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General Medicine > Pastest > Flashcards

Pastest Flashcards

1
Q

Vitamin D deficiency can cause hypocalcaemia

A

Vitamin D deficiency can cause hypocalcaemia

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2
Q

What is the lifespan of a sickle cell blood cell?

A

10-20 days

Remember sickle cell = HbS

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3
Q

Ghrelin is secreted by the lining of the stomach and makes you HUNGRY

A

Leptin is secreted by the fat cells as well as the stomach and skeletal muscle cells. It makes you feel FULL

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4
Q

Which test is used for screening / monitoring in acromegaly?

A

IGF -1

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5
Q

Which test is used for diagnosis of acromegaly?

A

OGTT

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6
Q

Basophillic stippling of RBC on film?

A

Lead poisoning

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7
Q

Lady with mild (K 5-6.4) and asymptomatic hyperkalaemia?

A

Calcium resonium

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8
Q

What must be excluded in ALL older men with acute renal failure?

A

Urinary retention

A catheter can be life saving

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9
Q

Differential of itch?

A

Hyperthyroidism
Liver disease e.g. PBC
Polycythameia rubra Vera
Scabies or other dermatology condition

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10
Q

What are the 2 stages of diagnosis in coeliac disease?

A

1) Positive serology for anti-endomysial/ anti-gliadin antibodies
2) Small bowel biopsy —> lymphocyte invasion, villous atrophy ad crypt hyperplasia

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11
Q

Which side effect is particularly associated with exenatide (and other GLP-1 agonists)

A

Delayed gastric emptying

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12
Q

Diagnosis in a lady on the OCP with hepatomegaly, abdo pain and ascites?

A

Budd-Chiari syndrome - caused by hepatic vein occlusion

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13
Q

Likely diagnosis in a patient with previous abdominal surgery, malabsorption and low vit B12

A

SIBO
Small intestinal bacterial overgrowth
Diagnose with culture of small intestinal aspirate

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14
Q

Tricuspid regurgitation?

A 
Loud systolic murmur
Heard throughout the chest
Non-radiating
Usually due to heart failure 
Raised JVP and peripheral oedema
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15
Q

Treatment of high grade NHL lymphoma

A

Rituximab

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16
Q

Follicular lymphoma = translocation of 14 and 18

A

Produces bcl2- protein -> rituximab is treatment of choice (in a complex regime)

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17
Q

Translocation of 8 and 14?

A

Burkitts lympoma - jaw lymphadenopathy + c-my release

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18
Q

Which mediator is linked to the development of achalasia and used in its treatment?

A

Nitric oxide

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19
Q

Nose, lungs and kidneys ?

A

Wegner’s

c-ANCA!

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20
Q

Anti-mitochondrial antibodies?

A

PBC - itchy

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21
Q

Mononuclear cells = T,B and NK

A

Granulocytes = nuetrophilsm basophils and eosinophils (all of which have multi lined nucleus)

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22
Q

Traveler with chronic diarrhoea, weight loss, B12 and folate deficiency. Small intestinal biopsy shows mononuclear infiltration and villus atrophy. Most likely diagnosis?

A

Tropical sprue

Treat with broad spectrum Abx such as tetracycline

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23
Q

Where are the changes of coeliac disease most apparent?

A

Proximal small bowel as this is where gluten exposure is maximim

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24
Q

How often to patient with UC have surveillance colonoscopies?

A

HIgh risk = annually
Med risk = 3 yearly
Low risk = 5 yearly

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25
Q

Treatment of a gastroma?

A

If you can find it - cut it out
If you can’t - use a somatostatin analogue e.g. octreotide
Stomatostatin is an inhibitor for lots of endocrine things

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26
Q

Confusion, reduced GCS, seizure and cherry red skin? Treatment?

A

Cyanide poisoning

Sodium thiosulphate

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27
Q

Man with episodes of sweating, diarrhoea and SOB. HIgh 5-hydroxyindolacetic acid

A

Carcinoid tumour

Usually GI

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28
Q

Lymph node pain on drinking alcohol

A

Hodgkins

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29
Q

Big tongue and peri-orbital bruising?

A

Amyloid

Congo Red

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30
Q

Typical blood results of primary hyperparathyroidism

A

High Ca, phosphate and alk phos

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31
Q

Blood results in pagers disease

A

Normal Ca and phosphate

Very high alk phos

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32
Q

Tenderness over the tragus is characteristic for….

A

Otitis externa

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33
Q

Managment of hyperphosphatemia e.g. in patients on dialysis

A

Lanthanum carbonate - a phosphate binder

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34
Q

Managment of patient with malignant hypertension and altered conscious level?

A

Sodium nitroprusside

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35
Q

Which score is used to predict the risk of score after TIA?

A

ABCD 2 SCORE

Considers:
Age, BP, features of TIA, duration of symptoms and DM

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36
Q

List some drugs that cause QT prolongation

A 
Amiodarone
Sotalol
TCA
SSRI
Haloperidol
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37
Q

What metabolic side effect is associated with SSRI and TCA?

A

Hyponatraemia

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38
Q

How quickly should HIV post-exposure prophylaxis be given after a needle stick injury from an HIV +ve person?

A

ASAP but within 72 hours

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39
Q

How does sodium valproate work?

A

It increases GABA activity

Associated with weight gain, hair loss/ curly regrowth and nause

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40
Q

Why should oramorph be held in a patient with c.diff?

A

Oramorph is an anti-motility and anti-peristaltic —> increase risk of delayed clearance of toxin and ultimately toxic megacolon

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41
Q

What is the commonest cause of Non-Hodgkins lymphoma?

A

Diffuse large B cell
It is relatively aggressive but responds well to treatment

(remember that follicular lymphoma is pretty common but usually has an indolent onset)

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42
Q

In a patient who is not bleeding, a platelet transfusion is only required if platelet count drops below 10 x10^9

A

The threshold for a platelet transfusion is

30x10^9 in patients who are bleeding

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43
Q

Which type of malignancy is associated with smear/ smudge cells?

A

CLL

they are the result of slide prep on abnormally fragile lymphocytes

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44
Q

What are Rouleaux formation associated with?

A

Multiple myeloma

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45
Q

What are Auer rods a feature of?

A

AML

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46
Q

What is the management of the condition associated with a slurred upstroke in the QRS?

A

Wolf-Parkinson White

Accessory pathway ablation

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47
Q

What are the features of neuroleptic malignant syndrome? Who is at risk?

A

Patients on clozapine

Features = hyperthermia, limb rigidity, altered mental status and autonomic dysfunction

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48
Q

Which investigation must be ordered prior to carrying out a CTPA for suspected PE?

A

CXR

a D-dimer is not required if Wells score is >4

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49
Q

Ototoxicity is a recognised side effect of furesomide

A

E.g. tinnitus and hearing losss

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50
Q

What is the triad of acute liver failure?

A

Jaundice
Encephalopathy
Coagulopathy

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51
Q

‘Young’ patients with stroke e.g. <55 require additional investigations such as ….. to identify the cause of their stroke

A

Autoimmune and thrombophilia screen

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52
Q

Steroids are the best treatment for minimal change nephropathy

A

A renal biopsy is only indicated in cases which are steroids resistance

Cyclophosphamide is second line treatment

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53
Q

Which drug should be given for the prevention of variceal bleeding in patients with oesophageal varies?

A

Propranolol

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54
Q

What is a TIPS procedure?

A

A treatment aimed at reducing portal hypertension e.g. in patients with refractory varcies

It connects the portal and hepatic vein

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55
Q

In G6PD deficiency, there is a reduction in glutathione which makes red cells vulnerable to oxidative stress. How is it inherited?

