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Sheff 3b > Past qs > Flashcards

Past qs Flashcards

1
Q

Vit D metabolism

A

made in skin

liver turns into 25-di hydroxy

kidney turns into 1-25 dyhydroxy vit D [active form]

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2
Q 
Allopurinol class 
Colchicine
A

xanthine oxidase inhibitor

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3
Q

Why does gout favour small joints

A

temperature - cooler in peripheries

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4
Q

2 features of cauda equina in lower limb, sphincter, perianal skin

A

Pain, paraesthesia, loss of reflexes

loss of tone, loss of control

Loss of sensation, skin breakdown, loss of anal wink

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5
Q

Ca in coeliac

A

Enteropathic MALT

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6
Q

Malaria species

A

female Anopheles Carrying falciparum malaria

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7
Q

2 things to test before lithium

A

thyroid
ECG
Renal function

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8
Q

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?

A

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

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9
Q

Where does ramsay hunt remain dormant?
2 mx?
Who should avoid ?

A

geniculate ganglion
acyclovir -
Corticosteroids/ eye drops

Pregnancy people

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10
Q

b thal

2 public health innitiative to pick up early
3 places excess iron after transfusion

A

Preconseptual testing
Neonatal/ante natal screening

Liver, Heart, pancreas

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11
Q

3 options in treatment of eczema

Physiology of anaphylaxis

A

emollients, steroid, Abx for infection

type 1 hypersensitivity- degranulation of mast
cells releasing histamine.

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12
Q

Oropharangeal Ca Mx with node

A

Neck dissection

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13
Q

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

A

Primary hyperPTH

bony mets / maligancy

Osteoclast activation, stops loss of ca in urine, increased ca absorption from GI.

Stones, nephrocalcinosis, arrhythmia, delirium

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14
Q

Renal colic key Ix

A

CT KUB

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15
Q

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

A

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.

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16
Q

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

A

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
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17
Q

Remember GCS

A

EVM 4,5,6

18
Q

t1dm

What to screen for microvascular damage

Other risks ?

A

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.

19
Q

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

A

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

20
Q

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?

A

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.

21
Q

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.

A

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

22
Q

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? /

A

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
23
Q

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

A

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.

24
Q

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? /

A

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
25
Q

Male, 75 year old smoker with haemoptysis. CXR shows a suspicious lump and there is
concern that he has a cancer with cerebral mets.
a) three investigations and reasons why you would do them

Cancer in right hilum spreading throughout lobe. Also some supraclavicular lymph nodes. No
abdo or cerebral mets. Bloods: low albumin (30), high platelets (500) and low sodium (131).
All other FBCs, U and Es and LFTs in normal ranges.

b) what type of cancer is this most likely to be? /1
c) what features make you suspicious of this? /2
d) How would you obtain a biopsy and why? /1
e) what are his treatment options? /2

A

a. Ct scan with contrast- get a detailed image of the tumor
b. Pet scan – staging
bloods LFTS…. baseline
c. Brain MRI- to see if the cancer has spread to the brain
d. Biopsy- to understand which type of cancer it is.

Squamous cell adenoma

smoking, non small cell Lung CA, near the
right hilum.

Ct guided biopsy- to guide treatment options

Surgery
Chemo
Radio

26
Q

76 year old woman, brought in by daughter. Two day history of abdominal pain, started
vomiting last night. Now has abdominal distention.

a) give two mechanisms and 4 causes of each /2+4
b) how would you investigate this? /2
c) what are your treatment considerations? /2

A

a. bowel obstruction
i. adhesions/ recent surgery – most common
ii. cancer
iii. constipation
iv. diverticulitis
v. autonomic dysfunction bowel control
vi. hernias

b. constipation
i. drugs
ii. dehydration
iii. autonomic neuropathy
iv. immobility

a. abdo xray - Xray shows distended loops of small bowel.
b. CT abdo/pelvis

a. conservative nil by mouth and fluids.
b. surgery – nil by mouth

27
Q

58 year old male scaffolder reports bilateral shoulder pain which moves to his left arm.
History of neck pain of three years?
a) how should you investigate this in a GP’s practice? /2

On examination he has patchy sensory loss on his left hand, loss of his left brachial reflex and
cervical tenderness.
b) three causes of this? /3

c) three investigations? /3

d) If the investigations pointed towards it being degenerative change, what treatment
advice can you give him? /2

e) what is the likely diagnosis and prognosis? /2

A

a. upper limb neoro exams of arms
b. shoulder examination
c. hx

a. cervical spine fractures
b. nerve root compression
c. intervertebral disk prolapse
cervical spondylosis

a. Xray
b. Nerve conduction studies
c. MRI ( for disc and nerves)

a. Strengthening exercises for muscles around the area
b. Nsaids- with PPI
Weight loss

a. osteoarthritis spine
b. long term management of C-spine pain.

28
Q

slit lamp, what 3 clinical findings would
support a diagnosis of anterior uveitis

2 different treatments you can give, and the route you give them

A

Cell and Flare, Keratic Precipitates, Hypopyon

steroid eye drop
pilocarpine (mydriatic eye drop)

29
Q

2 causes of eczema exacerbation bugs? And 2 treatments

how to avoid

A

HSV, Staph aureus
fluclox, acyclovir, fluids
avoid scratching, emollient use, hand hygiene

30
Q

With Mitral stenosis why
AF?
RV heave?
Raised JVP?

Dyspnea

A

Atrial fibrillation – increase of left atrial pressure and dilatation

o RV heave – increased flow across the narrowed valve

o Raised JVP – Pulmonary hypertension/ Right heart failiure

Increased atrial pressure due to stenosis
-> pulmonary HTN and fluid overload + pressure
Fluid -> intersitial

31
Q

State 2 histopathological hallmarks of Parkinson’s disease

  • State what you might find on CT brain in Parkinson’s (with no other pathology present
    except Parkinson’s)
A

Loss of dopaminergic neurones
Lewy Bodies

Absolutely Normal

32
Q

Calc fluids for burns

A

4 x weight x burn percentage

33
Q

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

A

1) Individual funding through PCT
2) Cancer drug fund (charity)
3) Private funding

34
Q

4 classic clinical features of plague psoriasis skin lesion

 2 clinical signs that distinguishes between psoriatic arthritis and rheumatic arthritis

 If rheumatoid factor is negative in this patient, does it rule out rheumatoid arthritis?
Provide reasoning.

A

well-demarcated, silver scaly plaque, erythematous rash, hyperproliferation (thickened)

DIPS affected in psoriatic
Nail involvement in psoriatic

NO, as RF is only 70% specific for RA

35
Q

What is the first line image of choice in conn’s syndrome?

Spironolactone
 Where does it act in the nephron?

 What happens at the mineralocorticod receptor site?

A

adrenal CT or MRI

collecting tubules

Aldosterone antagonist - Increases Na and water excretion but retains K at aldosterone-dependent sodium-potassium exchange site

36
Q

COPD what 1 investigation for mx / survival ?

A

BODE

Body mass index, airflow Obstruction, Dyspnea and Exercise capacity

37
Q

Osteoperosis

If back pain what fracture to exclude ?
Exam?

A

Wedge

Neuro / compression

38
Q

What pathological change would you see in the glomerular basement membrane in
someone who has diabetic nephropathy?

 2 drug treatment and 1 lifestyle advice for patient with nephrotic syndrome

A

Basement memberane thickening followed by mesangioexpansion and modular sclerosis

Dietary salt restriction and water.
Thiazide diuretic – bendroflumethiazide. Ferusemide.
ACE inhibitors to reduce proteinuria
Statin
LMWH
39
Q

What is an ecnomic evaluation ?

What makes a QALY


2 things which make an economic evaluation

2 types of economic evaluation

Define efficiency 


Identify opportunity cost



Identify equity

A

Assessment of efficiency, in other words it’s the comparative study of the cost
and effectiveness/benefits of a health care intervention 

Quality and Quanity (age) of life lived 


Cost and effectiveness 


cost benefit analysis, cost utility analysis, cost effectiveness 
analysis,

When resources are allocated between activates in such a way as to maximize
benefits for a given budget. 


to spend resources on one activity means a sacrifice in terms of 
lost
opportunity elsewhere

fairness and justice in distribution of cost and benefits.

40
Q

What is an advanced directive

A

An advance directive is a document by which a person makes provision for
health care decisions in the event that, in the future, he/she becomes unable to
make those decisions.

41
Q

Contrrol confounding

A

o Restriction - Limits study to people who are similar in relation to confounder Eg only men (could not then extrapolate for women)
o Randomisation - RCT is key for unknown confounders
o Matching - Comparison groups have same distribution of confounders

42
Q

Avoid bias

A
  • Random selection of participants / allocation to groups
  • Blinding - intervention studies / observational studies 

  • Objective vs subjective measures – e.g. use records rather than recall
  • Automated instruments vs observers

Sheff 3b (33 decks)

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