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Maud- Phase 2a > Phase 2a Mock SBAs > Flashcards

Phase 2a Mock SBAs Flashcards

1
Q

What is the gold standard Ix for suspected renal colic?

A

Non-contrast CT KUB

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2
Q

Commonest composition of renal stones?

A

Calcium oxalate

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3
Q

What are the storage and voiding symptoms of BPH?

A 
FUN= Frequency, Urgency, Nocturia 
SHIPP= Straining, Hesitancy, Incomplete emptying, Poor Stream, Post-micturition dribbling
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4
Q

Tamsulosin:
Class?
Indication?
MOA?

A 
Class= Alpha blocker 
Indication= BPH 
MOA= Alpha 1 adrenoceptor blocker therefore causes vasodilation and reduced resistance to urinary outflow
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5
Q

SE of Tamsulosin

A

Postural hypotension, dizziness, syncope

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6
Q

Which patient would be ideal for treating with Tamsulosin?

A

Male patient with BPH and HTN as alpha blockers help with both

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7
Q

Name a medication which is indicated for the use of BPH and resistant hypertension?

A 
Daxazosin (alpha blocker) 
Resistant HTN (when ACEi, CCB and thiazide diuretics have been ineffective)
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8
Q

Give common causes of UTIs?

A 
KEEPS 
Klebsiella
*E.Coli
Enterococcus 
Proteus / pseudomonas 
Staphylococcus saprophyticus
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9
Q

What are the 3 core features of nephrotic syndrome?

A

Hypoabluminaemia, Proteinuria, Peripheral oedema

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10
Q

What is the commonest cause of AKI?

A

Acute tubular necrosis

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11
Q

What is more likely to cause AKI, hypovolaemia or hypervolaemia?

A

Hypovolaemia can cause AKI

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12
Q

How does BPH cause post-renal AKI?

A

urinary tract obstruction increases intra-tubular pressure, this decreases GFR, increasing urea and creatinine in blood

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13
Q

Sepsis is a pre-renal cause of AKI. Does it cause an increase or a decrease of serum creatinine and ures?

A

Sepsis causes renal hypoperfusion therefore AKI

Decreased GFR, increase in serum urea and creatinine

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14
Q

What are the interval ranges for the stages of CKD?

A

1) > 90 + renal damage
2) 60-89 + renal damage
3a) 45-59 +/- renal damage
3b) 30-44 +/- renal damage
4) 15-29 +/- renal damage
5) <15 = established renal failure

(units in ml/min)
15, 30, 45, 60, 90

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15
Q

Name a test used to investigate chlamydia?

A

Nucleic acid amplification test

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16
Q

What is the best investigation to use in the management of pyelonephritis?

A

Midstream urine MC&S

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17
Q

What findings on urine dipstick indicate infection?

A

Nitrites and leukocytes

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18
Q

What is a characteristic presentation of chronic prostatitis?

A

pelvic or perineal pain > 3 months

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19
Q

Which drug is first line for UTI in pregnancy?

A

Nitrofurantoin

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20
Q

What are the triad of symptoms associated with bechet’s syndrome?

A

Oral apthous ulcers
Genital ulcers
Ocular inflammation

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21
Q

What are the triad of symptoms associated with budd-chiari syndrome?

A

Abdominal pain
Ascites
Liver enlargement

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22
Q

What are the symptoms of charcot’s triad?

A

RUQ pain
Fever
Jaundice

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23
Q

What are the triad of symptoms in reiter’s syndrome

A

AKA reactive arthritis
Can’t see- conjunctivitis
Can’t pee- urethritis
Can’t climb a tree- arthritis

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24
Q

Give an example of a serious complication of Polycystic Kidney Disease?

A

Associated with Berry aneurysms therefore SAH

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25
Q

What is the management of acute pulmonary oedema?

A

High flow O2
IV furosemide
IV morphine/GTN
Urgent CXR

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26
Q

What class of drug is Goserelin?

A

Leitenising Hormone Releasing Hormone (LHRH) agonist. (Goserlin mimics the shape of LHRH and binds to receptors to decrease release of LH therefore decreasing production of testosterone and subsequent growth of prostate- tx for prostate CA)

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27
Q

Give an example of a 5 alpha reductase inhibitor

A

Finasteride

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28
Q

What is the class, indication and mechanism of action of finasteride?

A 
Class= 5 alpha reductase inhibitor 
Indication= 2nd line tx of BPH
MOA= inhibit conversion of testosterone to dihydrotestosterone (a metabolite that stimulates prostate growth) via 5 alpha reductase enzyme.
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29
Q

Give 3 SEs of finasteride?

