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Phase 4 exam revision > Phase 4 > Flashcards

Phase 4 Flashcards

1
Q

5 risk factors for T2DM

A

obesity, PCOS, inactivity, family history, high sugar diet

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2
Q

Pathology of Acanthosis Nigrans

A

increase in circulation insulin, activates keratinocyte ILGF receptors. increased IGF leads to keratinocyte and dermal proliferation

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3
Q

Pathophysiology of vaso-occlusive crisises

A

Deoxygenated HbS molecules are insoluble and polymerise, become rigid and take up characteristic sickle cell shape. This leads to decreased survival and occlusion of microvasculature, causing ischaemia

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4
Q

Other areas of body occlusive crisis will affect

A

Abdomen - mesenteric
Lungs - acute chest syndrome
penis - priapism

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5
Q

Treatment of vaso-occlusive crisis

A

IV opiates, O2, rehrydate, warmth, antibiotics - hyposplenism, transfuse if Hb drops, long term hydroxycarbamide

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6
Q

FBC and blood film findings in sickle cell

A

sickle shaped RBCs, Howell-Jolly bodies, moderate anaemia, increased MCV

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7
Q

4 locations of transitional cell carcinoma

A

Bladder, ureter, renal pelvis, urethra

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8
Q

4 risk factors for bladder cancer

A

aromatic amines, Schistosomiasis, smoking, napthylamine

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9
Q

Blood supply to the bladder

A

Superior and inferior vesicle arteries which arise from the internal iliac arteries

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10
Q

4 eye symptoms found in MS

A

pain at rest, painful ocular movements, decreased visual acuity, colour desaturation

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11
Q

4 signs in the legs in MS

A

loss of fine touch sensation, decreased power, spasticity, hyperreflexia

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12
Q

3 investigations in MS

A

visual evoked potentials, MRI brain/spine, LP fro CSF analysis - oligoclonal bands

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13
Q

Management of MS

A

beta interferon

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14
Q

investigations in coeliac disease

A

antiTTG and antiendomysial antibodies.

Duodenal biopsy - villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes

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15
Q

explain changes in JVP in tricuspid regurgitation

A

V wave represents atrial diastole, in tricuspid regurgitation there is increased atrial pressure and therefore V wave is prominent

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16
Q

4 As of dementia

A

Aphasia, apraxia, agnosia, amnesia

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17
Q

Why do you give long term antibiotics in infective endocarditis

A

neither the valves or vegetations attached to them are supplied by blood vessels

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18
Q

4 triggers for a sickle cell crisis

A

cold, hypoxia, stress exercise, infection

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19
Q

3 things to palpate in scrotum

A

epididymis, testes vas deferens

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20
Q

where does hydrocele arise from

A

tunica vaginalis

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21
Q

5 components of the bishops score

A

Length, consistency, position, dilatation, station of head

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22
Q

2 ways to induce labour

A

amniotomy, prostaglandin followed by oxytocin

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23
Q

4 ways of recognising dehydration in a child

A

decreased skin turgor, sunken fontanelle, dry mucous membranes, decreased urine output

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24
Q

What is compartment syndrome

A

swelling of a muscle, leading to increased pressure in compartment, impaired blood flow leads to infarction

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25
Q

Signs of compartment syndrome

A

pain out of proportion with presentation, pain increased on passive flexion/extension of fingers/toes

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26
Q

4 complications of compartment syndrome

A

rhabdomyolysis, renal failure, gangrene, loss of limb

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27
Q

6 complications of fractures

A

DVT/PE, malunion/nonunion, compartment syndrome, avascular necrosis, nerve injury

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28
Q

Define dementia

A

Irreversible progressive global decline in cognitive function without any disturbance of consciousness

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29
Q

4 organisms causing pneumonia

A

Streptococcus Pneumoniae, Haemophilus Influenza, Staphylococcus Aureus, Klebsiella

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30
Q

Treatment for pneumonia

A

Amoxicillin (erythromycin if intolerant)

