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Pastest Learnings Flashcards

1
Q

Autosomal dominant, chromosome 4, triple repeat

A

Huntingtons

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2
Q

Decreased crown pubis/crown heel ratio. Infertility, gynacomastia, learning disability. Normal lifespan

A

Klinefelter

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3
Q

47 XXY or 48XXXY

A

Klinefelters

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4
Q

Digoxin toxicity features on ECG

A
  • premature ventricular beats
  • bradycardia
    Reverse tick sign
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5
Q

First and second line tx for heart failure?

A

1st: Beta blockers and ACEIs
2nd: aldosterone antagonists eg spiro

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6
Q

Side effects of which drug?

Acne, gum hypertrophy, paraesthesia, peripheral neuropathy

A

Phenytoin

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7
Q

Side effects of which anti epileptic drug?

HypoNa, thrombocytopaenia, haemolytic anaemia, dry mouth, fatigue

A

Carbamazepine

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8
Q

Lead poisoning symptoms in children?

A

GI symptoms and raised ICP (papillodema)

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9
Q

Iron toxicity symptoms in children?

A

Vomiting, GI bleeding, drowsiness, CVD compromise

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10
Q

Autosomal dominant condition leading to 80% increase in risk of bowel cancer

A

Lynch syndrome : increases risk of bowel, endometrial, stomach, ovarian, prostate, Urinary cancers

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11
Q

Von Hippel Lindau

A

Multiple cysts in brain, eyes, spinal cord, adrenals, kidneys, pancreas. Increases risk of kidney and pancreatic Ca

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12
Q

Psoriasis tx?

A
  1. Betnovate + vitamin D OD
  2. Vitamin D BD
  3. Steroid BD or coal tar
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13
Q

Common cause and presentation of interstitial nephritis

A

NSAIDs, arthralgia, eosinophilia

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14
Q

Anti-dsDNA, anti-Ro, ANA

A

SLE

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15
Q

SLE Presenting features

A
  • vasculitic lesions
  • mouth ulcers
  • butterfly rash
  • small joint arthralgia
  • ophthalmological involvement
  • Neuro involvement
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16
Q

Cranial nerve palsy, neck pain, headache, ptosis, miosis

A

Carotid artery dissection

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17
Q

Role of proximal and distal convoluted tubule?

A

Proximal: Sodium and glucose re absorption
Distal: urine concentration

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18
Q

Mechanism of action of acarbose

A

Inhibits alpha-glucosidase

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19
Q

Mechanism of action of metformin

A

decrease hepatic gluconeogenesis
Increase insulin sensitivity
May reduce GI carb absorption

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20
Q

COPD spirometry

A

FEV1<80%, FEV1:FVC <0.7 or 70%

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21
Q

Contraindications to sildenafil

A

ISMN - potent vasodilatory effects, hypoT

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22
Q

AFP, CEA, LDH cancer markers

A

Alpha fetoprotein - hepatocellular carcinoma
CEA-colon cancer
LDH - testicular cancer

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23
Q

Anti cholinergic symptoms

A

Mydriasis, reduced secretions, dry skin, fever, altered mental state

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24
Q

Drugs that exacerbate psoriasis

A

Lithium and beta blockers

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25
Q

Congenital adrenal hyperplasia at birth?

A

Large penis and pigmented (++testosterone), hyperK and hypoNa (low aldosterone), hypoglycaemia and hypotension (low cortisol). 21 hydroxylase deficiency

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26
Q

HOCM presentation?

A

Syncope after exercise, systolic murmur, worsens with valsalva, better with squatting. Jerky pulse

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27
Q

Ace inhibitor cough caused by?

A

Bradykinin breakdown

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28
Q

Infection predisposes to guttate psoriasis

A

Streptococcus infection

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29
Q

Ichthyosis

A

Dry scaly skin on abdomen, fingertips, fish scale appearance

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30
Q

Psoriasis on hands and soles of feet

A

Pustular psoriasis

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31
Q

Hepatitis B recent immunisation?

A

HBsAg antigen - HBS antibodies produced

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32
Q

Acute or recent infection of Hep B antibodies?

A

IgM anti-hepatitis B core (HbC)

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33
Q

Less common side effects of nicorandil

A

Mouth ulcers and stomatitis

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34
Q

Most common bugs in IECOPD

A

Moraxella, haemophilus, strep pneumoniae

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35
Q

Pulmonary HTN features

A

Raised JVP, SOB, left parasternal heave, peripheral oedema, pansystolic murmur (tricuspid regurgitation)

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36
Q

Cluster headaches treatment

A

Nasal sumitriptan or short burst oxygen therapy. Verapamil prophylactic.

