Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

finals > Phase 4 > Flashcards

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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

State 2 bacteria that are commonly associated with acute exacerbations of COPD

A

Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A COPD exacerbation patient remains dsypnoeic after optimal medical management. What may you consider now?

A

NIV - CPAP/BiPAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the mechanism of inheritance of haemophilia A?

A

X linked recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common cause of SBO? Other causes?

A

Adhesions
Malignancy
Hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you investigate c diff?

A

Stool sample - send for culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name four drugs or classes of drugs which cause constipation

A 
Opiates
Anticholinergics
Calcium supplements
CCBs
Diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How would you investigate bleeding in early pregnancy?

A

Beta HCG

USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Name 2 drug treatments for incomplete miscarriage in a Rh-ve woman

A

Anti D

Misoprostol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

A 40 year old woman is admitted with hypercalcaemia. What do you do immediately and why?

A

ECG as she is at risk of cardiac arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the 2 commonest causes of hypercalcaemia? How can you differentiate between the 2?

A

Malignancy and hyperparathyroidism

PTH level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Name 3 ways of managing hypercalcaemia

A

Fluids (normal saline), furosemide, bisphosphonate infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

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?

A

Intermittent claudication

Smoking, diabetes, hypertension, hyperlipidaemia, hypercholesterolaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

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?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What drug can be used in intermittent claudication if exercise therapy has not been effective?

A

Naftidrofuryl oxalate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

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

A

Neck extension
Mouth opening
Cervical spine XR
CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

50 year old woman with RA wants to undergo vaginal hysterectomy. On pred and MTX. Name 4 possible complications post op

A 
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?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

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.

A

ABCDE - protect airway because of bleeding
Haemostatic dressing, pressure, cautery
Vitamin K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

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?

A

Bleeding

May have needed dental sutures after removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How might you distinguish between testicular torsion and epididymo-orchitis on examination?

A

Torsion - testicle lies high and transverse, lack of cremasteric reflex
EO - retrotesticular pain, Prehn’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What investigation could you do to confirm torsion? Why is it important this is done quickly?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Name 2 organisms which may cause epididymo-orchitis. How could you investigate for them?

A

Chlamydia trachomatis
Neisseria gonorrhoeae
First pass urine for NAAT - also send for MC+S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Why do patients with Quinsy get trismus?

A

Muscular spasm caused by abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is Quinsy managed?

A

Drain abscess
ABx - penicillin, clinda, metronidazole
IV fluids
Analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What LN is affected by Quinsy?

A

Jugulodigastric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Name 3 features suspicious of malignancy on ovarian USS

A

Multiocular, bilateral, free fluid, mixture of cystic and solid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What organisms cause meningitis in young adults?

A

Neisseria meningitidis
Strep pneumoniae
HiB, GBS, listeria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What classification system would you use in Hodgkin’s lymphoma?

A

Ann Arbour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the characteristic histological feature of Hodgkin’s lymphoma?

A

Reed-Sternberg cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Name 4 short term side effects of chemotherapy treatment

A 
Nausea/vomiting
Anorexia
Fatigue
Neutropaenia
Hair loss
Easy bruising/bleeding
Constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

A patient on chemotherapy presents with neutropaenic sepsis. What treatment would you give?

A

Broad spectrum ABx e.g. tazocin IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Name 1 long term side effect of chemotherapy

A

Infertility
Congestive cardiac failure and HTN
Pulmonary fibrosis
Depression/anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Name 2 features on examination that would confirm ascites

A

Abdo distension
Shifting dullness
Fluid thrill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What 2 tests could you order to determine the cause of ascites?

A

Ascitic tap - culture, protein level
USS abdo
LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Give 3 signs of chronic liver disease seen on examination of the hands

A 
Clubbing
Palmar erythema
Asterixis
Terry's nails
Spider naevi
Dupuytren's contracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Give 3 complications of chronic liver disease

A

Liver failure
Hepatic encephalopathy
Hepatorenal syndrome
Oesophageal varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

A 40 year old male presents with painless haematuria. Name 5 tests you could order to determine the cause

A 
Cystoscopy
Urine MC+S
Renal tract USS
Noncontrast CT (stones)
U+Es
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What hereditary disease is renal cell carcinoma associated with?

