Past qs Flashcards
Vit D metabolism
made in skin
liver turns into 25-di hydroxy
kidney turns into 1-25 dyhydroxy vit D [active form]
Allopurinol class Colchicine
xanthine oxidase inhibitor
Why does gout favour small joints
temperature - cooler in peripheries
2 features of cauda equina in lower limb, sphincter, perianal skin
Pain, paraesthesia, loss of reflexes
loss of tone, loss of control
Loss of sensation, skin breakdown, loss of anal wink
Ca in coeliac
Enteropathic MALT
Malaria species
female Anopheles Carrying falciparum malaria
2 things to test before lithium
thyroid
ECG
Renal function
AF
b. What investigation would you do, and what would it show?
c. You want to slow her heart rate… Give 3 treatment options
d. What other class of drug would you want to use, give 2 examples with different mechanisms of action
e. What other treatment could you give and when?
B - ECG irreg irreg
c - Beta blocker- propanol [first line]
o Calcium channel blocker- verapamil or dialtiziem
o Digoxin
?Cardioversion / amiodarone
anticoagulants
Rivaroxaban - 10a inhibitor
warfarin - vit k antagonist
DC cardioversion if lasts after 3/52 anticoagulation
/if drugs fail could ablate
Where does ramsay hunt remain dormant?
2 mx?
Who should avoid ?
geniculate ganglion
acyclovir -
Corticosteroids/ eye drops
Pregnancy people
b thal
2 public health innitiative to pick up early
3 places excess iron after transfusion
Preconseptual testing
Neonatal/ante natal screening
Liver, Heart, pancreas
3 options in treatment of eczema
Physiology of anaphylaxis
emollients, steroid, Abx for infection
type 1 hypersensitivity- degranulation of mast
cells releasing histamine.
Oropharangeal Ca Mx with node
Neck dissection
HyperCa
high PTH and high Calcium and normal urinary calcium Dx?
If PTH was low dx?
3 actions of PTH
2 comps of hyper Ca
Primary hyperPTH
bony mets / maligancy
Osteoclast activation, stops loss of ca in urine, increased ca absorption from GI.
Stones, nephrocalcinosis, arrhythmia, delirium
Renal colic key Ix
CT KUB
What are the three parts of a health economic evaluation? /
What are the two features comprising a QALY?
What system do health economists use to evaluate disability(?)
Define healthcare economic ‘efficacy’?
e)What is the term when treatment is given elsewhere and benefit foregone other patients?/1
Cost both services
Benefits of both services
Comparison of the cost and benefit of the service and alternative service
number of years, quality of life
DALYS- diability adjusted life years
Getting the maximum cost/ health benefit outcomes from a service.
Opportunity cost- i.e the money is spent elsewhere because it gives better
benefit on another opportunity.
33 year old woman with no medical history collapses at the gym. Not a smoker. In ER she
does not open her eyes to pain, flexes left arm and leg to pain and produces incomprehensible
sounds. Her left pupil is fixed and dilated.
Why does SAH cause coma
4 other causes of coma
GCS level?
why fixed dilated pupil?
immediate mx?
4 features of brainstem death
raised ICP / hydrocephalus
hypoglycemia, hypoxaemia, trauma, seizures, electrolyte imbalance, menigocoal septicaemia
does not open eyes to pain -1
incomprehensible sounds- 2
flexes to pain- 4
GCS-7
Compression of CNIII
A-e assessment Ct scan prevent vasospasm- nimodipine Intubate; give 02 ?Manitol refer to neurosurgery
Resp arrest no cough reflex lack of corneal reflex Lack of pupillary reflex to light no reaction to ear washout dolls eye reflex
Remember GCS
EVM 4,5,6
t1dm
What to screen for microvascular damage
Other risks ?
Retinal screening
Kidney U&E – urine albumin and serum creatinine
Foot care screening- monofilament- sensation
ABPI- looking at arterial circulation- autonomic damage
Macrovascular: heart/brain/legs
Microvascular: eyes/kidneys/feet/nerves.
Two months after giving birth to her son, a mother stops eating and loses weight. She is not breastfeeding. She claims that the Devil is controlling her actions and she hears him telling her to harm her son. She also thinks that you can hear her thoughts.
a) four other features of depression you would ask for? /2
b) what features of psychotic illness is she experiencing? /3
c) what risks would you try to illicit? /2
d) what class of drugs would you treat her with? /1
e) what 4 other treatments might you consider? /2
lack of energy
b. lack of enjoyment of things she enjoyed doing before
c. struggling to sleep
d. feeling worthless/guilty
command hallucinations
delusional thinking
thought broadcasting
risk to self
risk to baby
Atypical antipsychotic
a. mood stabilizing drugs- lithium
b. talking therapies- CBT
c. SSRI
d. ECT
45 year old woman finds a lump in her breast. It is well-circumscribed, soft and non-tender.
a) what other features would you check on examination? /2
b) what immediate management should the GP consider (if any)? /2
c) what are the next steps the GP should take towards investigating the lump? /3
d) what other signs of breast disease should the woman look out for?
Any axial lymph nodes
Weather it is tethered or movable from the skin.
Unsure ?
referral for biopsy
mammogram
US
changes in nipple/ retraction
nipple discharge
skin changes on breast, orange skin appearance/ulceration/redness.
42 year old male bus driver. Uses contact lenses to -15 dioptres. On gliclazide, metformin, beclametasone, salbutamol + some antihypertensives. Has asthma, diabetes and hypertension. Reports blurring of vision in left eye and loads of floaters making it hard to see. Acuity is 6/6 and 6/60.
a) two causes of increasing floaters
b) what three investigations would you request and what would you see? /6
c) two causes of this? /2
d) is he safe to drive? Explain your answer.
diabetic retinopathy
retinal detachment ( most likely- in people with short signtedness )/ retinal tear
posterior vitreous detatchment
ageing
Fundoscopy - see curtain of retina
slit lamp -
USS - see blood
retinal tears
trauma
recent cataract surgery
No, need a combines acuity of 6/12
Young woman presents with history of PV bleeding and mild abdominal pain at the end of her cycle.
a) what other parts of the history would you ask about? /4
She has a positive pregnancy test, a closed os and a swollen uterus with blood in her vagina.
b) three causes of this? /3
c) three investigations? /
IMB/PCB
sexual hx / STI
How much blood?
Contraceptive
Threatened miscarriage / complete miscarriage i.e already happened Ectopic with fibroids Molar pregnancy Cervical ectropium Trauma to vaginal cana
TV ultrasound Abdominal ultrasound Urine dip Cervicle swab Continuing
Bladder cancer
a) commonest histological subtype? /1
b) where else can this be found? /2
c) what other cell types should be considered? /1
d) name four risks of bladder cancer? /2
e) which artery supplies the superior and inferior vesical arteries? /1
what lymph nodes should the surgeon consider when removing bladder and
prostate?
The cancer spreads to L2.]
e) give two signs of this at each of the following sites:
perianal skin
lower limb
anal and urinary sphincters /3
Transitional cell
Ureters, urethra
SQUAMOUS
FH
b. Smoking
c. Frequent bladder infections
d. Working in a rubber dye factory
Internal iliac
external iliac,
obturator, internal iliac (hypogastric), and common iliac nodes
Skin - numb, [skin breaks / loss of tone]
weakness, pain, reduced reflexes
decresed tone, faecal/ retention/incontinence.
23 year old Austrian woman with a two week history of productive cough gets crushing chest pain worse when she lies on her back. Your colleague says that this is pericarditis.
a) 4 investigations to confirm this. /2
b) what abnormal heart sound would you expect to hear? /1
c) two treatments for this? /2
You are bleeped later. She has a raised JVP, BP 90/40 mmHg and is tachycardic.
d) what is the cause of this? /1
e) two causes of pericarditis? /
US
Chest x ray/ echo
Bloods esr/crp/WBC
ECG
pericardial rub
NSaids/ colchine
Steroids
tamponade
recent viral infection bacterial infection such as TB recent MI chest trauma autoimmune disorders cancer uremic pericarditis
