PassMedicine learning Flashcards
1
Q
If a patient has a reduced AMTS (7/10) and low blood pressure a day post-operatively (hemicolectomy), what is the most common cause?
A
Hyponatraemia (U&Es will show low sodium levels)
2
Q
What are the risk factors for surgical patients for DVT? (10)
A
- Surgery greater than 90 minutes at any site or greater than 60 minutes if the procedure involves the lower limbs or pelvis
- Acute admissions with inflammatory process involving the abdominal cavity
- Expected significant reduction in mobility
- Age over 60 years
- Known malignancy
- Thrombophilia
- Previous thrombosis
- BMI >30
- Taking HRT or COCP
- Varicose veins with phlebitis
3
Q
What is classed as mechanical thromboprophylaxis? (4)
A
- Early ambulation after surgery is cheap and is effective
- Compression stockings (TED)
- Intermittent pneumatic compression devices
- Foot impulse devices
4
Q
For prophylaxis VTE treatment pre-surgery, when is dabigatran used?
A
Used prohylactically in hip and knee surgery. It does not require therapeutic monitoring. It has no known antidote and should not be used in any patient in whom there is a risk of active bleeding
5
Q
Why is unfractionated heparin sometimes used prophylactically?
A
It has a rapid onset and its therapeutic effects decline quickly on stopping and infusion. Its activity is measured using the APTT. If need be it can be reversed using protamine sulphate.
6
Q
Which type of kidney stone is associated with an inherited metabolic disorder?
A
Cystine stones (inherited recessive disorder of transmembrane cystine transport leading to decreased absorption of cystine from intestinal and renal tubule)
7
Q
What type of kidney stone is often a staghorn calculus with an alkaline urine?
A
Struvite (chronic infection with urease producing enzymes can produce an alkaline urine and formation of struvite stones)
8
Q
What are struvite stones formed from? (3)
A
- Magnesium
- Ammonium
- Phopshate
9
Q
What is the management for a patient who has been treated for acute pancreatitis, found to have a cystic lesion on the head of the pancreas, but is clinically stable?
A
Conservative management - it is a pancreatic pseudocyst. A raised amylase and a cystic lesion following pancreatitis is most likely to represent a pseudocyst. If a procedure would be required, then a radiological fine needle aspiration would be best suited.
10
Q
What are the indications for draining a pancreatic pseudocyst? (3)
A
- Signs of infection
- Mass effect on abdominal organs
- Persistent pseudocyst 12 weeks beyond it developing
(often even when there are symptoms associated with the pseudocyst, it is still managed conservatively due to the procedural risks)
11
Q
How may an anal or interspincteric abscess present?
A
A 24-48 hour history of increasingly severe ano-rectal pain. Patient may be febrile and the skin surrounding the anus may look normal if it is intersphincteric or red/show an abscess. They may not be able to tolerate a PR examination.
12
Q
How may someone with a fistula in ano present?
A
With a history of offensive discharge from the anus, but otherwise well. There may be a defect visible. The discharge may be foul and patients should be listed for examination under anaesthesia
13
Q
What is the most likely diagnosis for a 37 year old man presenting to A&E with severe central abdominal pain radiating to the back, vomiting on several occasions and guarding on examination.
A
Acute pancreatitis
14
Q
What are the top characteristic exam features (conditions) for abdominal pain?
A
- Peptic ulcer disease
- Appendicitis
- Acute pancreatitis
- Biliary colic
- Acute cholecystitis
- Diverticulitis
- Abdominal aortic aneurysm
- Intestinal obstruction
15
Q
What are the ‘unusual’ causes of abdominal pain that are important to remember?
A
- MI
- DKA
- Pneumonia
- Acute intermittent porphyria
16
Q
What is the most common cause of bladder cancers in the developed world?
A
90% of bladder cancers in the developed world are due to transitional cell carcinomas
17
Q
What is the most common cause of bladder cancer in the developing world and why?
A
Squamous cell carcinoma is the most common cause due to schistosomiasis
18
Q
A 31 year old man with a diffuse lumpy swelling on the left side of his scrotum presents to clinic. There is no pain and testicle is normal. What is the most likely diagnosis?
A
A varicocele
19
Q
What is the most likely diagnosis for a 44 year old man with a lump on his right testicle, it is discrete, soft and can be felt posterior to the right testicle.