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37
Q

Meningitis treatment in primary care

A

IM Ben pen

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38
Q

Most common cause glomerulonephriits

A

IgA nephropathy (Bergers), lung and kidney involvement

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39
Q

Cast nephropathy

A

Myeloma

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40
Q

Most common form of nephrotic syndrome in children?

A

Minimal change disease

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41
Q

thin basement membranes on renal biopsy, which disease

A

Alport syndrome : ears, kidney, eyes

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42
Q

Amiodarone monitoring blood tests? How often

A

LFTs and TFTs 6 monthly

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43
Q

Body burn percentages

A

Head and neck - 9%
Each upper limb - 9%
Lower limbs - 18%
Trunk - 36%

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44
Q

EBV causes what and predisposes to?

A

Infectious mono. Lymphoma.

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45
Q

Poor prognosis in breast cancer?

A

Young age, progesterone/estrogen negative,

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46
Q

IVDU, Recent resp infection, cavitating pneumonia

A

Staphylococcus

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47
Q

Immuno compromised individual, which pneumonia

A

Pneumocystis jiroveci

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48
Q

Alcohol and elderly pneumonia

A

Klebsiella

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49
Q

Low grade fever, rigors, hypotension and tachycardia with psoriasis

A

Erythrodermic psoriasis - emergency

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50
Q

Presentation of waldenstroms macroglobinaemia

A

IgM paraprotein causes hyperviscosity symptoms and amyloidosis. Infiltration of bone marrow and organs.

Retinal haemorrhages, lethargy, headache, blurred vision

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51
Q

Amyloidosis link to which IBD? Presents how?

A

Crohns - hepatomegaly, oedema

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52
Q

Marjolins ulcer

A

Underlying malignancy, slow healing, shallow ulcer

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53
Q

Lung tumour causing weight gain, HTN, hirsutism

A

Bronchial carcinoid

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54
Q

Haemophilia A : inheritance, clotting abnormality and deficiency

A 
X linked recessive
Prolonged APTT
Factor VIII (8) deficiency
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55
Q

Cobblestone lesions

A

Crohns

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56
Q

Varenicline side effects

A

Abnormal dreams, menorrhagia

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57
Q

Seminona vs teratoma

A

Seminona: 30-40, older (sergeants)
Teratoma: 20-30, younger (troops)

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58
Q

Screening for TB in at risk groups?

A

Mantoux test

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59
Q

MCA stroke presentation

A

Contra lateral hemiparesis, face and arm worse affected

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60
Q

ACA lesions?

A

Contralateral hemiparesis, leg and shoulder worse than arms and face

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61
Q

Behçet’s disease

A

More common in Turkey, Japan and Iran. Ulcers in mouth and genitalia

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62
Q

Mode of inheritance of duchenne muscular dystrophy

A

X linked recessive

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63
Q

Mode of inheritance vitamin d resistant rickets

A

X linked dominant

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64
Q

Which organism and which patients get malignant otitis externa

A

T2DM . Pseudomonas.

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65
Q

Erythema nodosum and proctitis

A

UC

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66
Q

Turner syndrome cardiac abnormality

A

Coarctation of aorta

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67
Q

Down syndrome CV defect

A

AVSD

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68
Q

Cyanosed child with ESM at left sterna edge

A

Tetralogy of fallot

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69
Q

Eye: Fluroscein staining shows a dendritic ulcer

A

Herpes simplex keratitis

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70
Q

Turner syndrome

A

45 XO: lymphodema, small chin, low hairline, webbed neck, short stature

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71
Q

Trisomy 18

A

Edwards syndrome: rocker bottom feet

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72
Q

22q11 disease and features

A

Di George ; cleft palate, Absent thymus, aortic arch abnormality, T cell dysfunction

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73
Q

Adverse effects of ACEIs in pregnancy

A

Renal function and skull abnormalities

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74
Q

Adverse effects of streptomycin in pregnancy

A

Audio and vestibular damage

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75
Q

Adverse effects of NSAIDS in pregnancy

A

Premature labour and closure of PDA

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76
Q

cyp450 INDUCERS

A

Carbamazepine, barbiturates, rifampicin and phenytoin, smoking and chronic alcohol

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77
Q

cyp450 inhibitors

A

STICK FACES COM

Sodium valproate
Trimethoprim 
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol
Chloramphenicol
Erythromycin
Ciprofloxacin Omeprazole Metronidazole Grapefruit juice
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78
Q

Abx for C. Diff?

