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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
What is the management of acute pulmonary oedema?
High flow O2 IV furosemide IV morphine/GTN Urgent CXR
26
What class of drug is Goserelin?
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)
27
Give an example of a 5 alpha reductase inhibitor
Finasteride
28
What is the class, indication and mechanism of action of finasteride?
``` 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. ```
29
Give 3 SEs of finasteride?
``` Breast enlargement / tenderness / CA Sex- impotence, loss of libido Hair growth (tx of male-pattern baldness) ```
30
Which drug may be effective for male-pattern baldness?
5 alpha reductase inhibitors | Finasteride
31
What is the definition of impotence?
Inability to sustain an errection sufficient for sexual intercourse or the inability to achieve ejaculation or both
32
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?
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
33
What is the commonest type of renal cell carcinoma?
Clear cell
34
Which empirical Abx should be given for pyelonephritis whilst awaiting MC&S?
Ciprofloxacin or co-amoxiclav | 7 days of: 500mg bd or 500/125mg TDS respectively
35
Commonest cause of pneumonia?
Streptococcus pneumoniae
36
Which cause of pneumonia is an AIDs defining condition?
Pneumocystis jiroveci
37
What type of organism is pneumocystis jiroveci
Fungus
38
Legionella pneumophilia is a cause of atypical pneumonia, it is associated/ caught through...
Infected water supplies and air conditioners
39
Why might patients with legionella pneumophilia infection have hyponatraemia
It's a known cause of SIADH therefore hyponatraemia
40
What is the side effect of Rifampicin?
Red/orange discolouration of urine
41
What is the side effect of Isoniazid?
Peripheral neuropathy
42
What is the side effect of pyrazinamide?
Hyperuricaemia causing gout
43
Which TB medication causes hyperuricaemia and hence is a risk factor for developing gout?
Pyrazinamide
44
What is the side effect of ethambutol?
Colour blindness and visual acuity loss
45
What would you give to prevent peripheral neuropahty in patients taking pyrazinamide?
Pyridoxine (B6)
46
What are the signs of tension pneumothorax
Increases resonance to percussion on affected side Reduced air entry on affected side Tracheal deviation AWAY from side of pneumothorax Tachycardia, Hypotension
47
Causes of respiratory acidosis
Ventilatory depression: Opiates, GBS, obstructive lung disease (asthma, COPD)
48
Give an example and an indication for the use of H1 receptor antagonists?
(antihistamineds) Fexofenadine- hayfever, urticaria Chlorphenamine- anaphlactic reaction mx
49
What CURB 65 scores indicate: Consider treatment at home Consider hospital treatment Consider intensive care treatment
0/1= tx home >/=2 consider hospital >/=3 consider intensive care
50
What is the electrolyte disturbance found in sarcoidosis?
Hypercalcaemia
51
What is the antibody associated with goodpasteur's syndrome?
Anti-glomerular basement membrane
52
What condition are anti CCP antibodies associated with?
Rheumatoid arthritis
53
What conditions are anti-smooth muscle antibodies most commonly associated with
AI hepatitis, primary biliary cirrhosis, SLE
54
What is the formula for calculating untis of alcohol?
Volume in Litres x ABV%
55
What are the components of the 6-in-1 vaccine?
Diptheria, teatnus, pertussis | Polio, Hib, Hep B
56
Give 4 examples of alcohol screening tools
AUDIT (Alcohol Use Disorder Identification Test) CAGE (Cut down, Annoyed, Guilty, Eye opener) FAST- alcohol harm assessment tool SADQ - alcohol dependence >31= severe dependence
57
What are the side effects of tricyclic antidepressants?
``` Dry Mouth Blurred vision Confusion Constipation Urinary Retention ``` "Drying up everywhere"
58
MOA for penicillins?
Inhibit bacterial cell wall synthesis
59
MOA for macrolides?
Inhibit protein synthesis by bacteria
60
MOA for quinolones?
Interfere with bacterial DNA replication and transcription
61
What class of drug is diclofenac?
NSAID
62
What class of drug is phenoxybenzamine?
Alpha blocker, long acting (relaxes smooth muscle causing vasodilation)
63
When might phenoxybenzamine be prescribed?
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)
64
What are the top causes of infective exacerbation of COPD?
Bacterial- *Haemophilius Influenzae, Streptococcus pneumonia Viral- Rhinovirus
65
What are the features of a life-threatening asthma attack?
"Life-threatening, Low chance survival" ``` Low PEF <33% Low O2 <92% Low RR- silent chest, exhaustion Low HR, Low BP Low conscioussness- confusion/coma ```
66
Give 2 examples of inhaled corticosteroids?
Beclametasone and Priprionate
67
Give an examples of a leukotriene receptor antagonist?
Monteleukast
68
Give the class and SEs of salbutamol?
Class= Beta-2-agonist SEs: Tachycardia, palpitations, anxiety, tremor. High dose may cause hypokalaemia
69
What is the commonest type of primary lung cancer in non-smokers?
Adenocarcinoma
70
What is the commonest type of lung CA associated with smokers?
Small cell lung CA | Squamous cell carcinoma
71
Give the hormones released and subsequent effect for each lung CA: Small cell lung CA Squamous cell carcinoma
SCLC= ADH (hyponatraemia), ACTH (cushing's) | Squamous cell CA= PTH (hypercalcaemia)
72
Which type of lung CA is strongly associated with asbestos exposure?
Mesothelioma
73
What are the 3 classical symptoms of PE?
Pleuritic chest pain SOB Haemoptysis
74
Give 2 drugs which may preciptate an asthma attack?
Aspirin | Beta blockers
75
``` What class of drugs are the following: Salbutamol Salmeterol Becolmetasone Ipratropium ```
``` Salbutamol= Short acting Beta 2 agonist Salmeterol= Long acting Beta 2 agonist Beclometasone= Inahled corticosteroid Ipratropium= Antimuscarinic ```
76
What is the diagnostic investiagtion for sarcoidosis and what do you see?
Tissue biopsy | Non-caseating granuloma
77
What type of hypersensitivity reaction if hypersensitivity pneumonitis?
Type 3
78
Following a diagnosis of epilepsy how long must you be seizure free before you are able to have your license reinstated by DVLA?
12 months
79
Carpal tunnel syndrome effects which nerve? | What are the nerve roots?
Median nerve | C5-T1
80
Name 4 cancers which can metastasise to the brain?
Lung Breast Kidney Bowel
81
Patient presents with stroke, CT confirms it is ischaemia, they first had symptoms 3 hours ago, what is the first stage in management?
Give alteplase (ischaemic strokes <4.5hrs)
82
CT presentation: Extra-dural Sub-dural SAH
EDH- biconvex SDH- crescent SAH- star
83
What is the acute treatment of migraine?
Sumatriptan | Ibruprofen / NSAID
84
Which sex does duchenne muscular dystrophy effect and why?
Males | X-linked recessive condition
85
Which medication can be given in Huntington's disease to manage sx of chorea?
Risperidone
86
Pyridostigmine is used in the treatment of...
Myaesthenia gravis (acetylcholinesterase inhibitor)
87
SC sumatriptan is used in the treatment of...
Cluster headche
88
Reed-Sternberg cells are found in which type of lymphoma?
Hodgkin's lymphoma
89
Auer rods are found in bone marrow biopsy of which type of leukaemia
Acute myeloid leukaemia
90
What type of infection is malaria and what is the infective organism which causes the most severe form of malaria?
Protozoal infection | Plasmodium falciparum
91
Hydroxycarbamide is a bone marrow suppressive drug used in the treatment of which 2 condiitons?
Polycythemia ruba vera | Sickle cell anaemia
92
What are the pentad of signs and symptoms associated with thrombotic thrombocytopenic purpura?
``` Microangiopathic haemolytic anaemia Decreased platelets AKI Neurological symptoms (headsaches, palsies, seizure, confusion, coma) Fever ```
93
What might you see on blood film of patient with thrombotic thrombocytopenic purpura?
RBC fragments- schistocytes
94
True or False, patients with thrombotic thrombocytopenic purpura should be treated with platelets?
NO- platelets will increase thrombosis | Treat with plasma exchange
95
Patient with confirmed diagnosis of unprovoked DVT should be followed up with which investigations?
Thrombophilia testing Investigation for undiagnosed CA "Clotting or Cancer"
96
``` In what circumstances are the following risk scores used: CHA2DS2VASc FRAX HAS-BLED QRISK-3 Wells's Score ```
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
Give several SE of chemotherapy
``` Alopecia N+V Constipation/ Diarrhoea Infertility Cytopenia (anaemia, neutropenia, thrombocytopenia) Secondary malignancy ```
98
What is meant by cytopenia?
One or more of your blood cells is lower than normal | E.g anaemia, neutropenia, thrombocytopenia
99
Give an example of a LMWH?
Dalteparin
100
What is the management of a patient with DVT
LMWH followed by maintenance on oral anticoagulant e.g warfarin / apixaban
101
Name a NOAC
Apixaban / Rivaroxiban
102
CD-20 is only found on which cells of the body?
B cells
103
What is the protein target for rituximab?
CD20
104
What is the first line treatment for severe/complicated malaria?
IV artesunate | alternative if not available is IV quinine + doxycycline
105
Give 3 causes of macroyctic anaemia?
Alcohol excess Liver disease Hypothyroidism Pernicious anaemia
106
What is pernicious anaemia
AI antibodies against parietal cells therefore decreased production of intrinsic factor therefore decreased Vit B12 absorption therefore macrocytic anaemia
107
What investigations can be done in pernicious anaemia?
Parietal cell antibodies, | IF antibodies
108
Which cells of the stomach secrete intrinsic factor?
Parietal cells
109
What is the treatment for pernicious anaemia
Vit B12 supplements / IM Vit B12 (hydroxocalbamin)
110
What is budd-chiari syndrome?
obstruction of hepatic vein (e.g tumour/thrombus) resulting in hepatic ischaemia and eventually liver failure
111
In what circumstance is chlordiazepoxide prescribed?
Benzodiazepine given to alcoholics attempting detoxx to prevent seizures
112
What kind of drug is fondaparinux?
anticoagulant This is unfractioned heparin can be used as an alternative to dalteparin/heparin in PE tx and prophylaxis
113
What is the medical term for 'liver flap'
Asterixis
114
What changes in the nails might indicate liver failure?
Clubbing | Leukonychia (white nails)
115
Bouchard's nodes are found where? Associated with which condition?
Proximal interphalangeal joint | Osteoarthritis
116
Describe the pain of acute pancreatitis
epigastric pain which radiates to the back
117
What biological marker when raised would indicate a diagnosis of pancreatitis?
Elevated Amylase
118
What are the causes of pancreatitis?
``` GET SMASHED Gallstones Ethanol excess Trauma Scorpion stings Mumps Autoimmune Steroids Hyperlipidaemia ERCP / Emboli Drugs ```
119
What is vincent's angina?
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
Wernicke's encephalopathy is caused by a lack of which vitamin?
B1 (Thiamine)
121
Wenicke's encephalopathy is related to which severe syndrome?
Korsakoff's syndrome
122
What are the symptoms of cerebellar disease (DANISH)?
``` dysdiadokinesis ataxia nystagmus intention tremor slurred/stacatto speech hypotonia ```
123
Amaurosis fugax classically presents with.... | It is caused by....
Painless unilateral vision loss secondary to emboli e.g lodged in retinal artery "curtain coming down"
124
Is glaucoma painful?
Yes
125
What is the presentation of glaucoma?
Painful eye, blurry vision, halos around objects
126
What is the typical eye condition/presentation associated with MS?
Optic neuritis
127
Is retinal vein occlusion painful?
No- painless sudden loss of vision
128
What class of drug is clonazepam?
Benzodiazepine
129
What is the indication for gabapentin?
Focal epilepsy (usually as add-on treatment when other drugs e.g carbamazepine show inadequate control) Neuropathic pain Migraine prophylaxis GAD
130
What is the indication and mechanism of action of rivastigmine?
``` Dementia (alzheimer's disease) Cholinesterase inhibitor (butrylcholinesterase and acetylcholinesterase) ```
131
What kind of seizures would a benzodiazepam be given for?
Management of acute seizures
132
What are the medications prescribed for: Generalised seizures Focal seizures
``` Generalised= Sodium valproate and lamotrigine Focal= Carbamazepine and lamotrigine (add-on gabapentin next if uncontrolled) ```
133
What condition commonly occurs with giant cell arteritis?
Polymyalgia Rheumatica
134
What is the treatment for GCA?
High dose oral predinsolone (40-60mg for 5-7 days) then reduce dose
135
In cases of pre-hospital suspected bacterial meningitis what medication is given?
IM benzylpenicillin
136
What is the pathophysiology of cauda equina syndrome?
prolapsed disc going into cauda equina and pressing on sacral nerves there
137
What are the red flags for cauda equina syndrome?
``` legs- severe/progressive bilateral neuro deficit urinary- retention +/- incontinence foaecal- icontinence Saddle anasthesia/parasthesia Decreased anal sphincter tone ```
138
What is the mechanism of action of mannitol?
Reduces ICP by setting up an osmotic gradient between the CSF and sub-arachnoid space
139
Give 5 infections which may cause polyneuropathies?
``` Hep C Viral infection Diptheria Leprosy HIV Lyme's disease ```
140
What class of drug is sulfasalazine?
DMARD
141
What is sjrogen's syndrome?
Immune destruction of exocrine glands which often presents with arthritis, dry eyes and dry mouth
142
What is the Schirmer test and what is used to diagnose?
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
What tests are used to diagnose sjrogen's syndrome?
Schirmer's test (strip of paper on eye to test tear production) Lacrimal gland biopsy Antibody testing
144
What is arthritis mutilans?
Severe form of psoriatic arthritis which causes severe inflammation of hands and feet (pencil in cup X-ray sign)
145
``` Which conditions have the following signs on X-ray: Bamboo spine Periarticular erosions Pencil in cup Osteophytes ```
Bamboo spine = Ankylosing spondylitis Periarticular erosions = gout Pencil in cup= psoriatic arthritis Osteophytes= osteoarthritis
146
Signs/symptoms of ankylosing spondylitis?
Aching back pain- wakes at night, Pain improves with exercise Loss of movement
147
What is the typical presentation of pseudogout?
Acute onset monoarthritis- often in the knee
148
Which medication is used to manage acute gout?
Colchicine (cute=colch)
149
What medication is used to manage gout long term?
Allopurinol (allo=long)
150
What type of drug is allopurinol?
Xanthine oxidase inhibitor
151
What is osteomalacia
Adult version of rickets, bones become soft usually due to vitamin D or calcium deficiency
152
T scores which indicate: Osteopenia Osteoporosis
Osteopenia= -1 to -2.5 | Osteoporosis=
153
How does dermatomyositis usually present?
Purple rash on face, red rash on knuckles | Arthritis
154
What are the 5 classical signs of inflammation?
``` Rubor (red) Dolor (pain) Calor (heat) Tumour (swelling) Loss of function ```
155
Define hyperplasia?
Increased tissue size due to increased number of cells
156
Define hypertrophy?
Increased tissue size due to increased size of constituent cells
157
Define metaplasia?
Change of a cell from one fully differentiated type to a different fully differentiated type
158
Define apoptosis
Decreased size of tissue due to programmed cell death
159
``` What are the following: Rhabdomyoma Rhabdomyosarcoma Leiomyoma Leiomyosarcoma ```
``` Rhabdomyoma= benign striated muscle neoplasm Rhabdomyosarcoma= malignant striated muscle neoplasm Leiomyoma= benign smooth muscle neoplasm Leiomyosarcoma= malignant smooth muscle neoplasm ```
160
Which cells predominate during acute inflammation chronic inflammation
acute= neutrophil polymorphs chronic= B lymphocytes, T lymphocytes, macrophages
161
Which cells of the immune system release histamine?
Mast cells
162
Which cancers typically spread to bone?
``` 5Bs of spread to bone Brain Bronchus Bryroid Bidney Brostrate ```
163
What are the 3 types of cardiomyopathy?
Restrictive, hypertrophic, dilated
164
Patient with septic shock most likely to be tachycardic or bradycardic?
Tachycardic
165
Patient with septic shock most likely to have cold or warm peripheries?
Warm peripheries and pyrexial
166
U waves on ECG indicate what diagnosis?
Hypokalaemia
167
What feature on ECG indicates unstable angina?
ST depression
168
What is Kussmal breathing and when might you see it?
Deep laboured breathing- form of hyperventilation meant to get rid of CO2 Seen in DKA
169
What is Grey Turner's sign? How long does it take to develop? What does it indicate? Commonly accompanied by what other sign?
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
What is Cullen's sign? How long does it take to develop? What does it indicate? Commonly accompanied by what other sign?
Superficial swelling and bruising around umbilicus Takes 24-48hrs to develop Indicated acute pancreatitis Accompanied by Grey Turner's Sign= bruising of flanks
171
Give several risk factors for liver cancer
Hep B/C infection Chronic alcohol use Non-alcoholic fatty liver disease Aflatoxin- toxin produced by aspergillus
172
Folic acid is a treatment for which category of anaemias?
tx of macrocytic anaemia- stimulates cell division
173
What is the treatment of sideroblastic anaemia?
Pyridoxine
174
MGUS stands for... | It is a condition which carries a risk of developing into what condition?
MGUS= monoclonal gammopathy of undetermined significance | 1% risk per year of developing into myeloma
175
Bite cells are characteristically found in what condition?
G6PD deficiency
176
What are the symptoms of myeloma?
``` CRAB- Calcium levels raised Renal impairment- raised creatinine Anaemia Bone- osteoporosis ```
177
Why do patients with polycythaemia ruba vera present with itching?
Abnormal numbers of RBCs stimulate histamine release
178
Give an examples of alpha haemolytic and beta haemolytic strep?
Alpha haemolytic strep= strep pneumonia, strep oralis, strep sanguis Beta haemolytic- strep pyogenes (group A) strep agalactiae (group B)
179
``` What microbes are the following agar jels used to culture? Blood Charcoal Chocolate Lowenstein-Jensen MacConkey ```
``` 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
Which microbiology test distinguishes staph from strep?
Calase test
181
Alpha haemolytic streptococcus... Optochinin sensitive= ? Optochin resistant= ?
strep pneumonia | strep viridans
182
What are the stages of the Medicine Research Council's dyspnea scale?
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
What is a penumoconioses and give 3 examples?
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
What is extrinsic allergic allveolitis and give 2 examples?
Lung conditions caused by hypersensitivity reaction to dust e.g bird fanciers lung / farmers lung (they are occupational lung disorders)
185
Finding on CXR for sarcoidosis?
Bilateral hilar lymphadenopathy
186
What is Kartagner's syndrome?
AKA immotile ciliary syndrome, autosomal recessive condition where cilia are defective= causes problems with respiratory and ear infections
187
What are the main infective organisms involved in bronchiectasis?
Staph aureus, strep poneumonia | Pseudomonoas aeruginosa, haemophilus influenzae
188
What is the pharmacological management of COPD?
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
What is the commonest cause of secondary hypoadrenalism?
long term corticosteroid usage
190
Patient has addison's disease, what is this and what is the diagnostic investigation?
Adrenal insufficiency- AI primary hypoadrenalism Reduced cortisol, aldosterone and sex hormones Postural hypotension, tanned, tired, tearful Give synacthen test
191
What are carcinoid tumours? | What is carcinoid syndrome?
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
What is trousseau's sign and when is it seen?
BP cuff inflated above systolic BP for 3 mins causes carpopedal flexion (wrist flexion) Hypocalcaemia
193
What is chvostek's sign and when is it seen?
Tapping facial nerve in parotid gland causing ipsilateral facial muscle twitch Hypocalcaemia
194
What is the T score for a patient with osteoporosis?
<2.5
195
What is the triad of symptoms for reactive arthritis
conjunctivitis - can't see urethritis - can't pee arthritis- can't climb a tree
196
Which microbiology test distinguished staph aureus from step pneumoniae?
Catalase test Staph aureus= catalase positive Strep pneumoniae= catalase negative
197
Name the organism: Gram +ve cocci Catalase -ve Alpha haemolytic
Strep poneumoniae
198
Name the organism: Gram -ve bacilli Aerobic Fastidious growth requirements
Haemophilous influenzae
199
Name the organism Gram +ve cocci Catlase +ve Coagulase +ve
Staph Aureus
200
``` Name the organism Gram -ve bacilli Aerobic Simple growth requirements MacConkey pink (lactose fermenter) ```
E.Coli
201
``` Name the organism Gram -ve bacilli Aerobic Simple growth requirements MacConkey pale (non-lactose fermenter) ```
Salmonella
202
How can you tell E.coli and salmonella apart in a lab?
MacConkey agar E.Coli= lactose fermenter= pink Salmonella= non-lactose fermeneter= pale
203
What are the features on XR on OA and RA
``` 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
What are the signs of OA on XR?
``` "LOSS" Loss of joint space Osteophyte formation Subchondral sclerosis Subchondral cysts ```
205
What are the signs of RA on XR?
``` "LESS" Loss of joint space Erosions (bony) Soft tissue swelling Soft bones (osteopenia) ```
206
What does gout joint fluid aspiration look like on microscopy?
"N+N" Needle-shaped crystals Negative birefringent under polarised light
207
What does pseudogout fluid aspiration look like on microscopy?
P=P Rhomboid-shaped crystals 'P'ositive birefringence under polarised light
208
Method of action of naproxen?
Non-selective inhibitor of COX 1 and COX 2 enzymes
209
Name 3 signs of RA in the hands?
Swann neck deformity Ulnar devation Boutonnieere deformity of thumb
210
Name 3 signs of OA in the hands?
Heberden's nodes Bouchard nodes Squaring of wrists
211
Name a risk tool used for upper GI bleeding?
Glasgow-blacthford score
212
Which gout treatment is for acute attacks? Which is for prevention?
Colchicine- now | Allopurinol- preventer
213
What is the primary and secondary treatment of a patient diagnosed with syphilis?
``` Primary= IM 2.4 megaunits benzathine penicillin Secondary= PO Azithromycin ```
214
James is diagnosed with meningococcal meningitis. What prophylactic medication should be given to his housemates?
Ciprofloxacin
215
Describe the PR interval and QRS compelxes in WPW?
Short PR interval | Wide QRS with delta wave (slurred upstroke to QRS)
216
Normal length of PR interval? QRS?
PR interval= 0.12-0.20s (3-5 sml squares) | QRS <0.12 (<3 sml squares)
217
What can cause a wide QRS?
``` R/L bundle branch block WPW Hyperkalaemia Ventricular rhythm Paced rhyhtm TCA poisoning ```
218
Small height QRS caused by...
Pericardial effusion Raised BMI Emphysema Cardiomyopathy
219
Tall QRS caused by,...
LVH | Young+Thin+Fit
220
What are 3 main types of SVT?
AVNRT AVRT (e.g WPW) Atrial tachycardia
221
``` What is the purpose of the following scores: CHA2DS2-VASc HASBLED ABCD2 Wells score QRisk ```
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
What class are the following diuretics: Furosemide Amiloride Bendroflumethiazide
``` Furosemide= loop diurteic Amiloride= potassium sparing diuretic Bendroflumethiazide= thiazide-like ```
223
What is Rovsing's sign? A positive result indicates what diagnosis?
Palpation of left lower quadrant increases pain response in right lower quadrant Positive result indicates appendicitis
224
First line investigation for suspected acromegaly? | Second line if 1st positive?
IGF-1 Oral glucose tolerance test
225
First line treatment for parkinson's which affects QOL?
Co-careledopa | combination of leveodopa and carbidopa
226
What is Ramsay-Hunt Syndrome?
Form of shingles that affects facial nerve, associarted with rash on outer ear. Present with unilateral paralysis of face including forehead and eyelid.
227
Nimodipine is given in what cirucumstance?
SAH to prevent vasospasm
228
True or false, patients with asthma may have a nocturnal cough?
True- at night airways tend to narrow causing increased airway resistance
229
Give 3 causative organisms of reactive arthritis?
Chlamydia trachomatis Salmonella Shigella
230
Paitent presents with varicocele, you suspect renal cell carcinoma, which vessel is effected?
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
What is Brudzinski's sign?
Patients hips and knees flex in response to neck flexion
232
What is kernig's sign?
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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