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31
Q

5 complications of pneumonia

A

Sepsis, respiratory failure, lobar collapse, AF, pleural effusion, pneumothorax

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32
Q

4 risk factors for OA

A

previous trauma, obesity, manual labour, athletes

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33
Q

4 findings on XR in OA

A

Loss of joint space, Osteophytes, Subchondral cysts, Subchondral sclerosis

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34
Q

2 drugs to give in IECOPD - name, class and mechanism

A

Salbutamol, Beta2agonist, direct stimulation of beta2 receptors in bronchial smooth muscle resulting in bronchodilatation.
Ipratropium, antimuscarinic, antagonises action of acetylcholine on muscarinic receptors on bronchial smooth muscles and results in muscle relaxation and bronchodilatation

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35
Q

IECOPD treated but blood gases still deteriorating - what next?

A

non invasive positive pressure ventilation

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36
Q

Haemophilia A - bleeding time/PT/APTT normal reduced or prolonged

A

Bleeding time - normal
PT - normal
APTT - prolonged

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37
Q

One mechanical and one pharmacological management of haemoarthrosis

A

Mechanical - rest and elevation

Pharmacological - treatment with factor VIII

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38
Q

How is haemophilia inherited

A

x linked recessive

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39
Q

Kid with haemophilia A needs dental extraction, what to prescribe pre op

A

Tranexamic acid or Desmopressin

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40
Q

4 features on XR suggestive of small bowel obstruction

A

Multiple dilated bowel loops, dilated bowel loops are central, no gas in large bowel, valvulae conniventes are seen across whole width of dilated bowel

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41
Q

3 causes of SBO

A

adhesions, incisional hernia, malignancy

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42
Q

4 immediate management of someone presenting with SBO

A

NG tube and suction, IV fluids, catheterise, analgesia, antiemetics, antibiotics

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43
Q

Features of UC

A

continuous lesions, superficial, crypt abscesses, decreased goblet cells, pseudo polyps, leadpipe appearance on xray

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44
Q

Features of Crohns

A

skip lesions, granulomas, strictures and fistulas, increased goblet cells

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45
Q

Complications of TURP

A

haematuria, urethral trauma/stricture, TUR syndrome, infection, ED, incontinence, retrograde ejaculation

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46
Q

5 side effects of atypical antipsychotics

A

weight gain, reduced libido, gynaecomastia, insulin resistance, agranulocytosis

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47
Q

Pt with CLL, where would you take a BM biopsy from

A

posterior iliac crest

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48
Q

4 features of a lump that would make you think of malignancy

A

hard consistency, painless, irregular margins, fixation to skin/chest wall, skin changes, discharge

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49
Q

commonest histological type of breast cancer

A

ductal adenocarcinoma

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50
Q

Management of acute pancreatitis

A

NBM, NG tube, IV fluids, analgesia, ERCP if gallstones cause

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51
Q

2 physical signs seen in pt with bulimia

A

Russells sign - callouses on knuckles

Dental erosions

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52
Q

4 symptoms of frontal lobe damage

A

Loss of attention, loss of abstract thought, perseverations, change of affect, loss of inhibitions, violence

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53
Q

3rd nerve palsy - 3 findings

A

eye down and out, dilated pupil, lid ptosis

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54
Q

signs of papilloedema on opthalmoscopy

A

venous engorgement, loss of venous pulsation, optic disc haemorrhages, blurring of optic margins, elevation of optic disc, Patons lines

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55
Q

signs of liver failure

A

ascites, gynaecomastia, jaundice, spider naevia, asterixisis, clubbing, leuconychia, hepatomegaly

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56
Q

Synthetic liver function tests

A

PT, INR, albumin

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57
Q

5 physical signs in acromegaly

A

brow enlargement, jaw enlargement, spade like hands, feet enlargement, increased interdental spaces, wide nose