A

X-linked recessive
Most common in Africa/ Asian people
Haemolysis is triggered by viral infections, antibiotics etc

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56
Q

Patients with a platelet count of <30 x10^9 + significant bleeding should receive a platelet transfusion

A

Pre-surgery, platelets should be at least 50 x10^9 for a planned procedure

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57
Q

70 y/o patient with unilateral rigidity and tremor and marked autonomic dysfunction?

A

Multi-system atrophy

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58
Q

In young men (<30) what are the 2 most common causes of lower abdominal pain?

A

Appendicitis

Testicular torsion/ Infection

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59
Q

Long QT syndrome is when the QT interval is >450ms

It can lead to life threatening VT (Torsades des Pointes). Give some causes:

A

Metabolic - hypokalaemia, hypomagensia and hypocalcaemia

Drugs - sotalol, amiodarone, TCA,

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60
Q

Why are coeliac patients offered the pneumococcal vaccine?

A

They have functional hyposplenism

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61
Q

What are the ECG changes required for thrombolysis?

A

ST elevation >1mm in 2 consecutive limb leads

ST elevation >2mm in 2 or moth consecutive anterior leads

New LBBB

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62
Q

Coeliac disease testing?

A

TTG and IgA (anti-endomyseal)

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63
Q

What MUST be monitored in a patient being started on phenytoin?

A

ECG for cardiac monitoring. High risk of arrhythmias

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64
Q

Steroids increase the risk of osteonecrosis

A

This is particularly significant in high risk bones such as scaphoid #

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65
Q

Which drug is used for the prophylaxis of cluster headaches?

A

Verapamil

Sumatriptan is used for the acute managment

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66
Q

Ulnar nerve = all of medial 1.5 fingers, front and back

Radial - most of back of hand and anatomical snuffbox

A

Median = most of palm, rest of thumb and to first joint on back of hand i.e. palm and tips of fingers

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67
Q

Options for migraine prophylaxis?

A

Propranolol OR topiramate

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68
Q

Rate control is usually first line for patients with AF

A

Hoewever if it is first onset of AF with a reversible cause (e.g. pneumonia) then rhythm control should be used

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69
Q

‘Pepper pot skull’

A

Characteristic finding of a patient with primary hyperparathyroidism

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70
Q

Other than resting, fluids and not kissing, what advice would you give a 18 year old boy with glandular fever?

A

Avoid contact sports for 8 week to avoid risk of spleen rupture

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71
Q

Temporal = superior quadrantopia

A

Parietal = inferior quadrantopia

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72
Q

Management of bradycardia?

A

Atropine - 500mcg IV if haemodynamically stable

If unstable/ atropine ineffective then do transcutaneous pacing

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73
Q

What is the first line for managing tremor in drug induced Parkinson’s?

A

Procycladine

it is an anti-muscarinic

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74
Q

In patients with HIV, PCP is classified as an AIDS defining condition

A

Typically occurs when the CD4 count is <200

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75
Q

What would you expect in a patient with a lacunar stroke?

A

Any one of the following

1) Unilateral weakness/ sensory deficit of face/arm/ leg
2) Pure sensory stroke
3) Ataxic hemiparesis

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76
Q

What would you expect in a patient with a posterior circulation stroke?

A

Any 1 of:

1) Cerebellar/ brainstem syndrome
2) Loss of consciousness
3) Isolated homonymous hemianopia

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77
Q

What features would you expect in a pontine haemorrhage?

A

1) Reduced GCS
2) Quadriplegia
3) Miosis

Has VERY poor prognosis

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78
Q

Name 4 live vaccine

A 
MMR
Polio
Yellow fever
Typhoid
BCG
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79
Q

Elderly patient with confusion, and intermittent hard stools with watery diarrhoea. Diagnosis and management

A

Faecal impaction with secondary overflow diarrhoea

Treat with high dose macrogol laxatives

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80
Q

Give a few causes of increased ferritin levels

A

1) Inflammation
2) Alcohol excess
3) CKD
4) Hereditary haemochromatosis
5) Iron overload due to repeat transfusions

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81
Q

How is T2DM managed in patients following an acute MI?

A

Oral diabetes medications are stopped and replaced with IV insulin infusion
There is evidence from several studies that excellent glyacemic control is beneficial at this time!

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82
Q

CML has 3 distinct phases.

A

Chronic - patients are often asymptomatic/ vague symptoms such as tiredness

Accelerated - abnormalities in blood tests

Blast crisis - >30% myeloblasts of lymphoblastic in the blood

Transformation in the blast phase is often to acute lymphoma

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83
Q

What factors affect HbA1c level?

A

HbA1c is produced by the glycolysation of Hb - this rate is proportional to the glucose concentration

1) Average blood glucose
2) Lifespan of a RBC

Lower than expected = sickle cell anaemia, G6PD and spherocytosis

Higher than expected = B12/ folate deficiency, IDA etc

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84
Q

Internuclear opthalmoplegia is due to a lesion of the medial longitudinal fasciculus tract which enables conjugate eye movement

A

Internuclear opthalmoplegia is due to a lesion of the medial longitudinal fasciculus tract which enables conjugate

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85
Q

Lip-smacking and post-vital dysphasia are localising features of a seizure in which area?

A

Temporal

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86
Q

Which injury is most likely to cause a wrist drop?

A

A # of the shaft of the humerus

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87
Q

Management of PCP?

A

Non-severe = oral co-trimoxazole

Severe = IV pentamidine

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88
Q

What is the most severe electrolyte abnormality that can complicate an AKI?

A

Hyperkalaemia

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89
Q

Multiple genital warts = treat with topical podophyllum

A

Solitary genital wart = cryotherapy

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90
Q

What are the triad of features associated with carcinoid syndrome?

A

Diarrhoea
Flushing
Abdo pain

(usually liver mets which release serotonin)

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91
Q

The eGFR criteria to be considered are remembered by the CAGE mnemonic

A 
C = creatinine
Age = age
G = gender
E = ethnicity
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92
Q

Tender goitre + hyperthyroid =

A

De Quervain’s thyroiditis

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93
Q

What proportion of patients with acute hep c will develop the chronic form?

A

55-85%

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94
Q

What is the managment for a patient with delerium who is a risk to themself due to severe agitation?

A

After trying the usual non-verbal reassurance etc the next best managment is Haloperidol or olanzapine

If the patient has PD or DLB then avoid and use lorazepam instead

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95
Q

Secondary prevention in a patient with AF that has had a stroke?

A

Oral anti-coagulation with warfarin OR a factor Xa inhibitor such as apixiban

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96
Q

Remember to diagnose rhadbomyolysis the CK would have to be really high

A

Like >10000 high

An elevation to <1000 is my more in keeping with soft tissue damage

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97
Q

In a patient with suspected PSC, what investigations are indicated?

A

US - typically shows a thickened, dilated gallbladder

MRCP - typically shows beading of the bile duct

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98
Q

Which artery is the site of major bleeding in patients with peptic ulcer disease?

A

Gastro-duodenal

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99
Q

IgA nephropathy causes visible haematuria a few days after an URTI

A

Post-infectious GN typically causes features 2-3 weeks after an URTI

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100
Q

How could you differentiate between a gastric and duodenal artery?

A 
Gastric = worse with eating, people often lose weight
Duodenal = relieved by eating, people gain weight (and much more common)
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101
Q

Treatment options for acute gout?

A

NSAIDs (don’t give if CKD)
Colchicine
Steroids

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102
Q

Which drug is given for restlessness at end of life?

