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past paper Q's Flashcards

1
Q

what are the 3 defining features of a health economic evaluation?

A

cost both services
benefits both services
comparison of the cost and benefit of the service and alternative service

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2
Q

2 features comprising a QALY?

A

number of years

quality of life- i.e. utility

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3
Q

what system do health economists use to evaluate disability?

A

dalys- disability adjusted life years

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4
Q

define healthcare economic ‘efficiency’

A

getting the max cost/ health benefit outcome from a service

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5
Q

what is the term when treatment is given elsewhere because it gives better benefit on another opportunity?

A

opportunity cost i.e the money is spent elsewhere because it gives better benefit on another opportunity

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6
Q

what is a SAH?

A

Bleeding into the subarachnoid space- between arachnoid membrane and pia mater

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7
Q

why does SAH cause a coma?

A

raised ICP and hydrocephalus

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8
Q

causes of coma?

A 
hypoglycaemia
meningococcal septicaemia
trauma
SAH
hypoxaemia
seizures
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9
Q

what causes a fixed dilated pupil?

A

3rd nerve palsy (oculomotor)

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10
Q

immediate management of SAH?

A 
A-E assessment
CT scan
treat hypertension- nimodipine
Intubate and give O2
mannitol-fusion colloid
refer for surgery to stem bleed- coiling
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11
Q

4 features of brainstem death?

A
  • no respiratory effort in reaction to turning off ventilator
  • fixed pupils unreactive to light
  • no corneal reflex
  • no cough reflex
  • no response to supra orbital pressure
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12
Q

screening by GP for microvascular damage of DM?

A

Retinal screening
kidney U&E- urine albumin and serum creatinine
Foot care screening- monofilament for sensation
ABPI

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13
Q

causes of increasing floaters?

A 
diabetic retinopathy
retinal detachment/tear
posterior vitreous detachment
trauma
recent cataract surgery
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14
Q

Ix of floaters in eye?

A

1) Fundus photography Schaffer’s sign- positive when you use a thin beam of bright light without a lens and see fine pigment floating in the anterior vitreous
2) ophthalmoscopy
3) ultrasound- flying angel sign

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15
Q

most common cell of bladder cancer?

A

transitional cell

squamous cell is most common

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16
Q

risk factors for bladder cancer?

A

FH
smoking
frequent bladder infections
working in a rubber dye factory

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17
Q

which artery supplies the superior and inferior vesical arteries?

A

internal iliac

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18
Q

what lymph nodes can bladder cancer metastasise to?

A

external iliac
obturator
internal iliac
common iliac

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19
Q

2 signs of cauda equina in the following areas?

  • perianal skin
  • lower limb
  • anal and urethral sphincters
A

Perianal skin -paraesthesia, decreased tone

Lower limb -upgoing plantars, pain, altered reflexes

Anal and urethral- decreased tone, incontinence

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20
Q

what abnormal heart sound is heart in pericarditis?

A

pericardial rub

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21
Q

4 Ix of pericarditis?

A

USS
CXR
bloods
ECG

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22
Q

2 treatments for pericarditis?

A

NSAIDS

Steroids

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23
Q

triad of cardiac tamponade?

A

raised JVP
BP 90/40
tachycardia

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24
Q

causes of pericarditis?

A 
recent viral infection
recent bacterial infection e.g. TB
recent MI
Chest trauma
Autoimmune disorders
Cancer
Uraemic pericarditis
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25
Q

moat common type of lung cancer?

A

squamous cell adenoma (non- small cell)

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26
Q

common causes of bowel obstruction?

A 
adhesions
cancer
constipation
diverticulitis
hernias
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27
Q

common causes of constipation?

A

drugs
dehydration
autonomic neuropathy
immobility

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28
Q

important things to assess in a fracture?

A

open/closed
stable/non-stable
neurovascular status
is it displaced

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29
Q

what is the salter harris classification of injury to growth plates?

A

1- through the growth plate
2- (most common)- through growth plate and metaphysis (proximal)
3- through growth plate and epiphysis (distal)
4- through all 3 elements
5- crush injury of growth plate

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30
Q

how does rivaroxaban work?

A

inhibits factor 10a

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31
Q

where does the varicella zoster virus reside?

A

geniculate ganglion

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32
Q

symptoms of ramsey hunt syndrome?

A

facial palsy
ear: vertigo, ear pain
altered taste, dry mouth, dry eyes

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33
Q

3 actions of PTH?