A 
Breast enlargement / tenderness / CA
Sex- impotence, loss of libido 
Hair growth (tx of male-pattern baldness)
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30
Q

Which drug may be effective for male-pattern baldness?

A

5 alpha reductase inhibitors

Finasteride

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31
Q

What is the definition of impotence?

A

Inability to sustain an errection sufficient for sexual intercourse or the inability to achieve ejaculation or both

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32
Q

A male patient who you recently prescribe Finasteride is delighted to tell you that his wife has recently fallen pregnant. What advice should you give him?

A

Pregnant women should not take, handle broken tablets or be exposed to semen of a man taking finasteride
Exposure of foetus to finasteride in this way can cause external genitalia abnormality to foetus
Wear a condom during sex whilst his wife is pregnant

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33
Q

What is the commonest type of renal cell carcinoma?

A

Clear cell

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34
Q

Which empirical Abx should be given for pyelonephritis whilst awaiting MC&S?

A

Ciprofloxacin or co-amoxiclav

7 days of: 500mg bd or 500/125mg TDS respectively

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35
Q

Commonest cause of pneumonia?

A

Streptococcus pneumoniae

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36
Q

Which cause of pneumonia is an AIDs defining condition?

A

Pneumocystis jiroveci

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37
Q

What type of organism is pneumocystis jiroveci

A

Fungus

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38
Q

Legionella pneumophilia is a cause of atypical pneumonia, it is associated/ caught through…

A

Infected water supplies and air conditioners

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39
Q

Why might patients with legionella pneumophilia infection have hyponatraemia

A

It’s a known cause of SIADH therefore hyponatraemia

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40
Q

What is the side effect of Rifampicin?

A

Red/orange discolouration of urine

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41
Q

What is the side effect of Isoniazid?

A

Peripheral neuropathy

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42
Q

What is the side effect of pyrazinamide?

A

Hyperuricaemia causing gout

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43
Q

Which TB medication causes hyperuricaemia and hence is a risk factor for developing gout?

A

Pyrazinamide

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44
Q

What is the side effect of ethambutol?

A

Colour blindness and visual acuity loss

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45
Q

What would you give to prevent peripheral neuropahty in patients taking pyrazinamide?

A

Pyridoxine (B6)

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46
Q

What are the signs of tension pneumothorax

A

Increases resonance to percussion on affected side
Reduced air entry on affected side
Tracheal deviation AWAY from side of pneumothorax
Tachycardia, Hypotension

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47
Q

Causes of respiratory acidosis

A

Ventilatory depression: Opiates, GBS, obstructive lung disease (asthma, COPD)

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48
Q

Give an example and an indication for the use of H1 receptor antagonists?

A

(antihistamineds)
Fexofenadine- hayfever, urticaria
Chlorphenamine- anaphlactic reaction mx

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49
Q

What CURB 65 scores indicate:
Consider treatment at home
Consider hospital treatment
Consider intensive care treatment

A

0/1= tx home
>/=2 consider hospital
>/=3 consider intensive care

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50
Q

What is the electrolyte disturbance found in sarcoidosis?

A

Hypercalcaemia

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51
Q

What is the antibody associated with goodpasteur’s syndrome?

A

Anti-glomerular basement membrane

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52
Q

What condition are anti CCP antibodies associated with?

A

Rheumatoid arthritis

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53
Q

What conditions are anti-smooth muscle antibodies most commonly associated with

A

AI hepatitis, primary biliary cirrhosis, SLE

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54
Q

What is the formula for calculating untis of alcohol?

A

Volume in Litres x ABV%

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55
Q

What are the components of the 6-in-1 vaccine?

A

Diptheria, teatnus, pertussis

Polio, Hib, Hep B

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56
Q

Give 4 examples of alcohol screening tools

A

AUDIT (Alcohol Use Disorder Identification Test)
CAGE (Cut down, Annoyed, Guilty, Eye opener)
FAST- alcohol harm assessment tool
SADQ - alcohol dependence >31= severe dependence

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57
Q

What are the side effects of tricyclic antidepressants?

A 
Dry Mouth 
Blurred vision
Confusion 
Constipation
Urinary Retention

“Drying up everywhere”

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58
Q

MOA for penicillins?

A

Inhibit bacterial cell wall synthesis

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59
Q

MOA for macrolides?

A

Inhibit protein synthesis by bacteria

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60
Q

MOA for quinolones?

A

Interfere with bacterial DNA replication and transcription

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61
Q

What class of drug is diclofenac?

