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Phase 2a > Practice qs > Flashcards

Practice qs Flashcards

1
Q

What structure initiates and controls ongoing voluntary movements?

A

basal ganglia

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2
Q

What characteristics of a headache make it likely to be a tension headache?

A

prolonged period of time
NO ASSOCIATED SYMPTOMS
bilateral dull pain

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3
Q

What are the 3 classic symptoms of aortic stenosis?

A

exercise induced chest pain
dyspnoea
presyncope

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4
Q

What are heart sounds and murmurs are a sign of aortic stenosis?

A

high-pitched crescendo decrescendo systolic ejection murmur, radiating to the carotids
2nd heart sound soft
slow-rising carotid pulse

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5
Q

What investigation can diagnose aortic stenosis?

A

echocardiogram

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6
Q

Cardiac muscle only has the capacity to enlarge by what process?

A

hypertrophy

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7
Q

What 2 types of hypertrophy can occur in the heart muscle?

A

pathological eg hypertension (increases cardiac afterload > increases workload > enlarges)
physiological ie in response to exercise

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8
Q

What are the 4 characteristic signs of multiple myeloma?

A

anaemia + hypercalcaemia + renal failure + lytic lesions

+ raised globulin levels

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9
Q

What are the causes of macrocytic anaemia?

A

B12 deficiency, myelodysplastic syndrome

liver dysfunction, alcoholism, hypothyroidism, certain drugs

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10
Q

What are the causes of microcytic anaemia?

A

iron deficiency,

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11
Q

What does the hypoglossal nerve innervate?

A

extrinsic and intrinsic muscle of the tongue

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12
Q

What is the most likely gram +ve cocci cause of meningitis?

A

streptococcus pneumoniae

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13
Q

What are the typical signs of diabetic peripheral neuropathy?

A

uncontrolled diabetes +
bilateral distal symmetrical sensory loss in both feet
burning, paraesthesia, tingling

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14
Q

What is the most specific antibody for rheumatoid arthritis?

A

anti-CCP

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15
Q

When is weakness caused by myasthenia gravis more marked?

A

in the evening or after exertion

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16
Q

What is the most sensitive screening test for LV failure?

A

BNP

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17
Q

What are some characteristic signs of Cushing’s syndrome?

A

HTN
weight gain + bruising (cortisol excess)
abdominal striae
severe > hypokalaemia (activation of mineralcorticoid receptor)

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18
Q

What are some acute infarct markers?

A

creatinine kinase

troponin

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19
Q

What is BNP an indication of?

A

heart failure

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20
Q

What might a LBBB indicate?

A

past infarct

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21
Q

What are the symptoms of Addison’s?

A

adrenal insufficiency > low cortisol + aldosterone
= tanned, tired, tearful, thin, throwing up

fatigue, weakness, weight loss, malaise
\+ hyponatraemia + hyperkalaemia/calcaemia
hyperpigmentation
low mood
thirst
hypotension
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22
Q

Who is diverticulitis likely to affect?

A

elderly

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23
Q

When might nitrates be high?

A

UTI

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24
Q

What can a D-dimer test do in the diagnosis of a DVT/PE?

A

exclude only

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25
Q

What is a potential complication of a mallory-weiss tear?

A

significant blood loss/haemorrhage

shock/collapse

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26
Q

How is a mallory-weiss tear usually treated?

A

endoscopic haemostasis

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27
Q

What characterises bulimia nervosa?

A

Recurrent episodes of binge eating followed by inappropriate compensatory
behaviour with a sense of lack of control

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28
Q

What are the potential complications of bulimia nervosa?

A 
kidney failure
cardiac symptoms
prolonged qt interval
dehydration
dental problems
muscle spasms
osteoporosis
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29
Q

What is the pathophysiology of grave’s disease?

A

autoimmune stimulation of TSH receptors by circulating IgG autoantibodies leading to increased stimulation of the thyroid gland

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30
Q

After TFTs, what other investigations can be done to diagnose grave’s?

A

thyroid USS

iodine thyroid scan

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31
Q

What are the signs of liver failure?

