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NICE CKS /Wrong Qs RT > PasTest Learning > Flashcards

PasTest Learning Flashcards

1
Q

kidney stones scan

A

urgent non contrast CTKUB unless pregnant or child

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2
Q

idiopathic pulmonary fibrosis mx

A

pirfenidone or nintedanib
downregulate growth factors
need FVC between 50-80%
stopped if FVC down by 10% in 10 months / disease progression

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3
Q

cerebellar signs / lateralises where

A

Dysdiadokinesia / dysmetria.
Ataxia.
Nystagmus.
Intention tremor.
Speech - slurred or scanning.
Hypotonia

lateralises same side as lesion

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4
Q

renal artery stenosis assess, signs

A

renal arteriography
malignant hypertension older person, worsening renal function, flash pulmonary oedema

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5
Q

MI dvla rules

A

1 week if you had angioplasty, it was successful and you don’t need any more surgery
4 weeks if you had angioplasty after a heart attack but it wasn’t successful
4 weeks if you had a heart attack but didn’t have angioplasty

6 weeks if bus driver

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6
Q

driving and HTN

A

if >180/110, malignant htn then can’t drive til treated

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7
Q

seizures and dvla

A

licence taken away, must be fit free for 12 months to reapply

reapply after 6 months fit free if due to medication change only

if one off non epileptic seizure then can restart driving after 6 months fit free

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8
Q

TIA and dvla

A

stop driving for 1 months with no further symptoms and only restart with doctor permission

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9
Q

dvla and angina

A

can drive if stable not if unstable

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10
Q

AAA and dlva

A

if >6.5cm AAA can’t drive

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11
Q

operations and dvla

A

must tell if can’t drive 3 months after op

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12
Q

diabetes and dvla

A

need to know if on insulin for more than 3 months

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13
Q

stroke and dvla

A

only tell them if having issues per doctor 1 month+ after stroke

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14
Q

fainting and dvla

A

can drive if no other issues and one off + doctor doesn’t think will affect your driving

if got arrhythmia syndrome + fainting can’t drive / also if had assoc cardiac arrest can’t drive

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15
Q

professional dilemmas tips

A

always choose the option that addresses the problem most directly first

confronting others always worsens the position relative to other similar options

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16
Q

these conditions may worsen during pregnancy

A

herpes infection, acne rosacea, SLE

internal inflammatory conditions + things like hidradenitis improve

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17
Q

inv to discriminate on causes of hypoglycaemia

A

low sugar with normal or high insulin = insulinoma

sugar-lowering drugs = C peptide

low insulin no ketones = anti insulin receptor Ab from cancer

insulin low, ketones high = alcohol, pituitary or adrenal failure

post prandial low sugar = either post gastric surgery or t2dm, do proglonged glucose tolerance test

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18
Q

non bilious projectile vomiting 3rd or 4th week of life with hypokalaemic metabolic alkalosis

A

pyloric stensosis (hypertrophy of circular pyloric muscle)

mx pyloromyotomy

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19
Q

very soon after birth, bile stained vomiting, abdo distension, not passing meconium after first few bowel movements

A

congenital duodenal atresia (1 third assoc with Down’s)

mx duodenojejunostomy

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20
Q

first few days of life, bilious vomiting, abdo distension, no meconium

A

Hirshsprung’s - no nerve ganglion cells in hindgut, no peristalsis, diagnose with biopsy. mx with surgical ‘pull-through’ operation

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21
Q

preterm, bilious vomiting, distended, bloody stools

A

Necrotising enterocolitis

can get pneumatosis intestinalis on the x ray (gas in gut wall)

mx bowel rest and IVI, abx

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22
Q

early after birth choking, coughing, cyanosis on feeding, recurrent LRTI

A

tracheoesophageal fistula or oesophageal fistula

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23
Q

athetosis

A

involuntary writhing movement
common with cerebral palsy

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24
Q

chorea

A

jerky fleeting movement

assoc with:
Huntingdon’s, certain drugs like phenytoin / L dopa, hyperthyroid, SLE, stroke

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25
Q

hemiballismus

A

violent swinging unilateral movement
brain infarct

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26
Q

rheumatic fever

A

Fever
Arthritis (painful, tender joints), most commonly in the knees, ankles, elbows, and wrists
Symptoms of congestive heart failure, including chest pain, shortness of breath, fast heartbeat
Fatigue (tiredness)
Chorea (jerky, uncontrollable body movements)

happens if scarlet fever/ strep throat or skin infection not treated appropriately

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27
Q

myoclonus

A

sudden jerking of single muscle group

epilepsy or benign essential

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28
Q

tics

A

repetitive twitching of face / hands

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29
Q

gilles de la tourette syndrome

A

multiple tics, barking, grunting

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30
Q

akathisia

A

restlessness of legs
assoc antipyschotics
3-6 weeks since start

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31
Q

dystonia

A

torticollis - spasming neck twisting (crick neck)
opisthotonus - stretching back with shoulders/heels only on bed

assoc antipsych within first 4 weeks

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32
Q

tardive dyskinesia

A

chewing, grimaces
choreoathetosis -(writhing rapid piano playing movements of fingers/toes)

12+weeks after treatment

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33
Q

RAST test

A

when looking for specific allergen
e.g. latex IgE

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34
Q

abnormal ears, shortened philtrum, micrognathia, hypertelorism, poor growth, recurrent infections, aortic arch abnormality, cleft palate

A

digeorge syndrome
deletion small bit chrom22
22q11 deletion syndrome
no or poor thymus and have assoc cardiac defects

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35
Q

pulsus alternans

A

strong and weak beat occurring alternately

causes: when taking BP, LVF, toxic myocarditis, paroxysmal tachycardias

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36
Q

pulsus paradoxus

A

abnormally large decrease in systolic BP and pulse during inspiration (>20mmhg)

seen in cardiac tamponade, severe COPD

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37
Q

plateau pulse

A

slow upstroke

found in aortic stenosis

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38
Q

pulsus bisferiens

A

two aortic waveforms per cycle

assoc AS, hypertrophic CM, AR

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39
Q

collapsing pulse

A

rapid upstroke and descent
assoc aortic regurg

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40
Q

pulsus bigeminus

A

two beats close together with longer pause

lots of causes incl PVCs

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41
Q

chondromalacia patellae

A

teenager anterior knee pain worse walking downstairs and after prolonged sitting

+Ve shrug test (compress patella while quads tight = pain)

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42
Q

inferior patellar pain, bony lump at tibial tuberosity, sporty teenage boy

A

self resolving as grow up , due to overuse of underdeveloped patellar ligament

osgood schlatter disease

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43
Q

osteochondritis dissecans

A

sporty teenager with vague pains made worse by activity with possible swelling, locking / catching and giving way

separation of subchorndral bone articular cartilage from bone surface

dx on imaging

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44
Q

patellar subluxation

A

knee giving way laterally with things like running/ jumping
anterior pain even when sitting, can be stiff and swollen too

knee brace

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45
Q

remember this with kid knee pain

A

always examine hip too, may be referred

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46
Q

pregnant UTI

A

can have nitro, NOT trimethoprim

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47
Q

diabetes insipidus

A

cranial - decreased ADH secretion
as below but responds to exogenous ADH

nephro - decreased ability to respond to ADH at the kidney
low urine osmolality + high volume dilute, high plasma osmolality

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48
Q

SIADH

A

low sodium, low osmolality
often have lung ca too

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49
Q

chronic reflux nephropathy

A

disease of childhood
occurs after recurrent backflow

often presents just as recurrent childhood UTIs, mostly aim to prevent infection and usually grow out of it

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50
Q

keratitis

A

impaired vision and ulcer near visual axis

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51
Q

iritis

A

= anterior uveitis
small distorted pupil with red eye

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52
Q

acute glaucoma

A

severe pain, severe visual impairment, red eye , vomiting

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53
Q

red eye red flags

A

acute extreme pain, acute visual loss, periorbital cellulitis not responding to abx

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54
Q

acute closed angle glaucoma

A

episodes blurred vision, headache, eye pain, nausea,, haloes around lights
acute painful red eye

needs urgent ophthal mx

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55
Q

signs on fundoscopy closed angle glaucoma

A

optic disc atrophy
optic disc cupping >21 mmhg IOP
blood vessels emerging from optic disk have breaks
lose nasal and superior fields first