A

NSAID

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62
Q

What class of drug is phenoxybenzamine?

A

Alpha blocker, long acting (relaxes smooth muscle causing vasodilation)

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63
Q

When might phenoxybenzamine be prescribed?

A

Prior to phaeochromocytoma surgery (surgery can cause a large release of catecholamines- adrenaline-, therefore by pre-blocking alpha receptors with phenoxybenzamine, we prevent massive hypertension)

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64
Q

What are the top causes of infective exacerbation of COPD?

A

Bacterial- *Haemophilius Influenzae, Streptococcus pneumonia

Viral- Rhinovirus

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65
Q

What are the features of a life-threatening asthma attack?

A

“Life-threatening, Low chance survival”

Low PEF <33% 
Low O2 <92% 
Low RR- silent chest, exhaustion 
Low HR, Low BP
Low conscioussness- confusion/coma
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66
Q

Give 2 examples of inhaled corticosteroids?

A

Beclametasone and Priprionate

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67
Q

Give an examples of a leukotriene receptor antagonist?

A

Monteleukast

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68
Q

Give the class and SEs of salbutamol?

A

Class= Beta-2-agonist
SEs: Tachycardia, palpitations, anxiety, tremor.

High dose may cause hypokalaemia

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69
Q

What is the commonest type of primary lung cancer in non-smokers?

A

Adenocarcinoma

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70
Q

What is the commonest type of lung CA associated with smokers?

A

Small cell lung CA

Squamous cell carcinoma

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71
Q

Give the hormones released and subsequent effect for each lung CA:
Small cell lung CA
Squamous cell carcinoma

A

SCLC= ADH (hyponatraemia), ACTH (cushing’s)

Squamous cell CA= PTH (hypercalcaemia)

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72
Q

Which type of lung CA is strongly associated with asbestos exposure?

A

Mesothelioma

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73
Q

What are the 3 classical symptoms of PE?

A

Pleuritic chest pain
SOB
Haemoptysis

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74
Q

Give 2 drugs which may preciptate an asthma attack?

A

Aspirin

Beta blockers

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75
Q 
What class of drugs are the following:
Salbutamol 
Salmeterol 
Becolmetasone 
Ipratropium
A 
Salbutamol= Short acting Beta 2 agonist 
Salmeterol= Long acting Beta 2 agonist 
Beclometasone= Inahled corticosteroid 
Ipratropium= Antimuscarinic
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76
Q

What is the diagnostic investiagtion for sarcoidosis and what do you see?

A

Tissue biopsy

Non-caseating granuloma

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77
Q

What type of hypersensitivity reaction if hypersensitivity pneumonitis?

A

Type 3

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78
Q

Following a diagnosis of epilepsy how long must you be seizure free before you are able to have your license reinstated by DVLA?

A

12 months

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79
Q

Carpal tunnel syndrome effects which nerve?

What are the nerve roots?

A

Median nerve

C5-T1

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80
Q

Name 4 cancers which can metastasise to the brain?

A

Lung
Breast
Kidney
Bowel

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81
Q

Patient presents with stroke, CT confirms it is ischaemia, they first had symptoms 3 hours ago, what is the first stage in management?

A

Give alteplase (ischaemic strokes <4.5hrs)

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82
Q

CT presentation:
Extra-dural
Sub-dural
SAH

A

EDH- biconvex
SDH- crescent
SAH- star

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83
Q

What is the acute treatment of migraine?

A

Sumatriptan

Ibruprofen / NSAID

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84
Q

Which sex does duchenne muscular dystrophy effect and why?

A

Males

X-linked recessive condition

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85
Q

Which medication can be given in Huntington’s disease to manage sx of chorea?

A

Risperidone

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86
Q

Pyridostigmine is used in the treatment of…

A

Myaesthenia gravis (acetylcholinesterase inhibitor)

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87
Q

SC sumatriptan is used in the treatment of…

A

Cluster headche

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88
Q

Reed-Sternberg cells are found in which type of lymphoma?

A

Hodgkin’s lymphoma

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89
Q

Auer rods are found in bone marrow biopsy of which type of leukaemia

A

Acute myeloid leukaemia

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90
Q

What type of infection is malaria and what is the infective organism which causes the most severe form of malaria?

A

Protozoal infection

Plasmodium falciparum

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91
Q

Hydroxycarbamide is a bone marrow suppressive drug used in the treatment of which 2 condiitons?

A

Polycythemia ruba vera

Sickle cell anaemia

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92
Q

What are the pentad of signs and symptoms associated with thrombotic thrombocytopenic purpura?