A 
jaundice
finger clubbing
palmar erythema
bruising
spider naevi
oedema
anorexia
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32
Q

What are the 3 stages of alcoholic liver disease?

A
  1. alcoholic fatty liver
  2. alcoholic hepatitis
  3. alcoholic cirrhosis
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33
Q

What are the complications of liver cirrhosis?

A

HCC
portal HTN
oesophageal varices

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34
Q

How liver failure lead to ascites?

A

low albumin produced > oncotic pressure lower than hydrostatic pressure > fluid leaks into abdominal cavity
portal HTN > hydrostatic pressure higher than oncotic pressure > fluid leaks into abdominal cavity

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35
Q

What are 2 example of anti-epileptic drugs and their side effects?

A

sodium valproate/carbamazepine

teratogenic (mainly valproate), cognitive disturbance, heart disease

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36
Q

Patient has had a recent chest infection and presents with pan- systolic murmur heard at the apex. Doctor suspects infective endocarditis. What might have caused the murmur?

A

mitral regurgitation

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37
Q

What would be seen on the echocardiogram of a pt with infective endocarditis?

A

vegetations on the heart valves

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38
Q

What are the signs of IE?

A 
murmur
splinter haemorrhages
Roth spots
Osler's nodes
Janeway lesions
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39
Q

What are the risk factors for IE?

A 
elderly
IVDU
poor dental hygiene 
cardiac surgery
prosthetic heart valves
congenital heart disease
pacemaker
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40
Q

What is the diagnostic criteria for giant cell arteritis?

A

age >50
temporal artery tenderness
new headache
giant cells/neutrophils on biopsy

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41
Q

What is a serious complication of GCA?

A

acute blindness

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42
Q

What is the management for GCA?

A

corticosteroids eg prednisolone
methotrexate
monitor and reduce likelihood of osteoporosis

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43
Q

Give an example of a 5-alpha-reductase inhibitor?

A

finasteride

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44
Q

What are the risk factors for breast cancer?

A 
genetic predisposition
late menopause + early menarche
never breast fed
increasing age
HRT
never having borne a child/1st child after 30
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45
Q

Which genes and their chromosomes increase the likelihood of developing breast cancer?

A

BRCA1 gene - chromosome 17

BRCA2 gene - chromosome 13

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46
Q

What is the most common type of breast cancer?

A

ductal carcinoma

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47
Q

Where can breast cancer metastasise to?

A

lung
bone
brain
liver

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48
Q

What chemotherapy drugs are used for breast cancer?

A

tamoxifen (pre-menopause)

anastrozole (post-menopause)

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49
Q

What organisms can cause UTIs?

A 
staph saprophiticus (gram +ve cocci)
e. coli (gram -ve rod, lactose fermenting)
klebsiella pneumoniae (gram -ve cocci)
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50
Q

What antibiotics can be used to treat UTIs?

A

trimethoprim

nitrofurantoin

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51
Q

In GORD pts often suffer from chest pain after eating. What might the differentials be for this?

A

MI
PE
pericarditis

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52
Q

What are 2 complications of GORD?

A

peptic stricture

Barrett’s oesophagus

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53
Q

What are 3 red flag signs for GORD complications?

A

weight loss
haematemesis
dysphagia

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54
Q

What is chronic bronchitis?

A

inflammation of the bronchi leading to mucociliary dysfunction and therefore lower ventilation

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55
Q

What are the 2 signs of COPD on LFTs?

A

FEV1/FVC <0.7

FEV1 < 80% of predicted

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56
Q

What is essential HTN?

A

primary cause unknown

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57
Q

How might the size of a kidney change with HTN?

A

reduced

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58
Q

What investigations might be requested and what cause may they show for HTN?

A

urinalysis > protein/albumin:creatinine/haematuria
bloods > creatinine/eGFR
fundoscopy/ophthalmoscopy > retinal haemorrhage, papilloedema
ECG/echo > left ventricular hypertrophy

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59
Q

What hormone changes result in a thyroid storm?

A

rapid increase in T4

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60
Q

What can be the complications of a thyroid storm if not treated?