A
Epididymal cyst
20
Q
What is the most likely cause for a 75 year old man to have a swelling in his right scrotum that cannot be palpated above and is large and non-tender?
A
Inguinal hernia
21
Q
What can be given IV to a patient with evidence of oedema on a head CT with the beginnings of mass effect, following a head trauma?
A
IV mannitol
22
Q
What first line investigation is important to perform in someone presenting with priaprism not associated with sexual stimulation?
A
A cavernosal blood gas analysis
23
Q
What does cavernosal blood gas analysis differentiate?
A
Differentiates an ischaemic and non-ischaemic priapism
24
Q
What are the causes of priapism? (5)
A
- Idiopathic
- Sickle cell disease
- Erectile dysfunction medication (e.g. Sildenafil)
- Iatrogenic - antihypertensives, anticoagulants, antidepressants, recreational
- Trauma
25
Which type of priapism is a medical emergency?
Ischaemic priapism - aspiration of blood and infection of saline flush is first line management
26
Which anaesthetic muscle relaxant is contraindicated in patients with penetrating eye injuries or acute narrow angle glaucoma and why?
Suxamethonium - because it increases intra-ocular pressure
27
What is the most common type of prostate cancer?
Adenocarcinoma
28
Which nerve is affected if a patient has a blown/dilated pupil and a head trauma?
Third cranial nerve
29
Why does a third cranial nerve palsy occur with some head injuries?
If the head injury results in an uncal herniation - the uncus of the temporal lobe herniates under the free edge of the tentorium cerebelli. The herniated uncus compresses the third cranial nerve causing a surgical third nerve palsy, presenting as a dilated and unreactive pupil
30
What is the other name for an uncal herniation?
Transtentorial herniation
31
Which anaesthetic agent has anti emetic properties?
Propofol
32
Which agent reverses the action of midazolam?
Flumenazil
33
Which biologic therapy is used to treat patients with crohns disease?
Infliximab
34
Which biologic therapy is used to treat an unresectable GI stromal tumour if it is KIT positive?
Imatinib
35
Which organism most commonly causes cholangitis?
E.coli
36
What are the features of Charcot's triad, associated with cholangitis?
1. RUQ pain
2. Fever
3. Jaundice
37
What is the first line investigation for a testicular mass?
USS
38
If there is a suspicion of bowel perforation, what is the best investigation to perform?
An erect CXR
39
Which formula is used to calculate fluid resuscitation in a burns patient?
Parkland formula for 24 hours (4ml X TBSA X body weight kg) - 50% is given in the first 8 hours and 50% given in the next 16 hours.
40
When should an LP be performed to detect a SAH?
12 hours from the start of the headache
41
In a patient with an upper GI bleed and melaena, why would urea levels be raised?
An increased urea level occurs due to the breakdown of red blood cells in the stomach. - it is usually indicative of an upper GI bleed
42
What is hereditary haemorrhagic telangiectasia also known as?
Osler-Weber-Rendu syndrome
43
Although hereditary haemorrhage telangiectasia is an autosomal dominant condition, what % of cases can occur spontaneously without prior family history?
20%
44
What are the 4 main diagnostic criteria for HHT? (2 or more = possible diagnosis, 3 or more = definite)
1. Epistaxis
2. Telangiectasis
3. Visceral lesions
4. Family history
45
The telangiectasis associated with HHT affects certain sites on the body, where are they? (4)
1. Lips
2. Oral cavity
3. Fingers
4. Nose
46
What are the complications of hepatitis B infection? (4)
1. Fulminant liver failure
2. Hepatocellular carcinoma
3. Glomerulonephritis
4. Polyarteritis nodosa
47
How does tricuspid atresia present?
Systolic ejection murmur at the left upper sternal border with a prominent apical pulse
48
What are the side effects of rifampicin? (4)
1. Discolouration of urine and tears - red/orange colour.
2. Abdominal discomfort
3. Hepatotoxicity
4. Flu-like symptoms
49
What is the serious adverse effect associated with ethambutol?
Optic neuritis
50
What are the adverse effects associated with isoniazid? (3)
1. Hepatits
2. Peripheral neuropathy
3. Agranulocytosis
51
What are the adverse effects associated with pyrazinamide? (4)
1. Myalgia
2. Arthralgia
3. Hepatitis
4. Hyperuricaemia
52
What is the first line medication for patients with glaucomas associated with raise intraocular pressure?