A 
Microangiopathic haemolytic anaemia 
Decreased platelets 
AKI 
Neurological symptoms (headsaches, palsies, seizure, confusion, coma) 
Fever
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93
Q

What might you see on blood film of patient with thrombotic thrombocytopenic purpura?

A

RBC fragments- schistocytes

94
Q

True or False, patients with thrombotic thrombocytopenic purpura should be treated with platelets?

A

NO- platelets will increase thrombosis

Treat with plasma exchange

95
Q

Patient with confirmed diagnosis of unprovoked DVT should be followed up with which investigations?

A

Thrombophilia testing
Investigation for undiagnosed CA

“Clotting or Cancer”

96
Q 
In what circumstances are the following risk scores used:
CHA2DS2VASc
FRAX
HAS-BLED
QRISK-3
Wells's Score
A

CHA2DS2VASc= risk of stroke for ptx with AF
FRAX= 10 year probability of fracture
HAS-BLED= risk of major bleeding for ptx on anticoagulation to assess risk-benefit in tx AF
QRISK-3= 10 year probability of MI / Stroke
Wells’s Score= (score for DVT / PE depending on which used!)

97
Q

Give several SE of chemotherapy

A 
Alopecia 
N+V 
Constipation/ Diarrhoea
Infertility 
Cytopenia (anaemia, neutropenia, thrombocytopenia)
Secondary malignancy
98
Q

What is meant by cytopenia?

A

One or more of your blood cells is lower than normal

E.g anaemia, neutropenia, thrombocytopenia

99
Q

Give an example of a LMWH?

A

Dalteparin

100
Q

What is the management of a patient with DVT

A

LMWH followed by maintenance on oral anticoagulant e.g warfarin / apixaban

101
Q

Name a NOAC

A

Apixaban / Rivaroxiban

102
Q

CD-20 is only found on which cells of the body?

A

B cells

103
Q

What is the protein target for rituximab?

A

CD20

104
Q

What is the first line treatment for severe/complicated malaria?

A

IV artesunate

alternative if not available is IV quinine + doxycycline

105
Q

Give 3 causes of macroyctic anaemia?

A

Alcohol excess
Liver disease
Hypothyroidism
Pernicious anaemia

106
Q

What is pernicious anaemia

A

AI antibodies against parietal cells therefore decreased production of intrinsic factor therefore decreased Vit B12 absorption therefore macrocytic anaemia

107
Q

What investigations can be done in pernicious anaemia?

A

Parietal cell antibodies,

IF antibodies

108
Q

Which cells of the stomach secrete intrinsic factor?

A

Parietal cells

109
Q

What is the treatment for pernicious anaemia

A

Vit B12 supplements / IM Vit B12 (hydroxocalbamin)

110
Q

What is budd-chiari syndrome?

A

obstruction of hepatic vein (e.g tumour/thrombus) resulting in hepatic ischaemia and eventually liver failure

111
Q

In what circumstance is chlordiazepoxide prescribed?

A

Benzodiazepine given to alcoholics attempting detoxx to prevent seizures

112
Q

What kind of drug is fondaparinux?

A

anticoagulant
This is unfractioned heparin
can be used as an alternative to dalteparin/heparin in PE tx and prophylaxis

113
Q

What is the medical term for ‘liver flap’

A

Asterixis

114
Q

What changes in the nails might indicate liver failure?

A

Clubbing

Leukonychia (white nails)

115
Q

Bouchard’s nodes are found where? Associated with which condition?

A

Proximal interphalangeal joint

Osteoarthritis

116
Q

Describe the pain of acute pancreatitis

A

epigastric pain which radiates to the back

117
Q

What biological marker when raised would indicate a diagnosis of pancreatitis?

A

Elevated Amylase

118
Q

What are the causes of pancreatitis?

A 
GET SMASHED 
Gallstones 
Ethanol excess 
Trauma 
Scorpion stings 
Mumps 
Autoimmune 
Steroids 
Hyperlipidaemia
ERCP / Emboli 
Drugs
119
Q

What is vincent’s angina?

A

Trench mouth
Progressive painful infection of the mouth which causes swelling, ulceration and sloughing off of dead tissue from mouth as a result of an infection starting in the gums.

120
Q

Wernicke’s encephalopathy is caused by a lack of which vitamin?

A

B1 (Thiamine)

121
Q

Wenicke’s encephalopathy is related to which severe syndrome?

A

Korsakoff’s syndrome

122
Q

What are the symptoms of cerebellar disease (DANISH)?