A

delirium
coma
death

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61
Q

What factors can precipitate a thyroid storm?

A

stress
infection
surgery

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62
Q

What medications can be given orally to treat a thyroid storm?

A

carbimazole
propanolol
potassium iodide

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63
Q

How does hydrocortisone work in the treatment of a thyroid storm?

A

inhibits peripheral conversion of T4 to T3

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64
Q

What type of anaemia occurs in myeloma?

A

normocytic normochromic

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65
Q

Why give bisphosphonates to pts with myeloma?

A

to reduce fractures and bone pain

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66
Q

How much fluid should pts with myeloma drink daily?

A

3L

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67
Q

Name 2 1st line drugs used in the treatment for chronic hepatitis?

A 
oral ribavirin (antiviral)
SC pegylated interferon alpha A, B
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68
Q

What type of drug would be prescribed for renal colic?

A

analgesics eg diclofenac

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69
Q

What lifestyle modifications can be made to reduce reoccurrence of kidney stones?

A 
reduce BMI
normal/low Ca2+ intake
low Na+ intake
normal dairy
low animal protein intake
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70
Q

Give 3 signs of brainstem compression?

A

deep/irregular breathing
ipsilateral pupil dilation
bilateral limb weakness
coma

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71
Q

How long do SABAs work for?

A

4hrs

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72
Q

Give 2 examples of LABAs?

A

salmeterol

formoterol

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73
Q

What makes LABAs last longer in tissues?

A

they are lipophilic

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74
Q

Name 4 types of melanoma?

A

nodular
superficial spreading
lentigo maligna
acral

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75
Q

Define ulcer

A

breach of the mucosal surface

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76
Q

How long is a normal QT interval?

A

0.08 - 0.10 seconds

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77
Q

What BP reading leads to a diagnosis of stage 1 HTN? and stage 2?

A

stage 1: >140/90 (>135/85 at home)

stage 2: >160/100 (>150/95 at home)

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78
Q

What is the normal cardio-thoracic ratio?

A

<1:2

heart is normally less than half the diameter of the chest

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79
Q

What are 2 possible causes of acromegaly?

A

benign pituitary tumour

ectopic carcinoid tumour

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80
Q

What investigations should be done to diagnose acromegaly?

A

glucose tolerance test
MRI of pituitary

(serum GH not diagnostic > pulsatile and increases due to stress, pregnancy and puberty)

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81
Q

Name 3 types of drugs used to treat acromegaly?

A

somatostatin analogues
GH receptor antagonist
dopamine agonist

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82
Q

A pt has a black curtain coming down vertically into their field of vision in one eye. What is this called and why does it happen?

A

amaurosis fugax

= involvement of ipsilateral ophthalmic artery

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83
Q

What symptoms indicate Bell’s palsy rather than stroke?

A

no forehead sparing !

drooling
difficulty speaking
dry eyes
phonophobia 
decrease in taste
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84
Q

What is the key feature of MG?

A

fatiguability with use

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85
Q

What is the key feature of MND?

A

BOTH UMN and LMN symptoms

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86
Q

What signs come first in MG? What is the order of signs after this?

A

eye signs: ptosis, diplopia
then dysphagia + dysarthria
then weakness of muscles of facial expression
then limb and trunk involvement

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87
Q

What are some of the causes of GORD?

A 
lower oesophageal sphincter hypotension
obesity
hiatus hernia
rolling/para-oesophageal hiatus
gastric acid hyper secretion
slow gastric emptying
drugs e.g. CCBs, nitrates
systemic sclerosis
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88
Q

What are the symptoms of GORD?

A 
heartburn
increased belching
food/acid regurgitation
odynophagia
increased salivation
chronic cough
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89
Q

What are the complications of GORD?

A

barrett’s oesophagus

peptic stricture

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90
Q

What ECG changes are seen in an MI?

A

ST elevation/depression
Q wave changes
inverted T wave

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91
Q

How does spironolactone work?

A

potassium sparing diuretic

inhibits aldosterone receptors in the distal tubules

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92
Q

Which CVS condition puts you at very high risk of a stroke? Why?

