Pastest Flashcards
1
Q
Vitamin D deficiency can cause hypocalcaemia
A
Vitamin D deficiency can cause hypocalcaemia
2
Q
What is the lifespan of a sickle cell blood cell?
A
10-20 days
Remember sickle cell = HbS
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
4
Q
Which test is used for screening / monitoring in acromegaly?
A
IGF -1
5
Q
Which test is used for diagnosis of acromegaly?
A
OGTT
6
Q
Basophillic stippling of RBC on film?
A
Lead poisoning
7
Q
Lady with mild (K 5-6.4) and asymptomatic hyperkalaemia?
A
Calcium resonium
8
Q
What must be excluded in ALL older men with acute renal failure?
A
Urinary retention
A catheter can be life saving
9
Q
Differential of itch?
A
Hyperthyroidism
Liver disease e.g. PBC
Polycythameia rubra Vera
Scabies or other dermatology condition
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
11
Q
Which side effect is particularly associated with exenatide (and other GLP-1 agonists)
A
Delayed gastric emptying
12
Q
Diagnosis in a lady on the OCP with hepatomegaly, abdo pain and ascites?
A
Budd-Chiari syndrome - caused by hepatic vein occlusion
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
14
Q
Tricuspid regurgitation?
A
Loud systolic murmur Heard throughout the chest Non-radiating Usually due to heart failure Raised JVP and peripheral oedema
15
Q
Treatment of high grade NHL lymphoma
A
Rituximab
16
Q
Follicular lymphoma = translocation of 14 and 18
A
Produces bcl2- protein -> rituximab is treatment of choice (in a complex regime)
17
Q
Translocation of 8 and 14?
A
Burkitts lympoma - jaw lymphadenopathy + c-my release
18
Q
Which mediator is linked to the development of achalasia and used in its treatment?
A
Nitric oxide
19
Q
Nose, lungs and kidneys ?
A
Wegner’s
c-ANCA!
20
Q
Anti-mitochondrial antibodies?
A
PBC - itchy
21
Q
Mononuclear cells = T,B and NK
A
Granulocytes = nuetrophilsm basophils and eosinophils (all of which have multi lined nucleus)
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
23
Q
Where are the changes of coeliac disease most apparent?
A
Proximal small bowel as this is where gluten exposure is maximim
24
Q
How often to patient with UC have surveillance colonoscopies?
A
HIgh risk = annually
Med risk = 3 yearly
Low risk = 5 yearly
25
Treatment of a gastroma?
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
26
Confusion, reduced GCS, seizure and cherry red skin? Treatment?
Cyanide poisoning
| Sodium thiosulphate
27
Man with episodes of sweating, diarrhoea and SOB. HIgh 5-hydroxyindolacetic acid
Carcinoid tumour
| Usually GI
28
Lymph node pain on drinking alcohol
Hodgkins
29
Big tongue and peri-orbital bruising?
Amyloid
| Congo Red
30
Typical blood results of primary hyperparathyroidism
High Ca, phosphate and alk phos
31
Blood results in pagers disease
Normal Ca and phosphate
| Very high alk phos
32
Tenderness over the tragus is characteristic for....
Otitis externa
33
Managment of hyperphosphatemia e.g. in patients on dialysis
Lanthanum carbonate - a phosphate binder
34
Managment of patient with malignant hypertension and altered conscious level?
Sodium nitroprusside
35
Which score is used to predict the risk of score after TIA?
ABCD 2 SCORE
Considers:
Age, BP, features of TIA, duration of symptoms and DM
36
List some drugs that cause QT prolongation
```
Amiodarone
Sotalol
TCA
SSRI
Haloperidol
```
37
What metabolic side effect is associated with SSRI and TCA?
Hyponatraemia
38
How quickly should HIV post-exposure prophylaxis be given after a needle stick injury from an HIV +ve person?
ASAP but within 72 hours
39
How does sodium valproate work?
It increases GABA activity
| Associated with weight gain, hair loss/ curly regrowth and nause
40
Why should oramorph be held in a patient with c.diff?
Oramorph is an anti-motility and anti-peristaltic —> increase risk of delayed clearance of toxin and ultimately toxic megacolon
41
What is the commonest cause of Non-Hodgkins lymphoma?
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)
42
In a patient who is not bleeding, a platelet transfusion is only required if platelet count drops below 10 x10^9
The threshold for a platelet transfusion is
| 30x10^9 in patients who are bleeding
43
Which type of malignancy is associated with smear/ smudge cells?
CLL
| they are the result of slide prep on abnormally fragile lymphocytes
44
What are Rouleaux formation associated with?
Multiple myeloma
45
What are Auer rods a feature of?
AML
46
What is the management of the condition associated with a slurred upstroke in the QRS?
Wolf-Parkinson White
| Accessory pathway ablation
47
What are the features of neuroleptic malignant syndrome? Who is at risk?
Patients on clozapine
| Features = hyperthermia, limb rigidity, altered mental status and autonomic dysfunction
48
Which investigation must be ordered prior to carrying out a CTPA for suspected PE?
CXR
| a D-dimer is not required if Wells score is >4
49
Ototoxicity is a recognised side effect of furesomide
E.g. tinnitus and hearing losss
50
What is the triad of acute liver failure?
Jaundice
Encephalopathy
Coagulopathy
51
‘Young’ patients with stroke e.g. <55 require additional investigations such as ..... to identify the cause of their stroke
Autoimmune and thrombophilia screen
52
Steroids are the best treatment for minimal change nephropathy
A renal biopsy is only indicated in cases which are steroids resistance
Cyclophosphamide is second line treatment
53
Which drug should be given for the prevention of variceal bleeding in patients with oesophageal varies?
Propranolol
54
What is a TIPS procedure?
A treatment aimed at reducing portal hypertension e.g. in patients with refractory varcies
It connects the portal and hepatic vein
55
In G6PD deficiency, there is a reduction in glutathione which makes red cells vulnerable to oxidative stress. How is it inherited?