A

osteoclast activation
stops loss of ca in the urine
increased absorption from GI

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34
Q

complications of hypercalcaemia?

A

cardiac arrhythmias
coma
cardiac arrest- short QT and Osborn wave

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35
Q

tx of hypercalcaemia?

A

fluid
furosemide
bisphosphonates
calcitonin

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36
Q

ix of beta thalassaemia?

A

FBC- microcytic hypochromic anaemia
Haemoglobin electrophoresis
DNA testing

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37
Q

what is a complication of treatment for B-thalassaemia?

how is this complication prevented?

A

iron induced oxidative stress
Liver
Heart
Brain

Iron chelation therapy

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38
Q

Ix for rectal bleeding?

A

Foecal calprotectin
bloods
anti-endomysial antibodies and anti-TTG
colonoscopy and biopsy

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39
Q

what is the pathophysiology behind anaphylaxis?

A

type 1 hypersensitivity reaction- degranulation of mast cells releasing histamine

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40
Q

what are the 5 causes for an association?

A

bias
chance
confounding
reverse causality

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41
Q

why isn’t there a PSA screening programme in the UK?

A 
length time bias- harmess tumours detected 
Unnecessary treatment
PSA is unreliable
Causes undue worry
many tumours are slow-growing
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42
Q

when is it appropriate to do a PSA?

A

Men above age 50
suspicious PR findings
monitoring treatment and remission of prostate cancer

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43
Q

what does an upright CXR exclude in a woman with constipation?

A

bowel perforation

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44
Q

what do the blood findings raised urea, low creatinine and high Na show?

A

dehydration

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45
Q

drug treatments of incomplete miscarriage?

A

anti-D

misoprostol

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46
Q

RFs of intermittent claudication?

A 
smoking
diabetes
hypertension
hyperlipidaemia
lack of exercise
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47
Q

how to do ABPI?

A

A blood pressure cuff is inflated around the lower calf muscle above the ankle joint, and a doppler ultrasound probe placed over the dorsalis pedis artery and the posterior tibial artery

  • the max cuff pressure at which the pulse can just be heard with the probe is recorded and related to SBP at brachial artery
  • lower BP in the legs is an indicator of PAD
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48
Q

important physical signs in pre-op assessment?

A

Mallampati- how much of the soft palate in visible on opening of the mouth

Thyromental and sternomental distance

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49
Q

complications seen in RA after routine surgery?

A

adrenal crisis from stopping prednisolone
RA produces hypercoaguable state- increased VTE risk, infection risk from steroid
Immunosuppression from methotrexate

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50
Q

how to differentiate between testicular torsion and epididymo-orchitis?

A

Prehn’s sign- scrotal elevation relieves pain in epididymitis but not torsion
Absent cremasteric reflex- torsion
testicle is higher- torsion

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51
Q

differentials of quinsy?

A 
epiglottitis
lymphoma
tonsillitis
pharyngitis
craniopharyngioma
glandular fever
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52
Q

what is the name of the lymph node affected by quinsy?

A

jugulodigastric lymph nodes

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53
Q

what hormone is hypersecreted in Conn’s syndrome and where from?

and what hormone is suppressed?

A

aldosterone (mineralocorticoid) , adrenal cortex

renin, JG apparatus

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54
Q

4 ECG features of hypokalaemia?

A

U have no POT and no T, but a large PR and a large QT

U waves
small or absent T waves
long PR
long QT

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55
Q

imaging in conn’s syndrome?

A

CT adrenal gland

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56
Q

where does spironolactone act?

A

aldosterone antagonist in the cortical collecting duct

used in ascites

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57
Q

2 ECG changes in ischaemia?

A

ST depression

T wave inversion

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58
Q

how do beta blockers work?

A

block beta-adrenoreceptors , antagonising the sympathetic NS (reducing NA and adrenaline)
reduces HR and force of contraction

can be cardio-selective or non-cardio selective e.g. propranolol
(can work in sphincters of GI tract- to make them contract)

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59
Q

how do nitrates work?

A

cause NO release which leads to vasodilation and decreased PVR

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60
Q

why do you do 3 samples of LP in a SAH?

A

One for virology, one for microbiology and one for biochemistry

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61
Q

what pathological structure causes SAH?

A

berry aneurysm

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62
Q

what causes headaches pre-SAH?

A

Sentinel headache due to much smaller lead from the ruptured aneurysm

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63
Q

how does salbutamol work?

