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Year 6 > Past papers > Flashcards

Past papers Flashcards

1
Q

Difference between ABPA and EAA

A

ABPA- IgE, BE on CXR

EAA- IgG, mild fever, bad when in place where exposed

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2
Q

Tx of serotonin syndrome

A

Benzos

Severe- cyproheptadine or chlorpromazine

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3
Q

Late signs of mesenteric ischaemia

A

High lactate, acidosis and
peritonism develop at a late stage when there is established bowel wall necrosis

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4
Q

When is a hernia likely to be strangulated

A

If it is very tender
No bowel motions

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5
Q

Initial ix of SCD

A

Blood film

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6
Q

Blood supply to legs and buttock

A

Internal- buttock
External leg

So if claudication in both- stenosis in common iliac

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7
Q

If low fibrinogen, WBC, RBC, plt what is dx

A

DIC from PML RARA
15:17

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8
Q

If calf pain on exertion, pulse not findable what is the mx

A

Exercise programme since on claudication

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9
Q

Tx of GBS

A

IVIG

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10
Q

25 yo with long standing cough, haemoptysis with rings on CXR

A

CF- not cancer since unlikely under 40

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11
Q

Sx of vesicular reflux

A

Extensive renal scarring can cause renal insufficiency,
end-stage renal disease, renin-mediated hypertension

Renal USS showed dilated calyces and
cortical thinning bilaterally

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12
Q

Increased tone, hypertensive, tachycardia and dilated pupils dx

A

Serotonin toxicity

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13
Q

TCA OD sx and tx

A

Long QRS
Dilated pupils
Arrythmias and seizures

Sodium bicarbonate

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14
Q

BB OD sx

A

BB have poor CNS penetration and causes bradycardia and hypotension; it would not
cause CNS depression

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15
Q

Common arrhythmia after CBAG

A

AF

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16
Q

Sx of candiasis on men

A

Diabetic
Balanitis
Itchy white discharge

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17
Q

Levels of diabetic retinopathy

A

Background (mild NPDR)- 1 or more micro aneurysm

Mod- cotton wool, haemorrhages, hard exudate

Severe- (pre proliferative)- blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants

Proliferative- new vessels on disc or elsewhere

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18
Q

CURB65 meaning and management

A

AMTS <8
Urea >7
R >30
B <90/60
>65

0/1- can discharge
2- can admit to ward
>3- HDU/ICU

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19
Q

Large vs SBO on presentation

A

Small- early vomitting
Large- if recurrent- think volvulus, early gross abdominal distention

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20
Q

Pain tx for sickle cell crisis

A

Fluids
IV morphine
Exchange transfusion if not working

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21
Q

When to use each type of test for significance in study

A

T test - normal distribution
Paired- if part of same group- i.e same group before and after treatment

Unpaired- comparing different groups

Mann–Whitney U-test- not normal distribution

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22
Q

Cohort study vs case control study

A

Case control- start with outcome- i.e disease and look back at factors

Cohort- prospective and retrospective
Start with exposure and either follow over time (pros) or look to see if developed disease (retro)

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23
Q

Specificity and sensitivity formula

A

Spec= TN/ without disease so TN/TN+FP

Sens= TP/with disease so TP/TP+FN

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24
Q

NPV and PPV formula

A

NPV= TN/TN+FN

PPV= TP/TP+FP

Determine accuracy of test to get it right/wrong
Takes into account prevalence

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25
Q

Ingested foreign body Ix

A

Lateral soft tissue X ray

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26
Q

Pseudomonas tx

A

Cipro or gent

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27
Q

Monitoring GBS respiratory function

A

FVC

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28
Q

Hoarsness and laryngeal involvement ix

A

Larygoscope

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29
Q

Toxoplasmosis on MRI

A

usually single or multiple ring-enhancing lesions, mass effect may be seen

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30
Q

Conductive hearing loss and haematuria

A

GPA

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31
Q

Tx of trigeminal neuralgia

A

Carbamazepine

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32
Q

When to refer for breast cancer

A

aged 30 and over and have an unexplained breast lump with or without pain or

aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern

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33
Q

Carpal tunnel Ix

A

EMG

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34
Q

Tx of rhabdo

A

Fluids

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35
Q

NSTEMI treatment algorithm

A

Aspirin on admission

GRACE score- If >3%
CA within 72 hours with possible PCI
ONLY give fondaparinux if not immediate PCI

<3% give ticagrelor

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36
Q

Tx of aortic stenosis

A

Only replace valve if
>40mmHg pressure
or symptamatic- SAD

If old or cormobid- TAVI
Younger- replace

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37
Q

Ventricular aneurysm vs free wall rupture vs papillary rupture sx post MI

A

HF symptoms, persistent ST elevation- Aneurysm

Muffled HS, hypotensive- free wall rupture

Early mitral regurg on auscultation- papillary rupture

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38
Q

When each type of bacteria causes IE

A

IVDU- staph
After valve replacement- staph epidermis
Other dentist- strep viridian’s

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39
Q

Which drugs inhibit CYP450

A

Increase drugs

Acute alcohol
Allopurinol
Azole
Ciprofloxacin
Disulifram
Erythromycin
Valproate

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40
Q

3rd line drugs for HF

A

Ivabradine
Hydralazine- Black afro
sacubitril-valsartan- ACE washout period

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41
Q

When to give ICD or resync therapy for HF

A

ICD- <35%, max meds, good QoL

Resync- Wide QRS

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42
Q

NYHA classification for HF

A

1- no sx
2- mild on physical- ordinary physical cause SOB
3- mod on physical no on rest- not normal things cause SOB
4- severe- even at rest

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43
Q

What antihypertensive should you not give to poorly controlled DM

A

Thiazides- reduce glucose tolerance

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44
Q

When to give drugs in ALS

A

VF/pVT- adrenaline and amiodarone- 3

Adrenaline- non shockable

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45
Q

NSTEMI vs inferior MI

A

NSTEMI- St depression and T wave inversion

Inf- ST depression in anterior leads, Tall R waves

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46
Q

What precipitates digoxin toxicity

A

Hypokalaemia
Amiodarone

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47
Q

Tx of SVT in asthmatics

A

Verapamil

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48
Q

How MI can present in DM an elderly

A

Silent
Sweating
SoB

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49
Q

Tx of orthostatic hypotension

A

Fludrocortisone

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50
Q

Tx algorithm of CVA

A

<4.5 hour- thrombolysis - then 24hrs later- aspirin for 2weeks
If over- 300mg aspirin for 2 weeks

After if AF anticoagulant if CHAD, or clopidogrel 75mg

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51
Q

Scorings for strokes

A

ROSIER- if stroke or mimic
NIHSS- severity
Barthel- ADLs

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52
Q

Tx of MG, GBS and MS

A

MG- pyridostigmine, prednisilone- if crisis IVIG

GBS- IVIG

MS- methylprednisolone IM

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53
Q

What drugs precipitate MG

A

Antibiotics- gent and macrolides
BB

Lithium
Phenytoin

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54
Q

Difference in sx between lesions in cerebellum

A

Vermis- gait ataxia

Hemi- peripheral

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55
Q

Sagittal vs cavernous thrombosis

A

Sagittal- peri orbital swelling, proptosis

Cavernous- CN palsies- V1,2 3, 4,6

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56
Q

Feeding in stroke/ MND

A

PEG
Can try NG first- but if long term disability with unsafe swallow- PEG

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57
Q

Driving restrictions in neuro conditions

A

First seizure- 6 months
TIA- 1 month

Epilepsy- can drive if seizure free for 1 year
Cant drive if meds withdrawn for 6 months

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58
Q

Pupil up and out and problems looking downstairs

A

4th CN palsy

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59
Q

SE of phenytoin

A

Peripheral neuropathy
Hypertrophic gums
Enaemia aplastic
No calcium- hypo

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60
Q

Isolated raised protein in LP

A

GBS

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61
Q

PE treatment algorithm

A

Well score
If >4- CTPA - longer than 4 hours- AC
IF CTPA neg- doppler if indicated

<4- D dimer - “

If D dimer neg- alternative
If +- CTPA

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62
Q

Effusion Ix and tx

A

Lights- 0.5 protein, 0.6 LDH, or LDH 2/3 ULN

(PE is exudative_

If turbid or pH <7.2 chest drain

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63
Q

COPD antibiotic therapy

A

Prophylaxis- azithromycin- >3 exacerbations in year- use if sputum purulent - ECG

If IE- amox, doxy or clarithro

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64
Q

Asthmatic features of COPD

A

Eosinophillia
Previous diagnosis of asthma or atopy
Diurnal variation of PEF
Variation in FEV over time

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65
Q

Step down of asthma

A

Reduce steroid by 25-50%

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66
Q

Insertion of needles or drains into chest

A

Lower border between ribs

SO for chest drain- just above 6th

Aspiration- just above 3rd

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67
Q

Referral for lung cancer

A

Haemoptysis >40 - unlikely if below 40

Chest X ray demonstrating

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68
Q

Silicosis X ray

A

Egg shell calcification of hilar
Upper lobe fibrosis

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69
Q

Dx of mycoplasma vs legionella

A

Myco- serology
Legionella- urinary antigen

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70
Q

Treatment order of RhA

A

2 DMARDs then biologics
Sulphalazine, hydroxycarbamide, meth

DAS >5.1 adding
<2.6 reducing

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71
Q

Tx of SLE, sjorgrens, diffuse scleroderma

A

SLE- maintain with hydroxycarbamide, pred and cyclo for fairs, ACEi for renal
If preg- azathiptine or HC

Sjogrens- HC

Scleroderma- ACEi for renal

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72
Q

When to give bisphosphoantes

A

start bisphosphonates if:
1) aged >75 y/o and fracture, a DEXA scan may not be required
2) <75 y/o than do DEXA first, <-2.5 = bisphosphonates
3) high-risk FRAX
Pagets

If patient on steroids:
2) aged > 65 no need DEXA
2) aged <65 do DEXA first
- if T score less than 1.5 -> give alendronate
- If T score more than 1.5 ->repeat scan 1-3 yearly

