broad complex tachycardia. How does the shape of the QRS affect the exact diagnosis?
QRS is polymorphic = Torsades de Points
QRS is monomorphic = VT
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?
Drugs which cause QTc prolongation.
Azithromycin - used prophylactically in COPD.
Start a beta blocker
Which blood disorder can glucocorticoids introduce?
Neutrophilia
Mx and prevention of high altitude cerebral oedema?
Mx = descent, oxygen and dexamethasone
Prevention = acetazolomide
Who can LTOT be offered to in COPD patients?
pO2<7.3 or pO2 7.3-8 with one of:
- Secondary polycythaemia
- Peripheral oedema
- Pulmonary HTN
In children acute illness, Down’s Syndrome and Prada Willi Syndrome can all cause hyper- or hypo- tonia?
Hypotonia!
Sx of Granulomatosis with Polyangitis?
Haemoptysis, dyspnoea, renal impairment, epistaxis, ear issues and a flat/saddle nose
Sx of Good Pasture’s Syndrome?
Haemoptysis, fever, nausea and glomerulonephritis
Sx of aspergillioma?
Haemoptysis and CXR with rounded opacity in a patient know to have had TB
What is the murmur in mitral stenosis? What is the most common cause?
Low-pitched mid-late diastolic murmur
Rheumatic fever
What has likely happened in an elderly patient who has fallen and now has raised CK?
Rhabdomyolysis
This then leads to acute tubular necrosis
What is often seen in pernicious anaemia?
B12 deficiency leading to pancytopenia.
Mainly in women with previous autoimmune diseases
Where should you definitely NOT cannulate in a known diabetic?
Feet!
A patient has presented with severe asthma that has not responded to bronchodilators. What should you do with them?
Admit!
Can you give the influenza vaccine to an ill person?
No, postpone until they are well!
Acute Tubular Necrosis is the commonest renal cause of AKI. How will the urine osmolality and sodium appear?
Urine osmolality will be low, urine sodium will be raised
What does a positive lachman test indicate?
ACL injury
VSD can occur secondary to an MI. How will it present?
Acute HF and a pansystolic murmur
What is the risk with a scaphoid fracture, how do we mitigate this?
Risk of avascular necrosis
Refer patients to ortho!
What ECG changes are seen in pericarditis?
PR depression and saddle shaped ST elevation
What is Sheehan’s syndrome?
Occurs after a severe PPH. Can cause hypopituitarism leading to amenorrhoea and lack of milk production
What is Asherman’s syndrome?
Pain and oligomenorrhoea occurring secondary to uterine adhesions/fibrosis (normally after multiple surgeries)
What is a renal complication of compartment syndrome?
Acute tubular necrosis
Which nerve supplies finger extension?
Radial nerve
Which nerve supplies finger adduction?
Ulnar nerve
What is the Hep A incubation period? Is it RNA or DNA?
2-4 weeks
RNA
Mx of GCA?
If no visual changes = high dose oral prednisolone
If visual changes = IV methylprednisolone
What should you do if there is still ketonaemia and acidosis 24 hours after starting DKA treatment?
Speak to a senior endocrinologist
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?
Metformin, once established add an SGLT-2 inhibitor
What is the aim of treatment in acute open angle glaucoma?
Reduce aqueous secretions and induce pupillary vasoconstriction
At what age should children play alone, alongside others and with others?
Alone = 18 month
Alongside others = 2 years
With others = 4 years
A pulseless sinus tachycardia is what?
PEA!
How can we treat the bilateral tremor of drug induced parkinsonism?
Procyclidine
Which parkinson’s drug is associated with pulmonary fibrosis?
Cabergoline
What will the serum sodium and osmolality and the urine be like in SIADH. What are the drug causes?
Serum sodium is reduced, osmolality is low, urine is concentrated.
Drugs = carbamazepine, sulfonylureas, SSRIs and tricyclics
How do you treat choking?
Encourage cough if they can speak
5xback blows -> 5xabdo thrusts
How should you treat new onset AF if the patient is haemodynamically unstable?
DC cardioversion
What abnormality is suggested in a child who has loss of internal rotation of the leg when in flexion?
SUFE
Name 2 features that suggest the ulcer is arterial?
Painful ulcer with an ABPI of <0.5
What is the timescale of alcohol withdrawal?
Symptoms = 6-12 hours
Seizures = 36 hours
Delirium tremens = 72 hours
A patient has a ?TIA. What should you do if they are on warfarin, a DOAC or have a bleeding disorder?
Admit to image and exclude haemorrhage
Mx of cluster headaches?
Acute = SC Sumatriptan
Prophylaxis = Oral Verapamil
Which murmur is often noted in infective endocarditis? What is the causative organism?
Early diastolic murmur (aortic regurg)
Strep. Pyogenes
What is VSD associated with increased risk of?
IE
How does acute alcoholic hepatitis appear on LFTs? Which drug can we give these patients?