A

beta-2 agonist

relaxation of bronchial smooth muscle, bronchodilation

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64
Q

symptoms of SLE?

A

malaise, fever, abdo pain, weight loss, fatigue, headache

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65
Q

signs of SLE?

A 
malar rash
discoid rash
photosensitivity
oral ulceration
arthritis
serositis
seizures/psychosis
proteinuria
anaemia
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66
Q

features of anti-phospholipid syndrome?

A 
CLOTS
Coagulation defect
Livedo reticularis
Obstetric (recurrent miscarriage)
Thrombocytopenia
SLE
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67
Q

what is amoebiasis?

A

Amoebiasis is caused by Entamoeba histolytica (an amoeboid protozoan) and spread by the faecal-oral route

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68
Q

features of amoebiasis?

A

dysentery- bloody diarrhoea

Amoebic liver abscess-mass in R lobe, fever, RUQ pain

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69
Q

what is found on stool microscopy of amoebiasis?

A

trophozoites, amoebic cysts

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70
Q

tx of amoebiasis?

A

mentronidazole

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71
Q

how do alpha blockers work?

A

smooth muscle of blood vessels and GI tract

vasoconstriction of blood vessels and decreased motility in the GI tract

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72
Q

where do beta receptors act?

A

cause smooth muscle relaxation
GI tract
blood vessels
bronchi

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73
Q

what is adrenaline produced by?

A

“chromaffin cells” in the adrenal glands

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74
Q

what is phaeochromocytoma

A

a tumour of the chromaffin cells that secretes unregulated and excessive amounts of adrenaline

caused by MEN 2

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75
Q

features of phaeochromocytoma?

A 
hypertension 
headaches
palpitations
sweating
anxiety
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76
Q

diagnosis of phaeochromocytoma?

A

24 hr urinary collection of metanephrines

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77
Q

mx of phaeochromocytoma?

A

Surgery is the definitive management. The patient must first however be stabilized with medical management:
alpha-blocker (e.g. phenoxybenzamine), given before a
beta-blocker (e.g. propranolol)

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78
Q

what is the pathophysiology of CML?

A

Philadelphia chromosome- t(9:22) chromosomal translocation= BCR-ABL gene= excess tyrosine kinase activity

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79
Q

tx of CML?

A

imatinib- tyrosine kinase inhibitor

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80
Q

what is the full name of chlamydia?

A

chlamydia trachomatis

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81
Q

what is the formula for fluid correction given to a burns patient?

A

4 x weight x burn percentage

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82
Q

what level of burns is burns with no blistering but reduced pin-prick sensation?

A

3rd degree, full thickness

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83
Q

electrolyte complication of burns?

A

hyperkalaemia due to lysis of cells

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84
Q

name some viral and bacterial causes of hospital acquired infections?

A

viral- norovirus, rotavirus

bacterial- campylobacter, staph aureus, E.coli, C.diff

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85
Q

possible sources of infection in hospital?

A

resp droplet/airborne
catheter
bloods/cannulas
food

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86
Q

cause of infectious mononucleosis?

A

EBV

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87
Q

causes of pharyngitis and cervical lymphadenopathy other that EBV?

A 
CMV
toxoplasmosis
HIV
rubella
mumps
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88
Q

features of mouth and throat examination of infectious mononucleosis?

A 
sore throat
tonsillar enlargement
erythema
uvula oedema
lymphadenopathy
palatal petechiae
pyrexia
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89
Q

test used to confirm infectious mononucleosis?

A

Monospot test-hereophil antibody test

FBC, WCC

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90
Q

other features of glandular fever?

A

splenomegaly- occurs in 50%
hepatitis- transient rise in ALT
lymphocytosis
haemolytic anaemia secondary to cold agglutins
maculopapular pruritic rash common in amoxicillin tx

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91
Q

how does serotonin work?

A

increases synaptic cleft serotonin level
proven to work with depression
less side effects

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92
Q

what is the most likely cause of mitral stenosis?

A

rheumatic fever- think in a patient with a new murmur and arthralgia after sore throat

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93
Q

cause of rheumatic fever?

A

streptococcus pyogenes

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94
Q

why do the following happen in mitral stenosis:

  • AF
  • RV heave
  • Raised JVP
A

AF- increase of left atrial pressure and dilatation
RV heave- RV hypertrophy
Raised JVP- pulmonary hypertension/ right heart failure

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95
Q

why does mitral stenosis cause dyspnoea?