A 
dysdiadokinesis 
ataxia 
nystagmus
intention tremor 
slurred/stacatto speech 
hypotonia
123
Q

Amaurosis fugax classically presents with….

It is caused by….

A

Painless unilateral vision loss secondary to emboli e.g lodged in retinal artery
“curtain coming down”

124
Q

Is glaucoma painful?

A

Yes

125
Q

What is the presentation of glaucoma?

A

Painful eye, blurry vision, halos around objects

126
Q

What is the typical eye condition/presentation associated with MS?

A

Optic neuritis

127
Q

Is retinal vein occlusion painful?

A

No- painless sudden loss of vision

128
Q

What class of drug is clonazepam?

A

Benzodiazepine

129
Q

What is the indication for gabapentin?

A

Focal epilepsy (usually as add-on treatment when other drugs e.g carbamazepine show inadequate control)
Neuropathic pain
Migraine prophylaxis
GAD

130
Q

What is the indication and mechanism of action of rivastigmine?

A 
Dementia (alzheimer's disease)
Cholinesterase inhibitor (butrylcholinesterase and acetylcholinesterase)
131
Q

What kind of seizures would a benzodiazepam be given for?

A

Management of acute seizures

132
Q

What are the medications prescribed for:
Generalised seizures
Focal seizures

A 
Generalised= Sodium valproate and lamotrigine 
Focal= Carbamazepine and lamotrigine (add-on gabapentin next if uncontrolled)
133
Q

What condition commonly occurs with giant cell arteritis?

A

Polymyalgia Rheumatica

134
Q

What is the treatment for GCA?

A

High dose oral predinsolone (40-60mg for 5-7 days) then reduce dose

135
Q

In cases of pre-hospital suspected bacterial meningitis what medication is given?

A

IM benzylpenicillin

136
Q

What is the pathophysiology of cauda equina syndrome?

A

prolapsed disc going into cauda equina and pressing on sacral nerves there

137
Q

What are the red flags for cauda equina syndrome?

A 
legs- severe/progressive bilateral neuro deficit 
urinary- retention +/- incontinence 
foaecal- icontinence 
Saddle anasthesia/parasthesia 
Decreased anal sphincter tone
138
Q

What is the mechanism of action of mannitol?

A

Reduces ICP by setting up an osmotic gradient between the CSF and sub-arachnoid space

139
Q

Give 5 infections which may cause polyneuropathies?

A 
Hep C Viral infection 
Diptheria 
Leprosy 
HIV
Lyme's disease
140
Q

What class of drug is sulfasalazine?

A

DMARD

141
Q

What is sjrogen’s syndrome?

A

Immune destruction of exocrine glands which often presents with arthritis, dry eyes and dry mouth

142
Q

What is the Schirmer test and what is used to diagnose?

A

Placing a strip of paper on the eye to assess tear production, used to diagnose sjrogens syndrome (which presents with dry eyes), alongside lacrimal gland biopsy and antibody testing

143
Q

What tests are used to diagnose sjrogen’s syndrome?

A

Schirmer’s test (strip of paper on eye to test tear production)
Lacrimal gland biopsy
Antibody testing

144
Q

What is arthritis mutilans?

A

Severe form of psoriatic arthritis which causes severe inflammation of hands and feet (pencil in cup X-ray sign)

145
Q 
Which conditions have the following signs on X-ray:
Bamboo spine 
Periarticular erosions 
Pencil in cup 
Osteophytes
A

Bamboo spine = Ankylosing spondylitis
Periarticular erosions = gout
Pencil in cup= psoriatic arthritis
Osteophytes= osteoarthritis

146
Q

Signs/symptoms of ankylosing spondylitis?

A

Aching back pain- wakes at night,
Pain improves with exercise
Loss of movement

147
Q

What is the typical presentation of pseudogout?

A

Acute onset monoarthritis- often in the knee

148
Q

Which medication is used to manage acute gout?

A

Colchicine (cute=colch)

149
Q

What medication is used to manage gout long term?

A

Allopurinol (allo=long)

150
Q

What type of drug is allopurinol?

A

Xanthine oxidase inhibitor

151
Q

What is osteomalacia

A

Adult version of rickets, bones become soft usually due to vitamin D or calcium deficiency

152
Q

T scores which indicate:
Osteopenia
Osteoporosis

A

Osteopenia= -1 to -2.5

Osteoporosis=

153
Q

How does dermatomyositis usually present?

A

Purple rash on face, red rash on knuckles

Arthritis

154
Q

What are the 5 classical signs of inflammation?

A 
Rubor (red)
Dolor (pain) 
Calor (heat)
Tumour (swelling) 
Loss of function
155
Q

Define hyperplasia?

A

Increased tissue size due to increased number of cells

156
Q

Define hypertrophy?

A

Increased tissue size due to increased size of constituent cells

157
Q

Define metaplasia?

A

Change of a cell from one fully differentiated type to a different fully differentiated type

158
Q

Define apoptosis

A

Decreased size of tissue due to programmed cell death

159
Q 
What are the following:
Rhabdomyoma
Rhabdomyosarcoma 
Leiomyoma 
Leiomyosarcoma
A 
Rhabdomyoma= benign striated muscle neoplasm
Rhabdomyosarcoma= malignant striated muscle neoplasm
Leiomyoma= benign smooth muscle neoplasm  
Leiomyosarcoma= malignant smooth muscle neoplasm
160
Q

Which cells predominate during
acute inflammation
chronic inflammation

A

acute= neutrophil polymorphs

chronic= B lymphocytes, T lymphocytes, macrophages

161
Q

Which cells of the immune system release histamine?

A

Mast cells

162
Q

Which cancers typically spread to bone?

A 
5Bs of spread to bone 
Brain 
Bronchus 
Bryroid 
Bidney 
Brostrate
163
Q

What are the 3 types of cardiomyopathy?

A

Restrictive, hypertrophic, dilated

164
Q

Patient with septic shock most likely to be tachycardic or bradycardic?

A

Tachycardic

165
Q

Patient with septic shock most likely to have cold or warm peripheries?

A

Warm peripheries and pyrexial

166
Q

U waves on ECG indicate what diagnosis?

A

Hypokalaemia

167
Q

What feature on ECG indicates unstable angina?

A

ST depression

168
Q

What is Kussmal breathing and when might you see it?

A

Deep laboured breathing- form of hyperventilation meant to get rid of CO2
Seen in DKA

169
Q

What is Grey Turner’s sign?
How long does it take to develop?
What does it indicate?
Commonly accompanied by what other sign?

A

Bruising of the flanks- a sign of retropetironeal haemorrhage
Takes 24-48 hours to develop
Indicates severe attack of acute pancreatitis

Accompanied by Cullen’s sign= bruising around umbilicus

170
Q

What is Cullen’s sign?
How long does it take to develop?
What does it indicate?
Commonly accompanied by what other sign?

A

Superficial swelling and bruising around umbilicus
Takes 24-48hrs to develop
Indicated acute pancreatitis

Accompanied by Grey Turner’s Sign= bruising of flanks

171
Q

Give several risk factors for liver cancer

A

Hep B/C infection
Chronic alcohol use
Non-alcoholic fatty liver disease
Aflatoxin- toxin produced by aspergillus

172
Q

Folic acid is a treatment for which category of anaemias?

A

tx of macrocytic anaemia- stimulates cell division

173
Q

What is the treatment of sideroblastic anaemia?

A

Pyridoxine

174
Q

MGUS stands for…

It is a condition which carries a risk of developing into what condition?

A

MGUS= monoclonal gammopathy of undetermined significance

1% risk per year of developing into myeloma

175
Q

Bite cells are characteristically found in what condition?

A

G6PD deficiency

176
Q

What are the symptoms of myeloma?

A 
CRAB-
Calcium levels raised
Renal impairment- raised creatinine
Anaemia 
Bone- osteoporosis
177
Q

Why do patients with polycythaemia ruba vera present with itching?

A

Abnormal numbers of RBCs stimulate histamine release

178
Q

Give an examples of alpha haemolytic and beta haemolytic strep?

A

Alpha haemolytic strep= strep pneumonia, strep oralis, strep sanguis

Beta haemolytic- strep pyogenes (group A) strep agalactiae (group B)

179
Q 
What microbes are the following agar jels used to culture?
Blood
Charcoal 
Chocolate
Lowenstein-Jensen
MacConkey
A 
Blood= strep e.g haemolytic bacteria
Charcoal = camplyobacter jejuni
Chocolate= haemophilus influenzae, neisseria meningitidis
Lowenstein-Jensen= TB
MacConkey = gram negative bacilli (organisms that ferment lactose)
180
Q

Which microbiology test distinguishes staph from strep?

A

Calase test

181
Q

Alpha haemolytic streptococcus…
Optochinin sensitive= ?
Optochin resistant= ?

A

strep pneumonia

strep viridans

182
Q

What are the stages of the Medicine Research Council’s dyspnea scale?

