Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Progress Tests > Passmed Year 3 > Flashcards

Passmed Year 3 Flashcards

1
Q

What do parietal cells secrete?

A

Gastrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms of brucellosis and key risk factors

A

Symptoms: Fluctuating fever, sweats, myalgia, arthralgia

Key risk factors: Animal contact, unpasteurised cheese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Symptoms of echinococcosis and key risk factors

A

Symptoms: Liver cysts (or other cysts)

Key risk factor: Contact with sheep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What body system does Cryptococcus neoformans infect?

A

CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptom and epidemiology of enterobius vermicularis

A

Anal itching in children or contacts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Malaria symptoms

A

Flu-like illness after 2 weeks. If untreated can cause respiratory distress, acidosis, raised ICP and organ failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Typical symptoms of candida skin infection

A

Red itchy rash in axilla or groin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Typical symptoms of herpes skin infections

A

Localised blistering and vesicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can patients with eczema get if they get a herpes skin infection?

A

Eczema herpeticum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Scabies treatment

A

Permethrin cream (treat all household contacts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Arterial supply of the bladder

A

Superior and Inferior vesical arteries (branches of internal iliac)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Venous supply of the bladder

A

Vesicoprostatic / vesicouterine plexus (drain into internal iliac)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lymphatic drainage of bladder

A

External and internal inguinal nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bladder innervation

A

Sympathetic: hypogastric plexus
Parasympathetic: pelvic splanchnic nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment for mild psoriasis

A

Topical corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MOA of dipyridamole

A

Anti-platelet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Score used to assess severity of acute pancreatitis

A

Glasgow score (score >3 indicates ICU / HDU referral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Artery that supplies posterior stomach

A

Splenic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Can CPAP be considered in acute heart failure?

A

Yes if not responding to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Contraindication of metoclopramide

A

Parkinson’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Mediator and examples of type I hypersensitivity reaction

A

IgE mediated
Anaphylaxis
Atopy e.g. asthma / hayfever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mediator and examples of type II hypersensitivity reaction

A

Cell mediated
Goodpastures
Pernicious anaemia
Pemphigus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Mediator and examples of type III hypersensitivity reaction

A

Immune complex mediated
SLE
Post-streptococcal glomerulonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mediator and examples of type IV hypersensitivity reaction

A

T cell mediated (delayed)
Scabies
MS
Allergic contact dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mediator and examples of type V hypersensitivity reaction

A

Antibodies act as agonists / antagonists
Grave’s disease
Myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Two types of osteomyelitis

A

Haematogenous (spread via blood)

Non-haematogenous (from adjacent soft tissue / trauma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Risk factors for osteomyeltis

A

Haematogenous: children, sickle cell, IVDU, immune suppression, infective endocarditis
Non-haematogenous: ulcers, pressure sores, diabetes, peripheral arterial disease, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Most common organism in osteomyelitis

A

Staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Most common organism in children with sickle cell and osteomyelitis

A

Salmonella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Investigation of osteomyelitis

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

MOA of cetuximab

A

Monoclonal antibody against epidermal growth factor receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Indications for cetuximab

A

Metastatic colorectal / head and neck cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Most common organism causing spontaneous bacterial pertonitis

A

E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Symptoms of spontaneous bacterial peritonitis

A

Abdo pain, fever, ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Diagnosis of spontaneous bacterial peritonitis

A

Paracentesis - raised neutrophils and culture and organism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Management of spontaneous bacterial peritonitis

A

IV abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Indications for abx prophylaxis against spontaneous bacterial peritonitis

A

Ascites and either previous spontaneous bacterial peritonitis or high protein on paracentesis or a high Child-Pugh score (>9)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Typical presentation of patient with taenia solium infection

A

Latin American patient with seizures and brain cysts on imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Symptoms of Lyme disease

A

Fever, arthralgia, headache, bullseye rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What electrolyte imbalance can hypomagnesaemia cause?

A

Hypocalcaemia (unresponsive to treatment with calcium and vitamin D supplements)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Main cells that mediate organ rejection

A

Cytotoxic T cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Symptoms of erysipelas

A

Elevated, well defined, painful rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Risk factors for erysipelas

A

Reduced immunity, older age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Microorganism responsible for erysipelas

A

Strep pyogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Typical rash in ringworm

A

Red, circular, scaly, itchy rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Organism that causes ringworm

A

Trichophyton rubrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is erysipelas?

A

Superficial, limited cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Treatment of erysipelas

A

Abx eg flucloxacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What should be co-prescribed with methotrexate?

A

Folic acid 5mg once per week (taken on a different day to the methotrexate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is Budd-Chiari syndrome?

A

Hepatic vein thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Risk factors for Budd-Chiari syndrome

A

polycythaemia
thrombophilia (e.g. protein C resistance / deficiency, antithrombin III deficiency)
pregnancy
combined oral contraceptive pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Symptoms of Budd-Chiari syndrome

A

Abdo pain (sudden onset and severe)
Ascites
Tender hepatomegaly
Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Investigations of Budd-Chiari syndrome

A

Ultrasound with doppler flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Surgical procedure in pyloric stenosis

A

Ramstedt’s pyloromyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Surgical procedure in achalasia

A

Heller’s cardiomyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Surgery to remove head of pancreas and duodenum

A

Whipple’s procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is achalasia?

A

Failure of peristalsis and lower oesophageal relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Symptoms of achalasia

A

dysphagia of BOTH liquids and solids
typically variation in severity of symptoms
heartburn
regurgitation of food (may lead to cough, aspiration pneumonia etc)
malignant change in small number of patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Investigation of achalsia

A 
oesophageal manometry (excessive LOS tone which doesn't relax on swallowing, considered the most important diagnostic test)
barium swallow (shows grossly expanded oesophagus, fluid level, 'bird's beak' appearance)
chest x-ray (wide mediastinum, fluid level)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

First line treatment in achalasia

A

Balloon dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Most common type of renal cancer

A

Renal cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Key complications of acute pancreatitis

A 
Peripancreatic fluid collections
Pseudocysts
Pancreatic necrosis
Abscess
Haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What nerve supplies the medial leg and foot?

A

Saphenous nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What nerve supplies the lateral leg and foot?

A

Sural nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What nerve supplies the dorsum of the foot?

A

Superficial peroneal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Inheritance of alpha-1 antitrypsin deficiency

A

Recessive / codominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Pathophysiology of alpha - antitrypsin deficiency

A

Reduces the breakdown of neutrophil elastase, which leads to emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Symptoms of alpha-1 antitrypsin deficiency

A

Emphysema / COPD symptoms (breathlessness, cough, frequent infections)
May have liver symptoms e.g. cholestasis, cirrhosis, carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Investigation of alpha-1 antitrypsin deficiency

A

A1AT concentrations

spirometry: obstructive picture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Management of alpha-1 antitrypsin deficiency

A

no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery, lung transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What does an ABG typically show in salicylate overdose?

A

salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What muscle flexes the proximal interphalangeal joints?

A

Flexor digitorum superficialis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What muscle flexes the diatal interphalangeal joints?

