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Finals Revision > PassMed September > Flashcards

PassMed September Flashcards

1
Q

What should you do with a patient found to have unilateral nasal polyps?

A

Urgent ENT referal - this is a RF for cancer

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2
Q

Which hand joints are most typically affected by the OA?

A

Osteoarthritis typically affects the DIP joints and carpometacarpal joints. PIP joints are typically sparred

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3
Q

What is the most common symptoms of acute open angle glaucoma? What is the primary treatment?

A

Peripheral visual field defects (most common), severe eye pain, redness of the eye and halos around lights
Timolol - reduces aqueous production

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4
Q

What is the management for primary hyperaldosteronism?

A

Potassium sparring diuretics (aldosterone antagonists) e.g. spironolactone

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5
Q

Name 4 symptoms of hypocalcaemia?

A

Perioral paraesthesia, tetany, cramps and convulsions

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6
Q

What is acute intermittent porphyria?

A

Can be triggered by nitrofurantoin
Causes severe abdo pain, HTN, tachycardia, hallucinations, anxiety and muscle weakness

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7
Q

What is the 1st line management of thrush?

A

Oral fluconazole

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8
Q

What is the 1st line Tx for low severity CAP?

A

Oral Amoxicillin

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9
Q

What should you suspect in a patient presenting with severe chest pain and shock after acute vomiting?

A

Boerhaave Syndrome (oesophageal rupture)

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10
Q

What will be seen in sick euthyroid syndrome?

A

Low T3/T4 with normal TSH and an acute illness

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11
Q

How should you treat urgency urinary incontinence?

A

Bladder training then oxybutanin

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12
Q

How frequently should you screen for glaucoma in someone with a positive family history?

A

Annually from 40 years

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13
Q

What should you do if you clinically suspect tension pneumothorax (no x-ray confirmation)

A

Immediate needle decompression in the 2nd intercostal space. Do not wait for imaging

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14
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous nephropathy - frequently due to malignancy

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15
Q

Which medication used in psych is associated with nephrogenic DI?

A

Lithium

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16
Q

What should you suspect in a patient presenting with subacute productive cough, foul smelling sputum and night sweats?

A

A lung abscess

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17
Q

What is the 1st line Ix for prostate cancer?

A

Multiparametric MRI

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18
Q

How may an acute mitral regurg (secondary to MI) present?

A

Pulmonary oedema and sudden breathlessness

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19
Q

Which antibiotic should you use for UTI in the 3rd trimester?

A

Amoxicillin
Nitro is teratogenic in 3rd trimester and Trimethoprim should be avoided completley

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20
Q

Are short or long sited people more at risk of acute close angle glaucoma?

A

Long sited

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21
Q

Are short or long sited people more at risk of acute open angle glaucoma?

A

Short sited

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22
Q

What are we worried about in a patient with persistent ST elevation following and MI?

A

Left ventricle aneurysm - this increases the risk of emboli

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23
Q

What should with give to a patient who is started on an NSAID and SSRI?

A

PPI

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24
Q

Name 3 viral infections that should be routinely screened for antenatally?

A

HepB, HIV and Syphillis

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25
Q

Is conn’s sydrome associated with metabolic acidosis or alkalosis?

A

Alkalosis

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26
Q

How long do mania and hypomania last respectivley?

A

Mania = at least 7 days
Hypomania = less than 7 days

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27
Q

What is chvostek’s sign and trousseu’s sign?

A

Seen in hypocalcaemia
Chvosteks sign = twitching of the facial muscles when tapping on the facial nerve
Trousseus sign = carpopaedal spasm when inflating the BP cough

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28
Q

What will sodium look like in the urine and blood in SIADH?

A

High in the urine and low in the blood

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29
Q

Which carcinoma is SIADH associated with?

A

Small cell lung cancer

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30
Q

What is the 1st line Tx for Grave’s Disease?

A

Carbimazole

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30
Q

What is the 1st line Tx for Grave’s Disease?

A

Carbimazole

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31
Q

How can we manage Thyrotoxicosis which occurs without hyperthyroidism?

A

Propanolol

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32
Q

How quickly should endoscopy be done in patients presenting with an upper GI bleed?

A

Within 24 hours

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33
Q

A patient presents with tenderness in the anatomical snuff box but no X-ray changes are seen. What should you do?