A

increased pressure in the atrium due to stenosis, backlog into pulmonary circulation leading to fluid overload leading to INCREASED HYDROSTATIC PRESSURE causing fluid to shift from vascular to interstitial causing oedema and SOB

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96
Q

treatments of COPD after standard medical therapy fails?

A

LTOT
home nebulisers
pulmonary rehab
CPAP

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97
Q

signs of CO2 retention?

A 
confusion
asterixis
warm extremities
bounding pulse
morning headache
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98
Q

what does a low base excess mean? (

A

there is a lower than normal amount of HCO3- in the blood, suggesting a primary metabolic acidosis or a compensated resp acidosis

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99
Q

how can pancreatitis lead to foul smelling, floaty stools?

A

pancreatic exocrine dysfunction- lack of faecal elastase

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100
Q

how are spinal cord compression and cauda equina different?

A

cauda equina- lower back pain and sciatica- bilateral, saddle anaesthesia, loss of anal tone, urinary retention

spinal cord compression- leg weakness and radicular pain, urinary and bowel incontinence, sensory level

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101
Q

treatments of addisons disease?

A

fludrocortisone

hydrocortisone

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102
Q

causes of addisonian crisis?

A
  • sepsis or surgery causing an acute exacerbation of
  • chronic insufficiency (Addison’s, hypopituitarism)
  • adrenal haemorrhage
  • steroid withdrawal
103
Q

mx of Addisonian crisis?

A
  • hydrocortisone 100mg IM or IV
  • 1L normal saline infused over 30-60 mins or with dextrose if hypoglycaemic
  • continue hydrocortisone 6-hourly until the patient is stable. No fludrocortisone in required because high cortisol exerts weak mineralocorticoid action
  • oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
104
Q

signs/symptoms of Addisonian crisis?

A

shock, confusion, N&V, fever, acute abdo pain, tachycardia

105
Q

causes of confusion in a patient with myeloma?

A

hypercalcaemia

uraemia

106
Q

what does a technicium bone scan look at and why is it not suitable in myeloma?

A

looks at osteoblastic activity

myeloma causes plasma cells to secrete IL-6 which inhibits osteoblast and stimulates osteoclastic activity

107
Q

Name 2 methods in which patient could get funding for cancer treatments not
recommended by NICE in the NHS

A

1) individual funding through PCT
2) cancer drug fund (charity)
3) private funding

consultants can apply for funding through NICE if they feel it is appropriate

108
Q

classic clinical features of plague psoriasis skin lesion?

A

well-dermarcated
silver scaly plaque
erythematous rash
hyperproliferation (thickened)

109
Q

differences between psoriatic and rheumatoid arthritis?

A

psoriatic arthritis affects distal interphalangeal joints and has nail changes

110
Q

what does COX stand for?

A

cyclooxygenase

111
Q

what substances do NSAIDs prevent from forming?

A

thromboxane A2

prostaglandin

112
Q

mechanism of steroid action in the nucleus and cytoplasm?

A

steroids are lipid-soluble so pass through cell membrane. They bind to steroid receptors in the cytoplasm where they combine and travel into the nucleus. There they bind to DNA receptors and control protein synthesis and enzymes that regulate vital cell activity.

113
Q

AEs of methotrexate?

A 
mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis
teratogenic- need to be on contraception
114
Q

ECG features of hypokalaemia?

A

flat inverted T waves, u waves, depressed ST, long QT

115
Q

what are the actions of aldosterone?

A

Increase sodium reabsorption from the distal tubule
Increase potassium secretion from the distal tubule
Increase hydrogen secretion from the collecting ducts

116
Q

diagnosis of COPD on spirometry?

A

FEV1 <80%

FEV1/FVC <0.7

117
Q

RFs for osteoporosis?

A

Steroids, hyperparathyroidism, alcohol, low testosterone, low BMI, early
menopause, renal failure, erosive, dietary, female sex, Asian/causasian, increasing age,
smoking, non- weight bearing

118
Q

what is a vertebral compression fracture in the spine called?

A

wedge fracture

119
Q

signs of lower motor neurone disease?

A

Muscle wasting
Reduced tone
Fasciculations (twitches in the muscles)
Reduced reflexes

120
Q

signs of upper motor neurone disease?

A

Increased tone or spasticity
Brisk reflexes
Upgoing plantar responses

121
Q

symptoms of bulbar or pseudobulbar palsy?

