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Past papers Flashcards

1
Q

If person on lithium develops polyuria, what is first investigation do

A

Serum calcium
Do not rush to do water deprivation assuming is diabetes insipidus

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1
Q

What can do to prevent contrast nephropathy prior to a CT if history of kidney disease

A

IV fluids infusion can protect kidney

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2
Q

What causes episodes where feel heart skips a beat in a young person

A

Ectopics- either ventricular or supraventricular

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3
Q

What is initial investigation for PSC post USS

A

MRCP

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4
Q

Proctitis and tender lymphadenopathy in MSM

A

LGV

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5
Q

What artery causes bleeding in peptic ucer disease posterior to the first and second parts of the duodenum

A

Gastroduodenum

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6
Q

Best management option for mets in the spine causing compression of cord

A

Radiotherapy

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7
Q

Inflammatory back pain features

A

Improvement with activity
Not relieved by rest
Younger population

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8
Q

Management of restlessness in a palliative patient in terminal stages

A

Midazolam via subcut infuser

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9
Q

What is first choice post operative analgesia

A

Opiods

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10
Q

What do for postoperative analgesia if a severe respiratory disease

A

Epidural as want to avoid opiods

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11
Q

A 78 year old man has type 2 diabetes. His clinician does not invite him to join
an internet-based self-monitoring programme because she considers him to be too old to engage with it effectively. What is this an example of?

A

Discrimination

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12
Q

Man attends for ramipril review, U&Es show hyperkalaemia, what do?

A

Repeat as likely spurious

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13
Q

If have cerebral symptoms in malaria, what is most likely cause

A

Falciparum

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14
Q

How is resp function monitored in myasthenia

A

FVC

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15
Q

Man has twitching that starts in left hand then spreads up arm, arm feels weak for an hour after

A

Focal seizure

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16
Q

If conscious how decide what form of glucose to give

A

If swallow appears to be intact then oral glucose
If not then glucogel

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17
Q

Post abdominal procedure, patient develops low grade fever and reduced breath sounds at lung bases

A

Atelectasis

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18
Q

How does atelectasis present post operatively

A

Low grade fever
SOB
Reduced air entry at both lung bases
If in pain then shallower breathing which means distal airway not receiving air

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19
Q

What makes lumbar spinal stenosis easier

A

Leaning forward and riding bike

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20
Q

When intubating someone what is cricoid pressure

A

Placing fingers over cricoid ring to prevent aspiration of gastric contents to airway

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21
Q

Man falls downstairs and brought into hospital, what is first thing do

A

Cervical spine immobilisation

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22
Q

If have confusion what is most likely type of pathogen causing meningitis

A

Bacterial

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23
Q

What are 2 types of metaplasia in barretts oesophagus

A

Intestinal- goblet and paneth cells seen
Squamous- none of these cells seen

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24
Q

How long keep patients in a sideroom for with C diff

A

Need to be in a sideroom for 48 hours with no diarrhoea

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25
Q

Below what creatinine clearance give warfarin for DVT/PE

A

15

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26
Q

If treating DVT/PE with warfarin, what is regime

A

Give LMWH for first 5 days then warfarin for 3 months

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27
Q

Management options for HCC

A

Surgery
Sorafenib

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28
Q

What is sorafenib

A

Multikinase inhibitor used in HCC management

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29
Q

How oftens should SCD patients receive pneumococcal vaccine

A

Every 5 years

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30
Q

What type of hypogonadism does haemochromatosis cause

A

Secondary as causes pituitary dysfunction

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31
Q

Lymphoma translocations

A

Follicular- 14;18
Mantle- 11;14
Burkitts- 8;14

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32
Q

If someone falls soon after parkinsons diagnosis what need to consider

A

Parkinsons plus syndromes

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33
Q

Which anti-epileptic most associated with weight gain

A

Sodium valproate

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34
Q

How long can’t drive if diagnosis of epilepsy

A

1 year

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35
Q

What do if patient with MI has AF and haem unstable

A

Following ALS pathway ABCDE would cardiovert

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36
Q

Vitreal vs retinal detachment

A

Vitreal= floaters
Retinal= loss of vision

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37
Q

If patient develops third nerve palsy after traumatic headinjury what is cause

A

Brain herniation

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38
Q

When is only time repair aortic abdominal aneurysm as urgent (not rupture)

A

If symptomatic

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39
Q

What is urgency of endovascular repair for AAA

A

Elective if above 5.5cm, growing by 1 cm
Urgent if rupture or symptomatic

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40
Q

Which type of bowel defunctioning is easiest to reverse

A

Loop ileostomy

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41
Q

Management of post transfusion purpura

A

IVIG

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42
Q

Presentation of post transfusion purprua

A

Purpura a week after transfusion

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43
Q

Liver failure triad

A

Jaundice
Encephalopathy
Coagulopathy

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44
Q

If recurrent sinusitis how can prevent it

A

Intranasal corticosteroids

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45
Q

What do if have any type of back pain but PMH of cancer

A

Refer to ortho

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46
Q

If suspected colorectal cancer what is first thing do

A

FIT test avoid urgent colonoscopy referral

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47
Q

Most specific sign on examination for comaprtment syndrome

A

Pain on passive movement

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48
Q

Most common complication from oesophagectomy

A

Anastamotic leak leading to mediastinitis

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49
Q

Second line laxative for acute constipation

A

Osmotic laxative like macrogol

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50
Q

Investigation of choice for lymphoma

A

Excisional node biopsy

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51
Q

What are orange peel lesion on shins bilaterally

A

Pretibial myxoedema

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52
Q

Process after getting a needlestick injury

A

Ask someone else to complete risk assessment and take the patient blood
Go immediately to ED or occ health

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53
Q

What need to do for all ARDS patients

A

Prone the patients

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54
Q

What use to determine if PE patient should be treated as inpatient

A

Pulmonary Embolism Severity Index score

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55
Q

If after chest drain develop cough and SOB what has caused

A

Re expansion pumonary oedema

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56
Q

What causes re expansion pulmonary oedema post chest drain

A

Rapid drainage of the pneumothorax

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57
Q

What give for gout if on warfarin

A

Colchicine- avoid NSAIDS due to risk of GI bleeding

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58
Q

Indications for external pacing

A

Unstable bradycardua which did not respond to atropine
Type 2 or complete HB post anterior MI
Trifasicular block before surgery

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59
Q

Difference in heart block caused by anterior vs inferior MI

A

Anterior- more long lasting and may need external pacing
Inferior- often transient and will not require pacing

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60
Q

Management of intermittent and recurrent testicular torsion

A

Urgent testicular fixation

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61
Q

Serotonin syndrome presentation

A

Sweating
Tremor
Confusion
Hyperreflexia

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62
Q

Ebola presentation

A

Incubation period up to 21 days
Initially flu like then develop diarrhoea, rash and kidney/liver dysfunction
Bleeding late stage