A

Grade 1= breathless with strenuous exercise
Grade 2= SOB when hurrying/walking up hill
Grade 3= walks slower than people of same age/ stops for breath when walking at own pace on flat
Grade 4= stops for breath after 100m on flat
Grade 5= too breathless to leave house/ breathless when changing clothes

(1- strenuous exercise, 2-hurrying /uphill, 3- slow walker, stops for breath on flat, 4- 100m flat, 5- can’t leave house)

183
Q

What is a penumoconioses and give 3 examples?

A

Group of lung conditions characterised by exposure to minerals, dust or metals e.g silicosis, asbestosis, coal workers lung
(they are occupational lung disorders)

184
Q

What is extrinsic allergic allveolitis and give 2 examples?

A

Lung conditions caused by hypersensitivity reaction to dust e.g bird fanciers lung / farmers lung
(they are occupational lung disorders)

185
Q

Finding on CXR for sarcoidosis?

A

Bilateral hilar lymphadenopathy

186
Q

What is Kartagner’s syndrome?

A

AKA immotile ciliary syndrome, autosomal recessive condition where cilia are defective= causes problems with respiratory and ear infections

187
Q

What are the main infective organisms involved in bronchiectasis?

A

Staph aureus, strep poneumonia

Pseudomonoas aeruginosa, haemophilus influenzae

188
Q

What is the pharmacological management of COPD?

A

If asthmatic/steroid responsive:

1) SABA / SAMA
2) Add ICS + LABA
3) Add LAMA
4) LTOT / prophylactic abx / mucolytics

If non-asthmatic/ non-steroid responsive:

1) SABA / SAMA
2) Add LABA + LAMA
3) LTOT / prophylactic abx / mucolytics

189
Q

What is the commonest cause of secondary hypoadrenalism?

A

long term corticosteroid usage

190
Q

Patient has addison’s disease, what is this and what is the diagnostic investigation?

A

Adrenal insufficiency- AI primary hypoadrenalism
Reduced cortisol, aldosterone and sex hormones
Postural hypotension, tanned, tired, tearful
Give synacthen test

191
Q

What are carcinoid tumours?

What is carcinoid syndrome?

A

Carcinoid tumour- tumour of enterochromaffin cells, commonly in terminal ileum/appendix
Carcinoid syndrome= one the liver is involved. Excess secretion of substance P, insulin, serotonin, ACTH and bradykinin cause a range of symptoms from hyperglycaemia to bronchoconstriction).

192
Q

What is trousseau’s sign and when is it seen?

A

BP cuff inflated above systolic BP for 3 mins causes carpopedal flexion (wrist flexion)
Hypocalcaemia

193
Q

What is chvostek’s sign and when is it seen?

A

Tapping facial nerve in parotid gland causing ipsilateral facial muscle twitch
Hypocalcaemia

194
Q

What is the T score for a patient with osteoporosis?

A

<2.5

195
Q

What is the triad of symptoms for reactive arthritis

A

conjunctivitis - can’t see
urethritis - can’t pee
arthritis- can’t climb a tree

196
Q

Which microbiology test distinguished staph aureus from step pneumoniae?

A

Catalase test
Staph aureus= catalase positive
Strep pneumoniae= catalase negative

197
Q

Name the organism:
Gram +ve cocci
Catalase -ve
Alpha haemolytic

A

Strep poneumoniae

198
Q

Name the organism:
Gram -ve bacilli
Aerobic
Fastidious growth requirements

A

Haemophilous influenzae

199
Q

Name the organism
Gram +ve cocci
Catlase +ve
Coagulase +ve

A

Staph Aureus

200
Q 
Name the organism 
Gram -ve bacilli 
Aerobic 
Simple growth requirements 
MacConkey pink (lactose fermenter)
A

E.Coli

201
Q 
Name the organism 
Gram -ve bacilli 
Aerobic 
Simple growth requirements 
MacConkey pale (non-lactose fermenter)
A

Salmonella

202
Q

How can you tell E.coli and salmonella apart in a lab?

A

MacConkey agar
E.Coli= lactose fermenter= pink
Salmonella= non-lactose fermeneter= pale

203
Q

What are the features on XR on OA and RA

A 
OA= LOSS
Loss of joint space 
Osteophyte formation 
Subchondral sclerosis 
Subchondral cysts 
RA= LESS
Loss of joint space 
Erosions 
Soft tissue swelling 
Soft bones (osteopneia)
204
Q

What are the signs of OA on XR?