A 
slurred speech
Dysphagia, 
labile mood, 
nasal regurgitation, 
weak wasted fasciculating tongue. 
Loss of gag reflex. 
Jaw jerk affected.
122
Q

what will happen to sensitivity and PPV if the prevalence of a disease increases?

A

sensitivity will stay the same
PPV will increase as there are less false positives (NPV will decrease as there are more false negatives for every true negative

123
Q

Ix for suspected crohn’s

A

high foecal calprotectin
colonoscopy
ESR/CRP
rectal biopst

124
Q

inducing remission drugs and maintaining remission drugs in crohns?

A

inducing remission- glucocorticoids e.g. prednisolone, budesonide, 5-ASA drugs (e.g. mesalazine) 2nd line

maintaining remission- azathioprine or mercaptopurine

125
Q

mx of erythema nodosum?

A 
best rest
analgesia
NSAIDs
venous compression therapy 
steroids if malignancy and infection ruled out
126
Q

If there is hearing loss + facial weakness, where is the acoustic neuroma located
intracranially?

A

cerebellopontine angle

127
Q

what are the features of an acoustic neuroma?

A

cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy

128
Q

name some biochemical abnormalities of nephrotic syndrome/

A

hypoalbuminaemia
hyperlipidaemia- a consequence of increased synthesis of lipoproteins as a direct
consequence of low plasma albumin.

129
Q

pathological change of basement membrane in diabetic nephropathy?

A

basement membrane thickening

130
Q

name some risk factors for PE and how they increase risk?

A

Virchow’s triad= stasis, hypercoagulability, endothelial damage

immobility= increased stasis
malignancy= pro-thrombotic state
prev DVT= increased risk of embolus
COCP- oestrogen increases pro-thrombotic state

131
Q

name some thromboprophylaxis methods?

A 
TED stockings
encourage mobilisation
dalteparin DC
leg elevation
flowtron- intermittent compression device
132
Q

how does LMWH work?

A

activates antithrombin which prevents conversion of prothrombin to thrombin

133
Q

how does clopidogrel work?

A

P2Y12 inhibitor- stops ADP binding to platelet receptor= platelets can’t aggregate

134
Q

how do DOACs work?

A

rivaroxaban= factor Xa inhibitor

135
Q

signs of down’s syndrome?

A 
single palmar crease
sandal gap
flat nasal bridge
small, low set ears
upsloping palpebral fissures
epicanthic folds
protruding tongue
brush field spots in eyes
136
Q

what is the most important risk factors for down’s syndrome?

A

maternal age for non-disjunction
prev down’s baby
translocation carrier

137
Q

2 genetic mutations for down’s syndrome?

A

non-disjunction/translocation/mosaic- trisomy 21

138
Q

2 GI malformations for down’s syndrome?

A

hirschsprungs disease

duodenal atresia

139
Q

risks to child with down’s syndrome?

A 
low IQ
early onset alzheimers
epilepsy
cataracts
leukaemia
140
Q

RFs for melanoma?

A

UV exposure
multiple moles
family history
pale skin

141
Q

which lymph nodes are melanoma of the lower leg likely to spread to?

A

superficial inguinal

external/internal iliac

142
Q

RFs for lack of vitamin D?

A 
dietary
protective clothing
housebound
renal/liver disease
malabsorption e.g. coeliac
143
Q

how is vitamin D absorbed?

A

through the intestine to liver to become 25(OH)D to go to the kidney

  • increases calcium and phosphate from the intestine
  • increases bone resorption
144
Q

how does PTH work?

A

BONE- works on bone to increase osteoclastic activity so there is more calcium in the bloodstream

KIDNEY- increases vit D activation and calcium resorption from the distal convoluted tubule and increased phosphate excretion

145
Q

why does lack of vitamin D cause demineralisation of bone?

A

lack of Vit , reduces calcium, and increasing PTH which increases osteoclastic activity

146
Q

4 things to do for Vitamin D deficiency?

A

Vit D + calcium supplements (Adcal), increase sunlight exposure, avoid using sunblock, avoid covering, diet (fish and milk), bisphosphonate (prevents osteoclastic activity)

147
Q

triggers of gout?

A 
chemo
acute illness
alcohol
surgery
diuretics
148
Q

what type of drug is

  1. colchicine
  2. allopurinol
A
  1. plant alkaloid
  2. xanthine oxidase inhibitor- reduces serum uric acid levels (can precipitate an acute attack so don’t start straight away)
149
Q

why does gout favour small distal joints?

