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AA Y4 Finals cards NE > PassMed round 2 > Flashcards

PassMed round 2 Flashcards

1
Q

what is 1st line Mx of scalp psoriasis?

A

topical betamethasone valerate

a corticosteroid shampoo

2nd line = topical vit D

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2
Q

what organism is the most common cause of both erythema multiforme and eczema herpeticum?

A

herpes simplex virus

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3
Q

is shingles diagnosed based solely on clinical exam or are additional Ix’s required?

A

it is diagnosed solely on clinical exam

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4
Q

how can erysipelas be differentiated from cellulitis?

compare causatives?

A

erysipelas has a raised and well defined border, cellulitis doesnt

ie- it is a more superficial, limited version of cellulitis

erysipelas = strep pyogenes

cellulitis = staph aureus

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5
Q

which skin condition presents initially with a herald patch?

who does it most commonly affect and how is it treated?

A

Pityriasis rosea

mostly affects teenagers and young people, often post-viral

it is self limiting and requires no treatment

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6
Q

compare the Tx for Pityriasis rosea and pityriasis versicolour?

A

Pityriasis rosea = self limiting

pityriasis versicolour = topical ketoconazole shampoo

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7
Q

which areas of the body are acral lentiginous melanomas specific to?

A

areas that are not sun exposed
ie- soles of feet and palms

differentiates them from other forms of melanoma

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8
Q

which rapidly growing skin lesion is characterised by a keratin core?

A

keratoacanthoma

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9
Q

what is the most appropriate management of actinic keratosis?

A

topical fluorouracil cream

it is a premalignant skin condition that develops due to chronic sun exposure

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10
Q

what is the most common hereditary haemolytic anaemia in people of Northern European descent?

A

hereditary spherocytosis

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11
Q

what should be prescribed in patients found to have polycythemia vera?

A

aspirin

these patients are at increased risk of thrombotic events due to blood’s hyper viscosity - therefore, prescribe aspirin

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12
Q

describe the management of acute chest syndrome in sickle cell disease?

A

analgesia

antibiotics

blood transfusion

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13
Q

what is acute chest syndrome in sickle cell disease due to?

A

due to a vast-occlusive episode in the pulmonary vasculature

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14
Q

how should acute haemolytic transfusion reaction be treated?

A

stop the transfusion and give generous IV fluid resuscitation

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15
Q

name the symptoms present in an acute haemolytic reaction following transfusion?

A
  • fever
  • abdominal pain
  • hypotension
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16
Q

in which transfusion reaction is the main differentiating symptom pain?

A

acute haemolytic reaction

often presents with abdomen pain, which is unique

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17
Q

what class of drugs can precipitate renal failure in patients with multiple myeloma?

A

NSAIDs

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18
Q

compare the transfusion threshold (for red cells) in patients without ACS and patients with ACS ?

A

without ACS - <70g/L Hb

with ACS - <80g/L Hb

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19
Q

what test should be used to diagnose hereditary spherocytosis?

A

EMA binding test

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20
Q

describe the presentation of lichen planus?

A

purple, raised, itchy rash and has fine white lines on the surface of the rash

Wickham striae inside the mouth - appears as white striae

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21
Q

what is the 1st line Tx for lichen planus?

A

potent topical steroids

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22
Q

what cancer is myelodysplasia most likely to progress to?

A

acute myeloid leukemia

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23
Q

what is DIC associated with on blood film?

A

schistocytes

due to the microangiopathic haemolytic anaemia

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24
Q

what finding on blood film is indicative of decreased splenic function?

A

Howell-jolly bodies

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25
Q

finding of auer rods on blood film is indicative of which leukemia?

A

acute myeloid leukaemia

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26
Q

what long term medication should those with sickle cell disease be started on to reduce the incidence of complications and acute crises?

A

hydroxycarbamide

it makes blood cells bigger and stay rounder and more flexible

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27
Q

how should transfusion-associated circulatory overload be treated?

A

IV loop diuretics

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28
Q

how are platelet levels affected in von willebrand’s disease?

A

they are unaffected

there is a prolonged bleeding time, prolonged APTT but a normal platelet count

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29
Q

a problem with which bleeding factor in particular will cause a prolonged APTT?

therefore, which condition will cause a prolonged APTT?

A

factor VIII

prolonged APTT is a reflection of defective CF VIII

haemophilia A will cause a very prolonged APTT

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30
Q

what is the most characteristic finding of chronic lymphocytic leukemia on blood film?

A

smear/smudge cells

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31
Q

compare the thresholds for platelet transfusion in a patient with

a) severe bleeding or bleeding at a critical site (CNS)
b) moderate, clinically significant bleeding

A

a) severe/critical bleeding = <100x10^9

b) moderate bleeding = <30x10^9

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32
Q

what 2 cancers can H.Pylori infection lead to?

A
  1. gastric adenocarcinoma
  2. gastric lymphoma (MALT)

arise in the antrum of the stomach

can present with systemic features like night sweats and fevers

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33
Q

what is used to treat chronic myeloid leukemia?

A

imatinib

tyrosine kinase inhibitor

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34
Q

in which leukemia can an increase in granulocytes at different stages of maturation be seen?

A

chronic myeloid leukemia

shows a leukoerthroblastic blood picture

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35
Q

which leukaemia typically causes a raised WCC and recurrent infections?

A

chronić lymphocytic leukemia

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36
Q

which DOAC is preferred for patients with renal disease?

A

apixaban

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37
Q

how is APS treated during pregancy?

A

aspirin + LMWH

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38
Q

what imaging technique is used to diagnose Lewy body dementia?

A

SPECT scan

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39
Q

what is the 1st line pharamcological Tx to treat delerium?

which patient group should this be avoided in? what should be given instead?

A

haloperidol (typical antipsychotic)

avoid haloperidol in patients with Parkinson’s
give them lorazepam instead

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40
Q

which form of dementia typically presents with a fluctuating course of cognition in contrast to other forms?

A

Lewy body dementia

the other dementias have a more steady and progressive deterioration in cognition

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41
Q

compare the sites of absorption of iron and vit B12?

A

iron: duodenum and proximal jejunum

Vit B12: terminal ileum

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42
Q

what is the most common indication for irradiated blood products?

A

conditions where the immune system is compromised

irradiated blood products are used as they are depleted in T lymphocytes

this reduces the risk of transfusion graft v host disease

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43
Q

compare the conditions that are associated with:

a) warm AI haemolytic anaemia
b) cold AI haemolytic anaemia

A

a) warm- chronic lymphocytic leukemia

b) cold - lymphoma, mycoplasma and EBV

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44
Q

what is another way of describing “large multinucleate cells with prominent eosinophilic nucleoli”?

A

reed steenberg cells

ie - those seen in a Hodgkin’s lymphoma

they can also be described as “mirror image nuclei”

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45
Q

the absence of which cells would make a diagnosis of chronic myeloid leukaemia more likely than acute myeloid leukaemia?

A

the absence of blast cells

acute myeloid leukaemia is associated with immature blast cells

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46
Q

what 2 blood products are administered 1st line in DIC?

A
  1. fresh frozen plasma

2. cryoprecipitate

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47
Q

which 2 cells may be seen on blood film in a patient with coeliac?

A

target cells

Howell jolly bodies

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48
Q

which cause of gastroenteritis should be suspected in someone who has had unpasteurised milk and cheeses?

A

listeria

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49
Q

what is the most likely causative in someone with a UTI with associated renal calculi?

A

proteus

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50
Q

what condition is nail pitting and oncholysis commonly associated with?

A

psoriasis and psoriatic arthritis

patients are at increased risk of CVD

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51
Q

which antibiotic is most commonly associated with causing erythema multiforme?

A

co-amoxiclav

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52
Q

what do actinic keratosis have the potential to progress to?

A

squamous cell carcinomas

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53
Q

which class of antibiotics can cause Toxic epidermal necrolysis?

A

penicillins

ie- co-amoxiclav

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54
Q

compare port wine stains and salmon patches - which resolves and which doesnt?

A

port wine stains dont resolve

salmon patches do resolve

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55
Q

name the subtype of eczema that is characterised by an intensely itchy pruritic rash on the palms and soles

A

pompholyx eczema

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56
Q

which cause of ulcer is associated with AI inflammatory conditions, such as IBD and RA?

A

pyoderma gangrenosum

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57
Q

what is the 1st line Mx for lichen sclerosus?

A

topical clobetasol propionate

a strong topical steroid

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58
Q

what is the most significant complication of PUVA therapy?

A

squamous cell skin cancer

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59
Q

which type of phototherapy is 1st line if being used in psoriasis?

A

narrowband UV B light

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60
Q

compare the definitions of hirsutism and hypertrichosis?

A

hirsutism: androgen dependant hair growth
hypertrichosis: androgen independent hair growth

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61
Q

compare the appearance of guttate psoriasis and pityriasis rosea?

A

guttate psoriasis: “tear drop” scaly papules on the trunk and limbs

pityriasis rosea: herald patch followed 1-2 weeks later by multiple, erythematous, oval lesions with a fine scale confined to the outer aspects

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62
Q

compare trichophyton rubrum and malasezia fur fur - what do they both cause?

A

trichoptyon rubrum: dermatophyte nail infections

malasezia furfur: seborrhoeic dermatitis

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63
Q

what is one of the most common side effects of clozapine?

A

constipation

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64
Q

which PD displays the negative symptoms of schizophrenia?

