Passmed Year 3 Flashcards
1
Q
What do parietal cells secrete?
A
Gastrin
2
Q
Symptoms of brucellosis and key risk factors
A
Symptoms: Fluctuating fever, sweats, myalgia, arthralgia
Key risk factors: Animal contact, unpasteurised cheese
3
Q
Symptoms of echinococcosis and key risk factors
A
Symptoms: Liver cysts (or other cysts)
Key risk factor: Contact with sheep
4
Q
What body system does Cryptococcus neoformans infect?
A
CNS
5
Q
Symptom and epidemiology of enterobius vermicularis
A
Anal itching in children or contacts
6
Q
Malaria symptoms
A
Flu-like illness after 2 weeks. If untreated can cause respiratory distress, acidosis, raised ICP and organ failure
7
Q
Typical symptoms of candida skin infection
A
Red itchy rash in axilla or groin
8
Q
Typical symptoms of herpes skin infections
A
Localised blistering and vesicles
9
Q
What can patients with eczema get if they get a herpes skin infection?
A
Eczema herpeticum
10
Q
Scabies treatment
A
Permethrin cream (treat all household contacts)
11
Q
Arterial supply of the bladder
A
Superior and Inferior vesical arteries (branches of internal iliac)
12
Q
Venous supply of the bladder
A
Vesicoprostatic / vesicouterine plexus (drain into internal iliac)
13
Q
Lymphatic drainage of bladder
A
External and internal inguinal nodes
14
Q
Bladder innervation
A
Sympathetic: hypogastric plexus
Parasympathetic: pelvic splanchnic nerves
15
Q
Treatment for mild psoriasis
A
Topical corticosteroids
16
Q
MOA of dipyridamole
A
Anti-platelet
17
Q
Score used to assess severity of acute pancreatitis
A
Glasgow score (score >3 indicates ICU / HDU referral)
18
Q
Artery that supplies posterior stomach
A
Splenic artery
19
Q
Can CPAP be considered in acute heart failure?
A
Yes if not responding to treatment
20
Q
Contraindication of metoclopramide
A
Parkinson’s
21
Q
Mediator and examples of type I hypersensitivity reaction
A
IgE mediated
Anaphylaxis
Atopy e.g. asthma / hayfever
22
Q
Mediator and examples of type II hypersensitivity reaction
A
Cell mediated
Goodpastures
Pernicious anaemia
Pemphigus
23
Q
Mediator and examples of type III hypersensitivity reaction
A
Immune complex mediated
SLE
Post-streptococcal glomerulonephritis
24
Q
Mediator and examples of type IV hypersensitivity reaction
A
T cell mediated (delayed)
Scabies
MS
Allergic contact dermatitis
25
Mediator and examples of type V hypersensitivity reaction
Antibodies act as agonists / antagonists
Grave's disease
Myasthenia gravis
26
Two types of osteomyelitis
Haematogenous (spread via blood)
| Non-haematogenous (from adjacent soft tissue / trauma)
27
Risk factors for osteomyeltis
Haematogenous: children, sickle cell, IVDU, immune suppression, infective endocarditis
Non-haematogenous: ulcers, pressure sores, diabetes, peripheral arterial disease, surgery
28
Most common organism in osteomyelitis
Staph aureus
29
Most common organism in children with sickle cell and osteomyelitis
Salmonella
30
Investigation of osteomyelitis
MRI
31
MOA of cetuximab
Monoclonal antibody against epidermal growth factor receptor
32
Indications for cetuximab
Metastatic colorectal / head and neck cancer
33
Most common organism causing spontaneous bacterial pertonitis
E. coli
34
Symptoms of spontaneous bacterial peritonitis
Abdo pain, fever, ascites
35
Diagnosis of spontaneous bacterial peritonitis
Paracentesis - raised neutrophils and culture and organism
36
Management of spontaneous bacterial peritonitis
IV abx
37
Indications for abx prophylaxis against spontaneous bacterial peritonitis
Ascites and either previous spontaneous bacterial peritonitis or high protein on paracentesis or a high Child-Pugh score (>9)
38
Typical presentation of patient with taenia solium infection
Latin American patient with seizures and brain cysts on imaging
39
Symptoms of Lyme disease
Fever, arthralgia, headache, bullseye rash
40
What electrolyte imbalance can hypomagnesaemia cause?
Hypocalcaemia (unresponsive to treatment with calcium and vitamin D supplements)
41
Main cells that mediate organ rejection
Cytotoxic T cells
42
Symptoms of erysipelas
Elevated, well defined, painful rash
43
Risk factors for erysipelas
Reduced immunity, older age
44
Microorganism responsible for erysipelas
Strep pyogenes
45
Typical rash in ringworm
Red, circular, scaly, itchy rash
46
Organism that causes ringworm
Trichophyton rubrum
47
What is erysipelas?
Superficial, limited cellulitis
48
Treatment of erysipelas
Abx eg flucloxacillin
49
What should be co-prescribed with methotrexate?
Folic acid 5mg once per week (taken on a different day to the methotrexate)
50
What is Budd-Chiari syndrome?
Hepatic vein thrombosis
51
Risk factors for Budd-Chiari syndrome
polycythaemia
thrombophilia (e.g. protein C resistance / deficiency, antithrombin III deficiency)
pregnancy
combined oral contraceptive pill
52
Symptoms of Budd-Chiari syndrome
Abdo pain (sudden onset and severe)
Ascites
Tender hepatomegaly
Jaundice
53
Investigations of Budd-Chiari syndrome
Ultrasound with doppler flow
54
Surgical procedure in pyloric stenosis
Ramstedt's pyloromyotomy
55
Surgical procedure in achalasia
Heller's cardiomyotomy
56
Surgery to remove head of pancreas and duodenum
Whipple's procedure
57
What is achalasia?