A

distal blood supply is cooler so crystals more likely to precipitate i.e. uric acid

150
Q

where are transitional cells found?

A

renal pelvis, ureter, urethra, bladder

151
Q

blood supply for bladder and nodal clearance?

A

internal iliac -> superior and inferior vesicle arteries

nodes- external iliac, common iliac

152
Q

coeliac antibodies?

A

anti-TTG
anti- endomysial
anti-gliadin

153
Q

advice before coeliac biopsy?

A

eat a gluten diet

154
Q

histology of coeliac?

A

crypt hyperplasia, villous atrophy, intraepithelial lymphocytes

155
Q

what do vitamin A and E deficiencies cause?

A

A- night blindness

E- peripheral neuropathy

156
Q

cancer risk of coeliac?

A

T call lymphoma of small bowel

157
Q

skin rash of coeliac?

A

dermatitis herpetiformis

158
Q

define economic evaluation?

A

Assessment of cost effectiveness - comparative study of the costs and benefits of a health care intervention. Costs and benefits need to be compared to at least two other interventions

159
Q

define efficiency

A

Allocation of resources between activities on order to maximise benefit

160
Q

what is opportunity cost?

A

to spend resources on one activity means a sacrifice in terms of lost opportunity elsewhere – benefits foregone from not allocating resources to the next best activity

161
Q

prophylaxis and protective measures for malaria?

A

malarone
doxycycline

wearing protective clothing, DEET spray

162
Q

3 reasons for malaria prophylaxis failure?

A
  1. non compliance
  2. resistance to meds
  3. inappropriate med for species
163
Q

diagnosis of malaria?

A

thick and thin blood film – need to take 3 films on 3 subsequent occasions
thick – detection of parasite
thin – detection of species
Rapid diagnostic test to look for antigen/enzymes of parasite

164
Q

symptoms of cerebral malaria?

A

Confusion, coma, seizures, encephalopathy

165
Q

symptoms of severe malaria?

A

seizures, AKI, ARDS, DIC, sepsis,

hypoglycemia

166
Q

treatment of malaria?

A

ACT – artemisinin combination

therapy

167
Q

treatment of complicated malaria?

A

IV artesunate

168
Q

2 things to regularly test in lithium treatment?

A

eGFR- renal function

TFTs

169
Q

signs of lithium toxicity?

A

tremor, confusion, ataxia, restlessness, hypertonicity, myoclonic jerks

170
Q

what is an apical lung tumour called?

A

Pancoast Tumor

171
Q

3 features of horner’s syndrome?

A

ptosis
miosis
anhydrosis
caused by sympathetic fibres

172
Q

why do people with lung cancer get shoulder and scapula involvement?

A

involvement of brachial plexus

173
Q

when nerve root causes wasting of thenar eminence?

A

supplied by median nerve- C8-T1

174
Q

what nerve causes a hoarse voice?

A

recurrent laryngeal nerve

175
Q

different features of hypertensive retinopathy on fundoscopy?

A
  1. Arteriolar narrowing
  2. AV nipping
  3. Flame haemorrhages, blot haemorrhages, cotton wool spots, exudates
  4. Papilloedema
176
Q

findings on slit lamp examination of anterior uveitis?

A

Cell and Flare (turbidity in aqueous humour), Keratic Precipitates, Hypopyon

177
Q

cause of eczema herpeticum?

A

HSV 1 and 2

178
Q

pathophysiology of lupus nephritis?

A

immune complex deposition on basement membrane.

179
Q

name some SLE treatments and class of drug?

A

Methotrexate – immunosuppressant
Corticosteroid – prednisolone
NSAID – naproxen
Hydroxychloroquine

180
Q

signs of examination on ascites?

A

Shifting dullness, fluid thrill

181
Q

signs in hands of chronic liver disease?

A

Palmar erythema, spider naevi, clubbing, leukonychia (white spots on nails), dupuytrens contracture,
asterixis/liver flap. Other – jaundice, gynaecomastia

182
Q

complications of chronic liver disease?

A 
varices
cirrhosis
 liver failure
hepatocellular carcinoma
hepatic encephalopathy – raised ammonia
itching 
bruising – decreased production of clotting factors
183
Q

pathophysiology of pleural effusion?

A

increased vascular permeability causes fluid to move into pleural space

184
Q

is a pleural fluid protein of 55 a transudate or exudate?

A

exudate a >30g/L

185
Q

how to diagnose TB?

A

microscopy – acid-fast bacilli on Ziehl-Neelson stain,

186
Q

why does an AKI cause tachypnoea?

A

metabolic acidosis caused by raised urea

trying to blow off C02 to compensate

187
Q

risk factors for T2DM?

A 
Overweight
age
FH
ethnicity
hypertension
gestational diabetes
heart disease or stroke
depression
PCOS
188
Q

signs of inflammatory arthritis?

A

Pain in the morning
Systemic features
Raised inflammatory markers

189
Q

signs of hyperthyroidism?

A

Irregularly, irregular pulse
pretibial myoedema
thyroid acropatchy- clubbing
inappropriate dressing

190
Q

signs of psoriatic arthritis?

A

nail pitting

alopecia

191
Q

which 2 places to ask to check in psoriatic arthritis?

A

behind ears

base of spine

192
Q

tx of PVD?

A

Stents

bypass surgery

193
Q

causes of poor ulcer healing?

A

poor perfusion
decreased mobility
malnutrition

194
Q

what is insertion of tendon to bone called?

A

enthesis

195
Q

symptoms of T2DM?

A 
polydipsia
polyuria
abdo pain
ED
recurrent UTI
thrush
196
Q

RFs for angina?

A 
smoking
DM
hypertension
age
FH
obesity
hyperlipidaemia
197
Q

secondary care ix of angina?

A

CT coronary angiography

exercise tolerance test with ECG

198
Q

drugs for angina?

A

everyone has GTN, statin and aspirin

BB e.g. bisoprolol or CCB nifedipine (if combined with BB)

199
Q

indicators for legionella pneumonia?

A

low sodium
travel history
bradycardia
dry cough

200
Q

6 Ix for haematuria?

A 
urine dipstick
urine culture
bloods- clotting, FBC, LFT
flexible cystoscopy
CT KUB?
XR/ CT
201
Q

most common type of renal cell cancer?

A

clear cell

202
Q

inherited risk factor for RCC?

A

Von- Hippel Lindau

203
Q

4 side effects of chemotherapy?

A

alopecia
nausea
constipation
peripheral neuropathy

204
Q

tx of neutropenic sepsis?

A

tazocin IV- penicillin (piperacillin) with beta-lactamase inhibitor (tazobactam)

205
Q

complications of chemo?

A

immunosuppression
cardiomyopathy
renal failure

206
Q

complications of MI

A 
heart failure
pericarditis
dressler's syndrome
mitral regurgitation
LVH
207
Q

immediate management of HF

A

Loop diuretics
O2
Opiates
Nitrates

208
Q

drugs of glaucoma

A

BB- timolol
prostaglandin analogue- lantoprost
carbonic anhydrase inhibitors- dorzolamide
oral/iv acetazolamide
pilocarpine drips (mydriatic)- constrict pupil
prevent recurrence- laser iridotomy

209
Q

why can asthma cause cushings syndrome?

A

exogenous steroids

210
Q

what is a confounder?

A

when an apparent association between an exposure and an outcome is actually the result of another factor e.g. office workers seem to be more likely to get lung cancer, but in fact more of them smoke

211
Q

features on a DRE that could point to prostate disease?

A

tender, boggy= prostatis
smooth, enlarged= BPH
craggy, irregular, enlarged= prostate cancer

212
Q

diagnosis of prostate cancer?

A

TRUSS biopsy

213
Q

what is passivity

A

were someone feels they are controlled by another person e.g. commanding a mother to kill their baby

214
Q

mx of puerperal psychosis?

A

atypical antipsychotic- risperidone, olanzapine
CBT
talking therapy

215
Q

immediate treatments for liver failure?

A

lactulose- prevent hepatic encephalopathy

vitamin K/ beriplex- to increase clotting factors

216
Q

hormone blood tests done in a sexual health disorder?

A 
testosterone and SHBG and albumin
LH/FSH
oestrogen
day 21 progesterone
free androgen index
prolactin 
TFTs
semen analysis
217
Q

four complications you might see in this RA patient after a routine surgical procedure?

A

adrenal crisis from stopping prednisolone
infection from steroid
hypercoagulable state- increased VTE risk
immune suppression from methotrexate

218
Q

what is included in PESI score?

A 
30 day outcome in PE
male
malignancy
heart failure 
chronic lung disease
tachycardia 
hypotension
etc
219
Q

what causes compartment syndrome?

A

increased pressure in the tissue in an anatomical area leads to necrosis and compression of structures
due to an increase in fluid building up pressure so tissue pressure is higher than capillary pressure

220
Q

drugs that contraindicate with warfarin?

A

any drug that prolongs QT

e.g. amiodarone, haloperidol, bendroflumethazide

221
Q

what is serotonin syndrome?

A

cognitive impairment
autonomic dysfunction
neuromuscular hyperactivity
tx= benzodiazepine

222
Q

mx of status epilepticus

A

buccal midazolam-> IV lorazepam -> contact anaesthetist -> phenytoin, sodium valproate, phenobarbitol

remember to do a blood glucose to exclude hypoglycaemia

223
Q

drug for alcohol withdrawal?

A

chlordiazepoxide

224
Q

Ix in addisons

A

Short synacthen test- cortisol doesn’t increase in problem with adrenals
CT adrenals
adrenal auto-antibody

225
Q

mx of addisonian crisis?

A

stress-dose hydrocortisone -> saline -> dextrose (and normal dose hydrocortisone)

226
Q

how to prevent addisonian crisis?

A

steroid sick days
increase in exercise
compliance
medical alert bracelet

227
Q

signs of a deteriorating baby?

A 
firm fontanelle
dry mucous membranes
no response
cyanosed
tachycardia
floppy
reduced urine output
not feeding properly
228
Q

bloods of paediatric sepsis?

A 
FBC
CRP 
Coagulation screen
blood cultures
ABG
BG
lactate
229
Q

paediatric sepsis 6?

A 
O2
IV or IV Abx
IV fluids
get senior help
inotropes e.g. DA
230
Q

what class of drug is cyclophosphamide?

A

alkylating agent

231
Q

well’s score for PE?

A 
signs and symptoms of DVT
alternative diagnosis less likely
tachycardia
immobilisation
prev DVT/PE
haemoptysis
maligancy
232
Q

signs of PE?

A 
haemoptyis
dyspnoea
tachycardia
fever
crackles
chest pain
233
Q

differentials for dysphagia?

A

cancer
pharyngeal pouch
MND
achalasia

234
Q

side effects of over treating with levothyroxine?

A 
thyrotoxicosis
AF
worsening of angina
palpitations
altered mental state 
tremor
235
Q

mx of leg injury in ambulance?

A 
IV access
gas and air
morphine
immobilise
ice and elevate to prevent compartment syndrome
236
Q

surgical mx of burns?

A

escarotomy

fasciotomy

237
Q

why do sickle cell pts have increased risk of gallstones?

A

haemolysis causes increased bilirubin-> stones

238
Q

prophylactic surgery of sickle cell?

A

splenectomy

239
Q

drug mx of sickle cell?

A

hydroxycarbamide (increases foetal Hb)

its an anti-metabolite

240
Q

signs of opioid withdrawal?

A

restlessness, pupil dilatation, insomnia, sweating, N&V, diarrhoea

241
Q

signs of opioid toxicity?

A 
hypotensive
tachycardia
pupil constriction
resp depression
constipation
242
Q

mx of IVDU addict?

A

sexual health screen
needle exchange
immunisation

243
Q

causes of intra-abdominal sepsis?

A

staph aureus- anaerobe
E.Coli- gram-negative
Enterococcus

244
Q

why does lactate go up in intra-abdominal sepsis?

A

hypoxia causes anaerobic respiration which causes lactate production
sign of increased mortality

245
Q

2 features of cauda equina in perianal area?

A

anal wink, saddle anaesthesia

246
Q

features of quinsy?

A

deviated uvula, purulent tonsils, trismus, painful swallowing

247
Q

UMN signs? (L1 and above)

A 
upgoing plantars
hypertonia
brisk reflexes
weakness
retention
248
Q

what is efficiency?

A

max benefit from resource allocation

249
Q

cerebral complications of malaria?

A

confusion, coma, seizures

250
Q

severe complications of malaria?

A

seizures, AKI, DIC, sepsis, hypoglycaemia

251
Q

2 things to test before lithium

A

eGFR, TFT

252
Q

what causes horner’s syndrome?

A

sympathetic nerve fibres

253
Q

features of bulbar palsy?

A

LMN

dysarthria, dysphagia, drooling, absent gag reflex, fasciculating tongue

254
Q

differentials of facial nerve palsy?

A

bells palsy, ramsey-hunt syndrome, parotid tumour

finals (14 decks)

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