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AA Y4 Finals cards NE > Passmed round 3 > Flashcards

Passmed round 3 Flashcards

1
Q

what is the 1st line management of acute otitis media with perforation?

A

5-7 day course of amoxicillin

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2
Q

what is excessive administration of 0.9% NaCl a recognised cause of?

A

hyperchloraemiac acidosis

therefore, Hartmans solution may be preferred when large volumes are to be administered

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3
Q

what is 1st line imaging for suspected aortic dissection?

A

CT angio thorax, abdomen and pelvis

if the patient is not haemodynamically stable enough for this, then transoesophageal echo is done

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4
Q

compare the diagnostic investigations in PSC and PBC?

A

PSC = MRCP

PBC = anti mitochondrial antibodies

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5
Q

what is the most appropriate approach to screen for gestational diabetes in future pregnancies of women who have been diagnosed in previous pregnancies?

A

OGTT immediately after booking and then at 24-28 weeks

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6
Q

name the key differentiating features between intestinal atresia, meconium ileus and necrotising enterocolitis?

A

meconium ileus - causes abdominal distension

necrotising enterocolitis- occurs only in pre term babies and causes bloody stool

intestinal atresia - causes bilious vomiting in 1st day of life

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7
Q

compare the treatment options for MG and myasthenic crisis?

A

MG - pyridostigmine

myasthenic crisis = IV immunoglobulin and plasmapheresis

a crisis is classed as when there is respiratory muscle weakness

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8
Q

what is elevated in Gilberts syndrome and biliary atresia? conjugated or unconjuagted bilirubin?

A

Gilbert’s syndrome = raised unconjugated bilirubin

biliary atresia = raised conjugated bilirubin

in biliary atresia, there is extra-hepatic biliary duct fibrosis, so the bilirubin is still able to be conjugated, but cannot pass. this can progress to liver failure

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9
Q

name 1st and 2nd line Tx of viral induced wheeze in a child?

A

1st line = SABA bronchodilator therapy

2nd line= oral montelukast or inhaled corticosteroid

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10
Q

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

A

lumbar puncture

elevated protein with a normal white cell count

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11
Q

only after how many weeks gestation may pre-eclampsia and gestational hypertension occur?

A

20 weeks

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12
Q

what class of drug is oxybutyin?

A

an antimuscarinic

used to treat urge incontinence

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13
Q

what is the most appropriate management of guillian barre?

A

IV immunoglobulins

to prevent the patients antibodies from damaging the peripheral nerves

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14
Q

what is the 1st line treatment for lichen planus?

A

potent topical steroids

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15
Q

what is the next step in management of ank spond if NSAIDs are not effective?

A

1st - DMARDs (sulphaslazine)

2nd = TNF alpha blockers

ie- etanercept or infliximab

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16
Q

describe how calcium levels can affect the QT interval?

A

hypocalcemia = QT prolonged

hypercalcemia = QT shortening

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17
Q

which type of psoriasis commonly affects teenagers and may follow a strep throat infection?

A

guttate psoriasis

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18
Q

what is the 1st and 2nd line Tx of scabies?

A

1st line = permethrin

2nd line = malathion

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19
Q

compare the treatment of bacterial vaginosis and bacterial candidiasis?

A

bacterial vaginosis = oral metronidazole

bacterial candidiasis = oral fluconazole one off dose or clotrimazole pessary if pregnant

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20
Q

how should secondary prevention APS be treated in pregnancy?

A

aspirin and LMWH

warfarin is used for 2ndary prevention in non-pregancy, but is CI’d in pregancy

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21
Q

compare the management of pre eclampsia and APS in pregancy?

A

pre eclampsia = aspirin

APS = aspirin and LMWH

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22
Q

which MEN syndrome is Zollinger-Ellison syndrome associated with?

A

MEN 1

ZE syndrome presents with multiple haste-duodenal ulcers causing abdominal pain and diarrhoea

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23
Q

what may hand preference before 12 months be an indicator of?

A

cerebral palsy

hand preference before 12 months is abnormal

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24
Q

what is another name for a relative afferent pupillary defect?

in which condition can it be seen?

A

Marcus-gunn pupil - damage to the afferent pathway of the affected eye

it is diagnosed in the swinging light test

seen in MS

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25
Q

name the CRAB features of myeloma?

A

Calcium elevated
Renal failure
Anaemia
Bone pain

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26
Q

compare the treatment of perianal fistulas and abscesses?

A

perianal fistula = metronidazole

perianal abscess = incision and drainage

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27
Q

what type of glomerulonephritis may good pastures syndrome cause?