X-linked recessive
Most common in Africa/ Asian people
Haemolysis is triggered by viral infections, antibiotics etc
56
Patients with a platelet count of <30 x10^9 + significant bleeding should receive a platelet transfusion
Pre-surgery, platelets should be at least 50 x10^9 for a planned procedure
57
70 y/o patient with unilateral rigidity and tremor and marked autonomic dysfunction?
Multi-system atrophy
58
In young men (<30) what are the 2 most common causes of lower abdominal pain?
Appendicitis
| Testicular torsion/ Infection
59
Long QT syndrome is when the QT interval is >450ms
| It can lead to life threatening VT (Torsades des Pointes). Give some causes:
Metabolic - hypokalaemia, hypomagensia and hypocalcaemia
Drugs - sotalol, amiodarone, TCA,
60
Why are coeliac patients offered the pneumococcal vaccine?
They have functional hyposplenism
61
What are the ECG changes required for thrombolysis?
ST elevation >1mm in 2 consecutive limb leads
ST elevation >2mm in 2 or moth consecutive anterior leads
New LBBB
62
Coeliac disease testing?
TTG and IgA (anti-endomyseal)
63
What MUST be monitored in a patient being started on phenytoin?
ECG for cardiac monitoring. High risk of arrhythmias
64
Steroids increase the risk of osteonecrosis
This is particularly significant in high risk bones such as scaphoid #
65
Which drug is used for the prophylaxis of cluster headaches?
Verapamil
| Sumatriptan is used for the acute managment
66
Ulnar nerve = all of medial 1.5 fingers, front and back
Radial - most of back of hand and anatomical snuffbox
Median = most of palm, rest of thumb and to first joint on back of hand i.e. palm and tips of fingers
67
Options for migraine prophylaxis?
Propranolol OR topiramate
68
Rate control is usually first line for patients with AF
Hoewever if it is first onset of AF with a reversible cause (e.g. pneumonia) then rhythm control should be used
69
‘Pepper pot skull’
Characteristic finding of a patient with primary hyperparathyroidism
70
Other than resting, fluids and not kissing, what advice would you give a 18 year old boy with glandular fever?
Avoid contact sports for 8 week to avoid risk of spleen rupture
71
Temporal = superior quadrantopia
Parietal = inferior quadrantopia
72
Management of bradycardia?
Atropine - 500mcg IV if haemodynamically stable
If unstable/ atropine ineffective then do transcutaneous pacing
73
What is the first line for managing tremor in drug induced Parkinson’s?
Procycladine
| it is an anti-muscarinic
74
In patients with HIV, PCP is classified as an AIDS defining condition
Typically occurs when the CD4 count is <200
75
What would you expect in a patient with a lacunar stroke?
Any one of the following
1) Unilateral weakness/ sensory deficit of face/arm/ leg
2) Pure sensory stroke
3) Ataxic hemiparesis
76
What would you expect in a patient with a posterior circulation stroke?
Any 1 of:
1) Cerebellar/ brainstem syndrome
2) Loss of consciousness
3) Isolated homonymous hemianopia
77
What features would you expect in a pontine haemorrhage?
1) Reduced GCS
2) Quadriplegia
3) Miosis
Has VERY poor prognosis
78
Name 4 live vaccine
```
MMR
Polio
Yellow fever
Typhoid
BCG
```
79
Elderly patient with confusion, and intermittent hard stools with watery diarrhoea. Diagnosis and management
Faecal impaction with secondary overflow diarrhoea
Treat with high dose macrogol laxatives
80
Give a few causes of increased ferritin levels
1) Inflammation
2) Alcohol excess
3) CKD
4) Hereditary haemochromatosis
5) Iron overload due to repeat transfusions
81
How is T2DM managed in patients following an acute MI?
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!
82
CML has 3 distinct phases.
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
83
What factors affect HbA1c level?
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
84
Internuclear opthalmoplegia is due to a lesion of the medial longitudinal fasciculus tract which enables conjugate eye movement
Internuclear opthalmoplegia is due to a lesion of the medial longitudinal fasciculus tract which enables conjugate
85
Lip-smacking and post-vital dysphasia are localising features of a seizure in which area?
Temporal
86
Which injury is most likely to cause a wrist drop?
A # of the shaft of the humerus
87
Management of PCP?
Non-severe = oral co-trimoxazole
Severe = IV pentamidine
88
What is the most severe electrolyte abnormality that can complicate an AKI?
Hyperkalaemia
89
Multiple genital warts = treat with topical podophyllum
Solitary genital wart = cryotherapy
90
What are the triad of features associated with carcinoid syndrome?
Diarrhoea
Flushing
Abdo pain
(usually liver mets which release serotonin)
91
The eGFR criteria to be considered are remembered by the CAGE mnemonic
```
C = creatinine
Age = age
G = gender
E = ethnicity
```
92
Tender goitre + hyperthyroid =
De Quervain’s thyroiditis
93
What proportion of patients with acute hep c will develop the chronic form?
55-85%
94
What is the managment for a patient with delerium who is a risk to themself due to severe agitation?
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
95
Secondary prevention in a patient with AF that has had a stroke?
Oral anti-coagulation with warfarin OR a factor Xa inhibitor such as apixiban
96
Remember to diagnose rhadbomyolysis the CK would have to be really high
Like >10000 high
| An elevation to <1000 is my more in keeping with soft tissue damage
97
In a patient with suspected PSC, what investigations are indicated?
US - typically shows a thickened, dilated gallbladder
| MRCP - typically shows beading of the bile duct
98
Which artery is the site of major bleeding in patients with peptic ulcer disease?
Gastro-duodenal
99
IgA nephropathy causes visible haematuria a few days after an URTI
Post-infectious GN typically causes features 2-3 weeks after an URTI
100
How could you differentiate between a gastric and duodenal artery?
```
Gastric = worse with eating, people often lose weight
Duodenal = relieved by eating, people gain weight (and much more common)
```
101
Treatment options for acute gout?
NSAIDs (don’t give if CKD)
Colchicine
Steroids
102
Which drug is given for restlessness at end of life?
Midazolam
103
Which part of the brain are early changes of Alzheimers most likely to be found in?