A

schizoid PD

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65
Q

what is the risk of triptans and SSRIs being co-prescribed?

A

serotonin syndrome

they should not be co-prescribed

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66
Q

name 2 forms of acute dystonia?

A

torticolis

oculogyric crisis

both are sustained muscle contractions

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67
Q

which antidepressant increases appetite?

A

mirtazapine (More)

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68
Q

compare 1st line Tx’s for acute stress disorders and PTSD?

A

ASDs: trauma-focused CBT

PTSD: eye movement desensitisation and reprocessing therapy

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69
Q

name an anticraving medication used to prevent alcohol relapse?

A

acamprosate

it is safe in combination with alcohol

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70
Q

which substance misuse medication will make you violently vomit if you consume alcohol?

A

disulfiram

its an irreversible inhibitor of acetaldehyde dehydrogenase

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71
Q

name 3 metabolic side effects of antipsychotics?

A

dysglycemia

dyslipidaemia

dysprolcatinemia

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72
Q

which 2 conditions can circumstantiality be a sign of?

A

anxiety disorders

hypomania

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73
Q

name the 4 1st rank symptoms of schizophrenia?

A

“At The Police Department”

  1. auditory hallucinations
  2. thought disorders
  3. passivity phenomena
  4. delusional perceptions
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74
Q

what are elderly patients on antipsychotics at increased risk of?

A

stroke/ VTE

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75
Q

which SSRI is 1st line post MI?

A

sertraline

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76
Q

used 1st line to Tx delirium tremens/alcohol withdrawal?

A

chlordiazepoxide

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77
Q

how long must symptoms persist to be classed as a depressive episode?

A

2 weeks

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78
Q

over what timeframe should an SSRI be stopped?

A

4 weeks

gradually reduce it to avoid discontinuation syndrome

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79
Q

how is acute dystonia 2ndary to antipsychotics usually managed?

A

procyclidine

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80
Q

name the possible risks of using SSRI during pregancy in 1st and 3rd trimesters?

A

1st trimester: congenital heart defects

3rd trimester: persistent pulmonary hypertension of the newborn

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81
Q

which antipsychotic lowers the seizure threshold, making seizures more likely?

A

clozapine

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82
Q

which BPAD is associated with mania and which with hypomania?

A

BPAD type 1 = mania

BPAD type 2= hypomania

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83
Q

name the timeframes of:
a) symtoms

b) seizures
c) delirium tremens

occurring in acute alcohol withdrawal?

A

a) symptoms = 6-12 hours
b) seizures = 36 hours
c) delerim tremens = 72 hours

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84
Q

how can a pyogenic granuloma be differentiated from an amelanotic melanoma?

A

a history of trauma

pyogenic granulomas occur following trauma

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85
Q

which medication is associated with spider naevi formation?

A

COCP

spider naevi fill from centre

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86
Q

treatment for mania?

what other medication should be stopped?

A

start antipsychotics

stop antidepressants

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87
Q

which electrolyte imbalance are SSRIs associated with?

A

hyponatremia

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88
Q

compare the conditions associated with knights move and flight of ideas?

A

knights move: schizophrenia

flight of ideas: mania

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89
Q

how are flight of ideas and knights move different from one another?

A

knights move - there NO link between the topics the person is jumping between

flight of ideas: there IS A link between the topics

knights move- seen in schizophrenia

flight of ideas - seen in mania

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90
Q

which side effect is more commonly associated with atypical than conventional antipsychotics?

A

weight gain

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91
Q

what is the 1st line Tx for borderline PD?

A

dialectical behaviour therapy

a form of CBT that has been adapted to help those who experience emotions very intensely

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92
Q

what should be monitored in patients on SNRIs?

ie- venlafaxine

A

blood pressure

they are associated with the development of HT

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93
Q

name the 3 classes of drugs that should never be combined due to the risk of serotonin syndrome?

A

SSRIs

triptans

monoamine oxidase inhibitors

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94
Q

which type of memory loss is associated with inability to remember things PRIOR to the insult?

A

retrograde

a side effect of CBT

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95
Q

compare the treatments for acute dystonia and tardive dyskinesia?

A

acute dystonia = procyclidine

tardive dyskinesia = tetrabenazine

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96
Q

which antidepressant increases the risk of a GI bleed the most?

A

SSRI

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97
Q

what does prescribing folic acid alongside methotrexate reduce the risk of?

A

meylosupression

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98
Q

what are used to manage acute flares of RA?

A

IM methylprednisolone acetate injections

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99
Q

what is the key Ix in diagnosing polymyalgia rheumatica?

A

raised inflammatory markers

ie - ESR and CRP

CK is normal (it is raised in myositis)

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100
Q

which MSK drug causes bulls eye macolopathy?

A

hydroxychloroquine

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101
Q

name 2 signs of proximal myopathy?

which condition is associated with proximal myopathy and bone pain/tenderness?

A
  1. difficulty rising from chair
  2. difficulty combing hair

assoc/x with osteomalacia

with low vit D

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102
Q

what organism can be seen in joint aspiration in reactive arthritis?

A

trick question - reactive arthritis develops after an infection where the organism cannot be recovered from the joint

therefore, synovial fluid will be sterile with a high WCC

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103
Q

describe CRP and ESR levels in SLE?

A

ESR is raised

CRP is normal

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104
Q

compare primary and secondary prophylaxis for APS?

A

primary: low dose aspirin
secondary: lifelong warfarin

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105
Q

what is the Ix of choice for a suspected psoas abscess?

A

CT abdomen

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106
Q

describe the Ca, PO4, ALP and PTH levels in osteomalacia?

A

LOW Ca and PO4

HIGH ALP and PTH

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107
Q

what are 1st line for lower back pain?

A

NSAIDs

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108
Q

if a patient presents with weakness of hip abduction and foot drop, but no loss of reflexes, what nerve root has to be affected?

A

L5 radiculopathy

it is the only one where no specific reflex is lost

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109
Q

which antibody is raised in myositis with lung fibrosis?

A

anti Jo-1 is raised

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110
Q

what 2 medications should be initially started for gout prophylaxis?

A

allopurinol and colchine

colchine should be taken for up to 6 months, to cover the allopurinol until it kicks in

allopurinol is the main drug for gout prophylaxis tho

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111
Q

what is 2nd and 3rd line for Ank Spond, following NSAIDs if they didnt help?

A

2nd line: DMARDs (sulphasalazine)

3rd line: TNF alpha blockers

ie- infliximab and entanercept

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112
Q

which hypersensitivity type reaction is antibody mediated?

A

type 2 hypersensitivity reactions

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113
Q

compare the most common site of osteomyelitis in children and adults?

A

children: metaphysis (highly vascular)
adults: epiphysis

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114
Q

which DMARD is structurally similar to aspirin?

a patient who is allergic to aspirin may also be allergic to this DMARD?

A

sulfasalazine

it is a 5-ASA

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115
Q

which symptoms must always be screened for in a review of a patient on methotrexate?

A

SOB

cough

fever

methotrexate can cause pneumonitis, which can lead to irreversible pul fibrosis of not caught early

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116
Q

at what age is screening for osteoporosis done?

A

65 y/o females

75y/o males

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117
Q

which medication should not be prescribed alongside methotrexate?

A

trimethoprim

increased risk of bone marrow suppression and severe pancytopenia

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118
Q

describe which movements are particularly affected in adhesive capsulitis?

A

external rotation affected most, more than internal rotation

active and passive movement is affected

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119
Q

describe the 3 phases of adhesive capsulitis?

A
  1. painful freezing phase
  2. adhesive phase
  3. recovery phase
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120
Q

how does the presentation of adhesive capsulitis differ from calcific tendinosis?

A

calcific tendinosis presents with pain and restriction in movement and unlike adhesive capsulitis, the shoulder would feel hot and swollen

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121
Q

which type of systemic sclerosis are CREST symptoms associated with?

which antibody is involved?

A

limited systemic sclerosis

anti-centromere antibodies

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122
Q

which blood test must be done prior to starting azathioprine?

A

TPMT

the enzyme that metabolises azathioprine

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123
Q

describe ESR and CK levels in polymyalgia rheumatica?

A

ESR = raised

CK = normal

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124
Q

why is CK normal in polymyalgia rheumatica?

A

the muscles aren’t affected

O/Ex, there is no true muscle weakness. any muscle weakness is due to myalgia (pain inhibition)

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125
Q

which tract is specifically affected in syringiomyelia?

therefore, which sensations are lost?

A

the Spinothalamic tract

loss of pain and temperature sensation

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126
Q

what is the Tx of choice for SLE?

A

hydroxychloroquine

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127
Q

most common causative of croup?

A

parainfluenza virus

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128
Q

which GI condition is especially common in babies born with CF?

A

meconium ileus

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129
Q

should children with hand foot and mouth disease be kept off school?

A

no, they do not need to be excluded

but, they should be kept of school if they feel unwell, until they are better

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130
Q

what class of antibiotic is used to treat whooping cough?

A

oral macrolide (erythromycin, clarithromycin)

it is given if onset of cough is within the preceding 21 days

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131
Q

in 2017, which vaccination became part of the “5 in 1” immunisation, to make it “6 in 1”?

A

Hepatitis B vaccination

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132
Q

what is the number 1 cause of painless massive GI bleeding in children between ages of 1 and 2?

A

Meckles diverticulum

patients always require a transfusion

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133
Q

stridor + cough = ?

