Peer Teaching Exam Questions Flashcards
Triad of HF symptoms?
- Oedema
- Fatigue
- Dyspnoea
Aortic dissection Symptoms?
- tearing chest pain
- Anuria
- unequal arm pulses/ pressures
Secondary Hypertension Causes?
- CKD, Polycystic Kidney Disease
- Conn’s, Cushing’s
How do you exclude a PE?
Negative D-dimer test
Treatment of Legionella?
Ciprofloxacin
Clarithromycin
How does Pulmonary Hypertension show on CXR?
Dilated pulmonary arteries
Right hypertrophy
Treatment of Haemochromatosis?
Deferoxamine
Antibodies found in someone with Myasthenia Gravis?
AChR
MuSK
What is a common diagnosis for an old man with a NEW back pain?
Multiple myeloma
What is Neisseria?
Gram negative cocci
give examples of aerobic and anaerobic gram positive bacilli?
aerobic = bacillus, listeria monocytogenes
anaerobic = clostridium difficile
What are the 6 P’s of acute limb ischaemia?
Pain
Pallor
Paraesthesia
Perishing cold
paralysis
Pulseless
How do you distinguish between salmonella and shigella?
XLD agar
Shigella = Red
Salmonella = Red with black dots
Where is there ST elevation for someone who had a RCA MI? (inferior heart)
2,3, aVF
Where is there ST elevation for someone who had a LAD MI? (antro-septal)
V1,V2 and involvement of circum
Where is there ST elevation for someone who had a circumflex MI? (lateral)
1, aVL, V5, V6
Describe briefly the 4 hypersensitivity reactions
1= Allergic (IgE)
2= Cytotoxic (goodpasture’s, Haemolytic)
3 = Immune complex deposition ( SLE, pneumonitis)
3 = Delayed (t cell)
What may these precursors cause?
Asthma
Pulmonary Hypertension
Bronchiectasis
pleural Effusion
a- Pneumonia
P - RHF
B - Pneumothorax
PE - CCF
What are the signs of Infective Endocarditis
FROMJANE
Fever
Roth Spots
Osler’s Nodes
Murmur heart
Janeway’s lesions
Anaemia
Nail haemorrhage
Emboli
What are the severity crtierias for the following
Fontaine
new York heart association functional classification
Dukes
Ann Arbor
Killip
Fontaine = PAD
new York heart association functional classification = HF
Dukes = infective Endocarditis
Ann Arbor = lymphoma
Killip - MI
What cells are seen on blood film for:
Iron deficiency anaemia
Haemolytic anaemia
Thalassaemia
glucose-6-phosphate deficiency
IDA = Hypochromic
Thalassaemia = Target cells
Haemolytic = Schistocytes
G6PD = bite and blister cells
What is:
Chadsvacs
ABCD2
wells
FRAX
QRISK2
chadsvacs = stroke risk after AF
ABCD2 = stroke risk after TIA
Wells = DVT probability
FRAX = fracture risk in 10yrs
QRISK2 = CVS disease in 10 years
What do the crystals look like in gout and pseudo gout?
GOUT = NEGATIVELY BIREFRIGENT NEEDLE SHAPED
PSEUDO-GOUT = POSITIVELY BIREFRINGENT RHOMBOID SHAPED
Nephritic vs Nephrotic key features?
Nephritic = Oliguria, Haematuria, Oedema, HTN, decreased GFR
nephrotic = oedema, proteinuria, hypalbuminaemia, hyperlipidaemia
How does ACE-i work?
inhibit bradykinin breakdown
What stain do you use to show iron
Perl’s
What can cause meningitis in pregnant women?
Listeria
What can cause meningitis in kids?
Strep agalactiae
What antibodies are found in a coeliac?
IgA tissue transglutaminase
IgA anti-endomysial
Why are tympanic sounds of abdomen heard?
Air in bowel due to obstruction
Where does Appendicitis pain start?
Diffuse pain in abdo then localises
Side effects of Steroids?