A

Flexor digitorum profundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Monitoring of Barratt’s oesophagus

A

for patients with metaplasia endoscopy is recommended every 3-5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Management of Barratt’s oesophagus

A

endoscopic surveillance with biopsies
high-dose proton pump inhibitor
If dysplasia of any grade is identified, endoscopic intervention is offered (options include endoscopic mucosal resection or radiofrequency ablation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Blood supply to thyroid

A

Superior and inferior thyroid arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Venous drainage of thyroid

A

Superior, middle and inferior thyroid veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Symptoms of strongyloides infection

A

Abdo pain, diarrhoea, papulovesicular lesions on the soles of his feet and an urticarial rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

How is strongyloides infection acquired?

A

Via soil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Symptoms of chlonorchis sinensis

A

abdominal pain, nausea, jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Risk factor for chlonorchis sinensis

A

Undercooked fish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Risk factor for taenia solium

A

Undercooked pork

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What system does taenia solium infect?

A

CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Symptoms of congenital ventricular septal defect

A

failure to thrive
features of heart failure (hepatomegaly, tachypnoea, tachycardia, pallor)
classically a pan-systolic murmur which is louder in smaller defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Management of congenital ventricular septal defect

A

Small VSDs which are asymptomatic often close spontaneously are simply require monitoring
Moderate to large VSDs usually result in a degree of heart failure in the first few months so need nutritional support, medication for heart failure (e.g. diuretics), surgical closure of the defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Complications of a ventricular septal defect

A

Aortic regurgitation
Infective endocarditis
Right sided hypertrophy and failure
Pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Indications for antibiotics in otitis media

A

Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Complications of otitis media

A 
perforation of the tympanic membrane
hearing loss
labyrinthitis
mastoiditis
meningitis
brain abscess
facial nerve paralysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Stanford classification of aortic dissection

A

Type A: Ascending aorta (2/3 of cases)

Type B: Descending aorta (1/3 of cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Management of aortic dissection

A 
Type A (ascending aorta): surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention
Type B (descending aorta): conservative management (bed rest, reduce blood pressure with IV labetalol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Complications of aortic dissection

A

aortic incompetence/regurgitation
MI
stroke
renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Actions of biceps brachii

A

Elbow flexion

Supination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Symptoms of an ovarian cyst

A

Asymptomatic
Pelvic pain
Bloating
Heavy periods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Management of inguinal hernias

A

Usually surgical mesh repair, even if asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

MOA of syntocinon

A

Synthetic oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Use of ergometrine

A

Can be used instead of oxytocin in the third stage of labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Drugs used in medical abortion

A

Mifepristone and misoprostol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Most common type of testicular cancers

A

Germ cell tumours (e.g. seminomas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Risk factors for testicular cancer

A 
male aged 20-30
infertility (increases risk by a factor of 3)
cryptorchidism
family history
Klinefelter's syndrome
mumps orchitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Symptoms of testicular cancer

A

a painless lump is the most common presenting symptom
hydrocele
pain (uncommon)
gynaecomastia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Testicular cancer tumour markers

A

AFP (60%)
LDH (40%)
hCG (20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Diagnosis of testicular cancer

A

Ultrasound first line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Treatment of testicular cancer

A

orchidectomy

chemotherapy and radiotherapy may be given depending on staging and tumour type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Prognosis of testicular cancer

A

Good

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is the qSOFA score used for?

A

Predicting increased mortality in sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What makes up the qSOFA score?

A

Resp rate >22
BP <100
Altered mental state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Symptoms of vitamin B3 deficiency

A

Dermatitis, dementia, diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Symptoms of vitamin B2 deficiency

A

Angular stomatitis, keratitis, glossitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Symptoms of vitamin B6 deficiency

A

anaemia, neuropathy, irritability and abdominal discomfort.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Symptoms of B12 deficiency

A

Anaemia and neurological symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

First line in neuropathic pain

A

Amitriptyline OR pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Second line in neuropathic pain

A

Amitriptyline AND pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

First line in neuropathic pain in diabetes

A

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Metformin ADRs

A

Gastrointestinal upsets are common (nausea, anorexia, diarrhoea), intolerable in 20%
reduced vitamin B12 absorption - rarely a clinical problem
lactic acidosis with severe liver disease or renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Metformin contraindications

A

chronic kidney disease: review if eGFR <45 and stop if eGFR < 30
Recent MI / sepsis / stroke / AKI
iodine-containing x-ray contrast media (day of and two days after procedure due to risk of renal impairment
alcohol abuse is a relative contraindication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Dose of adrenaline in anaphylaxis in adults

A

500 micrograms (0.5ml 1 in 1,000) IM. Repeat every 5 minutes if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Dose of adrenaline in anaphylaxis in children age 6-12

A

300 micrograms (0.3ml 1 in 1,000) IM. Repeat every 5 minutes if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Dose of adrenaline in anaphylaxis in children under 6

A

150 micrograms (0.15ml 1 in 1,000) IM. Repeat every 5 minutes if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Blood test that can be done to determine if someone has had an anaphylactic reaction

A

Serum tryptase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Indication for letrozole

A

Breast cancer in postmenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

MOA of tamoxifen

A

Oestrogen receptor blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is Ebstein’s anomaly and what is the key risk factor?

A

Ebstein’s anomaly is a congenital heart defect characterised by low insertion of the tricuspid valve resulting in a large atrium and small ventricle. It is sometimes referred to as ‘atrialisation’ of the right ventricle.
Ebstein’s anomaly may be caused by exposure to lithium in-utero (e.g. maternal mood disorder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is Wilson’s disease

A

Accumulation of copper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Symptoms of Wilson’s disease

A 
liver: hepatitis, cirrhosis
neurological e.g. speech / behaviour problems
Kayser-Fleischer rings
renal tubular acidosis
haemolysis
blue nails
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

ECG in hypokalaemia

A 
U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Causative organism for pneumonia in multiple otherwise fit patients who have developed pneumonia after air condition exposure.

A

Legionella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Most common causative agent of pneumonia in people with COPD

A

Haemophilus influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Most common causative agent of pneumonia in alcoholoics

A

Klebsiella pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Most common causative agent of pneumonia in patients with HIV

A

Pneumocystis jiroveci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Most common causative agent of pneumonia

A

Streptococcus pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Pancreatic cancer symptoms

A

classically painless jaundice
pale stools, dark urine, and pruritus
cholestatic liver function tests
anorexia
weight loss
epigastric pain (and often atypical back pain)
loss of exocrine function (e.g. steatorrhoea)
loss of endocrine function (e.g. diabetes mellitus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Imaging tests in pancreatic cancer

A

ultrasound has a sensitivity of around 60-90%

high-resolution CT scanning is the investigation of choice if the diagnosis is suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Management of pancreatic cancer

A

less than 20% are suitable for surgery at diagnosis
Whipple’s resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas with adjuvant chemotherapy
ERCP with stenting is often used for palliation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What is Rovsing’s sign and what does it indicate?

A

more pain in RIF than LIF when palpating LIF

appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Blood supply to prostate

A

Inferior vesical artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Venous drainage of prostate

A

Prostatic venous plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Lymphatic drainage of prostate

A

Internal iliac nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Hyperaldosteronism investigation

A

plasma aldosterone/renin ratio is the first-line investigation (high aldosterone and low renin due to negative feedback)
following this a high-resolution CT abdomen
if the CT is normal adrenal venous sampling (AVS) can be used to distinguish between unilateral adenoma and bilateral hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Treatment of hyperaldosteronism

A 
adrenal adenoma (Conn's syndrome): surgery
bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What is Conn’s syndrome?