A

Von Hippel Lindau

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the most likely histological type of RCC?

A

Clear cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is a potential curative treatment for RCC?

A

Radical nephrectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What treatment is appropriate for Legionnaire’s disease?

A

Azithromycin/ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Give 4 ways to demonstrate Gillick competency

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Give 2 features of a history that would concur with a diagnosis of stable angina

A

Central crushing chest pain on exertion
Exacerbated by cold weather, heavy meals, emotion
Relieved by rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Give 4 risk factors for IHD

A

Diabetes, smoking, hypertension, hyperlipidaemia, positive FH, obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What 2 tests would a cardiologist order to confirm angina diagnosis?

A

Stress echo
Coronary angiography
MR cardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Give 2 classes of drug with examples that can be used to treat angina

A

Beta blockers - atenolol

CCBs - verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Give 8 risk factors for T2DM

A

Age, sex, FHx, Asian ethnicity, obesity, PCOS, hypertension, smoking, gestational DM, antipsychotic use, alcohol intake, sedentary lifestyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

A patient is diagnosed with impaired glucose tolerance. What advice would you give to prevent progression to T2DM

A

Lose weight
Regular exercise
Eat healthy balanced diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Give 2 screening tests that diabetics have

A

Urinary A:Cr
Diabetic retinal photography
Annual foot check

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are 2 pathological features of the airways in asthma?

A

Hyperresponsiveness
Inflammation of airways
Reversible bronchoconstriction causing airflow obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How can asthma be diagnosed on lung function tests?

A

Obstructive spirometry picture - FEV1/FVC <0.7
PEF variability over 20%
Bronchodilator reversibility test - improvement in FEV1 of over 12%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Name 3 factors that affect ulcer healing

A 
Blood flow
Infection
Moisture
Diabetes
Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Name 4 features of acute limb ischaemia

A 
Pain
Pallor
Pulseless
Perishingly cold
Paraesthesia
Paralysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How can PVD be imaged?

A

Angiogram (CT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What ABPI value indicates PVD?

A

<0.9 = some arterial disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Give 3 symptoms and 3 signs of hyperthyroidism

A

Palpitations, diarrhoea, weight loss, heat intolerance, irregular periods, anxiety
Sweating, goitre, fine tremor, tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What area connects tendon to bone?

A

Enthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What name is given to inflammation of entire digit?

A

Dactylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What anatomical area is inflamed in the joints of an inflammatory arthritis?

A

Synovium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Where might areas of psoriasis be present that the patient hasn’t noticed?

A

Elbows, knees, scalp, lower back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Name 3 features suspicious of inflammatory rather than degenerative arthritis

A

Symmetrical polyarthritis
Red hot swollen joints
Worst in morning improves with use (>1hr)
Systemic symptoms e.g. fever, fatigue, night sweats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Name 4 exacerbating factors for asthma

A

Cold weather, infection, pets, smoking, house dust mites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What 4 things do you do in a cardiac arrest after the patient has recovered (return of spontaneous circulation)?

A 
Continue ABCDE approach
Controlled oxygenation and ventilation
12-lead ECG
Treat precipitating cause
Temperature control 
Call ITU to admit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What rhythms are shockable in an arrest?

A

VF, VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What are the H’s and T’s in cardiac arrest?

A

Hypovolaemia, hypoxia, hydrogen (acidosis), hypo/hyperkalaemia, hypoglycaemia, hypothermia
Toxins, tamponade, trauma, tension PTX, thrombosis (e.g. MI/PE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Name 5 physical signs in acromegaly

A 
Prognathism
Wide-spaced teeth
Coarse face
Macroglossia
Prominent supraorbital ridges
Spade like hands and feet
CTS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

In a patient with acromegaly what would the results of an OGTT + GH be?