A

rapidly progressive glomerulonephritis - crescentic glomerulonephritis on renal biopsy

both are associated with cANCA

may present with haemoptysis, sinusitis and microscopic haematuria

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28
Q

which autosomal dominant condition is associated with intussusception?

A

peutz-jaghers syndrome

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29
Q

which 2 classes of drugs should be avoided in HOCM?

A

ace inhibitiors

nitrites

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30
Q

what should all COPD patients with a bout of pneumonia be given, regardless of how well they are with it?

A

corticosteroids

ie - prednisolone 30mg for 5 days

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31
Q

compare which 2 conditions pulsus paradoxus and kussmaul’s sign are specific for?

A

pulsus paradoxus = cardiac tamponade (significant drop in BP on inspiration)

kussmaul’s sign = constrictive pericarditis (abnormal raise in JVP on inspiration)

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32
Q

compare the most common type of carcinoma in the lower urinary tract and the upper UT/kidney?

A

lower urinary tract = transitional cell carcinoma

kidney = squamous cell carcinoma

transitional cell carcinoma is a rare form of renal cancer- risk factors include exposure to chemicals in textile, plastic and rubber industries

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33
Q

which UTI med is contraindicated in someone on methotrexate?

A

trimethoprim

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34
Q

compare the dose of adrenaline given to patients in anaphylaxic shock if they are <12y/o and >12y/o?

A

<12y/o = 300 micrograms IM

> 12y/o = 500 micrograms IM

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35
Q

name the most common cause of nephrotic syndrome in a) children and b) adults?

A

a) children= minimal change disease

b) adults = membranous

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36
Q

in diabetic Mx, what is recommended if a triple combination of drugs has failed to reduce the HbA1c?

A

stop one of the 3 drugs and start a GLP-1 mimetic

especially if BMI >35

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37
Q

in which heart murmur may haemoptysis be seen?

A

mitral stenosis

due to increased pulmonary pressures causing rupture of the thin walled and dilated bronchial veins

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38
Q

name 4 things found in trichomonas vaginalis that are not found in BV?

A
  1. frothy, yellow/green discharge
  2. vulvovaginitis
  3. strawberry cervix
  4. motile trophozoites
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39
Q

which UTI antibiotic is safe to use when breastfeeding?

A

trimethoprim

nitro should be avoided - can cause haemolysis in G6PD infants

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40
Q

describe what is seen on ABG in pyloric stenosis?

A

hypochloraemic, hypokaaemic alkalosis

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41
Q

describe the pentad seen in thrombotic thrombocytopenic purpura?

A 
fever 
neuro signs 
thrombocytopenia 
haemolytic anaemia 
renal failure
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42
Q

compare the treatment for lactational and non-lactational mastitis?

A

lactational = flucloxacillin

non-lactational = co-amoxiclav

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43
Q

in an anemia 2ndary to CKD, what compound is the patient most likely to be deficient in?

A

EPO

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44
Q

which organism is most likely to cause erythema multiforme?

A

herpes simplex virus

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45
Q

compare the presentation of placenta praaevia and placental abruption?

A

both present with PV bleeding

placental abruption is painful, praaevia is not painful

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46
Q

what 2 main problems occur in CKD?

A
  1. low vit D as vitamin D cannot be activated

2. the kidneys normally excrete phosphate - CKD leads to a high phosphate - this pulls calcium from the bones

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47
Q

what results in a larger area of columnar epithelium being present on the ectocervix and causing a cervical ectropion?

A

elevated oestrogen levels

this includes ovulatory phase, pregnancy, COCP use

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48
Q

name 2 symptoms of cervical ectropion?

how is it managed?

A
  • vaginal discharge
  • post coital bleeding

ablative treatment is only used for troublesome symptoms- otherwise, it is left

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49
Q

UC remission inducing drug vs maintaining remission drug?

A

inducing remission = mesalazine (oral or topical)

maintaining remission following mild/moderate exacerbation = topical +/- rectal mesalazine

maintaining remission following a severe exacerbation or >2 exacerbations in <1 year = oral azathioprine

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50
Q

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

A
  1. analgesia
  2. IV heparin
  3. vascular review
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51
Q

what is the gold standard investigation for sickle cell disease?

A

haemoglobin electrophoresis

blood film useful to diagnose sickle cell, with classical target appearance

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52
Q

what is the most common cause of endocarditis within 2 months of prosthetic valve surgery?

A

Staph epidermidis

staph aureus most common if >2 months post surgery

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53
Q

how does hypercalcemia affect the QT interval?