A

Adrenal adenoma leading to hyperaldosteronism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Screening for PCKD

A

Ultrasound in relatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Diagnosis of oesophageal cancer

A

Endoscopy first line

Then CT for staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Management of oesophageal cancer

A

Surgery usually

May have adjuvant chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Oesophageal cancer adenocarcinoma vs squamous cells cancer

A

Adenocarcinoma more common in developed countries, squamous cell in developing
Adenocarcinoma more common in lower 1/3, squamous cell in upper 2/3
Adenocarcinoma key risk factors GORD and Barratts, squamous cell are smoking and alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Causes of jaundice in first 24 hours of life

A

rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Causes of neonatal prolonged jaundice (after 14 days)

A 
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
congenital infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Treatment of carpal tunnel syndrome

A 
corticosteroid injection
wrist splints at night
surgical decompression (flexor retinaculum division)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What nerve is compressed in cubital tunnel syndrome?

A

Ulnar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Cubital tunnel syndrome symptoms

A

Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant.
Patients may also develop weakness and muscle wasting
Pain worse on leaning on the affected elbow
Often a history of osteoarthritis or prior trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Cubital tunnel syndrome management

A

Avoid aggravating activity
Physiotherapy
Steroid injections
Surgery in resistant cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Diet encouraged in kidney disease

A

Low protein
Low phosphate
Low sodium
Low potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What causes hepatic encephalopathy?

A

Raised ammonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Grading of hepatic encephalopathy

A

Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Treatment of hepatic encephalopathy

A

Lactulose (promotes ammonia excretion)

Rifaximin (prophylaxis by modulating gut bacteria to reduce ammonia production)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Thyroid cancer management

A

total thyroidectomy
followed by radioiodine (I-131) to kill residual cells
yearly thyroglobulin levels to detect early recurrent disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Aetiology of ventricular septal defect

A

Congenital VSDs are often association with chromosomal disorders (e.g. Down’s syndrome, Edward’s syndrome, Patau syndrome, cri-du-chat syndrome)
Congenital infections
Acquired causes (e.g. post-myocardial infarction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Symptoms of rheumatic fever

A 
Evidence of recent streptococcal infection (swab or antigen test for group A strep)
Erythema marginatum
Polyarthritis
Carditis and valvulitis
Raised ESR or CRP
Pyrexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Management of rheumatic fever

A

Antibiotics (oral penicillin V)
Anti-inflammatories: NSAIDs are first-line
Treatment of any complications that develop e.g. heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Common CNS complication of HIV

A

Toxoplasmosis lesions (symptoms of headache, confusion, drowsiness)
Lymphoma lesions (symptoms of headache, confusion, drowsiness)
TB
Encephalitis
Meningitis (often caused by Cryptococcus)
Progressive multifocal leukoencephalopathy (symptoms of behavioural changes, speech, motor, visual impairment)
AIDS dementia complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Toxoplasmosis symptoms

A

Headache, confusion, drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Imaging in toxoplasmosis

A

Multiple ring enhancing lesions on CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

CNS lymphoma symptoms

A

Headache, confusion, drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

CNS lymphoma imaging

A

Single / multiple lesions that show solid enhancement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Toxoplasmosis treatment

A

Medical (sulfadiazine and pyrimethamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

CNS lymphoma management

A

Steroids
Chemo
May also have radiotherapy
Small tumours may consider surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What does CNS TB look like on imaging?

A

Single ring enhancing lesion on CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

What is Progressive multifocal leukoencephalopathy (PML)

A

Widespread demyelination of CNS tissue in lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Imaging of Progressive multifocal leukoencephalopathy (PML)

A

CT: single or multiple lesions, no mass effect, don’t usually enhance. MRI is better - high-signal demyelinating white matter lesions are seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

Imaging in AIDS dementia complex

A

Cortical and subcortical atrophy seen on CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

First line antibiotic in pregnant women with a UTI

A

Nitrofurantoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Zone of the adrenal gland where cortisol is produced

A

Zona fasciculata

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

What is carcinoid syndrome?

A

When a tumour secretes hormones e.g. serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Symptoms of carcinoid syndrome

A

Diarrhoea, flushing, SOB, itching, others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

Most common site of carcinoid tumours

A

GI tract, though they often have liver mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Diagnosis of carcinoid syndrome

A

CT
Octreoscan (binds to increased somatostatin receptors)
Urine 5HIAA
Niacin deficiency seen on bloods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

Treatment of carcinoid syndrome

A

Reduce alcohol and stress (reduces hormone release)
Somatostatin analogue e.g. octreotide to reduce hormone release
Surgery on tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

Treatment of testicular torsion

A

Treatment is with surgical exploration. If a torted testis is identified then both testis should be fixed as the condition of bell clapper testis is often bilateral.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

Does hydrocele trans illuminate?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Investigation of hydrocele

A

USS to exclude tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Causes of normal anion gap acidosis

A 
Gastrointestinal base loss e.g. diarrhoea
Renal tubular acidosis
Drugs: e.g. acetazolamide
Ammonium chloride injection
Addison's disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Causes of raised anion gap acidosis

A

Lactate: shock, hypoxia
Ketones: diabetic ketoacidosis, alcohol
Urate: renal failure
Acid poisoning: salicylates, methanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

Which muscle is responsible for causing flexion of the distal interphalangeal joint?

A

Flexor digitorum profundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

Symptoms of opioid overdose

A 
Tachycardia
Constricted pupils 
Psychotic symptoms
Cardiac arrest
Seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

What type of drug is heroin?

A

Opioid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

Management of opioid overdose

A

Naloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

Management of benzodiazepine overdose

A

Supportive care

flumazenil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

Management of amphetamine / cocaine overdose

A

Benzodiazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

Use of disulfirazem

A

Chronic alcohol use

Causes unpleasant symptoms with alcohol do discourage alcohol intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

Treatment of salicylate poisining

A

urinary alkalinization with IV bicarbonate

haemodialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

Management of lithium overdose

A

Fluids

Dialysis if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

Reversal of warfarin

A

Vitamin K, prothrombin complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

Reversal of heparin

A

Protamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

Management of ethylene glycol (antifreeze) overdose

A

Fomepizole now first line
Ethanol
Dialysis if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

Management of methanol poisoning

A

Fomepizole or Ethanol

Dialysis if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

Management of digoxin overdose

A

Digoxin-specific antibody fragments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

Management of carbon monoxide poisinging

A

High flow / hyperbaric O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Investigation of choice for bowel ischaemia

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Symptoms of chronic mesenteric ischaemia

A

Colickly, intermittent abdominal pain occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

Definition of ischaemic colitis

A

acute but transient compromise in the blood flow to the large bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

Management of ischaemic colitis

A
  • usually supportive
  • surgery may be required in a minority of cases if conservative measures fail. Indications would include generalised peritonitis, perforation or ongoing haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

Management of Raynauds

A 
all patients with suspected secondary Raynaud's phenomenon should be referred to secondary care (as it is associated with may underlying conditions)
first-line: calcium channel blockers e.g. nifedipine
IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months
202
Q

Definition of malignant otitis externa

A

Uncommon type of otitis externa that is found in immunocompromised individuals (90% cases found in diabetics) most commonly caused by Pseudomonas aeruginosa