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58
Q

6 signs of SLE

A

raynauds, malar rash, discoid rash, pallor, joint swelling, pericardial rub

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59
Q

6 symptoms of SLE

A

fatigue, malaise, dyspnoea, rash, photosensitivity, myalgia, joint pain

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60
Q

Mechanism of recurrent miscarriages in antiphospholipid syndrome

A

thrombosis of placental blood vessels

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61
Q

2 x management of SLE - drugs and class

A

Prednisolone - corticosteroid

Azathioprine - DMARDs

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62
Q

2 fat soluble vitamins and consequences of deficiency

A

K - reduced clotting factor production - bruising and bleeding
A - night blindness

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63
Q

4 treatments for HER2 +ve and oestrogen +ve breast cancer

A

Tamoxifen, herceptin, chemo, radiotherapy, node clearance

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64
Q

CSF analysis in bacterial vs viral meningitis

A

viral - clear, normal/low glucose, normal/high protein, lymphocytes
bacterial - turbid, low glucose, high protein, neutrophils

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65
Q

Where is klebsiella colonised in healthy populations vs alcoholics

A

Gut, lung in alcoholics - aspiration

treat with cefotaxime

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66
Q

5 differentials for acute headache

A

SAH, meningitis, trauma, stroke, pituitary apoplexy, central venous thrombosis

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67
Q

Pathophysiology of Addisons

A

Raised urea and creatinine - pre renal failure due to reduced circulating volume. Lack of aldosterone = lack of sodium reabsorption and lack of potassium secretion

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68
Q

2 drugs to treat addisons

A

hydrocortisone - glucocorticoid

fludrocortisone - mineralocorticoid

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69
Q

signs and symptoms of addisonian crisis

A

hypotension, severe abdominal pain, pyrexia, circulatory collapse

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70
Q

complications of PBC

A

cirrhosis, osteoporosis, malabsorption of fat soluble vitamins, hepatocellular carcinoma, renal tubular acidosis

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71
Q

Management of PBC

A

Colostyramine, fat soluble vitamins, Ursodeoxycholic acid, liver transplantation

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72
Q

Management of portal venous hypertension - acute bleed

A

resuscitation with cross matched blood and fluids, IV terlipressin, endoscopic band ligation

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73
Q

2 signs of MI on ECG

A

ST elevation >2mm in 2 or more chest leads, >1mm in 2 or more limb leads. Pathological Qwaves

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74
Q

2 drug treatments for angina and mechanism

A

Atenolol - bblocker - decreased sympathetic drive to the heart, decreased myocardial O2 demand. CCB - dilate peripheral vessels - decreased preload

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75
Q

4 symptoms of mania

A

delusions of grandiosity, pressure of speech, overactivity, inappropriate sexual behaviour, loss of inhibitions, reduced need for sleep, spending money recklessly

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76
Q

side effects of lithium

A

fine tremor, weight gain, polyuria, polydipsia, metallic taste

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77
Q

signs/symptoms of toxic dose of lithium

A

coarse tremor, confusion, diarrhoea and vomiting, ataxia, drowsiness

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78
Q

medications that increase lithiums effects in the body

A

ACEI, NSAIDs, SSRIs, diuretics

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79
Q

Organism causing HUS

A

Escherichia Coli O157

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80
Q

Pathology of HUS

A

Microangiopathic haemolytic anaemia. Endothelial layer of small vessels is damaged, as RBCs travel then get fragmented - intravascular haemolysis. Resulting schistocytes (fragments of red cell) are targeted for destruction by reticuloendothelial system in spleen

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81
Q

4 endocrine causes of hypertension

A

phaeochromocytoma - adrenaline
cushings - glucocorticoid
thyrotoxicosis - t4
SIADH - adh

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82
Q

5 contraindications of thrombolysis

A

Active bleeding, suspected aortic dissection, recent head trauma, intracranial neoplasm, previous haemorrhage stroke, previous allergic reaction to fibrinolytic agent

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83
Q

treatment of scabies

A

permethrin for pt and household members, wash clothing/bedding/towels

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84
Q

features of aspirin overdose

A

mixed respiratory alkalosis and metabolic acidosis. hyperventilation, tinnitus, lethargy, sweating, nausea, seizures, coma

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85
Q

what is primary biliary cholangitis

A

autoimmune chronic liver disorder, inflammation of interlobular bile ducts leads to progressive cholestasis and cirrhosis

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86
Q

which antibodies in PBC?

