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
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. 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
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. 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
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. 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.
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
Cell and Flare, Keratic Precipitates, Hypopyon
steroid eye drop
pilocarpine (mydriatic eye drop)
2 causes of eczema exacerbation bugs? And 2 treatments
how to avoid
HSV, Staph aureus
fluclox, acyclovir, fluids
avoid scratching, emollient use, hand hygiene
With Mitral stenosis why
AF?
RV heave?
Raised JVP?
Dyspnea
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
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)
Loss of dopaminergic neurones
Lewy Bodies
Absolutely Normal
Calc fluids for burns
4 x weight x burn percentage
Name 2 methods in which patient could get funding for cancer treatments not
recommended by NICE in the NHS
1) Individual funding through PCT
2) Cancer drug fund (charity)
3) Private funding
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.
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
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?
adrenal CT or MRI
collecting tubules
Aldosterone antagonist - Increases Na and water excretion but retains K at aldosterone-dependent sodium-potassium exchange site
COPD what 1 investigation for mx / survival ?
BODE
Body mass index, airflow Obstruction, Dyspnea and Exercise capacity
Osteoperosis
If back pain what fracture to exclude ?
Exam?
Wedge
Neuro / compression
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
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
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
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.
What is an advanced directive
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.
Contrrol confounding
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
Avoid bias
- 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
