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Passmedicine Questions Flashcards

1
Q

Electrolyte abnormality associated with thiazide diuretics

A 
Hyponatraemia
Hypokalaemia 
Hypomagnesemia 
Hypercalcaemia 
Hypocalciuria 
Hyperglycaemia (impaired glucose tolerance)
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2
Q

Example of thiazide diuretic

A

Bendroflumethiazide

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3
Q

ABG in diarrhoea

A

Normal anion gap acidosis

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4
Q

ABG in vomiting

A

Metabolic alkalosis

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5
Q

How do you calculate anion gap

A

(sodium + potassium) - (bicarbonate + chloride)

Range = 10/18 mmol/L

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6
Q

ABG in primary hyperaldosteronism

A

Metabolic acidosis - hypernatraemia and hypokalaemia

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7
Q

Posterior MI ECG

A

ST depression in V1-V3 and tall R waves in V1 and V2.

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8
Q

LBBB ECG findings

A

Broad QRS, dominant S wave in V1, broad monophasic R waves in lateral leads

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9
Q

RBBB ECG findings

A

Broad QRS complexes, RSR pattern in V1-V3, wide slurred S waves in lateral leads

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10
Q

Complications of thiazide diuretics

A

Gout

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11
Q

Levothyroxine interactions

A

Iron / calcium carbonate reduces absorbtion of levothyroxine

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12
Q

Management of COPD

A

1st line: SABA (eg. salbutamol) or SAMA (eg. ipratropium).

2nd line: LABA (eg. formoterol, salmeterol) and LAMA (eg. tiotropium) and inhaled corticosteroids (eg. beclomethasone)

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13
Q

What condition causes abnormal pigmentation of the large bowel due to the presence of pigment-laden macrophages?

A

Melanosis coli.

Often caused by prolonged laxative abuse.

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14
Q

Medication to use in type 2 DM patients who are obese

A

DPP-4 inhibitor

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15
Q

DM medications that can cause weight gain

A

Sulphonylurea
Pioglitazone
Insulin

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16
Q

How many days before surgery should warfarin be stopped?

A

5 days

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17
Q

Mechanism of action of indapamide

A

Thiazide-like diuretic

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18
Q

Mechanism of action of candesartan

A

ARB (angiotensin receptor blocker)

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19
Q

Common post-MI systolic murmur

A

Mitral regurgitation

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20
Q

What does notching of the inferior border of the ribs suggest?

A

Coarctation of the aorta

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21
Q

Signs of left ventricular aneurysms post-MI

A

Tiredness
Breathlessness
Persistent ST elevation

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22
Q

Ultrasound findings in chronic diabetic nephropathy

A

Large (early disease) / normal sized kidneys (later disease)

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23
Q

Ultrasound findings in chronic kidney disease

A

Bilateral small kidneys

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24
Q

Diagnosis criteria for AKI

A

Increase in creatinine > 26 umol/L in 48hrs
Increase in creatinine > 50% in 7 days
Decrease in urine output < 0.5 ml/kg/hr for more than 6 hours

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25
Q

How does hypertrophic obstructive cardiomyopathy present?

A

Exertional dyspnoea

Ventricular hypertrophy on ECG

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26
Q

What condition is metoclopramide contraindicated in?

A

Parkinsonism

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27
Q

When is BIPAP useful?

A

Type 2 respiratory failure. Especially COPD exacerbations

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28
Q

When is CPAP useful?

A

Type 1 respiratory failure. Especially pulmonary oedema

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29
Q

Primary pneumothroax management guidelines

A

Rim of air < 2cm + not short of breath = discharge.
If > 2cm or short of breath = aspiration.
If aspiration is unsuccessful = chest drain

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30
Q

Secondary pneumothorax management guidelines

A

Patient > 50 + rim of air > 2 cm +/- short of breath = chest drain insertion.
Rim of air 1-2cm = aspiration.
If aspiration fails = chest drain.
Rim of air < 1cm = give O2 and admit for 24 hrs

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31
Q

What nephritic syndrome develops 1-2 weeks after URTI?

A

Post streptococcus glomerulonephritis

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32
Q

What nephritic syndrome develops 1-2 days after URTI?