A

?Scaphoid fracture
Splint and re-scan in 1-2 weeks

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34
Q

An alcoholic presents to A&E with facial flushing, nausea, vomiting, palpitations and low BP. What antibiotic may have caused this?

A

Metronidazole

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35
Q

Sx and Mx of Seborrheic Dermatitis?

A

Scaly red patches in the hair and eyebrows
Topical ketoconazole

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36
Q

What does crescent sign seen on x-ray/MRI of the hip imply?

A

Avascular necrosis

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37
Q

Name one risk factor for avascular necrosis?

A

Long term steroid use

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38
Q

Which diabetes drug would most benefit an overweight patient?

A

SGLT-2 inhibitors e.g. canagliflozin or dapagliflozin

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39
Q

What is Takotsubo Cardiomyopathy?

A

Acute/sub-acute chest pain occurring after a stressful event in post-menopausal women

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40
Q

Sx of Brown-Sequard syndrome?

A

Same sided weakness and proprioception/vibration loss
Opposite sided pain and temperature loss

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41
Q

True or false, sarcoidosis is associated with DI?

A

True

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42
Q

Which type of drug should be avoided in patients with Myasthenia Gravis?

A

Beta-blockers

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43
Q

When should all pregnant women receive an OGTT?

A

24-28 weeks.
Those with previous GD should be screened earlier

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44
Q

What surgical procedure is generally executed in bowel emergencies such as perforation or obstruction?

A

Hartmann’s procedure

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45
Q

A young person presents with small bowel obstruction and has had dark spots in the mouth since birth. What should you suspect?

A

Peutz-Jeghers Syndrome

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46
Q

Which antibiotic can cause prolonged QT interval?

A

Erythromycin

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47
Q

What will the serum:creatinine ratio be in pre-renal disease?

A

High

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48
Q

How can you differentiate clinically between cellulitis and PE?

A

Fever present = think cellulitis

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49
Q

A patient has metabolic alkalosis and hypokalaemia. What should you suspect?

A

?Prolonged vomiting

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50
Q

How can you differentiate between an ACL/PCL injury and a meniscal injury based on the history?

A

ACL/PCL injury = rapid joint swelling after trauma
Meniscal injury = gradual joint swelling after trauma

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51
Q

What will the osmolarity of the plasma and urine be in DI?

A

Plasma = borderline or high osmolarity
Urine = low osmolarity

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52
Q

What should be used in the 1st line management of a Tone PPH?

A

IV Syntocinon

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53
Q

Maternal labetolol is a risk factor for what?

A

Neonatal hypogylcaemia

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54
Q

A patient has had an MI 1 week ago. They now present with a systolic murmur, hypotension and pulmonary oedema. What has happened?

A

Acute mitral regurgitation due to rupture of the papillary muscles

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55
Q

What is seen with acute tubular necrosis?

A

No response to fluid challenge
Urea:Creatinine <1:100
Hyperkalaemia
High urine sodium but low osmolality

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56
Q

What may be seen in acute angle closure glaucoma?

A

Severe eye pain, reduced visual acuity, redness of the eye, corneal haziness and a semi-dilated non-reactive pupil

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57
Q

Where does furosemide act?

A

On the ascending limb of the loop of Henle

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58
Q

A patient with known HIV presents with odonophagia and dyspahgia. What should you suspect?

A

Oesophageal candidaisis

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59
Q

What may be seen on an ECG in hypocalcaemia?

A

QT prolognation

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60
Q

A patient with endometriosis is not responsive to NSAIDs or the COCP. What is the 2nd line management?

A

GnRH analogues

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61
Q

Do you see hyper or hypo kalaemia in diarrhoea?

A

Hypokalaemia

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62
Q

How should you treat a patient in cardiac arrest with a shockable rhythm differently depending on if the arrest was witnessed on cardiac monitoring or not?

A

Witnessed = 3 successive shocks then CPR
Unwitnessed = 1 shock then CPR

63
Q

What lung condition can be caused by amioadarone?

A

Pulmonary fibrosis

64
Q

What is the classical triad of signs in primary hyperaldosteronism?

A

Hypertension, hypernatraemia and hypokalaemia

65
Q

What is the most common form of melenoma seen in those with dark skin? Sx?

A

Acral Lentiginous Melanoma.
Pigmentation of the nail bed affecting the proximal nail folds

66
Q

HNPCC is the most common congenital risk factor for bowel cancer. What else is it a risk factor for?

A

Endometrial cancer

67
Q

When can the IUD/IUS be inserted after birth?

A

Within 48 hours OR after 4 weeks

68
Q

How long should you observe for signs of life following an in-hospital failed resuscitation attempt?

A

5 Mins

69
Q

What does PTH do to your biochemistry?

A

Increases blood calcium and decreases phosphate

70
Q

What is and Argyll Robertson pupil?

A

Seen in neurosyphilis.
Irregular, constricted pupil which doesn’t react to light but does react to accommodation

71
Q

What is Holmes-Adie Syndrome?

A

Unilateral pupil dilation with absent light reflexes and slow accommodation. There will also be absent ankle reflexes

72
Q

How can we confirm a diagnosis of gout?

A

2 weeks after the inflammation settles we should measure serum urate levels

73
Q

What type of drugs should you always withhold in AKI?

A

Nephrotoxic drugs (e.g. ACEis, ARBs and NSAIDs), Metformin and diuretics

74
Q

What is the normal size of a kidney? How will the differ in CKD?

A

10-12cm
In CKD they will appear smaller

75
Q

What is the treatment pathway in paediatric asthma?

A

SABA -> SABA + Low dose ICS -> SABA + Low dose ICS + LTRA -> SABA + LABA + Low dose ICS

76
Q

What should you suspect in a patient who wears contact lenses and swims a lot presenting with eye pain, reduced visual acuity and photophobia?

A

Acanthamoeba keratitis

77
Q

What should you do if placenta praevia is noted in early scans?

A

Rescan at 32 weeks - if it is still there plan for early delivery at 38 weeks
In placenta praevia minor you can wait till 36 weeks to rescan

78
Q

In what circumstances should beta blockers be stopped in a patient presenting with acute heart failure?

A

If HR <50, 2nd/3rd degree AV block or if the patient is shocked

79
Q

Which methods of contraception work by inhibiting ovulation?

A

Implant, Injection, COCP and Desogestrel only POP

80
Q

How do the POP, the IUS and the IUD work?

A

POP = thickens cervical mucous
IUS = prevents endometrial proliferation
IUD = reduces sperm motility

81
Q

How can we use peak flow to stage the severity of an asthma attack?

A

Moderate = 50-75%
Severe = 33-50%
Life threatening = <33%

82
Q

What is Bumetanide?

A

A loop diuretic

83
Q

How should you handle any progressively worsening headache with higher cognitive function impairment?

A

Urgent CT head

84
Q

What should you suspect in any red/black skin lump which oozes or bleeds?

A

Nodular Melanoma

85
Q

What should you suspect in teenage girls presenting with knee pain on walking down the stairs?

A

Chondromalacia Patellae

86
Q

What is a Marjolin’s Ulcer?

A

Squamous cell carcinoma occurring at sites of chronic inflammation or previous injury

87
Q

What is a Pyoderma Gangrenosum?

A

Ulcers which occur at stoma sites

88
Q

What is the most common cause of occupational asthma?

A

Isocyanates

89
Q

Which metabolic abnormalities can be caused by loop diuretics?

A

Hyponatraemia or hypokalaemia or hypocalcaemia

90
Q

What is a T-score and a Z-score?

A

T-score = average bone mineral density compared to that of a healthy 30 year old of the same gender
Z-score = T-score but incorporating Age, gender and ethnicity

91
Q

What does HepA cause, who does it commonly affect?

A

Acute hepatomegaly and obstructive jaundice
Commonly seen in travellers who have recently returned to the UK

92
Q

What should you suspect in people with recurrent epistaxis and telangiectases?

A

Hereditary Haemorrhagic Telanglectasia

93
Q

What is Wellen’s Syndrome?

A

Critical LAD artery stenosis.
Patients present with chest pain. ECG will show deeply inverted or biphasic T waves in V2-3.
Troponin will be mildly raised

94
Q

There is ST elevation in V1-V4. Where is the clot?

A

LAD artery

95
Q

What can we use as an alternative medication to Atropine?