Failure of peristalsis and lower oesophageal relaxation
58
Symptoms of achalasia
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
59
Investigation of achalsia
```
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)
```
60
First line treatment in achalasia
Balloon dilation
61
Most common type of renal cancer
Renal cell carcinoma
62
Key complications of acute pancreatitis
```
Peripancreatic fluid collections
Pseudocysts
Pancreatic necrosis
Abscess
Haemorrhage
```
63
What nerve supplies the medial leg and foot?
Saphenous nerve
64
What nerve supplies the lateral leg and foot?
Sural nerve
65
What nerve supplies the dorsum of the foot?
Superficial peroneal nerve
66
Inheritance of alpha-1 antitrypsin deficiency
Recessive / codominant
67
Pathophysiology of alpha - antitrypsin deficiency
Reduces the breakdown of neutrophil elastase, which leads to emphysema
68
Symptoms of alpha-1 antitrypsin deficiency
Emphysema / COPD symptoms (breathlessness, cough, frequent infections)
May have liver symptoms e.g. cholestasis, cirrhosis, carcinoma
69
Investigation of alpha-1 antitrypsin deficiency
A1AT concentrations
| spirometry: obstructive picture
70
Management of alpha-1 antitrypsin deficiency
no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery, lung transplantation
71
What does an ABG typically show in salicylate overdose?
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
72
What muscle flexes the proximal interphalangeal joints?
Flexor digitorum superficialis
73
What muscle flexes the diatal interphalangeal joints?
Flexor digitorum profundus
74
Monitoring of Barratt's oesophagus
for patients with metaplasia endoscopy is recommended every 3-5 years
75
Management of Barratt's oesophagus
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)
76
Blood supply to thyroid
Superior and inferior thyroid arteries
77
Venous drainage of thyroid
Superior, middle and inferior thyroid veins
78
Symptoms of strongyloides infection
Abdo pain, diarrhoea, papulovesicular lesions on the soles of his feet and an urticarial rash
79
How is strongyloides infection acquired?
Via soil
80
Symptoms of chlonorchis sinensis
abdominal pain, nausea, jaundice
81
Risk factor for chlonorchis sinensis
Undercooked fish
82
Risk factor for taenia solium
Undercooked pork
83
What system does taenia solium infect?
CNS
84
Symptoms of congenital ventricular septal defect
failure to thrive
features of heart failure (hepatomegaly, tachypnoea, tachycardia, pallor)
classically a pan-systolic murmur which is louder in smaller defects
85
Management of congenital ventricular septal defect
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
86
Complications of a ventricular septal defect
Aortic regurgitation
Infective endocarditis
Right sided hypertrophy and failure
Pulmonary hypertension
87
Indications for antibiotics in otitis media
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
88
Complications of otitis media
```
perforation of the tympanic membrane
hearing loss
labyrinthitis
mastoiditis
meningitis
brain abscess
facial nerve paralysis
```
89
Stanford classification of aortic dissection
Type A: Ascending aorta (2/3 of cases)
| Type B: Descending aorta (1/3 of cases)
90
Management of aortic dissection
```
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)
```
91
Complications of aortic dissection
aortic incompetence/regurgitation
MI
stroke
renal failure
92
Actions of biceps brachii
Elbow flexion
| Supination
93
Symptoms of an ovarian cyst
Asymptomatic
Pelvic pain
Bloating
Heavy periods
94
Management of inguinal hernias
Usually surgical mesh repair, even if asymptomatic
95
MOA of syntocinon
Synthetic oxytocin
96
Use of ergometrine
Can be used instead of oxytocin in the third stage of labour
97
Drugs used in medical abortion
Mifepristone and misoprostol
98
Most common type of testicular cancers
Germ cell tumours (e.g. seminomas)
99
Risk factors for testicular cancer
```
male aged 20-30
infertility (increases risk by a factor of 3)
cryptorchidism
family history
Klinefelter's syndrome
mumps orchitis
```
100
Symptoms of testicular cancer
a painless lump is the most common presenting symptom
hydrocele
pain (uncommon)
gynaecomastia
101
Testicular cancer tumour markers
AFP (60%)
LDH (40%)
hCG (20%)
102
Diagnosis of testicular cancer
Ultrasound first line
103
Treatment of testicular cancer
orchidectomy
| chemotherapy and radiotherapy may be given depending on staging and tumour type
104
Prognosis of testicular cancer
Good
105
What is the qSOFA score used for?
Predicting increased mortality in sepsis
106
What makes up the qSOFA score?
Resp rate >22
BP <100
Altered mental state
107
Symptoms of vitamin B3 deficiency
Dermatitis, dementia, diarrhoea
108
Symptoms of vitamin B2 deficiency
Angular stomatitis, keratitis, glossitis
109
Symptoms of vitamin B6 deficiency
anaemia, neuropathy, irritability and abdominal discomfort.
110
Symptoms of B12 deficiency
Anaemia and neurological symptoms
111
First line in neuropathic pain
Amitriptyline OR pregabalin
112
Second line in neuropathic pain
Amitriptyline AND pregabalin
113
First line in neuropathic pain in diabetes
Duloxetine
114
Metformin ADRs
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
115
Metformin contraindications
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
116
Dose of adrenaline in anaphylaxis in adults
500 micrograms (0.5ml 1 in 1,000) IM. Repeat every 5 minutes if necessary
117
Dose of adrenaline in anaphylaxis in children age 6-12
300 micrograms (0.3ml 1 in 1,000) IM. Repeat every 5 minutes if necessary
118
Dose of adrenaline in anaphylaxis in children under 6
150 micrograms (0.15ml 1 in 1,000) IM. Repeat every 5 minutes if necessary
119
Blood test that can be done to determine if someone has had an anaphylactic reaction
Serum tryptase
120
Indication for letrozole
Breast cancer in postmenopausal women
121
MOA of tamoxifen
Oestrogen receptor blocker
122
What is Ebstein's anomaly and what is the key risk factor?