203
Q

Symptoms of malignant otitis externa

A

Diabetes (90%) or immunosuppression (illness or treatment-related)
Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea

204
Q

Treatment of malignant otitis externa

A

non-resolving otitis externa with worsening pain should be referred urgently to ENT
Intravenous antibiotics that cover pseudomonal infections

205
Q

Nerve damaged in claw hand

A

Ulnar

206
Q

Lifestyle modifications in gout

A

Weight loss
avoid food high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products
Reduce alcohol and avoid in an acute attack
vitamin C

207
Q

Cholesteatoma risk factors

A

Adolescents

Cleft lip

208
Q

Cholesteatoma symptoms

A

foul-smelling, non-resolving discharge
hearing loss
tympanic membrane crusting on otoscopy

209
Q

What is cholesteatoma

A

Cholesteatoma is a non-cancerous growth of squamous epithelium in the ear

210
Q

Management of cholesteatoma

A

ENT referral for surgical removal

211
Q

Symptoms of granulomatosis with polyangiitis

A

upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulonephritis

212
Q

Investigations in granulomatosis with polyangiitis

A

cANCA positive in > 90%, pANCA positive in 25%
chest x-ray: wide variety of presentations, including cavitating lesions
renal biopsy: epithelial crescents in Bowman’s capsule

213
Q

Management of granulomatosis with polyangiitis

A

steroids
cyclophosphamide (90% response)
plasma exchange

214
Q

Cause of S3 heart sound

A

considered normal if < 30 years old

heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis and mitral regurgitation

215
Q

Causes of S4 heart sound

A

aortic stenosis, HOCM, hypertension

216
Q

Risk factors for bladder cancer

A

age 50-80
male
smoking
schistosomiasis

217
Q

Most common bladder cancer

A

Transitional cell carcinoma

218
Q

Bladder cancer symptoms

A

Haematuria (painless)

219
Q

Bladder cancer diagnosis

A

Cystoscopy and biopsy

MRI / CT for staging

220
Q

Management of bladder cancer

A

Trans urethral resection (low grade)
Intravesical chemo
Surgery
Radiotherapy

221
Q

Virus that causes hand foot and mouth disease

A

Coxsackie A

222
Q

Advice to patients with shingles

A

Loose fitting clothing, creams and cool ice packs as symptom relief
Contagious until lesions crusted over

223
Q

Pain management in shingles

A

paracetamol and NSAIDs are first-line
if not responding then use of neuropathic agents (e.g. amitriptyline) can be considered
oral corticosteroids if the pain is severe and not responding

224
Q

Complications of shingles

A

Post-herpetic neuralgia

Ramsay Hunt syndrome

225
Q

Risk factors for pericarditis

A 
viral infections (Coxsackie)
tuberculosis
uraemia (causes 'fibrinous' pericarditis)
trauma
post-myocardial infarction, Dressler's syndrome
connective tissue disease
hypothyroidism
malignancy
226
Q

Key investigations in pericarditis

A

ECG and echo

227
Q

Inheritance of Fabry disease

A

X-linked recessive

228
Q

Symptoms of Fabry disease

A 
burning pain/paraesthesia in childhood
angiokeratomas
lens opacities
proteinuria
early cardiovascular disease
229
Q

Management of idiopathic pulmonary hypertension

A

Test response to vasodilators. If effective use these

If ineffective use other medications. Consider heart-lung transplant if severe

230
Q

Risk factors for idiopathic pulmonary hypertension

A

Female
30s - 50s
Genetic in 10%

231
Q

Symptoms of idiopathic pulmonary hypertension

A

progressive exertional dyspnoea is the classical presentation
other possible features include exertional syncope, exertional chest pain and peripheral oedema
cyanosis
right ventricular heave, raised JVP, tricuspid regurgitation

232
Q

Diagnosis of heart failure

A

Take BNP.
If high, echo within 2 weeks
If raised, echo within 6 weeks

233
Q

Pathogen causing bronchiolitis

A

RSV

234
Q

Pathogen causing croup

A

Parainfluenza virus

235
Q

Congenital syphilis symptoms

A

blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
rhagades (linear scars at the angle of the mouth)
keratitis
saber shins
saddle nose
deafness

236
Q

Symptoms of bubonic plague

A

Headache, fever, weakness, painful lymph nodes 3-7 days after rodent exposure

237
Q

Treatment of bubonic plague

A

Abx

238
Q

Causative organism in bubonic plague

A

Yersinia pestis

239
Q

Symptoms of cat scratch disease

A

Enlarged lymph nodes after cat scratch exposure

240
Q

Causative organism in cat scratch disease

A

Bartonella henselae

241
Q

Pathophysiology of rheumatic fever

A

follows an immunological reaction to recent (2-6 weeks ago) Streptococcus pyogenes infection.

242
Q

Dilated cardiomyopathy symptoms

A

right ventricular failure, dyspnoea, pulmonary oedema, and atrial fibrillation.

243
Q

Restrictive cardiomyopathy symptoms

A

right heart failure signs predominate: raised JVP, hepatomegaly, oedema, ascites.

244
Q

Atrial myxoma symptoms

A

dizziness, fainting and palpitations, due to obstruction of the conductive pathway.

245
Q

Murmur associated with hypertrophic cardiomyopathy

A

Ejection systolic

246
Q

Is there a vaccine for Hep A?

A

Yes

247
Q

Typhoid symptoms

A 
headache, fever, arthralgia
bradycardia
abdo pain or distension
constipation
rose spots on trunk
248
Q

Typhoid complications

A 
osteomyelitis (especially in sickle cell disease)
GI bleed/perforation
meningitis
cholecystitis
chronic carriage (1%)
249
Q

Antibody associated with Sjogrens

A

Anti-La

250
Q

Symptoms of lithium overdose

A 
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
251
Q

Nerve at risk of damage in inguinal hernia repair surgery

A

Ilioinguinal

252
Q

How to distinguish vestibular neuritis form labyrinthitis

A

vestibular neuritis: only the vestibular nerve is involved, hence there is no hearing impairment
Labyrinthitis: both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment.

253
Q

Age group most commonly affected by labyrinthitis

A

Middle age

254
Q

Symptoms of labyrinthitis

A

acute onset of:
vertigo (not triggered by movement but exacerbated by movement)
nausea and vomiting
sensorineural hearing loss (unilateral or bilateral with varying severity)
tinnitus
preceding or concurrent symptoms of upper respiratory tract infection
spontaneous unidirectional horizontal nystagmus towards the unaffected side
gait disturbance (may fall towards the affected side)

255
Q

Management of labyrinthitis

A

episodes are usually self-limiting

prochlorperazine or antihistamines may help reduce the sensation of dizziness

256
Q

Treatment for contact dermatitis

A

Topical steroid

257
Q

Symptoms of reactive arthritis

A

Conjunctivitis, urethritis and arthritis

258
Q

Typical age and gender of reactive arthritis

A

Young males

259
Q

What joint are most commonly affected in reactive arthritis?

A

Lower limbs

260
Q

Symptoms of scleroderma / systemic sclerosis

A

Raynaud phenomenon, skin thickening, calcinosis and telangectasia.