A

Isoprenaline/Adrenaline Infusion

96
Q

Name 2 drugs which can be used in pharmacological cardioversion

A

Amiodarone and Flecainide (only if a structurally normal heart)

97
Q

Where should you measure QT interval from?

A

Start of the Q wave to the end of the T wave

98
Q

Is hyper or hypo thyroidism associated with heavy menstrual bleeding?

A

Hypothyroidism
Hyperthyroidism is associated with oligomenorrhoea

99
Q

True or false, opioids cause urinary frequency.

A

False. The can cause urinary retention

100
Q

What should you do is a semen sample comes back abnormal?

A

Repeat in 3 months

101
Q

True or false Hereditary Haemochromatosis can cause cranial DI?

A

True!

102
Q

How does acute closure angle glaucoma present?

A

Severe pain, decreased visual acuity, semi-dilated non-reactive pupil, haloes around the light and a red eye.

103
Q

What metabolic abnormality can be caused by omeprazole?

A

Hypomagnesia - this can then lead to hypocalcaemia and hypokalaemia

104
Q

What X-ray finding is often seen in bronchiectasis?

A

Parallel line shadows (aka tram lines)

105
Q

What is seen in cardiogenic shock? Should you do a fluid challenge in these patients?

A

Systolic BP <90, low urine output, high lactate and cold peripheries
NO!

106
Q

True or false, glucocorticoids can cause neutrophilia?

A

True!

107
Q

What is a trifasicular block? Why is it important?

A

RBBB, 1st degree heart block and Left axis deviation.
This is an important cause of falls in the elderly

108
Q

What ECG changes are seen in Wolff-Parkinson-White Syndrome?

A

Short PR interval, broad QRS and a delta wave

109
Q

What is Brugada syndrome?

A

ST elevation in V1-V3. It can cause sudden nocturnal death!

110
Q

What are the symptoms of normal pressure hydrocephalus? What distinctive findings will you see on CT scan?

A

Urinary incontince, cognitive impairment and gait disturbance.
Ventriculomegaly out of proportion with sulcal enlargement

111
Q

A teenage boy presents with progressive muscle weakness and having to use his arms to stand up from sitting on the floor. What is the diagnosis?

A

Becker muscular dystrophy.
Similar to DMD but occurs in older boys (>10 years)

112
Q

What are the components of CHA2DS2VASc? Above what score should you definitely anticoagulate?

A

Congestive HF (1)
HTN (1)
Age >= 75 (2), 65-74 (1)
Diabetes (1)
Previous TIA, stroke or thromboembolism (2)
Vascular disease (1)
Female (1)
>= 2 you should anticoagulate

113
Q

Which are the best anti-emetics to use for different causes of nausea?

A

Ondansetron = oncology causes
Haloperidol = causes in your head
Prochlorperazine = Peculiar (dizziness)
Metoclopromide = Mesentery (GI)

114
Q

Who should you give steroids to in bacterial meningitis?

A

Children over 3 months. This helps to reduce the risk of hearing loss!

115
Q

Name 5 poor prognostic indicators in schizophrenia?

A

Strong family history, gradual onset, low IQ, prodromal social withdrawal and lack of obvious precipitant

116
Q

A patient presents with reduced foetal movement at 30 weeks. On doppler US there is no foetal heart beat. What should you do next?

A

Past 28 weeks and no foetal heart beat on doppler US - urgent USS

117
Q

Which drugs can affect the absorption of levothyroxine? How can you correct this?

A

Iron and Calcium carbonate. These should be taken at least 4 hours before/after levothyroxine

118
Q

How should you interpret the Wells score for PE?

A

> = 4 requires urgent CTPA and thrombolysis whilst waiting
<4 requires D-dimer, if positive do a urgent CTPA

119
Q

Sx, Ix and Mx for lumbar spinal stenosis?

A

Pain in the lower limbs which is relieved by lumbar flexion, sitting is better than standing and walking uphill is better than downhill.
Ix = MRI
Mx = laminectomy

120
Q

A patient just had bowel surgery and is now complaining of abdominal pain, bloating and vomiting. What should you suspect?

A

Post-operative ileus

121
Q

Which metabolic abnormality can acute pancreatitis cause?