AST:ALT >2
Raised GGT
Prednisolone
How will LFTs appear in cholestasis, how does this change over time?
ALP and GGT raised
Over time liver damage occurs so AST and ALT will start to rise
What does and AST or ALT of >1000 indicate?
Ischaemic hepatitis or paracetamol OD
How should chronic Sub-dural haemorrhage be managed?
Symptomatic = burr hole evacuation
Asymptomatic = conservative management
What is Felty’s syndrome?
Rheumatoid Arthritis with splenomegaly and low WCC
What is seen in CNIII palsy?
Ptosis, mydriasis and down & outwards deviation of the eye.
If mydriasis do an urgent CT head
What is Propylthiouracil?
Can treat hyperthyroidism and is preferred to carbimazole if patient is breastfeeding
Sx and Mx of Thyroid storm?
Sx = fever, tachycardia, nausea and vomiting, HTN, HF, confusion/agitation and deranged LFTs with jaundice
Mx = Beta-blockers, Propylthiouracil and hydrocortisone
What can we use to shrink fibroids prior to surgery?
GnRH agonists
Mx of a chemotherapy patient with a fever?
Immediate IV Abx e.g. Tazobactan
Above what BP are pregnant women required to be admitted for observation even if asymptomatic?
> 160/110
What are the rate limiting drugs which should be used in AF?
1st line = beta blockers or CCBs
2nd line = Digoxin
You are a doctor. A child appears unwell to you. What should you do?
Refer immediately to hospital.
Appearing unwell to a healthcare professional is a red flag symptom!
When should you do thrombolysis and thrombectomy in a stroke?
In a large ischaemic stroke which symptoms started <4.5 hours ago
Sx and Mx of Motor Neurone Disease?
Upper and lower motor neurone symptoms with no sensory issues and eye movements maintained.
Mx = Riluzole, BiPAP at night and PEG feeding
What are the risks of benzos in pregnancy?
1st trimester = cleft lip
3rd trimester = floppy baby syndrome
Should you give amiodarone in Torsades de Points caused by QTc prologation?
NO
Amiodarone with further prolong QTc
When can we use IV magnesium in ALS?
In VT or torsades de point do stabilise the myocardium
Should we treat asymptomatic bacteriuria in pregnancy?
YES!
Sx of Henoch-Scholein Purpura?
Purpura on the legs and buttocks, arthralgia/arthritis, abdo pain, proteinuria and haematuria
What can we give as a pharmacological weight loss treatment? Who can we give it to?
Orlistat
Those who have tried dietary, exercise and behavioural changes who have:
BMI >30 OR BMI >28 with risk factors
Who can we give cyclical progesterone HRT to?
Women who are still having periods
Haemolytic anaemia is the breakdown of red blood cells. What are the symptoms and how can we confirm diagnosis?
Sx = anaemia, splenomegaly and jaundice
Ix = normocytic anaemia, schistocytes on blood film and positive direct coombs test
Which electrolytes become deranged in refeeding syndrome?
Phosphate, magnesium and potassium
What are Greenstick fractures?
Commonly seen in children, these occur when there is a unilateral breech of the cortical surface of the bone
When should you admit a patient with hyperemesis gravidarum?
If there is >5% weight loss and/or ketonuria despite treatment with oral antiemetics such as cyclizine.
How should you give TXA in a major haemorrhage?
In a rapid bolus and then followed by a slow infusion
What ECG changes can be seen in aortic dissection?
Inferior ST elevation
You are a GP and you suspect a patient has Guillane-Barre Syndrome. What should you do?
Refer to hospital for a LP and nerve conduction studies
What type of contraceptives are contraindicated by current breast cancer?
All hormonal contraceptives!
How should medications be stopped in a medication overuse headache?
Simple analgesia and triptans should be stopped immediately
Opioids should be slowly withdrawn
What is the 1st line investigation for intussusception? What do you see?
Abdo USS
Bullseye or target sign
What is seen in dilated cardiomyopathy? What conditions is it associated with?
HF with reduced ejection fraction, dilated chambers with thin walls and valve regurgitation
Chronic alcoholism, cocaine abuse, hemochromatosis, sarcoidosis, infection and pregnancy
What should we do for patients with a post-tonsillectomy haemorrhage?
Refer urgently to ENT
How can we clinically differentiate between endometriosis and fibroids?
Endometriosis = dysmenorrhoea +/- urinary or bowel symptoms
Fibroids = menorrhagia (+/- pain)
Sx and Mx of Bell’s palsy?
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
You have a 3rd cranial nerve palsy in the Left eye. There is a haemorrhage leading to midline shift, on which side is it?
Left side!
What is the relationship between the COCP and different types of cancer?
Increases the risk of breast and cervical cancer
Decreases the risk of endometrial and ovarian cancer
What happens to growth hormone levels in anorexia nervosa?
They increase
Which artery is affected in amaurosis fugax?
The central retinal artery or the ophthalmic artery have been occluded
What is Diclofenac now contraindicated in?