261
Q

Medication used in variceal bleeding

A

Terlipressin

Prophylactic abx if they have cirrhosis

262
Q

Typical patients with intususseption

A

Boys more than twice as likely as girls

6-18 months

263
Q

Symptoms of intususseption

A

paroxysmal abdominal colic pain (characteristically draw their knees up and turn pale)
vomiting
bloodstained stool - ‘red-currant jelly’ - is a late sign
sausage-shaped mass in the right upper quadrant

264
Q

Key investigation in intususseption

A

USS

265
Q

Management of intususseption

A

the majority of children can be treated with reduction by air insufflation under radiological control
if this fails, or the child has signs of peritonitis, surgery is performed

266
Q

Endocrine effects of renal cell carcinoma

A

endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH

267
Q

Renal cell cancer management

A

Total / partial nephrectomy if localised

Chemo / biological therapy if higher grade

268
Q

Most common thyroid cancer

A

Papillary

269
Q

Prognosis in papillary thyroid cancer

A

Good

270
Q

Typical demographic of papillary thyroid cancer

A

Young females

271
Q

Management of papillary / follicular thyroid cancer

A

total thyroidectomy
followed by radioiodine (I-131) to kill residual cells
yearly thyroglobulin levels to detect early recurrent disease

272
Q

Hypokalaemia ECG

A 
U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT
273
Q

Most common causative agent of empyema

A

Strep pneumoniae

274
Q

Symptoms of pemphigus vulgaris

A

Mouth ulcers
Skin blisters - flaccid, easily ruptured vesicles and bullae, typically painful but not itchy, may develop months after the initial mucosal symptoms

275
Q

Treatment of pemphigus vulgaris

A

Steroids

Immunosuppressants

276
Q

Symptoms of extrinsic allergic alveolitis

A

acute (occurs 4-8 hrs after exposure): dyspnoea, dry cough, fever
chronic (occurs weeks-months after exposure): lethargy, dyspnoea, productive cough, anorexia and weight loss

277
Q

Investigation of extrinsic allergic alveolitis

A

imaging: upper/mid-zone fibrosis
bronchoalveolar lavage: lymphocytosis
serologic assays for specific IgG antibodies
blood: NO eosinophilia

278
Q

Management of extrinsic allergic alveolitis

A

Avoid precipitant

Oral steroids

279
Q

What is megaloblastic macrocytic anaemia?

A

RBCs not fully formed

280
Q

Symptoms of vitamin B12 deficiency

A

macrocytic anaemia
sore tongue and mouth
neurological symptoms
the dorsal column is usually affected first (joint position, vibration) prior to distal paraesthesia
neuropsychiatric symptoms: e.g. mood disturbances

281
Q

Treatment of B12 deficiency without neurological deficit

A

IM cobalamin 3 times per week for 2 weeks then 3 monthly

282
Q

Treatment for B12 deficiency with folate deficiency

A

Treat B12 deficiency first

283
Q

Symptoms of B6 deficiency

A

Peripheral neuropathy

Sideroblastic anaemia Convulsions

284
Q

Indication for pentoxifylline

A

Venous ulcer

285
Q

Definition of gastroschisis

A

Gastroschisis describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord

286
Q

Management of gastroschisis

A

vaginal delivery may be attempted

newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours

287
Q

Definition of exomphalos

A

abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum

288
Q

Management of exomphalos

A

Caesarian section
Staged repair where first a shell is formed around exposed bowel then a later operation returns it to the abdominal cavity

289
Q

What is anti phospholipid syndrome?

A

an autoimmune, hypercoagulable state

290
Q

Complications of anti phospholipid syndrome

A

miscarriage, stillbirth, preterm delivery, or severe preeclampsia

In rare cases, APS leads to rapid organ failure due to generalised thrombosis; this is termed ‘catastrophic antiphospholipid syndrome’ (CAPS) and is associated with a high risk of death.

291
Q

Diagnosis of anti phospholipid syndrome

A

one clinical event, i.e. thrombosis or pregnancy complication, and two positive blood tests spaced at least 3 months apart. These antibodies are: lupus anticoagulant, anti-cardiolipin and anti-β2-glycoprotein

292
Q

What is primary anti phospholipid syndrome

A

Primary antiphospholipid syndrome occurs in the absence of any other related disease

293
Q

What is secondary anti phospholipid syndrome

A

Secondary antiphospholipid syndrome occurs with other autoimmune diseases, such as systemic lupus erythematosus (SLE)

294
Q

Management of anti phospholipid syndrome

A

Heparin

295
Q

Symptoms of anti thrombin deficiency

A

Hypercoagulability

296
Q

Aetiology of anti thrombin deficiency

A

Autosomal dominant

297
Q

Symptoms of alpha-1 anti trypsin deficiency

A

lungs: panacinar emphysema, most marked in lower lobes
liver: cirrhosis and hepatocellular carcinoma in adults, cholestasis in children

298
Q

Lymphatic drainage of anal canal below pectinate line

A

Superficial inguinal nodes

299
Q

Lymphatic drainage of perineum, scrotum and vagina

A

Superficial inguinal nodes

300
Q

Lymphatic drainage of testes

A

Para-aortic lymph nodes

301
Q

Lymphatic drainage of ovaries

A

Para-aortic lymph nodes

302
Q

Lymphatic drainage of kidneys and adrenal glands

A

Para-aortic nodes

303
Q

Lymphatic drainage of anal canal above pectinate line

A

Internal iliac lymph nodes

304
Q

Lymphatic drainage of lower rectum

A

Internal iliac lymph nodes

305
Q

Lymphatic drainage of many pelvic structures

A

Internal iliac lymph nodes

306
Q

Lymphatic drainage of duodenum

A

Superior mesenteric nodes

307
Q

Lymphatic drainage of jejunum

A

Superior mesenteric nodes

308
Q

Lymphatic drainage of colon

A

Inferior mesenteric nodes

309
Q

Lymphatic drainage of upper rectum

A

Inferior mesenteric nodes

310
Q

Lymphatic drainage of stomach

A

Coeliac nodes

311
Q

Most common renal stones

A

Calcium oxalate

312
Q

Risk factors for calcium oxalate stones

A

High calcium is the key risk factor
Can be idiopathic
Other causes include antifreeze ingestion, vitamin C abuse, hypocitraturia and malabsorption (e.g. Crohn disease)

313
Q

Appearance of calcium oxalate stones on imaging

A

Radio-opaque

314
Q

Risk factor for uric acid stones

A

High cell turnover e.g. malignancy

315
Q

Appearance of uric acid stones on imaging

A

Radio lucent

316
Q

Risk factor for calcium phosphate stones

A

Renal tubular acidosis

317
Q

Appearance of calcium phosphate stones on imaging

A

Radio opaque

318
Q

Risk factor for struvite stones

A

Certain infections

319
Q

Appearance of struvite stones on imaging

A

Radio opaque

320
Q

Which lymphoma is associated with Reed-Sternberg cells?