A
  1. 10 days Vancomycin
  2. Fidaxomicin

If life threatening, add IV metronidazole

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79
Q

Argyll Robertson pupils - causes and presentation

A

Syphillus and diabetes, small and minimally reactive

Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)

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80
Q

Acne vulgaris pregnancy

A

Oral erythromycin

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81
Q

tick causing pneumonia

A

Q fever - coxiella. Also presents with hepatosplenpmegaly

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82
Q

Brucellosis presentation

A

Middle Eastern disease, unpasteurised milk: fever, pneumonia, hepatosplenomegaly, epididymoorchitis

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83
Q

MEN1

A

3 p; pituitary, parathyroid, pancreas

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84
Q

MEN2

A

Parathyroid, phaeo, medullary thyroid

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85
Q

MEN3

A

Phaeo, medullary thyroid, Marfanoid

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86
Q

FOOSH, fat pad sign on X-RAY, elbow injury

A

Radial head #

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87
Q

Glomerulonephritis: Ig ? Precipitant

A

IgA nephropathy, precipitated by URTI, young males

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88
Q

Chest, eye and renal involvement, c-ANCA +be

A

Granulomatosis with polyangitis

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89
Q

Adult stills disease

A

Rheumatic disease: pink rash, arthritis, recurrent fever

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90
Q

Proximal muscle weakness, tenderness, raised CK

A

Polymyositis

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91
Q

Headache, fever, agitation, hydrophobia

A

Rabies

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92
Q

Presentation and diagnosis of typhus

A

Fever, meningism, rash. Dx with serology

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93
Q

Emergency contraception pill options

A

Ulipristal acetate: up to 5 days post intercourse

Levonelle: 72 hours post intercourse, but efficacy drops

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94
Q

Referral pathway following abnormal smear?

A

Mild dyskaryosis AND HPV +ve: colposcopy and biopsy within 6wks
Moderate/high dyskaryosis : colposcopy 2wks

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95
Q

Crusting of both eyelids, worse in the morning, normal acuity and pupils

A

Blepharitis

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96
Q

Test for suspected acromegaly

A
  1. First line: IGF-1

2. 2nd line: OGTT

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97
Q

P-ANCA IBD?

A

UC

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98
Q

discrepancy between kidney size and worsening HTN

A

Renal artery stenosis

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99
Q

How might Burkitts lymphoma present?

A

Child with Ascites, abdo pain, hepatosplenomegaly, B symptoms,

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100
Q

How does internuclear opthalmoplegia present? Where is the lesion?

A

Rapid saccades, lesion in the medial longitudinal fasciculus (which connects 3rd and 6th nerve nuclei)

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101
Q

Risk factors for sudden infant death syndrome

A

Male sex, winter months, young maternal age

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102
Q

Management of unstable VT

A

Synchronised cardio version up to 3x

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103
Q

Telogenum effluviam presentation

A

acute onset hair shedding in response to variety of stressed eg anorexia, childbirth, chronic illness, etc

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104
Q

Hair loss with tapered hairs and exclamation mark hairs, fine white hair in areas of regrowth

A

Alopecia

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105
Q

Most common diarrhoea

A

Campylobacter

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106
Q

Treatment for prolonged and unwell gastroenteritis

A

Ciprofloxacin

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107
Q

GBS risks

A

Previous GBS, PROM, Pre term labour

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108
Q

UTI drugs in pregnancy and breastfeeding

A

Nitro - fine until term then you can’t
Trimethoprim - never
Cefalexin at term

After birth: trimethoprim safe in breast feeding

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109
Q

Tests for DDH, imaging, treatment

A

At 6 weeks, USS if:
Barlow - dislocates
Ortolani - relocates

If >4 months: X ray

Tx: Pavlik harness

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110
Q

VSD murmur and ECG findings

A

ECG: biventricular hypertrophy

Pansystolic murmur over lower left sternal edge

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111
Q

Immunoflurescence findings in pemphigus vulgaris vs bullolus pemphigoid? Antibody findings?