IHD, PAD, CVD and CHF
What anti-platelet medications do you use in secondary prevention of MI and stroke?
MI = Aspirin life long and Ticagrelor for 12 months
Stroke = life long clopidogrel
Which type of contraceptives should be avoided in those with a history of obstetric cholestasis?
Those which contain oestrogen
Where do varicoceles most commonly occur?
Left side of the scrotum
Who is primary sclerosing cholangitis most commonly associated with?
Males with IBD
Name 2 drugs which can cause acute interstitial nephritis
NSAIDs and PPIs
Name the rotator cuff muscles and their functions?
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
Sx, blood results and Mx of Dematomyositis?
Sx = progressive muscle weakness and a violet rash
Blood results = ANA and Anti-M-2 antibodies present
Mx = corticosteroids
What is seen on LP of viral encephalitis?
Protein/lymphocytes are raised and normal glucose
Sx of varicose veins?
Aching, itching, varicose eczema, haemodeserin deposits (hyperpigmentation), atrophie blanche (hypopigmentation) and lipodermatosclerosis (hard/tight skin)
What is Maddrey’s discriminant function?
Uses serum bilirubin and prothrombin time to assess if a patient with acute alcoholic hepatitis would benefit from glucocorticoids
Name one common trigger for cluster headaches?
Alcohol
Can you give Atorvastatin in pregnancy?
No - all statins are contraindicated in pregnancy
What suggests delirium over dementia?
Impairment of consciousness (i.e. reduced GCS), symptom fluctuation and hallucinations
How/when should you test pregnant women for gestational diabetes if they have a first degree relative with DM?
With an OGTT at 24-28 weeks
What is the best management of atypical endometrial hyperplasia?
All women = total hysterectomy
Post-menopausal women = + salpingo-oophorectomy
What test should you do if there is cortisol excess vs. cortisol deficiency?
Cortisol excess (cushing’s syndrome) = CT adrenals
Cortisol deficiency (addison’s disease) = Short Synacthen test
What should you do if a new born has transient cyanosis and suboptimal sp02?
No management needed - this is common in the 1st 10 mins of life.
Just observe
What metabolic abnormality is seen in cushing’s syndrome vs addison’s disease?
Cushing’s syndrome - Hypokalaemic metabolic alkalosis
Addison’s disease - Hyperkalaemic metabolic acidosis
What is the most common cause of bacterial pneumonia in children?
Strep. pneumoniae
How do we rate control in AF?
Beta-blocker or rate limiting CCB e.g. Verapamil - Amlodipine is NOT rate limiting
What are De Musset’s sign and Quincke’s sing? What condition are they seen in?
De Musset’s = head bobbing
Quincke’s = nailbed pulsation
Seen in aortic regurgitation
What is Swyer Syndrome?
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!
Sx of PID?
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
Which other hepatitis variant does Hep B vaccine protect against?
Hep D
Hep D requires the presence of Hep B to replicate!
Which chemotherapy regimes are used to treat Hodgkin’s and Non-Hodgkin’s lymphoma respectivley?
Hodgkin’s = ABVD
Non-Hodgkin’s = R-CHOP
What is expressive dysphasia?
Damage to broca’s area (dominant frontal lobe - due to superior MCA blockage). Patient can understand language but can’t generate speech
What is receptive dysphasia?
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
Sx and Mx of orbital cellulitis?
Sx = Erythema, eyelid swelling, proptosis, painful eye movements, fever and changes to (colour) vision
Mx = IV antibiotics
Sx and Mx of periorbital cellultiits?
Sx = erythema and swelling around the eye. They eye itself is not painful
Mx = oral or IV Abx
How long can the mirena coil make up the progesterone part of HRT for women who still have a uterus?
For the first 4 years
Which type of HRT should we use in those at risk of VTE?
Transdermal HRT
What are the SSRIs of choice in breastfeeding women?
Sertraline and Paroxetine
How do we manage an ectopic pregnancy with a foetal heartbeat?
Surgery
If they have both tubes do a salpingectomy, if not attempt a salpingotomy
When is aspirin contraindicated?
Children (unless Kawasaki), pregnancy and breast feeding
When should foetal movements be felt by? What do you do if they aren’t felt?
24 weeks
If not felt refer to foetal medicine
What is the first line investigation in ?acute pancreatitis?
USS abdomen
You see a peribronchial lung tumour and blood results show a raised PTH hormone related peptide. What type of tumour is present?
Squamous cell lung cancer
What is the method of action of cyclophosphamide and methotrexate?
Cyclophosphamide = alkylating agent
Methotrexate = antimetabolite
Sx and imaging seen in osteosarcoma?
Sx = bone pain and swelling
Imaging = codman triangle and a sunburst appearance
What is the order or management for osteoarthritis?
1) Topical analgesia
2) + Paracetamol
3) + NSAID
4) + Steroid injection
How does Wolff-Parkinson-White syndrome appear on ECG? What is it associated with?