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63
Q

If have hoarse voice post thyroidectomy what is cause and how investigate

A

Laryngeal nerve damage
Laryngoscopy

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64
Q

If post thyroidectomy develop stridor what worried about

A

Haematoma development

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65
Q

Management if develop haematoma post thyroidectomy

A

Immediate removal of skin clips on ward to relieve pressure

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66
Q

Systolic murmur in takayasus

A

Aortic regurg

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67
Q

What is steroid regime for sensorineural hearing loss

A

Oral pred for 7 days

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68
Q

What are at risk of if ocular trauma and susbsequent hyphema

A

Glaucoma

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69
Q

When is only time do loop colostomies

A

Obstructing cancers

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70
Q

Patient has renal stone causing hydronephrosis but no infection, what do

A

Nephrostomy

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71
Q

Patient with nephrotic syndrome develops abdo pain and haematuria, what is cause

A

Renal vein thrombosis due to hypercoagulable state

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72
Q

Severe pain when exposed to cold conditions

A

SCD

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73
Q

Arthrocentesis findings reactive arthritis

A

Yellow colour
No crystals

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74
Q

Arhtrocentesis colour difference, normal vs infection vs inflammatory

A

Normal= clear, straw, yellow
Infection= cloudy, turbid grey
Inflammatory= yellow

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75
Q

If post op fever, what are 2 things need to rule out

A

Infection
Thrombous

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76
Q

Management of diverticulitis

A

Assess for complicated disease
- sepsis
- obstruction
- acute abdomen
If uncomplicated offer oral abx (co amox) and analgesia
If complicated admit for IV cef and metro plus possible surgical intervention if indicated

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77
Q

Management of uncomplicated diverticulitis

A

Can be managed in primary care
- oral co-amox
- analgesia
- if no improvement in 72 hours admit

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78
Q

What abx in primary care for diverticulitis

A

Oral co amox
If CI
- oral cefalexin + metro
- oral metro +trimethoprin

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79
Q

Abx for diverticulitis in hospital

A

IV ceftriaxone and metronidazole

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80
Q

Complications of diverticulitis

A

Strictures
Abscess
Perforation
Fistula
Obstruction

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81
Q

Purpose of giving albumin alongisde paracentesis for ascites

A

Reduce post paracentesis circulatory dysfunction

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82
Q

What give alongside paracentesis for ascites

A

IV albumin

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83
Q

How check if NG tube in place

A

Aspirate looking for pH <5.5

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84
Q

What do if NG tube aspirate over 5.5

A

Do CXR

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85
Q

What do if unable to obtain NG tube aspirate

A

Turn patient on left side
Withdraw or advance the tube 10-20 cm
If still no luck do CXR

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86
Q

What assesses prognosis in pancreatitis

A

Glasgow IMRIE- done 48 hours post admission

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87
Q

What is included in glasgow imrie

A

Remember as PANCREAS
P - PaO2
A - Age
N - Neutrophilia
C - Calcium
R - Renal function
E - Enzymes
A - Albumin
S - Sugar: blood glucose

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88
Q

Indications to give sodium bicarb for TCA overdose

A

Widened QRS
Arrythmia

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89
Q

What indicates septic arthritis over flare of RA

A

Erythematous
Hot
Raised WCC

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90
Q

Most common mechanism of injury for ankle sprain

A

Inversion

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91
Q

Vision worse when going down stairs

A

Trochlear nerve injury

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92
Q

Skin squamous cell carcinoma management

A

If cosmetically important area or high risk then mohs micrographic surgery
Under 20mm in diameter= 4mm margins excision
Over 20mm= 6mm margins excision

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93
Q

Most common malignancy on lip

A

Skin SCC

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94
Q

Management of SCC on lip

A

Moh micrographic surgery as cosmetically significant area

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95
Q

If going to have surgery and anaemic what is preferred option for increasing Hb

A

Transfusion- if refused consider other options

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96
Q

What can offer as alternative to transfusion if jehovahs witness

A

EPO

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97
Q

Why give steroids in meningitis

A

To reduce neurological complications

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98
Q

Difference in vision affected ARMD vs POAG

A

Glaucoma= peripheral
ARMD= central as macula

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99
Q

What veins should amiodarone be given into

A

Ideally central as causes thrombophlebitis

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100
Q

Why give aciclovir in shingles

A

Reduce incidence of post herpetic neuralgia

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101
Q

Which CCB are able to give if HF

A

Amlodipine for HTN

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102
Q

Differentiating sequestration from aplastic crisis

A

Reticulocytes raised in sequestration

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103
Q

Management of periductal mastitis

A

Co amoxiclav or metro plus erythro

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104
Q

What is periductal mastitis

A

Infection of ducts underlying the skin

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105
Q

Tropical infection with bradycardia

A

Typhoid

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106
Q

What does positive femoral stretch test indicate about hip pain

A

Referred from lumbar spine

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107
Q

When consider ventilation for asthma

A

Acidotic
Refractory to medical tx

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108
Q

OA in knee presentation

A

Knee locking
Obese
Exercise induced pain

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109
Q

With regards to varicella and healthcare workers, what must have

A

If natural immunity is good, if none then vaccinate

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110
Q

What syndrome associated with bicuspid aortic valve

A

Turners

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111
Q

Most likely location for gallstone not causing jaundice

A

Cystic duct

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112
Q

What does not being able to view retina in patient with acute vision loss indicate

A

Vitreous haemorrhage

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113
Q

Differentials for acute pain in thigh

A

DVT
Superfical thrombophlebitis

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114
Q

Which vein if suspected for thrombophlebitis should be investigated in secondary care

A

Long saphenous

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115
Q

Hardened vein in leg that is painful and erythematous

A

Thrombophlebitis

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116
Q

Management of meningococcal sepsis in GP if penicillin allergy

A

If rash give IM benzylpenicillin or IM cefotaxime
If anaphylaxis history send straight to hospital for IV chloramphenicol

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117
Q

Acute glaucoma management in GP

A

Pilocarpine eye drops and oral acetazolamide
Lie down and send to hospital

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118
Q

If have non-healing otitis externa in diabetic what need to do

A

Refer urgently to ENT for IV ciprofloxacin

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119
Q

How often measure glucose if T1DM

A

At least 4 times including before each meal and before bed

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120
Q

What is dosulepin

A

TCA

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121
Q

After transfusion patient develops numbness in legs and palpitations

A

Hypocalcaemia

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122
Q

Hypocalcaemia presentation

A

CATS go numb
Convulsions
Arrythmias
Tetanny
Numbness

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123
Q

What electrolyte abnormalities common post transfusion

A

Hypocalcaemia- contain citrate which binds to endogenous calcium
Hyperkalaemia

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124
Q

If have addisons and not able to take normal steroids due to nausea what give

A

IM or IV hydrocortisone

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125
Q

What can give for meningococcus in primary care if pen allergic

A

IM cefotaxime

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126
Q

If neuropathic pain and unable to take oral medications what use

A

Lidocaine patch

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127
Q

Alongside restarting at lower rate, what also do for anaphylactoid reaction

A

Causes bronchoconstriction so give salbutamol

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128
Q

Most significant rf for aspiration pneumonia

A

Recent intubation

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129
Q

What do if patient comes in with strangulated hernia

A

DO NOT ATTEMPT TO MANUALLY REDUCE
Straight to theatre for open repair

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130
Q

Pus in the anterior chamber

A

Anterior uveitis

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131
Q

How do metastases appear on x ray

A

Sclerotic

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132
Q

Painless vs painful ulcers on genitals

A

Painful- herpes, chancroid
Painless- LGV, syphillis

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133
Q

Allergic conjunctivitis management

A

Topical antihistmines

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134
Q

How investigate unexplained IDA

A

Refer to gastroenterology if Hb under 110 in men and 100 in non-menstruating women
OF ANY AGE

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135
Q

IDA management at GP

A

Investigate if dietary or coeliac
If unexplained refer to gastro if Hb under 110 in men and under 100 in non-menstruating women

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136
Q

Which drugs may cause glaucoma

A

Antimuscarinc- TCA
Nebulised ipatropium

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137
Q

Contents of inguinal canal

A

Inferior epigastric vein and artery

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138
Q

What do if persistent haemorrhoid symptoms

A

Investigate further
Young = flexi sigmoidoscopy
Old= colonoscopy

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139
Q

What nerve damaged in mid humeral fracture

A

Radial

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140
Q

What is housemaids knee

A

Prepatellar bursa- look up more

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141
Q

What do if AF secondary to something like sepsis

A

Do not treat AF straightaway- treat cause first and see if responds to that

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142
Q

First line for suspected neck malignany

A

Endoscopy

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143
Q

Apple core stricture on barium

A

Cancer

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144
Q

Staging investigation for colorectal cancer

A

CT CAP

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145
Q

If need a CT for bowel obstruction but have CKD what do

A

Oral contrast like gastrograffin- avoid IV contrast which would normally use

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146
Q

When give bipap for COPD

A

After medical treatment with oxygen for an hour and still acidotic

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147
Q

Which lymph nodes do breast cancers metastasise to

A

Medial part of breast- internal thoracic
Lateral part of breast- axillary

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148
Q

CURB65 interpretation

A

0-1 outpatient
2 inpatient
3< consider ITU

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149
Q

First aid for drowning patients

A

5 rescue breaths

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150
Q

INR target for warfarin if recurrent DVT

A

3.5

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151
Q

What is most common AIDS presenting condition

A

PJP

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152
Q

What does inguinal lymphadenopathy with a sinus which expresses pus indicate

A

Chancroid

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153
Q

How often are colonoscopies performed in UC

A

Every 5 years

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154
Q

Management of mallory weiss tear

A

If heam stable and Hb normal then can observe and discharge

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155
Q

What has an increased osmotic gap in stool

A

Lactose intolerance

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156
Q

Birds beak on barium

A

Achalasia

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157
Q

If come back from india with chronic diarrhoea, what could be cause

A

Tropical sprue
Parasitic infection like giardia or cryptosporidium

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158
Q

If come back from india with chronic diarrhoea, what investigation need to do

A

Small intestine biopsy to look for villous atrophy indicative of tropical sprue or being able to identify a parasite

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159
Q

Blood findings of PSC

A

pANCA
Anti-smooth muscle
Typically seen by isolated ALP

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160
Q

Most common site for renal stones

A

Vesicoureteric junction

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161
Q

What causes ischaemia distal to an AV fistula

A

Distal hypoperfusion ischaemic syndrome where get shunting of blood

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162
Q

When suspect gastrinoma as cause of ulcers

A

Multiple
Bleeding
Refractory to treatment
Hpylori negative

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163
Q

What do if patient has treatment refractory upper GI symptoms

A

Refer for upper GI endoscopy if over 55
NICE recommend referral for over 55s with treatment refractory upper GI sx

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164
Q

What do for haemodynamically unstable PE patients if post op

A

Unfractionated heparin as thrombolysis would cause bleeding and not able to reverse

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165
Q

If patient in shock post trauma, what give

A

Packed red cells

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166
Q

For bleeding post trauma what use

A

Red blood cells
Tranexamic acid IV may be considered

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167
Q

What must do before relocating shoulder dislocation

A

Check for axillary nerve function

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168
Q

What must be with acute onset liver pain and hepatomegaly

A

Budd chiari

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169
Q

What do as second line for suspected hip fracture

A

MRI if still clinical question

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170
Q

In occupation asthma what does weeks peak flow diary show

A

During the week it gets worse

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171
Q

Management of occupational asthma

A

Redeployment to other area

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172
Q

What is bowel cancer screening programme in the UK

A

FIT kit offered to everyone 60-74 to carry out every 2 years

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173
Q

How differentiate between atelectasis and PE as cause of post op fever and SOB

A

Atelectasis 1-2 days post op
PE typically at least a week after

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174
Q

What do if recurrent DVTs whilst on warfarin

A

Change target INR to 3.5

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175
Q

Shigella management

A

Uncomplicated- nothing
Blood in stool- cipro
Notifiable disease

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176
Q

How do myeloma bony lesions appear on x ray

A

Lytic (well punched out)

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177
Q

Hereditary angioedema presentation

A

Attacks of pain or tingling around mouth
Often precipitated by dental anaesthetic
Occurs in late teens

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178
Q

What are carbuncles vs furuncles

A

Furuncle- root hair abscess
Carbuncle- root hair abscess with mutliple sinuses with puscoming out of

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179
Q

What diabetic drug can precipitate gastroparesis

A

GLP-1 agonists

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180
Q

What do if start GLP1 agonist and develop gastroparesis

A

Stop GLP1 agonist

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181
Q

Tender pea sized lump on superior pole which has developed over last 24 hours

A

Testicular appendage torsion

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182
Q

What do if patient comes in aggressively vomiting as side effect of chemo

A

IV ondensatron
IV fluid resus if necessary

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183
Q

If multiple nosebleeds within a short period of time what use to manage

A

Cautery

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184
Q

Which nodes do testes drain to

A

Para aortic

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185
Q

Lung disease following work in ceramics factory

A

Silicosis

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186
Q

When use furosemide for ascites

A

If refractory to spironolactone
Potassium rises as result of spironolactone

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187
Q

What nerve responsible for tears

A

Facial

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188
Q

If have chronic diarrhoea and high folate what could be cause

A

Small bowel overgrowth

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189
Q

Patient becomes feverish, hypotensive, oral ulcers, diarrhoea and generalised oedema following nasal packing

A

Toxic shock syndrome

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190
Q

Toxic shock syndrome presentation

A

Multiorgan failure
- diarrhoea
- septic
- generalised oedema
- rash
- ulcers in mouth

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191
Q

How diagnose toxic shock syndrome

A

Swab from area of infection source

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192
Q

What is most important part of treating DIC in sepsis

A

Treat underlying sepsis

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193
Q

If pelvic fracture what do to investigate urethral injuries

A

Retrograde urethrograthy- do before suprapubic catheter

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194
Q

Management of optic neuritis

A

If vision impaired then IV methylprednisolone

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195
Q

How view fractures of the mandible and what do if unclear from first investigation

A

X ray
May need CT

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196
Q

Presentation of diffuse oesophageal spasm

A

Young person
Dysphagia to both food and drink
Intermittent symptoms
Retro sternal pain

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197
Q

What gives corkscrew appearance on barium swallow

A

Diffuse oesophageal spasm

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198
Q

First line investigation for diffuse oesophageal spasm

A

Oesophageal manometry

199
Q

Differentials for dysphagia in young

A

Achalasia
Diffuse oesophageal spasm

200
Q

PCKD patient presents with flank pain and fever, what is most likely cause

A

Infected cyst

201
Q

How diagnose infected cyst in PCKD

A

Blood culture

202
Q

Imaging for rib fractures

A

Only do CXR if resp compromise otherwise delays getting CT

203
Q

What do if about to do elective cystoscopy and find patient has murmur with symptoms

A

Delay procedure refer to cardio

204
Q

How investigate a new onset suspected bulbar palsy

A

MRI
Syphylis serology
LP

205
Q

What is name given to lymphoedema treatment

A

Decongestive therapy which incorporates
- massaging
- compression bandaging

206
Q

What is organism for hydatid

A

Echinococcus

207
Q

Risk factor in UK for hydatid

A

Sheep farmer

208
Q

Bone cotton wool spot calcification

A

Chondrosarcoma

209
Q

Treatment options for PSC

A

Ursodeoxycholic acid
Definitive is liver transplant

210
Q

What is tinea incognito

A

If treat a tinea infection with a steroid and then it becomes worse

211
Q

If have been trekking in a tropical country and come back with lesions on foot what is likely cause

A

Cutaneous larva migrans

212
Q

Cutaneous larva migrans presentation

A

Recent tropical travel
Erythematous rash over feet
Vesicles present- erythematous trails from each vesicle

213
Q

How differentiate bleeding artery in stomach

A

Lesser curvature= left gastric
Greater curvature= gastroduodenal

214
Q

What do for treatment refractory severe c diff

A

Faecal transplant

215
Q

Causes of pulsatile tinnitus

A

Intracranial pathologies- MS
Vascular

216
Q

Investigating pulsatile tinnitus

A

Suspected MS- CT of temporal bone
Vascular- MR angio

217
Q

Most common side effect of ciclosporin

A

Nephrotoxicity

218
Q

Which medication can make you present with cerebellar syndrome appearing drunk

A

Phenytoin

219
Q

What organism shows air crescent sign on CT

A

Aspergillus

220
Q

What does 24Fr catheter mean

A

External circumfrence is 24mm

221
Q

What is proctitis syndrome

A

Can get STI infected rectum leading to proctitis symptoms
- incontinence
- blood in stool
- constant feeling of needing to go

222
Q

Presentation of proctitis syndrome

A

Incontinence
Blood in stool
Feeling of needing toilet all the time

223
Q

What do if discover an undescended testis in an adult

A

Remove it to eliminate cancer risk

224
Q

When can you give DOAC before CTPA

A

If very high clinical suspicion- ie risk factors, classic presentation etc

225
Q

What give for malaria prophylaxis

A

Combination therapy- atovaquone+proguanil

226
Q

What is conus medullaris

A

Get acute onset neurological symptoms from compression of spine at L2. Symptoms include
- inability to walk
- urinary control lost
- loss of anal tone

227
Q

Management of conus medullaris

A

Urgent decompressive laminectomy

228
Q

Lung complications of RA

A

Fibrosis
Pleuritis
Bronchiectasis

229
Q

Extra GI features of yersinia

A

Erythema nodosum
Mesenteric lymphadenitis

230
Q

Management if parvovirus in SCD

A

Admit
Transfusions

231
Q

What do if open up for appendecectomy and appendix appears absolutely normal

A

Still remove as reduces risk of cancer

232
Q

Causes of renal AV fistula

A

Previous biopsy or other cause of trauma

233
Q

Presentation of renal AV fistula

A

Haematuria
Hypertension

234
Q

After bone marrow transplant patient becomes SOB with diffuse crackles- spirometry shows obstructed picture

A

Bronchiolitis obliterans

235
Q

In trauma if bleeding internally in abdomen what do to reduce bleeding

A

Apply a pelvic splint

236
Q

What can use to medically treat a gastrinoma

A

Somatostatin which can reduce gastrin production

237
Q

Management of cryptococcal meningitis

A

IV amphotericin B

238
Q

Gold standard for small bowel overgrowth

A

Small bowel fluid culture

239
Q

If patient has hypotension and confusion post abdominal op what is next investigation

A

Bloods- X match etc
Taking back to theatre will take time to arrange

240
Q

Colonoscopy shows abnormal vessels in wall of colon

A

Angiodysplasia

241
Q

Angiodysplasia presentation

A

IDA
Blood on FIT
Can present with acute haemodynamic instability

242
Q

Angiodysplasia in bowel management

A

Ablation of vessels endoscopically

243
Q

Renal angiography shows string of beads appearance in young patient with HTN

A

Fibromuscular dysplasia

244
Q

What can use in dementia to treat insomnia

A

Trazodone

245
Q

Can CXRs rule out lung cancers

A

No

246
Q

On CXR what does calcification within the heart indicate

A

Myxoma

247
Q

In supracondylar humeral fractures which structure most at risk

A

Brachial artery

248
Q

What causes vertebral fractures above vs below T4

A

Above T4= cancer
Below = osteoporosis

249
Q

Skin peeling when having breast radiotherapy

A

Radiation dermatitis- give emollients

250
Q

If you are worried about adherance in chlamydia treatment what give

A

2 days worth of azithromycin

251
Q

When can stop variable insulin infusion post operatively

A

1 hour after can eat and drink
Has recommended short acting insulin

252
Q

What do if notice blood in ejaculate

A

Nothing- only consider referral if over 3x

253
Q

When refer if blood in ejaculate

A

If over 3x

254
Q

When give infliximab for RA, what is given alongside

A

Methotrexate

255
Q

What indicates severe autoimmune hepatitis

A

AST 5x upper limit
Evidence of necrosis on biopsy

256
Q

If is bundle branch block, what is likely MI vessel

A

LAD

257
Q

What can give for SOB in palliative patients

A

Opioids

258
Q

Interstitial pneumonia causes

A

Mycoplasma- most common
PJP
CMV
RSV

259
Q

What is when cough up tubular gelatinous materials

A

Plastic bronchitis

260
Q

If are electrocuted what is main risk to patient

A

Cause rhabdomyolysis and subsequent severe hyperkalaemia

261
Q

When changing a long term catheter what do

A

Give stat aminoglycoside unless renal impairment

262
Q

Patient lives alone in campervan collapses now feels faint and nauseous with headache

A

CO poisoning

263
Q

Best investigation for CO poisoning

A

Multi wavelength pulse oximetry

264
Q

If axillary nerve compromise how manage shoulder dislocation

A

Still do reduction in resus bay

265
Q

What do if reduction in ED fails for shoulder dislocation

A

Reduction under general GA in theatre

266
Q

Benign oesophageal stricture managemen

A

Endoscopic dilation and aggressive GORD management

267
Q

Causes of secondary restless leg syndrome

A

IDA
DM
Pregnant

268
Q

If patient comes in with acute IBD what is first imaging do

A

AXR

269
Q

Stepwise approach to buddchari

A

Anticoagulation
Angioplasty
Liver transplant

270
Q

Management of severe budd chiari

A

Liver transplant esp when liver enzymes in thousands

271
Q

What often precipitates salt losing nephropathy

A

Obstructive cause of kidney injury like a stone

272
Q

How can prevent relapses of guttate psoriasis

A

Tonsillectomy

273
Q

If patient has stroke signs in context of aortic dissection what do with regards to imaging

A

Is a complicated dissection so immediate vascular referral for echo

274
Q

First line investigation for boerhaves

A

CXR

275
Q

Whipples disease management

A

Co trimoxazole

276
Q

If have poor defaecation from pelvic floor weakness what use to investigate

A

MR defecography

277
Q

What are vocal chord nodules

A

Seen in singers, are hard growths on the larynx which can affect voice

278
Q

TMJ dysfunction presentation

A

Hearing loss
Clicking in jaw

279
Q

Which TB drugs can cause Vit D defic

A

Rifampicin
Isoniazid

280
Q

Most common cause of rhinitis, cough and sneezing

A

Rhinovirus

281
Q

Causes of renal papillary necrosis

A

SCD
Paracetamol chronic use
Pyelonephritis

282
Q

Management of viral warts

A

Salicylic acid
Can use cryo if a small number but avoid if large numbers

283
Q

Cluster of lesions on hands after starting etanecerpt

A

Viral warts

284
Q

If have cushingoid appearance then suddenly develop addisons symptoms what is cause

A

Abrupt withdrawal of steroid therapy

285
Q

Pre calyceal calcifications of kidney with bunch of grapes appearance

A

Medullary sponge kidney

286
Q

Management options for fistula

A

First line antibiotics
Surgical measures may be required- draining seton or fistulectomy
Can also consider infliximab to help seal

287
Q

Which drugs can increase risk of gallstones

A

Fibrates

288
Q

What white marks in mouth can be easily scraped off with minimal bleeding

A

Candida

289
Q

Management of paraphimosis

A

Soak foreskin in hypertonic saline and attempt to manually retract the foreskin

290
Q

Neurosarcoidosis presentation

A

Cranial diabetes insipidus

291
Q

If patient requires emergency surgery on warfarin what give

A

Prothrombin complex

292
Q

Which valvular disease is seen in pulmonary HTN

A

Pulmonary regurg

293
Q

Pulmonary HTN presentation

A

Peripheral oedema
Fatigue
Weakness
Pulmonary regurg sometimes seen

294
Q

Pulmonary HTN management

A

Oxygen
Diuretics
Bosentan

295
Q

What is bosentan

A

Endothelial receptor antagonist used in pulmonary HTN

296
Q

Asteatotic eczema presentation

A

Seen in elerderly in winter
Dry skin in weird pattern on legs

297
Q

Unilateral vs bilateral tinnitus referral

A

URgent for unilateral
Bilateral very common and does not require referral most of time

298
Q

In palliative patients what is best management of a bowel obstruction

A

Loperamide

299
Q

If have vitreal haemorrhage, what use to visualise retina for detachments

A

Ultrasound B scan of eye

300
Q

What counts as mild hyperkalaemia that would not be worried about in community

A

5-5.9 plus asymptomatic with no ECG changes

301
Q

Long term effect of cushings on calcium metabolism

A

Leads to secondary hyperparathyroidism

302
Q

First line for verrucas

A

Topical salicylic acid

303
Q

What is meibomiam cyst

A

Chalazion

304
Q

Chalazion management

A

Apply heat and massage daily

305
Q

What makes diabetic retinopathy pre proliferative as opposed to backgorund

A

IRMA
Cotton wool spots (soft exudates)
Blot haemorrahges

306
Q

TTP management

A

Exchange transfusion

307
Q

72 year old woman develops severe back pain after a coughing fit

A

Wedge fracture- note caused by minimal trauma

308
Q

Management of low grade small cell lung cancer

A

Chemoradiation

309
Q

Side effect of penicillamine

A

Membranous nephropathy

310
Q

Ruptured aortic aneurysm VBG

A

Raised anion gap metabolic acidosis from lactate

311
Q

Causes of coronary artery vasospasm

A

Cocaine
Some chemo agents

312
Q

Methadone side effects

A

Suppression of hypothalamic gonadal pathway which leads to reduced libido etc

313
Q

What do if someome has reduced libido but part of detoxification programme

A

Come back once done as methadone suppresses HPG pathway

314
Q

If morphine CI what use instead post op

A

Oxycodone

315
Q

First line for cervical spondylosis

A

NSAIDS then physio

316
Q

Malignant hyperthermia from anaesthetic management

A

Stop agent
Give dantrolene and cool patient

317
Q

What indicates general as opposed to localised peritonitis

A

Absent bowel sounds

318
Q

Best antibiotic for klebsiella

A

Meropenem

319
Q

2-3 months after starting drug get itchy violaceous rash

A

Lichenoid reaction

320
Q

Side effects of testosterone

A

Infertility
Acne
BPH
Breast tenderness

321
Q

Achilles tendon rupture management

A

Main intervention preferred nowadays is below knee plaster cast
Surgery for sports person or recurrent injuries

322
Q

What is reactive airway dysfunction

A

When exposed to irritant gas or fumes get asthma like symptoms 24 hours later

323
Q

What investigation used for reactive airway dysfunction syndrome

A

Metacholine challenge test

324
Q

BP 178/95, intracranial HTN headache 2 years after lung cancer resection

A

Cerebral metastases

325
Q

management of short duration acute low back pain in fit person

A

continue usual activity and provide safety netting

326
Q

first thing to do in oncology patient with neutropenic sepsis (A&E)

A

IV broad spectrum abx
(even before discussing with onc team / starting fluids)

327
Q

Anticoagulant choice for sub-massive pulmonary embolism in patient at risk of haemorrhage (previous peptic ulcer bleed in history)

A

IV unfractionated heparin, can be stopped and reversed in event of recurrent bleeding

328
Q

<30% increase in serum creatinine after starting anti-HTN medication, what do next?

A

repeat renal function in 2-4 weeks

329
Q

what to bear in mind if septic arthritis picture but no organisms seen on joint aspiration gram staining?

A

gram stain positive in only 50% of cases, so IV abx should be started regardless and cultures sent

330
Q

what investigation done following unilateral sensorineural hearing loss

A

MRI scan of internal acoustic meatus to exclude vestibular schwannoma/neoplasm

331
Q

What is the investigation of choice for an acute abdomen following abdominal surgery

A

CT (with contrast)

332
Q

what is the method for confirming norovirus

A

stool PCR

333
Q

Patients catheter output drops to 0 with associated haematuria what is likely cause and how manage

A

Blocked with clots
Flush with 50ml saline

334
Q

Patient working from hard metals industry has interstitial fibrosis bilaterally what is cause

A

Giant cell interstitial pneumonitis from cobalt exposure

335
Q

If had stroke due to high WCC from CML, what is immediate management

A

Leukapharesis

336
Q

What does milky joint aspirate suggest

A

Gout or pseudogout

337
Q

If knock elbow then becomes swollen over next few days what is cause

A

Olecranon bursitis

338
Q

What are 2 types of olecranon bursitis

A

Septic- indicated by unwell, fever etc
Non-septic

339
Q

Management of septic vs non-septic olecranon bursitis

A

Septic- aspirate and flucloxacillin
Aseptic- conservative, aspirate if very uncomfortable and large

340
Q

If mild hypernatraemia what do

A

Oral water

341
Q

Best drug for reducing triglycerides

A

Fibrates

342
Q

When do balloon valulotomy for MS

A

Under 1.5cm2 and valve intact
If valve poor then do replacement

343
Q

What do if strep bovis (group D strep identified as cause of IE)

A

Colonoscopy

344
Q

How does ambulatory blood pressure maangements work

A

Take 2 per hour all day and take average

345
Q

If have adenomas removed at colonoscopy how are followed

A

All undergo surveillance with colonoscopy for cancer either in 1, 3 or 5 years
Above 10mm is high risk

346
Q

What is main cause of mortality after a pneumectomy

A

Pulmonary oedema which often requires ECMO

347
Q

How should manage someone with borderline HTN measures with CVD rfx

A

Review in 1 year

348
Q

Effect of grapefruit juice on CYP450

A

Inhibits

349
Q

Hit by cricket ball and now distal phalynx is flexed

A

Mallet finger

350
Q

Management of mallet finger

A

Minor- Place finger in splint for 6 weeks
Severe- surgery

351
Q

Psoriasis patient has painful and itchy ear with discharge. On examination a scaly red lesion is seen in the ear. What is management?

A

Topical abx as psoriasis lesion has caused break in skin leading to infection

352
Q

What suggests mesenteric ischaemia on CT

A

Air in bowel wall
Air in portal vein

353
Q

What hypersensitivity is erythema multiforme

A

4

354
Q

What causes fracture of 5th metacarpal

A

Punching

355
Q

Patient on CCB for HTN discontinues due to side effects but has history of osteoporosis what give as 2nd line

A

Thiazides as increases calclium absorption

356
Q

How treat all non lactational mastitis

A

Co amox

357
Q

Mass in GI tract with spindle cells

A

GI stromal tumour

358
Q

What is phacoemulsification

A

Name for cataracts surgery

359
Q

What use as screening investigation for renovascular causes of HTN

A

USS can identify RAS or PCKD
If one of these comes back positive then can do MRA or CTA

360
Q

When consider prophylactic abx for UTIs

A

Over 1 a month

361
Q

What are options for prophylactic abx for recurrent UTIs

A

Trimethoprin or nitrofurantoin
If poor renal function then use trimethoprin

362
Q

What do for background, pre proliferative and proliferative diabetic retinopathy identified on fundoscopy at GP

A

Background- annual screening
Pre-proliferative- Routine referral to opthal
Proliferative- urgent referral

363
Q

Management of reactive airway dysfunction

A

Inhaled bronchodilators

364
Q

Patient hears hissing in ears what is management

A

Example of tinnitus- not always ringing
CBT if associated depression
Sound generators can help symptoms

365
Q

Trauma to chest and then RBBB

A

Myocardial- contusion
Think that RV is at front of chest so most likely to be affected

366
Q

Most urgent investigation for intraocular foreign body in metal welder

A

Fluoroscein angiography

367
Q

Cholangitis management options

A

ERCP
- stone removal
- sphincterectomy to allow stone to pass
- stent insertion if stricture or malignancy
If unfit for ERCP then can insert stent percutaneously

368
Q

Cholecystitis complications

A

Perforation
Gangrenous gall bladder
Abscess
Mirizzi
Fistula to bowel- get air in gallbladder

369
Q

When do CT in acute pancreatitis

A

If getting more unwell- look for complications ie abscess, haemorrhage

370
Q

Drug causes of priapism

A

Trazodone
SSRI
Heparin
Clozapine

371
Q

When give mannitol for a brain bleed

A

If any signs of raised ICP
- papilloedema
- cushings triad
- low GCS

372
Q

If evidence of sinusitis on imaging causing orbital cellulitis, what is management

A

First line= drain sinuses
IV tazocin

373
Q

You are assessing a 90-year-old female with advanced dementia who is bed-bound and has a grade two pressure ulcer. Her carer thinks she feels pain when being moved into bed. The patient takes no pain medication at present. The patient has severe nausea, vomiting and has severely impaired mental status.

A

Rectal paracetamol

374
Q

During anaesthesia which investigations are necessary

A

Capnography, pulse oximetry, ECG monitoring, non-invasive blood pressure monitoring, airway pressure alarms

375
Q

Normal cardiac axis

A

-30 to 90

376
Q

Trigeminal neuralgia on turning neck

A

Paroxysmal hemicrania

377
Q

Drug causes staining of teeth

A

Tetracycline

378
Q

A 58-year-old male with a fractured intracapsular neck of femur is scheduled for a hemiarthroplasty. He is on warfarin but has received vitamin K to normalise his INR before surgery. He has multiple comorbidities, including atrial fibrillation, previous TIAs, and type II diabetes, with a long list of medications. The senior house officer is reviewing his medications prior to tomorrow’s surgery. The patient is currently stable with normal vital signs.
Which medication is safe to take on the day of surgery?
Ramipril
Metformin
Digoxin
Aspirin
Gliclazide

A

Digoxin

379
Q

What can really affect wound healing for abdominal cancer resections and lead to complications such as sinus formation

A

Adjuvant radiotherapy

380
Q

What do with DVLA if diagnosed with MS

A

Inform DVLA but can continue to drive

381
Q

A 28-year-old male is referred to the Respiratory Outpatient clinic with a chronic non-productive cough. He is a non-smoker and has no other symptoms. Initial investigations reveal normal full blood count, C-reactive protein, chest X-ray, and spirometry. Next investigation?

A

Bronchial provocation test as next investigation for cough variant asthma

382
Q

Management of transient hypocalcaemia after parathyroid surgery

A

If mild symptoms or above 1.9 then observe
If severe tetany or below 1.9 then bolus of calcium gluconate

383
Q

Difference in morphology of heart between HTN and HOCM

A

HTN- uniformly hypertrophied
HOCM- enlarged in septa and apex

384
Q

Condition where penis becomes overly curved

A

Peyronies disease

385
Q

How manage recurrent seizures in short period of time

A

Give 2 doses of benzos
Can give phenytoin first line for a recurrent seizure if already given 2 doses of benzo

386
Q

What do for any new diagnosis of T1DM, hashimotos or coeliac

A

Screen for others

387
Q

What is a stokes adam attack

A

Where collapse because of cardiac problem (aka cardiac syncope)

388
Q

What give for fluids refractory sepsis

A

Noradrenaline

389
Q

Murmur in biscuspid aortic valve

A

Early systolic click

390
Q

Pneumonia signs in alcoholic who is covered in vomit

A

Aspiration pneumonia- mixed anaerobes

391
Q

Colorectal cancer 2WW guidelines

A

Over 40 years with abdominal pain and unexplained weight loss
Over 50 years with unexplained rectal bleeding
Over 60 years with a change in bowel habit or iron deficiency anaemia

392
Q

First line for if suspect colorectal cancer in GP

A

FIT
If above 10 refer

393
Q

What is blue sclera seen in

A

Ehlers danlos
Osteogenesis imperfecta

394
Q

What is astigmatism

A

Abnormal corneal curvature leading to inability to see both close and far

395
Q

Management of astigmatism

A

Cylindrical lenses

396
Q

If develop gingivitis on phenytoin what do

A

Refer to neurologist for medication review

397
Q

Where measure central venous pressure from

A

Insert through right internal jugular vein or right braciocephalic to superior vena cava which measures preload

398
Q

A 19-year-old, asymptomatic male presents to his General Practitioner. He is concerned since his father died of colorectal cancer at the age of 35 years. He is concerned that he may develop the condition himself. What would be the most appropriate management of this patient?

A

Colonoscopy
Normally do around age of 20 for those with family history of colorectal cancer death/diagnosis in 30s
If polyps found to panproctocolectomy

399
Q

What muscle and nerve contribute to winging of scapula

A

Long thoracic
Serratus anterior

400
Q

What does macula on mean

A

That central vision or overall acuity has not been affected

401
Q

If have inferonasal retinal visual loss then where is retinal tear

A

Superotemporal retinal tear

402
Q

If history of liver disease what would be best opiate choice

A

Fentanyl

403
Q

What is stomach complication of primary hyperparathyroidism

A

High Ca can lead to peptic ulceration

404
Q

Carpet layer presents with severe anterior knee pain and swelling over patellar

A

Pre patellar bursitis
Repetitive trauma over area from kneeling is responsible

405
Q

Bursitis management

A

Determine if septic from aspirate
If aseptic NSAIDs with or without steroid injection
If septic then antibiotics with therapeutic aspirate

406
Q

How position knee for aspiration

A

Knee fully extended

407
Q

Teenager has bitemp hemianopia and delayed growth, what is most likely cause

A

Craniopharyngioma most common in younger years as cause of panhypopituitarism compared to pituitary adenoma

408
Q

Lymphoedema presentation in leg

A

Painless unilateral swelling in leg
Worse towards end of day

409
Q

How diagnose lymphoedema

A

Clinically but can do lymphoscintigram

410
Q

When can stop drinking carbohydrate rich drinks before surgery

A

2 hours

411
Q

What are 2 best indicators of acute limb ischaemia compared to critical limb ischaemia

A

Parasthesia
Paralysis

412
Q

Management of HB in MI

A

Temporary pacing until after primary PCI/attempts at revascularisation

413
Q

Tropical sprue management

A

Folate supplementation
Tetracycline

414
Q

What does positive head impulse test show

A

That cause of vertigo is peripheral

415
Q

Which electrolyte if abnormal will lead to hypokalaemia

A

Hypomagnesaemia

416
Q

What do if T2DM on metformin during ramadan

A

Take 1/3 dose before sunrise
Take 2/3 after sunset

417
Q

In tension pneumothorax what is the type of shock

A

Obstructive

418
Q

When give IV paracetamol for renal stones

A

If IM diclofenac CI orif IM diclofenac has not worked in touching the pain

419
Q

Key distinguishing feature of lateral medullary syndrome

A

Dysphagia

420
Q

Vertical diplopia CN cause

A

Trochlear

421
Q

What is seen in the miller fischer variant of GBS

A

Opthalmoplegia
Ataxia
Areflexia
Descending paralysis

422
Q

If bleed on right side of brain leading to right to left shift, which cranial nerves will be affected

A

Right

423
Q

Efferent nerve for light reflex

A

3rd

424
Q

If propranolol CI for essential tremor what use

A

Primodine- barbiturate

425
Q

If measure urate during attack how interpret

A

Over 360= supports diagnosis
Under 360= remeasure at least 2 weeks after inflammation dies

426
Q

What do if bite from HIV +ve human

A

Let bleed
No need for PEP

427
Q

What is management of T1DM if HbA1c comes back as over 48

A

Increase doses

428
Q

If patient is on PCA and requests extra painkillers what do

A

Add paracetamol
Can not be on concomitant opioids

429
Q

Patient has pruritus, pale stools and positive smooth muscle abs, what is next step?
Bone marrow biopsy
Fecal calprotectin
MRCP
Ursodeoxycholic acid
Vitamin K

A

MRCP
Exclude duct obstructions, also note anti smooth muscle seen in some PBC patients

430
Q

Gold standard for typohoid

A

Can use blood cultures or widal test but BM aspirate the gold standard

431
Q

Curved rods causing gastroenteritis

A

Campylobacter

432
Q

New vessels on the iris in T1DM what do next

A

Measure intraocular pressure as is rubeosis iridis, a complication of proliferative T1DM which can lead to glaucoma

433
Q

What causes burr cells/echinocytes

A

Uraemia from CKD

434
Q

Patient comes in with recent knee replacement which is probably infected, what do

A

Urgent ortho referral as likely needs to be aspirated in theatre

435
Q

MOA of dipyramidole

A

Phosphodiesterase inhibitor

436
Q

ACEi effect on bowel

A

Constipation

437
Q

How differentiate between chylothorax and empyema

A

Centrifue pleural aspirate
In chylothorax will remain opaque

438
Q

Patient with UTI develops bilateral bibasal creps, what is cause

A

ARDS

439
Q

Max magnesium replacement rate per hour

A

36mmol

440
Q

Arterial spasm vs venous occlusion priapism

A

Venous (ischaemic)- painful and rigid. seen in SCD and malignancy
Arterial (noniscahemic)- painless and semirigid, caused by trauma

441
Q

On TB meds- develop microcytic anaemia with high ferritin

A

Isoniaxid causes sideroblastic anaemia

442
Q

Morphine to fentanyl

A

0.42

443
Q

Patient has memory loss and means forgetting to take daily morphine, what do

A

Switch to fentanyl patch with immediate release morphine for pain relief

444
Q

Palliative patient describes spasmodic pain, what use

A

Diazepam

445
Q

Which condition most associated with MG

A

Thymic hyperlasia

446
Q

How manage MG if thymoma

A

THymectomy

447
Q

How manage NPH

A

If fit for surgery- ventriculoperitoneal shunting
If not then conservative with repeated CSF taps

448
Q

Grade 3 HTN management in A&E

A

If symptomatic then- IV labetalol ASAP
If not then can consider oral agent

449
Q

Mesenteric adenitis cause

A

Yersinia enterocolitica

450
Q

Which anaesthetic use for perianal abscesses

A

Local unless suspect infiltration of sphincter

451
Q
A

Pyogenic granuloma

452
Q

How give adenosine

A

Initially give IV then start oral regime

453
Q

If awaiting surgery for achalasia what can give

A

Nifedipine

454
Q

How manage dermatitis herpetiformis

A

Dapsone- sulph antibiotic

455
Q

What do with fludrocortisone perioperatively

A

Stop
IV hydrocortisone will have enough mineralocorticoid effects

456
Q

If starting TPN, what need to monitor

A

Hypomagnesaemia

457
Q

When start TB meds

A

As soon as suspect TB

458
Q

Cholera antibiotic

A

Doxycycline

459
Q

What do if triple vessel disease noted at PCI

A

CABG

460
Q

How best assess small bowel disease in crohns

A

MRI

461
Q

Patient has had recent MI with drug eluting stent insertion, due for surgery. What do with current medications

A

Speak to cardiology as risk of stent stenosis

462
Q

If had MI or stroke in last 3 months what does this make ASA

A

4

463
Q

Triggers of lichenoid reaction

A

beta-blockers, thiazides, gold, quinine, quinidine, penicillamine, and ACEi

464
Q

If have infected surgical wound site with pus, how manage

A

Remove sutures to release pus

465
Q

Hep C patient develops leg oedema, what is cause

A

Membranoproliferative GN

466
Q

Patient with history of lung cancer presents with addisons, what is next investigation

A

CT abdomen as likely mets

467
Q

Treated with DKA and met resolution criteria but still confused

A

Cerebral oedema- do head CT

468
Q

If on long term steroids and develop high BM’s, what do

A

Give gliclazide for steroid induced diabetes if glucose above 10 twice 24 hours apart

469
Q

Acute mesenteric ischaemia management

A

If evidence of peritonitis, infarction or perforation then do urgent laparotomy
If not then do CTangio

470
Q

Investigation for chronic mesenteric ischaemia

A

CTangio

471
Q

If have DVT on a DOAC what do to manage

A

Increase dose of DOAC
Change to warfarin

472
Q

Patient with abdominal cancer has become anuric with abdominal pain, what do

A

USS of bladder
USS of renal tract and kidney to assess for obstruction and hydronephrosis from cancer obstruction

473
Q

Treatment of TED

A

Steroids
If visual acuity affected then consider surgical decompression if optic nerve indicated

474
Q

Difference in most common site of prostate adenocarcinoma vs BPH

A

BPH- transitional zone
Peripheral zone- cancer

475
Q

Candida presentation in men

A

Itching and redness
Dry plaques and papules

476
Q

Other than elbows and knees where can dermatitis herpetiformis affect

A

Shoulders

477
Q

Where is V1 chest lead placed

A

Right sternal border
4th ICS

478
Q

Blisters on back of hand and hypertichosis on cheek

A

Porphyria cutaneous tarda

479
Q

Best investigation for gastrinoma

A

Secretin stimulaiton test
Gastrin levels are good screening test

480
Q

Long term catheter can cause what in bladder

A

Squamous cell carcinoma

481
Q

Small breast lump which grows very rapidly after initially being mobile

A

Phyllodes

482
Q

Causes of lymphocytic picture on pleural tap

A

Cancer
TB

483
Q

How manage contacts of TB patients

A

Do mantoux test
If negative give BCG

484
Q

What is hemispatial neglect

A

Although can see an area you do not process its presence
Counts as higher dyfunction in stroke criteria

485
Q

If have AKI with renal stone what do

A

Insert JJ stent as suggests is obstructed

486
Q

Problem with trimethoprin in assessing eGFR

A

Increases creatinine secretion

487
Q

How does cryoglobulinaemia present

A

Hep C
Then vasculitis

488
Q

How manage hypertensive emergency with ACS

A

IV GTN

489
Q

Patient with T2DM on ward becomes hyperglycaemic with random glucose 20 what do

A

SC insulin or VRII
Hyperglycaemia common occurence in people with T2DM on ward

490
Q

How investigate renal TB

A

Early morning urine samples

491
Q

What defines stage 3 AKI

A

Over 3x baseline
Over 355
Under 0.3ml/kg/hour for 24 hours

492
Q

How diagnose PNH

A

Flow cytometry for CD55 and CD59

493
Q

Skin changes in PAN

A

Ulcers with palpable purpura
Use biopsy to diagnose

494
Q

Lots of white spots on glans of penis and management

A

Penile papules
Do nothing

495
Q

Quinsy management

A

Aspiration and abx
Avoid incision as proximity to carotid

496
Q

Patient with testicular cancer had orchidectomy. CT showed enlarged para-aortic lymph nodes. What will the MDT likely advise?

A

Radiotherapy

Finals (29 decks)

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