A

PV: Intraepidermal circular deposits. Anti desmosome Abs
BP: Linear IgG and C3 deposits. Anti hemidesmosome Abs

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112
Q

Name of manoeuvre for tx of BPPV

A

Epsley manoeuvre

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113
Q

Presentation of acute glaucoma

A

Red, painful eye, fixed and dilated pupil with hazy cornea

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114
Q

Acute glaucoma treatment

A

Acetazolamide, topical beta blocker

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115
Q

Optic neuritis pupil effects?

A

Loss of direct pupillary reflex, preservation of consensual reflex. Due to optic nerve damage

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116
Q

Medical treatment options for acromegaly

A

Somatostatin analogues and pegvisomant (GH antagonist)

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117
Q

How might a basilar artery infarction present?

A

Quadriplegia, locked in syndrome

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118
Q

Law around children and sexual intercourse

A

Under 13, no one considered competent to consent. Always statutory rape. Gillick competence is irrelevant. Involving parents difficult as you do not know how responsible they may be or involvement in child’s life

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119
Q

Treatment for stage 4 renal cancer

A

Immunomodulatory drugs

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120
Q

Abx for orbital cellulitis

A
  1. Co-amoxiclav

2. Clindamycin with metronidazole if penicillin allergy

121
Q

Becker’s vs Duchenne Muscular dystrophy and mode of inheritance

A

Becker’s - later childhood, slower progression
DMD- early childhood, rapid progression
Both X linked recessive

122
Q

Mechanism of action of aspirin

A

Inhibits thromboxane A2

123
Q

MOA of clopidogrel

A

Activates antithrombin III, which inactivates factor Xa. This prevents prothrombin from being converted into thrombin

124
Q

Presentation of dry AMD on retina

A

Drusen spots (yellow small spots)

125
Q

Myotonic dystrophy presentation and mode of inheritance

A

Myotonia, wasting and weakness of affected muscles, mainly face and upper limbs . Slowly progressive, associated with cataracts, hypogonadism, frontal balding. Slow relaxing, eg difficulty letting go of grip.
Autosomal dominant

126
Q

Which malaria subtype can lie dormant and how?

A

Plasmodium vivax ; hypnozites in the liver

127
Q

Tumour markers:
Ca 19-9
Ca 125
Ca 15-3

A

Ca 19-9 ; pancreatic
Ca 125 ; ovarian
Ca 15-3 ; breast

128
Q

Common side effects of levetiracetam

A

Weight changes, anorexia, GI symptoms, anxiety

129
Q

Presentation of benign rolandic epilepsy

A

Children; often during sleep or before waking, parasthesia of lips, slurred speech

130
Q

Gonococcal arthritis

A

Rash on palms and soles of feet with a fever and arthritis

131
Q

Pseudo vs gout under microscope

A

Gout: negatively bifringent crystals
Psuedogout: positively bifringent

132
Q

Tumours likely to metastasise to bone

A 
Thyroid 
Breast
Lung 
Kidney 
Prostate
133
Q

Presentation and usual precipitatant of toxic epidermal necrolysis

A

Affects 30-100% of body area, skin sloughs off easily (Nikolsky sign).

Drug induced often NSAIDs, methotrexate, steroids

134
Q

When to perform lithotripsy in renal stones?

A

Uncomplicated, normal renal anatomy, <1.5cm

135
Q

Presentation of viral conjunctivitis

A

Viral: Serous discharge, Recent URTI, Preauricular lymph nodes

136
Q

Treatment for wet vs dry AMD

A

Dry: antioxidants
Wet: anti VEGF agents

137
Q

Shadow on the red reflex or absent red reflex

138
Q

Cause of Argyll-Robertson pupils

A

Diabetes, syphillus

139
Q

Causes of papilloedema

A 
space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia
140
Q

Pupils in uveitis vs acute glaucoma

A

Uveitis: small, fixed oval pupil

Acute glaucoma: dilated pupil

141
Q

Causes of chorioretinits and necessary tests?

A

Must do HIV test.

Causes
syphilis
cytomegalovirus
toxoplasmosis
sarcoidosis
tuberculosis
142
Q

How do episcleritis/scleritis present, and how to distinguish between them?

A

Both present with red, tearing eye.

Vessels blanch in episcleritis when phenylephrine drops are applied and is not painful, whereas scleritis IS painful

143
Q

Presentation of optic neuritis

A

Pain, visual loss, loss of colour perception

RAPD and central scotoma

144
Q

Presentation of chorioretinitis

A

Pizza pie appearance ; red and white retinal spots

145
Q

Tunnel vision and night blindness?