Short PR interval, wide QRS and a delta wave
Increased risk of AF and atrial flutter
Tumour lysis syndrome is a complication of chemotherapy commonly seen in lymphoma and leukaemia. What can it cause?
Hyperkalaemia, hyperphosphateaemia, hyperuricaemia, hypercalcemia
It can lead to cardiac arrhythmias, seizures and acute renal failure
What is seen in Tetralogy of Fallot?
Overriding aorta, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary stenosis) and VSD
What will iodine-131 studies show in toxic multinodular goitre? What is the definitive management?
Multiple hot areas of iodine-131 uptake of varying intensity.
Definitive management = radioiodine therapy
What should you do with a 2 year old presenting with a limp, prodromal coryzal symptoms and no fever?
Refer for urgent specialist assessment.
Anyone presenting with a limp under 3 years old should be referred regardless of other symptoms
What is Holmes Adie Syndrome?
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
What should you do next with any patient presenting with ?IBS
Perform ESR, CRP, FBC and Coeliac serology (anti-tissue transglutimase antibodies)
What is considered a high risk AAA?
Symptomatic (e.g. pain), >= 5.5cm or rapidly enlarging (>1cm/year)
How should you manage renal stones?
<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
What drug class is venlafaxine?
Serotonin and noradrenaline reuptake inhibitor
How is CKD staged?
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
How does Staph. aureus gastroenteritis present?
Short incubation period (30mins-8hrs). Causes vomiting which resolves within 2 days
How does E.coli gastroenteritis present?
3-4 day incubation. Causes bloody diarrhoea and lasts about 1 week
How does Salmonella gastroenteritis present?
12-72hrs incubation. Causes diarrhoea and a fever and lasts 4-7 days
What management is given to those with severe enough bronchiolitis to require hospital admission?
Supportive management
In intrahepatic cholestasis, when and how should you deliver?
Induction of labour at 37 weeks
What are the eye symptoms of Myasthenia Gravis? What additional symptoms are seen if there is an associated thyoma?
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
What Ix is done to diagnose Myasthenia Gravis?
Check for antibodies against acetylcholine receptors
What is the 1st line Mx of Crohn’s disease
Induce remission with glucocorticoids.
Maintain remission with azathioprine or mercaptopurine
What is the 1st line Mx of UC?
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
Mx BPH?
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
5-Alpha Reductase Inhibitors can lead to some bothersome side effects. Name 4?
Reduced libido, erectile dysfunction, ejaculation problems and gynaecomastia
Below what eGFR is metformin contraindicated?
Below 30
What is a primary pneumothorax? How should you manage?
Pneumothorax with NO underlying cause
Air rim <2cm and no SOB - discharge
Air rim >2cm - aspiration and chest drain if failure
What is a secondary pneumothorax? How should you manage?
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
What is the gold standard imaging in MS?
MRI with contrast
How long should antidepressants definitely be taken for?
At least 6 months after remission
What happens if you correct hyponatraemia too rapidly?
Osmotic demyelination syndrome
Spastic quadriparesis, pseudobulbar palsy and emotional liability
What is Lateral Medullary Syndrome? What are the symptoms?
Posterior Inferior Cerebellar Stroke
Sx = ipsilateral Horner’s syndrome, ipsilateral facial numbness and contralateral body numbness, ipsilateral ataxia
What should you suspect has happened in a patient with chronic lymphocytic leukaemia who suddenly becomes more unwell?
It has transformed into high grade lymphoma
How do benzodiazepines work?
Enhance the effect of gamma-aminobutyric acid
What is chondrocalcinosis?
Calcification of the cartilage seen in pseudogout
What is the first line Mx for a massive PE with circulatory failure e.g. hypotension?
Thrombolysis
Is trimethoprim safe in breastfeeding?
YES
What is Etoricoxib?
An NSAID
Sx of Acoustic Neuroma?
Vertigo, tinnitus, unilateral sensorineural hearing loss, facial palsy and absent corneal reflex
How should you manage VZV exposure in pregnancy?
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
What is the MELD score?
Model of End Stage Liver Disease used to measure severity of liver cirrhosis
What is the definitive Mx of acute angle-closure glaucome?
Laser iridotomy
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?
- Nausea or vomiting
- Weight loss
- Reflux
- Dyspepsia
- Upper abdominal pain
What does venous sinus attenuation on MRI imply?
Transverse venous stasis - this is characteristic of Idiopathic intercranial hypertension
In ?DVT D-dimer and scan are going to be delayed. What should you do in the meantime?
Prescribe treatment dose of a DOAC
How can the forehead help us differentiate between an upper and lower motor neurone lesion?
Forehead sparing = UMN lesion
Forehead not spared = LMN lesion
What should you do if after 3 weeks of steroids treatment there is no improvement in bell’s palsy?
Urgent ENT refferal
Which opioids should be used in end of life care for patients with severe renal impairment?
Buprenorphine and Fentanyl
Mx of extracapsular hip fractures?
Intertrochanteric = dynamic hip screw
Subtrochanteric = intra medullary nail
How long should you stop warfarin before surgery, what is the target INR?
5 days before surgery
INR should be <1.5
A patient has secondary amenorrhoea with a positive progestin challenge. What does this suggest is the cause?
PCOS
Which type of MI has occurred if there is new AV node block? Which artery is occluded?
Inferior MI
Right coronary artery is occluded
What type of scan should we perform in a ?PE where the patient has severe renal impairment?
V/Q scan!
True or false, spironolactone can cause gynaecomastia?
True!
What is the 1st line Mx of open angle glaucoma?
Prostaglandin analogue eyedrops e.g. Latanoprost
What is the most accurate way to assess burns?
Lund and Brouder chart
Mx of Guillaine-Barre?
IV Immunoglobulins
Mx of Myasthenia Gravis?
Pyridostigmine 1st line, can also add prednisolone
Sx of vestibular neuronitis?
Vertigo, nausea and vomiting, horizontal nystagmus, no hearing loss or tinnitus!
Ix and Mx of vestibular neuronitis?
Ix = HiNTs exam to distinguish it from a PCA stroke
Mx = Prochlorperazine
What are the characteristic blood results seen in non-metastatic myeloma?
Raised calcium, normal or raised phosphate and normal ALP
What should you always worry about in a patient presenting with a painful CN III palsy?
Posterior communicating artery aneurysm
What should you worry about in anyone with a raised urea out of proportion with creatinine?
Upper GI bleed e.g. duodenal ulcer
Digested blood produces urea!
What symptoms are seen in shaken baby syndrome?
Retinal haemorrhages, subdural haemorrhages and encephalopathy
What does complement levels indicate in SLE?
Complement levels are low in active disease and raised in flares
When should a patient start to mobilise following a repair of a hip fracture?
Should fully weight bare immediately after!
Mx of Cows Milk Protein Allergy?
Extensively hydrolysed formula. If this fails switch to amino acid based formula
Mx of Meningitis in children?
<3 months old = IV Cefotaxime and Amoxicillin
>3 months old = IV Cefotaxime and Dexamethasone
When can you do PCI in STEMI what drugs are given before transfer to a PCI centre?
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
Which antiemetic should be avoided in bowel obstruction?
Metoclopromide
What investigation should you offer to all men with erectile dysfuntion?
Check their testosterone levels
If low check LH and FSH
What should you do if you see an infant with an inguinal hernia?
Urgent surgical correction
What is the 1st line and long term Mx of Poriasis?
1st line = potent corticosteroids and once daily vitamin D (use one in the morning and the other at night)
Long term = topical calcipotriol
What is indapamide, which metabolic abnormalities can it cause?
Thiazide like diuretic
Hypercalcaemia and hypokalaemia
How long can a urinary pregnancy test remain positive for after TOP?
4 weeks
What should you think of if there is bilateral hilar lymphadenopathy and raised serum ACE. How do you manage?
Sarcoidosis
If there is symptoms = steroids
When is a IV CCB e.g. verapamil always contraindicated?
In VT
What is used in the medical management of miscarriage?
Vaginal misoprostal
What metabolic abnormality can non-small cell lung cancers cause? How does this present on ECG?
Hypercalcaemia
Short QTc
What is Eplerenone?
An aldosterone antagonist
HF Mx (with reduced EF)?
1st line = ACEi or Beta blocker (+ loop diuretic if fluid overload)
2nd line = aldosterone antagonist
How can blood test help you differentiate between the causes of secondary amenorrhoea?
Low oestradiol + low LH/FSH = hypothalamic dysfunction
Low oestradiol + high LH/FSH = premature ovarian failure
Conn’s syndrome and vomiting both cause the same metabolic abnormalities. What are these abnormalities and how can you tell the difference between them?
Metabolic alkalosis and hypokalaemia
Conn’s is associated with a high BP where as vomiting is associated with a low BP
What is a Virchow’s node? What is it associated with?
A left sided supraclavicular lymph node
Associated with gastric cancer
What is seen in duodenal atresia?
Double bubble sign and billious vomiting
How should you treat those with new onset AF who present within 48 hours or who have co-existing HF?
Rhythm control with amiodarone
What should you do with a patient presenting with a BP >=180/120?
If they have signs or symptoms admit for specialist assessment
If no signs or symptoms do urgent investigations for signs of end organ damage
What is the key diagnostic investigation in Guillain Barre Syndrome. What will you see?
Lumbar puncture
Shows raised proteins and a normal WCC
True or false, anti-epileptic drugs are contraindicated in breast feeding?
FALSE!
They are safe!
Sx, Ix and Mx of Acute Interstitial Nephritis?
Sx = fever, rash, arthralgia, renal impairment, HTN and eosinophilia
Ix = white cell casts seen in the urine and sterile pyuria
Mx = steroids
How does calcium levels affect the QTc?
Hypercalcaemia = QTc shortening
Hypocalcaemia = QTc prolongation
What is a serious skin complication of chicken pox?
Group A Streptococcus necrotising fascitits
How is the BP, glucose, Na+ and K+ affected in addisons disease? What skin change may be noted?
Low BP, Glucose and Na+
High K+
Hyperpigmentation of the skin (especially in the palmar creases)
How will PTH, Ca2+, ALP and PO43- be affected in osteoporosis?
They will all be normal!
Sx of radial nerve damage? What type of # is it associated with?
Wrist drop and loss of sensation over the dorsal 1st/2nd metacarpal bones. Humeral shaft #
How do you manage DVT? How is this different if the eGFR is <15?
DOAC
If eGFR <15 use unfractionated heparin
How do you close a PDA? How do you keep a PDA open?
Close it with Ibuprofen or Indomethacin
Keep it open with Alprostadil (prostaglandin E1)
How can we manage MS?
High dose steroids
A patient presents with Sx of hyperthyroidism, raised ESR and painful goitre. What is the diagnosis and how can we manage?
De Quervian’s thyroiditis
Mx = analgesia. This is a self-limiting condition
How do we manage a baby who has lost >10% of its birth weight?
If well refer to midwife lead breastfeeding clinic
If unwell admit
How can lithium affect the calcium levels?
It will cause high calcium as it can lead to hyperparathyroidism
How long should UTI be treated for in pregnancy?
7 Days
Which hormones will be secreted LESS in an acute stress response?
Insulin, Oestrogen and Testosterone
Sx of Steven-Johnson-Syndrome?
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
What is hyphema? What can it result in?
Blood in the anterior chamber of the eye. Can lead to glaucoma
Sx and Ix of chronic pancreatitis?
Pain 10-30mins after a meal, steatorrhea and DM
Ix = CT and faecal elastase
What is the most common cause of COPD exacerbation. How should you manage?
Haemophilus Influenzae
5 days prednisolone. Abx if there is purulent sputum or signs of pneumonia
True or false NSAIDs can precipitate lithium toxicity?
TRUE!
What should you do with an adult presenting with a hydrocoele?
Urgent US to exclude an underlying cause
Can you give Diltiazem (CCB) in heart failure?
NO!
What are the time limitations for when you can measure PSA?
Must be 48 hours after intense exercise, ejaculation and DRE
Must be 1 month after prostatitis
True or false, hypoparathyroidism is a RF for gout?
False
Hyperparathyroidism is associated with gout
True or false, oxycodone can not be given in moderate to end stage renal failure?
False!
It can be given in moderate to end-stage renal failure
What should you give to reverse respiratory depression occurring secondary to MgSO4?
Calcium Gluconate
How does total iron binding capacity help us differentiate between iron deficiency anaemia and anaemia of chronic disease?
TIBC is high in iron deficiency anaemia and low/normal in anaemia of chronic disease
How is the liver affected in ADPKD?
ADPKD leads to hepatomegaly
What is the cause of a metabolic ketoacidosis where the blood glucose is normal or low?
How do we manage?
Alcoholic ketoacidosis
Mx = fluids and thiamine?
What is the most common ECG change in PE?
Sinus tachycardia
How can we manage orthostatic hypotension medically?
Fludrocortisone and midodrine
Which drug should you NEVER give alongside a beta blocker?
Verapamil!
Mx of NEC?
Nil by mouth and cefotaxime and vancomycin
Where do secondary brain tumours most commonly come from?
Lung, breast kidney and melanoma
Can you give ARBs in renal disease?
No! They are contraindicated for the same reason ACEis are
What is the preferred method of IOL?
Vaginal prostaglandin E2 (give after membrane sweep)
Amniotomy should only be done if the cervix is ripe (bishops score >=7)
What signs are found in PDA?
Large volume collapsing pulse and a continuous murmur at the left sternal edge
What medication should you give in ascites?
Spironolactone
How can we localise the cause of a bitemporal hemianopia?
Mainly upper quadrant affected = inferior compression of the optic chiasm = pituitary adenoma
Mainly lower quadrant affected = superior compression of the optic chiasm = craniopharyngioma
What is the most common complication of measles? What is the most common cause of death?
Most common = otitis media
Most common cause of death = pnuemonia
What is the diagnosis in a patient presenting with abdominal distension, tenderness and fluid/electrolyte loss with a positive fluid balance after abdo surgery?
Ileus!
What is the SSRI of choice in children or adolecents?
Fluoxetine
Which drugs can cause rhabdomyolysis when prescribed alongside statins. Sx?
Erythromycin or clarithromycin
Dark urine and muscle aches
What is seen in dermatomyositis?
Symmetrical proximal muscle weakness and gottron’s papules (seen on PIP and DIP joints)
When should you offer OGTT in pregnancy?
At booking visit if previous gestational diabetes. Otherwise at 24 weeks
True or false, UC is associated with increased risk of galls stones?
FALSE
Crohn’s is associated with increased risk of gall stones
UC is associated with increased risk of PSC
What type of contraceptives are contraindicated in women who have had gastric sleeve, gastric bypass or duodenal switch surgery?
Oral contraceptives. This includes emergency oral contraceptives
Sx, Ix and Mx in polycythaemia varia?
Sx = pruitis, splenomegaly and plethoric complexion
Ix = Raised Hb, haematocrit, platelets and WCC. JAK-2 positive
Mx = Aspirin and venesection
How can we manage miscarriage?
Expectant
Medical = vaginal misoprostol + antiemetics + analgesia
Surgical = dilation and curettage (vacuum aspiration) or take to theatre
Sx in bronchiolitis?
Preceding coryzal phase followed by cough, increased WOB an wheeze on chest
What does hypertrophic obstructive cardiomyopathy commonly lead to? How does the pulse appear?
HF with preserved ejection fraction
Jerky pulse
How do thiazide like diuretics affect glucose tolerance?
They worsen it so blood glucose will increase
Differentiate between cephalohematoma and caput succedaneum?
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
What will you hear if there is an ASD?
Ejection systolic murmur heard loudest on inspiration
Mx of reactive arthritis?
NSAIDs and intra-articular steroids
A patient has a stroke leading to ipsilateral CNIII palsy and a contralateral hemiparesis. Where is the lesion?
Posterior cerebral artery stroke aka webber syndrome
Cause, Sx and Mx of neurogenic shock?
Spinal cord trans-section leading to hypotension, bradycardia and flushing
Mx = vasopressors
How long should you use barrier contraception for after being treated with rifampicin?
4 weeks
Which part of the ear should you visualise in chronic or recurrent discharge?
The attic of the eardrum - this is to exclude cholesteatoma
What is the most common cardiac defect in turner’s syndrome?
Bicuspid aortic valve
What is the most common cause of ambiguous genitalia in newborns?
Congenital adrenal hyperplasia
Can you use paroxetine in pregnancy?
No! There is a high risk of congenital malformations
When are triptans always contraindicated? Why?
In coronary artery disease. They can cause coronary vasospasm
Sx and Ix of multiple myeloma?
CRAB
hyperCalcaemia, Renal failure, Anaemia (and thrombocytopenia) and Bone fractures/lytic lesions
Ix = monoclonal bands seen on serum electrophoresis
Secondary prevention of stroke/TIA?
No AF = Clopidogrel
AF = Warfarin or direct thrombin or factor Xa inhibitors (NOAC)
Which cancers commonly metastasise to lungs?
Breast, colorectal, prostate, renal, bladder
What should you suspect if you see multiple, large, round and well circumscribed masses in both lungs on CXR?
Cannon ball metastases seen in RCC
Mx of mycoplasma pneumoniae?
Erythromycin
What rheumatological condition are chemotherapy patients more at risk of getting?
Gout
Which rheumatological condition is rheumatoid arthritis a RF for?
Oseteoarthritis
What does a sine wave (sinusoidal pattern) on ECG indicate?
Suggestive of severe hyperkalaemia
What is a patients daily glucose requirement?
50-100g/day regardless of weight
In what conditions is diclofenac contraindicated?
IHD, PAD, CVD and CHF
Topical epidermal necrolysis occurs secondary to an acute drug reaction. Sx and Mx?
Systemic illness, nikolsky’s sign (epidermis separates from the dermis with mild pressure)
Mx = ICU and IVIG
What is a missed miscarriage?
Cervical os is closed and the gestational sac remains in the uterus but there is no foetal heart beat
What is characteristically seen in psoriatic arthritis?
Asymmetrical joint pain of the DIP and PIP joints which is worse in the morning but relieved by use
What should you do in a patient with croup and audible stridor at rest?
Admit!
What should you consider as the cause of primary amenorrhoea with a raised FSH/LH?
Primary gonadal dysgenesis e.g. Turner’s syndrome
Define obstructive vs restrictive lung disease?
Obstructive = very reduced FEV1, mildly reduced/normal FVC, FEV1:FVC <75%
Restrictive = reduced FEV1, very reduced FVC, FEV1:FVC >75%
How can we supress lactation when breast feeding is no longer indicated?
Cebergoline
What is an oculogyric crisis? What are the symptoms and what can cause it?
An acute dystonic reaction
Restlessness and agitation.
Involuntary upwards deviation of the eyes.
Causes = antipsychotics, metoclopramide and post-encephalitic Parkinson’s disease
Mx of oculogyric crisis?
IV benztropine or procyclidine
Which type of drugs classically causes acute interstitial nephritis?
Antibiotics
How does the addition of progesterone to HRT affect risks?
Increases the risk of breast cancer and VTE
How does HRT affect stroke and ischaemic heart disease risk?
All HRT increases the risk of stroke
All HRT increases the risk of IHD if taken >10 years after menopause
What is seen in Kallmann syndrome?
Low GnRH, Low LH and Low FSH
Primary amenorrhoea with the absence of a sense of smell
What is the Mx of an undisplaced scaphoid fracture?
Cast for 6-8 weeks
What is a mass at the cerebellopontine junction characteristic of? Which cranial nerves are affected?
Vestibular schwannoma
CN V, VII and VIII
What should you give to all HIV positive patients with a CD4 of <200?
Co-trimoxazole (antibiotic prophylaxis)
How does pheochromocytoma typically present?
Intermittent HTN, paroxysmal palpitations and sweating with tremors/anxiety
What is the most common cause of pneumonia in alcoholics?
Klebsiella
What is the commonest cause of massive painless GI bleed in children? How should you investigate?
Meckel’s diverticulum
Technetium scan or mesenteric arteriography if it is severe enough to require transfusion
What is HLA-B27 commonly associated with?
Autoimmune disorders e.g. ankylosing spondylitis, psoriatic arthritis, reactive arthritis and uveitis
When should you commence allopurinol after an acute gout attack? What is given second line?
3 weeks after
Febuxostat is second line
What should you do in a patient <3 months old presenting with UTI?
Immediate referral to paeds
How is renal cell carcinoma treated?
Radical nephrectomy (it is usually resistant to radio or chemo therapy)
How does subacromial impingement present?
Painful arc abduction between 90-120 degrees
Is a third hear sound normal?
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!
How often should women be routinely screened for cervical cancer?
25-49 years = every 3 years
50-64 years = every 5 years
What should you do if a cervical smear comes back positive for HPV?
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
What should you do if a cervical smear comes back as inadequate sample?
Repeat in 3 months, if there are 2 inadequate samples refer for colposcopy
Should you do a cervical smear in pregnancy?
No. Delay until 3 months post-partum unless there has been a missed screen or previous abnormal screen
Which cancers most commonly metastasise to bone in men and women? How does it appear on X-ray?
Prostate in men - will appear with sclerotic/blastic lesions
Breast in women - will appear with a mixed pattern of sclerotic and lytic lesions
Apart from breast and prostate, which other cancers commonly metastasise to bone? How do they appear?
Kidney, thyroid or lung. Will appear as lytic lesions
What is seroconversion disorder? How and when does it present?
Occurs 3-12 weeks after HIV infection
Can present with a non-specific rash, pharyngitis and fever
What should be used in the secondary prophylaxis of hepatic encephalopathy?
Lactulose and rifaximin
What does meckle’s diverticulum pain commonly mimic?
Appendicitis
Which type of pneumonia are you predisposed to if you have had a recent influenza infection?
Staph. aureus pneumonia
How can we differentiate between psoriatic and rheumatoid arthritis?
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
What is the most likely cause of the following pneumonias:
- Normal CAP
- Alcoholic/diabetic patient
- COPD
- Recent Flu
Normal CAP = strep. pneumoniae
Alcoholic/diabetic patient = klebsiella pneumoniae
COPD = Haemophilus pneumoniae
Recent flu = staph. aureus
What is the emergency management of croup?
High flow O2 and nebulised adrenaline
Sx and Mx of Pityriasis rosea?
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
Ix and Mx of Phaeochromocytoma?
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
What are the X-ray changes seen in psoriatic arthritis?
Periarticular erosions and bone resportion
What are the X-ray changes seen in gout?
Erosions with overhanging edges (rate bite erosions)
What are the X-ray changes seen in septic arthritis?
Joint effusion
What are the X-ray changes seen in osteoarthritis?
Loss of joint space, osteophytes and subchondral sclerosis
What are the X-ray changes seen in rheumatoid arthritis?
Loss of joint space, juxta-articular osteoporosis and soft tissue swelling. Late signs = periarticular erosions and subluxation
What are the X-ray changes seen in osteopenia?
Widened bulky physeal plates and irregularity
How do you treat hypertensive crisis (systolic BP >250) in pheochromocytoma?
Phentolamine
How do we treat tension pneumothorax?
Insertion of 14G cannula into the 2nd intercostal space
Mx of a scaphoid fracture which is displaced or with a proximal scaphoid pole fracture?
Surgical fixation
If simple fracture splint
What is the coffee bean sign on x-ray significant for?
Sigmoid volvulus
What is the most common type of RCC?
Clear cell carcinoma
What is gastroschisis? How do we manage?
Protrusion of the bowel without a peritoneal covering. Occurs lateral to the umbilical cord
Mx = urgent surgical correction and cling film covering
What is exomphalos/omphacoele and how do we maange?
Bowel protrusion within the peritoneal covering at the umbilical site
Mx = staged repair with completion at 6-12 months
What are the causes of obstructive lung disease?
COPD, Asthma, Bronchiectasis and Bronchiolitis obliterans
What is a serious complication of TURP?
Hyponatraemia due to glycine irrigation
What is the normal foetal HR?
100-160 bpm
What is seen in the blood/urine in osteomalacia?
Hypocalcaemia, hypophosphataemia, low vitamin D, raised ALP.
Low urinary calcium