A

hypercalcemia = short QT

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54
Q

what is the most common cause of cushing’s syndrome?

A

pituitary adenoma

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55
Q

what is the most appropriate diagnostic test for active TB?

A

sputum culture

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56
Q

what is the 1st line treatment for warm AI haemolytic anaemia?

A

steroids and rituximab

warm AI haemolytic anaemia typically characterised by fatigue and breathlessness with haemolytic blood picture

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57
Q

which 4 classes of drugs must be avoided in renal failure?

A

antibiotics - tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

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58
Q

which has mucosal involvement; bullous pemphigoid or pemphigus vulgaris?

A

pemphigus vulgaris has mucosal involvement, bullous pemphigoid does not

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59
Q

what is the 1st line hypertensive medication for someone with high blood pressure and CKD?

A

ACE inhibitor!

patients with CKD should be started on ACEi if they have an ACR>30mg/mmol

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60
Q

what medication has the strongest evidence for reducing relapse in MS?

A

natalizumab

methylprednisolone is used to treat acute flare ups of MS but isn’t used to reduce risk of relapse

pyridostigmine is used for eye involvement in myasthenia gravis

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61
Q

compare the roles of prostaglandins and oxytocin in the induction of labour?

A

prostaglandins - used to “ripen” the cervix in patients with a bishops score <5 and therefore induce labour

oxytocin - used to stimulate contractions (after prostaglandin has been given) in patients where labour has been induced

both can also be used in the active management of the 3rd stage alongside ergometrine

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62
Q

1st choice SSRI for Px w/ Hx of CVD?

A

sertraline

co-prescribe with PPI

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63
Q

describe the biochemical profile seen in osteomalacia?

A

LOW calcium, phosphate, vit D

HIGH ALP and PTH

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64
Q

what is 1st line Tx for prolactinommas?

A

dopamine agonists

bromocriptine, cabergoline

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65
Q

why is nephrotic syndrome associated with a hypercoaguable state?

A

due to loss of antithrombin III via the kidneys

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66
Q

what is the threshold for administering a platelet transfusion?

A

a platelet count <30x10^9 and clinically significant bleeding

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67
Q

what can chronic lymphocytic leukaemia transform to?

A

a high grade, B cell, non-hodgkins lymphoma

richter’s transformation

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68
Q

can you perform external cephalic version in a patient who is in labour with a transverse fetal lie?

A

yes- as long as the amniotic sac has not ruptured and the patient is not in active labour

if the sac has ruptured and patient is in active labour, an emergency CS should be performed instead

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69
Q

how should patients with a suspected PE be initially managed?

A

DOAC! - rivaroxaban

thrombolysis is reserved for patients with a MASSIVE PE - ie- showing severe haemodynamic instability

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70
Q

what is the difference between acute and critical limb ischemia?

A

critical limb ischaemia is the stop before acute limb ischaemia…

critical limb usually has onset over a few weeks and does not display the 6 P’s of acute limb ischemia

6P’s = pale, pulseless, perishingly cold, pain, paralysis, parasethesia

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71
Q

what is the 1st line imaging for suspected stroke, regardless of if ischemic or haemorrhagic is suspected?

A

non contrast CT head

contrast CT scans are more useful for detecting cerebral mets and abscesses

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72
Q

what anti platelet is used for the secondary prevention of stroke?

A

clopidogrel

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73
Q

what classifies a staggered OD of paracetamol? how does this influence management?

A

staggered OD = an OD taken over >1 hour

if there is a staggered OD or doubt over the time of the OD, acetylcysteine should be given regardless of plasma paracetamol conc

main indication that a liver transplant is required is if the pH remains <7.3 24 hours after ingestion

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74
Q

describe the LFTs normally seen in someone with acute cholecystitis?

A

LFTs are typically normal

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75
Q

what is the 1st line management of a women who reports reduced fetal movements?

A

1st step = handheld doppler to confirm fetal heartbeat

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76
Q

which 2 medications can SSRIs interact with and cause serotonin syndrome?

A

triptans

MAOIs (phenelzine)

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77
Q

what is the most common cause of glomerulonephritis in adults?

A

membranous nephropathy

thickened basement membrane on biopsy and sub epithelial spikes on silver staining

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78
Q

what is the most common complication of ERCP?

A

acute pancreatitis

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79
Q

what is the reason that prothrombin complex concentrate would be given in a massive haemorrhage?

A

to reverse warfarin

if a patient has a massive haemorrhage but isn’t on warfarin, then prothrombin complex concentrate is pointless

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80
Q

which medication is a risk factor for endometrial hyperplasia?

A

tamoxifen

it has anti-oestrogenic effects in the breast
BUT
it has pro-oestrogenic effects in the endometrium

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81
Q

name one antipshyotic that can cause tardive dyskinesia, and one that can reduce risk of tardive dyskinesia

A

causes tardive dyskinesia = chlorpromazine

reduces risk of tardive dyskinesia = clozapine

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82
Q

what can levodopa cause at peak dose?

A

dyskinesias

dystonia, chorea and involuntary writhing

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83
Q

presence of a herald patch and management

A

pityriasis rosea

self limiting over 6-12 weeks

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84
Q

rash proceeded by a strep throat 2-4 weeks prior

A

guttate psoriasis

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85
Q

tear drop plaque vs herald patch?

A

tear drop = guttate psoriasis

herald patch = pityriasis

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86
Q

how may a moderate vitreous haemorrhage be described?

A

moderate = numerous dark spots

in comparison to retinal detachment, where there is a dense shadow that starts peripherally and progresses to the centre

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87
Q

name 4 conditions that cause enlarged kidneys on US?

A

HIV associated nephropathy
PCKD
diabetic nephropathy
amyloidosis

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88
Q

how to differentiate between acute and chronic leukemias?

A

in acute leukemia, only the immature cells/blast cells are seen

in chronic leukemia, ALL stages of granulocyte maturation are seen

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89
Q

what is the most appropriate management of anterior uveitis in a patient with ank spond?

A

urgent ophthalmology review

steroids

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90
Q

2ndary prevention of TIA or ischemic stroke?

A

clopidogrel

the immediate treatment of TIA or ischemic stroke is aspirin 300mg, but it is NOT for secondary prevention

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91
Q

how can bronchiolitis and croup be differentiated?

A

bronchiolitis occurs in <1y/o and does not cause stridor (it causes wheeze)

croup occurs in any age and causes stridor

bronchiolitis = RSV

croup = parainfluenza virus

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92
Q

what are 1st line for N&V in pregancy?

A

anti histamines

eg- cyclizine, promethazine

93
Q

what is medical 1st line for uterine atony management?

A

syntocinon IV (oxytocin)

followed by ergometrine

94
Q

1st line Tx of bullous pemphigoid?

A

ORAL corticosteroids

95
Q

how may primary hyperparathyroidism be managed non-surgically?

A

use a calcimemetic eg- cinacelcet

this ‘mimics’ calcium when it binds to the parathyroid, causing the parathyroid to think there is high calcium levels and switch off

96
Q

what should be added to a patient with heart failure and a reduced ejection fraction if they are already on ACEi and BB?

A

spironolactone

97
Q

which TB drug can cause peripheral neuropathy?

what should be given alongside it to reduce risk?

A

isoniazid can cause peripheral neuropathy

give pyridoxine (B6) alongside it

98
Q

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

A

enteroviruses (coxackie B virus)

lymphocyte predominant on LP

99
Q

how do both fondaparinux and LMWH work?

A

they both activate antithrombin III

100
Q

what antibiotic should be given to pregnant women as group B strep prophylaxis?

A

benzylpenicillin

vancomycin should be used if pen allergic

erythromycin is used if there is preterm pre labour rupture of membranes

101
Q

what do small testicles in precocious puberty indicate as the cause?

A

adrenal hyperplasia

102
Q

what is the most common exudative and transudative causes of pleural effusions?

A

exudative (protein > 30g/l) = pneumonia

transudative (protein <30g/l) = heart failure

103
Q

what testicular cancer is likely in a male with raised bHCG and raised AFP?

A

non-seminomatous testicular cancer

a raised AFP excludes a seminoma

104
Q

what is the most common form of NH lymphoma in the UK? ?

A

diffuse large B cell lymphoma

105
Q

name 2 renal stones that are radio-lucent and 2 that are radio-opaque?

A

radio Lucent = urate and xanthine

radio-opaque = calcium phosphate and calcium oxalate

106
Q

compare the pain felt in PID and endometriosis?

A

PID - constant, non-cyclical pain

endometriosis = pain usually increases in severity with menstruation

107
Q

which STI is an obligate intracellular bacterium?

A

chlamydia trachomatis

108
Q

when should antibiotics be given in cases of acute otitis media? (4)

A
  1. symptoms present for >4 days
  2. patient systemically unwell
  3. patient at risk of complications
  4. patient <2y/o w/ bilateral OM
  5. tympanic membrane has ruptured
109
Q

describe insulin sick day rules ?