A

Hodgkin lymphoma

321
Q

Which lymphoma is associated with alcohol pain

A

Hodgkin lymphoma

322
Q

Blood tests in Hodgkin lymphoma

A

Anaemia, eosinophilia, raised LDH

323
Q

Aetiology of maple syrup urine disease

A

Autosomal recessive

324
Q

Management of maple syrup urine disease

A

restricting leucine, isoleucine and valine in the diet

325
Q

Complications of maple syrup urine disease

A

Ketoacidosis, neurological defects

326
Q

Causes of massive splenomegaly

A 
Myelofibrosis
Chronic myeloid leukaemia
Visceral leishmaniasis (kala-azar)
Malaria
Gaucher's syndrome
327
Q

Causes of non-massive splenomegaly

A

Any causes of massive splenomegaly plus…
Portal hypertension e.g. secondary to cirrhosis
Lymphoproliferative disease e.g. CLL, Hodgkin’s
Haemolytic anaemia
Infection: hepatitis, glandular fever
Infective endocarditis
Sickle-cell*, thalassaemia
Rheumatoid arthritis (Felty’s syndrome)

328
Q

APTT in haemophilia

A

Raised

329
Q

PT in haemophilia

A

Normal

330
Q

APTT in von Willebrand disease

A

Raised

331
Q

PT in von Willebrand disease

A

Normal

332
Q

APTT in vitamin K deficiency

A

Raised

333
Q

PT in vitamin K deficiency

A

Raised

334
Q

Echo findings in atrial myxoma

A

pedunculated heterogeneous mass typically attached to the fossa ovalis region of the interatrial septum

335
Q

Symptoms of atrial myxoma

A

systemic: dyspnoea, fatigue, weight loss, pyrexia of unknown origin, clubbing
emboli
atrial fibrillation

336
Q

What does interferon-gamma release assay test for?

A

Latent TB

337
Q

Why is irradiated blood useful?

A

It has fewer immune cells left so reduces risk of graft vs host disease

338
Q

Indications for irradiated blood products

A

Low immunity eg neonates or transplant patients

339
Q

What is graft vs host disease?

A

Immune cells in transplanted tissue begins to attack the host tissue

340
Q

Criteria for medical miscarriage

A

Foetal size less than 35mm
Low foetal heartbeat
hCG less than 1500

341
Q

What is courvousier’s sign?

A

a palpable gallbladder in the presence of painless jaundice is unlikely to be gallstones

Pancreatic or gall bladder malignancy is more likely

342
Q

Main risk factor for cholangiocarcinoma

A

PSC

343
Q

Symptoms of cholangiocarcinoma

A 
Persistent biliary colic symptoms
Anorexia and weight loss
Jaundice
Painless RUQ mass
Periumbilical / supraclavicular lymphadenopathy
344
Q

Management of TACO

A

Stop transfusion
O2
Diuretics

345
Q

Symptoms of TRALI

A

Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension

346
Q

Management of TRALI

A

Stop the transfusion

Oxygen and supportive care

347
Q

Symptoms of acute haemolytic transfusion reaction

A

fever, abdominal and chest pain, agitation and hypotension within a few minutes of transfusion

348
Q

Management of acute haemolytic transfusion reaction

A

Stop transfusion
Fluid resuscitation
Supportive management

349
Q

Murmur in HOCM

A

ejection systolic murmur that increases with Valsalva manoeuvre and decreases on squatting
May have mitral regurgitation

350
Q

ECG in HOCM

A

left ventricular hypertrophy
non-specific ST segment and T-wave abnormalities, progressive T wave inversion may be seen
deep Q waves

351
Q

Who should be screened for risk of osteoporosis?

A

Women over 65
Men over 75
Younger adults if there are other risk factors

352
Q

Scoring systems to estimate 10-year risk of fragility fractures

A

FRAX

Qfracture

353
Q

First line in maturity onset diabetes of the young

A

Sulfonylurea

354
Q

Pathophysiology of maturity onset diabetes of the young

A

Genetic defect reduces insulin secretion

355
Q

Pathophysiology of rheumatoid heart fever

A

antibodies to the bacteria causing a pharyngeal infection react with the cardiac myocyte antigen resulting in valve destruction

356
Q

Organism responsible for rheumatic heart fever

A

Strep pyogenes

357
Q

Diagnosis of rheumatic fever

A

Evidence of recent streptococcal infection (throat swab / antigens / antibodies)
2 major criteria (erythema marginatum, polyarthritis, carditis and valvulitis, SC nodules)
Or 1 major and 2 minor criteria (raised ESR or CRP, pyrexia, arthralgia, prolonged PR interval)

358
Q

Management of rheumatic fever

A

Antibiotics (oral penicillin V)
Anti inflammatory (NSAIDS first line)
Treatment of cardiac complications

359
Q

Causes of disseminated intravascular coagulation

A 
Infection
Malignancy
Trauma e.g. major surgery, burns, shock, dissecting aortic aneurysm
Liver disease
Obstetric complications
360
Q

Blood test results in disseminated intravascular coagulation

A

Prolonged clotting time
Decreased fibrinogen
Low platelets
Increased fibrinogen breakdown products

361
Q

Symptoms of congenital adrenal hyperplasia

A

Depends on the exact type but typically consists of genital ambiguity, precocious puberty and hypertension

362
Q

What age group is intraventricular haemorrhage associated with?

A

Neonates

363
Q

Treatment of intraventricular haemorrhage

A

Supportive. Shunting if there’s hydrocephalus and raised ICP

364
Q

Pathophysiology of paroxysmal nocturnal haemoglobinuria

A

Intravascular haemolysis leads to hemolytic anemia, dark urine in the morning, pancytopenia, and venous thrombosis

365
Q

Management of paroxysmal nocturnal haemoglobinuria

A

Replacement of blood products,anticoagulants, stem cell transplant

366
Q

What is Chvostek’s sign?

A

the facial twitch obtained by tapping the distribution of the facial nerve in front of the tragus. It is caused by mechanical irritability of peripheral nerves. It is indicative of hypocalcemia and is the most reliable test for hypocalcemia.

367
Q

Blood tests in hypoparathyroidism

A

Low PTH, low calcium, high phosphate

368
Q

Symptoms of hypocalcaemia

A

tetany: muscle twitching, cramping and spasm
perioral paraesthesia
Trousseau’s sign: carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic
Chvostek’s sign: tapping over parotid causes facial muscles to twitch
if chronic: depression, cataracts
ECG: prolonged QT interval

369
Q

What is trousseau’s sign and what does it suggest?

A

carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic
Hypocalcaemia

370
Q

What is pseudohypoparathyroidism?

A

Insensitivity to PTH

371
Q

Blood tests in pseudohypoparathyroisism

A

Low Ca
High phosphate
High PTH

372
Q

What is the S4 heart sounds caused by?

A

atrial contraction forces blood into a noncompliant left ventricle

373
Q

Causes of S4 heart sounds

A

HOCM, HTN, aortic stenosis

374
Q

Treatment of dengue fever

A

Symptom control eg fluids and analgesia

375
Q

Symptoms of dengue fever

A 
causes headache (often retro-orbital)
fever
myalgia
pleuritic pain
facial flushing (dengue)
maculopapular rash
376
Q

Features of excess acetylcholine

A 
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
377
Q

Symptoms of congenital rubella

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus arteriosus)
Glaucoma

378
Q

Symptoms of congenital toxoplasmosis

A

Cerebral calcification
Chorioretinitis
Hydrocephalus

379
Q

Arterial supply of parotid gland

A

Branch of external carotid

380
Q

Venous drainage of parotid gland

A

Retromandibular vein

381
Q

Lymphatic drainage of parotid gland

A

Deep cervical nodes

382
Q

What artery does the inferior rectal artery branch off?