A

anti mitochondrial

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87
Q

management of primary biliary cholangitis

A

pruritus - cholestyramine
fat soluble vitamin supplementation
ursodeoxycholic acid, liver transplantation

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88
Q

complications of PBC

A

cirrhosis, osteomalacia, osteoporosis, increased risk of hepatocellular carcinoma

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89
Q

what organism causes gonorrhoea

A

neisseria gonorrhoeae - gram negative diplococcus

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90
Q

treatment of gonorrhoea

A

ceftriaxone IM 500mg, azithromycin 1g PO

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91
Q

what organism causes chlamydia

A

chlamydia trachomatis - obligate intracellular pathogen

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92
Q

TB treatments and side effects

A

Rifampicin - orange secretions
Isoniazid - peripheral neuropathy
Pyrazinamide - hepatotoxic
Ethambutol - optic neuritis

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93
Q

Examples of typical antipsychotics vs atypical antipsychotics

A

chlorpromazine, haloperidol

atypical - clozapine, aripiprazole, olanzapine, quetiapine

94
Q

4 dopamine pathways that antipsychotics work on

A

mesolimbic, mesocortical, nigrostriatal, tuberoinfundibular

95
Q

Symptoms of depression

A

Core - low energy, low mood, anhedonia
cognitive - memory, concentration, thoughts of suicide, feelings of guilt, worthlessness, hopelessness
functional - sleep, weight loss/gain, loss of libido

96
Q

Feature of insecticide poisoning

A

Accumulation of acetylcholine - SLUD
Salivation, lacrimation, urination, defecation
hypotension, bradycardia, small pupils. treat with atropine

97
Q

How does tamoxifen work?

A

Selective oestrogen receptor modulator (SERM) - acts as an oestrogen receptor antagonist. Used in oestrogen +ve breast cancer. s/e - menstrual disturbance, hot flushed, VTE, endometrial cancer risk increased.

98
Q

causes of delirium

A 
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment
99
Q

driving rules in epilepsy

A

no driving for 6 months following first seizure. seizure free for 12 months before driving. no driving while mediation being withdrawn.

100
Q

organisms causing bronchiolitis

A

RSV, human metapneumovirus, adenovirus, parainfluenza

101
Q

2 signs on exmainatino for bronchiolitis

A

expiratory wheeze, widespread fine inspiratory crackles

102
Q

who can have PSA checked

A

over 50 with lower urinary symptoms, monitoring of prostate cancer resection, suspicious PR findings

103
Q

4 medications that cause constipation

A

opiates, iron tablets, anticholinergics, calcium

104
Q

pre op tests for somebody with RA

A

neck extension, malampati, cervical XR, CXR

105
Q

post op complications in a patient with RA

A

VTE - hypercoagulable
Poor healing - steroids
Infection - immunosupressed
Resp difficulty - lung fibrosis

106
Q

Investigations in intermittent claudication

A

ABPI

Doppler test brachial and medial malleolar pulse, extinguish wtih cuff. <0.9 some disease, <0.5 critical ichaemia

107
Q

Treatment of quinsy

A

IV fluids, analgesia, drainage, abx - clindamycin

108
Q

Which lymphnode affected by quinsy

A

Jugulodigastric node

109
Q

differentiating torsion and epidydimo-orchitis

A

epididymo-orchitis - Prehns sign, retrotesticular pain

torsion - red, swollen, transerse lie, n+v, absent cremasteric reflex

110
Q

How do nephrotoxic meds cause AKI

A

ACEI - reduce angiotensin2, less tone of efferent arteriole, more blood leaves
NSAIDs - inhibit prostaglandin, constriction of afferent arteriole, hypoperfusion

111
Q

Which lung cancer most common in non smokers

A

adenocarcinoma

112
Q

which lung cancer associated with hypercalcaemia

A

squamous cell - secretion of parathyroid related peptide

113
Q

What is a Howell Jolly body and when is it seen

A

Basophilic nuclear remnants in circulation erythrocytes - normally removed by spleen but seen in hyposplenism

114
Q

Haem results in Polycythaemia Rubra Vera

A

Rise in haemoglobin, rise in WCC, rise in PLT. Also Jakll mutation

115
Q

Pathology of DIC

A

Coagulation factors and platelets are consumed faster than they can be produced resulting in haemorrhage. Activation of coagulation cascade forms thrmbin which convert fibrinogen to fibrin, which in turn is broken down into degradation products - DDimer. Fibrin strands damage red blood vessels -> fragmented cells on blood film.

116
Q

Treatment of severe c diff

A

oral vancomycin and IV metronidazole

117
Q

What kind of organism is listeria monocytogenes

A

gram +ve bacillus

118
Q

What kind of organism is neisseria

A

gram -ve diplococci

119
Q

What kind of organism is haemophilus influenza

A

gram -ve cocci

120
Q

What kind of organism is E Coli

A

gram -ve bacillus

121
Q

CSF findings in bacterial meningitis

A

WCC raised - predominantly polymorphs, protein rasied, glucose low (<60% of serum)

122
Q

What kind of organism is streptococcus

A

gram +ve cocci usually in chains

123
Q

What kind of organism is staphylococci

A

gram +ve cocci in clusters

124
Q

What is charcots triad

A

Swinging fevers, RUQ pain, jaundice

Ascending Cholangitis

125
Q

Which antibiotics are most likely to cause C Diff

A

clindamycin, fluoroquinolones, cephalosporins and carbapenems

126
Q

Investigations for C Diff

A

Stool culture and PCR

127
Q

4 ways of preventing spread of c diff

A

Hand washing, bare below elbow, barrier nursing, disposable gloves, not using rectal thermometers

128
Q

Reversible causes of cardiac arrest

A

Hypoxia, Hypovolaemia, Hypothermia, Hyper/hypokalaemia, Tension pneumothorax, Toxin, Thombus, Tamponade

129
Q

Causes for a raised troponin

A

MI, sepsis, myocarditis, PE, heart failure, renal failure

130
Q

When do biochem cardiac markers peak and fall following MI

A

CK rises 4-8 hours post STEMI, peak at 24, fall 3-4 days

Troponin rise 3 hours, and stay high for 7-14 days

131
Q

3 signs of right heart failure

A

raised JVP, pulses paradoxes, kussmauls sign

132
Q

Complications following MI

A

Recurrent infarction, angina, pericarditis, pericardial effusion, PE, fever, VSD, mitral regurgitation, free wall rupture

133
Q

4 signs of severe haemodynamic compromise in arrhythmias

A

impending cardiac arrest, sever pulmonary oedema, SBP <90, decreased consciousness (treat immediately with unsynchronised external defibrillation for tachy and external pacing for brady)

134
Q

2 examples of regular and irregular broad complex tachycardias

A

regular - VT, SVT with BBB

irregular - AF with BBB, torsades de pointes

135
Q

2 findings of WPW on ECG

A

delta wave, short PR

136
Q

Pathology of respiratory failure

A

Type 1 - hypoxia - ventilation perfusion mismatch

Type 2 - hypoxia with hypercapnia - alveolar hypoventilation

137
Q

5 causes of haemoptysis

A

Bronchiectasis, PE, Cancer, Infection (TB, pneumonia, aspergilloma), trauma, goodpastures, wegeners

138
Q

3 causes each of transudative/exudative pleural effusions

A

Trans - fluid overload, cardiac failure, nephrotic syndrome

Exu - pneumonia, malignancy, RA, pancreatitis, haemothorax

139
Q

Which nerve at risk in humeral fracture and how to test

A

Radial, wrist extensions

140
Q

Which nerve at risk in suprachondylar fracture?

A

Ulnar nerve

141
Q

Which scoring system for assessing severity of GI bleeding

A

Rockall score

142
Q

Which scoring system to assess severity of liver disease in patients with cirrhosis

A

Child-Pugh score

143
Q

Define AKI

A

abrupt (<48h) reduction in kidney function associated with an increase in creatinine >26umol or >50% increase from baseline, or a reduction in UO (<0.5ml/kg/hour for >6hours)

144
Q

3 causes of pre renal, renal and post renal AKI

A

pre renal - hypovolaemia, renal artery stenosis, hypotenison
renal - vasculitis, sepsis, NSAIDs, gomerulonephritis
post renal - stones, BPH, HIV meds, increased abdo pressure

145
Q

indications for dialysis in AKI

A 
Acidosis
Electrolytes
Intoxication
Overload
Ureamia
146
Q

5 causes of decreased consciousness

A

hypoglycaemia, hypoxia, meningitis/encephalitis, tumour, epilepsy, opiates

147
Q

adrenaline dose in anaphylaxis

A

0.5ml of 1:1000 IM, repeat in 5 min

148
Q

ALARM symptoms in GI

A 
Anaemia
Loss of weight
Anorexia
Recent onset
Malaena/haematemesis
Swallowing difficulty
149
Q

Components of the Glasgow score for pancreatitis

A 
PaO2 - <8
Age - >55
Neutrophils - >15
Calcium - <2
Renal - urea >16
Enzymes - LDH >600, AST >200
Albumin - <32
Sugar - >10
150
Q

What do you measure to monitor carcinoid syndrome

A

Urinary 5-hydroxyindoleacitic acid (urinary 5-hiaa)

151
Q

Vesicular rash on face with tip of nose involved - what sign?

A

Hutchinsons - strong predictor of ocular involvement

152
Q

Mechanism of Dorzolamide

A

Carbonic anhydrase inhibitor - reduces production of aqueous humour

153
Q

How to differentiate horners syndrome and 3rd nerve palsy

A

3rd nerve palsy - ptosis and dilated pupil

Horners - ptosis and constricted pupil

154
Q

Triad of Wernickes

A

Confusion, ataxia, opthalmoplegia

155
Q

5 fs of abdo distension

A

fat, fluid, foetus, flatus, faeces

156
Q

Parkland formula

A

4ml x %TBSA x weight in kg = total over 24 hours, 50% over first 8 hours, 50% over next 16 hours

157
Q

Blood results in DIC

A

platelets low, PT up, APTT up, fibrinogen low, DDimer up, on film - fragmented RBCs - schistocytes

158
Q

Treatment of DIC

A

Platelets, Cryoprecipitate to replace fibrinogen, FFP to replace clotting factors,

159
Q

What is quinsy

A

peritonsillary abscess

160
Q

complications of food bolus

A

perforations, aspiration

161
Q

Mechanism of rivoroxiban

A

factor xa inhibitor

162
Q

Mechanism of warfarin

A

Vitamin K antagonist

163
Q

Mechanism of dabigatran

A

direct thrombin inhibitor

164
Q

4 AIDS defining illnesses

A

Kaposis sarcoma, PCP, CMV, TB

165
Q

3 cells that express CD4

A

dendritic cells, macrophages, T helper cells

166
Q

2 screening tests for TB

A

Mantoux, interferon gamma release assay

167
Q

2 ways of monitoring HIV

A

CD4 count, viral load

168
Q

Treatment for HCV

A

pegylated interferon a, ribavirin

169
Q

3 screening test in HCV+ve pt

A

OGD - varices
AFP + USS - HCC
fibroscan - cirrhosis

170
Q

3 investigations for diagnosing HCV

A

immunoblot assay, enzyme immunoassay, PCR

171
Q

5 cancers that commonlyl spread to bone

A

thryoid, breast, lung, kidney, prostate

172
Q

5 signs of decompensated liver failure

A

asterixis, ascites, hepatorenal syndrome, encephalopathy, varices

173
Q

3 histological findings in coeliac

A

villous atrophy, crypt hyperplasia, lymphocytic infiltration

174
Q

5 key symptoms in palliative care

A 
N+V
Secretions
Pain
Breathlessness
Distress/delirium
175
Q

kawasakis signs/symptoms

A 
Mucosal involvement
Hands/feet - erythema/desquamation
Eyes - bilateral conjunctivitis
Adenopathy - cervical
Rash - truncal, pleomorphic
Temp - >5 days
176
Q