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)
123
What is Wilson's disease
Accumulation of copper
124
Symptoms of Wilson's disease
```
liver: hepatitis, cirrhosis
neurological e.g. speech / behaviour problems
Kayser-Fleischer rings
renal tubular acidosis
haemolysis
blue nails
```
125
ECG in hypokalaemia
```
U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT
```
126
Causative organism for pneumonia in multiple otherwise fit patients who have developed pneumonia after air condition exposure.
Legionella
127
Most common causative agent of pneumonia in people with COPD
Haemophilus influenzae
128
Most common causative agent of pneumonia in alcoholoics
Klebsiella pneumoniae
129
Most common causative agent of pneumonia in patients with HIV
Pneumocystis jiroveci
130
Most common causative agent of pneumonia
Streptococcus pneumoniae
131
Pancreatic cancer symptoms
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)
132
Imaging tests in pancreatic cancer
ultrasound has a sensitivity of around 60-90%
| high-resolution CT scanning is the investigation of choice if the diagnosis is suspected
133
Management of pancreatic cancer
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
134
What is Rovsing's sign and what does it indicate?
more pain in RIF than LIF when palpating LIF
| appendicitis
135
Blood supply to prostate
Inferior vesical artery
136
Venous drainage of prostate
Prostatic venous plexus
137
Lymphatic drainage of prostate
Internal iliac nodes
138
Hyperaldosteronism investigation
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
139
Treatment of hyperaldosteronism
```
adrenal adenoma (Conn's syndrome): surgery
bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone
```
140
What is Conn's syndrome?
Adrenal adenoma leading to hyperaldosteronism
141
Screening for PCKD
Ultrasound in relatives
142
Diagnosis of oesophageal cancer
Endoscopy first line
| Then CT for staging
143
Management of oesophageal cancer
Surgery usually
| May have adjuvant chemo
144
Oesophageal cancer adenocarcinoma vs squamous cells cancer
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
145
Causes of jaundice in first 24 hours of life
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
146
Causes of neonatal prolonged jaundice (after 14 days)
```
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
congenital infections
```
147
Treatment of carpal tunnel syndrome
```
corticosteroid injection
wrist splints at night
surgical decompression (flexor retinaculum division)
```
148
What nerve is compressed in cubital tunnel syndrome?
Ulnar
149
Cubital tunnel syndrome symptoms
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
150
Cubital tunnel syndrome management
Avoid aggravating activity
Physiotherapy
Steroid injections
Surgery in resistant cases
151
Diet encouraged in kidney disease
Low protein
Low phosphate
Low sodium
Low potassium
152
What causes hepatic encephalopathy?
Raised ammonia
153
Grading of hepatic encephalopathy
Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma
154
Treatment of hepatic encephalopathy
Lactulose (promotes ammonia excretion)
| Rifaximin (prophylaxis by modulating gut bacteria to reduce ammonia production)
155
Thyroid cancer management
total thyroidectomy
followed by radioiodine (I-131) to kill residual cells
yearly thyroglobulin levels to detect early recurrent disease
156
Aetiology of ventricular septal defect
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)
157
Symptoms of rheumatic fever
```
Evidence of recent streptococcal infection (swab or antigen test for group A strep)
Erythema marginatum
Polyarthritis
Carditis and valvulitis
Raised ESR or CRP
Pyrexia
```
158
Management of rheumatic fever
Antibiotics (oral penicillin V)
Anti-inflammatories: NSAIDs are first-line
Treatment of any complications that develop e.g. heart failure
159
Common CNS complication of HIV
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
160
Toxoplasmosis symptoms
Headache, confusion, drowsiness
161
Imaging in toxoplasmosis
Multiple ring enhancing lesions on CT
162
CNS lymphoma symptoms
Headache, confusion, drowsiness
163
CNS lymphoma imaging
Single / multiple lesions that show solid enhancement
164
Toxoplasmosis treatment
Medical (sulfadiazine and pyrimethamine)
165
CNS lymphoma management
Steroids
Chemo
May also have radiotherapy
Small tumours may consider surgery
166
What does CNS TB look like on imaging?
Single ring enhancing lesion on CT
167
What is Progressive multifocal leukoencephalopathy (PML)
Widespread demyelination of CNS tissue in lesions
168
Imaging of Progressive multifocal leukoencephalopathy (PML)
CT: single or multiple lesions, no mass effect, don't usually enhance. MRI is better - high-signal demyelinating white matter lesions are seen
169
Imaging in AIDS dementia complex
Cortical and subcortical atrophy seen on CT
170
First line antibiotic in pregnant women with a UTI
Nitrofurantoin
171
Zone of the adrenal gland where cortisol is produced
Zona fasciculata
172
What is carcinoid syndrome?
When a tumour secretes hormones e.g. serotonin
173
Symptoms of carcinoid syndrome
Diarrhoea, flushing, SOB, itching, others
174
Most common site of carcinoid tumours
GI tract, though they often have liver mets
175
Diagnosis of carcinoid syndrome
CT
Octreoscan (binds to increased somatostatin receptors)
Urine 5HIAA
Niacin deficiency seen on bloods
176
Treatment of carcinoid syndrome
Reduce alcohol and stress (reduces hormone release)
Somatostatin analogue e.g. octreotide to reduce hormone release
Surgery on tumour
177
Treatment of testicular torsion
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.
178
Does hydrocele trans illuminate?