A

Midazolam

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103
Q

Which part of the brain are early changes of Alzheimers most likely to be found in?

A

Temporal lobe

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104
Q

A patient overdoses on their TCA. The ECG shows prolongation of the QRS. Management?

A

IV sodium bicarbonate

TCA overdose causes ECG changes and can lead to arrhythmias

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105
Q

Pulmonary fibrosis is a recognised complication of amiodarone

A

It classically does not cause clubbing

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106
Q

Features of hepatic encephalopathy

A

1) Inversion of sleep-wake pattern
2) lethargy and personality change
3) worsening confusion
4) progression to coma
5) liver flap

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107
Q

Features of Wernicke’s?

A

Opthalmoplegia
Ataxia
Confusion

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108
Q

Features of Korsakoff’s

A 
Amnesia
Confabulation 
Poor conversation
Lack of insight
Apathy
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109
Q

Features of delerium tremens

A

Hallucinations
Global confusion
Sweating
Tachycardia

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110
Q

Bone pain and proximal myopathy and low calcium?

A

Osteomalacia - phosphate and vit D will also be low

Can be due to dietary deficiency or renal disease

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111
Q

What is the main side effect of bleomycin?

A

Lung Fibrosis

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112
Q

What is the main side effect of doxorubicin?

A

Cardiomyopathy

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113
Q

What is the main side effect of vincristine?

A

Peripheral neuropathy and paralytic ileus

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114
Q

Which drug is used for prophylaxis in meningitis?

A

Oral ciprofloxacin

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115
Q

How do you convert codeine to oral morphine?

A

Divide by 10

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116
Q

What is chronic inflammatory demyelinating neuropathy?

A

A neurological condition which presents like a chronic form of GBS e.g. the symptoms progress over several weeks –> months. Peripheral neuropathy with prominent motor features
Treat with high dose steroids

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117
Q

SVT = narrow complex tachycardia. Less common

A

VT = broad complex tachycardia. More common

DC cardioversion/ amiodarone

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118
Q

Best test for Addison’s disease

A

Short synacthen test

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119
Q

Which conditions are associated with Rouleaux formation?

A

Myeloma

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120
Q

Most likely infecting organism in a diabetic patient with longstanding ulcer. Ulcer is wet with a pale green slough over it

A

Pseudomonas - causes green sloughy ulcers, other bugs like staph aureus cause a more invasive infection

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121
Q

Doxycycline can cause photosensitivity to light

A

e.g. easy sunburn

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122
Q

What is the time cut off for PCI in an MI?

A

120 minutes

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123
Q

What kind of drug is metaclopramide?

A

D2 receptor antagonist

Has significant risk of extrapyramidal side effects, especially tar dive dyskinesia etc

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124
Q

Management of choking?

A

Give 5 back blows
Give 5 abdominal thrusts
Keep alternating until dislodged/ unconscious

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125
Q

Which feature of the GCS is the best predictor of outcome?

A

The motor score

It is less likely to be affected by other injuries

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126
Q

Remember a patient does not have CKD if eGFR is <90 with no evidence of kidney disease

A

Only diagnose CKD stage 1 or 2 if there is other abnormalities such as high creatinine or abnormal renal USS

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127
Q

Why is high urea a bad prognostic sign for patients with an upper GI bleed?

A

Blood is basically protein so a big bleed = big protein meal

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128
Q

Inheritance pattern of haemochromatosis

A

Autosomal recessive

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129
Q

In any diabetic patient with any foot problem other than simple callous formation, what do you do?

A

Refer to the diabetic foot clinic

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130
Q

How do you manage Tornado de Pointes?

A

IV magnesium sulphate

Loads of causes including low K/ Mg/ Ca, glucose SAH etc

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131
Q

Blood film of an alocholic

A

Microcytic anaemia

Thrombocytopenia

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132
Q

What is the single most important action in a patient with DKA?

A

Start IV fluids (IL saline) ASAP

After fluids give insulin (0.1units/ kg/ hour)

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133
Q

SVT is a narrow complex tachycardia. What is the management?

A

1) Carotid sinus massage —>
2) Adenosine (CI in asthma, give verapamil)
3) DC cardioversion

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134
Q

Remember that mittelschmerz is a very common cause of mid-cycle pain

A

Inflammatory markers normal and pain resolves in 24-48 hours

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135
Q

What is the difference between type 1 and 2 mania?

A

Type 1 = mania and depression
Type 2 = hypomania and depression

(Mania occurs when there is severe impairment of function/ psychotic symptoms for >7 days)

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136
Q

Bilateral median nerve dysfunction in an elderly patient?

A

Most likely to be degenerative cervical myelopathy

Refer to neurosurgery

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137
Q

The majority of causes of infectious endocarditis are gram +ve cocci

A

E.g. strep viridans, staph aureus and staph epidermidis

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138
Q

In people with a diagnosis of bipolar, a routine referral should be made to the CMHT if they develop symptoms of hypomania

A

An urgent referral should be made if they are manic e.g. hallucinations

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139
Q

Isolated high bilirubin in a 22 year old male?

A

Likely to be Gilbert’s syndrome

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140
Q

What is the best investigation for a SUFE?

A

AP and frog leg X-ray

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141
Q

With regard to anti-platelet therapy, what is the best regime for a patient who has had an ischaemic stroke?

A

Aspirin 300mg for 14 days

Then clopidogrel 75mg life long

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142
Q

What is the commonest cause of ambiguous genitalia in babies?

A

Congenital adrenal hyperplasia

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143
Q

A raised ESR and osteoporosis is XXX until proven otherwise?

A

Myeloma

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144
Q

Where is the best place to inject an epi-pen?

A

Anterolateral aspect of middle third of the thigh

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145
Q

Amyloid can affect any body system but classically presents with weakness and breathlessness

A

It is a less common cause of hepato splenomegaly

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146
Q

Remember that gallstones is a MAJOR risk factor for pancreatitis

A

Remember that gallstones is a MAJOR risk factor for pancreatitis

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147
Q

Neisseria meningitis and strep pneumoniae are common causes of meningitis

A

Remember listeria in older adults and immunosupressed

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148
Q

Rickettsia typhi is the cause of endemic typhus

Spread from cat/ rat fleas

A

Salmonella paratyphi is the cause of paratyphoid fever

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149
Q

Which drugs should be avoided in patients with Lewy Body dementia?

A

All anti-psychotics due to the risk of irreversible Parkinsonism (risk is up to 50%)

E.g. haloperidol

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150
Q

Mitral regurgitation is associated with collage disorders such as Marfans and Ehlers Danilo’s

A

It is a pansystolic murmur

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151
Q

Anti-thyroid peroxidase antibodies?

A

Hashimoto’s thyroiditis

Hypothyroid + non-tender, firm goitre

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152
Q

2 important side effects of sitagliptin?

A

1) Steven Johnson Syndrome
2) Acute pancreatitis

Sitagliptin is a DPP4 inhibitor

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153
Q

Patient has hyperthyroidism then hypothyroidism?

A

Most commonly de quervain’s thyroiditis

Typically follows a viral infection
Phase 1 = hyperthyroid + raised ESR
Phase 2 = euthyroid
Phase 3 = months of hypothyroid
Phase 4 = return to normal

There will be reduced uptake on iodine scan

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154
Q

Most common type of thyroid cancer?

A

Papillary - orphan Annie eyes on microscopy

Good prognosis

Thyroglobulin tumour marker

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155
Q

Which type go thyroid cancer produces calcitonin?