A

GH levels stay the same (they should decrease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What visual field defect do you get in acromegaly? Where is the lesion and what imaging could you do?

A

Bitemporal hemianopia
Optic chiasm
MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

How might you manage acromegaly?

A

Somatostatin analogues - octreotide

Trans-sphenoidal resection of pituitary adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Name 6 signs and 6 symptoms of SLE

A 
Malar rash
Discoid rash
Photosensitivity
Raynaud's
Livedo reticularis
Oral ulcers
Pericardial rub
Arthralgia
Psychosis/seizures
Pleuritic chest pain/pericarditis
Fatigue
Weight loss
Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

A patient with SLE has recurrent 1st trimester miscarriages. What is the problem?

A

Antiphospholipid syndrome

Recurrent thrombosis in placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Name 2 drugs used to manage SLE and their class

A

Methotrexate - DMARD
Prednisolone - corticosteroid
Ibuprofen - NSAID

90
Q

Give 2 medications that can relax the oesophagus

A

CCBs e.g. diltiazem
Nitroglycerin
Sildenafil

91
Q

List 4 differentials for dysphagia in an 80y old lady

A 
Oesophageal stricture
Oesophageal cancer
Achalasia
Stroke/MND
Pharyngeal pouch
Oesophageal candidiasis
92
Q

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?

A 
Low Na, raised K
Assess A, B, C
Give IV fluids
Give IV hydrocortisone
Measure and correct blood glucose if required
93
Q

Describe the test used to diagnose Addison’s disease

A

Short synACTHen test
Synthetic ACTH is given - measure cortisol before and after
Exclude Addison’s if cortisol rises

94
Q

How might you investigate the underlying aetiology of Addison’s disease?

A

CXR: evidence of TB
AXR: adrenal calcification

95
Q

Give 3 benefits of a “box splint” in a fractured leg

A

Pain relief
Reduces bleeding from femur
Reduces risk of neurovascular injury
Stabilises limb and prevents further displacement of fracture

96
Q

Explain the mechanism of compartment syndrome

A

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
Q

What is the presentation of compartment syndrome?

A

Pain disproportionate to clinical findings
Pain on passive muscle stretching
Warm, erythematous, swollen limb
Increased CRT, weak/absent peripheral pulses
Paraesthesia

98
Q

How would you manage compartment syndrome?

A

Elevate limb
Remove all bandages and splint/remove cast
Fasciotomy

99
Q

How can compartment syndrome be prevented?

A

Make sure splint/bandage/cast not too tight
Recognise symptoms early and treat
Elevate limb

100
Q

Which imaging is most sensitive for PE?

A

CTPA (with contrast)

101
Q

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?

A 
Factor 10a inhibitor
3 months (as was provoked PE)
102
Q

How can you prevent PE in patients post surgery?

A

TED stockings/intermittent pneumatic compression
Prophylactic dose LMWH
Early mobilisation

103
Q

What is the genetic inheritance of sickle disease?

A

Autosomal recessive

104
Q

A patient with sickle cell comes in with a chest crisis. What would your initial management be?

A

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
Q

Why do people with sickle cell get gallstones?

A

In people with sickle cell disease, most gallstones are produced from excess bilirubin, which is caused by haemolysis

106
Q

How do you manage sickle cell chronically?

A

Pen V BD + immunisations
Folate
Hydroxycarbamide if frequent crises

107
Q

How does hydroxycarbamide reduce the frequency of painful crises in sickle cell?

A

Increases HbF levels

Improves blood flow and reduces vaso-occlusion

108
Q

Name 4 signs of opiate overdose

A 
Pinpoint pupils
Reduced GCS
Reduced resp rate/resp depression
Bradycardia
Vomiting
109
Q

Name 4 signs of opiate withdrawal

A 
Clammy, cold skin
Vomiting
Disorientation, mood swings
Pallor
Hypotension
110
Q

How would you advise an IVDU to protect their health?

A

Use needle exchanges
Practice safe sex
Engage with addiction services for methadone

111
Q

Why do you measure lactate in sepsis?

A

Measure of systemic tissue hypoperfusion

112
Q

What investigation can be used to monitor heart failure?

A

B-type naturetic peptide

113
Q

How do you predict a difficult intubation?

A 
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
Q

What parts of the WHO checklist do once the patient has arrived for surgery before anaesthetic?

A

Name, DOB, procedure, check consent form, site marked, allergies

115
Q

Name 3 ways in which the shoulder can be injured after a fall. How would you manage these?

A

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
Q

Where in the body can you get a transitional cell carcinoma?

A

Bladder

Ureter

117
Q

Which lymph nodes can bladder cancer metastasize to?

A

Hypogastric
External iliac
Common iliac

118
Q

Name 4 risk factors for bladder cancer

A 
Smoking
Alcohol
Dyes - azo dyes
Ionizing radiation
Arsenic
FH
Schistosomiasis
119
Q

Name 2 signs of cauda equina on examination of the anal sphincter

A

Reduced tone
Reduced perianal sensation
Incontinence

120
Q

Name 5 complications of TURP

A 
Bleeding
Infection - sepsis
Incontinence
Urinary retention
Retrograde ejaculation
Post-TURP syndrome
Impotence
121
Q

What is post-TURP syndrome?

A

Fluids used to irrigate bladder during procedure are absorbed into prostatic venous sinuses
Causes fluid overload, electrolyte disturbance and hyponatraemia

122
Q

Give 4 first rank symptoms of schizophrenia

A

3rd person auditory hallucinations
Delusional perception
Thought disorder (insertion, withdrawal, broadcasting, etc)
Passivity phenomenon

123
Q

A man with first episode psychosis is given haloperidol and his jaw locks. What has happened? What would you do to fix it?

A

Acute dystonic reaction

Procyclidine IM/IV

124
Q

A man on haloperidol describes a feeling of inner restlessness. What is this called?

A

Akathisia

125
Q

Name 5 side effects of atypical antipsychotics

A 
EPSEs (dystonia, akathisia, parkinsonism, bradykinesia, tardive dyskinesia) - though less frequent than typical antipsychotics
Weight gain
T2DM
Hyperlipidaemia
QTc prolongation
Sexual dysfunction
126
Q

Which antibodies do you test for in coeliac disease?

A

Anti-TTG

IgA endomysial Abs

127
Q

What are the histological features of coeliac disease?

A

Villous atrophy
Lymphocyte infiltration of crypts
Crypt hypertrophy

128
Q

Name the 4 fat soluble vitamins and what could happen if you were deficient for each one

A

A - night blindness
D - rickets
E - ataxia, dysarthria
K - easy bruising, bleeding

129
Q

Where do you take a bone marrow biopsy from?

A

Posterior iliac crest

130
Q

What 4 features of a breast lump would make you suspect malignancy?

A

Hard, fixed, irregular lump, doesn’t change with menses, growing
Skin tethering, peau d’orange, indrawn nipple, bloody nipple discharge

131
Q

Name 2 signs of bulimia on examination

A

Calluses/scars on dorsal surface of hand
Loss of dental enamel
Enlargement of parotid glands

132
Q

Name 4 risk factors for bulimia

A 
FH
Depression, anxiety
Substance misuse
Traumatic events, environmental stress
Poor self image
133
Q

Name 2 symptoms of optic neuritis

A

Painful ocular movement
Unilateral blurred vision
Loss of colour vision
Worsens on getting in hot bath (Uthoff phenomenon)

134
Q

What antibiotics would you give in meningitis? Prophylaxis for family?

A

Ceftriaxone IV

Rifampicin or ciprofloxacin PO

135
Q

What are the CSF findings in bacterial meningitis?

A 
Cloudy appearance
Elevated opening pressure
Raised WCC
Low glucose
Raised protein
136
Q

Describe the morphology of neisseria meningitidis

A

Gram negative diplococci

137
Q

Name 3 long term complications of meningitis

A 
SIADH
Seizures
Deafness
Blindness
Hydrocephalus
Intellectual deficits
138
Q

Where does klebsiella colonise normal people? How about alcoholics?

A

Normal floral of mouth, skin and intestine

They aspirate it and get klebsiella pneumonia

139
Q

What antiobiotics could you give for klebsiella pneumonia?

A

Tazocin
Meropenem
Levofloxacin/ciprofloxacin

140
Q

What is the treatment for delerium tremens?

A

Diazepam

Also give Pabrinex

141
Q

A patient with ?IE has a murmur on the left sternal edge. What is the valvular problem?

A

Tricuspid regurgitation

Pansystolic murmur

142
Q

Why do you have to give ABx for so long in infective endocarditis?

A

Valves have a poor blood supply

143
Q

Name 4 risk factors for pre-eclampsia

A 
First baby
First baby with new partner
Obesity
FHx
Multiple pregnancy
Pre existing hypertension
Maternal age >40
144
Q

Name 4 blood tests and 2 urine tests you would do in pre-eclampsia

A

FBC, clotting, LFT, uric acid, U+Es

Urine dip for protein, MC+S, 24h urine collection for protein quantification and Cr clearance

145
Q

What antihypertensive would you use in pre-eclampsia? What could you use to control seizures?

A

Labetalol

Magnesium sulphate

146
Q

What are 2 early signs of dementia?

A 
Amnesia (short term first)
Poor concentration
Struggling to follow conversation
Confusion about time and place
Mood changes
147
Q

What type of dementia presents with a fluctuating course and visual hallucinations?

A

Lew body dementia

148
Q

What type of blood vessel is involved in a subdural? Why are old people more susceptible to subdurals after minor trauma?

A

Bridging veins running from hemisphere to saggital sinus

Brain atrophy makes these veins more susceptible to rupture

149
Q

Give 2 reasons why you would have to drain a subdural in an elderly person

A

Raised ICP
Focal neurological deficit
Seizures

150
Q

Name 4 local complications of subdural haematoma evacuation

A 
Infection
Further haemorrhage
Brain tissue injury
Brain oedema
Seizures
151
Q

What are 3 metabolic or biochemical abnormalities you would expect in DKA?

A

Hyperkalaemia, hyperglycaemia, ketonaemia, acidosis

152
Q

Name 5 steps you would do to manage DKA

A 
ACBDE approach
Aggressive fluid resuscitation
Insulin replacement
Potassium replacement
Give maintenance fluids
Catheter to monitor urine output
153
Q

Name 4 chronic conditions which could cause ED in a 22 year old man

A

DM
HTN
Sickle cell
Depression/anxiety

154
Q

What bloods would you do to investigate ED in a 22 year old?

A

Prolactin
Testosterone
Fasting glucose or HbA1c
Lipid profile

155
Q

Name 3 management strategies for performance anxiety related ED

A

Psychosexual therapy
Sildenafil
Couples therapy/sensate focus

156
Q

What is the bony landmark at the top of the scrotum?

A

Pubic tubercle

157
Q

On examination of the scrotum what are the 3 things you palpate?

A

Testes
Vas deferens
Epididymis

158
Q

You suspect a patient has a hydrocoele. What test can you do in the practice? What test may a urologist do?

A

Transillumination

Ultrasound testes

159
Q

What layer of scrotum does a hydrocoele arise from? What embryological structure does it come from?

A

Tunica vaginalis

Processus vaginalis

160
Q

Name 4 possible causes of a hydrocoele

A

Prev surgery
Trauma
Tumour
Infection

161
Q

A pregnant woman is term +13 days. Why is induction indicated?

A

There is a high rate of still birth in prolonged pregnancy

162
Q

Name 3 parts of the Bishop score

A

Cervical length, consistency, dilatation
Position of cervix
Head station

163
Q

List 2 ways to induce labour

A

Prostaglandin pessary followed by oxytocin 6 hours later

Amniotomy

164
Q

What are 3 reassuring CTG features?

A

Accelerations
Variability >5 bpm
FHR 110-160
No decelerations

165
Q

Name 2 signs of respiratory distress in an infant

A 
Nasal flaring
Intercostal recessions
Subcostal recessions
Grunting
Tracheal tug
166
Q

Name 2 signs of bronchiolitis on auscultation

A

Wheeze (high pitched)

Fine end expiratory crackles

167
Q

Would you ask for CXR in bronchiolitis?

A

No, only if diagnostic ambiguity or atypical cause suspected

You can do nasophargyngeal aspirate and PCR of that to isolate virus

168
Q

Name 3 organisms which can cause bronchiolitis. Which is the most common cause?

A 
RSV - vaccinate with palivizumab
Parainfluenza virus
Mycoplasma pneumonia
Rhinovirus
Metapneumovirus
169
Q

Name 2 signs of dehydration in a child

A

Reduced tissue turgor
Reduced UO
Dry mucous membranes
Depressed fontanelle

170
Q

Name 2 triggers for sickle cell crisis

A

Cold, infection, hypoxia, dehydration, stress, exercise

171
Q

List 3 possible symptoms of vaso-occlusive crisis

A

Limb pain
Chest pain
Abdo pain

172
Q

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?

A

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
Q

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?

A

Continuous
Superficial
Common
Rare, non caseating

174
Q

What is your initial treatment and route for an acute flare of UC?

A

IV hydrocortisone

175
Q

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?

A 
Protect cervical spine
ABCDE approach
Give fluids
Oxygen
Brief neuro exam
Head to toe evaluation for injury

CT with contrast

176
Q

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?

A

Conservative management, monitor U+Es

Repeat urinalysis in GP to see if haematuria resolving

177
Q

Name 4 symptoms of viral conjunctivitis

A

Red eye
Discomfort/grittiness
Watery discharge
Slight blurred vision due to discharge

178
Q

Name 4 signs of viral conjunctivitis

A 
Conjunctival injection
Conjunctival chemosis
Follicles or papillae
Discharge may be visible
Rarely may have corneal involvement  - oedema
179
Q

Name 4 differentials for a unilateral red eye

A 
Virlal/bacterial conjunctivitis
Anterior uveitis
Acute angle closure glaucoma
Episcleritis
Keratitis
180
Q

What is the management of viral conjunctivitis?

A

Supportive care
Cool compresses, lubricating eye drops
Good hygeine, don’t share towels etc

181
Q

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?

A

Polycystic kidney disease

Autosomal dominant

182
Q

What is a complication of ADPKD?

A

Intracranial berry aneurysms leading to SAH

183
Q

What is the definitive management of ADPKD?

A

Renal transplantation

184
Q

Give 4 common causes for reduced GCS

A 
Drugs, alcohol
Hypoglycaemia
Sepsis
Seizure
Head injury - extradural, SAH
185
Q

A patient found in the park with a reduced GCS drops his GCS further to 7. What are the management priorities now?

A

Support his airways using simple devices while you call anaesthetist
CT head as may have evolving bleed - call neurosurgeons
ECG

186
Q

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

A 
Rosving's sign
Psoas sigh
McBurney's sign
FBC, urinalysis/pregnancy test
Ruptured ectopic pregnancy, ovarian cyst accident
187
Q

What bloods make up a confusion screen?

A 
FBC
CRP
U+E
LFT
Bone profile
B12 and folate
TFTs
Glucose
Coag/INR
188
Q

A patient’s mum is diagnosed with Alzheimer’s. What do you tell her about the inheritance?

A

In vast majority of cases Alzheimer’s isn’t inherited

189
Q

What antibiotic is used to treat CAP in the community?

A

Amoxicillin PO

Can use doxy or clari if not suitable

190
Q

A patient is diagnosed with Cushing’s. What investigation could you do to decide where to look for the problem?

A

Dexamethasone suppression test

191
Q

What hormone causes an electrolyte imbalance in Cushing’s? What receptor does it act on?

A

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
Q

A patient who had previously had acute pancreatitis develops diarrhoea months later. What complication has developed?

A

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
Q

List 2 RFs for knee osteoarthritis

A

Obesity

FH

194
Q

List 4 features of OA on XR

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

195
Q

What are the B symptoms in Hodgkin’s lymphoma?

A

Weight loss
Night sweats
Fever

196
Q

How do you initially treat Hodgkin’s lymphoma? Relapse?

A

ABVD regimen

BMT for relapse

197
Q

Explain 4 pathophysiological mechanisms behind ascites

A 
Portal hypertension
Portal vein thrombosis
Lymphoma
Pancreatitis
Renal failure
Congestive heart failure
Malignant ascites
198
Q

How can you prevent an oesophageal varices from bleeding?

A

Give beta blockers

199
Q

Explain how an audiogram works

A

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
Q

Explain what a tympanogram measures

A

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
Q

What is the main cause of hypokalaemia in DKA?

A

Insulin drives potassium into cells

202
Q

What is the Parkland formula?

A

(4xweight in kg) x %burn = fluid requirements over 24h

Give half of this in first 8h after injury

203
Q

Name 4 red flags in a child with a painful hip

A 
Pyrexia
Not weight bearing
Red warm skin over joint
Pain on movement of joint
Tachycardia
204
Q

Name 4 differentials for hip pain in children

A 
Septic arthritis
SUFE
Transient synovitis/irritable hip
Perthes' disease
DDH (undetected at screening)
205
Q

Name 2 investigations you would do for a child with a painful hip

A 
XR
BCs
FBC
ESR, CRP
Joint aspirate
206
Q

Name 4 features of delirium tremens

A

Acute confusional state - disorientation, clouding of consciousness, impairment of memory, agitation
Tremor
Visual hallucinations (small things eg. spiders)
Sweating, HTN

207
Q

What medications can be used to facilitate withdrawal from alcohol in people that are dependent?

A

Naltrexone
Acamprosate
Disulfiram

208
Q

What blood test could be useful in anaphylaxis?

A

Mast cell tryptase

209
Q

What follow-up would you arrange for a person who had anaphylaxis?

A

Give them an epi-pen and instruct them on how to use it

Follow up in immunology clinic

210
Q

What is the pathophysiology of anaphylaxis?

A

IgE binds to mast cell which causes release of histamine

211
Q

Name 8 symptoms of endometriosis

A 
Deep dyspareunia
Menorrhagia
Diarrhoea
Dysmenorrhoea
Infertility
Chronic pelvic pain
Ovulatory pain
Chronic fatigue
Dysuria, haematuria in bladder involvement
212
Q

Name 4 sites of endometriosis

A 
Ovaries
Pouch of Douglas
Uterosacral ligaments
Cervix, vagina
Bladder
Lung, pleura
GIT
213
Q

Name 2 drug treatments for endometriosis

A

COCP
NSAIDs/paracatamol
GnRH analogues

214
Q

Name 3 organisms that can cause viral meningitis

A

HSV1 and 2
VZV
Mumps, measles
Coxsackie

215
Q

Name 2 complications of bullous pemphygoid

A

Infection of skin lesions (bacterial/viral) - sepsis

Complications of treatment with steroids

216
Q

Name 2 tests used to diagnose bullous pemphygoid

A

Biopsy (from blister)

217
Q

Name 2 treatments for bullous pemphygoid

A

Systemic corticosteroids
Topical corticosteroids
Doxycycline PO

218
Q

Name 2 features of WPW on ECG

A

Delta waves

Short PR interval

219
Q

Why do you get hyperacusis in Bells palsy?

A

one of the small protective muscles in the ear, the stapedius, is paralyzed when the 7th nerve is damaged

220
Q

Name 3 causes of proteinuria in children

A 
Nephrotic syndrome
Nephritic syndrome
HSP
ATN
Alport syndrome
Pyelonephritis

finals (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions