Phase 4 Flashcards
1
Q
A 68 year old lady is found collapsed in the street. On arrival at the Accident and
Emergency Department she is fully conscious and has no specific symptoms. On
examination she has a regular pulse of 40 beats per minute. Diagnosis? What is the most likely cause of this condition?
A
3rd degree heart block SAN disease (e.g. ischaemic heart disease)
2
Q
A patient with confirmed 3rd degree heart block on ECG gives a history of repeated collapses over several weeks. What treatment does she need to prevent this? Name a medication that could have exacerbated her symptoms.
A
Pacemaker
Beta blocker
3
Q
You are called to the ward to find a patient having a seizure. What medication would you give and by what route?
A
Diazepam IV
4
Q
A patient is in a post-ictal state with impaired consciousness. What 2 actions are necessary for immediate patient safety?
A
Place in recovery position
Protect airway
5
Q
A patient with presumed lung cancer has a seizure. List 2 likely causes of the seizure, and an investigation you could use to confirm these.
A
Cerebral metastasis - CT head
SIADH - plasma osmolality/U+Es
6
Q
State 2 bacteria that are commonly associated with acute exacerbations of COPD
A
Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
7
Q
List two drugs that would be appropriate to give to a patient with a COPD exacerbation via a nebuliser.
What class of drug do they belong to and how do they exert their main effect to
relieve the patient’s symptoms?
A
Salbutamol - B2 agonist - stimulates B2 receptor in bronchial smooth muscle results in bronchodilatation
Ipratropium - antimuscarinic - antagonises action of ACh on muscarinic receptor on bronchial smooth muscle results in bronchodilatation
8
Q
A COPD exacerbation patient remains dsypnoeic after optimal medical management. What may you consider now?
A
NIV - CPAP/BiPAP
9
Q
A child with haemophilia A presents with haemarthrosis. State two methods by which further blood loss could be reduced, one of which
should be mechanical and the other pharmacological.
A
Mechanical: splinting joint
Pharmacological: factor VIII treatment
10
Q
What is the mechanism of inheritance of haemophilia A?
A
X linked recessive
11
Q
What drug could be prescribed pre-operatively in a patient with haemophilia A to reduce the risk of bleeding>
A
Desmopressin/DDAVP
Tranexamic acid
12
Q
State 4 features you may see on AXR in small bowel obstruction
A
Multiple dilated loops of bowel present centrally on XR
No gas within large bowel
Valvulae conniventes visible across whole width of dilated bowel
13
Q
What is the most common cause of SBO? Other causes?
A
Adhesions
Malignancy
Hernia
14
Q
State 4 immediate actions you would take in a patient presenting with SBO
A
Insert NG tube and suction
Insert cannula and give IV fluids
Analgesia
Antibiotics e.g. ceph and met
15
Q
The PSA test can pick up prostate tumours that would never cause symptoms and would mean early treatment-what two points in this mean screening is bad?
A
Length time bias - harmless tumours detected
Unnecessary Rx
16
Q
Why is there not a PSA screening programme in the UK?
A
Many people would have unnecessary biopsies and treatment, many of the cancers diagnosed would be slow growing and wouldn’t shorten life, PSA is unreliable, causes undue worry
17
Q
Give two times when is it appropriate to do a PSA in the UK?
A
Men above the age of 50, suspicious PR findings, monitoring treatment and remission of prostate cancer
18
Q
Old woman in prolonged hospital stay for repeated UTIs. At the end of her treatment she is ready to be discharged when she develops abdo pain with foul smelling diarrhoea.
Most likely organism and why?
A
C diff
Antibiotic therapy long term
19
Q
How do you investigate c diff?
A
Stool sample - send for culture
20
Q
What is the route of spread of c diff? How might you prevent the spread?
A
Faeco-oral via airbourne spores Barrier nursing Single occupancy rooms <90% bed occupancy Good handwashing
21
Q
An 80 year old woman presents to A+E with abdo pain and constipation. What would you exclude with an upright chest xray? Or with an abdominal xray?
A
CXR - bowel perforation
AXR - bowel obstruction
22
Q
An 80 year old woman is constipated. Her Na and Urea are raised and Creatinine is lowered. What could explain these findings?
A
Dehydration
23
Q
How might you manage constipation in the elderly?
A
Ispaghula husk (bulk forming laxatives) Maintain adequate hydration, diet high in fibre, avoid meds causing constipation
24
Q
Name four drugs or classes of drugs which cause constipation
A
Opiates Anticholinergics Calcium supplements CCBs Diuretics
25
How would you investigate bleeding in early pregnancy?
Beta HCG
| USS
26
Name 2 drug treatments for incomplete miscarriage in a Rh-ve woman
Anti D
| Misoprostol
27
A 40 year old woman is admitted with hypercalcaemia. What do you do immediately and why?
ECG as she is at risk of cardiac arrhythmias
28
What are the 2 commonest causes of hypercalcaemia? How can you differentiate between the 2?
Malignancy and hyperparathyroidism
| PTH level
29
Name 3 ways of managing hypercalcaemia
Fluids (normal saline), furosemide, bisphosphonate infusion
30
70 year old man presents with pain in his right calf. Smoker 10 a day. Eases with rest, worsened by exercise. Diagnosis? 3 risk factors?
Intermittent claudication
| Smoking, diabetes, hypertension, hyperlipidaemia, hypercholesterolaemia
31
You decide to measure the ABPI in a patient with intermittent claudication. How do you measure the ABPI? What would you expect it to be?
Lie patient flat. Measure brachial and medial malleolar pulses with Doppler probe. Inflate a BP cuff distal to the pulse and record the pressure at which it is extinguished. Leg/Arm < 0.9 indicates some arterial disease.
32
What drug can be used in intermittent claudication if exercise therapy has not been effective?
Naftidrofuryl oxalate
33
50 year old woman with RA wants to undergo vaginal hysterectomy. Has tingling in her hands. Name 2 signs on examination in pre-op and 2 helpful radiological investigations
Neck extension
Mouth opening
Cervical spine XR
CXR
34
50 year old woman with RA wants to undergo vaginal hysterectomy. On pred and MTX. Name 4 possible complications post op
```
Adrenal crisis
RA produces hypercoagulable state so VTE
Infection risk from MTX and pred
Reduced mobility leads to VTE risk
Rheumatoid lung plus atelectesis leads to infection?
```
35
40 year old man on warfarin for an aortic valve replacement. Has a wisdom tooth extracted a develops bleeding in the socket for the past 24 hours.
What is your immediate priority when assessing him? Name 3 local treatments and 1 systemic treatment.
ABCDE - protect airway because of bleeding
Haemostatic dressing, pressure, cautery
Vitamin K
36
40 year old man on warfarin for an aortic valve replacement. Has a wisdom tooth extracted a develops bleeding in the socket for the past 24 hours. Didn't tell dentist he was on warfarin. What is he at risk of and what should have been done?
Bleeding
| May have needed dental sutures after removal
37
How might you distinguish between testicular torsion and epididymo-orchitis on examination?
Torsion - testicle lies high and transverse, lack of cremasteric reflex
EO - retrotesticular pain, Prehn's sign
38
What investigation could you do to confirm torsion? Why is it important this is done quickly?
Testicular doppler USS - if torsion not surgically corrected in 4h risk of losing testicle. However if seriously suspect torsion don't delay exploratory surgery for doppler
39
Name 2 organisms which may cause epididymo-orchitis. How could you investigate for them?
Chlamydia trachomatis
Neisseria gonorrhoeae
First pass urine for NAAT - also send for MC+S
40
Why do patients with Quinsy get trismus?
Muscular spasm caused by abscess
41
How is Quinsy managed?
Drain abscess
ABx - penicillin, clinda, metronidazole
IV fluids
Analgesia
42
What LN is affected by Quinsy?
Jugulodigastric
43
Name 3 features suspicious of malignancy on ovarian USS
Multiocular, bilateral, free fluid, mixture of cystic and solid
44
What organisms cause meningitis in young adults?
Neisseria meningitidis
Strep pneumoniae
HiB, GBS, listeria
45
What classification system would you use in Hodgkin's lymphoma?
Ann Arbour
46
What is the characteristic histological feature of Hodgkin's lymphoma?
Reed-Sternberg cells
47
Name 4 short term side effects of chemotherapy treatment
```
Nausea/vomiting
Anorexia
Fatigue
Neutropaenia
Hair loss
Easy bruising/bleeding
Constipation
```
48
A patient on chemotherapy presents with neutropaenic sepsis. What treatment would you give?
Broad spectrum ABx e.g. tazocin IV
49
Name 1 long term side effect of chemotherapy
Infertility
Congestive cardiac failure and HTN
Pulmonary fibrosis
Depression/anxiety
50
Name 2 features on examination that would confirm ascites
Abdo distension
Shifting dullness
Fluid thrill
51
What 2 tests could you order to determine the cause of ascites?
Ascitic tap - culture, protein level
USS abdo
LFTs
52
Give 3 signs of chronic liver disease seen on examination of the hands
```
Clubbing
Palmar erythema
Asterixis
Terry's nails
Spider naevi
Dupuytren's contracture
```
53
Give 3 complications of chronic liver disease
Liver failure
Hepatic encephalopathy
Hepatorenal syndrome
Oesophageal varices
54
A 40 year old male presents with painless haematuria. Name 5 tests you could order to determine the cause
```
Cystoscopy
Urine MC+S
Renal tract USS
Noncontrast CT (stones)
U+Es
```
55
What hereditary disease is renal cell carcinoma associated with?
Von Hippel Lindau
56
What is the most likely histological type of RCC?
Clear cell
57
What is a potential curative treatment for RCC?
Radical nephrectomy
58
What treatment is appropriate for Legionnaire's disease?
Azithromycin/ciprofloxacin
59
Give 4 ways to demonstrate Gillick competency
1. Sufficient maturity and intelligence to understand treatment and implications
2. Can understand likely effects and risks
3. Can understand chances of success
4. Can understand other options available
60
Give 2 features of a history that would concur with a diagnosis of stable angina
Central crushing chest pain on exertion
Exacerbated by cold weather, heavy meals, emotion
Relieved by rest
61
Give 4 risk factors for IHD
Diabetes, smoking, hypertension, hyperlipidaemia, positive FH, obesity
62
What 2 tests would a cardiologist order to confirm angina diagnosis?
Stress echo
Coronary angiography
MR cardiogram
63
Give 2 classes of drug with examples that can be used to treat angina
Beta blockers - atenolol
| CCBs - verapamil
64
Give 8 risk factors for T2DM
Age, sex, FHx, Asian ethnicity, obesity, PCOS, hypertension, smoking, gestational DM, antipsychotic use, alcohol intake, sedentary lifestyle
65
A patient is diagnosed with impaired glucose tolerance. What advice would you give to prevent progression to T2DM
Lose weight
Regular exercise
Eat healthy balanced diet
66
Give 2 screening tests that diabetics have
Urinary A:Cr
Diabetic retinal photography
Annual foot check
67
What are 2 pathological features of the airways in asthma?
Hyperresponsiveness
Inflammation of airways
Reversible bronchoconstriction causing airflow obstruction
68
How can asthma be diagnosed on lung function tests?
Obstructive spirometry picture - FEV1/FVC <0.7
PEF variability over 20%
Bronchodilator reversibility test - improvement in FEV1 of over 12%
69
Name 3 factors that affect ulcer healing
```
Blood flow
Infection
Moisture
Diabetes
Smoking
```
70
Name 4 features of acute limb ischaemia
```
Pain
Pallor
Pulseless
Perishingly cold
Paraesthesia
Paralysis
```
71
How can PVD be imaged?
Angiogram (CT)
72
What ABPI value indicates PVD?
<0.9 = some arterial disease
73
Give 3 symptoms and 3 signs of hyperthyroidism
Palpitations, diarrhoea, weight loss, heat intolerance, irregular periods, anxiety
Sweating, goitre, fine tremor, tachycardia
74
What area connects tendon to bone?
Enthesis
75
What name is given to inflammation of entire digit?
Dactylitis
76
What anatomical area is inflamed in the joints of an inflammatory arthritis?
Synovium
77
Where might areas of psoriasis be present that the patient hasn't noticed?
Elbows, knees, scalp, lower back
78
Name 3 features suspicious of inflammatory rather than degenerative arthritis
Symmetrical polyarthritis
Red hot swollen joints
Worst in morning improves with use (>1hr)
Systemic symptoms e.g. fever, fatigue, night sweats
79
Name 4 exacerbating factors for asthma
Cold weather, infection, pets, smoking, house dust mites
80
What 4 things do you do in a cardiac arrest after the patient has recovered (return of spontaneous circulation)?
```
Continue ABCDE approach
Controlled oxygenation and ventilation
12-lead ECG
Treat precipitating cause
Temperature control
Call ITU to admit
```
81
What rhythms are shockable in an arrest?
VF, VT
82
What are the H's and T's in cardiac arrest?
Hypovolaemia, hypoxia, hydrogen (acidosis), hypo/hyperkalaemia, hypoglycaemia, hypothermia
Toxins, tamponade, trauma, tension PTX, thrombosis (e.g. MI/PE)
83
Name 5 physical signs in acromegaly
```
Prognathism
Wide-spaced teeth
Coarse face
Macroglossia
Prominent supraorbital ridges
Spade like hands and feet
CTS
```
84
In a patient with acromegaly what would the results of an OGTT + GH be?
GH levels stay the same (they should decrease)
85
What visual field defect do you get in acromegaly? Where is the lesion and what imaging could you do?
Bitemporal hemianopia
Optic chiasm
MRI
86
How might you manage acromegaly?
Somatostatin analogues - octreotide
| Trans-sphenoidal resection of pituitary adenoma
87
Name 6 signs and 6 symptoms of SLE
```
Malar rash
Discoid rash
Photosensitivity
Raynaud's
Livedo reticularis
Oral ulcers
Pericardial rub
```
```
Arthralgia
Psychosis/seizures
Pleuritic chest pain/pericarditis
Fatigue
Weight loss
Fever
```
88
A patient with SLE has recurrent 1st trimester miscarriages. What is the problem?
Antiphospholipid syndrome
| Recurrent thrombosis in placenta
89
Name 2 drugs used to manage SLE and their class
Methotrexate - DMARD
Prednisolone - corticosteroid
Ibuprofen - NSAID
90
Give 2 medications that can relax the oesophagus
CCBs e.g. diltiazem
Nitroglycerin
Sildenafil
91
List 4 differentials for dysphagia in an 80y old lady
```
Oesophageal stricture
Oesophageal cancer
Achalasia
Stroke/MND
Pharyngeal pouch
Oesophageal candidiasis
```
92
Young gentleman comes in with weight loss, fatigue, abdo pain. He was previously fit and
well. You suspect an Addisonian crisis. Sp02 92%, fever, hypotensive, creps left base.
What abnormalities in 2 cations do you expect to see in his blood count and 1 thing in
the WBC?
3 initial management points?
```
Low Na, raised K
Assess A, B, C
Give IV fluids
Give IV hydrocortisone
Measure and correct blood glucose if required
```
93
Describe the test used to diagnose Addison's disease
Short synACTHen test
Synthetic ACTH is given - measure cortisol before and after
Exclude Addison's if cortisol rises
94
How might you investigate the underlying aetiology of Addison's disease?
CXR: evidence of TB
AXR: adrenal calcification
95
Give 3 benefits of a "box splint" in a fractured leg
Pain relief
Reduces bleeding from femur
Reduces risk of neurovascular injury
Stabilises limb and prevents further displacement of fracture
96
Explain the mechanism of compartment syndrome
Osteofascial membranes divide limbs into separate compartments of muscles
Fracture causes oedema in compartment, increasing compartment pressure
This decreases venous drainage, further increasing compartment pressure
If compartment pressure exceeds capillary pressure this causes ischaemia
This is why loss of pulses is a late sign
97
What is the presentation of compartment syndrome?
Pain disproportionate to clinical findings
Pain on passive muscle stretching
Warm, erythematous, swollen limb
Increased CRT, weak/absent peripheral pulses
Paraesthesia
98
How would you manage compartment syndrome?
Elevate limb
Remove all bandages and splint/remove cast
Fasciotomy
99
How can compartment syndrome be prevented?
Make sure splint/bandage/cast not too tight
Recognise symptoms early and treat
Elevate limb
100
Which imaging is most sensitive for PE?
CTPA (with contrast)
101
A patient has PE after surgery and is to be commenced on rivaroxaban. What is its mechanism of action? How long does he need it for?
```
Factor 10a inhibitor
3 months (as was provoked PE)
```
102
How can you prevent PE in patients post surgery?
TED stockings/intermittent pneumatic compression
Prophylactic dose LMWH
Early mobilisation
103
What is the genetic inheritance of sickle disease?
Autosomal recessive
104
A patient with sickle cell comes in with a chest crisis. What would your initial management be?
Analgesia: IV opiates
Good hydration
O2
Keep warm
FBC, U+E, reticulocytes, BCs, urine dip, CXR
Give ABx before results come back - ceftriaxone
Exchange transfusion if severe
105
Why do people with sickle cell get gallstones?
In people with sickle cell disease, most gallstones are produced from excess bilirubin, which is caused by haemolysis
106
How do you manage sickle cell chronically?
Pen V BD + immunisations
Folate
Hydroxycarbamide if frequent crises
107
How does hydroxycarbamide reduce the frequency of painful crises in sickle cell?
Increases HbF levels
| Improves blood flow and reduces vaso-occlusion
108
Name 4 signs of opiate overdose
```
Pinpoint pupils
Reduced GCS
Reduced resp rate/resp depression
Bradycardia
Vomiting
```
109
Name 4 signs of opiate withdrawal
```
Clammy, cold skin
Vomiting
Disorientation, mood swings
Pallor
Hypotension
```
110
How would you advise an IVDU to protect their health?
Use needle exchanges
Practice safe sex
Engage with addiction services for methadone
111
Why do you measure lactate in sepsis?
Measure of systemic tissue hypoperfusion
112
What investigation can be used to monitor heart failure?
B-type naturetic peptide
113
How do you predict a difficult intubation?
```
Look at oro-facial anatomy
Use mallampati criteria - grade 3/4 suggest difficult intubation
Look for limitation of mouth opening
BMI of 35 or over
Thyromental distance >7cm
```
114
What parts of the WHO checklist do once the patient has arrived for surgery before anaesthetic?
Name, DOB, procedure, check consent form, site marked, allergies
115
Name 3 ways in which the shoulder can be injured after a fall. How would you manage these?
Fracture - clavicle, humerus - pain relief, conservative management
Shoulder dislocations - sedate patient, reduce dislocation, XR, brace
Shoulder separation - ligaments that hold clavicle to acromion tear. Apply ice, wear sling, physio, surgery if severe
Rotator cuff tear - RICE - if complete will need surgery
116
Where in the body can you get a transitional cell carcinoma?
Bladder
| Ureter
117
Which lymph nodes can bladder cancer metastasize to?
Hypogastric
External iliac
Common iliac
118
Name 4 risk factors for bladder cancer
```
Smoking
Alcohol
Dyes - azo dyes
Ionizing radiation
Arsenic
FH
Schistosomiasis
```
119
Name 2 signs of cauda equina on examination of the anal sphincter
Reduced tone
Reduced perianal sensation
Incontinence
120
Name 5 complications of TURP
```
Bleeding
Infection - sepsis
Incontinence
Urinary retention
Retrograde ejaculation
Post-TURP syndrome
Impotence
```
121
What is post-TURP syndrome?
Fluids used to irrigate bladder during procedure are absorbed into prostatic venous sinuses
Causes fluid overload, electrolyte disturbance and hyponatraemia
122
Give 4 first rank symptoms of schizophrenia
3rd person auditory hallucinations
Delusional perception
Thought disorder (insertion, withdrawal, broadcasting, etc)
Passivity phenomenon
123
A man with first episode psychosis is given haloperidol and his jaw locks. What has happened? What would you do to fix it?
Acute dystonic reaction
| Procyclidine IM/IV
124
A man on haloperidol describes a feeling of inner restlessness. What is this called?
Akathisia
125
Name 5 side effects of atypical antipsychotics
```
EPSEs (dystonia, akathisia, parkinsonism, bradykinesia, tardive dyskinesia) - though less frequent than typical antipsychotics
Weight gain
T2DM
Hyperlipidaemia
QTc prolongation
Sexual dysfunction
```
126
Which antibodies do you test for in coeliac disease?
Anti-TTG
| IgA endomysial Abs
127
What are the histological features of coeliac disease?
Villous atrophy
Lymphocyte infiltration of crypts
Crypt hypertrophy
128
Name the 4 fat soluble vitamins and what could happen if you were deficient for each one
A - night blindness
D - rickets
E - ataxia, dysarthria
K - easy bruising, bleeding
129
Where do you take a bone marrow biopsy from?
Posterior iliac crest
130
What 4 features of a breast lump would make you suspect malignancy?
Hard, fixed, irregular lump, doesn't change with menses, growing
Skin tethering, peau d'orange, indrawn nipple, bloody nipple discharge
131
Name 2 signs of bulimia on examination
Calluses/scars on dorsal surface of hand
Loss of dental enamel
Enlargement of parotid glands
132
Name 4 risk factors for bulimia
```
FH
Depression, anxiety
Substance misuse
Traumatic events, environmental stress
Poor self image
```
133
Name 2 symptoms of optic neuritis
Painful ocular movement
Unilateral blurred vision
Loss of colour vision
Worsens on getting in hot bath (Uthoff phenomenon)
134
What antibiotics would you give in meningitis? Prophylaxis for family?
Ceftriaxone IV
| Rifampicin or ciprofloxacin PO
135
What are the CSF findings in bacterial meningitis?
```
Cloudy appearance
Elevated opening pressure
Raised WCC
Low glucose
Raised protein
```
136
Describe the morphology of neisseria meningitidis
Gram negative diplococci
137
Name 3 long term complications of meningitis
```
SIADH
Seizures
Deafness
Blindness
Hydrocephalus
Intellectual deficits
```
138
Where does klebsiella colonise normal people? How about alcoholics?
Normal floral of mouth, skin and intestine
| They aspirate it and get klebsiella pneumonia
139
What antiobiotics could you give for klebsiella pneumonia?
Tazocin
Meropenem
Levofloxacin/ciprofloxacin
140
What is the treatment for delerium tremens?
Diazepam
| Also give Pabrinex
141
A patient with ?IE has a murmur on the left sternal edge. What is the valvular problem?
Tricuspid regurgitation
| Pansystolic murmur
142
Why do you have to give ABx for so long in infective endocarditis?
Valves have a poor blood supply
143
Name 4 risk factors for pre-eclampsia
```
First baby
First baby with new partner
Obesity
FHx
Multiple pregnancy
Pre existing hypertension
Maternal age >40
```
144
Name 4 blood tests and 2 urine tests you would do in pre-eclampsia
FBC, clotting, LFT, uric acid, U+Es
| Urine dip for protein, MC+S, 24h urine collection for protein quantification and Cr clearance
145
What antihypertensive would you use in pre-eclampsia? What could you use to control seizures?
Labetalol
| Magnesium sulphate
146
What are 2 early signs of dementia?
```
Amnesia (short term first)
Poor concentration
Struggling to follow conversation
Confusion about time and place
Mood changes
```
147
What type of dementia presents with a fluctuating course and visual hallucinations?
Lew body dementia
148
What type of blood vessel is involved in a subdural? Why are old people more susceptible to subdurals after minor trauma?
Bridging veins running from hemisphere to saggital sinus
| Brain atrophy makes these veins more susceptible to rupture
149
Give 2 reasons why you would have to drain a subdural in an elderly person
Raised ICP
Focal neurological deficit
Seizures
150
Name 4 local complications of subdural haematoma evacuation
```
Infection
Further haemorrhage
Brain tissue injury
Brain oedema
Seizures
```
151
What are 3 metabolic or biochemical abnormalities you would expect in DKA?
Hyperkalaemia, hyperglycaemia, ketonaemia, acidosis
152
Name 5 steps you would do to manage DKA
```
ACBDE approach
Aggressive fluid resuscitation
Insulin replacement
Potassium replacement
Give maintenance fluids
Catheter to monitor urine output
```
153
Name 4 chronic conditions which could cause ED in a 22 year old man
DM
HTN
Sickle cell
Depression/anxiety
154
What bloods would you do to investigate ED in a 22 year old?
Prolactin
Testosterone
Fasting glucose or HbA1c
Lipid profile
155
Name 3 management strategies for performance anxiety related ED
Psychosexual therapy
Sildenafil
Couples therapy/sensate focus
156
What is the bony landmark at the top of the scrotum?
Pubic tubercle
157
On examination of the scrotum what are the 3 things you palpate?
Testes
Vas deferens
Epididymis
158
You suspect a patient has a hydrocoele. What test can you do in the practice? What test may a urologist do?
Transillumination
| Ultrasound testes
159
What layer of scrotum does a hydrocoele arise from? What embryological structure does it come from?
Tunica vaginalis
| Processus vaginalis
160
Name 4 possible causes of a hydrocoele
Prev surgery
Trauma
Tumour
Infection
161
A pregnant woman is term +13 days. Why is induction indicated?
There is a high rate of still birth in prolonged pregnancy
162
Name 3 parts of the Bishop score
Cervical length, consistency, dilatation
Position of cervix
Head station
163
List 2 ways to induce labour
Prostaglandin pessary followed by oxytocin 6 hours later
| Amniotomy
164
What are 3 reassuring CTG features?
Accelerations
Variability >5 bpm
FHR 110-160
No decelerations
165
Name 2 signs of respiratory distress in an infant
```
Nasal flaring
Intercostal recessions
Subcostal recessions
Grunting
Tracheal tug
```
166
Name 2 signs of bronchiolitis on auscultation
Wheeze (high pitched)
| Fine end expiratory crackles
167
Would you ask for CXR in bronchiolitis?
No, only if diagnostic ambiguity or atypical cause suspected
| You can do nasophargyngeal aspirate and PCR of that to isolate virus
168
Name 3 organisms which can cause bronchiolitis. Which is the most common cause?
```
RSV - vaccinate with palivizumab
Parainfluenza virus
Mycoplasma pneumonia
Rhinovirus
Metapneumovirus
```
169
Name 2 signs of dehydration in a child
Reduced tissue turgor
Reduced UO
Dry mucous membranes
Depressed fontanelle
170
Name 2 triggers for sickle cell crisis
Cold, infection, hypoxia, dehydration, stress, exercise
171
List 3 possible symptoms of vaso-occlusive crisis
Limb pain
Chest pain
Abdo pain
172
A woman presents with a 6 weekk history of bloody diarrhoea. You suspect IBD. What bloods would you order an why?
What other Ix and why?
FBC - to assess whether she is anaemic (Hb) or if there are signs of infection (WCC)
ESR/CRP - inflammation
Blood culture - infection
Faecal calprotectin - marker of IBD
Plain abdo xray - to assess for toxic megacolon
Erect CXR looking for air under diaphragm (perf)
Colonoscopy
173
In the histology of UC...Continuous or patchy inflammation?
Deep or superficial inflammation?
Crypt abscesses rare or common?
Granulomas - frequent or rare? Caseating or non-caseating?
Continuous
Superficial
Common
Rare, non caseating
174
What is your initial treatment and route for an acute flare of UC?
IV hydrocortisone
175
A lady falls off her horse onto her left flank. She how has blood in her urine.
Name 4 aspects of immediate management. How would you investigate the blood in her urine?
```
Protect cervical spine
ABCDE approach
Give fluids
Oxygen
Brief neuro exam
Head to toe evaluation for injury
```
CT with contrast
176
A lady is found to have grade 2 renal trauma after a fall from a horse. How would you manage this? How would you tell the GP to follow up?
Conservative management, monitor U+Es
| Repeat urinalysis in GP to see if haematuria resolving
177
Name 4 symptoms of viral conjunctivitis
Red eye
Discomfort/grittiness
Watery discharge
Slight blurred vision due to discharge
178
Name 4 signs of viral conjunctivitis
```
Conjunctival injection
Conjunctival chemosis
Follicles or papillae
Discharge may be visible
Rarely may have corneal involvement - oedema
```
179
Name 4 differentials for a unilateral red eye
```
Virlal/bacterial conjunctivitis
Anterior uveitis
Acute angle closure glaucoma
Episcleritis
Keratitis
```
180
What is the management of viral conjunctivitis?
Supportive care
Cool compresses, lubricating eye drops
Good hygeine, don't share towels etc
181
A man has family history of renal failure (brother and father had it). On examination
he had bilateral loin masses. What is the diagnosis? What is the mode of inheritance?
Polycystic kidney disease
| Autosomal dominant
182
What is a complication of ADPKD?
Intracranial berry aneurysms leading to SAH
183
What is the definitive management of ADPKD?
Renal transplantation
184
Give 4 common causes for reduced GCS
```
Drugs, alcohol
Hypoglycaemia
Sepsis
Seizure
Head injury - extradural, SAH
```
185
A patient found in the park with a reduced GCS drops his GCS further to 7. What are the management priorities now?
Support his airways using simple devices while you call anaesthetist
CT head as may have evolving bleed - call neurosurgeons
ECG
186
A 20 year old girl presents with RIF pain and you suspect appendicitis. What 2 signs would you try to elicit? What 2 Ix would yo do? Name 2 other causes for her pain
```
Rosving's sign
Psoas sigh
McBurney's sign
FBC, urinalysis/pregnancy test
Ruptured ectopic pregnancy, ovarian cyst accident
```
187
What bloods make up a confusion screen?
```
FBC
CRP
U+E
LFT
Bone profile
B12 and folate
TFTs
Glucose
Coag/INR
```
188
A patient's mum is diagnosed with Alzheimer's. What do you tell her about the inheritance?
In vast majority of cases Alzheimer's isn't inherited
189
What antibiotic is used to treat CAP in the community?
Amoxicillin PO
| Can use doxy or clari if not suitable
190
A patient is diagnosed with Cushing's. What investigation could you do to decide where to look for the problem?
Dexamethasone suppression test
191
What hormone causes an electrolyte imbalance in Cushing's? What receptor does it act on?
Cortisol increases glomerular filtration rate, and renal plasma flow from the kidneys thus increasing phosphate excretion, as well as increasing sodium and water retention and potassium excretion in high amounts acting as aldosterone (in high amounts cortisol is converted to cortisone which acts on mineralcorticoid receptor mimicking the effect of aldosterone).
192
A patient who had previously had acute pancreatitis develops diarrhoea months later. What complication has developed?
Chronic pancreatitis leading to pancreatic exocrine failure
| This leads to reduced production of pancreatic enzymes which leads to inability to break down and absorb food
193
List 2 RFs for knee osteoarthritis
Obesity
| FH
194
List 4 features of OA on XR
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
195
What are the B symptoms in Hodgkin's lymphoma?
Weight loss
Night sweats
Fever
196
How do you initially treat Hodgkin's lymphoma? Relapse?
ABVD regimen
| BMT for relapse
197
Explain 4 pathophysiological mechanisms behind ascites
```
Portal hypertension
Portal vein thrombosis
Lymphoma
Pancreatitis
Renal failure
Congestive heart failure
Malignant ascites
```
198
How can you prevent an oesophageal varices from bleeding?
Give beta blockers
199
Explain how an audiogram works
In the audiology clinic, testing is done with headphones; we call them ‘air conduction thresholds’ as the sound must travel through the air of the ear canal to be heard. This process allows the audiologist to test the full hearing system.
Alternatively, hearing can be tested using a bone conductor – a device that rests on the bone behind the ear (held in place by a metal band stretching over the top of the head). This bone conductor transmits sound vibrations through the bones of the skull directly to the inner ear. This process allows the audiologist to test the hearing of the inner ear directly.
The audiologist would compare the air conduction and bone conduction results to determine where any hearing loss occurs.
200
Explain what a tympanogram measures
A tympanogram is a graphic representation of the relationship between the air pressure in the ear canal and the movement of the eardrum, or tympanic membrane, and the tiny bones in the air-filled middle ear space.
201
What is the main cause of hypokalaemia in DKA?
Insulin drives potassium into cells
202
What is the Parkland formula?
(4xweight in kg) x %burn = fluid requirements over 24h
| Give half of this in first 8h after injury
203
Name 4 red flags in a child with a painful hip
```
Pyrexia
Not weight bearing
Red warm skin over joint
Pain on movement of joint
Tachycardia
```
204
Name 4 differentials for hip pain in children
```
Septic arthritis
SUFE
Transient synovitis/irritable hip
Perthes' disease
DDH (undetected at screening)
```
205
Name 2 investigations you would do for a child with a painful hip
```
XR
BCs
FBC
ESR, CRP
Joint aspirate
```
206
Name 4 features of delirium tremens
Acute confusional state - disorientation, clouding of consciousness, impairment of memory, agitation
Tremor
Visual hallucinations (small things eg. spiders)
Sweating, HTN
207
What medications can be used to facilitate withdrawal from alcohol in people that are dependent?
Naltrexone
Acamprosate
Disulfiram
208
What blood test could be useful in anaphylaxis?
Mast cell tryptase
209
What follow-up would you arrange for a person who had anaphylaxis?
Give them an epi-pen and instruct them on how to use it
| Follow up in immunology clinic
210
What is the pathophysiology of anaphylaxis?
IgE binds to mast cell which causes release of histamine
211
Name 8 symptoms of endometriosis
```
Deep dyspareunia
Menorrhagia
Diarrhoea
Dysmenorrhoea
Infertility
Chronic pelvic pain
Ovulatory pain
Chronic fatigue
Dysuria, haematuria in bladder involvement
```
212
Name 4 sites of endometriosis
```
Ovaries
Pouch of Douglas
Uterosacral ligaments
Cervix, vagina
Bladder
Lung, pleura
GIT
```
213
Name 2 drug treatments for endometriosis
COCP
NSAIDs/paracatamol
GnRH analogues
214
Name 3 organisms that can cause viral meningitis
HSV1 and 2
VZV
Mumps, measles
Coxsackie
215
Name 2 complications of bullous pemphygoid
Infection of skin lesions (bacterial/viral) - sepsis
| Complications of treatment with steroids
216
Name 2 tests used to diagnose bullous pemphygoid
Biopsy (from blister)
217
Name 2 treatments for bullous pemphygoid
Systemic corticosteroids
Topical corticosteroids
Doxycycline PO
218
Name 2 features of WPW on ECG
Delta waves
| Short PR interval
219
Why do you get hyperacusis in Bells palsy?
one of the small protective muscles in the ear, the stapedius, is paralyzed when the 7th nerve is damaged
220
Name 3 causes of proteinuria in children
```
Nephrotic syndrome
Nephritic syndrome
HSP
ATN
Alport syndrome
Pyelonephritis
```