A 
"LOSS"
Loss of joint space 
Osteophyte formation 
Subchondral sclerosis 
Subchondral cysts
205
Q

What are the signs of RA on XR?

A 
"LESS"
Loss of joint space
Erosions (bony)
Soft tissue swelling 
Soft bones (osteopenia)
206
Q

What does gout joint fluid aspiration look like on microscopy?

A

“N+N”
Needle-shaped crystals
Negative birefringent under polarised light

207
Q

What does pseudogout fluid aspiration look like on microscopy?

A

P=P
Rhomboid-shaped crystals
‘P’ositive birefringence under polarised light

208
Q

Method of action of naproxen?

A

Non-selective inhibitor of COX 1 and COX 2 enzymes

209
Q

Name 3 signs of RA in the hands?

A

Swann neck deformity
Ulnar devation
Boutonnieere deformity of thumb

210
Q

Name 3 signs of OA in the hands?

A

Heberden’s nodes
Bouchard nodes
Squaring of wrists

211
Q

Name a risk tool used for upper GI bleeding?

A

Glasgow-blacthford score

212
Q

Which gout treatment is for acute attacks? Which is for prevention?

A

Colchicine- now

Allopurinol- preventer

213
Q

What is the primary and secondary treatment of a patient diagnosed with syphilis?

A 
Primary= IM 2.4 megaunits benzathine penicillin
Secondary= PO Azithromycin
214
Q

James is diagnosed with meningococcal meningitis. What prophylactic medication should be given to his housemates?

A

Ciprofloxacin

215
Q

Describe the PR interval and QRS compelxes in WPW?

A

Short PR interval

Wide QRS with delta wave (slurred upstroke to QRS)

216
Q

Normal length of PR interval? QRS?

A

PR interval= 0.12-0.20s (3-5 sml squares)

QRS <0.12 (<3 sml squares)

217
Q

What can cause a wide QRS?

A 
R/L bundle branch block
WPW
Hyperkalaemia 
Ventricular rhythm 
Paced rhyhtm 
TCA poisoning
218
Q

Small height QRS caused by…

A

Pericardial effusion
Raised BMI
Emphysema
Cardiomyopathy

219
Q

Tall QRS caused by,…

A

LVH

Young+Thin+Fit

220
Q

What are 3 main types of SVT?

A

AVNRT
AVRT (e.g WPW)
Atrial tachycardia

221
Q 
What is the purpose of the following scores:
CHA2DS2-VASc
HASBLED
ABCD2
Wells score
QRisk
A

CHA2DS2-VASc= risk of stroke in patients with AF
HASBLED= risk of bleeding for patients on anticoagulants
ABCD2= risk of stroke following suspected TIA
Wells score= risk of DVT/PE (separate scores)
QRisk= cardiovascular disease in next 10 years

222
Q

What class are the following diuretics:
Furosemide
Amiloride
Bendroflumethiazide

A 
Furosemide= loop diurteic 
Amiloride= potassium sparing diuretic 
Bendroflumethiazide= thiazide-like
223
Q

What is Rovsing’s sign? A positive result indicates what diagnosis?

A

Palpation of left lower quadrant increases pain response in right lower quadrant
Positive result indicates appendicitis

224
Q

First line investigation for suspected acromegaly?

Second line if 1st positive?

A

IGF-1

Oral glucose tolerance test

225
Q

First line treatment for parkinson’s which affects QOL?

A

Co-careledopa

combination of leveodopa and carbidopa

226
Q

What is Ramsay-Hunt Syndrome?

A

Form of shingles that affects facial nerve, associarted with rash on outer ear.
Present with unilateral paralysis of face including forehead and eyelid.

227
Q

Nimodipine is given in what cirucumstance?

A

SAH to prevent vasospasm

228
Q

True or false, patients with asthma may have a nocturnal cough?

A

True- at night airways tend to narrow causing increased airway resistance

229
Q

Give 3 causative organisms of reactive arthritis?

A

Chlamydia trachomatis
Salmonella
Shigella

230
Q

Paitent presents with varicocele, you suspect renal cell carcinoma, which vessel is effected?

A

Left renal cancer
Pressing on left renal vein which drains the left gonadal vein

(note the right renal vein does not drain right gonadal vein so varicocele only represents left)

231
Q

What is Brudzinski’s sign?

A

Patients hips and knees flex in response to neck flexion

232
Q

What is kernig’s sign?

A

Pain response elicited by flexing both the knees at hip at 90 degrees
Indicates meningeal irritation e.g SAH / Meningitis

Maud- Phase 2a (1 decks)

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