A

patient must not stop their insulin due to risk of ketoacidosis

concurrent illness will raise blood sugars and the demand for insulin will therefore rise

ensure they are checking their blood sugars frequently- every 2-4 hours

110
Q

what does factor V leiden mutation cause?

A

resistance to the action of protein C

111
Q

what is the role of methyldopa in Parkinson’s disease?

A

NO ROLE!

methyldopa is an antihypertensive that may be used in pregancy if labetalol is C/I’d.

co-careldopa is used in PD, and associated with the greatest improvement in symptoms and ADLs.

112
Q

name the indications for surgical involvement in sigmoid volvulus with bowel obstruction?

A
  1. repeated failed attempts at decompression
  2. necrotic bowel noted at endoscopy
  3. suspected or proven perforation or peritonitis

otherwise, 1st line Tx is a flexible sigmoidoscopy

113
Q

describe the appearance of lichen planus?

A

the PPPPs

purple, pruritic, raised lesions affecting the skin and membranes

diff from lichen sclerosis - itchy white plaques on the vulva of old women

114
Q

describe the appearance of metastatic prostate cancer?

A

focal sclerotic bony lesions

115
Q

what is the definition of munchausen’s syndrome?

A

purposefully causing symptoms

eg - a non-diabetic taking insulin

116
Q

antibiotic given to all women with PPROM?

A

erythromycin, 10 days

117
Q

1st line Tx of syphilis?

A

IM benzylpenicillin

118
Q

what is the most likely diagnosis in a man who’s dad had a splenectomy aged 30?

A

hereditary spherocytosis

119
Q

what test is used to diagnose hereditary spherocytosis?

A

EMA binding test = hereditary spherocytosis

Hb electrophoresis = sickle cell disease

120
Q

name 3 factors that are seen in hereditary spherocytosis?

A

normocytic anaemia
gallstones
family history

121
Q

which nerve is affected if a man develops a foot drop following a THR?

A

sciatic nerve

122
Q

which nerve is affected if a man develops a foot drop following a low anterior resection with his legs in the Lloyd Davis position?

A

peroneal nerve

123
Q

what 2 significant nerves branch from the sciatic nerve?

A

common peroneal

tibial nerve

damage to common peroneal causes foot drop

124
Q

damage to common peroneal nerve causes what?

A

foot drop

can be damaged in a TKR

125
Q

what is the main abnormality seen on ECG in hypercalcemia?

A

short QT interval

126
Q

compare hormone profiles of kallmans and kleinfelters?

A

kallman = low/normal FSH and LH

kleinfelters= High FSH and LH, low testosterone

127
Q

name the gold standard Ix done for aortic dissection?

what Ix is done if the patient is not haemodynamically stable enough for this?

A

gold standard = CT angiogram

if not HD stable = transoesophageal ECHO

128
Q

what is the causative in over 95% of cases of encephalitis?

what should be given 1st line?

A

herpes simplex virus

give IV acyclovir

129
Q

name 2 drugs that can be used to treat orthostatic hypertension?

A

fludrocortisone - increases the plasma volume

midodrine

130
Q

what most commonly precedes pityriasis rosea?

A

viral infection

fungal infection commonly precedes pityriasis versicolour

131
Q

what is the screening test for adult PKD?

A

renal USS

132
Q

what is cushing’s triad reflective of?

A

raised ICP

bradycardia
hypertension
wide pulse pressure

133
Q

how is intrahepatic cholestasis of pregancy managed?

A

ursodeoxycholic acid and delivery at 37-38 weeks

134
Q

what one med is 1st line in thyroid storm?

A

IV propranolol

135
Q

what 2 electrolyte abnormalities can cause prolonged QT intervals?

A

hypocalcemia

hypokalaemia

136
Q

in a case of SNHL, how may a diagnosis of acoustic neuroma or presbycusis be differentiated?

A

presbycusis is always a BILATERAL SNHL

if the HL is unilateral, more likely to be due to acoustic neuroma

137
Q

name the 2 most common manifestations of tardive dyskinesia?

A

abnormal involuntary movements
most common = chewing and pouting of the jaw

acute dystonia most common = torticollis, oculogyric crisis)

138
Q

what is the most common cause of tertiary hyperparathyroidism?

A

longstanding CKD 4

139
Q

describe the underlying pathology in tertiary hyperparaT?

A

it occurs after a prolonged secondary hyperparathyroidism

the PTH glands become autonomous and prouduce PTH even after the low calcium has been corrected

this then causes hypercalcemia

(in contrast to tertiary hyperparaT, secondary paraT has high PTH and low Ca

140
Q

what is preferred to prevent pathological bone fractures when the eGFR is <30?