A

croup

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134
Q

is there stridor in bronchiolitis?

A

no

this helps differentiate it from croup

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135
Q

which neck lumps are soft and transilluminate?

A

cystic hygroma

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136
Q

which neck lump has a fluid filled, anechoic appearance?

A

branchial cyst

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137
Q

compare the specificity and sensitivity of ANA and anti-dsDNA antibodies in SLE?

A

ANA - sensitive but not specific (a useful rule out test)

anto-dsDNA- specific but not as sensitive (only 60% will have raised titres)

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138
Q

what imaging do NICE recommend all patients receive in cases of suspected RA?

A

XRs of the hands and feet

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139
Q

compare the 1st and 2nd line Tx of OA?

A

1st: paracetamol + topical NSAIDs
2nd: oral NSAID + PPI

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140
Q

which medication used for gout has a severe interaction with azathioprine?
what does the interaction cause?

A

allopurinol + azathioprine

can cause bone marrow suppression

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141
Q

what is the most common organism found in young adults with septic arthritis?

A

N. Gonorrhoea

NOT chlamydia ( it causes reactive arthritis and does not show up on joint aspiration)

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142
Q

what should be started ASAP in RA?

A

methotrexate or another DMARD

plus a steroid in the acute phase

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143
Q

what finding on the thumb is characteristic of osteoarthritis?

A

squaring of the thumbs is characteristic of OA

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144
Q

what should be co-administered alongside allopurinol in prophylactic gout Tx?

A

NSAID or colchine cover

starting allopurinol in itself can trigger an acute flare of gout

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145
Q

which antibody is specific to drug induced lupus?

A

anti-histone antibodies

anti phospholipid syndrome = anti-cardiolipin antibodies

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146
Q

compare the symmetry seen in rheumatoid compared to psoriatic arthritis?

A

rheumatoid = symmetrical

psoriatic= asymmetrical

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147
Q

what must be monitored in patients on hydroxycholorquine?

A

visual acuity

hydroxycholorquine may result in severe and permanent retinopathy

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148
Q

what does diffuse systemic sclerosis involve which limited does not?

A

diffuse involves the chest and upper arms, with more severe internal organ involvement

limited just involves the distal arm and CREST

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149
Q

what investigation must be done prior to starting TNF inhibitors?
why?

A

CXR

TNF inhibitors can reactivate latent TB

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150
Q

which vasculitis is associated with hepatitis B infection?

A

polyarteritis nodosa

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151
Q

which shoulder condition presents with a painful arc of abduction?

A

subacromial impingement

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152
Q

which intestinal region is most likely to be affected by paediatric intestinal malrotation with volvulus?

A

duodenum

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153
Q

describe the murmur heard in an atrial septal defect?

A

ejection systolic murmur with a fixed splitting of the 2nd heart sound

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154
Q

compare what is heard in an ASD and VSD?

A

ASD: systolic murmur at left sternal edge with fixed splitting of 2nd heart sound

VSD: pan systolic murmur in lower left sternal boarder

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155
Q

name 4 cause of jaundice in the 1st 24 hours of life?

A
  • rhesus haemolytic disease
  • ABO haemolytic disease
  • hereditary spherocytosis
  • G6PD deficiency
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156
Q

what is 1st line therapy for threadworm?

A

mebendazole

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157
Q

what is the most common complication of measles?

A

otitis media

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158
Q

according to the kocker criteria, what temperature allows transient synovitis to be differentiated from septic arthritis?

A

temperature > 38.5 degrees = septic arthritis

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159
Q

at what age does pyloric stenosis typically present?

A

week 2-4 of life

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160
Q

what advice should be given regarding school exclusion in hand, foot and mouth disease?

A

no need to stay off school if child feels well

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161
Q

in which paediatric GI condition is episodic crying and drawing of legs into the chest characteristic?

A

intussusception

target sign on US also

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162
Q

in children, what is a common complication of viral gastroenteritis?

how is this complication treated ?

A

transient lactose intolerance

Tx = removal of lactose for a few months followed by a gradual reintroduction

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163
Q

name 4 red flag signs suggesting high risk conditions in children?

A
  • weak, high pitched or continuous cry
  • grunting
  • tachypnoea
  • moderate or severe chest indrawing
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164
Q

what should be given to all children who have an asthma attack?

A

steroid therapy

3 days prednisolone oral

in addition to their salbutamol inhaler

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165
Q

what should be trialled in a child with asthma that is not controlled using a SABA and a low dose ICS?

A

leukotriene receptor antagonist

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166
Q

what antibiotic is used to treat atypical pneumonia?

A

a macrolide

ie- erythromycin

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167
Q

what is the most important investigation to confirm pertussis?

A

per nasal swab

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168
Q

what condition do small testis in a case of precocious puberty indicate?

A

adrenal hyperplasia

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169
Q

which neonatal condition presents with abdominal distension, feeding intolerance and bloody stool?

what is the diagnostic investigation?

A

necrotising enterocolitis

Ix = abdominal XR

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170
Q

why is amoxicillin given in addition to cefotaxime in cases of meningitis in babies <3mths?

A

to cover for listeria

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171
Q

what is the causative of scarlet fever?

A

group A haemolytic strep

usually strep pyogenes

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172
Q

what is the causative agent of roseola infantum?

A

human herpes virus 6

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173
Q

which skin condition in infants typically spares the flexural regions/creases?

A

irritant dermatitis

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174
Q

what is 1st line Tx for scarlet fever?

A

oral phenoxymethylpenicillin

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175
Q

at what age will most children have a good pincer grip?

A

12 months

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176
Q

which Ig is passed from mother to infant via breast milk?

which is the only Ig that can cross the placenta?

A

IgA passes to infant via breast milk

IgG is the only one that can cross the placenta

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177
Q

which 2 drugs most commonly cause drug induced lupus?

A

procainamide

hydralazine

isoniazid also causes it but is less common

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178
Q

which congenital heart defect causes “atrailisation” of the right ventricle?

A

Ebstein’s anomaly

causes a low insertion of the tricuspid value, resulting in a large right atrium and small right ventricle causing tricuspid incompetence

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179
Q

when is indomethacin used?

A

it is given to the neonate if the ECHO shows PDA one week after delivery

it closes the PDA

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180
Q

what does treating chickenpox with NSAIDs increase risk of?

A

increased risk of necrotising fascitits

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181
Q

what is the most common cause of nephrotic syndrome in children?

how can this be managed?

A

minimal change disease

the majority (90%) respond well to steroids

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182
Q

compare what is heard with VSD and PDA?

A

VSD: pansystolic murmur

ASD: continuous, machine like murmur

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183
Q

which peadiatric GI conditions are commonly associated with malrotation?

A

exomhalos

diaphragmatic hernia

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184
Q

how long should the trial of PPI be in an infant with GORD?

A

trial for 4 weeks

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185
Q

which antibody is seen in dermatomyositis?

A

anti-Jo 1 antibody

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186
Q

which medications do you want to avoid when treating acute gout flares in a patient with gastric or duodenal ulcers?

A

NSAIDs

always treat them with colchine

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187
Q

compare the bones that are broken in galeazzi and monteggia fractures?

A

Galeazzi: radial fracture, distal RU dislocation

monteggia: ulnar fracture, proximal RU dislocation

both cause dislocation at the radioulnar joint

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188
Q

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

A

congenital adrenal hyperplasia

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189
Q

which childhood rash typically starts abruptly after the preceding temperature subsides?

A

roseola infantum

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190
Q

which brain haemorrhage is most common in preterm neonates?

A

intraventricular haemorrhage

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191
Q

what is the main side effect of gout?

A

diarrhoea

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192
Q

which drug is safe to use for RA in pregancy?

A

hydroxycholorquine

it is also used 1st line in SLE

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193
Q

what is the mainstay of Tx in SLE?

A

hydroxychlorquine

monitor visual symptoms

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194
Q

what 2 causatives must be asked about in a possible diagnosis of reactive arthritis?

A

STIs - can be caused by gonorrhoea and chlamydia

gastroenteritis - recent bout of diarrhoea?

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195
Q

what type of HS reaction are AI diseases?

A

type 2 - antiBody

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196
Q

what is the main differentiating factor between psoriatic and rheumatoid arthritis?

A

RA = symmetrical presentation

psoriatic arthritis = asymmetrical presentation

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197
Q

what nerve and nerve root make up the triceps reflex?

A

radial nerve C7

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198
Q

what nerve and nerve root is tested in the biceps reflex?

A

C5 and C6 musculocutaneous nerve

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199
Q

what is the 1st line Tx of osteomalacia?

A

vit D supplements

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200
Q

describe the use of topical or oral NSAIDs in OA treatment?

A

OA of the knee or hand = topical NSAIDs 1st line

OA anywhere else = oral NSAIDs

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201
Q

what should patients on warfarin be given if they are undergoing immediate, emergency surgery?

A

give them 4 factor prothrombin complex concentrate

if surgery can wait for 6-8 hours - give them 5mg vit K IV

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202
Q

how are PT and APTT affected by warfarin therapy?

A

warfarin affects the extrinsic pathway:

PT is prolonged

APTT is normal

INR is the patients PT divided by a normal persons PT

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203
Q

what clotting factors are affected by warfarin?

A

1972

clotting factors 10, 9, 7 and 2

204
Q

name the 3 indications of warfarin?

A

1st line for mechanical heart valves

2nd line after DOACs for:

  • VTE
  • AF
205
Q

how does the pain in aortic dissection differ from STEMI?

A

aortic dissection: pain is sharp, abrupt and severe

STEMI: pain is tight/crushing

206
Q

what 2 drugs are 1st to be started in angina?

A

Beta blocker

Calcium channel blocker

207
Q

what change can hypokalaemia cause on ECG?

how can this manifest clinically?

A

hypokalaemia can cause prolonged QT

this can present as recurrent periods of syncope

also causes U waves

208
Q

what is 1st line Mx for a PE with haemodynamic instability?

A

thrombolysis

209
Q

if patient is haemodynamically stable, what is 1st line Tx for PE?

A

DOAC is 1st line

210
Q

what should all diabetics with hypertension be treated with, regardless of age?

A

ace inhibitors

211
Q

which heart murmur causes a collapsing pulse and head bobbing in time to the pulse?

A

aortic regurgitation

an early diastolic murmur

212
Q

what class of drug is indapamide?

when is it used in hypertension?

A

thiazide-like-diuretic

it is used if ACEi and CCB have not worked

213
Q

why should verapamil and BBs never be taken concurrently?

A

risk of heart block and fatal arrest

214
Q

which condition is kussmauls sign seen in? what is kussmauls sign?

A

seen in constrictive pericarditis

when there is a raised JVP with inspiration

215
Q

what is pulsus paradoxus?

in what condition is it seen?

A

an abnormally large drop in BP on inspiration

seen in cardiac tamponade

216
Q

compare how loop diuretics and thiazide diuretics affect blood calcium levels?

A

thiazide diuretics can cause hypercalcemia

loop diuretics can cause hypocalcemia

217
Q

what is the 1st line Ix for investigating someone with stable angina?

A

CT coronary angiography

218
Q

what timeframe must new onset AF present within to be considered for electrical cardioversion?

A

new onset AF must present within 48 hours of onset to be considered for electrical cardioversion

219
Q

how should a major bleeding situation be managed in a patient on warfarin?

A

stop warfarin

give IV vit K

give prothrombin complex concentrate IV

220
Q

what is the most appropriate anti anginal to prescribe 1st line in a patient with known HF?

A

bisoprolol

221
Q

1st line Tx for angina?

A

beta blocker or calcium channel blocker

all patients should also be on a statin and aspirin

222
Q

mitral stenosis and aortic regurgitation are both diastolic murmurs.

compare where each are heard the loudest?

A

mitral stenosis: loudest over the apex

aortic regurgitation: loudest over the aortic area

223
Q

which murmur commonly causes atrial fibrillation?

A

mitral stenosis

it causes this secondary to left atrial enlargement

224
Q

name 3 murmurs that cause a pansystolic murmur?

A
  • mitral regurgitaiton
  • tricuspid regurgitation
  • ventricular septal defect (harsh in character)
225
Q

name 3 causes of an ejection systolic murmur?

A
  • aortic stenosis
  • pulmonary stenosis
  • HOCM

or an ASD

226
Q

which drugs used in heart failure have no effect on long term survival?

A

loop diuretics and nitrates

227
Q

compare the conditions that cause a slow rising and collapsing pulse?

A

slow rising pulse = aortic stenosis

collapsing pusle = aortic regurgitation, PDA

228
Q

what cardiac condition can macrolides cause?

A

torsades de pointes

associated with a long QT interval, resulting in the polymorphic VT

229
Q

which cause of neck lump typically contains cholesterol crystals?

A

branchial cysts

they are located in the anterior triangle, usually in front of the sternoclemastoid

230
Q

compare how hearing is affected in labrynthitis and vestibular neuronitis?

A

labrythitis- hearing loss

vestibular neuronitis - no hearing loss

231
Q

when may intranasal corticosteroids be considered in a patient with acute sinusitis?

A

if the sinusitis has been present for more than 10 days

232
Q

how are patients with a sudden onset SNHL treated?

A

7 day course of oral prednisolone

233
Q

what medication can be used in the acute phase of vestibular neuronitis?

A

prochlorperazine

it can only be used in the acute phase and should be stopped after a few days

234
Q

what type of hearing loss is seen in otosclerosis?

A

conductive HL

also presents with tinnitus

it is an autosomal dominant form of inheritance

235
Q

how is vestibular neuronitis treated?

A

expectant management with reassurance

236
Q

describe a typical presentation of vestibular neuronitis?

A

recurrent vertigo attacks lasting hours/days

horizontal nystagmus present

NO hearing loss or tinnitus

237
Q

if nasal packing and silver nitrate cautery fails to control epistaxis, which artery should be ligated?

A

the sphenopalatine artery

238
Q

what finding on dix halpike is suggestive of BPPV?

A

onset of rotatory nystagmus

239
Q

which medications can cause tinnitus?

A

aspirin and other NSAIDs, when taken in high doses

240
Q

what is Ramsay hunt syndrome also known as?

name some typical features?

A

herpes zoster oticus

ear pain, facial nerve palsy and vesicular rash around the ear

241
Q

how is Ramsay hunt syndrome treated ?

A

oral acyclovir and corticosteroids

242
Q

what is the 1st line AB for tonsillitis?

A

phenoxymethylpenicillin for 10 days

243
Q

in otitis externa, are antibiotics prescribed for oral or topical?

A

topical

topical AB and topical steroid given

244
Q

which medication is most helpful for preventing attacks of Menieres disease?

A

betahistine

245
Q

name the 2 most common causes of acute otitis media?

A

strep pneumoniae

H.INfluenza

246
Q

what is the most likely lesion occurring in a young female in the tail of the parotid gland?

A

pleomorphic adenoma

the commonest tumours of the parotid gland and often slow growing, smooth and mobile

247
Q

how should acute otitis media with perforation be managed?

A

prescribe oral amoxicillin

if pen allergic, give a macrolide

248
Q

which neck lump is located at the anterior border of the sternoclemastoid muscle?

A

branchial cysts

249
Q

what is the most appropriate next step in a patient who has been diagnosed with paroxysmal AF?

A

calculate their CHA2DS2-VASc score and consider a DOAC

250
Q

1st line Tx of pericarditis?

A

NSAID + colchine

251
Q

which class of antibiotics can cause Torsades de pointes?

A

macrolides

they prolong the QT interval

252
Q

BBs or CCBs are used 1st line for prophylaxis in angina.

why isn’t amlodipine used in this case?

A

it has to be a rate limiting CCB (ie- verapamil or diltiazem)

amlodipine is a long acting CCB and not a rate-limiting one - it tends to work more peripherally than on the cardiac tissue (which is why it can cause ankle swelling)

253
Q

what does an arterial blood gas in PE most likely show?

A

resp alkalosis

due to hyperventilation

254
Q

what murmur is most commonly caused by rheumatic fever?

A

mitral stenosis

255
Q

what is the most common arrhythmia to occur following MI?

A

ventricular tachycardia (monomorphic)

this is the most common cause of death following an MI

256
Q

which valve is most commonly affected in infective endocarditis?

A

the mitral valve

257
Q

what does a RBBB with left axis deviation on ECG suggest?

A

bifascicular block

this and trifascicular blocks (RBBB + LAD + 1st degree HB) is a common cause of falls in the elderly

258
Q

what is persistent ST elevation after a previous MI very suggestive of?

A

left ventricle aneurysm

blood stagnates in the enlarged LV and can result in thrombus formation

this can lead to embolic stroke or other systemic embolisms

259
Q

what is the mechanism of action of alteplase?

A

activates plasminogen to form plasmin

260
Q

what vitamin deficiency may a gastrectomy result in?

A

B12 deficiency

can cause subacute combined degeneration of the cord

261
Q

name 3 features suggestive of subacute combined degeneration of the cord?

A

loss of vibration sense

ataxia

absent ankle reflexes

262
Q

what is the 1st line imaging done for suspected pancreatitis?

A

transabdominal US

2nd line: CT scan

263
Q

how should obstructive urinary calculi with signs of infection be treated?

A

urgent renal decompression (nephrostomy) and IV antibiotics

264
Q

compare how congenital inguinal and infantile umbilical hernias are managed?

A

congenital inguinal hernias = urgent surgery

infantile umbilical hernias= majority resolve without intervention

265
Q

what is the investigation of choice for suspected acute cholecystitis?

A

ultrasound

266
Q

what is the Tx of choice for ascending cholanggitis?

A

ERCP

in severe cases, it should be done ASAP

in most others, it should be done electively in 24-48 hours

267
Q

what class of medication are most useful in a patient with an overactive bladder?

A

anti-muscarinics

ie- tolterodine or oxybutyin

268
Q

name 2 features that would make a diagnosis of renal cell carcinoma more likely than bladder cancer?

A

a ballotable mass and renal angle tenderness would make renal cell carcinoma more likely

269
Q

what is the difference between ileostomy and colostomy ?

A

ileostomy - a stoma formed from the small bowel

colostomy - a stoma formed from the large bowel

270
Q

what is the most common causative of acute prostatitis?

A

E.Coli

in young men, it can be caused by chlamydia and gonorrhoea

271
Q

what is the most common form of prostate cancer?

A

adenocarcinoma

272
Q

which scrotal swelling can be palpated as separate from the body of the testicle?

A

eipididymal cyst

273
Q

how can lidocaine toxicity be reversed?

A

a lipid emulsion

274
Q

what is the only cause of a swelling in the scrotum that you cannot palpate above?

A

an inguinalscrotal hernia

it passes down from the inguinal canal and into the scrotum

275
Q

compare when in diastole aortic regurgitation and mitral stenosis murmurs are heard?

A

aortic regurgitation- heard early in diastole (it blows)

mitral stenosis - heard mid/late diastole (it rumbles)

276
Q

what is the 1st investigation that should be performed in suspected acute limb ishcmeia?

A

handheld arterial doppler

it is quick and easy

it wouldn’t be ABPI as it would not identify the site of arterial occlusion and would not guide management

277
Q

what is the most approiopte management pre op for a patient on warfarin?

A

stop their warfarin 5 days before surgery

give them LMWH - then stop this the evening before surgery

278
Q

where are diverticula most commonly found?

A

the sigmoid colon

279
Q

what does an emergency Hartmann’s procedure involve?

A

a resection of the rectosigmoid colon

an end colostomy is formed

280
Q

what is the most common complication of ERCP?

ERCP= the procedure used to remove gallstones

A

pancreatitis

281
Q

which vein is used to deliver total parenteral nutrition?

A

the subclavian vein

it is regarded as a central line and the tip of the line is in the RA/SVC

282
Q

which condition is associated with granular, muddy brown urinary casts?

A

acute tubular necrosis

283
Q

which renal condition may cause cannonball mets in the lung, which causes haemoptysis?

A

renal cell adenocarcinoma

284
Q

what is a potential complication of aromatase inhibitors used for ER +ive breast cancer in post-menopausal women?

A

osteoporosis

ie- anastrozole

285
Q

compare the roles of laparoscopic cholecystectomy and ERCP in managing conditions?

A

laparoscopic cholecystectomy is the treatment of choice for biliary colic, and removes the gallbladder

ERCP is used to remove obstructing gallstones from the common bile duct or pancreatic duct (open surgery cannot get into these ducts to remove the stones)- used in cases of ascending cholangitis

286
Q

what is the 1st line medication to start in a patient with BPH and predominant voiding symptoms (poor flow, hesitancy and terminal dribbling)?

A

alpha-1 antagonists (alpha blockers)

eg- tamsulosin, alfuzosin

287
Q

what is the 1st line Ix for suspected prostate cancer?

A

multiparametric MRI

288
Q

compare the gold standard initial scans looking for bile duct stones and renal calculi?

A

bile duct stones = Ultrasound/MRCP

renal calculi = CT KUB

289
Q

what medication do NICE recommend all patients with established CVD be on?

A

a statin (atorvastatin)

290
Q

name the 2 most common causatives of ascending cholangitis?

A

E.Coli (most common)

klebsiella

291
Q

name the 2 medications all patients with peripheral arterial disease should take?

A

statin + clopidogrel

292
Q

how are small bowel obstructions managed initially?

A

“drip and suck”

IV fluids and a nasogastric tube, with additional potassium

293
Q

how is an acute upper urinary tract obstruction managed?

A

nephrostomy

294
Q

name the 3 things involved in the inital management of acute limb ischemia?

A
  • analgesia
  • IV heparin
  • vascular review
295
Q

the risk of which cancer is raised in people with achalasia?

A

squamous cell carcinoma

condition presents late with a poor prognosis

296
Q

which type of cancer occurs secondary to Barretts oesophagus?

A

adenocarcinoma

297
Q

which class of drug can cause angioedema as a side effect?

A

ACE inhibitors

298
Q

which nerve root is responsible for leg extension, the patellar reflex and ankle dorsiflexion?

A

L4

299
Q

how should a PE in a patient who is haemodynamically unstable be managed acutely?

A

commence immediate thrombolysis

if patient is haemodyamically stable, commence a DOAC

300
Q

Parkinson’s disease dementia and normal pressure hydrocephalus both cause confusion and abnormal gait.
How can they be differentiated?

A

normal pressure hydrocephalus presents with incontinence, PD dementia usually does not

301
Q

what is the most likely condition in a patient with severe dysmenorrhoea that is unresponsive to NSAIDs and deep dyspareunia?

A

endometriosis

gold standard Ix = laparoscopy

302
Q

what is the 1st line Tx for menorrhagia?

A

the IUS

303
Q

what is the best imaging technique for diagnosing adenomyosis?

A

MRI

adenomyosis is the presence of endometrial tissue in the myometrium

304
Q

which anti epileptic drugs are safe to use in breastfeeding mother?

A

lamotrigine, levetiracetam

carbamazepine

AVOID lithium

sodium valproate should be avoided in all women of childbearing age, regardless of pregancy or breastfeeding

305
Q

insulin should be commenced if fasting glucose in pregancy is greater than what?

A

fasting glucose > 7mmol/l

start insulin

306
Q

what is the aim of treating menopausal symptoms?

A

replace oestrogen

307
Q

what is given for medical management of a miscarriage?

A

vaginal misoprostol alone (prostaglandin)

current NICE guidelines state that misoprostaolol alone should be given, no need for oral mifepristone

308
Q

in the GP setting, how are all women with secondary dysmenorrhoea managed?

A

referred to gynaecology for investigation

309
Q

how should premature ovarian insufficiency be managed?

A

COCP replacement therapy until age 51

they require both oestrogen and progesterone

310
Q

which emergency contraception is C/I’d in patients with asthma?

A

ellaone (ulipristal acetate)

311
Q

which antibiotic is given as group B streptococcus prophylaxis?

A

benzylpenicillin

312
Q

what condition causes neonatal bilious vomiting and a double bubble sign on AXR?

A

duodenal atresia

more commonly seen in babies with downs syndrome

313
Q

where is the most common site for berry aneurysms to burst, resulting in a subarachnoid haemorrhage?

A

the circle of willis

314
Q

which condition causes insidious onset confusion in the elderly, with urinary incontinence and gait disturbance?

A

normal pressure hydrocephalus

an accumulation of CSF in the ventricles

315
Q

compare what US and CT KUB are used to diagnose in renal colic?

A

US - done initially to diagnose hydronephrosis

CT KUB- done to look for the cause of the obstruction causing the hydronephrosis

(US cannot directly show a stone)

316
Q

if a low lying placenta is identified at the 20 week scan, when should it be re-scanned?

A

rescan at 34 weeks

if still present at 34 weeks and grade 3 or 4, elective CS at 37-38 weeks

317
Q

compare the pain felt in endometriosis and pelvic inflammatory disease?

A

the pain in endometriosis is cyclical, and is most painful during a period

the pain in PID is not associated with menstruation, and is constant in nature

318
Q

what is now the 1st line medical therapy to induce ovulation in someone with PCOS?

A

letrozole

it is now preferred over clomifene citrate

319
Q

which diabetic drugs is safe when breastfeeding?

A

insulin and metformin

320
Q

what is by far the most common cause of primary hyperparathyroidism?

A

a solitary adenoma

321
Q

in exams, how is hyperparathyroidism typically presented?

A

elderly females with an unquenchable thirst and inappropriately normal or raised PTH

PTH levels may be normal in hyperparathyroidism

322
Q

how many units of insulin is there in 1ml?

A

100 units

it is therefore vital that insulin is only drawn up using an insulin syringe

323
Q

what is the 1st line imaging of choice when investigating thyroid nodules?

A

ultrasonography

324
Q

in the context of thyrotoxicosis, which condition is the only one to cause a tender goitre?

A

de quervains thyroiditis

325
Q

what condition is hypertension + hypokalaemia suggestive of?

A

hyperaldosteronism

1st line Ix: aldosterone/renin ratio

1st line Tx: spironolactone

326
Q

describe the electrolyte abnormality seen in Cushing’s syndrome?

A

hypokalaemic metabolic alkalosis

327
Q

what is the most common position of the foetal head during labour? OA or OP?

A

occipito-antetior

328
Q

prior to starting EPO in a patient with CKD and suspected iron deficiency anaemia, what must be checked before starting EPO replacement?

A

their iron status

329
Q

what is the most common cause of fatigue, soft ejection systolic murmur and pallor in a patient with CKD?

A

anaemia

most often caused by iron deficiency or EPO deficiency

330
Q

name 4 common findings in acute interstitial nephritis?

A
  • abnormal blood results
  • fever
  • arthralgia
  • rash
331
Q

how is renin used to differentiate primary and secondary aldosteronism?

A

primary aldosteronism: low renin

secondary aldosteronism: high renin

332
Q

which type of diuretic is used to prevent re accumulation of ascites?

A

spirinolactone

333
Q

what monitoring is required in patients with HSP?

why is this monitoring required?

A

blood pressure and urinalysis

patients with HSP are at risk of renal failure

334
Q

what is the gold standard Ix for all nephropathies apart from suspected minimal change (in kids)?

A

renal biopsy

335
Q

what Ix is key to diagnose placenta praaevia?

A

transvaginal US

it improves the accuracy of placental localisation and is considered safe

336
Q

what medical treatment is offered for medical terminations of pregancy?

A

vaginal misoprostol (prostaglandins)

oral mifepristone is required if the fetus still has a heartbeat

337
Q

compare the treatment for mild/moderate and severe premenstrual syndrome?

A

mild/moderate = COCP

severe = SSRI

338
Q

when should screening for gestational diabetes be done?

A

screen using OGTT at 24-28 weeks of pregancy

339
Q

name the 3 anti-epileptic medications that are safe in pregancy?

A

lamotrigine

levetiracetam

carbamazepine

340
Q

what is bilious vomiting on the 1st day of delivery most likely to be due to?