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73
Q

What supplements should be give with BP

A

Vit D and calcium- only calcium if diet inadequate

Must correct these before BP

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74
Q

APLS sx ix and tx

A

Livedo reticularis- Lacey
VTE
Miscarriage

Anticardiolipin, Lupus anticoagulant

Tx- low dose aspirin no VTE
warfarin- VTE

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75
Q

Fever, pink rash, hypotensive, arthralgia tx

A

Stills
NSAIDs 1weeks- then steroids

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76
Q

RhA pre op check

A

Lateral and AP neck X ray

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77
Q

Tx of OA

A

Paracetamol
Topical NSAIDs- hands and knees

Then Oral NSAIDs with PPI or Weak opioid

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78
Q

RF of pseudo gout

A

Acromegaly
Hyperparathyroid
Haemachromatosis
Hypothyroid
Wilsosn

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79
Q

Symptoms of AS

A

Anterior uveitis
Aortic regurg
Apical fibrosis
Achilles tendonitis

Squaring
Supraspinatous calc
Syndesmophytes

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80
Q

Sx and cause of avascular necrosis

A

Asymp then pain
In long bones- femur

Chemo
Steroids

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81
Q

Adhesive capsulitis vs subacromial bursitis vs rotator cuff tear

A

Adhesive- >40, DM, no trauma, limited external rotation

SB- impingement- painful arc at 60-120- no weakness, activity

Tear- pain <60- weakness- associated with activity, trauma/sporting

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82
Q

Septic arthritis blood and aspirate

A

50% have negative gram stain
So if high WCC and signs- treat with IV ABx

WBC 10,000/mm3 and may be as high as 100,000/mm3. Neutrophil levels are >90%

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83
Q

SLE bloods

A

Low plt
Low FBC
Low WCC
Low complement

Female

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84
Q

Roots vs peripheral neuropathy signs of upper limbs

A

If peripheral- sensation will be located to hand only

If root- will be forearm

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85
Q

Radial head fracture

A

FOOSH

Impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination

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86
Q

Herniated disc Sx

A

Pain unilaterally
Sudden pain in back

Straight leg raise +- sciatic nerve- L4- S3

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87
Q

UC remission tx

A

Rectal AS
Then in 4 weeks and no remission and oral then steroids

If had severe or >2 in a year- mercaptopurinol or azathioprine

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88
Q

SBP dx and tx

A

Neuts >250
Tx- tazoscin

Prophylaxis- propanolol and cipro

Spiro for ascites, may drain if tense ascites

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89
Q

Stain for haemachromatosis

A

Pearls

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90
Q

What should you do to prepare for H pylori testing

A

Breath test- ABx 4 weeks, PPI 2 weeks

Endoscopy- PPI 2 weeks

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91
Q

Tx of Peutz, FAP and HNPCC

A

Peutz- endoscopy 2-3 yrs

FAP- usually >100 polyps, any polyp- resection

HNPCC- scanty polyp
Colonoscopy 1-2 yrs from 25 , can have prophylactic surgery
Can cause endometrial cancer

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92
Q

Crohsn vs UC on pathology

A

UC- Crypt abscess and pseudopolyps

Crohns- goblet increase and granuloma

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93
Q

Pyoderma gangrenosa description and symptoms

A

Initially features:
usually starts quite suddenly
small pustule, red bump or blood-blister

later features:
the skin then breaks down resulting in an ulcer which is often painful
the edge of the ulcer is often described as purple, violaceous and undermined.

the ulcer itself may be deep and necrotic

may be accompanied by
systemic symptoms
fever
myalgia

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94
Q

Cause of pruritus

A

IDA
Lymphoma

Polycythaemia

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95
Q

PBC vs PSC tx

A

PSC- observation
PBC- ursodeoxy

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96
Q

NG tube placement

A

pH <5.5 in right place

If not- CXR

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97
Q

Paracetamol OD tx

A

<1 hours- charcoal

> 1 measure at 4
If >150mg/kg in 8 hours
Or if staggered or unknown timing
or >24 hrs with symptoms
NAC

If pH <7.3 at 24 hours- liver transplant

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98
Q

Venous vs arterial vs neuropathic vs pyoderma sx

A

Venous- irregular, eczema, haemosiderin, painless, medial malleolus, shallow, foul smelling

Arterial- painful, punched out, toes

Neuropathic- bottom of foot

Pyoderma- irregular, painful, prev trauma, purple border, deep and necrotic

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99
Q

Sx and Tx of intermittent claudication, critical limb ischaemia and acute limb ischaemia

A

IC- only pain when walking
Exercise programme
Quit smoking
Clopidogrel and statin

Critical- >2 weeks, pain at rest, ulcers
Urgent referral
>10cm- bypass/ endarectomy
<10cm- angioplasty

Acute- Ps, doppler ABPI, IV heparin- immediate referral
Thrombolysis or endarectomy

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100
Q

Tx of scaphoid fracture

A

Suspected fracture- futuro splint imaging 7 days
Proximal pole- fixation
Dispaced- fix

Undisplaced- cast

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101
Q

Tx of VT

A

If pulseless- shock

If pulse- unstable- shock
Stable- amiodarone- then if not working- sync shock

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102
Q

Ottawa rules for ankle

A

Pain and one of posterior malleolus <6cm from base, inability to weight bare

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103
Q

Insulin regime when DKA

A

FRII - 0.1 U/Kg

Continue long acting, stop short

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104
Q

Acne rosacea sx and tx

A

Pustules- over nose and forehead which is worsened by sunlight

topical Ivermectin- moderate pustle
Ivermectin and doxy- severe

More Telangectasia- laser

More flushing- bromidine

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105
Q

Sign for retrocaecal appendicitis

A

Psoas sign
Acute retrocaecal appendicitis is indicated when the right thigh is passively extended with the patient lying on their side with their knees extended

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106
Q

Imaging of acoustic neuroma

A

MR imaging with contrast of internal acoustic meatus

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107
Q

Tx of SBO

A

NG tube and fluids
If fails to work- surgical

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108
Q

Bacterial vs viral meningitis sx

A

Bacterial- high pressure, high fever, hours to develop

Viral- normal pressire, days to develop
Coxsackie

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109
Q

If shocked and JVP is high what tx do you give

A

Adrenaline

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110
Q

Tx of venous ulcer

A

Stockings

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111
Q

TLS biochemistry and treatment

A

High P, K and creatinine, low Ca

High risk- high tumour turnover- IV rasburicase or allopurinol

Low risk- PO allopurinol

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112
Q

Plt and RBC transfusion indications

A

Plt- <10, <30 and bleeding, <50 procedure, <100 for eyes

RBC- <70 or <80 ACS

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113
Q

G6PD presentation and triggers

A

Males !
Jaundiced

Malarials, sulpha, nitro

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114
Q

Tx of DAT + HA

A

Steroids and rituximab

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115
Q

When to treat suspected neutropenic sepsis

A

If obvious risk
RR >25 and temp >38- IB Abx

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116
Q

PKD vs Hereditary sphere vs G6PD vs Thala vs AIHA presentation

A

PKD- burr cells or ehcinocytes
G6PD- males after triggers, Heinz
AIHA- CLL, CLE, mycoplasma causes- speherocytes and DAT +
Thala- Sig lower MCV, high A2, basophilic stiplling
HS- spherocytes, Northern European

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117
Q

DKA dx, tx and resolution

A

Dx
pH <7.3
Glucose >11
Ketones >3

Treat with fluid, 0.1U fixed of rapid insulin
Add potassium when in range 3.5-5.5
Add dextrose when <14

Resolution
When >7.3
Ketones <0.6
Bicarb >15

If acidosis and ketones not resolved in 24 hours- refer to endo

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118
Q

Drugs affecting TSH and T4

A

Ferrous and Caglu- decreases resorption of levo
Should take 4 hours apart

Amiodarone- causes hyper/hypo
If hypo- continue and take thyroxine
If hyper- stop amiodarone and take carbimazole if goitre or steroids if no goitre

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119
Q

Treatment of Graves

A

Proponalol and Carbimazole

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120
Q

When to give hypertonic solution

A

When Na <120

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121
Q

Tx of SIADH

A

Fluid restrict
Demeclocycline

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122
Q

Tx of subclinical hypothyroid

A

> 10 3m apart- 6m trial levo

5.5-10 and symptomatic- trial

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123
Q

When to increase insulin rate in DKA

A

If glucose isn’t falling by 3/hr
If ketone aren’t falling by 0.5 per hour

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124
Q

Problems occurring with fluid resuscitations

A

If hyponatraemic- increase Na too fast- demyelination- central pontine myelinosis

If hypernatraemic- decrease Na too fast- cerebral oedema

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125
Q

ACAG vs anterior uveitis vs scleritis vs keratitis vs retinal detachment vs ischamic sx vs optic neurtiis and tx

A

ACAG- hazy cornea, painful, large pupil - IV acet, timolol and pilo, UR

AU- small irregular pupil, causative condition, photophobia, reduced acuity - UR

Scleritis- painful, vessels don’t move- no reduction in sacuoty, causing condition- Referral urgent

Keratitis- red eye, painful, gritty- UR

Ischamia- curtain coming down_- UR

ON- pain when moving- red desats- UR

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126
Q

Differentiating between types of hypopituitism

A

Apoplexy- pain like SAH

Macroadenoma- can often be unnoticed
May cause change in viison

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127
Q

Painful legs, red eyes, pyrexia

A

Leptospirosis

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128
Q

Blood film of coeliac disease

A

Siderocytes
Howell Jolly

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129
Q

Post thrombotic syndrome - sx

A

Pain, oedema, dermatitis, ulceration, abnormal skin pigmentatio

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130
Q

When can you extend thrombectomy fort stroke to 24 hours

A

If advanced scanning shows salvageable brain tissue

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131
Q

Infection from cats

A

Bartonella- systemic symptoms

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132
Q

How papiloedema is described and when it presents

A

Blurring of optic margins
Venous engorgment

Causes
SOL
HTN
IIH

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133
Q

Ix and treatment of varicose veins

A

Doppler USS- retrograde flow

Treat with compression stockings

Only referral if significant symptoms, venous ulcer

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134
Q

If pt denies eppley manoeuvres what can you do

A

Exercises at home
Brandt-Daroff exercises

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135
Q

Verbal part of GCS

A

1- none
2- sounds
3- words
4- confused
5- normal

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136
Q

Ix of wet ARDM

A

Fluroscein angiography If neovasculism is suspected

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137
Q

Driving after MI

A

4 weeks
6 weeks if lorry off inform DVLA

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138
Q

Virus causing nasopharyngeal cancer and tonsillar cancer

A

NPG- EBV

Tonsillar- HPV

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139
Q

If have fasting glucose of 8.1 what next

A

Should do OGTT

140
Q

When to surgically removed bowel in UC

A

Dysplastic changes
Severe flair- resistant to tx

141
Q

When to intubate

A

<8

142
Q

High carboxyHb tx

A

High flow O2
Pa O2 will be normal

143
Q

Analgesia of SCD

A

Fluids- caused by dehydration
IV morphine
Of fails- exchange

144
Q

Urine sodium in DI and PP

A

DI- high urine sodium

PP-low urine sodium

145
Q

Endoscopy for vocal cords, cant maintain strong grip what improves sx

A

Pyridostigmine- since checking weak vocal cords

146
Q

Hyperthyroid hand changes

A

Oncholysis
acropachy

147
Q

Morphine to SC

A

/2

148
Q

When to stop statins

A

CK 5 ULN
or with macrolide
or LFT 3 UMN

149
Q

If Lower GI bleeding what Ix should you do

A

Flexible sigmoidoscopy- if normal
Colonoscopy

150
Q

2cm smooth non-tender swelling fixed to underlying structures on L wrist

A

Ganglion

151
Q

When to refer to the coroner

A

o Unexpected or sudden deaths
o Not seen within 14 days before death
o Death occurs within 24 hours of hospital admission
o Accidents, injuries and suicide
o Industrial injury or disease (e.g. asbestosis)
o Deaths occurring as a result of ill treatment, starvation or neglect
o Death occurred during an operation or before recovery from the effect of an anaesthetic
o Poisoning, including taking illicit drugs

152
Q

Test for femoral nerve irritation

A

Femoral strach test
Lay pronated
Extend hip behind- + if pain- radiculopathy in L2-4

153
Q

Chlamydia exposure what do you do

A

Test and treat without results

154
Q

Tx of otitis externa in diabetics

A

Cipro to cover psuedo

155
Q

DEXA scan t and z score meaning

A

T score- compared to young healthy
Z- compared to same age

156
Q

Most likely cause a brain mets

A

Lung

157
Q

Cause of juxta articular oesteopaenia

A

RA

158
Q

Medial vs lateral epicondylitis

A

Lateral epicondylitis: worse on resisted wrist extension/suppination whilst elbow extended

Medial epicondylitis is commonly referred to as ‘golfer’s’ elbow. The pain is aggravated by wrist flexion and pronation

159
Q

Results of syphillis testing

A

Treponum HA test (specific)
Venerum test/rapid plasma reagin (non specific)

If specific + and non - successful treatment
If specific - and non + false positive (SLE, pregnancy, HIV)

160
Q

If on bisphosphonates for 5 years what should you do

A

Treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.

Continue if
- >75y/o
- on steroids
- prev hip/vertebral fracture
- high risk FRAC
- T score <2.5 still

161
Q

Tx of ascites

A

Fluid restrict if sodium <125
Spironolactone otherwise
Low sodium diet

162
Q

When is liraglutide used

A

person has a BMI of at least 35 kg/m²
prediabetic hyperglycaemia (e.g. HbA1c 42 - 47 mmol/mol)

163
Q

Mx of hiatus hernia

A

Lifestyle and PPI- sliding
If paraoesophgeal- rolling- surgery if others fail

164
Q

Tx of vestibular neuritis

A

Short course of prochlorperazine
Rehab exercises if chronic

165
Q

Boehavves dx

A

Contrast swallow

166
Q

Diarrhoea and hypoglycaemia dx

A

Cholera

167
Q

Tx of constipation in IBS

A

Bulk forming laxatives
Ispaghula husk

168
Q

Anti nausea in migraines

A

Metoclopramide

169
Q

Unilateral lymph node enlargement with eosinophillic nuclei

A

Reed sternberg
Hodgkin

Nuclei can also be called mirror image

170
Q

Prevention of second TIA

A

Clopidogrel and aspirin

171
Q

What drug causes hypomagnesia

A

Cisplatin

172
Q

Vaccine after Hep B infection

A

Pneumococcal

173
Q

Tx of sebhorreic dermatitis

A

Topical ketoconazolr

174
Q

Menieres vs acoustic

A

Meniere- tinnitus and fullness
Acoustic- corneal reflex

175
Q

If BPh but have urge and incontinence what tx

A

Oxybutynin for overreactive bladder

176
Q

Tx of nasal polyps

A

Unilateral large- referral
Bilateral- inhaled CS

177
Q

Asthmatic with 4.9 K and one 3 HTB meds what do you give

A

A blocker

178
Q

Rapid progressing GLN examples and findings on biopsy

A

GPA, eGPA, Goodpastures

Crescenteric

179
Q

Central Retinal artery occlusion vs Anterior ischemic optic neuropathy on fundoscopy

A

CRAO- cherry red spot with pale retina
AION- Engorged pale optic disc with blurred margins

180
Q

What drugs used in surgery are those With MG resistant to

A

Suxamethonium

181
Q

Most common heriditary cause of thrombosis

A

Factor C resistance- Factor V Leiden

182
Q

Acute abdo pain and acidotic

A

DKA
Not paracetamol as doesn’t acutely cause acidosis

183
Q

Homonymous hemianopia with macular sparing lesion location

A

Occipital cortex

184
Q

Tx of acute flare up in RhA

A

IM pred

185
Q

Mx of acute panc

A

Aggressive early fluid resuscitations (since fluid in 3rd space)

186
Q

Bisferens pulse cause

A

HOCM

187
Q

Whole body convulsion with no awareness loss

A

Psychogenic

188
Q

Unilateral blurry vision and halos surrounding light sources

A

Cataracts

189
Q

How tranexamic acid should be given in major haemorrhage

A

Rapid bolus followed by slow infusion

190
Q

If scan is negative and d dimer is positive what do you do

A

Stop DOAC and repeat scan in 1 week

191
Q

Latent TB features and tx

A

Ghon focus- bacteria may be in granuloma

Isoniazid with rifampicin for 3 months or I for 6m

192
Q

What can compartment syndrome do to renal function

A

Cause rhabdo and cause AKI

193
Q

Bennets and potts fracture

A

bennets- fracture of base of thumb, usually in fights
Potts- bimalleolar

194
Q

Testicular cancer sx (non genital related)

A

gynaecomastia

195
Q

If giving a HF patient >2 bags of transfusion what else should you give them

A

Furosemide STAT

196
Q

If HIV + what should you do

A

Start HAART and test again in 12 w

197
Q

Coeliacs can be deficient in

A

B12, iron and folate

198
Q

What medication should be stopped in C diff

A

Opioids

199
Q

How to detect acute kidney graft failure

A

Asymptomatic
picked up by a rising creatinine, pyuria and proteinuria

200
Q

Testing in chronic pancreatitis

A

Annual Hba1c- since DM will likely develop

201
Q

Painful knee shortly after chlamydia infection synovial fluid

A

High WCC but sterile
Reactive arthritis

202
Q

If PE suspected and CTPA negative what next

A

Doppler of leg

203
Q

If OP and CKD 5 what do you give

A

Denosumab

204
Q

Thiazide vs furosemide effect on calcium

A

Thiazide- increases
Loop- decrease

205
Q

Important investigation after aminosalicylate

A

FBC- for agranulocytosis

206
Q

Osteolytic and sclerotic lesions

A

Pagets

207
Q

If long wait for CTPA what do you do

A

DOAC and wait
Only D dimer if <4

208
Q

When to use sync CV

A

Unstable pulse VT
Unstable tachys

209
Q

Acne in pregnancy

A

Erythromycin if not responding to BPO

210
Q

How to prepare for colonoscopy

A

Laxatices day before surgery

211
Q

What can happen if you give a lot of insulin in HHS

A

Myelinosis

212
Q

Aspirin in AKI

A

Can be continued

213
Q

Seb dermatitis vs tine capitus

A

Tinea- hair loss

213
Q

Seb dermatitis vs tine capitus

A

Tinea- hair loss

214
Q

When should you wait bare after surgery for hip fracture

A

As soon as tolerabel

215
Q

Yellow fever features

A

Illness
Recovery for 48 hours
Deterioration- jaundice and haematemesis

216
Q

Congenital adrenal hyperplasia sx

A

Since defifiecnt in enzymes making cortisol and aldosterone
Increase in test- early menarche, hirsutism
Addisons features

217
Q

Shingles analgesia

A

After NSAIDs, para and neuropathic pain
Can give prednisilone in first2 weeks as long as on acilovir

218
Q

Pus in anterior chamber of eye tx

A

Steorids and cyclo (atropine, tropicamdie)
Since anteiror uveitis

219
Q

When to use Escharotomy

A

Indicated in circumferential full thickness burns to the torso or limbs.

Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involve

220
Q

Tx of herpes

A

10d valaciclovir

221
Q

Labyrunthitis vs neuronitis

A

Labyrinth- hearign loss

222
Q

What precipitates Pompholyx eczema

A

Warmth
Eczema on palms and soles

223
Q

Cause of OM in sickle cell pts

A

Salmonella

224
Q

Sudden change in cognition and control mx

A

Urgent imaging

225
Q

AKI stages

A

1- 1.5-1.9- 0.5 for >6 hrs
2- 2-2.9- 0.5 for >12hrs
3- >3 - 0.3 for >24 hours

226
Q

Tx of hyperthyroid in pregnancy

A

Propylthiouracil

227
Q

Cause of keratitis

A

Contact lens- acanthaboea (water exposure) , pseudomonas
Non- staph

228
Q

Acute SNL hearing loss mx

A

Urgent ENT referral
High dose steroids
Audiometry and Brain MRI

229
Q

Drug indued Lupus

A

HIP
Hydralazine
Isoniazid
Phenytoin

230
Q

Posterior communicating artery vs cavernous sinus thrombosis

A

CVT- proptosis, 3rd nerve palsy, absent corneal reflex

PCA- 3rd nerve palsy

231
Q

BMI ASA

A

30-40 2
40+ 3

232
Q

Thumbprinting on x ray

A

Mesenteric ischamiea

233
Q

Unilateral vs bilateraal papiloedema

A

Unilateral- optic nerve tumour
Bilateral- HTN, IIH, tumour

234
Q

Drug in MND that offers survival benefit

A

Riluzole

235
Q

Prophylaxis of gout

A

Allopurinol but also colchicine when starting allopurinol as prophylaxis

236
Q

Myeloma investigations

A

Serum protein electrophoresis
whole body MRI

237
Q

Gingivitis mx

A

Simple- dentist
Systemic- refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine mouth wash
simple analgesia

238
Q

Ix of GBS

A

LP and NCS

239
Q

AI hepatitis AB

A

Anti smooth muscle or ANA 1
Anti LK 2

240
Q

Refractory anaphylaixs

A

Resistant to 2 doses on adrenaline

241
Q

Antibodies in drug induced lupus

A

Anti histone

242
Q

ECG of pericarditis and tx

A

PR depression and widespread ST
Colchicine and NSAIDs

243
Q

Minimal displaced malleolar fracture below talar dome mx

A

Weight baring with controlled ankle motion boot

244
Q

CI to lung surgery for cancer

A

SVCO
Malignant pleura
FEV <1.5
Vocal cord paralysis

245
Q

Brain death testing

A

Fixed unresponsive pupils
No cornea reflex
No response to supraorbital pressure
No cough reflex
No resp effort if disconnected

2 separate doctors test on seperate occasions

246
Q

When to give oral 5ASA in UC if mild disease

A

If disease is affecting ascending colon as enema will not reach that far

247
Q

If history of nausea after surgery what drug is useful

A

Propofol since AE effect

248
Q

Biopsy of membranous vs GPA vs minimal vs FSG

A

Membranous- subepithelial spikes, BM thickening

GPA- crescenteric, along BM linear

Minimal- not seem, seem on EM

FSG- only some changes, not all- collagen sclerosis

249
Q

NSTEMI conservative management

A

Aspirin plus clopidogrel if high risk bleed
Ticagrelor if low risk

250
Q

Treating Hep B exposure

A

Test their Anti Hbs Abs
If low- non responder- give vaccine an dIG
If high- vaccine

251
Q

Diagnosis of IBD in severe flare

A

Flexible sigmoidoscopy since colonoscopy is CI

252
Q

Long vs short saphenous location

A

Long- medial
Short- lateral

253
Q

Presbycusis findings

A

Bilateral high frequency- SN loss

254
Q

Tx of thyrotoxic storm

A

Propanolol
CM/PTU
HC

255
Q

When to treat K with insulin

A

If changes or >6

256
Q

Which medication falsely lowers GFR

A

Trimethorpeim

257
Q

Bullous pemphigoid and Pemphigus vulgaris AB attack what

A

Epidermal BM- bulls
Caherin- PV

258
Q

Acne progression treatment

A

Add oral lymecycline in addition to treatment

Topical adapelene with topical benzoyl peroxide and oral lymecycline

259
Q

Mx of BB OD

A

Glucagon

260
Q

Diabetic renal biopsy

A

Nodular glomerulsclerosis

261
Q

Tx of enteral feeding with hyperglycaemia

A

Insulin

262
Q

Tx of non infective exacerbation of COPD

A

Pred 5 d

263
Q

Dysuria with negative urine dip next ix

A

STI check

264
Q

How to calculate NNT

A

1/CER (Control Event Rate) – EER (Experimental Event Rate)

In %
So if CER is 12% and EER is 20%
NNT= 1/20-12

265
Q

RRR and ARR

A

RRR= 1- (EER/CER)

ARR=CER-EER

266
Q

AB for GPA and eGPA

A

GPA- cANCA or proteinase

eGPA- pANCA or MPO

267
Q

Tx of TIA with AF

A

Aspirin 300mg
Then AC

268
Q

Tx of cavernous sinus thrombosis

A

LMWH

269
Q

When cant you use colchicine

A

<50 gfr

270
Q

Tx of MRSA on IE

A

Vanc and rifampicin
Add gent if prosthetic HV

271
Q

Tests for Herceptoin

A

ECG- can cause cardiomyopathy

272
Q

Hep C with pro thrombotic state and oedema ix

A

Urien dip and PCR
For membranous GLN

273
Q

Tx of hypocalcaemia

A

<2 or symptomatic give IV
ECG

274
Q

Ix for reduced GCS with DKA

A

CT head for oedema

275
Q

Tx of steroid induced diabetes

A

Sulphonylurea

276
Q

Mx of Barrets

A

PPI and endoscopy 3-5 yrs
If dysplasia- resection

277
Q

How should you ix coeliac

A

Measure TTG and IgA
If IgA deficiency measure IgG TTG

278
Q

Mx of mesenteric ischaemia

A

Peritonitic- laparotomy
Not- CT agnio

279
Q

Max dose of AC and getting thrombosis what do you do

A

Switch to another
Filter only for those who cant tolerate AC

280
Q

Relative risk

A

Relative risk =risk exposed to drug%/ risk not exposed%

281
Q

Tx of IgA nephropahty

A

ACEi

282
Q

Retinal detachment vs central retinal O

A

Retinal- curtain cowning over
Retinal- stroke RF

283
Q

Tx of septic arthritis in prosthetic limb resistant to ABx

A

Surgical washout

284
Q

Tx to stop smoking

A

varenicline OR bupropion
V- nicotin partial agonist
B- norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

Pregant can use if CBT fail s

285
Q

Lump only present on standing

A

Varicocele

286
Q

What can donezepil cause

A

3rd degree Hb

287
Q

Dressler syndrome tx

A

Aspirin/ NSAIDs

288
Q

Leprosy sx and mx

A

Hypopigmented skin
Sensation

Dapson and rifampicin

289
Q

Tumour of parotid gland

A

Pleiomorphic adenoma

290
Q

Continual pneumonia sx and smokes mx

A

2ww referral

291
Q

ABx before abdo surgery

A

IV coamox

292
Q

Present to GP with acute chole mx

A

Admission

293
Q

Ix of CLL

A

Immunophenotyping
Flow cytometry

294
Q

Infections in splenectomy

A

Step pneum
H influ
N menig

295
Q

Active form of VIt D

A

Calcitriol

296
Q

OA vs fracture

A

Cant weight bare or SLR in fracture

297
Q

When to use oxycodone vs afentanil

A

Oxycodone 30-60
afentanil <30

298
Q

What are those on chemo more prone to MSK

A

Gout

299
Q

What AB is present in UC

A

pANCA

300
Q

Where does Pagets affect the most

A

skull, spine/pelvis, and long bones

301
Q

Mx of open fractures

A

Debridement- within 12hrs for high energy and 24 for not
External fixation for soft tissue swelling- severe
Good if lots of soft tissue swelling