Temporal lobe
104
A patient overdoses on their TCA. The ECG shows prolongation of the QRS. Management?
IV sodium bicarbonate
| TCA overdose causes ECG changes and can lead to arrhythmias
105
Pulmonary fibrosis is a recognised complication of amiodarone
It classically does not cause clubbing
106
Features of hepatic encephalopathy
1) Inversion of sleep-wake pattern
2) lethargy and personality change
3) worsening confusion
4) progression to coma
5) liver flap
107
Features of Wernicke’s?
Opthalmoplegia
Ataxia
Confusion
108
Features of Korsakoff’s
```
Amnesia
Confabulation
Poor conversation
Lack of insight
Apathy
```
109
Features of delerium tremens
Hallucinations
Global confusion
Sweating
Tachycardia
110
Bone pain and proximal myopathy and low calcium?
Osteomalacia - phosphate and vit D will also be low
| Can be due to dietary deficiency or renal disease
111
What is the main side effect of bleomycin?
Lung Fibrosis
112
What is the main side effect of doxorubicin?
Cardiomyopathy
113
What is the main side effect of vincristine?
Peripheral neuropathy and paralytic ileus
114
Which drug is used for prophylaxis in meningitis?
Oral ciprofloxacin
115
How do you convert codeine to oral morphine?
Divide by 10
116
What is chronic inflammatory demyelinating neuropathy?
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
117
SVT = narrow complex tachycardia. Less common
VT = broad complex tachycardia. More common
| DC cardioversion/ amiodarone
118
Best test for Addison's disease
Short synacthen test
119
Which conditions are associated with Rouleaux formation?
Myeloma
120
Most likely infecting organism in a diabetic patient with longstanding ulcer. Ulcer is wet with a pale green slough over it
Pseudomonas - causes green sloughy ulcers, other bugs like staph aureus cause a more invasive infection
121
Doxycycline can cause photosensitivity to light
e.g. easy sunburn
122
What is the time cut off for PCI in an MI?
120 minutes
123
What kind of drug is metaclopramide?
D2 receptor antagonist
| Has significant risk of extrapyramidal side effects, especially tar dive dyskinesia etc
124
Management of choking?
Give 5 back blows
Give 5 abdominal thrusts
Keep alternating until dislodged/ unconscious
125
Which feature of the GCS is the best predictor of outcome?
The motor score
| It is less likely to be affected by other injuries
126
Remember a patient does not have CKD if eGFR is <90 with no evidence of kidney disease
Only diagnose CKD stage 1 or 2 if there is other abnormalities such as high creatinine or abnormal renal USS
127
Why is high urea a bad prognostic sign for patients with an upper GI bleed?
Blood is basically protein so a big bleed = big protein meal
128
Inheritance pattern of haemochromatosis
Autosomal recessive
129
In any diabetic patient with any foot problem other than simple callous formation, what do you do?
Refer to the diabetic foot clinic
130
How do you manage Tornado de Pointes?
IV magnesium sulphate
| Loads of causes including low K/ Mg/ Ca, glucose SAH etc
131
Blood film of an alocholic
Microcytic anaemia
| Thrombocytopenia
132
What is the single most important action in a patient with DKA?
Start IV fluids (IL saline) ASAP
| After fluids give insulin (0.1units/ kg/ hour)
133
SVT is a narrow complex tachycardia. What is the management?
1) Carotid sinus massage —>
2) Adenosine (CI in asthma, give verapamil)
3) DC cardioversion
134
Remember that mittelschmerz is a very common cause of mid-cycle pain
Inflammatory markers normal and pain resolves in 24-48 hours
135
What is the difference between type 1 and 2 mania?
Type 1 = mania and depression
Type 2 = hypomania and depression
(Mania occurs when there is severe impairment of function/ psychotic symptoms for >7 days)
136
Bilateral median nerve dysfunction in an elderly patient?
Most likely to be degenerative cervical myelopathy
| Refer to neurosurgery
137
The majority of causes of infectious endocarditis are gram +ve cocci
E.g. strep viridans, staph aureus and staph epidermidis
138
In people with a diagnosis of bipolar, a routine referral should be made to the CMHT if they develop symptoms of hypomania
An urgent referral should be made if they are manic e.g. hallucinations
139
Isolated high bilirubin in a 22 year old male?
Likely to be Gilbert’s syndrome
140
What is the best investigation for a SUFE?
AP and frog leg X-ray
141
With regard to anti-platelet therapy, what is the best regime for a patient who has had an ischaemic stroke?
Aspirin 300mg for 14 days
| Then clopidogrel 75mg life long
142
What is the commonest cause of ambiguous genitalia in babies?
Congenital adrenal hyperplasia
143
A raised ESR and osteoporosis is XXX until proven otherwise?
Myeloma
144
Where is the best place to inject an epi-pen?
Anterolateral aspect of middle third of the thigh
145
Amyloid can affect any body system but classically presents with weakness and breathlessness
It is a less common cause of hepato splenomegaly
146
Remember that gallstones is a MAJOR risk factor for pancreatitis
Remember that gallstones is a MAJOR risk factor for pancreatitis
147
Neisseria meningitis and strep pneumoniae are common causes of meningitis
Remember listeria in older adults and immunosupressed
148
Rickettsia typhi is the cause of endemic typhus
| Spread from cat/ rat fleas
Salmonella paratyphi is the cause of paratyphoid fever
149
Which drugs should be avoided in patients with Lewy Body dementia?
All anti-psychotics due to the risk of irreversible Parkinsonism (risk is up to 50%)
E.g. haloperidol
150
Mitral regurgitation is associated with collage disorders such as Marfans and Ehlers Danilo’s
It is a pansystolic murmur
151
Anti-thyroid peroxidase antibodies?
Hashimoto’s thyroiditis
Hypothyroid + non-tender, firm goitre
152
2 important side effects of sitagliptin?
1) Steven Johnson Syndrome
2) Acute pancreatitis
Sitagliptin is a DPP4 inhibitor
153
Patient has hyperthyroidism then hypothyroidism?
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
154
Most common type of thyroid cancer?