A

Medullary - associated with Marian’s syndrome

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156
Q

The 2 key values for DM are 7 (fasting) and 11.1 (random/ OGTT)

A
  1. 8 is cut off for impaired glucose tolerance

6. 1 is cut off for impaired fasting glucose

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157
Q

In a patient on metformin - what is the second line therapy?

A

1) SU such as gliclazide (if they are not very over weight)

2) Sitagliptin ( DPP4 inhibitor) - good because it causes weight loss

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158
Q

HbA1c level diagnostic for DM and pre-diabetes?

A

Pre-diabetes= 6-6.4% (42-47)

DM = >6.5% (48-52)

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159
Q

What HbA1c level is diagnostic of DM?

A

HbA1c of 6.5% or more

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160
Q

BG in Conn’s syndrome?

A

Often a metabolic alkalosis

High Na, low K

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161
Q

Which type of Hodgkin’s lymphoma has the poorest prognosis?

A

Lymphocyte depleted

Modular sclerosing is the most common and has a good prognosis

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162
Q

Patient with DKA is treated with fluids and insulin. She develops confusion - what is the most likely cause?

A

Cerebral oedema - presents with headache, visual disturbance etc

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163
Q

Managment of DVT in pregnancy

A

Use LMWH - warfarin is contraindicated

164
Q

The overnight dexamehtasone supression test is used to confirm Cushing’s. What U&E result would you expect?

A

Hypokalaemia metabolic alkalosis

165
Q

Major side effect of SGLT2 inhibitors?

A

E.g. Dapagliflozin

Causes sugary pee —> increased risk of thrush etc

166
Q

What is the mechanism of action of orlistat?

A

Lipase inhibitor

(

167
Q

What is the first line investigation for suspected Conn’s syndrome?

A

Renin: aldosterone ratio
(in Conn’s aldosterone levels are high and renin low)

If there is an adenoma —> remove
If bilateral hyperplasia —> spironolactone (aldosterone antagonist

168
Q

In hypocalcaemia:

Chovstek - cheek twitches after tapping facial nerve

A

Trousseau sign = hand spasm with wrist flexion - often when taking BP

169
Q

What is the management of diabetes insipidus?

A

Pituitary cause = desmopressin

Nephrogenic cause = chlorothiazide (a thiazide diuretic)

170
Q

What is the direct Coombs test used for?

A

It tests antibodies on the blood in vivo

Used to investigate newborn jaundice and in cases of possible autoimmune haemolysis e.g. transfusion reaction

171
Q

What is the ‘got a bad unit’ mnemonic for?

A

Transfusion reactions e.g.
G - graft vs host
O - overload
T - thrombocytopenia

A - alloimmunization

B - blood pressure instaboity
A - acute haemolytic reaction
D - delayed reaction

U - urticaria
N - neutorphila
I - infection
T - transfusion associated lung injury

172
Q

Why are patients having a bone marrow transplant given ‘irradiated’ blood products?

A

It depletes T lymphocyte numbers which reduces risk of graft vs host disease!

173
Q

What is Waterhouse- Freidrichsen syndrome?

A

Bilateral adrenal haemorrhage, often in the presence of meningococcal septicaemia

174
Q

Iron sulphate reduces the absorption of thyroxine and can therefore cause an increase in TSH

A

Iron sulphate reduces the absorption of thyroxine and can therefore cause an increase in TSH

175
Q

In a severely bleeding patient e.g. DIC, what is the best predictor of severity / need to give cryoprecipitate?

A

Low fibrinogen

176
Q

What is the treatment of a man with acute retention, secondary to clots?

A

Bladder irrigation through a 3 way catheter

177
Q

Pioglitazone increases insulin sensitivity. What are the side effects?

A

Weight gain
Fluid retention - CI in HF
Increased risk of # and bladder cancer

178
Q

How do you manage a patient who is deficient in both folate and B12 but does not have pernicious anaemia?

A

Give IM B12 injections

Start oral folic acid when b12 levels are normal to prevent sub-acute degeneration of the spinal cord

179
Q

In a patient with a high calcium, what should the PTH be if the parathyroid is working properly?

A

It should be low as it is being suppressed - being normal would actually be inappropriate!

180
Q

Test for phaeochromocytoma?

A

24 hour urinary test for METANEPHRINES

181
Q

What rate should the insulin infusion be started at in a DKA?

A

0.1 units/ hours

182
Q

Which renal disease present with nephritic syndrome?

A

Rapidly progressing GN (AKI, crescenteric GN)
IgA nephropathy
Alpert syndrome

183
Q

If a post-menopausal lady has a hip # she should be started on bisphosphonate and calcium supplements

A

There is no need for a bone scan

184
Q

Target BP for type 2 DM?

A

<140/80

< 130/80 if end organ damage e.g. proteinuria

185
Q

What is the commonest viral infection to get post solid organ transplant?

A

CMV

Treat with ganciclovir

186
Q

Plasma and urine results in diabetes insipidus?

A

Plasma osmolality is high - patients are thirsty

Urine osmolality is low - patients cannot concentrate urine

187
Q

What is ‘sub-clinical’ hypothyroidism?

A

Raised TSH
Normal T4

(risk of progression to hypothyroidism is 2-5% per year)

Repeat TFT in several months

188
Q

What is the first line insulin regime for adult with newly diagnosed T1DM?

A

Twice daily basal bolus with detemir

189
Q

What are the target blood sugars for T1 diabetic patients?

A

Aim for HbA1c <48 (6.5%)
On waking = 5-7
At other time of day = 4-7

Patients should check blood glucose 4 times per day at least - after each meal and before bed

190
Q

Anti-centromere antibodies?

A

Associated with limited systemic sclerosis

191
Q

Which condition is anti-CCP associated with?

A

RA

It is highly specific

192
Q

Which diuretic should you give in a patient with ascites?

A

Spironolactone

193
Q

What infection is known to precipitate aplastic crisis in sickle cell and hereditary spherocytosis?

A

Parvovirus B19

194
Q

How does acute and chronic renal graft rejection occur?

A

Acute = <6 months with graft pain and features of infection + rising creatinine. Diagnose with boyish and manage with high so ease steroids

Chronic >6 months with gradual decline in renal function

195
Q

Papillary tumour is commonest thyroid cancer, typically spread to lymphatic

A

Follicular is 2nd most common thyroid cancer, usually metastasises early to bone and lung

196
Q

Fused podocytes on electron microscopy

A

Minimal change glomerulonephritis

the commonest cause of nephrotic syndorme in children

197
Q

What are the 4 type of sickle cell crisis?

A

1) Thrombotic - thrombus can form anywhere e.g. AVN
2) Sequestration crisis - sickling within an organ e.g. spleen, lung or chest
3) Aplastic crisis - triggered by infection with parvovirus B19
4) Haemolytic crisis - rare

198
Q

How could you differentiate between vWD and haemophilia by looking at a clotting screen?

A

The APTT will be increased in both

The bleeding time is INCREASED in vWD and normal in haemophilia

199
Q

Isolated prolonged APTT ….

A

Haemophilia

Remember: APTT tests intrinsic pathway (factor 8 etc)

200
Q

Why should you avoid amitryptilline in a patient with BPH?

A

Amitryptilline can cause urinary retention

201
Q

DVT/ PE treatment time

A

Remember warfarin and LMWH should be given concurrently initially - stop dalteperin when INR in target range

Post - op = 3 months
Unprovoked = 6 months
Recurrent/ thrombophilia = life long

202
Q

What is the screening test for adult polycystic kidney disease?

A

US abdomen

203
Q

Clinically, what are the 2 most common causes of VT?

A

Hypokalaemia

Hypomagnesia

204
Q

What is the first line angina proplhyaxis?

A

Bisoprolol

use nicorandil if CI e.g. taking verapamil

205
Q

When should clopidogrel be stopped before elective surgery?

A

7 days

same for prasugrel and ticagrelor which are similar

206
Q

What are the features of trifascicular block?

A

A relatively common cause of falls in the elderly

PR prolongation
RBBB
Left axis deviation

207
Q

What is the definitive investigation of ? Oesophageal rupture

A

CT contrast swallow

208
Q

Mid diastolic murmur at apex

A

Mitral stenosis

209
Q

What type of murmurs are IVDU as risk of having?

A

Right sided murmurs e.g. tricuspid regurgitation from endocarditis

210
Q

Ejection systolic murmur which does not radiate to the carotids?

A

Aortic sclerosis

NOT aortic stenosis

211
Q

pansystolic murmur

A

Mitral/ tricuspid regurgitation

212
Q

Early diastolic murmur

A

Aortic regurgitation

213
Q

Mid-diastolic

A

Mitral stenosis

214
Q

What is the surgical management for late stage lung disease e.g. alpha 1 anti-trypsin or COPD?

A

Lung reductions surgery

By removing the worst part of the lung, airflow and alveolar gas exchange will be improved

215
Q

Management of young man with HOCM. This was discovered after syncope while playing football

A

Refer to cardiology for implantable cardio-defibrillator to reduce risk of of sudden death

Beta blockers can also be used to reduce symptoms

216
Q

Which type of lung cancer is most likely to cause gyanecomastia?

A

Adenomacarcinoma

most common in non-smokers and mets to brain and bone

217
Q

Rayndauds + intermittent claudication + extensive smoking history

A

Think Buerger’s syndrome

218
Q

Secondary prevention post-MI

A

All patient should be on:

  • Aspirin
  • ACEI
  • Beta-blocker
  • Clopidogrel (for at least 1 month - up to 1 year)
  • Statin
219
Q

Remember that adenosine must be given via a central or large peripheral vein

A

E.g. at least the antecubital fossa

220
Q

U wave

A

Hypokalaemia

221
Q

Systolic murmur radiating through to the back with fixed S2 splitting

A

Atrial septal defect
The most commonly detected congenital heart defect found in adults

This murmur and embolism/ stroke are most common features

222
Q

What are the 2 main indications for surgery in bronchiectasis?

A

1 - uncontrolled haemoptysis

2 - localised disease e.g. 1 lobe

223
Q

1st line investigation for a lady who present to rapid access chest pain clinic with angina sounding pain. ECG normal.

A

CT angio

224
Q

Always remember that fever, night sweat and fatigue are B symptoms of all types of cancer

A

Not just TB

225
Q

For people with personal/ FH of DVT who are at increased risk and clots and are flying long haul, what should you advice?

A

Use flight sock

226
Q

Pulsus alterans

A

Upstroke varies between strong and weak

Indicates systolic dysfunction and seen in HF

227
Q

Vaccines for patient with new COPD?

A

Annual influenza

One of pneumococcal

228
Q

Asthmatic patient with SVT. Drug management?

A

Verapamil

Cannot give adenosine as is contraindicated

229
Q

What is the ‘normal’ ejection fraction?

A

55-70%

230
Q

Murmur of VSD?

A

Classically pan-systolic

Associated with chromosomal disease such as downs

231
Q

What is the criteria for long term oxygen in COPD patients?

A

pO2 < 7.3

Or pO2 7.3-8 with other features such as peripheral oedema

232
Q

Which scoring system is used to determine disease severity in RA?

A

DAS 28

233
Q

Central back/chest and different BP in arms?

A

Aortic dissection

Stanford A - affects ascending aorta and arch —> v bad —> surgical management

Stanford B - beyond brachiocephalic vessels —> medical management

234
Q

Large bowel = haustra

A

Small bowel = valvulae conniventes

235
Q

Sweating, headaches and bitemporal hemianopia?

A

Acromegaly

236
Q

Left homonymous hemianopia (with macular sparing):

A

Lesion of RIGHT optic tract

Macular sparing = occipital cortex

237
Q

Webers syndrome?

A

Midbrain stroke syndorme presenting with ipsilateral CN 111 palsy and contralateral hemiplegia/ hemiparesis

238
Q

Initial management of spinal cord compression

A

8mg oral dexamethasone and urgent referral to oncology

back pain, worse on lying down and coughing, limb weakness

239
Q

Patient who has just started chemo develops high K and phosphate but low calcium. Diagnosis? Which drug is given prophylaxically to prevent this?

A

Tumour lysis syndrome = complicates treatment of high grade lymphoma and leukaemia

Give allopurinol to prevent

240
Q

Smear cells

A

Chronic lymphocytic leukaemia

The main complication is of hypogammaglobulinaemia which puts patients at risk of recurrent infections

241
Q

Adenocarcinoma is usually a peripheral lung tumour

A

Squamous is more likely to be central and found near big airways

242
Q

TSH autoantibody +

A

Graves’ disease
(almost diagnostic)

Commonest form of hyperthyroid in the UK

243
Q

Anti-thyroid peroxidase antibodies?

A

Hashimoto

always causes a hypothyroid

244
Q

Although platelets are low in TTP, platelet transfusion is CI due to increased risk of thrombosis

A

Treatment is with plasma exchange and immunosupression

245
Q

Difference between primary, secondary and tertiary hyperparathyroidism?

A

Primary = high PTH and calcium due to solitary adenoma

Secondary = low Ca which causes parathyroid hyperplasia —> high PTH
Seen ONLY in chronic renal failure

Tertiary = prolonged secondary —> high Ca and high phosphate

246
Q

Action in a healthcare worker who is bitten by a hep B +ve person

A

If already vaccinated —> give Hep B booster

If not vaccinated —> hep B immunoglobulin + booster

247
Q

What is the most common metabolic complication in patients with cancer?

A

Hypercalcaemia

248
Q

Patient with sub-acute onset of dementia, myoclonus (jerky movements) and mood disturbance. EEG is abnormal

A

CJD

249
Q

Migratory thrombophlebitis/ Trousseau sign ….

A

Associated with pancreatic cancer

250
Q

Left supraclavicular node?

A

Gastric cancer
Cholangiocarcinoma
Lymphoma

251
Q

Girls with Turners syndrome are usually very small so are entitled to growth hormone therapy

A

Girls with Turners syndrome are usually very small so are entitled to growth hormone therapy

252
Q

Talk though the interpretation of hep B serology?

A

HBsAG (surface antigen) = implies acute infection (1-6 months)
If present for >6 months = chronic disease

Anti-HBs = immunity due to previous infection of immunisation - it is NEGATIVE in chronic disease

Anti-HBc = acute of current infection

—>

HBsAg +ve = ongoing infection
Anti-HB c is only +ve if caught

253
Q

Hyperosmolar hyperglycaemic state occurs in T2DM. What are the features?

A 
Dehydration
Osmolality >320
Hyperglycaemia 
pH >7.3
No significant ketones (<3)

(similar to DKA but symptoms will be slightly different, higher glucose of lower ketones)

254
Q

Why should statins be taken at night?

A

The majority of cholesterol synthesis happens overnight - this is particularly true of simvastatin which has a short half life

255
Q

What is the first line investigation is a patient with ? Acute mesenteric ischaemia

A

Lactate - it is raised as the poor blood supply —> anaerobic metabolism

256
Q

How does strep pneumoniae look under microscope?

A

Gram +ve diplococci

257
Q

Muscle pain + reduced power + very very high CK

A

Polymyositis (dermatomyositis is skin changes)

258
Q

Muscle pain + normal power + elevated ESR but normal CK

A

polymyalgia rheumatica

259
Q

1st line anti-hypertensive in a 60 year old lady with severe ankle oedema?

A

Thiazide diuretic

260
Q

1st line treatment for paroxysmal AF?

A

Bisoprolol

261
Q

At what age should a child be measured in height not length?

A

height cab start being measured at 2 years old

262
Q

Most likely diagnosis in a 2 day old with green coloured vomiting - non-projectile?

A

Volvulus or malrotation

AXR is first line

263
Q

Average age of onset of bipolar disorder?

A

21

264
Q

What mass of drug is present in 1ml of 1:1000 adrenaline ?

A

0.01

265
Q

What mass of drug is in 10ml of 1% lidocaine?

A

100mg

266
Q

What mass of drug is in 100ml of 10% glucose?

A

10g

267
Q

Remember that wet ARMD is a painless cause of sudden visual loss

A

Remember that wet ARMD is a painless cause of sudden visual loss

268
Q

STI and gram -ve diplococci

A

Gonorrhoea

269
Q

In old people, body weight may remain normal despite loss of muscle mass

A

In old people, body weight may remain normal despite loss of muscle mass

270
Q

What features of bronchiolitis warrant admission?

A

1) Apnoea
2) Sat <92 %
3) Poor oral intake
4) Severe respiratory distress e.g. RR>70, grunting, sternal recession etc

271
Q

Management of bradycardia and hypotension in a child having squint surgery?

A

This is due to stimulation of the oculocardiac reflex

Treat with atropine

272
Q

How does high urine protein explain bilateral ankle oedema?

A

She probably has a nephrotic syndrome?

273
Q

Best treatment for a patient with MODY and a HNF1 alpha mutation?

A

SU e.g. gliclazide

Very responsive so low dose is needed

274
Q

In the 2nd trimester of pregnancy, maternal BP decreases

A

It increases and returns to pre-pregnancy level by the third trimester

275
Q

The tidal an minute volume increases in pregnancy

A

Vital capacity is unchanged

276
Q

Most likely cause of jaundice in a newborn?

A

<24 hours = haemolysis or infection
>24 hours in an otherwise well baby = physiological

Prolonged jaundice (>10-14 days) = infection, hypothyroid, galactosaemia

277
Q 
Where should the following items be disposed of?
Paper towel
Empty medication blister pack
Unused needle
Empty vaccine vile
Used IV drip tubing
A 
Paper towel - black bag
Empty medication blister pack - black bag
Unused needle - sharps bin
Empty vaccine vile - sharps bin
Used IV drip tubing - orange bag
278
Q

Learning disability IQ ranges

A 
Mild = 50-70
Moderate = 35-49
Sever = 20-34
Profound = <20
279
Q

Anterior MI

Leads and territory

A

Leads V2-5

RCA

280
Q

Anteroseptal MI

A

Lead V1-3

LAD

281
Q

Anterolateral MI

A

1, aVL
V4-6

(Circumflex artery)

282
Q

Inferior MI

A

II, III aVF

RCA

283
Q

Anti-centromere antibody?

A

Systemic sclerosis

284
Q

Treatment fo typhoid?

A

IV ceftriaxone

285
Q

Serotonin involved in aversive/ defensive system

A

Dopamine is neurotransmitter in appetitive and approach system

286
Q

Patient placement/ PPE for patient with TB

A

Droplet precaution

Single room + surgical mask for staff

287
Q

How to you manage a choking baby?

A

Back slaps and then chest thrusts

Abdominal thrusts are not used in babies

288
Q

Most abundant antibodies in the blood?

A

IgG

More grannies than mums!

289
Q

Antibody class present in breast milk, saliva and tears

A

IgA

290
Q

Which antibody is found as a pentameric molecule?

A

IgM

291
Q

Bladder parasympathetic stimulation excites bladder and relaxes urethral sphincter

A

Bladder sympathetic stimulation relaxes detrusor but contracts sphincter

292
Q

What needs to be measured before starting lithium?

A 
ECG (only if CV disease or risk factors)
UE
TFT
BMI
FBC
293
Q

Which area of the brain is fist affected in Alzheimer’s disease?

A

Nucleus basalis of Meynet

294
Q

Investigations for upper GI bleed

A 
FBC
UE
LFT
Clotting
 X match 4 units

May want to start the major haemorrhage protocol

Blatchford score:

  • Hb
  • BUN (blood urea nitrogen)
  • BP
  • HR
  • Malaena
  • syncope
  • Heart/ cardiac disease
295
Q

What drug should be given in bleed due to oesophageal varices?

A

Terlipressin

296
Q

Cullen = around umbilicus

A

Grey tuner = flank

297
Q

Talk through the scoring system for pancreatitis severity?

A 
Pa O2 <7.9
Age >55
Neutrophils >15
Calcium <2mmol/L
Renal function - urea >16mmol/L
Enzymes - LDH >600,AST >200
Albumin -< 32
Sugar >10
298
Q

Differential for onset of gastroenteritis within 6 hours?

A

Toxins

Staph aureus
Bacillus cereus
Clostridium perfringes - mainly meat

299
Q

Differential for gastroenteritis with 12-72 hour incubation

A 
Campylobacter - commonest
Salmonella
Shigella
E.coli - travellers diarrhoea 
C.diff
300
Q

Rice water stools

A

Cholera

301
Q

Remember bilirubin conjugation occurs in liver so if high unconjugated bilirubin = pre liver problem = increased breakdown e.g haemolysis, DIC, Gilbert’s syndrome etc

A

High conjugated = liver problem e.g. hepatitis, EBV, Wilson’s etc

302
Q

First line treatment for trigeminal neuralgia?

A

Carbamazepine

exclude red flags e.g. sensory changes, hearing problems, FH of MS, age <40

303
Q

Pepper pot skull

A

Myeloma

304
Q

How does sodium valproate work?

A

It increased GABA activity

305
Q

Phenytoin, lamotrigine and carbamazepine all act on sodium channels

A

Remember carbamazepine is first line for partial seizures

306
Q

Anthacyclines all end in ‘ubicin’.

What are there major side effect?

A

Cardiomyopathy

307
Q

Vinicristine causes peripheral neuropathy

A

Cisplatin causes ototoxicity and hypomagnesia

308
Q

SOB, RHF, raised JVP and +ve Kussmauls sign?

A

Constrictive pericarditis

Also associated with pericardial knock

309
Q

Opiates, radiotherapy and bisphosphonates such as pamidronate are all useful for managing pain caused by bony mets

A

Opiates, radiotherapy and bisphosphonates such as pamidronate are all useful for managing pain caused by bony mets

310
Q

What is calcitonin a tumour marker of?

A

Medullary thyroid cancer

311
Q

CA 19-9

A

Pancreatic cancer

312
Q

S-100 tumour marker

A

Melanoma

Schwanoma

313
Q

Remember transudate effusions are failures of everything e.g. heart, liver, kidneys and thyroid

A

Exudate effusions have lots of protein e.g. infection, connective tissue disease, neoplasia, pancreatitis etc

314
Q

What is haematochezia?

A

Passage of fresh blood PR

315
Q

The urea level is high in patients with an upper GI bleed as blood is digested in the stomach

A

It is lower if it is a lower GI bleed

316
Q

How do you step down asthma medication?

A

When well controlled e.g. not using salbutamol then reduce steroid by 25-50%

317
Q

1st line treatment in gastroperesis?

A

Metoclopramide

318
Q

Refer all children with a palpable abdominal mass to paediatric very uregently. Why?

A

To exclude a neuro last OA or Wilks tumour

319
Q

What is the management of hairy cell leukaemia?

A

Chemotherapy - agents such as cladribine and pentostain are first line

320
Q

How is anti-phospholipid syndrome managed in pregnancy?

A

Start LMWH once fetal heart detected and stop at 34 weeks

Aspirin is given for duration of pregnancy

321
Q

Which simple test can be done to differentiate between Type 1 and type 2 DM?

A

C-peptide

It will be low in people with type 1 and normal/ high in people with type 2

322
Q

Small bowel obstruction and air in the biliary tree on AXR

A

Gallstone ileus

323
Q

Don’t forget to mention increased risk of IHD and depression in patients with RA

A

Don’t forget to mention increased risk of IHD and depression in patients with RA

324
Q

Methotrexate is bad for myelosupression, liver cirrhosis and pneumonitis

A

Sulfasalazine affects skin and sperm

All biological drug increase risk of infection and risk of reactivation of TB

325
Q

CRP is typically normal in SLE…

A

ESR is raised

326
Q

What are the most common causes of drug induced lupus?

A

Procainamide and Hydralazine

Isoniazid and phenytoin are rarer causes

Most of the typical SLE features expect renal and CNS involvement is unusual

ANA +ve but dsDNA -ve

327
Q

Remember that anti-phospholipid syndrome increases risk of arterial and venousus thrombosis

A

Prolonged APTT and thrombocytopenia are features

328
Q

After a SABA/ SAMA in patients with COPD, what is the next step?

A

FEV1 >50% = LAMA or LABA

FEV1 <50% = LAMA or LABA+ICS

Next line is LAMA + LABA + ICS

329
Q

What is pulmonary hypertension?

A

> 25mmHg

normal pulmonary pressure is 10-14mmHg

330
Q

AF rhythm control can be achieved with amiodarone, flecainide or sotalol. In which patients would rhythm control be most useful?

A

<65
First presentation
Lone AF/ secondary to corrected cause e.g. alcohol
Symptomatic

331
Q

After diagnosing Cushing’s syndrome with a low dose dexamethasone suppression test, how do you identify the cause?

A

High dose dexamethasone supression tests

Will suppress in ACTH dependent Cushing’s e.g. pituitary tumour, but will NOT suppress in adrenal Cushing’s/ ectopic ACTH

332
Q

What is the max rate of IV K infusion on a general ward?

A

10 mmol/hr

E.g. 40mmol K added to a bad of saline and given over 4 hours

333
Q

What is the commonest type of thyroid cancer?

A

Papillary - don’t forget it is assocaited with psammoma bodies and orphan Annie nuclei

334
Q

Managment of a child with nephrotic syndrome in GP land?

A

Start with oral prednisolone (may wish to discuss with paediatrician)

The vast majority of cases are caused by minimal change GN. Referral for biopsy only if steroids are not effective I

335
Q

What are the 5 main headache features that require urgent imaging?

A 
Postional change
Reduced conscious level
New neurological deficit
Vomiting
Progressive headache with fever
336
Q

Management of GH secreting timeout causing acromegaly?

A

1) trans-sphenoidal surgery is first line

2) if surgery CI then a somatostatin analogue such as OCTREOTIDE

337
Q

Inferior rectus is the most commonly involved muscle in Graves eye disease

A

Inferior rectus is the most commonly involved muscle in Graves eye disease

338
Q

Which ECG changes are most common after a large blood transfusion?

A

Hyperkalaemia

339
Q

How much glucose does an adult require per day?

A

50-100g (regardless of weight)

340
Q

Vancomycin is the first choice treatment for MRSA. What is second line?

A

Linezolid

341
Q

If someone has new diagnosed TB you have to order a…

A

HIV test

342
Q

What does cryoprecipitate contain?

A

Factor VIII
Fcator XIII
VWF
Fibrinogen

343
Q

What is the diagnosis in a renal biopsy showing segmental tuft sclerosis?

A

Focal segmental glomerulosclerosis

344
Q

On a renal biopsy, what does a Kimmelsteil-Wilson nodule suggest?

A

The patient has DM

Nodule is due to glycogen deposition

345
Q

Crescenteric GN is found on biopsy in rapidly progressive GN. What conditions can cause rapidly progressive GN?

A

Goodpastures
Wegners
SLE
Etc

346
Q

Waldenstrom’s macroglobulinaemia = IgM paraprotein

A

Myeloma usually causes IgG paraprotien, IgA or IgD (m is rare)

Unlike waldenstroms, boney lesions are probable

347
Q

Consider LADA in patients who develop DM symtpoms in early adulthood, especially if they have other autoimmune features e.g. thyroid diseas

A

Consider LADA in patients who develop DM symtpoms in early adulthood, especially if they have other autoimmune features e.g. thyroid diseas

348
Q

What are the features of Bell’s palsy?

A

Face - facial muscle paralysis
Ears - stapedius —> hearing affected
Taste - chorda tympani
Tears - reduced tears and saliva

349
Q

What visual field defect is associated with craniopharyngioma?

A

Craniopharyngioma causes a bitemporal inferior quadrantopia - they sit above the pituitary gland

350
Q

The main use of EPO is to treat the anaemia which results from CKD. What are the side effects?

A

EPO increases the amount and viscosity of blood:

  • HT
  • cerebral oedema
  • red cell aplastia
  • bone ache
  • flu-like
  • risk of stroke

Remember that iron deficiency will cause prevent patKent’s responding appropriately to EPO

351
Q

Anterior cerebral artery stroke = contralateral hemiparesis with leg affected >arm

A

Middle cerebral artery = contralateral hemiparesis, face >arm > leg
Contralateral homonymous hemianopia
Aphasia

352
Q

Anterior cerebral artery stroke = contralateral hemiparesis with leg affected >arm

A

Middle cerebral artery = contralateral hemiparesis, face >arm > leg
Contralateral homonymous hemianopia
Aphasia

353
Q

Posterior cerebral artery stroke = contralateral homonmyous hemianopia with macular sparing
Visual agnostia

A

Basilar artery = locked in

354
Q

Remember that PTH level can be normal in primary hyperparathyroidism

A

It Ca is high, normally PTH level will fall. If this does not happen then it is primary hyperparathyroidism

355
Q

Neuroleptic malignant syndrome can occur with anti-psychotics such as haloperidol and Parkinson’s drugs such as levodopa when the dose is stopped.How should you manage it?

A

Stop anti-psychotic
IV fluids
Consider dopamine agonist such as bromocriptine
Consider dantrolene (muscle relaxant)

356
Q

Which is the best drug for the management of chemo induced N and V?

A

Ondansetron

serotonin receptor antagonist

357
Q

Which is the best drug for the management of chemo induced N and V?

A

Ondansetron

serotonin receptor antagonist

358
Q

Management of Ischaemic stroke if outwith the 4.5 hour window?

A

Aspirin 300mg

359
Q

Thrombolysis is CI in stroke if patients….

A 
Previous intracranial heamorrhage
Seizure during stroke
 SAH
Recent LP
PREGNANT
360
Q

1st line for trigeminal neuralgia?

A

Carbamazepine

361
Q

What do Reed-Sternberg cells look like?

A

‘Large multinucleated cells with prominent eosinophilic nucleoli’

362
Q

Target HbA1c in type 1?

A

<48 mmol/l (<6.5)

363
Q

Activated protein C resistance is the commonest inherited thrombophilia

A

Von Willebrand is the most common inherited bleeding disorder

364
Q

In a patient on metformin for T2DM, at what HbA1c level should you add a 2nd drug?

A

7.5% of 58mmol/l

365
Q

HbA1c between 42 and 47 = pre-diabetes

A

HbA1c between 42 and 47 = pre-diabetes

366
Q

Anti-thyroid peroxidase antibodies?

A

Hashimoto

367
Q

Rectal midazolam 10mg is a good option for an adult patient with a seizure

A

Rectal midazolam 10mg is a good option for an adult patient with a seizure

368
Q

Radioactive iodine is the treatment of choice in toxic multinodular goitre

A

Radioactive iodine is the treatment of choice in toxic multinodular goitre

369
Q

Talk through the ABCD 2 score?

A 
Age (>60)
BP (>140/90)
Clinical features (unilateral weakness = 2, speech disturbance =1)
Duration (>60 = 2, <60 =1)
DM =1

Score 4 or above = high risk = need to be seen within 24 hours

Remember to give aspirin

370
Q

What type of uptake on iodine scan is seen in Subacute de Quervain’s thyroiditis?

A

Reduced

(4 stages:
1 -hyper with painful goitre, 
2 - euthyroid
3 - months of hypothyroid
4 - return to normal
371
Q

V1-V4 = LAD

II, III, aVF = RCA

A

V5-6, I, aVL = circumflex

372
Q

What are the 4 steps of treatment in a child with status epilepticus?

A

Buccal midazolam
IV lorazepam
IV phenytoin
Rapid sequence induction of anaesthesia

373
Q

How do you remember the ECG features of hypokalaemia?

A

U have no pot and no T but a long PR and a long QT

U waves
Small/ absent T waves
Long PR
Long QT

374
Q

What is ITP?

A

Idioapathic thrombocytopenia purpura = isolated low platelet count —> easy bruising and bleeding

The acute form on more common in children, follows an infection and resolves within 1-2 weeks

Chronic form is more common in young women and runs a relapsing, remitting course

375
Q

CLL is commonest leukaemia in adults. Caused by monoclonal proliferation of well differentiated B lymphocytes

A

Usually asymptomatic but risk of:

Hypogammaglobulinaemia
Warm autoimmune haemolytic anaemia
Transformation to high grade lymphoma

Blood film shows smear/ smudge cells

376
Q

What is Richter’s transformation?

A

Transformation of CLL to high grade lymphoma

rare but patients become very unwell very quickly

377
Q

In spinal cord compression, lesions above L1 usually cause UMN signs in leg and a sensory level

A

Lesions below L1 usually causes LMN signs in leg and perianal numbness

378
Q

Which blood test can be done to differentiate between a seizure and pseudoseizure?

A

Prolactin

will be elevated in a true seizure

379
Q

What is the cut-off for treating Hyperkalaemia with 10ml of 10% calcium gluconate, 10U of actrapid insulin and glucose and possibly salbutamol?

A

K >6.5mmol/l or ECG changes

tall tented T —> loss of p wave —> widening of QRS —> approaching sinusoidal

380
Q

Triptan are used as preventers in migraines. They are CI in previous IHD!

A

Triptan are used as preventers in migraines. They are CI in previous IHD!

381
Q

Define neutropenic sepsis?

A

Patient having anti-cancer treatment who has a neutrophil count >0.5 AND

  • > 38
  • OR signs of sepsis e.g HR>100
382
Q

Epileptic patient with polyuria, polydipsia and high Na

A

Probably nephrogenic diabetes insipidus due to lithium therapy

383
Q

Why doe nephrotic syndrome cause increased risk of VTE?

A

There is increased filtration and excretion of protein C, S and anti-thrombin

384
Q

Post renal transplant patients are at very high risk of which type of cancer?

A

SCC

25% of patients who live 20 years post-transplant will develop. SCC

385
Q

Burkitt’s lymphoma is a high-grade B cell lymphoma. What are the 2 types?

A

Endemic - involves mandible/ maxilla in Africans

Sporadic - abdominal tumour in HIV +VE people

Starry sky

386
Q

How does progressive supranucelar palsy present?

A

Typically with impaired balance —> falls
Vertical gaze palsy
Symmetrical onset
Poor response to Levodopa

387
Q

What must be excluded in a patient with a painful 3rd nerve palsy?

A

Posterior communicating aneurysm

388
Q

What is the correct action in a baby with an inguinal hernia?

A

Refer for surgery

Paediatric hernias have a high risk of complication

389
Q

When assessing carpal tunnel, which clinical test is most sensitive?

A

Phalens

More sensitive than tapping tinel!

390
Q

HSP is an IgA mediated, small vessel vasculitis

A

Treatment is with analgesia and support

Usually self limiting in children, although a significant proportion will have a relapse

391
Q

Yellow fever causes fever, leg pains and jaundice. Incubation period of 2-14 days

A

There is a characteristic remission between the 2 phases of the disease

392
Q

Ondansetron is a 5-HT3 receptor antagonist. Where does it work?

A

Blocks serotonin in the chemoreceptor trigger zone of the medulla oblongata

393
Q

Crescenteric GN tends to cause a very rapid nephritic syndrome with the patient feeling very unwell

A

Membranous GN presents slower and patients are more likely to complain of oedema and periorbital swelling

394
Q

Ortolani = ABduct hip to try and reduce dislocated hip

ortalani when the hip is OUT

A

Barlow = ADuct hip and punch downwards to try and dislocate a hip

(Barlow = bad = dislocating hip)

395
Q

23 y.o female with diarrhoea and weight loss. Colonoscopy shows pigment laden macrophages ? Melanosis coli

A

This is in-keeping with laxative abuse

396
Q

Most likely diagnosis in a lady who is hypothermic, hyporeflexic, bradycardia and is having seizures?

A

Myxoedemic coma

397
Q

Essential tremor is a high frequency tremor which usually occurs when there is sustained muscle tone e.g. painting. Other than hands, which other body part is commonly affected?

A

Vocal cords and head

Improves with alcohol

Propranolol is 1st line

398
Q

Average age at which a child starts saying mama and dada?

A

9 months

399
Q

In pre-renal renal failure, the kidneys hold to as much Na as possible to conserve volume —> urine Na will be <20 and urine to plasma osmolality will be >1.5

A

In ATN, the kidneys cannot hold onto any Na so the urine Na is high and the urine:plasma osmolality is low

400
Q

Osmolality is osmolar concentration of plasma per kg of solvent

A

Osmolality is an osmolar concentration of plasma and is proportional to number of particles per litre solution

401
Q

Young adult with hypopigmented patches?

A

Pityriasis versicolor

Topical anti-fungal e.g. ketoconazole shampoo

402
Q

How do you manage hypokalaemia?

A

3 - 3.4 = mild —> oral correction (over days to weeks)
2.5 - 2.9 + asymptomatic —> rapid oral correction OR iv therapy
<2.5 OR symptoms OR ECG changes —> transfer to HDU, cardiac monitoring, 3 x 1L bags of saline with 40mmol K per bag, over 24 hours (infusion rate cannot excess 20mmol/hour)

403
Q

Which antibiotic should be added to cover atypical pneumonia?

A

Clarithromycin

404
Q

Which antibiotic should be added if pneumonia is secondary to influenza?

A

Flucloxacillin

405
Q

How do you treat myxodemic coma?

A

Hydrocortisone and levothyoxine

406
Q

Commonest cause of an isolated thrombocytopenia?

A

ITP

407
Q

How do you treat a thyroid storm?

A

Beta-blocker - control HR and tremor
Carbimazole - reduces thryoid hormone production
Hydrocortisone - treat adrenal insufficiency/ reduce serum thyroid level

General Medicine (6 decks)

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