A

Hypocalcaemia

122
Q

What are the 3 Ms of primary biliary cirrhosis? What is the management?

A

IgM, Anti-Mitochondrial antibodies, Middle aged women
Ursodeoxycholic acid

123
Q

Which cranial nerve palsy leads to ptosis?

A

CN III

124
Q

When can the COCP be restarted after birth?

A

After 3 weeks if not breast feeding, after 6 weeks if breast feeding

125
Q

What test may be used to help diagnose age related macular degeneration?

A

Amsler grid testing

126
Q

True or false, LH and FSH are low in Turner’s syndrome?

A

False, they will be raised!

127
Q

Name 4 Parkinson’s drugs which are likely to cause disinhibition?

A

Dopamine receptor agonists:
Bromocriptine, Ropinirole, Cabergoline and Apomorphine

128
Q

Which syndrome can be caused by with-holding parkinsons medications?

A

Neuroleptic Malignant Syndrome

129
Q

What are the ECG changes noted in hypokalaemia?

A

Tall p waves, flattened/inverted T waves, ST depression, prominent U waves

130
Q

What should you suspect in any patient presenting with persistent ST elevation but no chest pain post MI?

A

Left ventricular aneurysm

131
Q

Which type of arrhythmia is commonly associated with pneumothorax?

A

PEA

132
Q

How can you differentiate between infantile spasms and infantile colic?

A

Infantile spasms = child is distressed between spasms
Infantile colic = child is distressed during spasms

133
Q

What is the key symptom to warn patients about before starting them on levodopa?

A

Large variations in motor function due to on-off phenomenon

134
Q

What is the most sensitive and specific lab result which identifies cirrhosis in those with chronic liver disease?
What scan can you do to confirm this?

A

Thrombocytopenia
Transient Elastography

135
Q

How quickly do you need to refer ?parkinsons disease patients to neuro?

A

URGENTLY

136
Q

What test should you perform in all patients with new AF?

A

Transthoracic echo

137
Q

Which hepatitis vaccine should be offered to men who have sex with men?

A

Hep A

138
Q

What is the pattern of Haemophilia inheritance?

A

X-linked recessive

139
Q

What can we use instead of amiodarone if it is not available?

A

Lidocaine

140
Q

Name the signs of cerebellar damage?

A

Dysdiadochokineaseia and Dysmetria
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia

141
Q

What are the most common and most aggressive types of melanoma

A

Most common = superficial spreading
Most aggressive = nodular

142
Q

How does chronic venous insufficiently often present visually?

A

Brown pigmented skin, legs which are wider at the knee than the ankle and eczema

143
Q

Define PPH?

A

The loss of >=500mls of blood from the genital tract within 24 hours of birth of the baby

144
Q

If thrombosis is suspected as the cause of cardiac arrest what should you do?

A

Thrombolyse with alteplase and then continue CPR for 60-90 mins

145
Q

True or False, a LUTI can precipitate urinary retention?

A

True

146
Q

When should you give adrenaline and amiodarone in shockable rhythms?

A

After 3 shocks

147
Q

How does MG affect sensitivity to anaesthetic agents?

A

People with MG are more sensitive to Rocuronium but resistant to suxamethonium

148
Q

Below what BM should neonates be admitted for IV 10% dextrose even if they are asymptomatic?

A

<1

149
Q

What should you suspect in a patient with recent MI who presents with sudden HF, raised JVP and pulsus paradoxus?

A

Left ventricular free wall rupture

150
Q

You hear a new pansystolic murmur in a patient who had an MI 5 days ago. What do you suspect?

A

Ventricular Septal Defect

151
Q

How can we assess bowel anastomoses after bowel surgery?

A

Gastrografin enema

152
Q

How do you manage latent TB?

A

3/12 of isoniazid (+pyridoxine) AND rifampicin
OR
6/12 of isoniazid (+pyridoxine)

153
Q

Which nerve and nerve root control the triceps reflex?

A

Radial nerve
C7

154
Q

What is the 1st line management of absence seizures?

A

Sodium valproate or ethosuximide

155
Q

How do you manage amiodarone induced hypothyroidism?

A

Continue amiodarone but add levothyroxine

156
Q

How do we manage infantile colic?

A

Reassurance and support, this is a benign condition!

Finals Revision (23 decks)

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