A

AF

blood collects in the atria and forms clots

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93
Q

What are the 3 key aspects of Conn’s?

A

HTN associated with hypokalaemia
HTN <40yrs
HTN despite being on 3+ antihypertensives

metabolic acidosis

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94
Q

What happens to renin and aldosterone levels in primary and secondary hyperaldosteronism?

A

primary: low renin + high aldosterone (adrenal carcinoma/adenoma/hyperplasia)
secondary: high renin + high aldosterone (excess activation of RAAS > low circulating volume, likely to be a renin secreting tumour, renal artery stenosis, HF, pregnancy, cor pulmonale)

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95
Q

How do pts with Cushing’s present?

A 
HTN
abdominal striae, bruising
moon face
buffalo hump, central obesity
weight loss in extremities
severe > hypokalaemia
increased body hair, acne
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96
Q

How do pts with Addison’s disease present?

A

hyper pigmentation
central weight loss
hypotension

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97
Q

When is a water deprivation test with desmopressin used? How is it done, what does it show?

A

diagnosing DI > is it a cranial or nephrogenic cause?
large amount of water lost in DI due to: decreased production of ADH (cranial) or impaired response to ADH (nephrogenic)

deprive pt of water, test pre and post giving desmopressin
urine osmolality after des is high > cranial cause
low > nephrogenic cause

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98
Q

What is the full diagnostic criteria for DM?

A

Fasting plasma glucose >7mmol/L
HbA1c of ≥48mmol/mol
Symptoms and random plasma glucose >11mmol/L

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99
Q

What rhyme is used to remember to signs and symptoms of hypercalcaemia?

A

bones, stones, groans and psychiatric moans

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100
Q

What ECG changes are seen in hyperkalaemia?

A

absent p wave, prolonged PR, tall tented T wave, wide QRS

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101
Q

What is the classical triad of symptoms associated with Carcinoid syndrome? What is it?

A

cardiac involvement, diarrhoea and flushing

paraneoplastic syndrome > tumour cells produce 5-HT

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102
Q

Which antibodies are specific to coeliac disease?

A

IgA tissue transglutaminase (tTGA)

IgA endomysial antibody (EMA)

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103
Q

What investigation should be done if a pheochromocytoma is suspected?

A 
plasma metanephrines (breakdown products of adrenaline)
24hr urine catecholamines
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104
Q

What is the difference between Cushing’s syndrome and disease?

A

Cushing’s syndrome: clinical picture (signs and symptoms) that reflect prolonged abnormal elevation of cortisol

Cushing’s disease: a pituitary adenoma secretes excessive ACTH, causing Cushing’s syndrome

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105
Q

What is the immediate management for a pt with suspected DKA? What needs to be closely monitored?

A

IV fluids
then IV insulin
monitor K+ carefully as can drop dramatically

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106
Q

What is the most appropriate investigation to confirm Cushing’s?

A

dexamethasone suppression test

dose of dexamethasone (glucocorticoid steroid) at night and measuring cortisol and ACTH in the morning
normal = cortisol suppressed
cushings = no change at low dose as hypothalamus and pituitary are used to high levels of cortisol, no reaction > try higher dose

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107
Q

What electrolyte disturbance would make you think SIADH?

A

excessive ADH > excessive water is reabsorbed into the blood > dilutes sodium > hyponatraemia

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108
Q

What is the 1st line investigation for stable angina?

A

stress ECG > changes occur when ischaemia is induced

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109
Q

What is the 1st line treatment for trigeminal neuralgia? 2nd line?

A

1st line = carbamazepine

2nd line = gabapentin

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110
Q

Which medication used to treat TB can interact with the OCP?

A

rifampicin (RIPE)

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111
Q

What signs are positive in meningitis?

A

brudzinski’s sign: hips and knees flex in response to neck flexion
kerning’s sign: flex hip and knees at 90 degrees, then extend the knee up, if painful = +ve

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112
Q

A smoker presents with Horner’s syndrome and resp symptoms. What is the most likely cause?

A

pancoast tumour in the apex of the lung

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113
Q

What is the 1st line treatment for Parkinson’s? What 2 medications is it derived from and why?