A

intestinal atresia

malrotation causing bilious vomiting is more likely to occur on the 3rd day

duodenal atresia is associated with downs syndrome

meconium ileus associated with cystic fibrosis

341
Q

how is post op ileus best managed?

A

conservatively

NG tube insertion for stomach decompression for symptom control and place patient nil by mouth to allow bowel rest

342
Q

what is prolactin release inhibited by?

A

dopamine

in cases of a prolacinoma, give cabergoline

343
Q

what is the most appropriate initial investigation to do for phaeochromocytoma?

A

urinary metanephrines

344
Q

name the 1st line and then diagnostic Ix’s for acromegaly ?

A

1st line: serum IGF-1 levels

diagnostic: OGTT

345
Q

which medications should be taken at least 4 hours apart from levothyroxine?

why?

A

calcium carbonate and iron tablets should be taken at least 4 hours after levothyroxine

they reduce the absorption of levothyroxine

346
Q

what is the 1st line Ix for suspected primary hyperaldosteronism?

A

a plasma aldosterone:renin ratio

347
Q

in primary hyperaldosteronism, what 2 Ix’s can help distinguish between unilateral adenoma and bilateral hyperplasia of the adrenal glands as the cause?

A

1st: CT abdomen
2nd: adrenal venous sampling

if there was unilaterally increased aldosterone on sampling, it’d suggest a unilateral adenoma

if aldosterone increased bilaterally, suggests bilateral hyperplasia

348
Q

which form of hyperparathyroidism presents with extremely high serum PTH and moderately raised serum calcium?

A

tertiary hyperparathyroidism

349
Q

what is the single most important blood test to assess the response’s to treatment in someone with hypothyroidism?

A

TSH

350
Q

1st line Tx of phaeochromocytoma?

A

phenoxybenzamine

351
Q

in DKA management, what should be started initially, even before IV insulin infusion?

A

1L NaCl 0.9% IV

in DKA patients will typically be in a fluid deficit of 7 litres

352
Q

how is hypercalcemia managed initially?

A

1st = IV 0.9% saline

2nd= biphosphonates

353
Q

what antibiotic is recommended for COPD prophylaxis?

A

azithromycin

for use in patients who typically experience 4 or more exacerbations per year

354
Q

compare 2nd line Tx of COPD depending on if the patient is steroid responsive/asthmatic or not?

A

1st line: SABA or SAMA

2nd line if steroid responsive: LABA + ICS

2nd line if not steroid responsive: LABA + LAMA

355
Q

in COPD, can a SAMA be taken at the same time as a LAMA?

A

no - if patient is starting LABA + LAMA, then they must switch from the SAMA onto a SABA

356
Q

describe the spirometry picture seen in idiopathic pulmonary fibrosis?

A

restrictive picture

reduced FEV1
reduced FVC

FEV1:FVC ratio is normal or increased

357
Q

use the acronym “CHARTS” to name the 6 causes of upper zone fibrosis?

A 
Coal workers pneumoconiosis 
Histiocytosis/hypersensitivity pneumonitis 
Ank spond
Radiation 
TB 
Silicosis/sarcoidosis
358
Q

what is the most dangerous form of asbestos?

A

crocidolite (blue) asbestos is the most dangerous form

359
Q

name steps 1, 2 and 3 of adult asthma management?

A

step 1: SABA (salbutamol)

step 2: add ICS

step 3: add LKRA (montelukast)

360
Q

name 5 causes of an obstructive spirometry pattern?

A
  • asthma
  • COPD
  • bronchiectasis
  • cystic fibrosis
  • airway obstruction due to tumours
361
Q

compare the FEV1:FVC ratios in obstructive and restrictive diseases?

A

obstructive: FEV1:FVC < 70%
restrictive: FEV1:FVC = normal or slightly increased

362
Q

describe the histology seen in coeliac disease?

A

villous atrophy

crypt hyperplasia

raised intra-epithelial lymphocytes

363
Q

which 2 antibodies are raised in autoimmune hepatitis?

how is it treated ?

A

anti nuclear antibodies

anti smooth muscle antibodies

Tx = steroids and other immunosupression (ie- azathioprine)

364
Q

what is the gold standard diagnosis for coeliac disease?

A

endoscopic intestinal biopsy (jejunal biopsy)

365
Q

what is the most sensitive and specific lab finding for liver cirrhosis in those with chronic liver disease?

A

thrombocytopenia

platelet count < 150,000

366
Q

what are the 2 best blood tests to do to assess liver function?

A

albumin

prothrombin time

best lab test to assess degree of cirrhosis = thrombocytopenia

367
Q

describe the histological change that occurs in Barrett’s oesophagus?

A

metaplasia from squamous epithelium to columnar epithelium

368
Q

which vaccine should people with coeliac disease receive every 5 years?
why?

A

pneumococcal

due to hyposplenism, which can lead to more severe infections

those with coeliac also get the influenza vaccine every year

369
Q

what is the most appropriate next test to perform in a patient with NAFLD?

A

enhanced liver fibrosis testing

it is recommended to aid diagnosis of liver fibrosis

370
Q

what is now the investigation of choice to detect liver cirrhosis?

A

transient elastography

371
Q

what does dysplasia in Barretts oesophagus require treatment wise?

A

endoscopic mucosal therapy

an endoscopic intervention is always required if dysplasia is identified in Barretts oesophagus

372
Q

what is the 1st line Ix for acute mesenteric ischemia?

A

venous blood gas

lactate is raised

373
Q

name 2 conditions that increase risk of hepatocellular carcinoma?

A

haemachromatosis

a1 antitrypsin deficiency

374
Q

what should be prescribed in all patients with suspected hepatic encephalopathy?

A

lactulose

375
Q

what is 1st line Tx for irritable bowel syndrome?

A

loperamide

376
Q

what is the 1st line imaging for someone with progressive dysphasia?

A

endoscopy

high chance dysphasia is caused by cancer- endoscopy allows you to look at the tumour and take biopsies

377
Q

what is the most common cause of vit B12 deficiency?

A

pernicious anaemia

loss of B12 results in a megaloblastic anaemia and peripheral neuropathy (can progress to subacute combined degeneration of the cord)

378
Q

compare the 1st line imaging done for a Mallory-weiss tear and boerhaave syndrome?

how can both these conditions be differentiated from each other?

A

mallory- weiss tear = endoscopy

boerhaave syndrome = CT contrast swallow

mallory weiss tear rarely causes systemic upset, but boerhaave syndrome does

379
Q

compare 1st line initial screening tests for haemachromatosis and Wilson’s disease?

A

haemachromatosis= transferrin saturation

Wilson’s disease = caeruloplasmin

although both can present similarly, only Wilson’s disease causes neuropsychiatric symptoms

380
Q

what is Budd chiari syndrome also known as?

what is the 1st line Ix?

A

hepatic vein thrombosis

usually seen in the context of underlying haematological disease or other procoagulant condition

1st line Ix = ultrasound with doppler flow

381
Q

describe the blood results that would occur in someone with coeliac disease?

A

anaemia with a low ferritin, folate or B12

382
Q

what electrolyte abnormality can be caused by PPIs?

A

hyponatremia

383
Q

what is currently 1st line treatment for Wilson’s disease (excess copper)?

A

penicillamine (it chelates copper)

venesection is 1st line Tx for haemachromatosis

384
Q

what finding is found on blood test in Wilson’s disease?

A

reduced serum copper

excess copper is deposited in the tissues, causing a low level of copper in the blood

385
Q

compare the definitions of McBurney’s sign and rovsings sign?

A

McBurney’s: the site where pain from appendicitis is the most severe

Rovsing’s sign: RIF pain on palpation of LIF

386
Q

compare the LFT pattern seen in pancreatic cancer and hepatocellular cancer?

A

hepatocelluar cancer: would show hepatocellular derangement of LFTs (ALT and GGT)

pancreatic carcinoma: causes a cholestatic picture on LFTs (raised ALP and bilirubin )

387
Q

name the lifestyle factor and then the medication that is used to manage ascites?

A

lifestyle: sodium and fluid restriction, alcohol cessation
mediation: spironolactone

388
Q

compare who gets the pneumococcal vaccine as a one off, and who gets it every 5 years?

A

one off pneumococcal = COPD

every 5 years = coeliac (due to hyposplenism), CKD, hyposplenism

389
Q

which respiratory condition typically presents with an initial dry cough over 3-4 days followed by a productive cough that resolves within 3 weeks?

what finding is used to guide antibiotic therapy?

A

bronchitis

antibiotic therapy is guided by the CRP level - oral doxycycline

390
Q

1st line Tx of acute bronchitis (if CRP is elevated)?

A

doxycycline 5 days

391
Q

which lobe of the brain is most likely affected if patient presents with lip smacking and post-ictal aphasia?

A

temporal lobe

392
Q

in an ischaemic stroke, describe the timeframes that a) thrombolysis and b) thrombectomy should be performed within?

A

a) thrombolysis - performed within 4.5 hours of onset of stroke symptoms
b) thrombectomy- performed within 6 hours of symptom onset

393
Q

name the anti emetics used for:

a) chemotherapy induced nausea
b) raised ICP causing nausea
c) vestibular causes
d) GI causes?

A

a) chemotherapy induced - ondansetron
b) raised ICP= haloperidol
c) vestibular causes = prochlorperazine
d) GI = metoclopramide

394
Q

compare how long one must stop driving for if they suffer a 1st seizure with:

a) normal brain imaging and EEG
b) abnormal brain imaging and abnormal EEG?

A

a) normal brain imaging = 6 months

b) structural abnormalities = 12 months

395
Q

compare what is used to reduce ICP in a) traumatic brain injury and b) CNS infections/neoplasms?

A

a) raised ICP due to traumatic brain injury = IV mannitol

b) raised ICP due to CNS infections = IV dexamethasone

396
Q

what blood test can be done to differentiate between a pseudo seizure and a true seizure?

A

prolactin

elevated prolactin following a seizure is suggestive of a general tonic clonic/partial seizure

397
Q

what is the management of a stroke following thrombolysis?

A

300mg aspirin for 14 days

then, take 75mg clopidogrel lifelong

if clopidogrel is contraindicated, take 75mg aspirin + modified release dipyridamole

398
Q

what type of CT is 1st line radiological Ix for suspected stroke

A

non contrast CT

399
Q

what are the 2 most common causes of acute pancreatitis?

A
  1. gallstones

2. alcohol

400
Q

what form of peritonitis is commonly seen in patients with ascites secondary to liver cirrhosis?

name the initial AB Tx and then also the prophylactic Tx

A

spontaneous bacterial peritonitis

Treat it with cefotaxime

prophylactic tx = oral ciprofloxacin

401
Q

name the ABC of irritable bowel syndrome?

A

Abdominal pain
Bloating
Change in bowel habit

402
Q

what is the 1st line Tx of hepatic encephalopathy?

why?

A

1st line = lactulose

it promotes the excretion of ammonia and increases the metabolism of ammonia by gut bacteria

403
Q

where is the underling problem in a patient whose right eye is deviated upwards and rotated outwards?

A

right 4th nerve palsy

404
Q

compare which vessels are affected in: a) epidural haemorrhage b) subdural haemorrhage

A

a) epidural haemorrhage = middle meningeal artery

b) subdural haemorrhage = bridging veins

405
Q

describe the position of the eye in a 3rd nerve palsy?

A

“down and out” with ptosis

also presents with a dilated eye, known as mydriasis

406
Q

what causative is guillian barre most associated with?

A

campylobacter jejuni

407
Q

compare the densities of blood on CT in cases of haematomas?

A

hyperdense = acute haematomas

hypodense= chronic haematomas

408
Q

what is the key diagnostic test for suspected guillian barre syndrome?

A

lumbar puncture

409
Q

which medication should be avoided in cases of bowel obstruction ?

A

metoclopramide

410
Q

what electrolyte imbalance is the most important cause of VT?

A

hypokalaemia

411
Q

which coronary artery supplies the AV node?

why is this significant?

A

the right coronary artery supplies the AV node

therefore, if it becomes blocked, it can result in a complete heart block

412
Q

what is 1st line rate control for atrial fibrillation?

A

bisoprolol

413
Q

compare the gold standard imaging for a suspected aortic dissection in a patient who is a) stable and b) unstable?

A

a) stable = CTPA

b) unstable = transoesophageal echo

414
Q

compare 1st line Tx for PE depending on if the patient is haemodynamically stable or not?

A

HD stable: DOAC

HD unstable: thrombolysis w/ alteplase

415
Q

if a patient is in status epilepticus and is not responding to benzodiazepines, what should be given?

A

a phenytoin infusion, IV

416
Q

what is a painful 3rd CN nerve palsy until proven otherwise?

A

a posterior communicating artery aneurysm

3rd CN palsy + headache = PCOM aneurysm

417
Q

what is the most appropriate antiemetic to prescribe to someone with Parkinson’s?

A

domperidone

it does not cross the blood brain barrier, so does not cause extra-pyramidal side effects

418
Q

which cranial nerves are affected in vestibular schwanommas?

A

CN V, VII and VIII

vestibular schwanommas therefore cause a combination of vertigo, SNHL and tinnitus

419
Q

which anti-epileptic medication may cause a megaloblastic anaemia?

A

phenytoin

it alters folate metabolism, so can cause a megaloblastic anaemia

420
Q

what medication can be used to treat idiopathic intracranial hypertension?

A

acetazolamide

it is a carbonic anhydrase inhibitor

421
Q

in diabetes mellitus, what is the relevance of C-peptide?

A

it allows T1DM to be differentiated from T2DM

C-peptide is a by product of insulin production, therefore it will not be present in T1DM but will be present in T2DM

422
Q

name the 2 investigations that need to be done to confirm acromegaly as a diagnosis?

A

OGTT and serial GH measurements

423
Q

what test is useful to screen for disease recurrence in medullary type thyroid cancer?

A

serum calcitonin levels

useful to detect sub clinical recurrence

424
Q

name the 3 tests that can be done to diagnose asthma, and the order in which they are done?

A
  1. spirometry
  2. bronchodilator reversibility
  3. fractional exhaled nitric oxide testing
425
Q

what medication should all patients with COPD and pneumonia be given, even if there is no COPD exacerbation?

A

prednisolone

426
Q

what is the 1st line Mx of atelectasis?

A

chest physiotherapy and deep breathing exercises

427
Q

name the 3 antibiotics that can be used 1st line for infective exacerbation of COPD?

A

amoxicillin

clarithromycin or doxycycline if pen allergic

428
Q

in hormone replacement therapy, the COCP is 1st line if not C/I’d.
when is cyclical COCP given rather than continuous COCP for HRT?

A

women should be prescribed cyclical COCP HRT if their LMP was <1year ago

they can take continuous COCP if they’ve been on cyclical HRT for >1 year or if its been 2 years since their LMP

429
Q

name 4 enzyme inducing drugs?

A

carbamazepine

rifampicin

phenytoin

st johns wort

they therefore accentuate the toxicity of many other drugs if taken in combination

430
Q

which class of antibiotic is nephrotoxic?

A

aminogglycosides

gentamicin

431
Q

do phenytoin and carbamazepine induce or inhibit the P450 system?

A

they induce it

means that they will increase the breakdown of many drugs, hence the drugs will not be as effective

432
Q

what antibiotic is used as prophylaxis for close contacts of meningococcal meningitis?

A

oral ciprofloxacin

433
Q

where should swabs for chlamydia and gohnrrohea in women be taken from?

A

the vulvo-vaginal area

NAAT is used to analyse the swab

434
Q

what are the most common causes of viral meningitis in adults?

A

enteroviruses (coxsackie virus)

on LP - lymphocyte predominance, normal glucose and normal protein)

435
Q

which organism is most likely to cause tonsillitis?

A

strep pyogenes

436
Q

name the 1st line drug used for rate control in AF, and the 2nd line drug that is used in asthmatics?

A

1st line = bisoprolol

2nd line= diltiazem (used in asthmatics, a CCB)

437
Q

in NSTEMI Mx, compare the drug that is given alongside aspirin in a patient who is a) a high bleeding risk and b) not a high bleeding risk?

A

a) high bleeding risk = clopidogrel

b) not a high bleeding risk= ticagrelor

438
Q

which area of the heart does the right coronary artery supply?
what leads does this correspond to?

A

the inferior part

II, III, aVF

439
Q

NICE state that rate control should be offered 1st line to people with AF, except 3 groups. name the 3 groups? what control should be used on them instead?

A
  • AF with co-existent heart failure
  • first onset AF
  • AF with an obvious reversible cause

use rhythm control

440
Q

what is 1st line Mx of optic neuritis in a patient with MS?

A

high dose oral or IV steroids

important to note that the steroids shorten the duration of relapse and do not alter the degree of recovery

441
Q

what is the most appropriate initial management of guillian barre syndrome?

A

IV immunoglobulins or plasma exchange

442
Q

which SN condition are unilateral tinnitus and deafness classically associated with?

A

acoustic neuroma

also have an absent corneal reflex and vertigo

443
Q

how do lacunar strokes most commonly present?

A

as a pure motor hemiparesis, pure sensory stroke, sensorimotor stroke or ataxic hemiparesis

444
Q

infective conjunctivitis is normally a self limiting condition. however, which topical antibiotic is used 1st line and which is used in pregancy if they are required?

A

1st line = topical chloramphenicol

2nd line/pregancy = topical fusidic acid

445
Q

describe the associations between open and closed angle glaucomas and long and short sightedness?

A

closed angle glaucomas associated with long sightedness

open angle glaucomas associated with short sightedness

446
Q

describe the presentation of orbital cellulitis? how does this differ from preseptal cellulitis?

A

orbital cellulitis = reduced visual acuity, proptosis, pain and restriction of eye movement

pre septal cellulitis- does not cause reduced visual acuity or painful eye movements

447
Q

name the 3 eye drops used acutely to treat acute angle closure glaucoma? what is also given IV?

A

1, direct parasympathomimetic (pilocarpine)

  1. BB (timolol)
  2. alpha 2 agonist

also give IV acetazolamide

448
Q

which eye drop is used 1st line for open angle glaucoma?

A

1st line = prostaglandin eye drop

2nd line = BB, carbonic anhydrase inhibitor

449
Q

name the triad seen in Horners syndrome?

A

miosis (small pupil)

ptosis

enophthalmos (sunken eye)

450
Q

how is proliferative retinopathy treated?

A

pan retinal laser photocoagulation

451
Q

what is the 1st line Tx of anterior uveitis?

A

steroid and mydriatic eye drops

452
Q

what class of medication is pilocarpine (ophthalmology)?

A

a parasympathomimetic

it ‘mimics’ the parasympathetic system, causing pupillary constriction

used 1st line in acute closure angle glaucoma

453
Q

what 4 investigations must be done before someone starts TB treatment?

A

FBC
U&Es
LFTs
vision testing

454
Q

what is the investigation of choice in genital herpes?

A

NAAT testing

455
Q

what organism causes pubic lice?

what is the treatment for public lice?

A

caused by pthirus pubis

Tx = marathon lotion or permethrin cream

456
Q

what antibiotic is used to treat legionella?

A

macrolides

ie- clarithromycin

457
Q

what treatment should be given to a women diagnosed with primary herpes infection in her 3rd trimester of pregancy?

A

oral acyclovir 400mg TDS until delivery

458
Q

which causative of pneumonia is associated with erythema multiforme and a dry cough?

A

mycoplasma pneumoniae

459
Q

which NSAID is contraindicated in any form of cardiovascular disease?

A

diclofenac

if patient is on diclofenac and has CVD, switch them to naproxen or low dose ibuprofen

460
Q

how can thiazide diuretics cause digoxin toxicity?

A

digoxin is a competitive binder to the ATPase pump - it is in competition with K+

thiazide diuretics can cause hypokalaemia - therefore, more digoxin will bind to the ATPase pump, having a more profound effect and causing toxicity

digoxin toxicity = bradycardia, vomiting, confusion, lethargy, down-sloping ST depression and inverted T waves

461
Q

which 2 antibiotics require therapeutic drug monitoring in patients with renal impairment due to their accumulation and toxicity in renal impairment?

A

vancomycin

gentamicin

462
Q

name 2 common adverse side effects of sulfonylureas?

A
  • hypoglycaemic episodes

- weight gain

463
Q

which diabetic medication should be given secondary to metformin in patients with a high risk, or pre-existing, CVD?

A

SGLT-2 inhibitors

464
Q

how does Addison’s disease (steroid insufficiency) affect glucose levels?

A

Addisons disease causes hypoglycaemia

cortisol increases blood glucose levels, so a lack of it will cause blood glucose levels to drop

465
Q

which type of thyroid cancer produces calcitonin, which can be used as a tumour marker?

A

medullary thyroid cancer

466
Q

which type of diabetes medication increases the levels of incretins, such as GLP-1 and GIP?

A

gliptins - ie, stigagliptin

467
Q

name the 1st line and then the diagnostic test for acromegaly (excess GH)?

A

1st line = serum IGF-1

diagnostic = OGTT

in acromegaly there is no suppression of GH

468
Q

what’s the difference between cushings disease and cushings syndrome?

A

Cushing’s syndrome = a collection of signs and symptoms due to prolonged exposure to cortisol

cushing’s disease = a specific type of cushings syndrome due to ACTH production from a pituitary adenoma

469
Q

what term is used to describe a rapid loss of renal function associated with the formation of epithelial crescents in the glomeruli?

A

rapidly progressive glomerulonephritis

470
Q

what is found on microscopic examination in cases of acute interstitial nephritis?

A

eosinophilic casts

471
Q

what are the 2 most common presenting features of amyloidosis?

A

breathlessness and weakness

it can affect any organ in the body but is most commonly associated with loss of renal function and proteinuria

472
Q

name the triad seen in HUS?

A
  1. AKI
  2. microangiopathic haemolytic anaemia
  3. thrombocytopenia
473
Q

what is the most likely underlying cause of glomerulonephritis in a patient with haemoptysis and haematuria?

A

anti glomerular basement membrane disease

rapidly progressive glomerulonephritis causes proteinuria and haematuria

474
Q

what is seen on renal biopsy in GBM disease causing glomerulonephritis?

A

linear IgG deposits along the basement membrane

475
Q

what is the most common and important viral infection in solid organ transplant recipients?

A

cytomegalovirus

in such cases, ganciclovir is the treatment of choice

476
Q

compare what is the most appropriate type and volume of fluid to give someone with no clinical signs of heart failure and someone with clinical signs of heart failure?

A

no heart failure: 500ml 0.9% saline STAT

heart failure: 250ml 0.9% saline STAT

477
Q

which part of the visual field is affected 1st in primary open angle glaucomas?

A

peripheral visual fields

nasal scotomas progress to ‘tunnel vision’
also present with decreased visual acuity and optic disc cupping

478
Q

what is the most appropriate management of a patient with suspected anterior uveitis?

A

urgent ophthalmology review

steroid and cycloplegic eye drops

479
Q

in a palliative setting, what should be given for gastric stasis, presuming there is no problem with extrapyramidal side effects?

A

metoclopramide

if there is a problem with extrapyramidal side effects, use domperidone

480
Q

what is the best 1st line anti emetic for intracranial causes of N&V?

A

cyclizine

it has direct actions on the vestibular system and chemoreceptor trigger Zone

481
Q

compare the most common locations of squamous cell carcinomas and adenocarcinomas in the lungs?

A

squamous cell carcinomas: more commonly found near large airways

adenocarcinomas: more commonly found peripherally

482
Q

what is the underlying cause of Horner’s syndrome?

how does it therefore present?

A

cause = loss of innervation of the sympathetic trunk

presents = ptosis and constricted pupil

in comparison, a 3rd nerve palsy causes ‘down and out’ and dilated pupil

483
Q

which neuro condition can present with a Marcus gun pupil?

what is a Marcus gunn pupil?

A

MS patients

Marcus gunn pupil is when there is a relative afferent pupillary defect - it is diagnosed during the swinging light test

484
Q

how should an acute otitis media with perforation be managed?

A

5/7 days of oral amoxicillin

485
Q

what are the 2 most common symptoms of optic neuritis?

A

vision loss and eye pain

486
Q

which eye condition is associated with HLA B27 conditions such as ank spond?

A

anterior uveitis

487
Q

what antibiotic should be given to all cases of suspected orbital cellulitis?

A

IV cefotaxime

488
Q

should antibiotics (amoxicillin) be prescribed to a patient with otitis media and no ear pain?

A

no - NICE recommend only prescribing antibiotics if there is otorrhoea or bilateral otitis media in a child <2 y/o

489
Q

what is 1st and 2nd line management of primary open angle glaucoma?

A

1st line = latanoprost

2nd line = beta blocker or carbonic anhydrase inhibitor

timolol a BB, so C/I’d in asthmatics

490
Q

what may failure to correct childhood squints lead to?

A

amblyopia

also known as ‘lazy eye’

491
Q

how is anterior uveitis most likely to be treated?

A

steroid eye drops and cytoplegic eye drops

492
Q

what medication should be used to reverse tricyclic overdose?

A

IV bicarbonate

493
Q

what additional medication should patients with MI secondary to cocaine use be given as part of acute ACS treatment?

A

IV lorazepam

to reduce the risk of vasospasm

494
Q

which 2 calcium channel blockers can worsen/cause heart failure?

how?

A

verapamil and diltiazem

they are both negatively ionotrophic, meaning they weaken the contractions of the heart

495
Q

compare the sites of action of verapamil and amlodipine?

A

verapamil - works centrally on cardiac muscle tissue, reducing the strength of contraction - therefore cannot be used at the same time as BBs

amlodipine - works on calcium channels more peripherally, so can cause ankle oedema but not pulmonary oedema

496
Q

what medication should be used to treat postpartum thyroiditis?

A

propranolol

NOT carbimazole

497
Q

what type of antidiuretic is used to treat nephrogenic diabetes insipidus?

A

thiazide diuretic

NOT loop diuretic

498
Q

which class of diuretics can cause hypercalcemia?

A

thiazide diuretics

they also cause hypokalaemia

499
Q

compare the symptoms caused by cerebellar vermis and cerebellar hemisphere leisons?

A

cerebellar vermis = central ataxia (gait ataxia)

cerebellar hemisphere= peripheral ataxia (“finger-nose past pointing)

500
Q

what is the most appropriate initial test to do to diagnose cushing’s disease?

A

a LOW DOSE dexamethasone suppression test

this diagnoses cushings disease - once it has been done, a high dose dexa suppression test can be done to establish if it is cushing’s disease (ie pit adenoma) or ectopic ACTH production (ie cushings syndrome)

501
Q

what volume do ureteric calculi have to be less than to be considered for lithotripsy?

A

<2cm

also can’t have any signs of infection

stones >2cm are better managed with percutaneous nephrolithotomy

502
Q

what would make you think a diagnosis of bronchiolitis is more likely than a diagnosis of croup?

A

bronchioltits affects <1y/o and does not tend to cause stridor

503
Q

what values of 2hr OGTT allow impaired fasting glucose to be diagnosed?

A

if 2hr OGTT is between 7.8 and 11.1, impaired fasting glucose is likely

504
Q

what feature of allows the location of a lesion to be distinguished between the optic tract and occipital cortex?

A

if there is macular sparing or not

macular sparing = occipital cortex lesion

no macular sparing = optic tract lesion

505
Q

which nerve supplies the extensor muscle group of the upper limb?

A

radial nerve

loss of the Radial nerve results in wRist drop

506
Q

which nerve is responsible for finger adduction?

A

the ulnar nerve

507
Q

what is the main difference in appearance of seborrhoeic keratosis and actinic keratosis?

A

seborrhoeic keratosis have a “stuck on” appearance

actinic keratosis do not have a stuck on appearance

AA Y4 Finals cards NE (40 decks)

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