302
Q

Test for hypermobility

A

Beighton score

303
Q

Buckle vs greenstick fracture

A

Buckle-bulge due to compression
GS- fracture due to bend

304
Q

Imaging for avascular necrosis

A

MRI is best

305
Q

Ix for man with osteoporosis

A

Testosterone

306
Q

Tx of shock after spinal damage

A

Vasopressors- neurogenic shock

307
Q

Inheritance of BRCA1 gene

A

AD- so 50% chance children or siblings have it

308
Q

Neo adjuvant chemo in breast uses

A

To down size tumour- WLE instead of mastectomy

309
Q

If varicocele what mx

A

Urgent referral

310
Q

Torsion of spermatic cord vs appendage

A

Cord- no reflex
Appendage- partial reflex

311
Q

Halo sign in breast

A

Cyst

312
Q

When to refer varicose veins to secondary care

A

Superficial vein thrombosis.
A venous leg ulcer
Skin changes

313
Q

Tx of intermittent torsion

A

Prophylactic emergency fixation

314
Q

swollen, hyperaemic optic disc with peripapillary splinter haemorrhages.

A

Non artertic optic neuropathy
Diabetes

315
Q

Absent gag reflex pathology

A

Medulla

316
Q

Mx of feeding in oesophageal cancer

A

Gastroscopy
Since radio can cause painful swallowing

317
Q

Tx of collapsed lung due to atelectasis

A

Chest physio
Then bronchoscopy

318
Q

Superior vs inferior homonymous hemianopia lesions

A

Superior- temporal, inferior radiation

Inferior- Parietal, superior

319
Q

Tx of TTP

A

Plasma exchange

320
Q

Low vs high radial nerve damage

A

Low- no sensory loss
High- wrist and tricep and sensory loss

321
Q

Odds ratio

A

OR=AD/BC
odds of exposed/odds of unexposed

322
Q

FLushing after treatment with NAC

A

Stop
Restart slower +/- chlorampenine

323
Q

Dx of pneumococcal pneumonia

A

Urinary antigen

324
Q

Pneumonia with poor air conditioning

A

Legionella

325
Q

Pneumonia with CF

A

Pseuodomonas

326
Q

Glucose in CSF to serum ratio in viral/bacterial meningitis

A

Viral- >0.6
Bacterial- <0.4

327
Q

Sx after radiation of prostate cancer

A

Radiation proctitis
Diarrhoea, tenesmus

328
Q

Tx of Pemberton sign + NHL

A

Dexamethasone- means obstructing SVC

329
Q

If hyper echoic lesions on liver CT what next ix

A

Colonoscopy- since undetectable sometimes on CT

330
Q

What should you give as breakthrough pain mx and other meds with it

A

Immediate release morphine 1/6
Senna regularly and as required Anti emetic

331
Q

Lisfranc injury

A

Dislocation of the base of the second metatarsal and the medial cuneiform in the midfoot.

The injury usually occurs due to a direct force, such as a sudden rotation of the joint during such as changing direction or a forced plantar flexion

332
Q

Displaced fracture mx before surgery next day

A

Closed reduction and plaster slab

333
Q

Sx and mx of CRPS

A

Excessive pain 4-6 weeks after injury
Tx with amitryptilin e

334
Q

BRAC 2 cancer

A

Prostate and breast in men

335
Q

Smith vs galazzi

A

Smith- in distal
Galeazzi- shaft

336
Q

Obstructive bowel AE and chemo

A

Cyclizine for obstruction
Ondan- chemo

337
Q

Mx of acute vs chronic osteomyelitis

A

Chronic- await MSC results
Surgical debridement

338
Q

Treatment of VRE and of staph epididermis

A

VRE- linezolid
Staph- remvoal of central line and vanc

339
Q

Positive tournique test meaning

A

Petechiae show up on skin with BP cuff
Dengue virus

340
Q

Pyogenic vs hydatid vs amoebic

A

CT to differentiate

Pyogenic- E coli in adults
Tx drainage (typically percutaneous) and antibiotics
amoxicillin + ciprofloxacin + metronidazole
if penicillin allergic: ciprofloxacin + clindamycin

Hydatid- asymptomatic- pain, surgery
Daughter cyst

Amoebic cyst- diarrhoea, cyst
Metronidazole
Entamoeba histolytica

341
Q

If diabetic and bloating after meals what tx

A

Metoclopramide

342
Q

Surgery for IE

A

Prolonged PR
Recurrent
HF

343
Q

Tx of green faeces

A

cholestyramine
Increases absoprtion of bile

344
Q

Pneumonia and crusty lip

A

Strep pneumonia assocaited with cold sores

Year 6 (28 decks)

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