A

co-careldopa (levodopa + carbidopa)

levodopa = precursor to dopamine: when used alone, it is broken down peripherally before it has any effect on the basal ganglia > should be used in conjunction with Carbidopa, which prevents its breakdown

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114
Q

What is the 1st line treatment for pregnant women with an uncomplicated UTI?

A

nitrofurantoin (usually would be trimethroprim but this is teratogenic)

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115
Q

What happens to TSH and T4 levels in secondary hyperthyroidism? Why?

A

high TSH + T4

due to pituitary gland pathology

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116
Q

The blockage of what vein could cause a left varicocele? What might the blockage be due to?

A

left renal vein
drains the left gonadal vein from the left testes > congestion in lgv > varicocele
could be due to left renal cell carcinoma

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117
Q

What kind of diet can lower a pt’s INR? Why?

A

leafy greens - spinach, kale

high in vitamin K > interacts with warfarin and lowers INR

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118
Q

Name a protective factor for osteoporosis?

A

high BMI > puts stress on bones > increases BMD

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119
Q

Define cachexia?

A

extreme weight loss and muscle wasting

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120
Q

What is Courvoisier’s sign?

A

painless jaundice + palpable gallbladder > pancreatic/biliary neoplasm until proven otherwise

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121
Q

What are the key signs of giant cell arteritis?

A

sudden blindness
scalp tenderness
headache

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122
Q

What do owl’s eye intranuclear lesions in the bowel suggest?

A

CMV infection

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123
Q

What type of crystals are found in the joint aspiration for gout and pseudo gout?

A

gout > needle shaped negatively birefringent

pseudo (more commonly affects knees) > rhomboid shaped positively birefringent crystals

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124
Q

A warm swollen and tender joint is always what until proven otherwise?

A

septic arthritis

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125
Q

What is the 1st line treatment for BPH?

A

tamulosin: alpha-1 blocker

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126
Q

When is a lumbar puncture useful for diagnosing an SAH?

A

after 12 hrs > as this is when you see xantochromia (yellow CSF)

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127
Q

What is seen on a CT head that would indicate SAH?

A

star sign

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128
Q

What is the treatment pathway for T2DM?

A

1st line = metformin + lifestyle changes
+ sufonylurea
+ insulin if no improvement

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129
Q

Painless haematuria in the absence of a UTI is what until proven otherwise?

A

bladder cancer

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130
Q

Match the presentation with the haematological condition:

a. painless rubbery lump that aches on drinking alcohol
b. breathlessness, frequent infections, bleeding
c. bone pain, fractures, infection
d. infections, bleeding, fever

A

a. Hodgkin’s lymphoma
b. AML
c. multiple myeloma
d. CLL

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131
Q

What tests are done to diagnose acromegaly?

A

IGF-1 test

if +ve > oral glucose tolerance test to confirm

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132
Q

What is Rovsing’s sign?

A

palpation of LIF increases pain in RIF > +ve > indicates appendicitis

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133
Q

ST elevation in what leads indicates an inferior STEMI?

A

II, III, aVF

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134
Q

What are the key signs of cardiac tamponade?

A 
quiet heart sounds
cool peripheries
bibasal coarse crackles (early pulmonary oedema)
hypotension
tachycardia
history of chest trauma
low voltage QRS complexes
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135
Q

Where does the fluid lie within the testes in a hydrocele?

A

tunica vaginalis

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136
Q

What can cause a hydrocele?

A
  • Patent processus vaginalis
  • Testis tumour
  • Trauma
  • Infection
  • Testicular torsion
  • Generalised oedema
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137
Q

What are 2 key differential diagnosis of a hydrocele?

A

testicular torsion

strangulated hernia

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138
Q

What investigation can be done to diagnose a hydrocele? And 2 tests to exclude a malignant teratoma but confirm the hydrocele?

A

scrotal US

serum alpha-fetoprotein
serum hCG

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139
Q

What are 2 classes of bronchodilators as an alternative to beta agonists?

A

muscarinic antagonists

methylxanthines

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140
Q

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

A 
cyanosis/PaO2 <8kPa
PEFR < 33%
silent chest
confusion
exhaustion
bradycardia
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141
Q

Risk factors for an arterial ulcer?

A

smoking
atherosclerosis
DM
hypercholesterolaemia

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142
Q

What are the signs of an arterial ulcer?

A 
small + painful
worsened when elevated
Punched out ulcer
- Cold/ Pale leg
- Sharply defined ulcer
- Shiny skin
- Loss of hair on leg
- Absent peripheral pulses
- Arterial bruits
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143
Q

What 2 investigations should be carried out to diagnose an arterial ulcer?

A

doppler US

ankle brachial pressure index

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144
Q

What are the treatment options for an arterial ulcer?

A

Keep ulcer clean + covered

  • Analgesic e.g. ibrupofen/ morphine
  • Vascular reconstruction
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145
Q

What are the differences between an arterial and venous ulcer?

A 
A vs V
Small ulcer vs Large ulcer
Punched out ulcer vs Shallow ulcer
Painful vs Minimal pain
No oedema vs Oedema of lower leg
No varicose veins vs varicose veins
Absent peripheral pulses vs Peripheral pulses present
Cold skin vs Warm skin
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146
Q

What is the name of the criteria used to diagnose Irritable Bowel Syndrome?

A

rome III criteria

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147
Q

What class of drug can be given to relieve bloating and the associated pain in IBS?

A

antispasmodics/cholinergics

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148
Q

Which microorganisms can cause IE?

A

Staphylococcus Aureus

  • Pseudomonas Aeruginosa
  • Streptococcus Viridans
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149
Q

What is the criteria used to diagnose IE?

A

modified duke’s

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150
Q

How long are abx given for IE?

A

4-6wks

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151
Q

Signs of IE?

A 
ventricular tachycardia
fever
confusion
Splinter haemorrhages on nail beds of fingers
- Embolic skin lesions
- Osler nodes
- Janeway lesions
- Roth spots
- Petechiae
- New valve lesion/ regurgitant murmur
- sepsis of unknown origin
- haematuria
- finger clubbing
- embolization of vegetations
152
Q

What is the antibody for Goodpasture’s syndrome?

A

anti-GBM

153
Q

Treatment for mild-moderate UC?

A

mesalazine

154
Q

Known asthma, presents with severe breathlessness, barely able to speak
O/E dynamic hyperinflation, severe wheeze throughout both lungs, accessory breathing
Sats ?lowish, RR ?28/min, HR ?110/min. Appropriate 1 st -line mgmt.?

A

24% O2 venturi mask

155
Q

What benign lesion of the colon has a

high risk of malignant transition?

A

villous adenoma

156
Q

1st line investigation for chronic liver disease, after bloods?

A

US abdo

157
Q

Acute management of gout?

A

oral diclofenac

colchicine

158
Q

X-ray shows a mid-shaft fracture of the humerus with posterior displacement.
OE he is unable to extend his wrist or fingers.
What nerve has he likely damaged?

A

radial

159
Q

What is Charcot foot?

A

weakening of the bones/soft tissue due to neuropathy
common in diabetics
> swelling, change of shape, loss of sensation/circulation, frequent fractures, dislocation, joint destruction

160
Q

What is Paget’s disease of bone?

A

new bone tissue gradually replaces old bone tissue
> affected bones become fragile and misshapen
commonly affects pelvis, skull, spine and legs

161
Q

What substance is likely to be depleted in myocytes after a STEMI?

A

ATP

162
Q

A deficiency in which protein produced by the liver is a risk factor for HCC?

A

alpha-1-antitrypsin

163
Q

What is pretibial myxoedema? What is it seen in?

A

red, swollen skin on shins, texture like orange peel

Grave’s dermopathy

164
Q

What effect does gaining weight and starting smoking have on liver enzymes?

A

increases them

165
Q

What effect does coeliac, Crohn’s and hepatitis have on serum albumin?

A

coeliac > decrease
Crohn’s > decrease
Hepatitis > increase

166
Q

What is the role of albumin?

A

synthesised in the liver helps to bind water, cations, fatty acids and bilirubin
key in maintaining the oncotic pressure of blood

167
Q

When can albumin levels fall?

A

Liver disease resulting in a decreased production of albumin (e.g. cirrhosis)

Inflammation triggering an acute phase response which temporarily decreases the liver’s production of albumin

Excessive loss of albumin due to protein-losing enteropathies or nephrotic syndrome.

168
Q

What conditions can cause a glove and stocking polyneuropathy?

A

HTN, diabetes, vitamin B12 deficiency, lead poisoning

169
Q

What is a prolactinoma? What is the 1st line treatment?

A

benign tumour of the pituitary gland, produces excess prolactin

initial treatment > bromocriptine (dopamine agonist > inhibits release of prolactin)

170
Q

What is the 1st and 2nd line treatment for primary generalised epilepsy?

A

1st > sodium valproate (CI IN PREGNANCY)

2nd > lamotrigine

171
Q

What is the 1st and 2nd line treatment for partial/focal epilepsy?

A

1st > carbamezapine

2nd > lamotrigine

172
Q

What is a normal JVP?

A

<3cm

173
Q

What can cause a high JVP?

A

Right-sided heart failure: commonly caused by left-sided heart failure/pulmonary HTN (often due to COPD = most common/interstitial lung disease/PE)

Tricuspid regurgitation (due to infective endocarditis/rheumatic heart disease

Constrictive pericarditis (often idiopathic, possibly RA, TB)

174
Q

How does a pt with cor pulmonale present?

A

SoB, peripheral oedema, syncope, chest pain, increased breathlessness on exertion > non-specific!

usually sx of the underlying lung disease are more apparent

175
Q

What are the signs of cor pulmonale?

A

Hypoxia
Cyanosis
Raised JVP (due to a back-log of blood in the jugular veins)
Peripheral oedema
3rd heart sound
Murmurs (e.g. pan-systolic in tricuspid regurgitation or ejection systolic murmur radiating to the carotids)
Hepatomegaly due to back pressure in the hepatic vein (pulsatile in tricuspid regurgitation)
Bilateral air entry, inspiratory wheeze

176
Q

How does encephalitis present?

A

headache
fever
clouding of consciousness
possibly neck stiffness, photophobia, seizures, focal neurology

177
Q

How does psoriatic arthritis present?

A

psoriasis rash usually precedes arthritis (red, flaky, crusty patches of skin covered with silvery scales)

5 patterns of disease:
- asymmetrical oligoarthritis
- symmetrical seronegative inflammatory polyarthritis (resembles RA)
- spondylitis (sacroiliitis + early cervical spine involvement)
- DIPJS involvement only
(with nail dystrophy, dactylics)
- arthritis mutilans > periarticular osteolysis, bone shortening, destruction of small bones in hands, pencil in cup X-ray changes)
HLA-B27 associated

178
Q

What treatment alternative is there for stroke if the 4.5hrs for thrombosis has passed?

A

thrombectomy

179
Q

Which virus is associated with nasopharyngeal carcinoma?

A

EBV

180
Q

What is the acute management of AF?

A

provoking cause treated

cardioversion: urgent synchronised DC CV
- LMWH to minimise risk of thromboembolism
- if DC CV fails, medical CV > IV flecainide, amiodarone

ventricular rate control: block the AV node

  • CCB e.g. verapamil
  • beta-blocker e.g. bisoprolol
  • digoxin
  • anti-arrhythmic e.g. amiodarone
181
Q

What does the NHS diabetes risk assessment tool assess?

A

risk of developing diabetes type 2 in the next 10 yrs

182
Q

What does FRAX assess?

A

10-yr probability of fracture

183
Q

What does CHA2DS2VASC assess?

A

1 yr risk of a stroke in an AF pt

184
Q

What does Wells score assess? What does a score <2 exclude?

A

probability of a DVT

Well’s <2 + negative d-dimer > excludes need for US

185
Q

What is the most common type of inherited colorectal cancer?

A

hereditary non-polyposis colorectal carcinoma (HNPCC)

186
Q

What is a delta wave on ECG? What does it indicate?