Prostaglandin analogue eyedrops = latanoprost
53
What is the aim of eye drops in treating open angle glaucoma?
To reduce intra-ocular pressure which in turn has been shown to prevent progressive loss of visual fields
54
What type of surgery may be performed for people with open angle glaucoma with refractory?
Trabeculectomy
55
What are the causes of erythema nodosum? (9)
1. Strep infection - scarlet fever and rheumatic fever
2. TB
3. Lymphogranuloma venereum
4. Mycoplasmia pneumonia
5. Sulfonamides
6. Crohn's/UC
7. Hodgkin's and non-Hodgkins
8. Pregnancy
9. EBV, hep B, hep C and HIV
56
What is the most likely diagnosis for a 40 year old woman presenting with erythema nodosum, non-productive cough, joint pains and bilateral hilar lymphadenopathy on CXR?
Sarcoidosis
57
What electrolyte abnormality is often seen with sarcoidosis?
Hypercalcaemia
58
What is the most common cause of heel pain in adults?
Plantar fasciitis
59
How can mesenteric infarction present?
Sudden onset pain with vomiting and occasionally passage of bloody diarrhoea - the pain present is usually out of proportion to the physical signs
60
How is the anion gap calculated?
([Na+] + [K+] - [Cl] + [HCO3])
61
What is the anion gap used for?
To classify metabolic acidosis into either:
1. Raised anion gap (seen in DKA)
or
2. Normal anion gap seen in patients with diarrhoea due to GI bicarbonate loss
62
What medication is contraindicated if a patient requires GTN spray?
PDE 5 inhibitors e.g. sildenafil - concomitant use of both a nitrate and phosphodiesterase inhibitor may lead to significant hypotension and the potential to precipitate an MI.
63
What is seen on an ECG of someone with hypothermia?
Bradycardia with J waves, and sometimes prolonged PR, QT and QRS intervals.
Could also lead to VT, VF and asystole (temp <16 degrees)
64
What is the most likely treatment that has been given to a patient with CKD stage 5, suffering from new side effects including abdominal pain, back pain, muscle weakness and anxiety?
Calcium acetate - will have been given to treat hyperphosphataemia. The calcium acetate is a calcium-based binder which can lead to hypercalcaemia - hence the symptoms.
65
What is sarcoidosis?
A multisystem chronic inflammatory condition characterised by formation of non-caveating epithelioid granulomata at various sites of the body. It often affects the lungs and thoracic cavity.
66
At what age range is peak onset of sarcoidosis?
20s-40s
67
What are the systemic/constitutional upset symptoms associated with sarcoidosis?
1. Fever
2. Night sweats
3. Malaise/fatigue
4. Weight loss
5. Heerfodr's syndrome
68
What is Heerfodt's syndrome?
Inflammation of the submaxillary/parotid glands with uveitis and facial nerve palsy
69
What % of people with sarcoidosis have lung involvement?
90%
70
What happens to the lungs in people with sarcoidosis?
There is usually a restrictive pattern seen with diffuse parenchymal lung disease, however airflow obstruction is also found and patients can present with:
1. Dry cough
2. Fever
3. Dyspnoea
4. Chest discomfort/pain
71
How can sarcoidosis affect the skin?
1. Papules - brownish/red infiltrative plaques on the extremities and trunk
2. Erythema nodosum
3. Lupus pernio on the nose and cheeks (this is uncommon but pathognomonic)
72
What is Lofgren's syndrome?
It is a combination of erythema nodosum with arthritis
73
What are the differentials for sarcoidosis? (9)
1. RA
2. Lymphoma
3. Metastatic malignancy
4. TB
5. MS
6. Lung cancer
7. SLE
8. Multiple myeloma
9. Churg-Strauss syndrome
74
What is the treatment for a patient with known sarcoidosis who is experiencing headaches and a burning sensation in their eyes?
Corticosteroids e.g. oral prednisolone
75
What blood test can be used to determine if a seizure has occurred/differenitate between a pseudo-seizure?
Prolactin - elevated serum prolactin 10-20 minutes after an episode can be used to differentiate a general tonic-clonic/partial seizure from a non-epileptic pseudo seizure
76
What factors about a seizure may indicate it is in fact a pseudo seizure?