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56
Q

mx glaucoma oopen angle

A

prostaglandin analogue
- latanoprost
then beta blocker - timolol

then carbonic anhydrase inhibitor - brinzolamide

can add trabeculoplasaty if nec

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57
Q

mx closed angle glaucoma

A

lie pt flat, pilocarpine eydrops, acetazolamide oral tablet or dorzolamide drops

after acute attack then mx with laser peripheral iridotomy

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58
Q

t2dm present

A

metabolic syndrome, acanthosis nigricans, if v severe polydips,polyuria

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59
Q

dx t2dm

A

dx >48 hba1c x2
x1 if sympomatic

fasting gluc >7 abnormal

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60
Q

mx t2dm

A

3-6 monthly monitoring hba1c
dietician, aim 5-10% weight loss if high BMI
annual eye, BP, diabetic foot, kidney screen

drugs:
1. metformin
2. add ‘gliptin (pioglitazone) or SU (gliclazide) or SGLT2inhibitor (‘flozins)
3. metformin, gliptin, gliclazide
4. GLP1 mimetic (trulicity/dulglutide) / add insulin

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61
Q

common diabetic meds SEs

A

metformin - diarrhoea, metallic taste, lactic acidosis in those with organ failures

SU/gliclazide - hypoglycaemia, weight gain

‘flozins /SGLT2i - DKA, hypos, UTIs

gliptins / PGs - GI disturbance, headache, rarely pancreatitis

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62
Q

burns survey

A

% body area burned and depth, pre injury weight, FBC, U+E, glucose

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63
Q

osteomalacia

A

generalised aches proximal myopathy, RFs for vti D deficiency

Looser zones (linear areas of low density on x ray)

low calcium, low normal phosphate, high ALP

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64
Q

brodie abscess

A

intraosseus subacute pyogenic OM, usually in children and staph bateria

lytic lesion surrounded by reactive sclerotic zone

chronic dull aching pain

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65
Q

paget disease

A

bone / joint pain worse at night and feels warm
peripheral neuropathy
usually pelvis spine or skull
old
can get hearing probs

mx with bisphosphonates

high calcium, normal phos, high ALP

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66
Q

child, nauseous, testicular pain, point tenderness upper pole, small point of blue discolouration to scrotal skin

A

torted hydatid of morgagni
still likely to have exploratory surg to r/out torsion given sx

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67
Q

woody hard irregular area in testis palpation normal AFP

A

seminoma

teratoma have high AFP

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68
Q

spermatocoele

A

can occur post vasectomy due to sperm collecting
usually expectant mx but can be excised

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69
Q

multiple target lesions with concentric colours

A

erythema multiforme
often due to herpes simplex

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70
Q

erythema migrans

A

lyme disease
2 weeks after bullseye lesion

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71
Q

stevens johnson syndrome

A

rare severe skin reaction to meds
often abx
red rash and prodromal illness
skin lost in sheets

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72
Q

headache worse in morning, visual disturbance, dizziness, pulsatile tinnitus

A

idiopathic intracranial HTN
unclear cause

can get enlarged blind spot and reduced visual field due to papilloedema

acutely - steroids, LPs, diuretics
surgical shunts , weight loss

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73
Q

ethmoidal sinusitis

A

needs ethmoid sinus drainage
then cef abx

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74
Q

indication mastectomy

A

DCIS, tumour incl nipple, multifocal tumour, large tumour in small breast

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75
Q

lumpectomy indication breast

A

well circumscribed in single quadrant, no local spread

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76
Q

cytology reporting

A

c1 not enough cells
c2 good sample not malign
c3 probably benign, repeat
c4 largely malignant
c5 all cells are malignant

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77
Q

when amniocentesis

A

after week 15

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78
Q

nocturnal enuresis

A

common, grow out of it
enuresis alarm at first

can use short term desmopressin if needed

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79
Q

diagnostic criteria migrain

A

5 headache attacks lasting 4-72 hrs
at least two of: unilateral, throbbing, worsened by movement, severe

many don’t get auras

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80
Q

AML genotype

A

philadelphia chromosome
t9:22

weight loss, middle aged, high WCC, anaemia, high platelets

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81
Q

URTI then get haematuria

A

IgA nepropathy / Bergers disease

usually resolves although can progress

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82
Q

cast nephropathy

A

assoc with light chain deposits in kidney from m myeloma

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83
Q

minimal change disease

A

nephrotic picture (oedema, proteinuria) in a child

dx with biopsy (clear)

mx with steroids

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84
Q

alport syndrome

A

inherited
nephrotic with ear + eye issues too

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85
Q

hard exudates in retina

A

htn and diabetes
lipoproteinleakingfrom blood vessels, ringed white deposits

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86
Q

soft exudates in retinan

A

cotton wool spots - due to infarcted retina, assoc with ischaemia

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87
Q

healthy old man, longer term leg pain with no injury, high ALP, all else normal

A

paget’s

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88
Q

bony met sources

A

prostate, breast, kidney, thyroid, lung

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89
Q

hypercalc, renal fail, anaemia, bone pain

A

myeloma

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90
Q

levetiracetam associations

A

GI symtpoms, reflux, anorexia, anxiety

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91
Q

phenytoin SEs

A

gingival hypertrophy, acne, hirsuitism, aplastic anaemia

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92
Q

sodium valproate SEs

A

weight gain, low plts, tremor

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93
Q

carbamazepine SEs

A

dry mouth, low sodium, blood disorders, gynaecomastia, male inferitility

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94
Q

cyp450 inducers

A

PCBRAS (lower effective dose of a medication metabolised this way like warfarin)

phenytoin
carbamazepine
barbz
rifampicin
alcohol chronic
sulphonylureas /gliclazide

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95
Q

cyp450 inhibitors

A

SICKFACES.COM

sodium valproate
isoniazid
cimetidine
ketoconazole
fluconazole
alcohol acute
chloramphenicol
erythromycin/clari
sulfonamide (trimethroprim)
cipro
omeprazole
metronidazole

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96
Q

cyp450 common substrates

A

Statins
Theophylline
Phenytoin
Warfarin
Selective serotonin reuptake inhibitors (SSRI): sertraline, citalopram, fluoxetine
Amitriptyline
Codeine
Caffeine

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97
Q

child, gradually inc hip pain, reduced ROM, sclerotic femoral head on x ray

A

avascular necrosis of the hip

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98
Q

5 day unilat child limp, ROM restricted, normal inv, recovers after 3 days

A

transient synovitis

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99
Q

cryptococcal meningitis

A

HIV +ve
india ink stain +v
amphotericin mx

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100
Q

htn mx summary

A

black or >55 yrs:

  1. CCB
  2. add ACEx / ARB
  3. add thiazide or spironolactone instead if K+ <4.5

<55 yrs non black pts:

  1. ACEx or ARB
  2. add CCB
  3. add thiazide or spironolactone instead if K+ <4.5
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101
Q

dx htn

A

clinic bp 140/90 + and HBPM of 135/85+

also check bloods, ECG, urine acr and modify metabolic RFs

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102
Q

contralateral hemiparesis, ipsilateral facial palsy, abducens palsy

A

lesion of the pons

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103
Q

insertion sites of CNs to help identify brain lesion origins

A

skull base - I, II
midbrain - III, IV, V
pons - VI, VII, V
cerebellopontine angle - VIII
medulla - IV to XII

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104
Q

itchy rash reaction = what

A

IgE mediated therefore skin prick test or RAST

skin patch is for contact based llergies

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105
Q

ovarian hyperstimulation syndrome

A

after clomiphene or hormones to prep for egg collection

abdo fluid build up, nausea, dehydration, effusions

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106
Q

risk factors breast ca

A

high BMI, early menarche, older

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107
Q

2-5 day incubation, reheated takeaway meal , abdo cramps and diarrhoea

A

campylobacter jejuni
self limiting
rarely need abx

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108
Q

food poisoning short incubation <18 hrs

A

clostridium perfringens if longer

if very short with reheated rice thinkk b cereus

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109
Q

meniere’s

A

fluctuant hearing loss
vertigo
tinnitus
aural fullness
normal eardrums

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110
Q

bppv

A

vertigo minutes to seconds, head movements,nausea

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111
Q

cholesteatoma

A

recurrent ear discharge, foul
conductive hearing loss
retracted eardrum with crusting

usually comes on after long term recurrent ear inf

mx is surgical

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112
Q

age related macular degen

A

big inc after 70
straight lines look wavy
blurry central vision
poor vision in low light levels
peripheral vision preserved
can progress to ‘wet’ from dry which means blood vessels form that damage the macula

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113
Q

central retinal artery occlusion

A

cherry red spot
acute persistent painless loss of vision
metabolic risk factors

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114
Q

central retinal vein occlusion

A

subacute variable visual loss
pain, eye redness, photophobia

retinal haemorrhages, dilated torturous vessels, macular oedema, optic disc oedema

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115
Q

retinal detachment

A

floaters, flashing lights, field loss, loss of visual acuity
shadow in peripheral fields
very urgent mx needed

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116
Q

childhood vax schedule

A

8 weeks
- 6 in 1
- menB
-rotavirus

12 weeks
- 6 in 1
- pneumococcal
- rotavirus

16 weeks
- 6 in1
- menB

1 year old
-Hib, menC
- MMR
-pneumococcal, menB booster

3 yrs 4 months
- MMR booster
- some of 6 in1 booster

12, 13 yrs
- HPV

14,15 yrs
- menACWY
- DTP booster

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117
Q

when to give child ORS or IVI

A

ORS:

2+ vomits or 5+ diarrhoea eps in 24 hrs
can’t tolerate fluids
<1 yr old

IVI
can’t tolerate NG fluids
in shock
not improving on ORS

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118
Q

possible rare side effect cipro

A

achilles tendon rpture

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119
Q

pt on long term dialysis with widespread joint pains and stiffness

A

dialysis amyloidosis

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120
Q

female with groin lump no cough impulse, not reduced on lying down, transilluminates

A

hydrocoele of canal of Nuck

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121
Q

tender groin lump in a woman, no cough impulse, reduced below and lateral to pubic tubercle

A

femoral hernia

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122
Q

man with bluish lump in groin with palpable cough impulse, disappears lying down

A

saphena varix

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123
Q

lobulated consistency lump

A

lipoma

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124
Q

child motor milestones (head control, rolling, sit, crawl, stand, walk, run, hop)

A

3 months - head control
6 months - rolls over
9 months - sits, crawls
12 months - stands
18 months - walks
2 years - runs, can climb stairs 2 foot per step
3-4 years - stand one foot
5 years - skip /hop

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125
Q

fine motor and vision milestones

A

3 months - fix and follow, reach
6 month - co ordination, transfers
9-12 months - pincer grips
18 months - uses spoon
2 years - scribbles, lines
3-4 years - builds bridge with bricks
5 years - full drawings

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126
Q

hearing and language milestones

A

3 months - cries, laughs, vocalises
6 months - localises sounds, babbles
9 months - inappt sounds
12 months - babbles, simple commands, says mama dada
18 months - uses words
2 years - 2 word phrases
3-4 years - short sentences
5 years - fluency

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127
Q

social milestones

A

3 month - laughs
6 months - alert interactive, startles
9 months - stranger anxiety
12 months - waves bye, responsive
18 months - stranger shyness tantrums
2 years - knows identity, parallel play
3-4 years - interactive
5 years - dressing

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128
Q

fragile x syndrome

A

FMR1 ribonuceloprotein issue
X linked dominant
developmental delay
learning disability
long narrow face, large ears, large testicles , hyperactivity

hard to detect usually presents post puberty

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129
Q

klinefelter syndrome

A

47 XXY
infertility, tall lanky male
small testicles
gynaecomastia

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130
Q

turner syndrome

A

45 X0
short webbed neck
low set ears
low hairline
short stature
absent menarche

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131
Q

trisomy 18 / edward syndrome

A

cardiac defects, oesophageal atresia,, intellectual disability, microcephaly, micrognathia

neonatal hypotonia, apnoea, seizures

commonly have VSD
would be detected at neonatal screening

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132
Q

management of tachyarrhythmias summary

A

adverse features - shock, ischaemia, syncope, HF -> synchronised DC shock x 3 and then amiodarone 300 then 900mg

otherwise:

narrow QRS:
regular = vagal manoeuvres then 6/12/12mg adenosine
if no sinus achieved - likely atrial flutter, give beta blocker

irregular = likely AF, give beta blocker or diltiazem

broad QRS:
regular: if VT or uncertain, 300mg amiodarone over 60 mins, then 900mg over 24 hrs
if SVT with BBB then treat as SVT

irregular: need expert help, consider amiodarone

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133
Q

Hutchinson’s sign

A

shingles to tip of nose (i.e. V1 ophthalmic branch of trigeminal nerve, risk of corneal ulceration , nee urgent treatment)

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134
Q

arm dermatomes sensation

A

C5 outer shoulder / deltoid
C6 thumb, radial side forearm
C7 - heaven, index + middle finger
C8 - ring and little finger
T1 - ulnar side forearm
T2 - inner shoulder, triceps

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135
Q

spinothalamic tract does

A

pain and temp

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136
Q

dorsal column does

A

light touch and vibration and proprioception

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137
Q

myotomes upper limb

A

C5 shoulder abduction
C6 elbow flexion
C7 elbow,wrist,finger extension
C8 finger flexion
T1 finger abduction, thumb abduction

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138
Q

lower limb dermatomes

A

L1 asis and area surrounding groin
L2 upper outer thigh
L3 knee and inner thigh
L4 medial ankle
L5 foot
S1 lateral ankle and outer foot
S2 genitals
S3 groin around genitals

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139
Q

myotomes lower limb

A

L2/L3 - hip flexion

L4/L5 - hip extension

L3/L4 - knee extension

L5/S1 - knee flexion

S1/S2 - ankle plantarflexion

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140
Q

syringobulbia

A

fluid filled cyst within spinal cord extending into the brainstem (below this level is called syringomyelia)
causes CN palsies and dissociated sensory loss

UMN signs below lesion
LMN signs at lesion levlel

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141
Q

MND signs

A

combined UMN/LMN signs in the same body regions

usually starts with limb symptoms and progresses to slurring / poor speech

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142
Q

MS signs

A

only UMN signs
average age 30
usually presents with optic neuritis or isolated limb tingling /weakness

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143
Q

upper motor neurone signs

A

normal muscle bulk
mild weakness
increased tone
brisk reflexes
upgoing plantars

lesion has to be in central nervous system / brain

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144
Q

lower motor neurone signs

A

atrophic muscle
severe weakness, worse distally
fasciculations
reduced tone
reduced reflexes
downgoing plantars

peripheral nervous system only

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145
Q

paracetamol overdose

A

if staggered overdose, start NAC immediately

or if likely over 150mg/kg as high risk toxicity then

otherwise a/w bloods

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146
Q

mx of angina

A

GTNspray
beta blocker +/- CCB first line
can then consider adding long acting nitrate etc if not tolerating those

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147
Q

life threatening asthma exacerbation

A

PEFR <33% normal
sats <92%
silent chest
cyanosis
clinical shock

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148
Q

severe asthma exacerbation

A

can’t talk in full sentences
PEFT 33-55%
RR >25
HR >110
accessory muscles
sats >92%

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149
Q

moderate asthma exacerbation

A

talk in full sentences
PEFR 50-75%
RR <25
HR <110

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150
Q

chronic asthma mx

A
  1. SABA
  2. add low dose ICS
  3. add LABA (switch to MART/combination inhaler)
  4. increase ICS
  5. add LTRA
  6. specialist opinion
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151
Q

acute asthma hosp mx

A

high flow o2
neb salbutamol, ipratropium
steroids oral or IV
add abx if likely infection

if no improvement can try magnesium, IV salb, aminophylline

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152
Q

indications to refer asthma pt to ITU

A

deteriorating PEFT
worsening hypoxia
rising CO2
decreasing pH
exhaustion
reduced GCS

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153
Q

Pierre Robin syndrome

A

not inherited
micrognathia, glossoptosis(tongue pushed back)
freq resp infections as neonate
cleft palate

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154
Q

single palmar crease, protruding tongue, brachiocephaly, prominent epicanthal folds, upward slanting palpebral fissures

A

Down’s syndrome appearance

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155
Q

Noonan’s syndrome

A

autosomal dominant
low set ears, micrognathia
short webbed neck, delayed puberty in males
commonly get pulmonary stenosis and pectus excavatum as well as bleeding defects