Papillary - orphan Annie eyes on microscopy
Good prognosis
Thyroglobulin tumour marker
155
Which type go thyroid cancer produces calcitonin?
Medullary - associated with Marian’s syndrome
156
The 2 key values for DM are 7 (fasting) and 11.1 (random/ OGTT)
7. 8 is cut off for impaired glucose tolerance
| 6. 1 is cut off for impaired fasting glucose
157
In a patient on metformin - what is the second line therapy?
1) SU such as gliclazide (if they are not very over weight)
| 2) Sitagliptin ( DPP4 inhibitor) - good because it causes weight loss
158
HbA1c level diagnostic for DM and pre-diabetes?
Pre-diabetes= 6-6.4% (42-47)
DM = >6.5% (48-52)
159
What HbA1c level is diagnostic of DM?
HbA1c of 6.5% or more
160
BG in Conn’s syndrome?
Often a metabolic alkalosis
| High Na, low K
161
Which type of Hodgkin’s lymphoma has the poorest prognosis?
Lymphocyte depleted
| Modular sclerosing is the most common and has a good prognosis
162
Patient with DKA is treated with fluids and insulin. She develops confusion - what is the most likely cause?
Cerebral oedema - presents with headache, visual disturbance etc
163
Managment of DVT in pregnancy
Use LMWH - warfarin is contraindicated
164
The overnight dexamehtasone supression test is used to confirm Cushing’s. What U&E result would you expect?
Hypokalaemia metabolic alkalosis
165
Major side effect of SGLT2 inhibitors?
E.g. Dapagliflozin
| Causes sugary pee —> increased risk of thrush etc
166
What is the mechanism of action of orlistat?
Lipase inhibitor
| (
167
What is the first line investigation for suspected Conn’s syndrome?
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
In hypocalcaemia:
| Chovstek - cheek twitches after tapping facial nerve
Trousseau sign = hand spasm with wrist flexion - often when taking BP
169
What is the management of diabetes insipidus?
Pituitary cause = desmopressin
Nephrogenic cause = chlorothiazide (a thiazide diuretic)
170
What is the direct Coombs test used for?
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
What is the ‘got a bad unit’ mnemonic for?
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
Why are patients having a bone marrow transplant given ‘irradiated’ blood products?
It depletes T lymphocyte numbers which reduces risk of graft vs host disease!
173
What is Waterhouse- Freidrichsen syndrome?
Bilateral adrenal haemorrhage, often in the presence of meningococcal septicaemia
174
Iron sulphate reduces the absorption of thyroxine and can therefore cause an increase in TSH
Iron sulphate reduces the absorption of thyroxine and can therefore cause an increase in TSH
175
In a severely bleeding patient e.g. DIC, what is the best predictor of severity / need to give cryoprecipitate?
Low fibrinogen
176
What is the treatment of a man with acute retention, secondary to clots?
Bladder irrigation through a 3 way catheter
177
Pioglitazone increases insulin sensitivity. What are the side effects?
Weight gain
Fluid retention - CI in HF
Increased risk of # and bladder cancer
178
How do you manage a patient who is deficient in both folate and B12 but does not have pernicious anaemia?
Give IM B12 injections
| Start oral folic acid when b12 levels are normal to prevent sub-acute degeneration of the spinal cord
179
In a patient with a high calcium, what should the PTH be if the parathyroid is working properly?
It should be low as it is being suppressed - being normal would actually be inappropriate!
180
Test for phaeochromocytoma?
24 hour urinary test for METANEPHRINES
181
What rate should the insulin infusion be started at in a DKA?
0.1 units/ hours
182
Which renal disease present with nephritic syndrome?
Rapidly progressing GN (AKI, crescenteric GN)
IgA nephropathy
Alpert syndrome
183
If a post-menopausal lady has a hip # she should be started on bisphosphonate and calcium supplements
There is no need for a bone scan
184
Target BP for type 2 DM?
<140/80
| < 130/80 if end organ damage e.g. proteinuria
185
What is the commonest viral infection to get post solid organ transplant?
CMV
| Treat with ganciclovir
186
Plasma and urine results in diabetes insipidus?
Plasma osmolality is high - patients are thirsty
Urine osmolality is low - patients cannot concentrate urine
187
What is ‘sub-clinical’ hypothyroidism?
Raised TSH
Normal T4
(risk of progression to hypothyroidism is 2-5% per year)
Repeat TFT in several months
188
What is the first line insulin regime for adult with newly diagnosed T1DM?
Twice daily basal bolus with detemir
189
What are the target blood sugars for T1 diabetic patients?
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
Anti-centromere antibodies?
Associated with limited systemic sclerosis
191
Which condition is anti-CCP associated with?
RA
| It is highly specific
192
Which diuretic should you give in a patient with ascites?
Spironolactone
193
What infection is known to precipitate aplastic crisis in sickle cell and hereditary spherocytosis?
Parvovirus B19
194
How does acute and chronic renal graft rejection occur?
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
Papillary tumour is commonest thyroid cancer, typically spread to lymphatic
Follicular is 2nd most common thyroid cancer, usually metastasises early to bone and lung
196
Fused podocytes on electron microscopy
Minimal change glomerulonephritis
| the commonest cause of nephrotic syndorme in children
197
What are the 4 type of sickle cell crisis?
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
How could you differentiate between vWD and haemophilia by looking at a clotting screen?
The APTT will be increased in both
| The bleeding time is INCREASED in vWD and normal in haemophilia
199
Isolated prolonged APTT ....
Haemophilia
Remember: APTT tests intrinsic pathway (factor 8 etc)
200
Why should you avoid amitryptilline in a patient with BPH?
Amitryptilline can cause urinary retention
201
DVT/ PE treatment time
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
What is the screening test for adult polycystic kidney disease?
US abdomen
203
Clinically, what are the 2 most common causes of VT?
Hypokalaemia
| Hypomagnesia
204
What is the first line angina proplhyaxis?
Bisoprolol
| use nicorandil if CI e.g. taking verapamil
205
When should clopidogrel be stopped before elective surgery?