A

IgA nephropathy

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33
Q

What are the features of primary hyperaldosteronism?

A

Hypertension.

Hypokalaemia.

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34
Q

How are primary and secondary hyperaldosteronism differentiated?

A

Plasma aldosterone/renin ratio.

High ratio = primary
Low ratio = secondary

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35
Q

How is primary hyperaldosteronism diagnosed?

A

Adrenal imaging.
If unsuccessful: adrenal venous sampling.

Differentiates between unilateral adenoma (Conn’s syndrome) and bilateral hyperplasia

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36
Q

What are the features of aldrenal insufficiency? (Addison’s)

A

Hypotension
Hyponatraemia
Hyperkalaemia

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37
Q

What is a raised ACR?

A

> 3 mg/mmol

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38
Q

What medication should be commenced if ACR is raised?

A

ACE-i

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39
Q

What electrolyte imbalance can be caused by PPIs?

A

Hyponatraemia

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40
Q

What hormones are reduced by the stress response?

A

Insulin
Oestrogen
Testosterone

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41
Q

What is the commonest cause of mortality in CKD patients on haemodialysis?

A

Ischaemic heart disease

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42
Q

ECG findings in hypokalaemia

A

Prominent U-waves, best seen in precordial leads.
T waves have a ‘sine wave’ appearance.
Prolonged QTc > 600ms.
Borderline PR interval.

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43
Q

Features of Good Pasture’s Syndrome

A

Haemoptysis

Haematuria

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44
Q

What ACS medication is contraindicated in patients with hypotension?

A

Nitrates

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45
Q

What skull changes are seen in multiple myeloma?

A

Rain-drop skull (a random pattern of dark spots)

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46
Q

What skull changes are seen in primary hyperparathyroidism?

A

Pepperpot skull

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47
Q

What blood results are seen in beta-thalassaemia trait (minor)?

A

Disproportionate microcytic anaemia - raised haemoglobin A2 (HbA2)

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48
Q

What is the correct management if a DVT US is negative?

A

Stop DOAC and repeat US in a week

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49
Q

Causes of a raised APTT

A

Haemophilia (A,B,C)
Von Willebrand disease
Heparin

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50
Q

Casues of a prolonged PT

A

Liver disease
DIC
Vitamin K deficiency
Warfarin

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51
Q

Causes of a prolonged PT and APTT

A

Vitamin K deficiency - liver disease, malabsorption
DIC
Factor V or X

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52
Q

What blood product is the most likely to cause iatrogenic septicaemia with a Gram-positive organism?

A

Platelets (stored at room temperature)

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53
Q

What blood product is the most likely to cause iatrogenic septicaemia with a Gram-negative organism?

A

Packed red cells

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54
Q

What nuclei are seen in Reed-Sternberg cells?

A

Mirror image nuclei

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55
Q

When should a patient with AF + an acute stroke (not haemorrhagic) be started on anticoagulation?

A

Two weeks after the event

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56
Q

What blood results indicate an aplastic crisis?

A

Severe anaemia and a reduced reticulocyte count

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57
Q

What is an ejection systolic murmur heard best on inspiration?

A

Pulmonary stenosis

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58
Q

What is an ejection systolic murmur heard best on expiration?

A

Aortic stenosis

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59
Q

What is a mid-late diastolic murmur heard loudest in expiration?

A

Mitral stenosis

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60
Q

What is a mid-systolic murmur heard loudest in expiration?

A

Mitral valve prolapse

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61
Q

What is a mid / late diastolic murmur heard loudest in inspiration?

A

Tricuspid stenosis

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62
Q

What adjustments should be made to levothyroxine in pregnancy?

A

Increase levothyroxine by 50%

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63
Q

What scale is used to identify obstructive sleep apnoea?

A

Epworth Sleepiness Scale

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64
Q

What is 1st line management for moderate / severe obstructive sleep apnoea?

A

CPAP

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65
Q

What is classified as NYHA class I?

A

No symptoms

No limitation

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66
Q

What is classified as NYHA class II?

A

Mild symptoms

Slight limitation of physical activity

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67
Q

What is classified as NYHA class III?