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156
Q

fever pain score

A

1 point each

fever over 38
purulence
<3 days of symptoms
inflamed tonsils
no cough coryza

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157
Q

thyroglossal cyst

A

midline cystic lump near hyoid bone moving up or down when swallow or protrude tongue

mx : ENT do Sistrunk’s procedure

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158
Q

branchial cyst

A

painless, slow-growing, smooth fluctuant swelling in lateral neck

ENT - give abx and excise

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159
Q

cystic hygroma

A

neonatal abnormality
seen on antenatal USS
usually in axillae

sclerotherapy or surgical removal

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160
Q

ranula

A

clear/bluish cyst at floor of mouth

excision incl sublingual gland

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161
Q

laryngocoele

A

air filled cyst that can bulge internally into the larynx

intermittent neck swelling that becomes palpable after valsalva manoeuvre

mx surgical excision

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162
Q

mx of unknown neck lump

A

red flag 2ww if - 45yrs+ and unexplained neck lump or persistent and unexplained and younger than that

otherwise urgent USS if unexplained enlarging lump

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163
Q

aortic stenosis

A

ejection systolic murmur loudest over aortic valve

crescendo decrescendo

radiates to carotids

if no radiation may be aortic sclerosis

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164
Q

mitral regurg

A

pansystolic murmur loudest over mitral area, radiates axilla, displaced apex beat

can develop post MI due to ischaemic papillary dysfunction

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165
Q

aortic regurg

A

decrescendo early diastolic murmur loudest at left sternal edge

assoc with marfan’s

collapsing pulse

severe AR = austin flint murmur

clinical signs assoc:
- corrigan’s sign (visible distension + collapse of neck carotids)
- de musset’s (head bobbing with heartbeat)
-quincke’s sign (pulsations seen in nailbed with light compression)
-traube’s sign (pistol shot sound when steth placed over femoral artery)
-muller’s sign (uvula pulsations seen with beats)

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166
Q

mitral stenosis

A

low pitching rumbling mid diastolic murmur
assoc with AF
malar flush a sign

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167
Q

triscuspid regurg

A

pansystolic murmur

assoc with inf endocarditis and righ ventriular dilatation

congenital cause is Ebstein anomaly

clinical signs:
right sided HF signs
v waves visible in jugular
visible hepatic pulsation

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168
Q

pulmonary stenosis

A

ejection systolic

mostly congenital assoc

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169
Q

pulmonary regurg

A

usually due to pulmonary HTN

early decrescendo murmur

Graham Steel murmur if assoc with mitral stenosis

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170
Q

tricuspid stenosis

A

mostly assoc with rheumatic fever

mid diastolic murmur rarely audible

raised JVP, RVF signs

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171
Q

hypocalcaemia signs

A

tingling, muscle aches / spasms, tetany, seizures

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172
Q

common thyroid surgery complication

A

parathyroid injury and therefore low calcium

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173
Q

behcet disease

A

arthritis iritis recurrent oral and genital ulcers

raised inflamm markers

positive pathergy test (latent papule at site of needle insertion)

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174
Q

nikolsky sign

A

differentiates intra vs subepidermal blisters

hallmark sign of pemphigus, TEN or staph scalded skin syndrome

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175
Q

auspitz sign

A

small bleeding points after removing scales

psoriasis

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176
Q

koebner phenomenon

A

new plaques / vitiligo or lichen planus in sites of trauma

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177
Q

sebaceous cyst

A

small non tender smooth mobile lump, can’t move skin over the top

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178
Q

lipoma

A

soft doughy, mobile on palpation, skin moves freely over

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179
Q

o/e thyroid malignancy

A

would move with swallowing and be hard, firm and non tender
midline and skin moves over

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180
Q

marjolin’s ulcer

A

consider if poorly healing ulcer
this is a type of SCC in a venous ulcer

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181
Q

likely injury falling onto shoulder tip

A

acromioclavicular dislocation
marked downwards shoulder displacement causes

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182
Q

FOOSH injuries

A

young - posterior displacement of radial epiphysis, greenstick # or supracondylar # of humerus

teen - # clavicle

young adult - scaphoid # or humeral #

elderly - colle’s distal radius # or humeral #

183
Q

risk of humeral #

A

injury to radial nerve in spiral groove causing wrist drop and sensory loss at base of thumb

184
Q

causes posterior shoulder dislocation

A

seizures or electrocution

185
Q

anterior shoulder dislocation

A

presents with panful shoulder held in external rotation

risk to axillary nerve - injury would cause decreased sensation over deltoid + weakness of this muscle

186
Q

sialolithiasis

A

salivary gland stones

hard lump under tongue, worse and more swollen on eating

give NSAIDs and refer ENT (+ abx if signs of infection)

187
Q

I.E. signs

A

fevers chills malaise night sweats arthralgia

heart murmurs, splinter haem, Janeway lesions, Osler nodes, Roth spots

188
Q

LUTS with normal prostate male

A

alpha blocker like doxazosin (can add oxybutynin if further mx needed)

give finasteride 5a reductase inhibitor to men with enlarged prostates or raised PSA

189
Q

testing for chlamydia in PID

A

NAAT

also symptoms incl deep dyspareunia, lower abdo/adnexal tenderness

190
Q

radial nere injury

A

numb posterior arm and dorsum hand
wrist drop
absent triceps and supinator reflex

191
Q

meidannerve injury

A

numb lateral hand
weak pronation and flexion
weak 1-3rd fingers
hand of benediction whenflexing fingers

192
Q

ulnar nerve injury

A

numb hypothenar area and medial fingers
weak flexion
claw hand on extension

193
Q

cluster headache mx

A

nasal triptan
short burst oxygen therapy

after specialist input
verapamil prophylaxis

194
Q

continuous murmur in baby radiating to the back
breathless sweaty FTT

A

patent ductus arteriosus

195
Q

cyanosed newborn baby with oligaemic lung fields

A

pulmonary atresia

196
Q

3 month old baby with cyanotic episodes and short systolic murmur at upper left ternal edge, boot shaped heart (RVH), oligaemic lung fields

A

tetralogy of fallot

overriding aorta
VSD
right ventricular hypertrophy
right ventricular outflow tract obstruction

197
Q

CLL mx

A

if 17p deletion or TP53 delection then = acalabrutinib

otherwise bendamustine + rituximab

198
Q

hodgkin’s vs non hodgkin’s lymphoma

A

Despite the many differences between these two types of lymphatic cancer, both have similar symptoms, such as:

Enlarged lymph nodes in the armpits, neck or groin
Fever and/or night sweats
Unexplained weight loss
Severe itching
Ongoing fatigue

key differences:

Hodgkin = younger patient, starts in neck / upper body, pain in LN after alcohol

199
Q

first line mx for CML

A

imatinib (tyrosine kinase inhibitor)

200
Q

ALL mx

A

steroids + one of many types of chemotherapy agent

unless got philadelphia chromosome then add in imatinib TK inhibitor

if younger and not responding may try CAR-T therapy

201
Q

fatigue, fever, pallor, abnormal bruising, abnormal bleeding, raised LN, HSM

A

leukaemia

202
Q

ALL

A

2-4 year old child
acute proliferation of blast cells, usually B cell lineage

30% of children have t 15:17 translocation

30% of adult sufferers have PHiladelphia t 9:22 translocation

assoc with Downs

203
Q

CLL

A

chronic B cell proliferation
usually >55 yrs old

assoc rarely with warm AI haemolytic anaemia

can transform into high grade lymphoma (Richter’s transformation)

smear or smudge cells on blood film

204
Q

CML

A

chronic/accelerated and blast phases
chronic can last 5 years and pt asympto
blast phase >30% blast cells in blood

typical change is philadelphia t 9:22

205
Q

AML

A

most common adult leukaemia

can come from transformation of myeloprofilerative disorder (MF or PRV)

blood film = lots of blast cells and auer rods

206
Q

tumour lysis syndrome

A

cause - uric acid release by tumour cell destruction
crystals form in kidney interstitium
cause AKI

mx with allopurinol or rasburicase

must mx other electrolytes too

207
Q

atenolol and verapamil don’t give together why

A

severe risk of asystole and hypotension

208
Q

dx uncomplicated vasovagal syncope

A

no features suggesting alternative diagnosis

3Ps
posture
provoking factors
prodromal symptoms of faint

209
Q

epilepsy indicator symptoms needing 2ww neuro referral for EEG

A

tongue biting
transientLOC withhead turning
no memoryof abnormal behaviour duringLOC
unusualposturing
prolonged limb jerking(brief seizure-like activity can happen with a faint)
confusion afterwards
prodromal deja vu
incontinence