Growth problems
increased risk to infection
osteoporosis
HTN
oedema
DM
What is a Reynolds pentad
symptoms suggesting the diagnosis obstructive ascending cholangitis, a serious infection of the biliary system.
It is a combination of
Charcot’s triad (RUQ pain, jaundice, and fever)
shock (low blood pressure, tachycardia)`
an altered mental status
questions before cancer surgery/
are they medically fit
is there mets
is it resectable
What are monoclonal bands in blood film found in?
MS
Why are methotrexate and trimethoprim related?
Folate antagonists so cant be used during pregnancy
what do you call trimethoprim and sulfamethoxazole?
co-trimoxazole
what antibiotic binds to RNA polymerase?
Rifampicin
name an aminoglycoside
Gentamycin
name a macrolide
Erythromycin / clarithromycin
name a cephalosporin
Cefuroxime
Cephalexin
name a glycopeptide
Vancomycin
Definition of anaemia
decrease in Hb conc due to plasma volume increase
Cause of Macroscopic anaemia?
B12/folate
alcohol
hypothyroid
Cause of CML
translocation of gene between 9,22 causing formation of Philadelphia chromosome
Ann Arbor staging?
1 - one node
2 - multiple lymph
3 - above or below diaphragm below = 3b and both sides of body
4 - organ mets
How can you tell its ALL on blood film?
increase conc of lymphoblast’s
How is febrile neutropenia found
Fever over 38c
Absolute neutrophil count <1
What is Rituximab?
monoclonal antibody which targets CD20 protein on surface of a b cell to treat lymphoma
What disease is it if someone has hyperkalaemia, hyperuricaemia, hyperphosphatemia, hypocalcaemia
Tumour lysis syndrome
How is tumour lysis syndrome treated and how does hyperkalaemia show on ECG
Fluids, allopurinol, electrolyte balance
tall T, absent p, broad QRS
How does hypercalcaemia show on ECG
short QT is hyper so hypo is long QT
What is the name of a pink diplococci organism
Neisseria Meningitidis
What are the real names of meningitis
Pneumococcal septicaemia
Meningococcal septicaemia
treatment of meningitis?
IV Cefotaxime
Headache red flags?
Seizure
Altered: consciousness, memory,confused
Papilloedema
Cluster Headache
What drug is given to decrease intracranial pressure?
IV Mannitol
What has fasciculations and spasticity?
UMN or LMN
LMN has fasciculations
UMN has spasticity (increased tone and brisk reflexes)
Give examples of primary and secondary adrenal insufficiency
Primary = Addisons, TB, Trauma
Secondary = Steroids, Congenital, Neoplasm
How does hyperglycaemia lead to insulin secretion?
1) Increased uptake of glucose by cells
2) Increased ATP levels and K+ channels close
3) Depolarisation of membrane opens Ca2+ channels
4) Increased Ca2+ means exocytosis of insulin-containing vesicles
5) Insulin released by beta cells in Islets of Langerhans
Thyroid autoantibodies?
anti-thyroid peroxidase antibodies (TPOAb)
thyrotropin receptor antibodies (TRAb)
thyroglobulin antibodies (TgAb)
Treatment of Hyperthyrodism/ Graves
Beta blockers
Carbimazole
Radio iodine therapy
Thyroidectomy
2 main symptoms of DI?
Polyuria and Polydipsia
symptoms of pheochromocytoma
plapitations, sweating, headache
blood tests for Pheochromocytoma
Plasma catecholamines
what cells produce plasma catecholamines and where are they found
Chromaffin cells in the adrenal medulla
What is Deontology?
the morality of an action should be based on whether that action itself is right or wrong under a series of rules, rather than based on the consequences of the action.
Why does someone breath heavily during DKA?
Respiratory compensation to get rid of the CO2
What shape are the different types of haemorrhage in the brain
sub-dural = crescent shaped
extra-dural = lens shape
sub-arachnoid = 5 point star
HYPERDENSE
What does Pericarditis show on ECG?
Saddle shaped ST elevation and PR depression
What heart murmur does:
Mitral Stenosis and Mitral Regurgitation show?