A

denosumab

141
Q

name 3 side effects of GTN spray?

A

hypotension
tachycardia
headache

142
Q

when do aortic aneurysms measuring 3-4.5cm and >4.5cm need to be ultrasounded?

A

3-4.5 = every 12 months

4.5-5.5 = every 3 months

> 5.5 = surgery

143
Q

what is the role of ADH?

A

it re-absorbs water back into the kidneys

144
Q

in a positive HIV case, when must post exposure prophylaxis be started for it to be effective?

A

must be started within 72 hours of the exposure

otherwise, antiretroviral therapy should be started

145
Q

which anti epileptic is most likely to cause Steven Johnson syndrome?

A

carbamazepine

the medication is usually stated 2-3 weeks before the onset of the syndrome

146
Q

what is the most common clotting disorder?

what is the most common bleeding disorder?

A

most common clotting disorder= factor V leiden (protein C resistance)

most common bleeding disorder = von willebrand’s disease

147
Q

which lichen is Wickham’s striae seen in?

A

lichen planus

148
Q

koplicks spots vs strawberry tongue

A

koplicks spots = measles

strawberry tongue = scarlet fever

149
Q

1st line AB for otitis externa in diabetics?

1st line AB for uncomplicated OE?

A

OE in diabetics = ciprofloxacin-it covers pseudomonas

uncomplicated UE = flucloxicillin

150
Q

PAPP-A, AFP, estriol, HCG and nuchal translucency in a downs baby?

A

REDUCED = PAPP-A, AFP and estriol

RAISED = HCG

thickened nuchal translucency

151
Q

name 2 rate limiting calcium channel blockers?

A

verapamil

diltiazem

152
Q

what can be given to reverse BB toxicity?

A

atropine if bradycardia

if resistant, give glucagon

153
Q

what are the most common renal tumours?

A

renal adenocarcinomas

154
Q

describe the features of anterior uveitis?

A

Red eye with reduced acuity, photophobia, small pupil and ciliary flush

155
Q

compare the murmur heard in ASD and VSD?

A

ASD = ejection systolic

VSD = pansystolic

156
Q

which glomerunephropathy causes thickened basement membrane on light microscopy?

A

membranous glomerulonephritis

157
Q

is ggoodpastures nephritic or nephrotic?

A

always nephritic

158
Q

the most common ovarian cancer?

the most common ovarian cyst?

A

ovarian cancer= serous carcinoma

ovarian cyst = follicular cyst

159
Q

what is the treatment for gonorrhoea?

A

IM ceftriaxone

160
Q

what is the main advantage of atypical antipsychotics over typical antipsychotics?

A

significant reduction in extra pyramidal side effects

161
Q

where is the spastic paresis, loss of proprioception and vibration and loss of pain and temperature seen in brown sequard syndrome?

A

ipsilateral to side of injury = loss of motor, proprioception and vibration

contralateral to side of injury = loss of pain and temperature

162
Q

how is haemophilia A transferred?

A

X linked recessive

these conditions are only passed from mothers to sons

males with an X linked recessive condition cannot pass it onto their sons, as they only inherit the Y chromosome

163
Q

What does the DAS28 score have to be above for someone with RA to be eligible for infliximab?

A

> 5.1

164
Q

maculopapualr rash on upper areas + mucosal ulcers+ fever?

A

primary HIV infection

esp if its someone from abroad

165
Q

which clinical feature is most commonly suggestive of a diagnosis of retinoblastoma?

A

leukocoria

a white pupillary reflex

also- strabismus or failure to thrive

166
Q

only in which circumstances is a pregnant women offered a OGTT ASAP?

A

if she has a previous history of gestational diabetes

167
Q

what clinical sign is seen in a bulbar palsy?

A

loss of gag reflex

bulbar palsy due to dysfunction in CN 9,10&12

168
Q

most common type of lung cancer in the UK?

A

squamous cell carcinoma

169
Q

which lung cancer most commonly cavitates?

A

squamous cell carcinoma

170
Q

which lung cancer causes hypercalcemia? how?

A

squamous cell

it releases PTHrp

171
Q

what vitamin is deficient in pellagra?

what are the 4 Ds in pellagra?

A

pellagra = deficient in B3 (niacin)

Dementia
Dermatitis
Diarrhoea
Death

172
Q

which medication used to treat BPH is most likely to cause postural hypotension?