210
Q

diagnose bacterial vaginosis

A

vaginal pH >4.5
fishy odour and discharge

211
Q

transient global amnesia

A

usually >50
triggers can include cold/hot water, sex, heavy exercise
no neuro impairment except anterograde memory

diagnosis of exclusion

must be witnessed
usually don’t recognise others around them but know who they are
no neuro signs no LOC
no epilepsy
resolves in 24 hrs
no recent head injury

unlikely to recur

212
Q

cerebral venous thrombosis

A

headache, focal neuro, ICH, assoc prothrombotic statae

need cerebral angiography

213
Q

asympto carotid dissection incidental finding

A

if no prev ischaeimic issues can mx with antiplatelets / anticoags and f/up surveillance

214
Q

blurred vision, conjunctival injection, dendritic ulceration to the cornea, otherwise well

A

herpes simplex virus keratitis

215
Q

what is trachoma

A

cause of preventable infectious blindness in developing world

chlamydia causes

chronic keratoconjunctivitis

216
Q

sudden ocular pain, halos around lights, vomiting, fixed and mid dilated pupil

A

acute closed angle glaucoma

217
Q

diverse elbow / ankle / joint pain, hx of risky sex,, tendon swelling, vesiculopustular skin rash and unwell with fever

A

gonococcal arthritis

218
Q

mononeuritis multiplex

A

multiple individual peripheral nerves affected in diverse areas

assoc AI disorders and diabetes

219
Q

median neuropathy signs

A

carpal tunnel syndrome

can be caused by pregnancy low thyroid RA or occupational

thenar wasting, sensory loss + weakness

tinel + phalen’s positive

220
Q

cubital tunnel syndrome

A

ulnar neuropathy

weak and wasted hypothenar
pain at elbow
tingling medial hand + ring/little finger

froment’s sign - can’t pinch and hold onto paper

221
Q

meralgia paresthetica

A

compression of lateral femoral cutaneous nerve

numbness + tingling of lateral thigh
increased by walking and relieved by sitting
normal strength and tone

222
Q

femoral neuropathy

A

can come on due to surgery, hip dislocation or retroperitoneal haematoma

poor knee extension + hip flexion
sensory loss around anterior leg
reduced patellar reflex

223
Q

sciatic neuropathy

A

ankle jerk diminished
muscle weakness around ankle
sensory loss entire foot

usually assoc with hip arhthroplasty, prolonged lithotomy position etc

224
Q

peroneal neuropathy

A

compressed at lateral border by the knee

foot drop and foot eversion
sensory loss to dorsum of foot

225
Q

more common age teratoma vs seminoma

A

seminoma 35-45 years
tertatoma 20-30 years

226
Q

palpable separate smooth lump at back of testicle

A

epididymal cyst

227
Q

painless scrotal swelling below and anterior to testes which will transilluminate

A

hydrocoele

228
Q

left sided painless testicular swelling

A

classically ‘bag of worms’ feeling within spermatic cord above testis
will disappear on lying down
veins increase on standing
may have cough impulse

assoc with infertility

if RIGHT sided needs urgent specialist referral (v rare)

229
Q

2ww colorectal criteria

A

40+ with wt loss/abdo pain
50+ unexplained rectal bleeding
60+ with IDA / change bowel habit
+ve FIT test

230
Q

psoriasis can increase risk of what

A

all metabolic syndrome stuff incl CVD

231
Q

congenital abnormality associations with drugs (Set 1)

A

lithium Ebstein’s anomaly - heart defect

thalidomide - phocomelia (malformed limbs)

warfarin - can cause foetal bleeding or foetal warfarin syndrome (nasal hypoplasia, calcified femur/vertebrae, brachydactyly)

warfarin safe in breastfeeding btw

carbamazepine - spina bifida + macrocephaly

232
Q

congenital abnormality associations with drugs (Set 2)

A

ACEx - 2nd trim onwards - IUGR, renal tubular aplasia

vitamin A - ear malformations

233
Q

abx safe vs unsafe in pregnancy

A

SAFE:
penicillins
erythromycin
cephalosporins (cefs)

AVOID:
1st trim: streptomycin, trimethoprim (folate interference)
3rd trim: tetracyclines

234
Q

hyperacute graft rejection mechanism

A

class 1 HLA ab activation, granulocyte adhesion and thrombosis

acute rejection then involves donor MHC 1 reacting with host CD8

235
Q

phenytoin SEs

A

gingival hypertrophy and tenderness

236
Q

child urinary symptoms

A

if constant incl dribbling etc then OAB - can use oxybutynin if over 5

otherwise treat as noct enuresis

237
Q

mx of pt with symptomatic carotid artery stensosi

A

if <50% manage RFs and give aspirin

if greater than that do endartectomy

238
Q

female <30 with breast lump + no suspicious featuers

A

refer routinely to breast surgery

239
Q

breast clinic 2ww referral when

A

30+ with new lump in breast or axillae

any age with skin / nipple changes or sx suspicious of ca

240
Q

cold agglutinins and raised antibody titres + pneumonia

A

mycoplasma

clari

241
Q

marjolin’s ulcer

A

non healing sores increasing at site of scars, pus, easy bleeding, lots of granulation

type of scc

242
Q

bipap indications

A

COPD with resp acidosis
hypercapnic resp failure secondary to chest wall deformity or neuromusc disease
weaning from treacheal intubation

243
Q

obstructive sleep apneoa mx

A

CPAP and weight loss
use epworth scale

244
Q

kawasaki disease mx

A

treated with single infusion IVIG and then higher dose aspirin for 2 weeks before lower dose until echo done at 6-8 weeks (can get coronary artery aneurysm complication - if clear, stop mx)

NB oral steroids are used if fever persists >36 hrs after IVIG

245
Q

psoriasis indications for referral

A

immediate:
erythroderma (>90% skin coverage)
severely worsening / unwell pt
generalised pustular

routine if:
>10% body area coverage
psych distress
poor response to mx

246
Q

psoriasis mx generic

A
  1. lifestyle advice / emollient
  2. topical steroids up to 8 weeks +/- OD vit D analogue
  3. stop steroids, try 8-12 weeks BD vit D analogue
  4. if still not working, add potent topical steroids (as had 4 week break) or coal tar preparation for next 4 weeks
  5. can try dithranol
  6. referral
247
Q

sickle cell genetics

A

single gene disorder on chromosome eleven
beta globin chain issue

248
Q

decreased libido, infertility, gynaecomastia, LD, normal lifespan

A

klinefelter’s 47XXY or 48XXXY

249
Q

most common inherited cause of LD in men, sex linked, macro orchidism

A

fragile x syndrome

250
Q

weak right triceps + brachioradialis, absent triceps jerk, normal sensation otherwise

A

radial nerve injury (usually get wrist drop too if Q not being stupid)

worth noting don’t always have altered sensation

251
Q

amiodarone SEs

A

slate grey complexion, avoid sunlight
can get thyroid disorder either way
or pulmonary fibrosis

monitor with CXR and TFTs

252
Q

perorbital area swollen and red, eye red and proptosed, conjunctiva chemosed, restricted eye movements, evidence of RAPD, swollen optic disc

A

orbital cellulitis

commonly caused by ethmoidal sinusitis which requires surgical drainage

give taz to adults and co amox to kids

253
Q

OA mx

A

weight loss if overweight
physio / muscle strengthening
topical NSAIDs then
oral NSAIDs + PPI
joint injection with steroids

if sig impact, refer ortho

254
Q

harsh systolic murmur, not changing with inspiration, biventricular hypertrophy

A

VSD

255
Q

early peaking systolic murmur worse on valsalva and reduced on squatting, assoc with jerky pulse
LVH on ECG

A

HOCM

256
Q

pain on resisted supination / elbow issue

A

lateral epicondylitis

257
Q

pain on resisted palmar flexion with elbow issue

A

medial epicondylitis

258
Q

sudden unilateral painless loss of vision, CVD risk factors, fundoscopy shows cherry red spot and pale retina

A

central retinal artery occlusion

259
Q

hypertensive retinopathy

A

copper wiring - vessels appear copper colours
AV nipping - veins appeared indented
dot,blot,flame haemorrhages
cotton wool spots - retinal ischaemia
papilloedema