1. Pelvis thrusting
2. Crying after seizure
3. Don't occur when alone
4. Gradual onset
77
In a male with a pelvic fracture and a high displaced prostate, with perineal oedema and a urine dipstick showing blood, what is the top differential?
A membranous urethral rupture
78
In someone with a pelvic fracture with abdominal pain, peritonism and not passing any urine, what is the top differential?
Ruptured bladder
79
What is the assessment tool used to differentiate between stroke and stroke mimics?
ROSIER - recognition of stroke in the emergency room scale
80
What is the Bamford classification? (3)
A way of classifying stroke using the following criteria:
1. Unilateral hemiparesis and/or hemisensory loss of the face, arm and leg
2. Homonymous hemianopia
3. Higher cognitive dysfunction e.g. dysphasia
81
What are the 4 different types of ischaemic stroke?
1. Total anterior circulation infarct - TACI 15%
2. Partial anterior circulation infarct - PACI 25%
3. Lacunar infarcts - LACI 25%
4. Posterior circulation infarcts - POCI 25%
82
Which type of ischaemic stroke involves the middle and anterior cerebral arteries and involves all 3 of the Bamford criteria?
TACI
83
What symptoms, although cannot alone be used to differentiate, are more common in patients who have had a haemorrhagic stroke? (4)
1. Decrease in level of consciousness
2. Headache
3. Nausea and vomiting
4. Seizure
84
In pemphigus - which structure do antibodies target?
Desmosomes
85
What is pemphigus?
An autoimmune disease caused by antibodies directed against desmosomes. The antibodies target desmoglein 3, a cadherin-type epithelial cell adhesion molecule.
86
How does pemphigus present?
Generally in younger people with flaccid, easily ruptured vesicles and bullae and mucosal ulceration.
87
Why can placenta percreta lead to frank haematuria?
The invasive placental implantation into the myometrium can rarely extend into the bladder and cause severe bleeding
88
What is adult polycystic kidney disease associated with in terms of symptoms and problems in other organs?
```
Patients may have a renal mass, hypertension, renal calculi and macroscopic haematuria.
They can also have:
1. Liver cysts (70%)
2. Berry aneurysms (25%)
3. Pancreatic cysts (10%)
```
89
What autoantibody is almost diagnostic of Graves' disease?
TSH receptor stimulating autoantibodies (90%)
90
In addition to TSH receptor stimulating autoantibodies, which other autoantibody is present 75% of the time in Graves' disease?
Anti-thyroid peroxidase antibodies
91
Which auto-antibody is found 90% of the time in Hashimoto's ?
Anti-thyroid peroxidase autoantibodies
92
What is night blindness and tunnel vision associated with?
Retinitis pigmentosa
93
What is retinitis pigmentosa?
It primarily affects the peripheral retina resulting in tunnel vision.
94
Which of the TB treatments can cause gout?
Pyrazinamide - hyperuricaemia causing gout
95
What is the most likely diagnosis for someone with acute onset joint pain with effusions, and RF and anti-CCP are negative, but serum ACE levels are raised?
Sarcoidosis - treatment with steroids
96
What are the complications of DKA? (6)
1. Gastric stasis
2. Thromboembolism
3. Arrythmias due to hyperkalaemia
4. Iatrogenic cerebral oedema
5. Acute respiratory distress syndrome
6. AKI
97
Rovsing sign positive is a clinical marker for what?
Appendicitis
98
If someone presents with symptoms of Sjogrens syndrome e.g. dry eyes, dry mouth, Schirmer's test positive, what is the most appropriate antibody blood test to perform?
Anti-Ro/Anti-La antibodies
99
In addition to anti-Ro and anti-La, which other blood test will be 100% positive for people with Sjogrens (but is less useful as it is not specific)?
Rheumatoid factor
100
What condition is associated with hypermetropia?
Acute closed angle glaucoma
101
What is primary open angle glaucoma associated with in the eye?
Myopia
102
What are the risk factors for open angle glaucoma? (6)
1. Genetics - family history
2. Afro-caribbean ethnicity
3. Myopia
4. Hypertension
5. Diabetes
6. Corticosteroids
103
How can open angle glaucoma present?
1. Peripheral visual field loss
2. Decreased visual acuity
3. Optic disc cupping
104
What is the most common malignancy associated with acanthosis nigricans?
GI adenocarcinoma
105
A patient presents with lethargy and back pain and has raised ALP in the presence of normal LFTs. What should this raise suspicion of?
Boney metastases
106
What is the triad of symptoms for reactive arthritis?
Urethritis + arthritis + conjunctivitis
| can't see, can't pee, can't climb a tree
107
Of the malaria prophylaxis medications, which one is taken weekly but should be avoided in the patient has a history of depression?
Mefloquine
108
Which antimalarial is associated with photosensitivity?
Doxycycline
109
If a patient is being tested for coeliac disease, what must they do for 6 weeks prior to the test?
Eat gluten
110
What two tests are carried out when suspected coeliac disease?
Tissue transglutaminase antibodies and IgA
111
Is Bell's palsy an upper or lower motor neurone condition?
Lower motor neurone - meaning the entire side of the face is affected.
112
Why are upper motor neurone defects forehead sparing?
Because the ganglia are innervated bilaterally
113
What is Plummer-Vinson syndrome a triad of?
1. Dysphagia
2. Glossitis
3. Iron deficiency anaemia
114
Which two drugs can caused drug-induced lupus?
1. Procainamide (antiarrhythmia)
| 2. Hydralazine
115
What are the features of lupus? (4)
1. Arthralgia
2. Myalgia
3. Malar rash
4. Pleurisy
116
Which antibody is positive in 100% of people with SLE?
ANA
117
How does adhesive capsulitis present?
It presents as a painful stiff shoulder with restriction of active and passive range of motion in abduction, interval and external rotation.
The classic impairment is external rotation.
118
What is the more common name for adhesive capsulitis?
Frozen shoulder
119
Which condition is frozen shoulder associated with?
Diabetes
120
How long does frozen shoulder aka adhesive capsulitis last for?
Typically between 6 months and 2 years
121
What is the management for frozen shoulder? (4)
No single intervention - treatment options include:
1. NSAIDs
2. Physiotherapy
3. Oral corticosteroids
4. Intra-articular corticosteroids.
122
A 54 year old female presents with fatigue and xerostomia (dry mouth). Her blood tests reveal no infection, raised bilirubin and raised ALP, but normal ALT. What is the most likely diagnosis?
Primary biliary cirrhosis
123
In carpel turner syndrome, what is found on examination? (4)
1. Weakness of thumb abduction (abductor pollicis bravis)
2. Wasting of thenar eminence
3. Tinnel's sign (tapping causes paraesthesia)
4. Phalen's sign (flexion of the wrist causes symptoms)
124
Why do people with coeliac disease have to be 'up to date' with immunisations?
Because they have functional hyposplenism - for this reason all patients with coeliac are offered the pneumococcal vaccine
125
What is haemochromatosis?
It is an autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation.
126
Which genes and chromosome are involved in haemochromatosis?
The gene mutation is in the HFE gene and both copies are on chromosome 6
127
Which blood marker is considered the most useful when investigating people for haemochromatosis?
Transferrin saturation
128
What is the typical iron study profile for men and women with haemochromatosis? (3)
1. Transferrin saturation >55% in men and >50% in women
2. Raised ferritin >500ug/l
3. Low total iron binding capacity
129
What is the first-line treatment for haemochromatosis?
Venesection
130
What is Peutz-Jeghers syndrome?
An autosomal dominant condition characterised by numerous hamartomatous polyps in the GI tract, but also pigmented freckles on the lips, face, palms and soles.
131
In Wilson's disease, what is the treatment?
Penicilamine (chelates copper)
132
How do children present in Wilson's disease?
Generally they tend to present with liver disease e.g. hepatitis/cirrhosis
133
How does young adults tend to present with Wilsons disease?
Neurological symptoms e.g. speech, behavioural and psychiatric problems
134
What is the most common causative agent of ascending cholangitis?
E.coli
135
What is the first line treatment for ocular myasthenia gravis?
Pyridostigmine
136
What is the treatment for Pneumocystis jiroveci pneumonia (PJP)?
Pneumocystis jiroveci penumonia is treated with co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole
137
What is Felty's syndrome?
It is a condition characterised by splenomegaly and neutropenia in a patient with rheumatoid arthritis.