Mitral Stenosis: Early Diastolic
Mitral Regurg: Pan-systolic
What heart murmur does:
Aortic Stenosis and Aortic Valve Replacement show?
Ejection systolic ‘crescendo-decrescendo’
Valve replacement = systolic click
Which bacteria is most common in the community for Pnuemonia?
Strep. Pneumoniae
What Hypersensitivity reaction is Goodpastures?
Type 2
What Hypersensitivity reaction is SLE?
type 3
What Hypersensitivity reaction is Graft rejection?
type 4
Where does lung cancer commonly spread?
Bone, Brain, Liver, Lymph, Adrenal Glands
what would you see if someone has a collapsed lung?
Sail Sign
Which antibody is seen in SLE?
Anti-double stranded DNA (Anti-dsDNA) antibodies are a group of anti-nuclear antibodies (ANA)
What is likely if someone has nocturnal diarrhoea?
IBD
What sign is shown in acute Cholecystitis?
Murphy’s Sign
What is negative in cholangitis?
Murphy’s Sign
What is Common in the left iliac region of the bowel?
Volvulus
Difference in pain with gastric and duodenal ulcers?
Gastric = pain when full/ after eating
Duodenal = pain when hungry
Give Inflammatory and Non inflammatory reasons for joint pain
Inflammatory = Autoimmune/ AS/ Crystal Arthritis/ Infection
Non-inflammatory = OA/ Fibromyalgia
3 differential diagnoses of HLA-B27 positive?
AS
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis
What classing system is used for fractures?
Salter- Harris Classification
What is meant by a T/Z score?
T= bone density compared to 25 year old of same gender
Z = bone density compared to average of same age of same gender
when might you prescribe allopurinol?
Long term gout
Kidney stones - reduce uric acid
Hyperuricaemia - tumour lysis syndrome
Temporal Arthritis treatment?
Steroids (prednisolone)
Triad of renal cancer symptoms?
Flank pain
Haematuria
Palpable Mass
function of kidney?
Excretion of electolytes, water, urea
produces Epo
Ultrafiltration
Causes of CKD
Pre renal, renal, post renal
Pre-renal- DM/ high cholesterol
Renal = NSAIDs, glomerulonephritis
Post renal = kidney stones
Cause of Nephritic Syndrome
IgA nephropathy
post strep infection
SLE
ANCA positive vasculitis
Definition of erectile dysfunction?
Inability to gain and maintain erection long enough to achieve sexual satisfaction
Pharmacological and surgical treatment of Stress incontinence
Duloxetine
Artificial Sphincter
Name the bacteria that cause chlamydia and gonorrhoea
Neisseria gonorrhoeae
Chlamydia Trachomatis
What drug is used to treat syphilis
Azithromycin
Describe the different types of Salter Harris Classification
Type 1 = Through growth plate
Type 2 = Through growth plate and metaphysis (most common)
Type 3 = Growth plate and epiphysis
Type 4 = all 3 elements
Type 5 = Crush injury of growth plates
Cause of Polycythaemia?
JAK-2 mutation
Signs and Symptoms of Polycythaemia?
Hepatosplenomegaly
Pruritis
Plethoric face
thrombus formation
Gout due to increased uric acid / DNA breakdown
Diagnosis of polycythaemia?
- JAK-2 mutation
- FBC
- Bone marrow aspirate
Treatment of polycythaemia?
1) Venesection
2) Hydroxycarbamide
3) Interferon - alpha
Symptoms of Polycystic kidney disease
Hypertension.
Bump.
Haematuria (blood in urine).
Proteinuria.
Back pain and flank pain. Back pain or flank pain is the most common symptom of ADPKD
What may polycystic kidney disease cause?
Berry aneurysm- ruptures and becomes sub-arachnoid haemorrhage
Acute Pyelonephritis (Upper UTI) symptoms?
- Fever
- Chills
- Flank pain
- Nausea and Vomiting
- Increased WCC distinguishes upper from lower
Complications of CKD
- Hyperkalaemia
- Hypocalcaemia (renal osteodystrophy)
- Encephalopathy (flap)
- Pericarditis
- Increased renin so HTN
- Anaemia (reduced EPO)
Complications of DKA
- Kussmaul breathing
- Pear drop breath
- Hyperkalaemia
- Cerebral Oedema
what may trigger DKA and what is the treatment? same as (HONK coma)
Infection, MI, wrong dose insulin
Treatment:
- Fluids
- Insulin
- Electrolyte replacement
Complications of Pancreatitis?
- Pancreatic Pseudocyst / abscess (infection by e.coli)
- Hypovolaemic shock
- Acute Respiratory Distress Syndrome
Chronic = Diabetes
Main visible diagnostic of cirrhosis?
Regenerative nodules
fibrotic tissue and collagen
Complications of Cirrhosis
- Gastro-oesophageal varices
- Ascites
- Splenomegaly
- Hepatorenal failure
- Jaundice
- Palmar erythema due to oestrogen increase
Symptoms of Cirrhosis
- Pruritis
- Easy bruising (low coagulation factors)
- Hepatic Encephalopathy (liver flap)
- Ascites
Gold standard Dx of Cirrhosis?
Liver biopsy (nodules and fibrosis)
Lab findings of Cirrhosis
Raised:
- Bilirubin
- AST>ALT ratio
- ALP, GGT
Thrombocytopenia
Diagnosis of Hypertension?
Ambulatory blood pressure monitor
Causes of HTN?
- Acromegaly
- Conn’s
- Hyperthyroidism
- Glomerulonephritis
Exclude secondary HTN?
- renin/ aldosterone
- Full blood count
- U+E
Signs of Asthma?
- Low O2 sats
- Use of Accessory muscles
- Tachypnoea
- Hyper-resonant percussion
Bedside asthma tests?
Peak flow, ABG, ECG
Asthma pathological changes
- Increase mucous
- bronchoconstriction
- inflammation of mucosa
Example of corticosteroid an method of action?
Prednisolone- upregulates anti-inflammatory genes
downregulates pro-inflammatory genes
Ann Arbor staging, what is different betwee 3A and 3b ?
B- symptoms (fever, weight loss, night sweats)
Extra-articular effect of Rheumatoid Arthritis?
- Anaemia
- Pericarditis
- neuropathy
Worldwide common cause of Hypothyroidism and the treatment?
Iodine deficiency and Levothyroxine (T4)
Definition of a UTI
A UTI is a pure growth of more than 10^5 organisms per ml collected from a fresh clean catch urine sample
Lifestyle advice to reduce UTI
Clean after sex, increase fluid intake and regular voiding
Common complication of a UTI?
Pyelonephritis - Ascending bladder infection into the renal parenchyma
4 areas of Wilson and Junger Criteria?
Condition - important, understood, detectable stage
treatment- accepted and early, facilities
Test - suitable, early, accepted
Benefits- cost effective, agreed on who to treat
Mental Capacity requirements?
1) Ability to understand information
2) retain information
3) Evaluate information
4) Communicate decision
Investigations of hernias?
- Endoscopy
- Barium swallow
Name a different class of drug instead of PPI
H2 receptor antagonist
Ranitidine
Risk factors to TB
- Immunosuppressed
- Close contact to infected/ crowded living conditions
- Alcoholics
- Homeless
X-ray of TB?
- Cavitation
- upper lobe consolidation
- pleural effusion
What are the 4 quadrants of medical ethics?
medical indications,
patient preferences,
quality of life,
contextual features
What are the signs of lung collapse and hypcalcaemia
Sail sign
Hypocalcaemia:
Chvosteks sign
Trousseau sign
Site of action of loop diuretic
Block NKCC2 in ascending loop of henle
Thiazide mode of action
Blocks Na+/Cl- co-transporter In DCT
Aldosterone antagonist method
Blocks aldosterone at ENACs in collecting duct
Breast cancer treatment and causes of lumps
Chemo and Trastuzumab
Causes:
lipoma
cancer
cysts
implant rupture
fibroadenoma
Name a dopamine agonist and what would be seen on Parkinson brain
Lewy bodies, loss of dopaminergic neurones
Ropinirole