260
Q

optic disc cupping

A

glaucoma

261
Q

age related macular degen

A

drusen
if wet version, vessels grow into the macula

262
Q

diabetic retinopathy basic stages with details

A
  1. background diabetic retinopathy (microaneursyms, dot+blot haemorrhages)
  2. pre proliferative (+ cotton wool spots)
  3. proliferative (+new vessels at optic disc or elsewhere)
  4. advanced diabetic ret (all of above + complications e.g. vitreous bleeds, raised IOP, detachment)
263
Q

mx proliferative diabetic ret

A

panretinal photocoagulation (you see clusters of burn marks on the retina)

264
Q

stages hypertensive retinopathy

A
  1. grade 1 - arteriolar narrowing
  2. AV nipping
  3. retinal bleeds, hard exudates, cotton wool spots
    • optic disc swelling + symptoms of malignant HTN
265
Q

central retinal vein occlusion fundoscopy

A

retinal hypoxia leads to extravasation of bloods - widespread bleeds, tortuous veins, cotton wools spots, disc swelling

266
Q

unexplained syncope with normal inv - DLVA

A

don’t drive 6 months / they must inform

267
Q

scarlet fever

A

strep throat + strawberry tongue, papular rash etc

268
Q

child - tingling of lips / tongue, interference with speech / drooling / twitching of face / mouth
often begins during sleep or on waking

A

benign rolandic epilepsy

269
Q

10-16 yrs old, generalised epilepsy with myoclonic jerks, some GCS impairment

A

juvenile myoclonic epilepsy

270
Q

temporal lobe epilepsy

A

partial or focal seizures. affects speech / taste / memory -> deja vu, GI disturbance, olfactory hallucinations
repeated vocalisations, automatism / lip smacking

271
Q

imaging choice for osteolytic lesions in multiple myeloma

A

whole body low dose CT

272
Q

DPP4 inhibitor

A

sitagliptin

273
Q

sulphonylurea

A

gliclazide

274
Q

hard exudates vs soft exudates

A

hard exudate = yellow deposits of lipoprotein leaking out of blood vessels (hence diabetes/HTN disease)

soft exudate = cotton wool, in infarcted retina with swollen nerve fibres

275
Q

rare causes of stridor

A

vascular ring - 2 week old child, worse when crying, barium swallow shows filling defect (rare)

low grade fever, hoarse cough + stridor = acute laryngotracheobronchitis AKA croup

young child with stridor assoc with painless hand / feet / lip swelling - rare condition, angioneurotic oedema

276
Q

farm worker with headache, fever, myalgia, petechial rash, jaundice, fever, raised urea + liver damage

A

weil’s disease / leptospirosis -doxy

277
Q

farm / dairy ingestion, joint pain, fever, fatigue, systemic symptoms

A

brucellosis - doxy

278
Q

firm red papules to the hands, handle sheep

A

orf

279
Q

acute febrile illness, risk of rodent exposure - fever / rash/ polyarthirits

A

rat bite fever

280
Q

borfelia burgdorferi

A

lyme disease
bullseye rash

281
Q

painless multiple scaly rash pale on dark skin, dark on pale skin

A

pit versicolor

282
Q

painful swollen limb, tingling, febrile, dusky skin

A

nec fasciitis

283
Q

45+ inc irregular periods, irriatble, tearful

A

perimenopausal

284
Q

clear non offensive vaginal discharge / occasional spotting post cocp

A

cervical ectropion

285
Q

macrocytosis, raised LFTs, mild hypothyroid

A

alc excess

286
Q

pernicious anaemia

A

abs vs instrinsic factor which is needed to absorb b12

can get peripheral neuropathy and subacute combined degen of spinal cord

287
Q

moa common haem drugs

A

heparin - potentiates antithrombin III

aspirin - blocks thromboxane

clopi - blocks platelet ADP receptors which then stops glycoprotein activation

288
Q

drug related low potassium

A

loop diuretics, thiazides, alcohol xs, insulin, beta agonists

289
Q

drug related high potass

A

spironolactone, ACEx, ARB, nsaids, ciclosporins, beta blockers

290
Q

circumcorneal redness, blurred vision, photophobia, small pupil

A

anterior uveitis /iritis

291
Q

e histolytica complications

A

liver abscess
diarrhoea
dev country poor sewage barrier
floaty stools etc

292
Q

returning traveller 2 weeks ago, constipation progressing to bloody diarrhoea, gradually increasing fever, fatigue, rose spots

A

typhoid fever (salmonella typhi)

293
Q

HIV diarrhoea

A

cyryptosporidium

294
Q

urethritis, seronegative arthritis, conjunctivitis

A

reactive arthritis (common triggers can be post chlamydia or food poisoning)
assoc with HLA B27

295
Q

fat sausage fingers / dactylitis, nail pitting, oncholysis

A

psoriatic arthritis

296
Q

bronchial carcinoid tumour

A

neuroendo lung tumour

weight gain, high BP, hirsuitism

297
Q

headache, confusion, seizure, blackout, dark urine + a cancer hx

A

SIADH

298
Q

(right handed pt)
contralateral hemiplegia, left hemisphere neglect, dysarthria, left side homonyous hemianopia

A

non dominant MCA infarct

299
Q

headache, fever, eye pain, cranial nerve defects, seizures (assoc with cellulitis)

A

carvenous sinus thrombosis

300
Q

ipsilateral facial weakness, contralateral trunk weakness, dysphagia / dysarthria, vertigo, nystagmus

A

PICA stroke

301
Q

kawasaki

A

5+ day high fever, bilateral conjunctival injection, polymorphous rash, strawb tongue, cracked tongue, oedema / erythema to hands + feet, cervical LNs

302
Q

blood test scarl fever

A

anti streptolysin antibodies

303
Q

fever, rash, cough, blanching erythematous rash, white/grey lesions to buccal mucosa

A

measles

koplik spots

304
Q

discrete rose pink macpap rash, itchy in adults, large palatal petichae (forcheimer sign)

A

rubella

teratogenic in preg women sadly

305
Q

parvo b19

A

slapped cheek syndrome
circumoral pallor
red cheeks

306
Q

otitis externa with discharge/ unwell /hearing loss

A

topical abx/steroid

just acetic acid if no severe signs

307
Q

cataracts pathophys

A

lens opacification
replace lens

308
Q

nephritic syndrome

A

proteinuria, haematuria, HTN

309
Q

Goodpasture’s / hypersensitivity angiitis

A

haemoptysis + haematuria

anti GBM abs
prove with linear immunofluorescence / crescent moon appearance to glomeruli

310
Q

nephrotic triad

A

hypoalb
high prot
oedema

311
Q

CKD stages

A

1 >90ml/min
2 60-90
3a 45-60
3b 30-45
4 15-30
5 <15

312
Q

hyperkalaemia typical ECG

A

tall tented T waves, broad QRS, prolonged PR, flattened P waves

313
Q

hypokalaemia typical ECG

A

prolonged PR interval, prominent U waves, T wave inversion, ST depression

314
Q

hypercalcaemia typical ECG

A

shortened QT interval

severe = J waves

315
Q

hypocalcaemia typical ECG

A

prolonged QT interval

316
Q

carotid dissection

A

important cause of stroke in under 40s
string sign on doppler

317
Q

palm/sole rash + septic arth

A

gonococcalarth

318
Q

severe hyperemesis, first trim pre eclampsia, vaginal bleeding

A

hydatiform mole
v high bHCG

319
Q

scotomas

A

glaucoma - arcuate scotoma
toxic neuropathy - centrocaecal scotoma
ret pigmentosa - ring scotoma
macula / AMD - central scotoma

320
Q

assessing MS

A

MRI with contrast

321
Q

polymyositis assoc

A

assoc malignancy in older pt 20% of time

marked weakness + tenderness

322
Q

PMR criteria

A

bilateral shoulder/neck stiffness
onset <2 weeks
ESR >40
morning stiffness >1 hr
65+
bilat upper limb tendernes

323
Q

intracapsular hip # locations

A

subcapital
transcervical
basicervical

324
Q

femoral nail

A

femoral shaft

325
Q

DHS

A

intertrochanteric or peritrochanteric #

326
Q

cannulated screw hip # type

A

undisplaced subcapital #

hemiarth or THR preferred

327
Q

displaced intracapsular hip #

A

hemiarth or THR

328
Q

hip # classification

A

Garden class

1 - undisplaced, incomplete #
2- undisplaced, complete #
3 - partly displaced,complete#
4- displaced, complete #