Yes
179
Investigation of hydrocele
USS to exclude tumour
180
Causes of normal anion gap acidosis
```
Gastrointestinal base loss e.g. diarrhoea
Renal tubular acidosis
Drugs: e.g. acetazolamide
Ammonium chloride injection
Addison's disease
```
181
Causes of raised anion gap acidosis
Lactate: shock, hypoxia
Ketones: diabetic ketoacidosis, alcohol
Urate: renal failure
Acid poisoning: salicylates, methanol
182
Which muscle is responsible for causing flexion of the distal interphalangeal joint?
Flexor digitorum profundus
183
Symptoms of opioid overdose
```
Tachycardia
Constricted pupils
Psychotic symptoms
Cardiac arrest
Seizures
```
184
What type of drug is heroin?
Opioid
185
Management of opioid overdose
Naloxone
186
Management of benzodiazepine overdose
Supportive care
| flumazenil
187
Management of amphetamine / cocaine overdose
Benzodiazepine
188
Use of disulfirazem
Chronic alcohol use
| Causes unpleasant symptoms with alcohol do discourage alcohol intake
189
Treatment of salicylate poisining
urinary alkalinization with IV bicarbonate
| haemodialysis
190
Management of lithium overdose
Fluids
| Dialysis if severe
191
Reversal of warfarin
Vitamin K, prothrombin complex
192
Reversal of heparin
Protamine
193
Management of ethylene glycol (antifreeze) overdose
Fomepizole now first line
Ethanol
Dialysis if severe
194
Management of methanol poisoning
Fomepizole or Ethanol
| Dialysis if severe
195
Management of digoxin overdose
Digoxin-specific antibody fragments
196
Management of carbon monoxide poisinging
High flow / hyperbaric O2
197
Investigation of choice for bowel ischaemia
CT
198
Symptoms of chronic mesenteric ischaemia
Colickly, intermittent abdominal pain occurs
199
Definition of ischaemic colitis
acute but transient compromise in the blood flow to the large bowel
200
Management of ischaemic colitis
- usually supportive
- surgery may be required in a minority of cases if conservative measures fail. Indications would include generalised peritonitis, perforation or ongoing haemorrhage
201
Management of Raynauds
```
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
Definition of malignant otitis externa
Uncommon type of otitis externa that is found in immunocompromised individuals (90% cases found in diabetics) most commonly caused by Pseudomonas aeruginosa
203
Symptoms of malignant otitis externa
Diabetes (90%) or immunosuppression (illness or treatment-related)
Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
204
Treatment of malignant otitis externa
non-resolving otitis externa with worsening pain should be referred urgently to ENT
Intravenous antibiotics that cover pseudomonal infections
205
Nerve damaged in claw hand
Ulnar
206
Lifestyle modifications in gout
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
Cholesteatoma risk factors
Adolescents
| Cleft lip
208
Cholesteatoma symptoms
foul-smelling, non-resolving discharge
hearing loss
tympanic membrane crusting on otoscopy
209
What is cholesteatoma
Cholesteatoma is a non-cancerous growth of squamous epithelium in the ear
210
Management of cholesteatoma
ENT referral for surgical removal
211
Symptoms of granulomatosis with polyangiitis
upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulonephritis
212
Investigations in granulomatosis with polyangiitis
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
Management of granulomatosis with polyangiitis
steroids
cyclophosphamide (90% response)
plasma exchange
214
Cause of S3 heart sound
considered normal if < 30 years old
| heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis and mitral regurgitation
215
Causes of S4 heart sound
aortic stenosis, HOCM, hypertension
216
Risk factors for bladder cancer
age 50-80
male
smoking
schistosomiasis
217
Most common bladder cancer
Transitional cell carcinoma
218
Bladder cancer symptoms
Haematuria (painless)
219
Bladder cancer diagnosis
Cystoscopy and biopsy
| MRI / CT for staging
220
Management of bladder cancer
Trans urethral resection (low grade)
Intravesical chemo
Surgery
Radiotherapy
221
Virus that causes hand foot and mouth disease
Coxsackie A
222
Advice to patients with shingles
Loose fitting clothing, creams and cool ice packs as symptom relief
Contagious until lesions crusted over
223
Pain management in shingles
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
Complications of shingles
Post-herpetic neuralgia
| Ramsay Hunt syndrome
225
Risk factors for pericarditis
```
viral infections (Coxsackie)
tuberculosis
uraemia (causes 'fibrinous' pericarditis)
trauma
post-myocardial infarction, Dressler's syndrome
connective tissue disease
hypothyroidism
malignancy
```
226
Key investigations in pericarditis
ECG and echo
227
Inheritance of Fabry disease
X-linked recessive
228
Symptoms of Fabry disease
```
burning pain/paraesthesia in childhood
angiokeratomas
lens opacities
proteinuria
early cardiovascular disease
```
229
Management of idiopathic pulmonary hypertension
Test response to vasodilators. If effective use these
| If ineffective use other medications. Consider heart-lung transplant if severe
230
Risk factors for idiopathic pulmonary hypertension
Female
30s - 50s
Genetic in 10%
231
Symptoms of idiopathic pulmonary hypertension
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
Diagnosis of heart failure
Take BNP.
If high, echo within 2 weeks
If raised, echo within 6 weeks
233
Pathogen causing bronchiolitis
RSV
234
Pathogen causing croup
Parainfluenza virus
235
Congenital syphilis symptoms
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
Symptoms of bubonic plague
Headache, fever, weakness, painful lymph nodes 3-7 days after rodent exposure
237
Treatment of bubonic plague
Abx
238
Causative organism in bubonic plague
Yersinia pestis
239
Symptoms of cat scratch disease
Enlarged lymph nodes after cat scratch exposure
240
Causative organism in cat scratch disease
Bartonella henselae
241
Pathophysiology of rheumatic fever
follows an immunological reaction to recent (2-6 weeks ago) Streptococcus pyogenes infection.
242
Dilated cardiomyopathy symptoms
right ventricular failure, dyspnoea, pulmonary oedema, and atrial fibrillation.