Treatment of kawasakis

A

Prevent CAAs, ivig, high dose aspirin, echo at follow up

177
Q

4 components of tetralogy of fallot

A

VSD
Overriding aorta
LVH
RVOO - usually PV stenosis

178
Q

triad of nephrotic syndrome

A

proteinuria
oedema
hypoalbuminaemia
(most common cause in kids is minimal change - treat with pred)

179
Q

What is Bells palsy

A

Acute, unilateral facial nerve paralysis. Lower motor neuron - forehead affected. treat with pred/eye care

180
Q

risk factors for ovarian cancer

A

+++ ovulations - early menarche, late menopause, nulliparity. pill is protective - reduces ovulations

181
Q

risk factors for endometrial cancer

A

same as ovary - +++ovulations. also diabetes, obesity, tamoxifen, PCOS

182
Q

Investigating post menopausal bleeding

A

> 55 y/o - TVUSS if <4mm endometrial thickness high NPV. if >4 = hysteroscopy and biopsy

183
Q

Pathophysiology of antiphospholipid syndrome

A

Paradoxical rise in APTT, reaction of lupus anticoagulant antibodies with phospholipids involved in coagulation cascade

184
Q

Where does varicella zoster reside

A

geniculate ganglion

185
Q

3 actions of PTH

A

osteoclast activation, retention of Ca in kidneys, increased Ca absorption from GIT

186
Q

Investigations for beta thalassaemia

A

FBC - microcytic hypochromic anaemia
Hb electrophoresis
DNA testing

187
Q

Investigations in iron deficiency anaemia

A

Colonoscopy/endoscopy
faecal calprotectin
anti TTG/endomysial antibodies

188
Q

classes of antidepressants with one example of each

A

Selective serotonin reuptake inhibitors - sertraline
Tricyclics - amitriptylline
Monoamine oxidase inhibitors - selegiline
Serotonin and norepinephrine reuptake inhibitor - venlafaxine

189
Q

Vestibular Schwannoma symptoms

A

vertigo, hearing loss (sensironeural), tinnitus, absent corneal reflex, ataxia, raised ICP

190
Q

What is an acoustic neuroma

A

tumour of the vestibulocochlear nerve (CNVIII)

191
Q

3 causes of SNHL

A

pathology in cochlear or CNVIII - rubella, MMR, acoustic neuroma, menieres, ototoxis drugs (aminoglycosides)

192
Q

3 causes of conductive hearing loss

A

wax, foreign body, cholesteatoma, perforation

193
Q

Audiogram - axis

A

x axis - frequency in hertz, y axis - hearing level in decibels

194
Q

Rinnes and Webers findings in SNHL and CHL

A

normal - R=AC>BC, W=equal
SNHL - R=AC>BC, W=localises to normal ear
CHL - R=BC>AC, W=localises to affected ear

195
Q

Signs and symptoms of salicylate overdose

A

High anion gap metabolic acidosis, respiratory alkalosis, tinnitus, pyrexia, n+v, seizures, coma

196
Q

Treatment of salicylate overdose

A

ABCDE, activated charcoal, IV sodium bicarbonate, haemodialysis

197
Q

how to calculate alcohol units

A

vol in ml x ABV /1000

198
Q

What is the Maddrey score and when/how is it used

A

Alcoholic hepatitis. score above 32 poor prognosis - steroids may help.

199
Q

2 bugs that commonly cause cellulitis

A

strep pyogenes

staph aureus

200
Q

Causes of hyperparathyroidism

A

80% solitary adenoma, 15% hyperplasia

201
Q

Signs and symptoms of hyperparathyroidism

A

polydipsia, polyuria, bone pain, renal stones, depression, hypertension

202
Q

What imaging to use in hyperparathyroidism

A

Technetium MIBI subtraction scan

203
Q

Which vessels affected in subdural haematoma

A

Rupture of bridging veins, elderly and alcoholics at risk

204
Q

Mechanism of hydroxycarbamide in SCA

A

increased production of HbF, decreased Hb polymerisation, NO raised

205
Q

Fundoscopy findings in CRVO

A

tortuous veins, optic disc edema, retinal haemorrhages, cotton wool spots

206
Q

3 causes of proteinuria in children

A

nephrotic syndrome, alport syndrome, glomerulonephritis

207
Q

quadruple test for downs syndrome

A

oestradiol, hCG, AFP, inhibin A

208
Q

booking tests in pregnancy

A

syphilis, rubella, HIV, hepB

209
Q

hypothermia ECG findings

A

J waves, arrhythmias

210
Q

define hernia

A

Protrusion of a viscus/part of a viscus through the walls of its containing cavity into an abnormal position

211
Q

4 Rs of fracture management

A

Resuscitation, Reduction, Restriction, Rehabilitation

212
Q

What organism causes gas gangrene

A

clostridium perfringens

213
Q

4 injuries of shoulder

A

dislocation, impingement syndrome, adhesive capsulitis, rotator cuff tear

214
Q

What is disc prolapse

A

herniation of nucleus pulposus through annulus fibrosis

215
Q

5 causes of carpal tunnel syndrome

A 
Water - pregnancy
Radial #
Inflammation -RA
Soft tissue swelling
Toxic - EtoH
216
Q

3 types of hearing test

A

Pure tone audiometry, tympanometry, evoked response audiometry

217
Q

2 types of neonatal hearing screening

A

otoacoustic emissions, audiological brainstem responses

218
Q

why do you get hyperacusis in bells palsy?

A

stapedius palsy

219
Q

3 ways of protecting eye in bells palsy

A

lubricating eye drops, tape closed at night, dark glasses

220
Q

What is ramsay hunt syndrome

A

reactivation of VSV in geniculate ganglion on CNVII

221
Q

presentation of retinal detachment

A

4 fs
flashers, floaters, fall in acuity, field loss
painless
Rx - urgent surgery

222
Q

What drug for intermittent claudication

A

Naftidrofurly oxalate

223
Q

diagnosis of bullous pemphigoid

A

skin biopsy of blister - split under epidermis

direct immunoflourescence staining of adjacent skin shows antibodies

224
Q

why do we have blind spot in eyes

A

optic disc - no photoreceptors

225
Q

pattern of loss in macular degeneration

A

central visual loss

226
Q

causes of macrocytic anaemia

A

B12/folate deficiency, alcohol excess, reticulocytosis, hypothyroidism, myedlodysplastic syndromes

227
Q

findings in central retinal vein occlusion

A

severe retinal haemorrhages, stormy sunset appearance, poor acuity, RAPD, cottonwool spots, retinal vein dilatation

228
Q

triad of HUS

A

microangiopathic haemolytic anaemia, thrombocytopaeniam renal insufficiency

229
Q

2 complications following bells palsy

A

synkinesis - eye blinking makes corners of mouth turn up

crocodile tears - eating causes unilateral lacrimation instead of salivation

230
Q

2 physical signs in appendcitis

A

rovsings sign - pain in rif when lif pressed, rebound tenderness

231
Q

Transudate and exudate in pleural effusion

A 
Effusion protein < 25g/L = transudate
Effusion protein >35g/L = exudate
If between 25-35g/L: apply Light’s Criteria
Light’s Criteria
 serum protein ratio >0.5
 serum LDH ratio 
 LDH is 0.6 x ULN
232
Q

signs and symptoms of hypercapnia

A

confusion, asterixis, decreased consciousness, bounding pulse

Phase 4 exam revision (2 decks)

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