A

tamsulosin (alpha blocker)

173
Q

what is the most appropriate diagnostic test for coeliac disease after TTG and IgA?

A

endoscopy and duodenal biopsy

174
Q

what is pathognomic for bronchiectasis?

A

signet ring sign

bronchiectasis can occur secondary to COPD

it is distal airway dilatation

175
Q

which antibiotic can cause hyperkalemia?

A

trimethoprim

176
Q

HUS triad?

caught from what?

A 
haemolytic anaemia (jaundice) 
thrombocytopenia 
renal failure (oliguria)

caught from E.Coli 0157, commonly meat from a BBQ

177
Q

compare the symptoms seen in an anterior cerebral artery occlusion from a middle cerebral artery occlusion?

A

anterior artery occlusion= foot and lower leg weakness, no speech disturbance

middle artery occlusion = speech disturbance, lower and upper limb weakness

178
Q

what is now considered the most effective way for confirming HSV?

A

NAAT

179
Q

which coronary artery is most likely to be affected in an anterolateral MI?

A

LAD

180
Q

what is the 1st line Mx of an AVNRT?

A

vagal manœuvres (same as any other narrow complex tachycardia)

these attempt to transiently block the AV node - if unsuccessful, give IV adenosine

181
Q

which ID causes explosive, watery, non-bloody diarrhoea?

what is the diagnostic test?

how is it managed?

A

giardiasis

diagnostic test= stool microscopy

managed = metronidazole

182
Q

baby coughing to the point of vomiting and turning blue?

A

whooping cough

183
Q

deficiency of what vitamin seen in rickets?

A

vit D

184
Q

what is the most appropriate Tx for gastroparesis, seen in T1DM?

A

metoclopramide - its a pro kinetic antiemetic

185
Q

what is 1st line Tx for polycythemia vera?

A

1st - aspirin for reducing risk of thrombotic events

2nd- venesection/phlebotomy - 1st line to keep the Hb in range

186
Q

metformin should be avoided if eGFR is less than what?

A

eGFR<30

give DPP-4 inhibitor, pioglitazone or sulphonylurea instead

187
Q

what medication is given for:

a) cranial DI
b) nephrogenic DI

A

a) cranial DI = terlipressin

b) nephrogenic DI = thiazide diuretic

188
Q

name the 1st line Ix and then the most sensitive/diagnostic for pertussis?

A

1st line= culture of organism on per nasal swab

most accurate = PCR

189
Q

what is the commonest complication of a parathyroidectomy?

A

hypocalcemia

190
Q

what would be seen on biopsy of liver in PBC?

A

presence of granulomas

AI granulomatous inflammation results in damage to the interlobular bile ducts

191
Q

in terms of hepatitis B serology interpretation, describe what a positive IgM or IgG would mean?

A

IgM +ive = acute hep B infection

IgG +ive = chronic or previous hep B infection

192
Q

what is pneumobilia a hallmark sign of?

A

gallstone ileus

air within the biliary tree

causes symptoms of small bowel obstruction

193
Q

what is the definitive management of acute cholecystitis?

A

NICE now recommend early laparoscopic cholecystectomy, within 1 week of diagnosis

previously, surgery was delayed for several weeks until inflammation had subsided

194
Q

name the most common murmur developed following an MI.

what are the 2 things that cause this murmur to develop post MI?

A

most common murmur post MI = pan systolic murmur

causes:

1) mitral regurg, secondary to rupture of papillary muscle
2) VSD- due to rupture of inter ventricular wall

both cause a pan systolic murmur

195
Q

what are the 2 most common causatives of neonatal conjunctivitis?

conjunctivitis in the 1st 28 days of life

how is it treated?

A

chlamydia and gonorrhoea

IV and topical antibiotics

196
Q

what can be used as a diagnostic marker for hepatocellular carcinoma?

A

raised AFP = hepatocellular cancer

197
Q

what should be done after a pregnant women has been treated for a UTI?

A

a test of cure

mid stream urine sample to be sent for culture

198
Q

name the factors in AKI that would indicate the need for a referral for haemofiltration?

A

AEIOU

Acidosis 
Electrolyte (hyperkalemia >7) 
Intoxication 
Oedema (refractory pul oedema) 
Uremia (urea >40 or encephalitis)
199
Q

what blood glucose value at 2 hours would be suggestive of impaired glucose tolerance?

A

2h blood glucose between 7.8 and 11mmol/L

200
Q

what specific receptor do atypical antipsychotics work on to reduce psychotic symptoms?

A

dopamine receptor antagonism

201
Q

how should a patient with AF be treated initially if their CHAD2VASc score is >2?

A

DOAC 1st line!!

factor Xa inhibitor - apixiban

warfarin is 2nd line

202
Q

what is the difference between Coombs positive and negative haemolytic anaemia?

A

Coombs positive = AI

coombs negative = non-AI

203
Q

what is the 1st line medication for BPH?

A

alpha-1 antagonist

eg - tamsulosin, alfuzosin

they decrease the smooth muscle tone of the prostate and bladder

204
Q

what 2 medications should those with PAD be taking?

A

clopidogrel and statin

take a statin, regardless of baseline cholesterol

clopidogrel = antiplatelet

205
Q

in the case of a ‘white out’ lung lesion, name 3 conditions that would cause the trachea to be pulled toward the whiteout?

A

pneumonectomy
complete lung collapse (eg-endobronchial intubation)
pulmonary hypoplasia

206
Q

in the case of a ‘white out’ lung lesion, name 3 conditions that would cause the trachea to be pulled away from the whiteout?

A

pleural effusion
diaphragmatic hernia
large thoracic mass

207
Q

test to confirm H.pylori eradication?

A

UREA breath test

208
Q

which steroid is indicated to be given to the mother to reduce risk of RDS?

A

dexamethasone

209
Q

what is the severity of COPD based on?

A

the FEV1 readings

FEV1> 80% = normal
FEV1 50-79% = moderate
FEV1<30% = very severe

210
Q

explain the roles of mifepristone and misoprostol in abortions?

A

mifepristone = ends the pregancy (kills the baby)

misoprostol = expulsion of the baby

in the event of a missed or incomplete miscarriage (when the baby is already dead), misoprostol is used alone for medical management

211
Q

name the drugs used in an abortion?

A

mifepristone and misoprostol

212
Q

out of all antiparkinsons meds, which are most likely to cause inhibition disorders?

A

dopamine agonists

eg- cabergoline, bromocriptine, ropinirole

213
Q

name a common cause of sudden, painless vision loss in a patient with poorly controlled diabetes?

A

vitreous haemorrhage

you would also be unable to gain any view of the retina in fundoscopy with this (unlike CRAO or CRVO)

214
Q

name the mild and then severe Tx of acne rosacea?

A

mild = topical metronidazole

severe = oral tetracycline

widespread telangiectasia = laser therapy

215
Q

what fluid would be given to a patient with acute, severe, symptomatic hyponatremia?

A

hypertonic saline

this is saline with a NaCl conc higher than 0.9% (usually 3%), to replace the Na

216
Q

Tx for otitis externa in diabetics?

A

ciprofloxacin - to cover pseudomonas

uncomplicated OE = topical antibiotic with a combined topical steroid, or oral fluclox if infection is spreading

217
Q

what test is recommended for downs syndrome in a women who is 11-13+6 weeks pregnant?

A

the combined test - nuchal scan + PAPP-A and hCG

218
Q

what test for downs is recommended in a women who is >13+6 weeks pregnant?

A

the triple or quadruple test

dating scan + oestriol, hCG, AFP and inhibin A

addition of inhibin A makes the triple test the quadruple test

219
Q

what is the AB Tx for PID?

A

ceftriaxone, doxy, metronidazole

220
Q

how can gestational cholestasis be differentiated from gestational fatty liver?

A

gestational cholestasis causes itch on hands and feet, and LFTs dont tend to rise above 250u/l

gestational fatty liver causes a greater increase in LFTs and no itch

221
Q

how is biliary atresia definitively diagnosed?

A

cholangiography

222
Q

homonymous hemianopia + macular sparing location of lesion?

A

occipital cortex

occipital cortex lesions present with macular sparing, optic tract present without macular sparing

223
Q

which UTI medication can lead to a falslely low eGFR reading?

A

trimethoprim

224
Q

how should non-infective exacerbations of COPD be treated?

A

prednisolone 30mg for 5 days

no ABs needed

225
Q

what is the most common underlying pathology causing bowel perf in old patients?

A

diverticular disease

226
Q

what type of anaemia can methotrexate cause?

A

macrocytic anaemia

it is a folate antagonist, so can cause a folate deficiency

227
Q

what is the initial management for a cerebral venous sinus thrombosis?

A

LMWH

228
Q

in a patient with a multiple myeloma, what is used to treat the hypercalcemia?

A

biphosphonates

229
Q

name the disseminated gonococcal infection triad?

A

tenosynovitis
migratory polyartritis
dermatitis

seen as a gram neg diplococci

AA Y4 Finals cards NE (40 decks)

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