A

Inferior mesenteric

383
Q

Causes of minimal change disease

A

Idiopathic
Drugs
Lymphoma
EBV

384
Q

Biopsy results in minimal change disease

A

electron microscopy shows fusion of podocytes and effacement of foot processes

385
Q

Prognosis in minimal change disease

A

Good, though relapse is common

386
Q

What movement is difficult in winged scapula?

A

Shoulder abduction

387
Q

Lymphatic drainage of ovaries

A

Para-aortic lymph nodes

388
Q

Lymphatic drainage of uterus

A

Mostly iliac lymph nodes

Some inguinal or para-aortic lymph nodes

389
Q

Lymphatic drainage of cervix

A

Internal and external iliac nodes and presacral nodes

390
Q

Symptoms of pernicious anaemia

A

Symptoms of anaemia
Neurological features (eg peripheral neuropathy, spinal cord degeneration and neuropsychiatric symptoms)
Mild jaundice

391
Q

What is a hypertrophic scar?

A

A scar with excess collagen leading to nodules within the wound boundary

392
Q

Complications of hypertrophic scars

A

Contractures

393
Q

What is a keloid scar?

A

A scar with excess collagen that extends beyond the wound edge

394
Q

Organism most common in infective endocarditis following dental infection

A

Strep viridans eg strep mitis

395
Q

What cancer is Rb gene associated with?

A

Retinoblastoma

396
Q

What is cushings disease?

A

Pituitary daemons leads to excess ACTH and excess cortisol

397
Q

Most common cause of endogenous excess of cortisol

A

Pituitary adenoma

398
Q

Management of fistulae

A

They will often heal on their own so conservative measures such as skin protection and nutritional support are the main management

399
Q

What drug is used to treat iron overload in haemochromatisis?

A

Desferrioxamine

400
Q

Symptoms of CML

A

anaemia: lethargy
weight loss and sweating are common
splenomegaly may be marked → abdo discomfort
an increase in granulocytes at different stages of maturation +/- thrombocytosis
decreased leukocyte alkaline phosphatase
may undergo blast transformation (AML in 80%, ALL in 20%)

401
Q

Early X-ray finding in ankylosing spondylitis

A

Sacroiliitis

402
Q

Arterial supply of rectum

A

Superior rectal artery

403
Q

Venous drainage of rectum

A

Superior rectal vein

404
Q

Lymphatic drainage of rectum

A

Mesorectal lymph nodes (superior to dentate line)
Internal iliac and then para-aortic nodes
Inguinal nodes (inferior to dentate line)

405
Q

Symptoms of congenital CMV

A

fever, jaundice, hepatosplenomegaly, growth retardation, hearing loss

406
Q

What is factor V Leiden?

A

Inherited condition that increases risk of clots

407
Q

CLL complications

A

anaemia
hypogammaglobulinaemia leading to recurrent infections
warm autoimmune haemolytic anaemia in 10-15% of patients
transformation to high-grade lymphoma (Richter’s transformation)

408
Q

What is hirschprung’s disease?

A

Failure of neural crest cells to migrate to Auerbach’s and Meissner’s plexus means part of the bowel isn’t innervated

409
Q

Symptoms of Hirschprung’s disease

A

neonatal period e.g. failure or delay to pass meconium

older children: constipation, abdominal distension

410
Q

Investigation of Hirschprung’s disease

A

abdominal x-ray

rectal biopsy: gold standard for diagnosis

411
Q

Management of Hirschprung’s disease

A

initially: rectal washouts/bowel irrigation

definitive management: surgery to affected segment of the colon

412
Q

What is horseshoe kidney?

A

The kidneys are fused at their inferior pole causing there to be just one long kidney that it located more inferiorly

413
Q

Trigger finger symptoms

A

Pain
Stiffness
Locking on flexion that causes difficulty with extension

414
Q

Risk factors for dupytrens contracture

A 
Older Male
Family history 
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
415
Q

Symptoms of dupuytren’s contracture

A

Fixed flexion of palm, particularly of the 4th and 5th finger
May develop nodules on the affected fingers

416
Q

Management of Dupuytren’s contracture

A

consider surgical treatment of Dupuytren’s contracture when the metacarpophalangeal joints cannot be straightened and thus the hand cannot be placed flat on the table

417
Q

What is Gardners syndrome a variant of?

A

FAP

418
Q

Symptoms of acute graft vs host disease

A

Painful maculopapular rash (often neck, palms and soles), which may progress to erythroderma or a toxic epidermal necrolysis-like syndrome
Jaundice
Watery or bloody diarrhoea
Persistent nausea and vomiting

419
Q

Symptoms of chronic graft vs host disease

A

Skin: Many manifestations including poikiloderma, scleroderma, vitiligo, lichen planus
Eye: Often keratoconjunctivitis sicca, also corneal ulcers, scleritis
GI: Dysphagia, odynophagia, oral ulceration, ileus. Oral lichenous changes are a characteristic early sign (2)
Lung: my present as obstructive or restrictive pattern lung disease

420
Q

Management of graft vs host disease

A

Steroids first line

Other immunosuppressants second line

421
Q

What is Eisenmengers syndrome?

A

Left-to-right shunt is reversed due to pulmonary hypertension

422
Q

Symptoms of venous sinus thrombosis

A

Headache

Seizures

423
Q

Aetiology of Ehlers Danlos syndrome

A

Autosomal dominant

424
Q

Symptoms and complications of Ehlers Danlos syndrome

A

elastic, fragile skin
joint hypermobility: recurrent joint dislocation
easy bruising
aortic regurgitation, mitral valve prolapse and aortic dissection
subarachnoid haemorrhage (due to Berry aneurism rupture)
angioid retinal streaks

425
Q

Most common site of ectopic testes

A

Superficial inguinal pouch

426
Q

Management of undescended testes

A

Place in the scrotum at 1 year of age (before this point they may descend spontaneously)

427
Q

Testicular examination in testicular torsion

A

Enlarged and tender testis

428
Q

What is an ectopic testis?

A

Testis laying outside the path of normal descent

429
Q

What muscles does the axillary nerve innervate

A

Deltoid abs teres minor

430
Q

What clotting factor is deficient in haemophilia A?

A

VIII

431
Q

What clotting factor is deficient in haemophilia B?

A

IX

432
Q

What does APTT represent?

A

Intrinsic and common pathways

433
Q

What does prothrombin time represent?

A

Extrinsic and common pathways

434
Q

What does bleeding time represent?

A

Platelet function

435
Q

Blood test results in haemophilia (APTT, PT, Bleeding time)

A

Prolonged APTT

Normal PT and bleeding time

436
Q

HPV strains associated with genital warts

A

6 and 11

437
Q

What is Zollinger Ellison syndrome?

A

Zollinger-Ellison syndrome is condition characterised by excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas.

438
Q

Symptoms of zollinger ellison syndrome

A

multiple gastroduodenal ulcers
diarrhoea
malabsorption

439
Q

What is the best test to diagnose Zollinger Ellison syndrome?

A

Fasting gastrin levels

440
Q

What is a cholesteatoma?

A

A non cancerous growth of squamous epithelium in the ear

441
Q

What is myringitis?

A

Condition associated with otitis externa whereby cysts form on the tympanic membrane

442
Q

Management and complications of cholesteatoma

A

ENT referral for consideration of surgical removal.

Complications include erosion of the ossicles

443
Q

Management of intususseption

A

the majority of children can be treated with reduction by air insufflation under radiological control, which is now widely used first-line compared to the traditional barium enema
if this fails, or the child has signs of peritonitis, surgery is performed

444
Q

Symptoms of intususseption

A

paroxysmal abdominal colic pain
during paroxysm the infant will characteristically draw their knees up and turn pale
vomiting
bloodstained stool - ‘red-currant jelly’ - is a late sign
sausage-shaped mass in the right upper quadrant

445
Q

Which part of the cochlea does the stapes articulate with?

A

Oval window

446
Q

What is a smiths fracture?

A

Fracture of the distal radius, distal fragment is displaced volarly

447
Q

What is a Colles fracture?

A

Fracture of the distal radius, distal fragment is displaced posteriorly

448
Q

What is a monteggia fracture?

A

Fracture of the proximal third of the ulna. The proximal head of the radius becomes dislocated

449
Q

What is a Galeazzi fracture?

A

Fracture of the distal third of the radius The distal radioulnar joint becomes dislocated

450
Q

Symptoms of graft vs host disease

A

cholestasis and subsequent jaundice, a widespread rash and diarrhoea in many cases. It tends to occur during the year following transplant.

451
Q

What is hyper acute transplant rejection and what timescale does it occur in?

A

Type 2 hypersensitivity reaction due to preformed antibodies against ABO or HLA antigens within minutes to hours

452
Q

What is acute graft failure and what timescale does it occur within?

A

T cell mediated rejection due to ABO incompatibility within 6 months

453
Q

What is chronic graft failure and what timescale does it occur in?

A

T cell and antibody mediated mechanisms causing organ fibrosis after more than 6 months

454
Q

Management of acute graft failure

A

May be reversible with steroids and immunosuppressants

455
Q

What system is affected by schistosomiasis?

A

Urinary

456
Q

Calcium levels in primary hypercalcaemia

A

High

457
Q

Phosphate levels in primary hypercalcaemia

A

Low

458
Q

PTH levels in primary hypercalcaemia

A

Normal or raised

459
Q

Calcium in secondary hyperparathyroidism

A

Low or normal

460
Q

Phosphate in secondary hyperparathyroidism

A

Low or normal

461
Q

PTH in secondary hyperparathyroidism

A

High

462
Q

PTH in hypercalcaemia secondary to hyperthyroidism or malignancy

A

Low

463
Q

Venous drainage of adrenals

A

Left: left renal vein
Right: IVC

464
Q

Lymphatic drainage of tip of tongue

A

Sub mental nodes

465
Q

Venous drainage of mid tongue

A

Submandibular nodes

466
Q

Calcium in pagets

A

Normal

467
Q

Phosphate in pagets

A

Normal

468
Q

PTH in pagets

A

Normal

469
Q

ALP in pagets

A

High

470
Q

Lymphatic drainage of upper limb

A

Axillary nodes

471
Q

What is “hungry bone syndrome”?

A

A rare complication of hyperparathyroidism surgery whereby the reduced PTH causes hypocalcaemia as the bones were used to high PTH levels

472
Q

Where is McBurney’s point?

A

1/3 of the way along a line drawn from the Anterior Superior Iliac Spine to the Umbilicus

473
Q

What is McBurney’s point?

A

The point where most pain is elicited by pressure in acute appendicitis

474
Q

What is osteopetrosis?

A

rare disorder of defective osteoclast function resulting in failure of normal bone resorption, which results in dense, thick bones that are prone to fracture

475
Q

Definition of acute graft vs host disease

A

Is classically defined as onset within 100 days of transplantation
Usually affects the skin (>80%), liver (50%), and gastrointestinal tract (50%)

476
Q

Symptoms of acute graft vs host disease

A

Painful maculopapular rash (often neck, palms and soles), which may progress to erythroderma or a toxic epidermal necrolysis-like syndrome
Jaundice
Watery or bloody diarrhoea
Persistent nausea and vomiting
Can also present as a culture-negative fever

477
Q

Definition of chronic graft vs host disease

A

Classically occurs after 100 days following transplantation
Has a more varied clinical picture: often lung and eye involvement in addition to skin and GI, although any organ system may be involved

478
Q

Symptoms of chronic graft vs host disease

A

Skin: Many manifestations including poikiloderma, scleroderma, vitiligo, lichen planus
Eye: Often keratoconjunctivitis sicca, also corneal ulcers, scleritis
GI: Dysphagia, odynophagia, oral ulceration, ileus. Oral lichenous changes are a characteristic early sign (2)
Lung: my present as obstructive or restrictive pattern lung disease

479
Q

Treatment of graft vs host disease

A

Steroids first line

Other immunosuppressants if steroids ineffective

480
Q

B12 deficiency symptoms

A

Macrocytic anaemia
Sore tongue and mouth
Neurological symptoms
Neuropsychological symptoms eg mood disturbance

481
Q

Phaeochromocytoma symptoms

A

Flushing, headache, palpitations, resistant hypertension

482
Q

Nerve affected if there is hip abduction, foot drop and loss of sensation over the sole of the foot

A

L5

483
Q

Nerve affected if there is reduced sensation over the inguinal area and reduced power in hip flexion

A

L1

484
Q

Nerve affected if there is reduced sensation on the anterior thigh and reduced hip flexion

A

L2

485
Q

Nerve affected if there is reduced sensation over the distal thigh and reduced hip flexion and knee extension

A

L3

486
Q

Nerve affected if there is no sensation over the medial lower leg and reduced knee extension and reduced dorsiflexion

A

L4

487
Q

Nerve affected if there is no sensation in posterolateral leg and lateral foot and reduced plantar flexion

A

S1

488
Q

Effect of PTH on phosphate

A

Reduces serum phosphate

489
Q

Complications of PVI

A

Tamponade, stroke, pulmonary vein stenosis

490
Q

Features of opioid misuse

A

Rinorrhoea, track marks, pinpoint pupils, drowsiness, watery eyes, yawning

491
Q

Causes of avascular necrosis

A

Long term steroids
Chemotherapy
Alcohol excess
Trauma

492
Q

Symptoms of avascular necrosis

A

Initially asymptomatic

493
Q

Investigation of avascular necrosis

A

X-ray may be normal initially

MRI investigation of choice

494
Q

Management of avascular necrosis

A

May need joint replacement

495
Q

When to give anti-D to Rh -ve mother

A 
Delivery of Rh +ve infant
Termination of pregnancy 
Miscarriage
Antepartum haemorrhage 
Amniocentesis, CVS or foetal blood sampling
Abdo trauma
496
Q

Where is McBurney’s point?

A

2/3 of the way from the umbilicus to the ASIS

497
Q

Treatment for urge incontinence

A

Bladder retraining

Second line is bladder stabilising drugs eg oxybutynin

498
Q

Treatment for stress incontinence

A

Pelvic floor muscle retraining

Second line is surgery or duloxetine

499
Q

Incontinence risk factors

A 
advancing age
previous pregnancy and childbirth
high body mass index
hysterectomy
family history
500
Q

What is overflow incontinence

A

due to bladder outlet obstruction, e.g. due to prostate enlargement

501
Q

Incontinence investigation

A

bladder diaries should be completed for a minimum of 3 days
vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
urine dipstick and culture
urodynamic studies

502
Q

Most common type of ovarian tumour

A

Serous

Progress Tests (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions