Past Paper Pop Quiz Flashcards
What would be the cause of meningitis where the LP showed lymphocytosis, high protein, low glucose and negative India ink staining?
Tuberculosis meningitis
Name a drug that can reduce proteinuria?
ACEi
reduce BP
List 4 drugs that can cause hyperkalaemia
ACEi
B Blockers
K+ sparing diuretics
NSAIDs
List 5 conditions that can cause hyperkalaemia
Hyperglycaemia Burns Rhabdomyolysis Acute Renal failure Chronic renal failure
Describe the hepatitis serology of someone who has been vaccinated
HBsAb
vaccine contains HBsAg
Describe the hepatitis serology seen in acute infection
HBsAg HBcAg HBeAg (active + infectious) HBcAb IgM HBcAb IgG
Describe the hepatitis serology seen in chronic infection
HBsAg
HBcAg
HBeAg (active + infectious)
HBcAb IgG
Describe the hepatitis serology seen in someone who has been previously infected
HBsAb
HBcAb IgG
What is Beck’s triad?
Muffled heart sounds
Distension of jugular veins
Hypotension
What does Becks triad indicate?
Cardiac tamponade
What is Kussmaul breathing? What does this indicate? Give 2 causes
Deep sighing breaths (blowing off CO2)
Metabolic acidosis
DKA
Renal failure
What is Kussmauls sign? What does this indicate? Give 3 causes
Rise in JVP on inspiration Limitation of right ventricular filling Constrictive pericarditis Restrictive cardiomyopathy Cardiac tamponade
How does Conn’s syndrome cause high blood pressure?
Aldosterone increases sodium reabsorption
This causes increased water reabsorption leading to high BP
Which organism can cause a bilateral pneumonia in middle to old aged patients?
Legionella spp
What occurs in ACTH dependent Cushing’s syndrome? Give 2 causes
Excess ACTH causes the excess cortisol production
Cushings disease: ACTH producing pituitary adenoma
Ectopic ACTH secretion
What occurs in a dexamethasone suppression test? What does this indicate?
Healthy: Presence of Dexamethasone provides negative feedback + suppresses ACTH release
Cushings: ACTH levels remain high
What occurs in ACTH independent Cushing’s syndrome?
Hyperactive adrenals/ adrenal tumour making excess cortisol
How can ACTH independent and dependent tumours be differentiated?
Dependent: HIGH plasma ACTH, HIGH CORTISOL
Independent: LOW plasma ACTH, HIGH CORTISOL
Describe the levels of cortisol seen in low and high dose dexamethasone suppression tests in Cushings syndrome caused by adrenal tumours, ectopic secretion and pituitary tumours
Adrenal tumor Low dose: no change High dose: no change Ectopic ACTH-producing tumor Low dose: no change High dose: no change Pituitary tumor (Cushing's Disease) Low dose: no change High dose: normal suppression
Which skin condition causes formation of papule and pustules on the background of erythetamous skin?
Rosacea
What is the firstline anticonvulsant medication for a patient presenting with a seizure?
IV Lorazepam
What medication can be used for a patient in SVT?
Adenosine
What 2 vasovagal manoeuvres can be used for a patient in SVT?
Carotid sinus massage
Valsalva manœuvre
In which disease may you use penicillamine? What is an important possible side effect?
Wilson’s disease
Agranulocytosis + immunosuppression
In which MSK disorder do you see punched out periarticular erosions?
Gout
What is the most common cause of travellers diarrhoea?
Escherichia coli
How does bilateral lower limb pitting oedema differ from generalised pitting oedema?
Bilateral lower limb pitting edema suggests cardiac failure
Generalized peripheral pitting edema + swelling of eyelids indicates hypoalbuminemia
How do quinolones, macrolides and metronidazole interact with warfarin?
Cyp450 inhibitors
Increase action of Warfarin
How does Rifampicin interact with Warfarin?
Cyp450 inducer
Decreases action of Warfarin
Name a class of antibiotics safe to use in patients taking Warfarin
Aminoglycosides e.g. Gentamicin
List 7 side effects of sedative use
Loss of coordination Slurred speech Decreased attention + memory Disinhibition Aggression Hypotension Respiratory depression.
List 5 side effects of sedative withdrawal
N+V Autonomic hyperactivity Insomnia Delirium Seizures
What is the classic presentation of polymyalgia rheumatic?
Muscle stiffness + pain symmetrically affecting proximal muscles
What constitutional symptoms may arise in polymyalgia rheumatica?
Weight loss
Fatigue
Night sweats
How does IV adrenaline improve coronary perfusion pressure in cardiac arrest`?
Interacts with alpha + beta adrenergic receptors to cause peripheral + splanchnic vasoconstriction
This diverts blood away from the skin + GIT to the heart + brain
What biochemistry causes alkalosis?
LOW CO2 = Respiratory alkalosis
High HCO3- = Metabolic alkalosis
What biochemistry causes acidosis?
HIGH CO2 = Respiratory acidosis
LOW HCO3- = Metabolic acidosis
What test is diagnostic of Sjorgens syndrome? What other features may be present?
Schirmer’s test: <10mm filter paper moist after placing under eyelid
Anti-Ro + Anti-La antibodies
What non-metastatic extrapulmonary manifestations may arise in small cell carcinoma?
Inappropriate secretion of ADH: hyponatraemia
Ectopic secretion of ACTH: Hypercortisolism- Hypokalaemia or Cushings syndrome
In which form of lung cancer may you see hypercalcaemia due to ectopic secretion?
Squamous cell carcinoma due to PTHrP
Which cranial nerves are affected by a pathology in the cavernous sinus?
III IV VI Ophthalmic division of V Maxillary division of V
What is the most common AIDS defining illness? List 4 symptoms
Pneumocystis jirovecii pneumonia Dry cough Dyspnoea Weight loss Fatigue
What feature on dermoscopy would suggest a malignant melanoma rather than a benign naaevus or pigmented seborrhoeic keratosis?
Irregular pigment netword
List 3 gastric primary causes of hypokalaemia
Vomiting
Diarrhea
Villous adenoma of the colon
List 3 renal primary causes of hypokalaemia
Type 1 + 2 renal tubular acidosis
Cushings
Conn’s
List 5 drugs that can cause hypokalaemia
Thiazides Loop diuretics Osmotic diuretics Beta 2-agonists Insulin
What A-E mneumonic can be used to remember drugs that can cause long QT syndrome?
A: AntiArrhythmics (Amiodarone, Flecainide)
B: AntiBiotics (Macrolides, Aminoglycosides)
C: AntiCychotics (Haloperidol, Quetiapine, Risperidone)
D: AntiDepressants (SSRIs, TCAs)
D: Diuretics
E: AntiEmetics (Ondansetron)
In which condition should use of B-blockers be avoided if possible?
Asthma
B blockers can precipitate bronchospasm
What is the triad seen in nephrotic syndrome?
Proteinuria >3.5g in 24hrs
Hypoalbuminaemia <30g/L
Oedema
What mnemonic can be used for CYP inducers?
CRAPS out drugs Carbamezapine Rifampicin barbiturates Phenytoin St Johns Wort
What mnemonic can be used for CYP inhibitors?
Some Certain Silly Compounds Annoyingly Inhibit Enzymes Grrrr Sodium valproate Ciprofloxacin Suphonamide Cimetidine/ Omeprazole Antifungals, Amiodarone Isoniazid Erythromycin Grapefruit juice
Which drugs interact with enzyme inducers/ inhibitors?
Warfarin cOCP Theophylline Corticosteroids Tricyclics Pethidine Statins
What is the most common cause of glomerulonephritis?
IgA nephropathy
Name a cause of nephrotic syndrome in adults and kids?
Kids: Minimal change glomerulonephritis
Adults: Membranous glomerulonephritis
What ECG change is seen in a posterior MI?
Posterior descending artery
ST depression in V1-4
Which joints are usually spared in RA?
DIP joints
What measurement is often used to identify chronic pancreatitis?
Faecal elastase (LOW) due to exocrine insufficiency
Describe the typical results of iron studies in hereditary haemochromatosis
High Serum Iron: deficiency of hepcidin leads to increased iron transport into the blood via ferroportin
High Ferritin: increased serum iron leads to an increase in ferritin in a compensatory attempt to increase intracellular iron storage
Low Transferrin: increased serum iron leads to decreased transferrin levels to prevent more iron from becoming plasma protein bound in the blood
High Transferrin Saturation: due to high serum iron + low transferrin
Low Total Iron Binding Capacity (TIBC): a measure of the blood’s capacity to bind iron to transferrin. As transferrin is low, it is more difficult for iron to bind to transferrin.
What are the 3 stages of diabetic retinopathy?
Background: Hard exudates, microaneurysms + blot haemorrhages
Pre-proliferative: Soft exudates (retinal ischaemia)
Proliferative: New vessel formation in response to ischaemia. Prone to bleeding
What parameter should be closely monitored in patients with GBS?
FVC
GBS can cause respiratory muscle weakness, respiratory failure + death
What is the most common cause of CKD?
Diabetes mellitus
Give 2 signs of appendicitis
Rovsing’s sign: Palpation of LIF illicits pain in RIF
Psoas sign: LHS, straight right leg + passively extending right hip
In which cases are abdominal aortic aneurysms surgically intervened with?
If diameter >5.5cm
If rapidly expanding >1cm per year
How frequently are smaller asymptomatic AAAs checked?
3-4.5cm: every year
4.5-5.5cm: every 3 months
What does HUS commonly follow?
E. coli O157 infection in children
What is the triad in HUS?
Microangiopathic haemolytic anaemia
Acute renal failure (Uraemia)
Thrombocytopenia
What is the pentad in TTP?
Microangiopathic haemolytic anaemia Acute renal failure (Uraemia) Thrombocytopenia Fever Neuro problems: headaches, confusion, seizures
What distinguishes Legionella pneumophila from the other atypical pneumonias?
Found in bodies of water kept <60°C
e.g. as air conditioning units
Causes confusion.
Urinary antigens
What is the GRACE scoring system used for?
Risk stratifying patients who have suffered an NSTE-ACS
Name 2 firstline antibiotics used in uncomplicated UTIs
Nitrofurantoin
Trimethoprim
How do grade 3 haemorrhoids and type 2 rectal prolapse differ?
Rectal prolase: circular, muscular folds (intussusception of whole circumference of the rectal wall)
Hemorrhoids: radial folds (submucosal, fibrovascular, arterio-venous sinusoids)
What is Dressler’s syndrome?
Pericarditis arising 2-10 weeks post MI