7 days
| same for prasugrel and ticagrelor which are similar
206
What are the features of trifascicular block?
A relatively common cause of falls in the elderly
PR prolongation
RBBB
Left axis deviation
207
What is the definitive investigation of ? Oesophageal rupture
CT contrast swallow
208
Mid diastolic murmur at apex
Mitral stenosis
209
What type of murmurs are IVDU as risk of having?
Right sided murmurs e.g. tricuspid regurgitation from endocarditis
210
Ejection systolic murmur which does not radiate to the carotids?
Aortic sclerosis
| NOT aortic stenosis
211
pansystolic murmur
Mitral/ tricuspid regurgitation
212
Early diastolic murmur
Aortic regurgitation
213
Mid-diastolic
Mitral stenosis
214
What is the surgical management for late stage lung disease e.g. alpha 1 anti-trypsin or COPD?
Lung reductions surgery
| By removing the worst part of the lung, airflow and alveolar gas exchange will be improved
215
Management of young man with HOCM. This was discovered after syncope while playing football
Refer to cardiology for implantable cardio-defibrillator to reduce risk of of sudden death
Beta blockers can also be used to reduce symptoms
216
Which type of lung cancer is most likely to cause gyanecomastia?
Adenomacarcinoma
| most common in non-smokers and mets to brain and bone
217
Rayndauds + intermittent claudication + extensive smoking history
Think Buerger’s syndrome
218
Secondary prevention post-MI
All patient should be on:
- Aspirin
- ACEI
- Beta-blocker
- Clopidogrel (for at least 1 month - up to 1 year)
- Statin
219
Remember that adenosine must be given via a central or large peripheral vein
E.g. at least the antecubital fossa
220
U wave
Hypokalaemia
221
Systolic murmur radiating through to the back with fixed S2 splitting
Atrial septal defect
The most commonly detected congenital heart defect found in adults
This murmur and embolism/ stroke are most common features
222
What are the 2 main indications for surgery in bronchiectasis?
1 - uncontrolled haemoptysis
2 - localised disease e.g. 1 lobe
223
1st line investigation for a lady who present to rapid access chest pain clinic with angina sounding pain. ECG normal.
CT angio
224
Always remember that fever, night sweat and fatigue are B symptoms of all types of cancer
Not just TB
225
For people with personal/ FH of DVT who are at increased risk and clots and are flying long haul, what should you advice?
Use flight sock
226
Pulsus alterans
Upstroke varies between strong and weak
Indicates systolic dysfunction and seen in HF
227
Vaccines for patient with new COPD?
Annual influenza
| One of pneumococcal
228
Asthmatic patient with SVT. Drug management?
Verapamil
Cannot give adenosine as is contraindicated
229
What is the ‘normal’ ejection fraction?
55-70%
230
Murmur of VSD?
Classically pan-systolic
Associated with chromosomal disease such as downs
231
What is the criteria for long term oxygen in COPD patients?
pO2 < 7.3
Or pO2 7.3-8 with other features such as peripheral oedema
232
Which scoring system is used to determine disease severity in RA?
DAS 28
233
Central back/chest and different BP in arms?
Aortic dissection
Stanford A - affects ascending aorta and arch —> v bad —> surgical management
Stanford B - beyond brachiocephalic vessels —> medical management
234
Large bowel = haustra
Small bowel = valvulae conniventes
235
Sweating, headaches and bitemporal hemianopia?
Acromegaly
236
Left homonymous hemianopia (with macular sparing):
Lesion of RIGHT optic tract
Macular sparing = occipital cortex
237
Webers syndrome?
Midbrain stroke syndorme presenting with ipsilateral CN 111 palsy and contralateral hemiplegia/ hemiparesis
238
Initial management of spinal cord compression
8mg oral dexamethasone and urgent referral to oncology
| back pain, worse on lying down and coughing, limb weakness
239
Patient who has just started chemo develops high K and phosphate but low calcium. Diagnosis? Which drug is given prophylaxically to prevent this?
Tumour lysis syndrome = complicates treatment of high grade lymphoma and leukaemia
Give allopurinol to prevent
240
Smear cells
Chronic lymphocytic leukaemia
The main complication is of hypogammaglobulinaemia which puts patients at risk of recurrent infections
241
Adenocarcinoma is usually a peripheral lung tumour
Squamous is more likely to be central and found near big airways
242
TSH autoantibody +
Graves’ disease
(almost diagnostic)
Commonest form of hyperthyroid in the UK
243
Anti-thyroid peroxidase antibodies?
Hashimoto
| always causes a hypothyroid
244
Although platelets are low in TTP, platelet transfusion is CI due to increased risk of thrombosis
Treatment is with plasma exchange and immunosupression
245
Difference between primary, secondary and tertiary hyperparathyroidism?
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
Action in a healthcare worker who is bitten by a hep B +ve person
If already vaccinated —> give Hep B booster
If not vaccinated —> hep B immunoglobulin + booster
247
What is the most common metabolic complication in patients with cancer?
Hypercalcaemia
248
Patient with sub-acute onset of dementia, myoclonus (jerky movements) and mood disturbance. EEG is abnormal
CJD
249
Migratory thrombophlebitis/ Trousseau sign ....
Associated with pancreatic cancer
250
Left supraclavicular node?
Gastric cancer
Cholangiocarcinoma
Lymphoma
251
Girls with Turners syndrome are usually very small so are entitled to growth hormone therapy
Girls with Turners syndrome are usually very small so are entitled to growth hormone therapy
252
Talk though the interpretation of hep B serology?
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
Hyperosmolar hyperglycaemic state occurs in T2DM. What are the features?
```
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
Why should statins be taken at night?
The majority of cholesterol synthesis happens overnight - this is particularly true of simvastatin which has a short half life
255
What is the first line investigation is a patient with ? Acute mesenteric ischaemia
Lactate - it is raised as the poor blood supply —> anaerobic metabolism
256
How does strep pneumoniae look under microscope?