A

Retinitis pigmentosa

146
Q

Marfanoid and sudden loss of vision

A

Lens disclocation upwards

147
Q

Ocular manifestations of RA

A 
keratoconjunctivitis sicca (most common)
episcleritis (erythema)
scleritis (erythema and pain)
corneal ulceration
keratitis
148
Q

Keith Wagner classification of hypertensive retinopathy

A

Grade 1: tortuous vessels, arteriolar narrowing, silver wiring
Grade 2: AV nipping
Grade 3: cotton wool exudates, flame/blot haemorrhages
Grade 4: papilloedema

149
Q

Conjunctivitis tx in pregnant women

A

Topical fusidic acid

150
Q

definitive treatment for acute angle-closure glaucoma

A

Laser peripheral iridotomy

151
Q

Reversal of dabigatran

A

Idarucizumab

152
Q

First line treatment of CML

153
Q

CML presentation

A

Massive splenomegaly
Raised WCC
Anaemia

154
Q

Presentation of immune thrombocytopenic purpura

A

Petichiae, purpura, bleeding (epistaxis)

155
Q

First line management for ITP

A

oral prednisolone

156
Q

Disseminated intravascular coagulation blood test picture

A
  • Low platelets (as consumed)
  • Low fibrinogen (fibrinolysis activated)
  • High PT/APTT (prolonged bleeding times)
  • High DD (fibrinogen degradation product)
157
Q

Causes of DIC

A

sepsis
Trauma
Malignancy
Obstetric complications

158
Q

Antidote for heparin

A

Protamine sulfate

159
Q

Adrenaline dosing from children to adults

A

Of 1:1000

0-6: 150mcg
6-12: 300mcg
12 - adult: 500mcg

160
Q

Opioids in CKD patients

A

Alfentanil, buprenorphine and fentanyl

161
Q

Side effects of cyclophosphamide

A

Haemorrhagic cystitis

162
Q

Side effects methotrexate

A

Liver fibrosis, myelosuppression, lung fibrosis

163
Q

Side effects Vincristine

A

Peripheral neuropathy

164
Q

Oral codeine to morphine conversion

A

Oral codeine to morphine (divide by 10). Therefore, oral codeine 10mg = oral morphine 1mg.

Breakthrough dose 1/6th.

165
Q

Side effect doxorubicin

A

Cardiomyopathy

166
Q

Machine like murmur radiating to the back

167
Q

Presentation of RCC

A

Flank pain, haematuria, abdo mass. Hypercalcaemia and varicocele sometimes

168
Q

Disorder affecting nails associated with lymphoedema or pleural effusion

A

Yellow nail syndrome

169
Q

CHADSVAS

A

CHA2 DS2 VAS

CXR
HTN
Age >75(2)
DM
Stroke/TIA
Vasc disease 
Age 65-74
Sex female
170
Q 
STEMI leads
Inferior 
Anterolateral
Anteroseptal
Anterior
Posterior
A 
Inferior : II, III, avf
Anterolateral: I, avl, v4-6
Anteroseptal: v2-4
Anterior: v2-6
Posterior: v1-v3, recip
171
Q

Lymphocytosis and neutropenia with recurrent tonsillitis

172
Q

STEMI management re PCI

A

PCI within 120 mins, or primary fibrinolysis within 12 hours if PCI can’t happen within that timeframe

Unfractionated heparin as part of PCI.

173
Q

Drug management of HTN

A

<55 or t2DM: A, A+C OR A+D

> 55 or black: C, C+A OR C+D

Both then A+C+D

ACEIs have reduced efficacy in black people, so go for ARB instead

If treatment resistant and require a 4th drug, spiro if potassium <4.5, otherwise alpha/beta blocker

174
Q

When would you give 3 back to back shocks?

A

Patient already on cardiac monitor and goes into VT/VF

175
Q

Angina management

A

Beta blocker OR Rate limiting calcium channel blocker (eg diltiazem)

Do not coprescribe, consider asthma patients

176
Q

Post MI medications

A

Beta blocker, ACEI, statin, aspirin, clopidogrel

177
Q

What drug for AF and heart failure together?

178
Q

When to stop ramipril re kidney function

A

Creatinine rise >30%
EGFR fall >25%

Swap to an ARB

179
Q

Which artery corresponds to which MI location

A

Inferior - right coronary
Anteroseptal/lateral - LAD
Lateral - left circumflex

180
Q

Hypokalaemia on ECG

A

Long QT and U waves

181
Q

Tx of bradyarrythmias

A

If shocked - atropine IV

If stable - transcutaneous pacing

182
Q

Components of GRACE score

A

Age, troponin, renal function, blood pressure

183
Q

Persistent ST elevation following recent MI, no chest pain

A

Left ventricular aneurysm

184
Q

What drug to avoid in HOCM

185
Q

Statin dosing for first time

A

Atorvastatin
20mg primary prevention
80mg secondary

186
Q

Tx for VT

A

If stable - Amiodarone

If not - synchronised cardioversion

187
Q

COCP and cancer

A

Protects against ovarian and endometrial

Increased risk of breast and cervical

188
Q

Post partum emergency contraception

A

Only 21 days post birth

EllaOne and Levonelle both okay as both are progesterone based

189
Q

COCP UKMEC 4 Re smoking and breastfeeding

A

Age > 35 and >15 cigarettes per day

Breastfeeding <6 weeks PP is UKMEC4

190
Q

POP vs desogestrel MOA

A

POP ; thickens cervical mucus

Desogestrel; inhibits ovulation

191
Q

GDM management

A

BM <7: diet and exercise, if no improvement after 2 weeks, metformin
>7: insulin

192
Q

Folic acid high risk dose and criteria

A

Anti epileptics, coeliac, diabetes, thalassaemia,BMI >30

5mg pre conception until w12

193
Q

When does Downs screening happen in pregnancy

A

11-13+6 weeks (includes nuchal scan)

194
Q

When does auto antibody and anaemia screening happen in pregnancy

195
Q

congenital rubella triad

A

Sensorineural deafness, cataracts, pulmonary artery stenosis

196
Q

HPV strains assoc with cervical cancer

197
Q

Risk factors for ovarian cancers

A

Many ovulations, ie early menarche, late menopause, nuliparity

198
Q

Mx of bleeding in early pregnancy

A

<6 weeks, expectant for threatened miscarriage if painless

> 6 weeks, refer to EPAU

199
Q

Flexural and facial psoriasis tx

200
Q

Keloid tx

A

Intralesional triamcinolone

201
Q

Normal ABPI values

A

0.9-1

Less than 0.9 suggests arterial insufficiency

202
Q

Otitis externa, blepharitis and eczema like rash

A

Seborrhaeic dermatitis

203
Q

Rosacea tx

A

mild/moderate: topical metronidazole

severe/resistant: oral tetracycline

204
Q

direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis

A

Dermatitis herpetiformis

205
Q

Seborrhaeic dermatitis features and treatment

A

peri-orbital and nasolabial scaly rash associated dandruff

Topical ketoconazole

206
Q

Lichen planus features

A

4 P’s

planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common

207
Q

Impetigo treatment and presentation

A

Golden crust lesion on lips
1st line: hydrogen peroxide
2nd line: topical fusidic acid

Flucloxacillin if severe

208
Q

Causes of erythema multiforme,

A

Infections: herpes , Streptococcus, mycoplasma pneumoniae

drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine

disease:
SLE
sarcoidosis
malignancy

209
Q

Onychomycosis treatment

A

Oral terbinafine

210
Q

Lichen planus treatment

A

Topical steroids

211
Q

Tx for capillary hemangioma

A

Propanolol

212
Q

Medication to prescribe following SAH

A

Nimodopine to prevent vasospasm

213
Q

Head injury, lucid interval

A

extradural (epidural) haematoma

214
Q

Vasectomy failure rate and semen analysis follow up

A

1 in 2000

Semen analysis at 16 and 20 weeks

215
Q

Breast cancer referral pathway on 2WW

A

aged 30 and over and have an unexplained breast lump with or without PAIN or
aged 50 and over with any of the following symptoms in ONE nipple only: discharge, retraction or other changes of concern

216
Q

CT head within 8 hours criteria

A

age 65 years or older
any history of bleeding or clotting disorders
dangerous mechanism of injury
more than 30 minutes’ retrograde amnesia of events immediately before the head injury

217
Q

1st line investigation for high PSA in suspected prostate cancer

A

Multiparametric MRI

218
Q

Prostate cancer risk factors

A

increasing age
obesity
Afro-Caribbean ethnicity
family history: around 5-10% of cases have a strong family history

219
Q

Tx for epididimoorchitis and unknown organism

A

IM ceftriaxone one off dose, 10 days doxycycline

220
Q

Screening for abdominal aneurysms

A

One off USS at 65

221
Q

Test of exocrine function in chronic pancreatitis

A

Faecal elastase

222
Q

First and second line tx for BPH

A

Alpha 1 antagonists eg tamsulosin

5 alpha-reductase inhibitors e.g. finasteride (may take 6 months)

223
Q

Anaesthetic with anti emetic properties

224
Q

Contraindication to donepizil

A

Bradycardia/sick sinus syndrome

225
Q

Features of ankylosing spondylitis

A

6 As

Achilles tendonitis 
Amyloidosis
AV node block
Aortic regurgitation
Anterior uveitis
Apical fibrosis
226
Q

management of patients following a fragility fracture

A

> 75y; bisphosphonates

<75: DEXA first

227
Q

Severe side effect of hydroxychloroquine

A

Retinopathy

228
Q

When to avoid prescribing sulfasalazine

A

Aspirin allergy

G6PD deficiency

229
Q

Drugs that cause drug induced lupus

A

procainamide

hydralazine

230
Q

Triad of reactive arthritis and triggers

A

Uveitis
Arthritis
Urethritis

However not always the case. Usually precipitated by GI infection or urogenital infection

231
Q

Likely organism to cause osteomyelitis in sickle cell disease

A

Non typhi salmonella

232
Q

Tinnitus, conductive hearing loss, family hx

A

Otosclerosis

233
Q

Otitis external treatment

A

Mild: acetic acid

Severe (discharge, deafness) : abx and steroid

234
Q

Drugs that cause tinnitus

A 
Aspirin
NSAIDS
Aminoglycosides (Gentamicin)
Furosemide
Quinine
235
Q

Antibiotics treatment for otitis external in diabetics

A

Ciprofloxacin

236
Q

Centor criteria

A

presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

237
Q

Causes of gum hypertrophy

A

phenytoin, ciclosporin, calcium channel blockers and AML

PACC

238
Q

Otitis externa in diabetics - antibiotic choice

A

Ciprofloxacin - cover for pseudomonas

239
Q

Treatment of glue ear

A

None, allow to resolve for 6-12 weeks, UNLESS
Symptoms are significantly affecting hearing, development or education
Immediate referral in children with Downs syndrome or cleft palate

240
Q

Smudge cells / smear cells on blood film

241
Q

Haemophilia A is a deficiency in what factor ?

242
Q

Drugs causes colour changes to vision

A

Sildenafil - blue tint

Digoxin - green/yellow tint

243
Q

Antidote to tricyclics in overdose

A

IV bicarbonate

244
Q

Adverse effects of quinolones

A

(Eg ciprofloxacin)
Tendon damage
Reduced seizure threshold in epilepsy
Prolonged QT interval

245
Q

Drugs to avoid in heart failure

A

“They Never Give Verapamil”

Thiazolididiniones (eg pioglitazone)
NSAIDs (except low dose aspirin)
Verapamil
Glucocorticoids

246
Q

Amiodarone monitoring

A

TFTs and LFTs 6 monthly

247
Q

Sodium valproate and pioglitazone monitoring

248
Q

Diclofenac contraindications

249
Q

Adrenaline doses in anaphylaxis and cardiac arrest

A

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM

cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

250
Q

Preciptating factors of digoxin toxicity

A

HypoK
Renal failure
Some drugs,eg amiodarone, diltiazem, thiazides

251
Q

What abx to stop with statins

A

Macrolides eg erythromycin

252
Q

Minimum SSRI term and tapering

A

6 months

4 weeks of dose reduction

253
Q

Cotard syndrome

A

Belief that they are dead or rotting

254
Q

De Clerembault syndrome

A

Belief that someone of higher stature is in love with them

255
Q

Ekbom syndrome

A

Delusional parasitosis

256
Q

Othello syndrome

A

Delusional infidelity belief

257
Q

NSAIDs and SSRI risk

A

Bleeding, always co prescribe PPI

258
Q

Atypical anti psychotics

A

QORCAA

Quetiapine
Olanzapine
Risperidone
Clozapine
Aripiprazole 
Amisulpride
259
Q

SSRI discontinuation symptoms

A

Sweating
GI symptoms
Paraesthesia

260
Q

MOA of benzodiazepines

A

Enhance the effect of GABA

261
Q

Anti psychotic risks in elderly

A

Stroke / VTE

262
Q

Typical antipsychotics

A

Haloperidol

Chlorpromazine

263
Q

SSRI post myocardial infarction

A

Sertraline

264
Q

Drugs to avoid in breastfeeding

A 
AC LAMBS 
Lithium
Benzos 
Aspirin 
Amiodarone 
Carbimazole
Methotrexate 
Sulphonylureas
265
Q

First line treatment for primary dysmenorrhea

A

NSAIDs such as mefanemic acid

266
Q

Hyperemesis gravidarum diagnostic criteria

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

267
Q

Investigating infertility

A

> 12 months regular sex and <35

If >35, >6 months regular sex

268
Q

When is expectant management of ectopic pregnancy indicated

A

Asymptomatic
No foetal heartbeat
bHCG<1000

269
Q

Need for contraception after menopause

A

> 50, no periods for 12 months

<50, no periods for 24 months

270
Q

Gestation week for:

  • early scan to confirm dates
  • Anaemia and auto-antibody screens
  • Anti D given
  • Anomaly scan
A
  1. 10-12 (and this is often done with Down’s screening, 11wks)
  2. 8 and 28
  3. 28 and 34
  4. 18 weeks
271
Q

How long does Nexplanon provide protection for

272
Q

Premature ovarian failure age

273
Q

Diagnostic thresholds for GDM

A

fasting glucose is >5.6 mmol/L

2-hour glucose is >7.8 mmol/L

274
Q

Ménière’s disease treatment

A

Acute attacks: prochorperazine

Prophylaxis: beta histine

275
Q

Diabetes diagnosis criteria

A

Fasting > 7
Random > 11
Hba1c >48

If asymptomatic need 2 readings

276
Q

Conditions causing lower than expected hba1c

A

Sickle cell
G6PD
Hereditary spherocytosis

277
Q

Diabetic drugs causing fourniers gangrene

A

SGLT2 inhibitors

278
Q

When to commence third line therapy or insulin in T2DM

A

Hba1c above 7.5

279
Q

Impaired fasting glucose and impaired glucose tolerance definition

A

IFG: 6.1 to 7
IGT: 7.8 to 11.1

280
Q

MOA and example of SLGT2 inhibitors

A

Dapaglifozin

Prevent glucose reabsorption in kidneys

281
Q

MOA and example of thiazolididiones

A

Pioglitazone reduces peripheral insulin resistance

282
Q

Sulphonylurea MOA and example

A

Gliclazide increases insulin production

283
Q

Gliptin MOA

A

reduce insulin resistance

284
Q

Pioglitazone contraindications

A

Heart failure

Bladder cancer

285
Q

Drug causes of raised prolactin

A

Think of p’s

MetocloPramide
DomPeridone
Phenothiazines
HaloPeridol

286
Q

features of RA vs OA

A 
OA - LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis 
Subchondral cysts

RA - LESS
Loss of joint space
Erosions
Soft bones (osteoporosis/osteopenia)
Soft tissue swelling
287
Q

Dual antiplatelet therapy for people with acute STEMI having primary PCI

A

If not on anticoagulant: aspirin for life and prasugrel/ticagrelor

If already on anticoagulant/stable CAD: aspirin for life and clopidogrel

288
Q

How to calculate osmolarity

A

2Na + urea + glucose

289
Q

Calculate ion gap

A

Na - [HCO + CL]

290
Q

Systematic scleroderma antibodies

A

Anti scl 70

291
Q

Limited cutaneous systemic sclerosis antibodies

A

CREST
Anti centromere
Anti nuclear

292
Q

Physiological changes of pregnancy

A

Hb and BP fall

Everything else rises

293
Q

Mammogram screening programme

A

Every 3 years 50-70

294
Q

NSTEMI tx

A
  1. Aspirin 300mg, if NOT FOR IMMEDIATE PCI, fondaparinux
  2. Assess GRACE score
  3. If <3%, ticagrelor
  4. If >3% PCI & prasugrel OR ticagrelor
295
Q

STEMI tx

A
  1. Aspirin 300mg
  2. PCI within 120 mins, give prasugrel
  3. if not, thrombolyse with anti thrombin, followed by ticagrelor
296
Q

Stroke Mx

A

If <4.5 hours, thrombolysis and thrombectomy

If <6 hours, thrombolysis

297
Q

Asthma ladder <5y

A
  1. SABA
  2. SABA + 8wk trial of MODERATE dose ICS
  3. SABA + low dose ICS + LTRA
  4. Stop LTRA refer to specialist
298
Q

Asthma ladder 5-16y

A
  1. SABA
  2. SABA + low dose ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA
  5. SABA + low dose MART
  6. SABA + high dose MART

MSRA (8 decks)

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