329
Q

summary of weird drowsy child scenarios

A

colicky abdo pain, vomiting, papilloedema - lead poisoning

severe vom and GI bleeding then drowsy and cvs compromise - iron toxicity

sudden onset drowsiness in 2 week old infant - raised PT - may be intracerebral bleed due to inadequate vit K

normal lumbar puncture in drowsy baby with EEG slow waves in temporal lobe - herpes simplex encephalitis

neuro signs / drowsy baby with african ethnicity - may be cerebral infarct assoc with SCD

330
Q

older pt, excess painkiller hx, normocytic anaemia, raised creat

A

analgesic nephropathy

331
Q

E nodosum

A

painful, red, bruised looking nodules to anterior leg surface

332
Q

colles #

A

dorsal displacement of distal radius

333
Q

smith #

A

volar displacement of distal radius

334
Q

bennett #

A

of base of metacarpal of thumb

painful swollen thenar eminence, can’t move thumb

335
Q

turner’s assoc with

A

aortic coarctation

336
Q

clear CSF
raised WCC
mildly raised protein
normal CSF to plasma glucose ratio

A

viral meningitis

337
Q

turbid CSF
raised WCC (++ neutrophils)
raised protein
very low CSF to plasma glucose ratio

A

bacterial meningitis

338
Q

RA features on x ray

A

periarticular osteoporosis
narrowed joint space
juxta-articular bony erosions
sublux
deformity
periarticular soft tissue swelling

339
Q

RA features in the hand o/e

A

swan neck deformity
ulnar deviation of MCP joints
boutonniere deformity of thumb
bouchard’s nodes in isolation

340
Q

OA signs on x ray

A

subchondral cysts
osteophytes
narrowed joint space
subchondral sclerosis

heberdon’s DIP nodes
bouchard’s PIP nodes

341
Q

mx shingles if immunocomp

A

if post transplant or on chemotherapy etc
need IV mx and admission

342
Q

toddler with progressive ataxia, dysarthria, optic atrophy, absent lower limb reflexes, LVH

A

freidreich’s ataxia

343
Q

charcot marie tooth

A

auto dominant
progressive sensorimotor neuropathy

presents with slowly progressive distal weakness + sensory loss

344
Q

hungtindon’s presentation

A

chromosome 4 issue

chronic progressive personality / behaviour change, chorea, FH

345
Q

unpasteurised milk

A

brucellosis context clue

346
Q

metro doxy SEs warning

A

metro - no alcohol
doxy - no sun

347
Q

Multiple endocrine neoplasia 1 (MEN1)

A

parathyroid tumours, pituitary tumours, pancreas tumours

this and MEN 2a present with hypercalc / hyperparaT

348
Q

MEN2a /2b

A

both assoc with phaeos and medullary thyroid ca

difference is type 2b assoc with marfanoid appearance + neuromas too

349
Q

subacute meningism, progressive headache, RF for HIV

A

fungal meningitis

350
Q

target range CD4 count HIV

A

aim above 350 cells per mm cubed

351
Q

conjunctivitis in preg lady

A

topical fusidic acid eye drops not chloramphenicol as pregnant

352
Q

bullous pemphigoid vs pemphigus vulgaris

A

pemphigus vulgaris = thin walled flaccid blisters that rupture easily, intraepidermal splitting

bullous pemphigoid = subepiderminal splitting

353
Q

postprandial pain, fear of eating, weight loss, vascular RF hx

A

chronic mesenteric ischaemia

354
Q

absence seizure mx

A

ethosuximide

can have valproate if male

355
Q

guidelines for ACE/ARB bloods monitoring

A

if eGFR/creat drop of less than 25% then can continue and rpt test to check stable

if more than that drop, stop drugs

356
Q

guidelines for stopping antidepressants

A

if first episode of depression, ideally take treatment for at least 6 months before weaning down

if recurrence, for 12 months

357
Q

common metastasis sites for: osteosarcoma, colorectal + breast ca

A

osteosarcoma - to lung
colorectal - to liver
breast - to bone

358
Q

older pt, blood in urine, raised calcium level, varicocoele

A

renal cell adenocarinoma (classically have palpable mass, haematuria, flank pain)

359
Q

wilm’s tumour

A

nephroblastoma
one of most common childhood malignancy, found in kids aged 3-4 yrs

360
Q

ACEx and renal artery stenosis

A

they worsen the kidney function if have renal artery stenosis

361
Q

acute interstitial nephritis vs acute tubular necrosis

A

AIN = hypersensitivity reaction to a drug usually, will have eosinophilia, systemic symptoms, treat by withdrawing the drug

ATN = toxic insult to tubular cells, ‘muddy brown casts’, either nephrotoxic or ischaemic cause

362
Q

knee pain for a few weeks with limited hip joint movement in 6 year old

A

perthes aka avascular necrosis of femoral epiphysis

363
Q

obese teenager with limp and groin pain with leg discrepancy

A

SUFE

364
Q

typical vs atypical antipsychotics and EPSEs

A

more common with typicals i.e. haloperidol

365
Q

what type of signs with MS

A

upper motor neurone signs

366
Q

furosemide side effect

A

ototoxicity (may get ringing in ears etc)

367
Q

contraind LP

A

raised ICP signs
haemodynamically unstable
purpura
seizures until stabilised
plt <100 or on anticoag
infected LP site
resp compromise

368
Q

drug choice for cmv mx if mx needed

A

ganciclovir

369
Q

drug of choice for nephrogenic DI (i.e. not respsonding to ADH)

A

chrlorothiazide

370
Q

possible SE from statin

A

peripheral neuropath

371
Q

mx asymptomatic renal stones

A

lithotripsy if <1.5cm in size and normal kidneys

372
Q

normal kidney, larger stone >1.5cm

A

perc nephrolithotomy

373
Q

symptomatic kidney stone with poor kidney func

A

nephrectomy

374
Q

kidney stones (small) not responding to ESWL

A

ureterorenoscopy and holmium laser

375
Q

ground glass kidney stone mx

A

cystine calculi
alkaline diuresis mx

376
Q

dry mouth, gritty eyes, joint aches

A

sjogren’s

schirmer tear test dx

377
Q

polyarteritis nodosa

A

mid vessel vasculitis
middle aged men
fever, wt loss, malaise followed by severe organ sequelae assoc with infaractions

378
Q

hypertensive retinopathy emergency mx (Swollen discs)

A

iv labetalol

379
Q

ottowa ankle rules

A

criteria for ankle x ray

pain in malleolar area +
- tenderness at posterior tip or medial or lateral malleolous
- unable to weight bear

380
Q

fever, meningism,rash, foreign country

A

typhus

381
Q

hydrophobia and neuropsych issues

A

rabies

382
Q

breech position, DDH, monitoring

A

US scan of hips by 6 weeks to assess

383
Q

mx of uterine atony

A

bimanual compression
then IV oxytocin/ergometrine
then intrauterine carboprost
then rectal misoprostol
then balloon tamponade / ligation of uterine arteries / hysterectomy

384
Q

child around 13 months / weaning age with cutaneous and GI symptoms

A

CMPA

IgE mediated if urticarial rash and more immediate reaction, otherwise non IgE

385
Q

dermatomyositis

A

myalgia, purple eyelids, orbital oedema, Gottron’s papules of the knuckles, retinopathy

386
Q

biltaeral ptosis, difficulties letting go of grip, <40 presentation, FH

A

myotonia dystrophica (Auto dominant)

wasted mastication muscles, swan neck, ptsosis, can’t let go

387
Q

unilateral conductive haring loss, fh, pinkish tympanic membrane, younger pt

A

otosclerosis

388
Q

normal Rinne WEber findings

A

+ve rinnes both ears (air>bone conduction)