243
Restrictive cardiomyopathy symptoms
right heart failure signs predominate: raised JVP, hepatomegaly, oedema, ascites.
244
Atrial myxoma symptoms
dizziness, fainting and palpitations, due to obstruction of the conductive pathway.
245
Murmur associated with hypertrophic cardiomyopathy
Ejection systolic
246
Is there a vaccine for Hep A?
Yes
247
Typhoid symptoms
```
headache, fever, arthralgia
bradycardia
abdo pain or distension
constipation
rose spots on trunk
```
248
Typhoid complications
```
osteomyelitis (especially in sickle cell disease)
GI bleed/perforation
meningitis
cholecystitis
chronic carriage (1%)
```
249
Antibody associated with Sjogrens
Anti-La
250
Symptoms of lithium overdose
```
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
```
251
Nerve at risk of damage in inguinal hernia repair surgery
Ilioinguinal
252
How to distinguish vestibular neuritis form labyrinthitis
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
Age group most commonly affected by labyrinthitis
Middle age
254
Symptoms of labyrinthitis
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
Management of labyrinthitis
episodes are usually self-limiting
| prochlorperazine or antihistamines may help reduce the sensation of dizziness
256
Treatment for contact dermatitis
Topical steroid
257
Symptoms of reactive arthritis
Conjunctivitis, urethritis and arthritis
258
Typical age and gender of reactive arthritis
Young males
259
What joint are most commonly affected in reactive arthritis?
Lower limbs
260
Symptoms of scleroderma / systemic sclerosis
Raynaud phenomenon, skin thickening, calcinosis and telangectasia.
261
Medication used in variceal bleeding
Terlipressin
| Prophylactic abx if they have cirrhosis
262
Typical patients with intususseption
Boys more than twice as likely as girls
| 6-18 months
263
Symptoms of intususseption
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
Key investigation in intususseption
USS
265
Management of intususseption
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
Endocrine effects of renal cell carcinoma
endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH
267
Renal cell cancer management
Total / partial nephrectomy if localised
| Chemo / biological therapy if higher grade
268
Most common thyroid cancer
Papillary
269
Prognosis in papillary thyroid cancer
Good
270
Typical demographic of papillary thyroid cancer
Young females
271
Management of papillary / follicular thyroid cancer
total thyroidectomy
followed by radioiodine (I-131) to kill residual cells
yearly thyroglobulin levels to detect early recurrent disease
272
Hypokalaemia ECG
```
U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT
```
273
Most common causative agent of empyema
Strep pneumoniae
274
Symptoms of pemphigus vulgaris
Mouth ulcers
Skin blisters - flaccid, easily ruptured vesicles and bullae, typically painful but not itchy, may develop months after the initial mucosal symptoms
275
Treatment of pemphigus vulgaris
Steroids
| Immunosuppressants
276
Symptoms of extrinsic allergic alveolitis
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
Investigation of extrinsic allergic alveolitis
imaging: upper/mid-zone fibrosis
bronchoalveolar lavage: lymphocytosis
serologic assays for specific IgG antibodies
blood: NO eosinophilia
278
Management of extrinsic allergic alveolitis
Avoid precipitant
| Oral steroids
279
What is megaloblastic macrocytic anaemia?
RBCs not fully formed
280
Symptoms of vitamin B12 deficiency
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
Treatment of B12 deficiency without neurological deficit
IM cobalamin 3 times per week for 2 weeks then 3 monthly
282
Treatment for B12 deficiency with folate deficiency
Treat B12 deficiency first
283
Symptoms of B6 deficiency
Peripheral neuropathy
| Sideroblastic anaemia Convulsions
284
Indication for pentoxifylline
Venous ulcer
285
Definition of gastroschisis
Gastroschisis describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord
286
Management of gastroschisis
vaginal delivery may be attempted
| newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours
287
Definition of exomphalos
abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum
288
Management of exomphalos
Caesarian section
Staged repair where first a shell is formed around exposed bowel then a later operation returns it to the abdominal cavity
289
What is anti phospholipid syndrome?
an autoimmune, hypercoagulable state
290
Complications of anti phospholipid syndrome
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
Diagnosis of anti phospholipid syndrome
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
What is primary anti phospholipid syndrome
Primary antiphospholipid syndrome occurs in the absence of any other related disease
293
What is secondary anti phospholipid syndrome
Secondary antiphospholipid syndrome occurs with other autoimmune diseases, such as systemic lupus erythematosus (SLE)
294
Management of anti phospholipid syndrome
Heparin
295
Symptoms of anti thrombin deficiency
Hypercoagulability
296
Aetiology of anti thrombin deficiency
Autosomal dominant
297
Symptoms of alpha-1 anti trypsin deficiency
lungs: panacinar emphysema, most marked in lower lobes
liver: cirrhosis and hepatocellular carcinoma in adults, cholestasis in children
298
Lymphatic drainage of anal canal below pectinate line
Superficial inguinal nodes
299
Lymphatic drainage of perineum, scrotum and vagina
Superficial inguinal nodes
300
Lymphatic drainage of testes
Para-aortic lymph nodes
301
Lymphatic drainage of ovaries
Para-aortic lymph nodes
302
Lymphatic drainage of kidneys and adrenal glands
Para-aortic nodes
303
Lymphatic drainage of anal canal above pectinate line
Internal iliac lymph nodes
304
Lymphatic drainage of lower rectum
Internal iliac lymph nodes
305
Lymphatic drainage of many pelvic structures
Internal iliac lymph nodes
306
Lymphatic drainage of duodenum
Superior mesenteric nodes
307
Lymphatic drainage of jejunum
Superior mesenteric nodes
308
Lymphatic drainage of colon
Inferior mesenteric nodes
309
Lymphatic drainage of upper rectum
Inferior mesenteric nodes
310
Lymphatic drainage of stomach
Coeliac nodes
311
Most common renal stones
Calcium oxalate
312
Risk factors for calcium oxalate stones
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
Appearance of calcium oxalate stones on imaging
Radio-opaque
314
Risk factor for uric acid stones
High cell turnover e.g. malignancy
315
Appearance of uric acid stones on imaging
Radio lucent
316
Risk factor for calcium phosphate stones
Renal tubular acidosis
317
Appearance of calcium phosphate stones on imaging
Radio opaque
318
Risk factor for struvite stones
Certain infections
319
Appearance of struvite stones on imaging
Radio opaque
320
Which lymphoma is associated with Reed-Sternberg cells?
Hodgkin lymphoma
321
Which lymphoma is associated with alcohol pain
Hodgkin lymphoma
322
Blood tests in Hodgkin lymphoma
Anaemia, eosinophilia, raised LDH
323
Aetiology of maple syrup urine disease
Autosomal recessive
324
Management of maple syrup urine disease
restricting leucine, isoleucine and valine in the diet
325
Complications of maple syrup urine disease
Ketoacidosis, neurological defects
326
Causes of massive splenomegaly
```
Myelofibrosis
Chronic myeloid leukaemia
Visceral leishmaniasis (kala-azar)
Malaria
Gaucher's syndrome
```
327
Causes of non-massive splenomegaly
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
APTT in haemophilia
Raised
329
PT in haemophilia
Normal
330
APTT in von Willebrand disease
Raised
331
PT in von Willebrand disease
Normal
332
APTT in vitamin K deficiency
Raised
333
PT in vitamin K deficiency
Raised
334
Echo findings in atrial myxoma
pedunculated heterogeneous mass typically attached to the fossa ovalis region of the interatrial septum
335
Symptoms of atrial myxoma
systemic: dyspnoea, fatigue, weight loss, pyrexia of unknown origin, clubbing
emboli
atrial fibrillation
336
What does interferon-gamma release assay test for?
Latent TB
337
Why is irradiated blood useful?
It has fewer immune cells left so reduces risk of graft vs host disease
338
Indications for irradiated blood products
Low immunity eg neonates or transplant patients
339
What is graft vs host disease?
Immune cells in transplanted tissue begins to attack the host tissue
340
Criteria for medical miscarriage
Foetal size less than 35mm
Low foetal heartbeat
hCG less than 1500
341
What is courvousier’s sign?
a palpable gallbladder in the presence of painless jaundice is unlikely to be gallstones
Pancreatic or gall bladder malignancy is more likely
342
Main risk factor for cholangiocarcinoma
PSC
343
Symptoms of cholangiocarcinoma
```
Persistent biliary colic symptoms
Anorexia and weight loss
Jaundice
Painless RUQ mass
Periumbilical / supraclavicular lymphadenopathy
```
344
Management of TACO
Stop transfusion
O2
Diuretics
345
Symptoms of TRALI
Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension
346
Management of TRALI
Stop the transfusion
Oxygen and supportive care
347
Symptoms of acute haemolytic transfusion reaction
fever, abdominal and chest pain, agitation and hypotension within a few minutes of transfusion
348
Management of acute haemolytic transfusion reaction
Stop transfusion
Fluid resuscitation
Supportive management
349
Murmur in HOCM
ejection systolic murmur that increases with Valsalva manoeuvre and decreases on squatting
May have mitral regurgitation
350
ECG in HOCM
left ventricular hypertrophy
non-specific ST segment and T-wave abnormalities, progressive T wave inversion may be seen
deep Q waves
351
Who should be screened for risk of osteoporosis?
Women over 65
Men over 75
Younger adults if there are other risk factors
352
Scoring systems to estimate 10-year risk of fragility fractures
FRAX
| Qfracture
353
First line in maturity onset diabetes of the young
Sulfonylurea
354
Pathophysiology of maturity onset diabetes of the young
Genetic defect reduces insulin secretion
355
Pathophysiology of rheumatoid heart fever
antibodies to the bacteria causing a pharyngeal infection react with the cardiac myocyte antigen resulting in valve destruction
356
Organism responsible for rheumatic heart fever
Strep pyogenes
357
Diagnosis of rheumatic fever
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
Management of rheumatic fever
Antibiotics (oral penicillin V)
Anti inflammatory (NSAIDS first line)
Treatment of cardiac complications
359
Causes of disseminated intravascular coagulation
```
Infection
Malignancy
Trauma e.g. major surgery, burns, shock, dissecting aortic aneurysm
Liver disease
Obstetric complications
```
360
Blood test results in disseminated intravascular coagulation
Prolonged clotting time
Decreased fibrinogen
Low platelets
Increased fibrinogen breakdown products
361
Symptoms of congenital adrenal hyperplasia
Depends on the exact type but typically consists of genital ambiguity, precocious puberty and hypertension
362
What age group is intraventricular haemorrhage associated with?
Neonates
363
Treatment of intraventricular haemorrhage
Supportive. Shunting if there’s hydrocephalus and raised ICP
364
Pathophysiology of paroxysmal nocturnal haemoglobinuria
Intravascular haemolysis leads to hemolytic anemia, dark urine in the morning, pancytopenia, and venous thrombosis
365
Management of paroxysmal nocturnal haemoglobinuria
Replacement of blood products,anticoagulants, stem cell transplant
366
What is Chvostek’s sign?
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
Blood tests in hypoparathyroidism
Low PTH, low calcium, high phosphate
368
Symptoms of hypocalcaemia
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
What is trousseau’s sign and what does it suggest?
carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic
Hypocalcaemia
370
What is pseudohypoparathyroidism?
Insensitivity to PTH
371
Blood tests in pseudohypoparathyroisism
Low Ca
High phosphate
High PTH
372
What is the S4 heart sounds caused by?
atrial contraction forces blood into a noncompliant left ventricle
373
Causes of S4 heart sounds
HOCM, HTN, aortic stenosis
374
Treatment of dengue fever
Symptom control eg fluids and analgesia
375
Symptoms of dengue fever
```
causes headache (often retro-orbital)
fever
myalgia
pleuritic pain
facial flushing (dengue)
maculopapular rash
```
376
Features of excess acetylcholine
```
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
```
377
Symptoms of congenital rubella
Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus arteriosus)
Glaucoma
378
Symptoms of congenital toxoplasmosis
Cerebral calcification
Chorioretinitis
Hydrocephalus
379
Arterial supply of parotid gland
Branch of external carotid
380
Venous drainage of parotid gland
Retromandibular vein
381
Lymphatic drainage of parotid gland
Deep cervical nodes
382
What artery does the inferior rectal artery branch off?
Inferior mesenteric
383
Causes of minimal change disease
Idiopathic
Drugs
Lymphoma
EBV
384
Biopsy results in minimal change disease
electron microscopy shows fusion of podocytes and effacement of foot processes
385
Prognosis in minimal change disease
Good, though relapse is common
386
What movement is difficult in winged scapula?
Shoulder abduction
387
Lymphatic drainage of ovaries
Para-aortic lymph nodes
388
Lymphatic drainage of uterus
Mostly iliac lymph nodes
| Some inguinal or para-aortic lymph nodes
389
Lymphatic drainage of cervix
Internal and external iliac nodes and presacral nodes
390
Symptoms of pernicious anaemia
Symptoms of anaemia
Neurological features (eg peripheral neuropathy, spinal cord degeneration and neuropsychiatric symptoms)
Mild jaundice
391
What is a hypertrophic scar?
A scar with excess collagen leading to nodules within the wound boundary
392
Complications of hypertrophic scars
Contractures
393
What is a keloid scar?
A scar with excess collagen that extends beyond the wound edge
394
Organism most common in infective endocarditis following dental infection
Strep viridans eg strep mitis
395
What cancer is Rb gene associated with?
Retinoblastoma
396
What is cushings disease?
Pituitary daemons leads to excess ACTH and excess cortisol
397
Most common cause of endogenous excess of cortisol
Pituitary adenoma
398
Management of fistulae
They will often heal on their own so conservative measures such as skin protection and nutritional support are the main management
399
What drug is used to treat iron overload in haemochromatisis?
Desferrioxamine
400
Symptoms of CML
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
Early X-ray finding in ankylosing spondylitis
Sacroiliitis
402
Arterial supply of rectum
Superior rectal artery
403
Venous drainage of rectum
Superior rectal vein
404
Lymphatic drainage of rectum
Mesorectal lymph nodes (superior to dentate line)
Internal iliac and then para-aortic nodes
Inguinal nodes (inferior to dentate line)
405
Symptoms of congenital CMV
fever, jaundice, hepatosplenomegaly, growth retardation, hearing loss
406
What is factor V Leiden?
Inherited condition that increases risk of clots
407
CLL complications
anaemia
hypogammaglobulinaemia leading to recurrent infections
warm autoimmune haemolytic anaemia in 10-15% of patients
transformation to high-grade lymphoma (Richter's transformation)
408
What is hirschprung’s disease?
Failure of neural crest cells to migrate to Auerbach’s and Meissner’s plexus means part of the bowel isn’t innervated
409
Symptoms of Hirschprung’s disease
neonatal period e.g. failure or delay to pass meconium
| older children: constipation, abdominal distension
410
Investigation of Hirschprung’s disease
abdominal x-ray
| rectal biopsy: gold standard for diagnosis
411
Management of Hirschprung’s disease
initially: rectal washouts/bowel irrigation
| definitive management: surgery to affected segment of the colon
412
What is horseshoe kidney?
The kidneys are fused at their inferior pole causing there to be just one long kidney that it located more inferiorly
413
Trigger finger symptoms
Pain
Stiffness
Locking on flexion that causes difficulty with extension
414
Risk factors for dupytrens contracture
```
Older Male
Family history
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
```
415
Symptoms of dupuytren’s contracture
Fixed flexion of palm, particularly of the 4th and 5th finger
May develop nodules on the affected fingers
416
Management of Dupuytren’s contracture
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
What is Gardners syndrome a variant of?
FAP
418
Symptoms of acute graft vs host disease
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
Symptoms of chronic graft vs host disease
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
Management of graft vs host disease
Steroids first line
| Other immunosuppressants second line
421
What is Eisenmengers syndrome?
Left-to-right shunt is reversed due to pulmonary hypertension
422
Symptoms of venous sinus thrombosis
Headache
| Seizures
423
Aetiology of Ehlers Danlos syndrome
Autosomal dominant
424
Symptoms and complications of Ehlers Danlos syndrome
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
Most common site of ectopic testes
Superficial inguinal pouch
426
Management of undescended testes
Place in the scrotum at 1 year of age (before this point they may descend spontaneously)
427
Testicular examination in testicular torsion
Enlarged and tender testis
428
What is an ectopic testis?
Testis laying outside the path of normal descent
429
What muscles does the axillary nerve innervate
Deltoid abs teres minor
430
What clotting factor is deficient in haemophilia A?
VIII
431
What clotting factor is deficient in haemophilia B?
IX
432
What does APTT represent?
Intrinsic and common pathways
433
What does prothrombin time represent?
Extrinsic and common pathways
434
What does bleeding time represent?
Platelet function
435
Blood test results in haemophilia (APTT, PT, Bleeding time)
Prolonged APTT
| Normal PT and bleeding time
436
HPV strains associated with genital warts
6 and 11
437
What is Zollinger Ellison syndrome?
Zollinger-Ellison syndrome is condition characterised by excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas.
438
Symptoms of zollinger ellison syndrome
multiple gastroduodenal ulcers
diarrhoea
malabsorption
439
What is the best test to diagnose Zollinger Ellison syndrome?
Fasting gastrin levels
440
What is a cholesteatoma?
A non cancerous growth of squamous epithelium in the ear
441
What is myringitis?
Condition associated with otitis externa whereby cysts form on the tympanic membrane
442
Management and complications of cholesteatoma
ENT referral for consideration of surgical removal.
| Complications include erosion of the ossicles
443
Management of intususseption
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
Symptoms of intususseption
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
Which part of the cochlea does the stapes articulate with?
Oval window
446
What is a smiths fracture?
Fracture of the distal radius, distal fragment is displaced volarly
447
What is a Colles fracture?
Fracture of the distal radius, distal fragment is displaced posteriorly
448
What is a monteggia fracture?
Fracture of the proximal third of the ulna. The proximal head of the radius becomes dislocated
449
What is a Galeazzi fracture?
Fracture of the distal third of the radius The distal radioulnar joint becomes dislocated
450
Symptoms of graft vs host disease
cholestasis and subsequent jaundice, a widespread rash and diarrhoea in many cases. It tends to occur during the year following transplant.
451
What is hyper acute transplant rejection and what timescale does it occur in?
Type 2 hypersensitivity reaction due to preformed antibodies against ABO or HLA antigens within minutes to hours
452
What is acute graft failure and what timescale does it occur within?
T cell mediated rejection due to ABO incompatibility within 6 months
453
What is chronic graft failure and what timescale does it occur in?
T cell and antibody mediated mechanisms causing organ fibrosis after more than 6 months
454
Management of acute graft failure
May be reversible with steroids and immunosuppressants
455
What system is affected by schistosomiasis?
Urinary
456
Calcium levels in primary hypercalcaemia
High
457
Phosphate levels in primary hypercalcaemia
Low
458
PTH levels in primary hypercalcaemia
Normal or raised
459
Calcium in secondary hyperparathyroidism
Low or normal
460
Phosphate in secondary hyperparathyroidism
Low or normal
461
PTH in secondary hyperparathyroidism
High
462
PTH in hypercalcaemia secondary to hyperthyroidism or malignancy
Low
463
Venous drainage of adrenals
Left: left renal vein
Right: IVC
464
Lymphatic drainage of tip of tongue
Sub mental nodes
465
Venous drainage of mid tongue
Submandibular nodes
466
Calcium in pagets
Normal
467
Phosphate in pagets
Normal
468
PTH in pagets
Normal
469
ALP in pagets
High
470
Lymphatic drainage of upper limb
Axillary nodes
471
What is "hungry bone syndrome"?
A rare complication of hyperparathyroidism surgery whereby the reduced PTH causes hypocalcaemia as the bones were used to high PTH levels
472
Where is McBurney's point?
1/3 of the way along a line drawn from the Anterior Superior Iliac Spine to the Umbilicus
473
What is McBurney's point?
The point where most pain is elicited by pressure in acute appendicitis
474
What is osteopetrosis?
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
Definition of acute graft vs host disease
Is classically defined as onset within 100 days of transplantation
Usually affects the skin (>80%), liver (50%), and gastrointestinal tract (50%)
476
Symptoms of acute graft vs host disease
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
Definition of chronic graft vs host disease
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
Symptoms of chronic graft vs host disease
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
Treatment of graft vs host disease
Steroids first line
| Other immunosuppressants if steroids ineffective
480
B12 deficiency symptoms
Macrocytic anaemia
Sore tongue and mouth
Neurological symptoms
Neuropsychological symptoms eg mood disturbance
481
Phaeochromocytoma symptoms
Flushing, headache, palpitations, resistant hypertension
482
Nerve affected if there is hip abduction, foot drop and loss of sensation over the sole of the foot
L5
483
Nerve affected if there is reduced sensation over the inguinal area and reduced power in hip flexion
L1
484
Nerve affected if there is reduced sensation on the anterior thigh and reduced hip flexion
L2
485
Nerve affected if there is reduced sensation over the distal thigh and reduced hip flexion and knee extension
L3
486
Nerve affected if there is no sensation over the medial lower leg and reduced knee extension and reduced dorsiflexion
L4
487
Nerve affected if there is no sensation in posterolateral leg and lateral foot and reduced plantar flexion
S1
488
Effect of PTH on phosphate
Reduces serum phosphate
489
Complications of PVI
Tamponade, stroke, pulmonary vein stenosis
490
Features of opioid misuse
Rinorrhoea, track marks, pinpoint pupils, drowsiness, watery eyes, yawning
491
Causes of avascular necrosis
Long term steroids
Chemotherapy
Alcohol excess
Trauma
492
Symptoms of avascular necrosis
Initially asymptomatic
493
Investigation of avascular necrosis
X-ray may be normal initially
| MRI investigation of choice
494
Management of avascular necrosis
May need joint replacement
495
When to give anti-D to Rh -ve mother
```
Delivery of Rh +ve infant
Termination of pregnancy
Miscarriage
Antepartum haemorrhage
Amniocentesis, CVS or foetal blood sampling
Abdo trauma
```
496
Where is McBurney’s point?
2/3 of the way from the umbilicus to the ASIS
497
Treatment for urge incontinence
Bladder retraining
| Second line is bladder stabilising drugs eg oxybutynin
498
Treatment for stress incontinence
Pelvic floor muscle retraining
| Second line is surgery or duloxetine
499
Incontinence risk factors
```
advancing age
previous pregnancy and childbirth
high body mass index
hysterectomy
family history
```
500
What is overflow incontinence
due to bladder outlet obstruction, e.g. due to prostate enlargement
501
Incontinence investigation
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
Most common type of ovarian tumour
Serous