A

Moderate symptoms

Marked limitation of physical activity

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68
Q

What is classified as NYHA class IV?

A

Severe symptoms

Unable to carry out any physical activity without discomfort

Symptoms present at rest

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69
Q

What ACS medication is contraindicated in pregnany?

A

Statins

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70
Q

What may be seen on a blood film of a patient with functional hyposplenism secondary to coeliac disease?

A

Howell-Jolly bodies and target cells

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71
Q

What is first line treatment for a mild-moderate flare of distal ulcerative colitis?

A

Topical (rectal) mesalazine

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72
Q

What ECG changes are seen in acute pericarditis?

A

Widespread saddle shaped ST elevation

PR depression

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73
Q

What is 1st line treatment for meningitis in young adults?

A

IV ceftriaxone

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74
Q

What is the mechanism of action of loop diuretics?

A

Inhibits the Na-K-Cl cotransporter in the thick ascending limb of the loop of Helne

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75
Q

What does of atorvastatin is given after an MI?

76
Q

What is the second line management of hypertension in African-Caribbean patients after a CCB?

77
Q

What vaccines should be offered to patients with chronic hepatits?

A

One-off pneumococcal

Annual influenza

78
Q

What ECG changes are seen in hypokalaemia?

A

Prolonged PR interval and prominent U waves

79
Q

What other condition should patients with type 1 diabetes be screened for on diagnosis?

A

Coeliac disease

80
Q

What difference is present in the blood results between iron deficiency anaemia and anaemia of chronic disease?

A 
IDA = TIBC is high 
ACD = TIBC is low / normal
81
Q

What tumour marker is associated with colorectal cancer?

A

Carcinoembryonic antigen (CEA)

82
Q

What condition is superior vena cava obstruction assoicated with?

A

Lung cancer

83
Q

What are the symptoms of superior vena cava obstruction?

A 
Dyspnoea
Swelling of the face, arms and neck 
Headache : often worse in the mornings 
Visual disturbance 
Pulseless jugular venous distension
84
Q

Can hypothermia cause pancreatits?

85
Q

What is 1st line management of hydronephrosis?

A

Urethral catheter

86
Q

What are the symptoms of charcot’s cholangitis?

A

Fever, jaundice, RUQ pain

87
Q

What condition can cause an over-estimated HbA1c on bloods?

A

Splenectomy

due to the increased lifespan of RBCs

88
Q

How many stages of renal cell carcinoma are there?

89
Q

What organism commonly causes aspiration pneumonia?

A

Klebsiella

90
Q

What is the ratio of oral to parenteral morphine?

91
Q

How should a severe flare of ulcerative colitis be treated?

A

Admit to hospital and give IV corticosteroids

92
Q

What do the results of a dexamethasone supression test show in an adrenal adenoma?

A

Cortisol is not suppressed by low dose dexamethasone.

Cortisol is not suppressed by high-dose dexamethasone.

ACTH is suppressed by high-dose dexamethasone.

93
Q

What do the results of a dexamethasone supression test show in a pituitary adenoma?

(Cushing’s Disease)

A

Cortisol is not suppressed by low-dose dexamethasone.

Cortisol is suppressed by high-dose dexamethasone.

ACTH is suppressed by high-dose dexamethasone.

Often too small to be detected on pituitary MRI.

94
Q

What do the results of a dexamethasone supression test show in ectopic ACTH syndrome?

(eg. small cell lung cancer)

A

Cortisol is not suppressed by low dose dexamethosone.

Cortisol is not suppressed by high dose dexamethasone.

ACTH is not supressed by high dose dexamethasone.

95
Q

What condition with weakness and vision blurring is assoicated with thyroid conditions?

A

Myesthenia Gravis.

96
Q

What is a side effect of adenosine?

A

Flushing / warmth

97
Q

What analgaesia should be used in renal colic?

A

IM diclofenac

98
Q

What electrolyte balance can be seen with acute pancreatitis?

A

Hypocalcaemia

99
Q

What biliary condition is associated with ulcerative colitis?

A

Primary sclerosing cholangitis

100
Q

What antibodies are assoicated with primary sclerosing cholangitis?

A

ANCA (anti-neutrophil cytoplasmic antibodies)

Anti-smooth muscle cell antibodies

101
Q

What score is used to determine stroke risk in AF?

A

CHA2DS2-VASc

102
Q

What is the 1st line anticoagulant used in AF?

103
Q

What is a characteristic of Crohn’s disease but not UC?

A

Skip lesions

Increased goblet cells

Granulomas

Bowel obstruction

Fistulae

104
Q

What is a characteristic of UC but not Crohn’s?

A

No inflammation beyond the submucosa

Crypt abscesses

Depletion of goblet cells and mucin

105
Q

What is the imaging of choice in renal colic?

A

Non-contrast CT KUB

106
Q

How are calcium renal stones prevented?

A
  • High fluid intake
  • Low animal protein
  • Low salt diet
  • Thiazide diuretics
107
Q

How are oxalate stones prevented?

A
  • Cholestyramine

- Pyridoxine

108
Q

How are uric acid stones prevented?

A
  • Allopurinol

- Urinary alkalisation eg. oral bicarbonated

109
Q

What is the most common causative organism of spontaneous bacterial peritonitis?

110
Q

What medications are used in secondary prevention of CVD?

peripheral vascular disease

A
  • Clopidogrel 75mg

- Atorvastatin 80mg

111
Q

What type of anaemia would sickle cell disease cause?

A

Normocytic

Other findings:

  • raised reticulocytes
  • Sickle cells on a blood film
112
Q

First line investigation for liver cirrhosis

A

Transient elastography

113
Q

What is the biochemical pattern on primary hyperparathyroidism?

A
  • Mild hypercalcaemia
  • Low serum phosphate
  • Raised / normal PTH
114
Q

What is the biochemical pattern of multiple myeloma?

A
  • Hypercalcaemia
  • Normocytic anaemia
  • Renal failure (raised urea and creatinine)
115
Q

What type of medication is candesartan?

116
Q

What is the management of HF with a reduced ejection fraction?

A
  • ACE-i (or ARB)
  • Beta blocker

2nd line:
- + spironolactone

117
Q

What condition is assoicated with carbimazole use?

A

Agranulocytosis

118
Q

What is the 1st line insulin regime for newly diagnosed type 1 diabetics?

A

Basal-bolus using twice-daily insulin detemir

119
Q

Signs of idiopathic intracranial hypertension

A

Papilloedema.

6th nerve palsy

120
Q

Symptoms of riased intracranial pressure

A

Exacerbation of headache on straining or bending forwards

Nausea

Vomiting

Visual disturbances (including double vision).

121
Q

Acute adverse effects of phenytoin

used for seizures

A 
Acute: 
Initially: 
- dizziness 
- diplopia 
- nystagmus 
- slurred speech 
- ataxia
Later: 
- confusion 
- seizures
122
Q

Chronic adverse effects of phenytoin

A

Common:

  • gingival hyperplasia
  • hirsutism
  • coarsening of facial features
  • drowsiness
  • Megalblasic anaemia
  • Peripheral neuropathy
  • osteomalacia (enhanced vitamin D metabolism)
  • lymphadenopathy
  • dyskinesia
123
Q

What is the most common cause of viral meningitis in adults?

A

Enteroviruses eg. coxsackie B

124
Q

What are the lumbar puncture signs of viral meningitis?

A
  • lymphocytosis
  • raised protein
  • normal glucose
  • normal opening pressure
  • clear CSF
125
Q

What are the lumbar puncture signs of bacterial meningitis?

A
  • Elevated protein
  • Reduced glucose
  • Cloudy / turbid appearance
  • Raised opening pressure
126
Q

What is a common causative organism of bacterial meningitis?

A

Neisseria meningitidis

127
Q

What are concerning signs of raised intracranial pressure?

A

Cushing’s triad:

  • Widening pulse pressure
  • Bradycardia
  • Irregular breathing

Also:
- Hypertension

128
Q

What medication can be used as prophylaxis for prevention of rebleeding following a variceal bleed?

A

A non-cardioselective beta blocker eg. propanolol

129
Q

What medications are used in an acute variceal bleed?

A
  • Fluid resucitation
  • Correct clotting: FFP, vitamin K
  • Terlipressin.
  • Ceftriaxone IV (prophylactic antibiotic which reduces mortality in patients with liver cirrhosis)
  • Endoscopy and variceal band ligation
  • Seng-staken-Blakemore tube if uncontrolled haemorrhage
  • Transjugular intrahepatic portosystemic shunt if all other measures fail
130
Q

Prophylaxis of variceal haemorrhage

A

Endoscopic variceal band ligation - every two weeks until all varicies eradicated.

PPI cover is given to prevent EVL-induced ulceration

131
Q

What is a cause of liver failure following cardiac arrest?

A

Ischaemic hepatitis

132
Q

What is a complication of carbimazole?

A

Agranulocytosis

133
Q

What can cause a false negative mantoux test?

A 
TB 
AIDS
Long-term steroid use (eg. in UC)
Lymphoma 
Sarcoidosis 
Extremes of age 
Fever 
Hypoalbuminaemia 
Anaemia
134
Q

What is the commonest type of lymphoma in the UK?

A

Diffuse large B cell lymphoma

135
Q

What system is used for staging non-Hodgkin’s lymphoma?

A

Ann Arbor system

Stage 1 - one node affected
Stage 2 - more than one node affected on the same side of the diaphragm
Stage 3 - nodes affected on both sides of the diaphragm
Stage 4 - extra-nodal involvement eg. spleen, bone marrow, CNS

136
Q

What complication can occur after bilateral adenectomy for Cushing’s?

A

Nelson’s syndrome

137
Q

Acute seizure management

A

Rectal diazepam 10-20mg for adults - can be repeated once after 10-15 minutes

Midazolam oromucosal solution 10mg in adults

138
Q

STEMI ECG findings

A
  • Q waves
  • ST elevation
  • Inverted T waves
139
Q

Posterior MI ECG findings

A
  • Tall R waves in V1-V3
  • ST depression in V1-V3
  • Upright T-waves
140
Q

What causes a tender thyroid goitre?

A

De Quervain’s thyroiditis

141
Q

What is Conn’s syndrome?

A

Primary hyperaldosteronism

142
Q

What are the features of primary hyperaldosteronism?

A
  • Hypertension
  • Hypokalaemia (eg. muscle weakness)
  • Alkalosis
143
Q

What investigations should be done in primary hyperaldosteronism?

A

1st line:

  • plasma aldosterone/renin ration
  • Results: high aldosterone, low renin

If postive:
- CT abdo and adrenal vein sampling (differentiate between unilateral and bilateral sources of aldosterone excess)

144
Q

What is the management of primary hyperaldosteronism?

A

Adrenal adenoma: surgery

Bilateral adrenocortical hyperplasia: aldosterone antagonist eg. spironolactone

145
Q

Heart failure drug management

A

1st line:
- ACE-i + Beta blocker

2nd line:
- aldosterone antagoist (eg. spironolactone, elperenone)

3rd line: (by a specialist)

  • Ivabradine
  • Sacubitril-valsartan
  • Digoxin
  • Hydralazine in combination with nitrate
  • Cardiac resynchronisation therapy
146
Q

Management of abdominal aortic aneurysms

A

< 3cm = normal

3 - 4.4 cm = small (rescan every 12 months)

4.5 - 5.4 cm = medium (rescan every 3 months)

> = 5.5 cm = large (refer within 2 weeks for surgical intervention (EVAR))

Symptomatic / rapidly enlarging aneurysms (>1cm a year) = EVAR

147
Q

When should COPD patients be assessed for oxygen therapy?

A
  • FEV1 < 30% predicted
  • Cyanosis
  • Polycythaemia
  • Peripheral oedema
  • Raised JVP
  • O2 sats < 92%
148
Q

What patients should be offered long term oxygen therapy in COPD?

A
  • Patients with pO2 < 7.3

- Patients with pO2 7.3-8 + secondary polycytaemia / peripheral oedema / pulmonary hypertension

149
Q

How is prostate cancer staged?

A

Gleason Score

150
Q

What is the first line management of sinus bradycardia?

A

Atropine 500mg IV

151
Q

What type of oesophageal cancer is related to GORD and barrett’s oesophagus?

A

Adenocarcinoma

152
Q

What is the most likely lung cancer in smokers?

A

Squamous cell carcinoma

153
Q

What type of cancer may develop after exposure to asbestos?

A

Mesothelioma

154
Q

What is the most common lung cancer in non-smokers?

A

Adenocarcinoma

155
Q

What medication can lead to gout?

A

Thiazide diuretics

decrease uric acid excretion from the kidneys

156
Q

What is a side effect of thiazide-like diuretics?

A

Erectile dysfunction

Hypokalaemia

157
Q

What is a side effect of calcium channel blockers?

A

Ankle swelling

158
Q

How long before a surgery should you stop taking the combined oral contraceptive pill?

159
Q

What medications increase the risk of C.diff?

A

Cephalosporins

Clindamycin

PPIs

160
Q

How is C.diff diagnosed?

A

C. diff toxin in the stool

161
Q

How is C.diff managed?

A

Oral metronidazole for 10-14 days

If severe then vancomycin can be used

162
Q

What are the ECG changes seen in PE?

A

Sinus tachycardia

or

S1Q3T3

163
Q

What are the signs of acute tubular necrosis?

A

Worsening renal function + muddy brown casts

Associated with compartment syndrome following trauma (production of myoglobinuria)

164
Q

What is a common cause of acute interstitial nephritis?

A

Drug toxicity

165
Q

What is the daily requirement of glucose?

A

50-100g a day

166
Q

What is the management of minimal change glomerulonephritis?

A

Prednisolone

  • If doesn’t respond: cyclophosphamide
167
Q

What might be seen on urine microscopy of patients taking loop diuretics?

A

Hyaline casts

168
Q

What is a side effect of spironolactone?

A

Gynaecomastia

169
Q

What does hypocalcaemia indicate in renal disease?

A

The renal disease is chronic

170
Q

What are some signs of chronic renal failure?

A
  • Shrunken kidneys
  • Secondary hyperparathyroidism
  • Hypocalcaemia (reduced levels of D/1,25(OH)2D - which results in reduced reabsorption of calcium from the kidneys)
171
Q

What urine tests indicate acute tubular necrosis?

A
  • High sodium
  • Low urine osmolarity
  • Brown casts
172
Q

What is seen on renal biopsy in membranous nephropathy?

A
  • Thickened basement membrane on light microscopy

- sub-epithelial spikes on silver staining

173
Q

How is membranous nephropathy managed?

A

Conservative + ACE-i + statin + prophylactic anticoagulation

174
Q

What are features of ADPKD?

A 
Hypertension 
Recurrent UTIs
Abdominal pain 
Renal stones 
Haematuria 
Chronic kidney disease
175
Q

What variables is eGFR calculated from?

A

CAGE

  • Creatinine
  • Age
  • Gender
  • Ethnicity
176
Q

What is the intitial intervention in hyperkalaemia?

A

IV calcium gluconate

177
Q

What is the most common infection in patients with solid organ transplants?

A

Cytomegalovirus

178
Q

What is the most common causative organism in patients with peritonitis secondary to peritoneal dialysis?

A

Staphylococcus epidermis

179
Q

How is anion gap calculated?

A

(Na + K) - (Cl + HCO3)

180
Q

What does a raised anion gap indicate in metabolic acidosis?

A

Diabetic ketoacidosis

181
Q

What does a normal anion gap indicate in metabolic acidosis?

A

GI bicarbonate loss due to diarrhoea

182
Q

What medication can cause diabetes insipidus?

183
Q

Which patients would fibromuscular dysplasia be suspected in?

A

Young females who develop AKI after initiation of an ACE-i

184
Q

What is the treatment for hyperacute transplant rejection?

A

There is no treatment available - the rejected graft must be removed

185
Q

What medications commonly cause acute interstitial nephritis?

A

NSAIDs, penicillins, sulphur-based medicines, PPIs, ciprofloxacin, allopurinol

186
Q

How is stable angina managed?

A

1st line:
- beta blocker OR calcium channel blocker

2nd line:
- beta blocker + calcium channel blocker

If both drugs are not tolerated use one of:

  • a long-acting nitrate
  • ivabradine
  • nicorandil
  • ranolazine

Medicine (15 decks)

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