Weber heard equally both ears

389
Q

conductive hearing loss findings test

A

negative rinne a.k.a. bone cond>air conduction

Weber’s lateralises to bad ear

390
Q

sensineural hearing loss Rinne Weber

A

+ve rinne’s
weber’s lateralises to the unaffected ear

391
Q

post natal urinary incontinence and watery vaginal d/c after assisted delibery

A

possible cystovaginal fistula

392
Q

anti smooth muscle antibodies assoc

A

AI hepatitis

393
Q

ITP defining feature

A

isolated low platelets

postviral autoimm complic

394
Q

tetralogy of fallot tetrad

A

overriding aorta
VSD
RVH
right vent outflow tract obstruction

boot shaped heart
oligaemic lung fields

395
Q

cyantoic congential heart defects

A

tetralogy
transposition of arteries
tricuspid atresia
pulmonary atresia

396
Q

acyanotic congenital heart defects

A

VSD
ASD
PDA
coarctation

397
Q

down and out eye nerve lesion

A

third nerve (oculomotor)

398
Q

expressive dysphasia, personality change, disinhib, anosmia, grasp reflex, incontinence

A

frontal lobe lesion

399
Q

visuospatial,language loss, sensory change

A

parietal lobe lesion

400
Q

dominant hemisphere lesoin

A

dysphasia, apraxia, left right disorientation

401
Q

non dominant hemisphere lesion

A

contralateral neglect
prosopognosia

402
Q

memory /verbal changes, personality change, receptive dysphasia

A

temporal lobe lesion

403
Q

homonymous hemianopia

A

occipital lobe lesion

404
Q

ipsilateral deafness, nystagmus, corneal reflex reduced, ipsilateral cerebellar signs, nerve palsies 7/5

A

cerebellopontine angle lesion

405
Q

unequal pupils, eye muscle paralysis, amnesia, sleepiness

A

midbrain lesion

406
Q

fever, AKI, cerebral dysfuction, low platelets, microangiopathic haemolytic anaemia

A

TTP
rare

407
Q

small and distorted pupil

A

anterior uveitis /iritis

408
Q

solitary fleshy vascular lesion, rapidly growing and easy bleeding
commonly on fingers and hands

A

pyogenic granuloma

benign

409
Q

mx endometrioma

A

chocolate cyst

need gnrh analogue pre surgical resection

410
Q

hypersensitivity reactions categorise

A

acid

allergic - type 1 - immediate
cytotoxic - type2 - ab mediated
immune complex deposition - type3
delayed / cell mediated - type 4 - e.g. graft rejections

411
Q

itchy rash on nipple

A

paget’s disease of nipple, assoc breastc a

412
Q

common long term drug monitoring blood test frequency

A

amiodarone - TFT/LFT/U+E 6monthly
azathioprine - FBC, LFT 3 monthly
lithium - U+E, TFT, plasma levels, 6 monthly
methotrexate - FBC, U+E, LFT 3 monthly

413
Q

clozapine monitoring

A

weekly FBC until week 18 after initiation

then monitor 6 monthly alongside lipids, glucose

yearly health monitoring

414
Q

MCA strokes

A

contralateral hemiparesis/sensory loss + contralateral homo heminanopia

left hemisphere typically dominant

dominant MCA stroke - added aphasia

non dominant - added hemineglect

415
Q

lacunar stroke

A

pure hemiparesis alone
pure hemisensory loss
and others

416
Q

infected nasal swab / tampon / more rarely infected wound with fever / rash / low BP / diarrhoea / skin changes

A

toxic shock syndrome

417
Q

microcytic anaemia with normal MCHC and raised HbA2

A

beta thalassaemia

hba2 decides thisover alpha

418
Q

holmes adie syndrome

A

absent knee and ankle jerks with dilated unreactive pupil

young females, unknown cause

419
Q

miosis, ptosis, reduced sweating to forehead of same side

A

horner syndrome

assoc lung ca

420
Q

post MI meds

A

ACE inhib, dual antiplatelet, beta blocker, statin

421
Q

pericarditis

A

nsaids until asympto then 3 months colchicine

422
Q

gonorrhoea, chlamydmia mx

A

gonorrhoea - im cef
chlamydia - doxy or azithro if preg

423
Q

wells score dvt likely

A

2+ points

424
Q

summary transfusion reactions

A

febrile - most common, small temp rise minute afterwards - supportive

haemolytic reaction - ABO incompat - v bad, IV fluids, diuretics

allergic reaction - urticaria - antihistmaines, continue

TRALI - ARDS type reaction, stop tranfusion, treat airway

TACO - SOB (fluid overload), slow down rate and give diuretics

425
Q

anitcholinergic syndrome signs

A

flushingk dry skin, mydriasis, loss of accommodation, fever, sinus tachy, constipation

give activated charcoal, gastric lavage

give physostigmine if tachydysrhythmia

426
Q

treating hirsuitism in pcos

A

COCP with cyproterone acetate

427
Q

pcos trying for baby

A

clomiphene (stimulates ovulation)

risk of OHSS

428
Q

dka mx

A

fluid resus first then VRII

429
Q

common cancers that met to bone

A

BPKLT

breast prostate kidney lung thyroid

430
Q

conn’s and mx

A

HTN, hypokalaemia, hypernatraemia

mx with spironolactone

431
Q

types of thyroid cancers

A

papillary - local spread only
follicular - more aggressive and invades lungs
anaplastic - very very aggressive and invades trachea / oesophageal areas
medullary - produces calcitonin

432
Q

MS signs

A

intention tremor
nstyagmus
slurred speech
uthoff phenom (worsening neuro func with high temp)
lhermitte sign (elec shock bending neck forward)
ataxia

433
Q

monitoring GBS

A

may affect resp muscles so need to monitor FVC in case you need intubation

mx ivig plasmapharesis

434
Q

bitemporal heminanopia lesion location

A

optic chiasm / pituitary

435
Q

homonymous hemianopia lesionlocation

A

contralateral optic tract

436
Q

homonymous quandrantanopia lesion location

A

contralateral optic radiation temporal lobe

437
Q

homonymous heminaopia with macular sparing lesion location

A

contralateral occipital cortex

438
Q

Ab vs desmosome

A

pemphigus vulgaris

439
Q

ab vs skin basement membrane

A

bullous pemphgoid

440
Q

difficulty reading, distorted straight lines

A

age releated macular degen

441
Q

atypical pneumonia sx in farmer, usually abroad, contact with ticks / animals

A

think q fever

442
Q

ddx hyponatraemia

A

true = low sodium, low serum osmolality

hypovolaemic - GI loss, diuretics, burns/skin losses

euvolaemic - SIADH, low thyroid, low adrenals

hypervolaemic - HF, liver failure, renal failure, nephrotic syndrome

NB - if urinary sodium >20, cause is some form of renal loss, if urine osmolality very high 500+ only SIADH

443
Q

ethambutol

A

may cause optic neuritis

444
Q

most common causes nephrotic syndrome

A

minimal change (most common in kids)
membranous nephropathy
amyloid
lupus
diabetic nephropathy
focal segmental glomerulosclerosis

445
Q

most common cause nephritic syndrome

A

IgA nephropathy (post viral reaction - days after)
HSP (IgA vasculitis - may precede IgA neprho)
post strep glomerulonephritis (weeks after)
granulomatosis with polyangitis (saddle nose)
Goodpasture’s (anti GBM abs)
haemolytic uraemic syndrome (post E coli infection)

446
Q

high unconjugated bilirubin

A

means pre hepatic cause aka haemolytic

if high conjugated = hepatic or posthepatic

447
Q

monteggia vs galeazzi fractures

A

monteggia - ulnar # with dislocated proximal radial head

galeazzi =radial # with dislocated distal ulnar

448
Q

pterygium vs pinguecula

A

pterygium - fleshy triangular mass extending over cornea

pinguecula - small yellow blob not over cornea

both due to irritated conjunctiva

449
Q

leukoplaki

A

white lesions to mucosa that can’t be brushed off, assoc with alc,smoking
may need biopsy as assoc scc

NB if towards edges of tongue, assoc EBV in immunocomp patient

450
Q

pit rosea

A

herald patch then xmas tree lesions, due to one of hhv viruses

451
Q

burn body % calcs

A

head - 9%
upper limb - 9% each
trunk - 36%
genitalia - 1%
lower limb - 18% each

452
Q

de quervain’s thyroiditis (subacute thyroiditis)

A

viral illness then hyperthyroid with neck/jaw pain + fever
then progresses to hypothyroid

453
Q

grave’s vs hashmoto’s thyroiditis

A

grave’s has anti TSH abs but frequently has anti TPO as well
more likely grave’s if got the eye symptoms too

454
Q
A

NICE CKS /Wrong Qs RT (3 decks)

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