Gram +ve diplococci
257
Muscle pain + reduced power + very very high CK
Polymyositis (dermatomyositis is skin changes)
258
Muscle pain + normal power + elevated ESR but normal CK
polymyalgia rheumatica
259
1st line anti-hypertensive in a 60 year old lady with severe ankle oedema?
Thiazide diuretic
260
1st line treatment for paroxysmal AF?
Bisoprolol
261
At what age should a child be measured in height not length?
height cab start being measured at 2 years old
262
Most likely diagnosis in a 2 day old with green coloured vomiting - non-projectile?
Volvulus or malrotation
| AXR is first line
263
Average age of onset of bipolar disorder?
21
264
What mass of drug is present in 1ml of 1:1000 adrenaline ?
0.01
265
What mass of drug is in 10ml of 1% lidocaine?
100mg
266
What mass of drug is in 100ml of 10% glucose?
10g
267
Remember that wet ARMD is a painless cause of sudden visual loss
Remember that wet ARMD is a painless cause of sudden visual loss
268
STI and gram -ve diplococci
Gonorrhoea
269
In old people, body weight may remain normal despite loss of muscle mass
In old people, body weight may remain normal despite loss of muscle mass
270
What features of bronchiolitis warrant admission?
1) Apnoea
2) Sat <92 %
3) Poor oral intake
4) Severe respiratory distress e.g. RR>70, grunting, sternal recession etc
271
Management of bradycardia and hypotension in a child having squint surgery?
This is due to stimulation of the oculocardiac reflex
| Treat with atropine
272
How does high urine protein explain bilateral ankle oedema?
She probably has a nephrotic syndrome?
273
Best treatment for a patient with MODY and a HNF1 alpha mutation?
SU e.g. gliclazide
| Very responsive so low dose is needed
274
In the 2nd trimester of pregnancy, maternal BP decreases
It increases and returns to pre-pregnancy level by the third trimester
275
The tidal an minute volume increases in pregnancy
Vital capacity is unchanged
276
Most likely cause of jaundice in a newborn?
<24 hours = haemolysis or infection
>24 hours in an otherwise well baby = physiological
Prolonged jaundice (>10-14 days) = infection, hypothyroid, galactosaemia
277
```
Where should the following items be disposed of?
Paper towel
Empty medication blister pack
Unused needle
Empty vaccine vile
Used IV drip tubing
```
```
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
Learning disability IQ ranges
```
Mild = 50-70
Moderate = 35-49
Sever = 20-34
Profound = <20
```
279
Anterior MI
| Leads and territory
Leads V2-5
RCA
280
Anteroseptal MI
Lead V1-3
LAD
281
Anterolateral MI
1, aVL
V4-6
(Circumflex artery)
282
Inferior MI
II, III aVF
| RCA
283
Anti-centromere antibody?
Systemic sclerosis
284
Treatment fo typhoid?
IV ceftriaxone
285
Serotonin involved in aversive/ defensive system
Dopamine is neurotransmitter in appetitive and approach system
286
Patient placement/ PPE for patient with TB
Droplet precaution
Single room + surgical mask for staff
287
How to you manage a choking baby?
Back slaps and then chest thrusts
Abdominal thrusts are not used in babies
288
Most abundant antibodies in the blood?
IgG
| More grannies than mums!
289
Antibody class present in breast milk, saliva and tears
IgA
290
Which antibody is found as a pentameric molecule?
IgM
291
Bladder parasympathetic stimulation excites bladder and relaxes urethral sphincter
Bladder sympathetic stimulation relaxes detrusor but contracts sphincter
292
What needs to be measured before starting lithium?
```
ECG (only if CV disease or risk factors)
UE
TFT
BMI
FBC
```
293
Which area of the brain is fist affected in Alzheimer’s disease?
Nucleus basalis of Meynet
294
Investigations for upper GI bleed
```
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
What drug should be given in bleed due to oesophageal varices?
Terlipressin
296
Cullen = around umbilicus
Grey tuner = flank
297
Talk through the scoring system for pancreatitis severity?
```
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
Differential for onset of gastroenteritis within 6 hours?
Toxins
Staph aureus
Bacillus cereus
Clostridium perfringes - mainly meat
299
Differential for gastroenteritis with 12-72 hour incubation
```
Campylobacter - commonest
Salmonella
Shigella
E.coli - travellers diarrhoea
C.diff
```
300
Rice water stools
Cholera
301
Remember bilirubin conjugation occurs in liver so if high unconjugated bilirubin = pre liver problem = increased breakdown e.g haemolysis, DIC, Gilbert’s syndrome etc
High conjugated = liver problem e.g. hepatitis, EBV, Wilson’s etc
302
First line treatment for trigeminal neuralgia?
Carbamazepine
| exclude red flags e.g. sensory changes, hearing problems, FH of MS, age <40
303
Pepper pot skull
Myeloma
304
How does sodium valproate work?
It increased GABA activity
305
Phenytoin, lamotrigine and carbamazepine all act on sodium channels
Remember carbamazepine is first line for partial seizures
306
Anthacyclines all end in ‘ubicin’.
What are there major side effect?
Cardiomyopathy
307
Vinicristine causes peripheral neuropathy
Cisplatin causes ototoxicity and hypomagnesia
308
SOB, RHF, raised JVP and +ve Kussmauls sign?
Constrictive pericarditis
| Also associated with pericardial knock
309
Opiates, radiotherapy and bisphosphonates such as pamidronate are all useful for managing pain caused by bony mets
Opiates, radiotherapy and bisphosphonates such as pamidronate are all useful for managing pain caused by bony mets
310
What is calcitonin a tumour marker of?
Medullary thyroid cancer
311
CA 19-9
Pancreatic cancer
312
S-100 tumour marker
Melanoma
| Schwanoma
313
Remember transudate effusions are failures of everything e.g. heart, liver, kidneys and thyroid
Exudate effusions have lots of protein e.g. infection, connective tissue disease, neoplasia, pancreatitis etc
314
What is haematochezia?
Passage of fresh blood PR
315
The urea level is high in patients with an upper GI bleed as blood is digested in the stomach
It is lower if it is a lower GI bleed
316
How do you step down asthma medication?
When well controlled e.g. not using salbutamol then reduce steroid by 25-50%
317
1st line treatment in gastroperesis?
Metoclopramide
318
Refer all children with a palpable abdominal mass to paediatric very uregently. Why?
To exclude a neuro last OA or Wilks tumour
319
What is the management of hairy cell leukaemia?
Chemotherapy - agents such as cladribine and pentostain are first line
320
How is anti-phospholipid syndrome managed in pregnancy?
Start LMWH once fetal heart detected and stop at 34 weeks
Aspirin is given for duration of pregnancy
321
Which simple test can be done to differentiate between Type 1 and type 2 DM?
C-peptide
| It will be low in people with type 1 and normal/ high in people with type 2
322
Small bowel obstruction and air in the biliary tree on AXR
Gallstone ileus
323
Don’t forget to mention increased risk of IHD and depression in patients with RA
Don’t forget to mention increased risk of IHD and depression in patients with RA
324
Methotrexate is bad for myelosupression, liver cirrhosis and pneumonitis
Sulfasalazine affects skin and sperm
All biological drug increase risk of infection and risk of reactivation of TB
325
CRP is typically normal in SLE...
ESR is raised
326
What are the most common causes of drug induced lupus?
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
Remember that anti-phospholipid syndrome increases risk of arterial and venousus thrombosis
Prolonged APTT and thrombocytopenia are features
328
After a SABA/ SAMA in patients with COPD, what is the next step?
FEV1 >50% = LAMA or LABA
FEV1 <50% = LAMA or LABA+ICS
Next line is LAMA + LABA + ICS
329
What is pulmonary hypertension?
>25mmHg
| normal pulmonary pressure is 10-14mmHg
330
AF rhythm control can be achieved with amiodarone, flecainide or sotalol. In which patients would rhythm control be most useful?
<65
First presentation
Lone AF/ secondary to corrected cause e.g. alcohol
Symptomatic
331
After diagnosing Cushing’s syndrome with a low dose dexamethasone suppression test, how do you identify the cause?
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
What is the max rate of IV K infusion on a general ward?
10 mmol/hr
E.g. 40mmol K added to a bad of saline and given over 4 hours
333
What is the commonest type of thyroid cancer?
Papillary - don’t forget it is assocaited with psammoma bodies and orphan Annie nuclei
334
Managment of a child with nephrotic syndrome in GP land?
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
What are the 5 main headache features that require urgent imaging?
```
Postional change
Reduced conscious level
New neurological deficit
Vomiting
Progressive headache with fever
```
336
Management of GH secreting timeout causing acromegaly?
1) trans-sphenoidal surgery is first line
| 2) if surgery CI then a somatostatin analogue such as OCTREOTIDE
337
Inferior rectus is the most commonly involved muscle in Graves eye disease
Inferior rectus is the most commonly involved muscle in Graves eye disease
338
Which ECG changes are most common after a large blood transfusion?
Hyperkalaemia
339
How much glucose does an adult require per day?
50-100g (regardless of weight)
340
Vancomycin is the first choice treatment for MRSA. What is second line?
Linezolid
341
If someone has new diagnosed TB you have to order a...
HIV test
342
What does cryoprecipitate contain?
Factor VIII
Fcator XIII
VWF
Fibrinogen
343
What is the diagnosis in a renal biopsy showing segmental tuft sclerosis?
Focal segmental glomerulosclerosis
344
On a renal biopsy, what does a Kimmelsteil-Wilson nodule suggest?
The patient has DM
| Nodule is due to glycogen deposition
345
Crescenteric GN is found on biopsy in rapidly progressive GN. What conditions can cause rapidly progressive GN?
Goodpastures
Wegners
SLE
Etc
346
Waldenstrom’s macroglobulinaemia = IgM paraprotein
Myeloma usually causes IgG paraprotien, IgA or IgD (m is rare)
Unlike waldenstroms, boney lesions are probable
347
Consider LADA in patients who develop DM symtpoms in early adulthood, especially if they have other autoimmune features e.g. thyroid diseas
Consider LADA in patients who develop DM symtpoms in early adulthood, especially if they have other autoimmune features e.g. thyroid diseas
348
What are the features of Bell’s palsy?
Face - facial muscle paralysis
Ears - stapedius —> hearing affected
Taste - chorda tympani
Tears - reduced tears and saliva
349
What visual field defect is associated with craniopharyngioma?
Craniopharyngioma causes a bitemporal inferior quadrantopia - they sit above the pituitary gland
350
The main use of EPO is to treat the anaemia which results from CKD. What are the side effects?
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
Anterior cerebral artery stroke = contralateral hemiparesis with leg affected >arm
Middle cerebral artery = contralateral hemiparesis, face >arm > leg
Contralateral homonymous hemianopia
Aphasia
352
Anterior cerebral artery stroke = contralateral hemiparesis with leg affected >arm
Middle cerebral artery = contralateral hemiparesis, face >arm > leg
Contralateral homonymous hemianopia
Aphasia
353
Posterior cerebral artery stroke = contralateral homonmyous hemianopia with macular sparing
Visual agnostia
Basilar artery = locked in
354
Remember that PTH level can be normal in primary hyperparathyroidism
It Ca is high, normally PTH level will fall. If this does not happen then it is primary hyperparathyroidism
355
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?
Stop anti-psychotic
IV fluids
Consider dopamine agonist such as bromocriptine
Consider dantrolene (muscle relaxant)
356
Which is the best drug for the management of chemo induced N and V?
Ondansetron
| serotonin receptor antagonist
357
Which is the best drug for the management of chemo induced N and V?
Ondansetron
| serotonin receptor antagonist
358
Management of Ischaemic stroke if outwith the 4.5 hour window?
Aspirin 300mg
359
Thrombolysis is CI in stroke if patients....
```
Previous intracranial heamorrhage
Seizure during stroke
SAH
Recent LP
PREGNANT
```
360
1st line for trigeminal neuralgia?
Carbamazepine
361
What do Reed-Sternberg cells look like?
‘Large multinucleated cells with prominent eosinophilic nucleoli’
362
Target HbA1c in type 1?
<48 mmol/l (<6.5)
363
Activated protein C resistance is the commonest inherited thrombophilia
Von Willebrand is the most common inherited bleeding disorder
364
In a patient on metformin for T2DM, at what HbA1c level should you add a 2nd drug?
7.5% of 58mmol/l
365
HbA1c between 42 and 47 = pre-diabetes
HbA1c between 42 and 47 = pre-diabetes
366
Anti-thyroid peroxidase antibodies?
Hashimoto
367
Rectal midazolam 10mg is a good option for an adult patient with a seizure
Rectal midazolam 10mg is a good option for an adult patient with a seizure
368
Radioactive iodine is the treatment of choice in toxic multinodular goitre
Radioactive iodine is the treatment of choice in toxic multinodular goitre
369
Talk through the ABCD 2 score?
```
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
What type of uptake on iodine scan is seen in Subacute de Quervain’s thyroiditis?
Reduced
```
(4 stages:
1 -hyper with painful goitre,
2 - euthyroid
3 - months of hypothyroid
4 - return to normal
```
371
V1-V4 = LAD
| II, III, aVF = RCA
V5-6, I, aVL = circumflex
372
What are the 4 steps of treatment in a child with status epilepticus?
Buccal midazolam
IV lorazepam
IV phenytoin
Rapid sequence induction of anaesthesia
373
How do you remember the ECG features of hypokalaemia?
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
What is ITP?
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
CLL is commonest leukaemia in adults. Caused by monoclonal proliferation of well differentiated B lymphocytes
Usually asymptomatic but risk of:
Hypogammaglobulinaemia
Warm autoimmune haemolytic anaemia
Transformation to high grade lymphoma
Blood film shows smear/ smudge cells
376
What is Richter’s transformation?
Transformation of CLL to high grade lymphoma
| rare but patients become very unwell very quickly
377
In spinal cord compression, lesions above L1 usually cause UMN signs in leg and a sensory level
Lesions below L1 usually causes LMN signs in leg and perianal numbness
378
Which blood test can be done to differentiate between a seizure and pseudoseizure?
Prolactin
| will be elevated in a true seizure
379
What is the cut-off for treating Hyperkalaemia with 10ml of 10% calcium gluconate, 10U of actrapid insulin and glucose and possibly salbutamol?
K >6.5mmol/l or ECG changes
| tall tented T —> loss of p wave —> widening of QRS —> approaching sinusoidal
380
Triptan are used as preventers in migraines. They are CI in previous IHD!
Triptan are used as preventers in migraines. They are CI in previous IHD!
381
Define neutropenic sepsis?
Patient having anti-cancer treatment who has a neutrophil count >0.5 AND
- >38
- OR signs of sepsis e.g HR>100
382
Epileptic patient with polyuria, polydipsia and high Na
Probably nephrogenic diabetes insipidus due to lithium therapy
383
Why doe nephrotic syndrome cause increased risk of VTE?
There is increased filtration and excretion of protein C, S and anti-thrombin
384
Post renal transplant patients are at very high risk of which type of cancer?
SCC
25% of patients who live 20 years post-transplant will develop. SCC
385
Burkitt’s lymphoma is a high-grade B cell lymphoma. What are the 2 types?
Endemic - involves mandible/ maxilla in Africans
Sporadic - abdominal tumour in HIV +VE people
Starry sky
386
How does progressive supranucelar palsy present?
Typically with impaired balance —> falls
Vertical gaze palsy
Symmetrical onset
Poor response to Levodopa
387
What must be excluded in a patient with a painful 3rd nerve palsy?
Posterior communicating aneurysm
388
What is the correct action in a baby with an inguinal hernia?
Refer for surgery
| Paediatric hernias have a high risk of complication
389
When assessing carpal tunnel, which clinical test is most sensitive?
Phalens
| More sensitive than tapping tinel!
390
HSP is an IgA mediated, small vessel vasculitis
Treatment is with analgesia and support
| Usually self limiting in children, although a significant proportion will have a relapse
391
Yellow fever causes fever, leg pains and jaundice. Incubation period of 2-14 days
There is a characteristic remission between the 2 phases of the disease
392
Ondansetron is a 5-HT3 receptor antagonist. Where does it work?
Blocks serotonin in the chemoreceptor trigger zone of the medulla oblongata
393
Crescenteric GN tends to cause a very rapid nephritic syndrome with the patient feeling very unwell
Membranous GN presents slower and patients are more likely to complain of oedema and periorbital swelling
394
Ortolani = ABduct hip to try and reduce dislocated hip
| ortalani when the hip is OUT
Barlow = ADuct hip and punch downwards to try and dislocate a hip
(Barlow = bad = dislocating hip)
395
23 y.o female with diarrhoea and weight loss. Colonoscopy shows pigment laden macrophages ? Melanosis coli
This is in-keeping with laxative abuse
396
Most likely diagnosis in a lady who is hypothermic, hyporeflexic, bradycardia and is having seizures?
Myxoedemic coma
397
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?
Vocal cords and head
Improves with alcohol
Propranolol is 1st line
398
Average age at which a child starts saying mama and dada?
9 months
399
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
In ATN, the kidneys cannot hold onto any Na so the urine Na is high and the urine:plasma osmolality is low
400
Osmolality is osmolar concentration of plasma per kg of solvent
Osmolality is an osmolar concentration of plasma and is proportional to number of particles per litre solution
401
Young adult with hypopigmented patches?
Pityriasis versicolor
Topical anti-fungal e.g. ketoconazole shampoo
402
How do you manage hypokalaemia?
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
Which antibiotic should be added to cover atypical pneumonia?
Clarithromycin
404
Which antibiotic should be added if pneumonia is secondary to influenza?
Flucloxacillin
405
How do you treat myxodemic coma?
Hydrocortisone and levothyoxine
406
Commonest cause of an isolated thrombocytopenia?
ITP
407
How do you treat a thyroid storm?
Beta-blocker - control HR and tremor
Carbimazole - reduces thryoid hormone production
Hydrocortisone - treat adrenal insufficiency/ reduce serum thyroid level