138
What is the most common extra-renal complications associated with autosomal dominant polycystic kidney disease?
Liver cysts
139
What is the most common organism to cause gas gangrene?
Clostridium perfringens
140
Which renal stones are radio-lucent? (2)
Urate and xanthine
141
What is Beck's triad, and what is it characteristic of?
```
It is a triad of:
- Falling BP
- Rising JVP
- Muffled heart sounds
...characteristic of cardiac tamponade
```
142
What are the classic signs of right sided heart failure? (3)
1. Raised JVP
2. Ankle oedema
3. Hepatomegaly
143
What is the first line treatment for restless leg syndrome?
Ropinirole - or another dopamine agonist
144
What is the surgical treatment for late stage alpha-1-antitrypsin deficiency?
Lung volume reduction surgery
145
What are the characteristics of testicular torsion? (3)
1. Acute testicular pain
2. Unilateral swollen
3. Retracted testicle with loss of cremasteric reflex
146
What are the eGFR variables? (CAGE)
C - creatinine
A - age
G - gender
E - ethnicity
147
What is Plummer-Vinson syndrome? (it is a triad)
A triad of:
1. Dysphagia
2. Glossitis
3. Iron-deficiency anaemia
148
What causes the dysphagia in Plummer-Vinson syndrome?
Oesophageal webs AKA post-cricoid webs.
149
What are the features of autonomic dysfunction secondary to type 2 diabetes? (3)
1. Postural hypotension
2. Loss of respiratory arrhythmia
3. Erectile dysfunction
150
What is Reynold's pentad?
It is charcots triad (fever, RUQ pain and jaundice) with hypotension and confusion
151
In what condition is Reynold's pentad seen?
Severe cases of ascending cholangitis
152
What is Becks triad indicative of?
Cardiac tamponade (hypotension, raised JVP and muffled heart sounds)
153
What is Cushing's triad?
It is triad of decreased respiratory rate, bradycardia and hypertension, seen in patients with raised intracranial pressure
154
What is the management for sigmoid volvulus?
Decompression by sigmoidoscope and insertion of a flatus tube
155
What is the management for malignant distal obstructive jaundice due to unresectable pancreatic carcinoma?
Biliary stenting
156
What does Hartmanns procedure entail?
Often performed in an emergency if there is a perforated bowel, the procedure involves resecting the appropriate part and then forming an ileostomy/colostomy
157
Why is an ileostomy spouted?
Because the contents that is produces are alkaline and can damage the skin - alkaline due to the pancreatic enzymes being produced
158
What prophylactic antibiotics are given to people with animal bites - and what is given if they are penicillin allergic?
Co-amoxiclav = first-line
Penicillin allergy = doxycycline + metronidazole
159
When can you elicit lateral epicondylitis pain?
When the elbow is extended and wrist extension/suppination is resisted
160
Which organism is most likely to develop in an emphysematous cavity, which is resistant to broad spectrum antibiotics?
Aspergillus fumigatus
161
Which organism is the most common cause of malaria?
Plasmodium falciparum
162
What is subacute thyroiditis also known as?
De Quervain's thyroiditis
163
What are the 4 phases of De Quervain's thyroiditis?
```
Phase 1 (typically lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
Phase 2 (1-3 weeks): euthyroid
Phase 3 (weeks-months): hypothyroidism
Phase 4: thyroid structure and function goes back to normal
```
164
On investigation of De Quervians thyroiditis - thyroid scintigraphy, what is found?
Globally reduced uptake of iodine-131
165
How is the Q-T interval measured on an ECG?
It is the time between the start of the Q wave and the end of the T wave
166
Which drug is used to treat patients who develop neuroleptic malignant syndrome?
Bromocriptine - it is a dopamine agonist
167
Which organism is the most common cause of fungal toe infection?
Trichophyton rubrum
168
What does the direct Coombs test for?
Autoimmune haemolytic anaemia
169
What type of hearing loss is seen in presbycusis?
Bilateral high frequency, sensourinal hearing loss - so air conduction is better than bone conduction
170
What are the first-line investigations for a patient with suspected vestibular schwannoma? (2)
1. Audiogram
| 2. Gadolinium-enhanced MRI head scan
171
Kaposki's sarcoma is caused by which virus?
Human herpesvirus 8 - HHV8
172
What treatment is first line for hyperhidrosis (excessive sweating)?
20% aluminium chloride hexahydrate in alcohol solution
173
Why should metformin be suspended when a patient has diarrhoea and vomiting illness?
Increases the risk of lactic acidosis
174
What are the common side effects of amiodarone? (10)
1. Bradycardia
2. Hyper/hypothyroidism
3. Pulmonary fibrosis/pneumonitis
4. Liver fibrosis/hepatitis
5. Jaundice
6. Taste disturbance
7. Persistent slate grey skin discolouration
8. Raised serum transaminases
9. Nausea
10. Constipation (particularly at the start of treatment)
175
What is polyarteritis nodosa?
PAN is a vasculitis affecting medium-sized arteries with necrotising inflammation leading to aneurysm formation.
PAN is more common in middle-aged men and is associated with hepatitis B infection.
176
What are the clinical features of PAN? (8)
1. Fever
2. Weight loss
3. Hypertension
4. Livedo reticularis (like sixes and sevens on back of legs)
5. ANCA are found in 20% of patients with polyarteritis nodosa
6. Testicular pain
7. Malaise
8. Arthralgia
177
What is the optimal treatment for someone with maturity onset diabetes of the young (MODY) type hepatic nuclear factor 1 alpha (HNF1A)?
Sulfonylureas - gliclazide are the optimal treatment
178
Tonsilar squamous cell carcinoma is associated with which viral infection?
HPV
179
What is myxoedema coma?
It is a serious and extreme complication of hypothyroidism, resulting in multi-organ abnormalities and mental deterioration - confusion and hypothermia.
180
What is the treatment for myxoedema coma? (4)
It is a medical emergency and requires:
1. IV thyroid replacement therapy (levothyroxine i presume)
2. IV fluid
3. IV corticosteroids
4. Electrolyte imbalance correction
181
In the treatment of hypertension - after the standard ACEi, CCB and thiazide-like diuretic are used, what is the next step in management if it is still poorly controlled?
This depends on the patients potassium levels:
K+ <4.5 = low dose spironolactone
K+ >4.5 = add an alpha or beta-blocker
182
What are the new drugs that are being trialled for hypertension?
Direct renin inhibitors - Aliskiren
183
What are the differences in presentation between IgA nephropathy and post-strep glomerulonephritis?
IgA - develops 1-2 days after URTI whereas post-strep is 1-2 weeks after URTI.
Post-strep is associated with proteinuria.
184
Which corticosteroid has high glucocorticoid activity and low mineralcorticoid activity?
Dexamethasone
185
What is the treatment for patients with a pituitary tumour causing acromegaly?
Trans-sphenoidal surgery
186
What is the most likely diagnosis for someone with symptoms of obstructed defecation - passing mucous and experiencing pelvic pain. PR exam is normal and barium enema is normal.
Rectal intussusception
187
The mnemonic PANCREAS is useful for remembering what investigations offer a prognostic valve in pancreatitis, what are they?
```
P - PaO2 <8
A - age >55
N - neutrophilic WCC >15
C - calcium <2
R - renal function - urea >16
E - enzymes LDH>600
A - albumin <32
S - sugar - blood glucose >10
```
188
What is Courvoisier's law?
Carcinoma of the pancreas - the development of jaundice in association with a smooth RUQ mass.
189
P-ANCA antibodies will be positive in which conditions? (3)
1. UC
2. Primary sclerosing cholangitis
3. Churg-Strauss syndrome
190
ANA ..antibodies are positive in which conditions? (4)
1. SLE
2. Sjogren's syndrome
3. Diffuse cutaneous systemic sclerosis
4. Limited cutaneous systemic sclerosis
191
What does the term scleroderma mean?
Hard skin
192
What is scleroderma also known as?
Systemic sclerosis or SSc
193
What type of problems with skin do people have with systemic sclerosis? (4)
1. Excessive scarring
2. Swollen
3. Tight
4. Hard skin
(generally on hands/fingers, but can also be on face and arms)
194
In addition to skin changes, what other problems can occur with sclerosis or scleroderma?
```
As fibrosis (scarring) is the main problem, it can lead to scarring in:
1. Skin
2. GI tract
3. Heart
4. Lungs
It can also cause vascular problems:
5. Raynauds
6. Ischaemia of the extremities
7. Pulmonary arterial hypertension
8. Renal disease
```
195
Why do people with sclerosis experience skin thickening?
Protein collagen deposits in higher amounts in the skin of people with sclerosis - the excess collagen can deposit in the fingers, face and hands. It is due to increased fibroblast activity resulting in abnormal growth of connective tissue.
196
What are the two subgroups of sclerosis?
Diffuse and limited cutaneous
197
Which type of sclerosis is most common?
Limited cutaneous
198
In limited cutaneous scleroderma, what is affected? What is the mnemonic used to remember the symptoms?
```
Areas of the skin include face, forearms and lower legs up to the knee.
CREST
C - calcinosis
R - raynaud's
E - oesphageal dysmotility
S - sclerodactyly
T - telangiectasia
```
199
How is diffuse scleroderma different to limited?
The skin areas involved are more extensive, including the upper arms, thighs and trunk
200
What are the 'cardinal features' of SSc (systemic sclerosis)?
1. Excessive collagen production and deposition
2. Vascular damage
3. Immune systemic activation via autoantibody production and cell-mediate autoimmune mechanisms
201
What are the risk factors for developing SSc?
Cause unknown, but RFs:
1. Genetic predisposition
2. Infectious agents - cytomegalovirus, parvovirus B19, H.pylori, hep B, EBV, chlamydia
3. Chemicals - pesticids, organic solvents, hair dyes
4. Drugs e.g. cocaine, bleomycin, vitamin K
5. Radiation therapy
6. Physical trauma?!
7. Vit D deficiency (strong association apparently)
202
How can systemic sclerosis present?
1. Raynaud's phenomenon
2. Skin hardening in hands or face
3. Non-specific MSK pain, fatigue
203
Which subtype of SSc has a quicker onset?
Diffuse
204
What may be the signs in the hands of SSc?
1. Swelling (non-pitting oedema) of fingers and toes
2. Skin thickening
3. Swelling of hands - unable to make fist or make 'the prayer sign'
4. Loss of bulk from finger pads
5. Raynaud's phenomenon
205
What can be the signs on the face of SSc?
1. Tightening of facial skin
2. Tight lips (microstomia) - can make dental hygiene difficult
3. Telangiectasia
4. Salt and pepper appearance of the skin
5. Dry or itchy skin
206
What are the MSK features of SSc?
1. Joint pain and swelling
2. Myalgia
3. Restriction of joint movement, contractures, muscle atrophy
207
What are the GI symptoms associated with SSc? (7)
1. Heartburn and GORD
2. Oesophageal scarring and dysphagia
3. Delayed gastric emptying
4. 'Watermelon stomach'
5. Reduced small bowel motility (malnutrition)
6. Constipation
7. Obstruction/pseudo-obstruction
208
What are the two main pulmonary problems associated with SSc?
1. Pulmonary fibrosis (interstitial lung disease) - occurs in up to 80% of people, causes restrictive lung disease (cough, dyspnoea, coarse basal crackles)
2. Pulmonary arterial hypertension
209
Which autoantibodies are positive in SSc?
1. Anti-Scl 70 (strongly associated with lung fibrosis and a poor prognosis)
2. ACA
3. Anti-RNA polymerase III antibody
210
Which anti-TB drug can cause optic neuritis?
Ethambutol
211
Which drugs are known to cause hepatotoxicity? (10)
1. Methotrexate
2. Ciclosporin
3. Rifampicin
4. Sulphonlyureas
5. Isoniazid
6. Sodium valproate
7. Amiodarone
8. Phenytoin
9. Pioglitazone
10. Pyrazinamide
212
SLE is associated with which antibodies? (3)
1. ANA
2. Anti-dsDNA
3. Anti-histone (drug induced lupus)
213
Bamboo spine is associated with which condition?
Ankylosing spondylitis
214
What is the treatment for salicylate overdose?
Supportive, IV bicarbonate
215
What is the most common cause of pneumonia after flu?
Staph. aureus
216
A 30-year-old woman presents with weight gain and irregular menstruation. Her blood pressure is elevated at 170/100 mmHg and there is evidence of proximal muscle weakness. What is the most likely diagnosis?
Cushing's syndrome
217
Anti-TPO antibodies are seen in which thyroid disease?
Hashimoto's