A

slurring of the upstroke of the QRS complex > associated with wide QRS

AP from the SAN is able to conduct to the ventricles very quickly through the accessory pathway > QRS occurs immediately after the P wave

indicate of Wolff-Parkinson-White syndrome

187
Q

2ndary preventative treatment of heart failure?

A

furosemide

188
Q

What are the ECG findings for pericarditis?

A

widespread saddle-shaped ST elevation in all leads = diagnostic
PR depression

189
Q

What is a Mantoux test?

A

screening for TB
+ve > raised hardened area measuring >6mm in diameter where the fluid was injected
strongly +ve: >15mm diameter

190
Q

What is Wolff-Parkinson White syndrome? What are the ecg findings?

A

congenital heart disorder
accessory pathway between atria and ventricles > impulses avoid AVN > atrioventricular reentrant tachycardia

short PR interval (<120)
wide QRS with slurred onset (delta wave)
ST segment and T wave changes

191
Q

What can a nucleic acid amplification test be used to test for?

A

malaria, TB, SARS

192
Q

When might serum lactate levels be raised?

A

any condition that decreases the amount of oxygen available to the body/increased lactate production e.g. strenuous exercise, systemic shock, acute mesenteric ischaemia

193
Q

What medication if a risk factor for developing gout?

A

diuretics

194
Q

What is fondaparinux? What is its mechanism of action?

A

activates antithrombin II = anticoagulant
inhibits activated factor X

used for DVT prophylaxis

195
Q

Apraxic gait involves what?

A

magnetic/shuffling gait
difficulty getting started
often seen in frontal lobe disorders e.g. dementia

196
Q

What is cardiac tamponade?

A

blood/fluid/pus/gas fills the pericardial space

> reduced ventricular filling > haemodynamic compromise = EMERGENCY

197
Q

Causes of cardiac tamponade?

A 
trauma, HIV > young people
malignancy, CKD > elderly
MI
infection e.g. TB
connective tissue disease e.g. SLE, RA
radiation, drugs
198
Q

How does cardiac tamponade present?

A

anxiety, fatigue, altered mental status, oedema, waxing/waning

dyspnoea, tachycardia, tachypnoea, cold/clammy extremities
often features of pericarditis

199
Q

What are the signs of cardiac tamponade?

A 
PULSUS PARADOXUS
distended neck veins, hypotension, tachycardia tachypnoea, hepatomegaly
muffled heart sounds
pericardial rub
increased JVP

Beck’s triad > jugular venous distension, hypotension + diminished heart sounds

200
Q

What are the signs of haemolytic anaemia?

A

splenomegaly
jaundice, gallstones (excess bilirubin)
leg ulcers
underlying disease e.g. SLE

reduced Hb, increased reticulocyte count
presence of schistocytes on blood film
high bilirubin, urobiliogen, stercobilinogen
MACRCOCYTIC

201
Q

Causes of haemolytic anaemia?

A

AI, infection, 2ndary to systemic disease

roc membrane defects, enzymes defects, thalassaemia, sickle cell

202
Q

When is the posterior sag test used? What is it?

A

tests for integrity of the PCL

pt lies supine, raise leg so knee and hip are at 90o
support leg under lower calf
observe position of tibia in comparison to femur
+ve > posterior drop of tibia
-ve > remains straight

203
Q

When is Thomas’ test used? What is it?

A

tests for fixed flexion deformity of the hip e.g. in OA

pt lies supine, both hips flexed simultaneously to limit
ensure lordosis is obliterated but placing a hand under the spine
hold one hip firmly in position, lower other limb
+ve > knee unable to rest on couch if flexion deformity present
normal flexion: 130o

204
Q

When is the Trendelenburg test used? What is it?

A

assesses strength of hip abductors (gluteus medius and minimus)

pt standing
lift each foot off ground in turn (lifts right foot > left hip abd being tested)
position hands on pt’s iliac crests, does hip on unsupported side lift or droop?
+ve > pelvis of unsupported side (lifted leg) sags due to failure of abductors to stabilise hip
normal = level/slightly raised

205
Q

When is Buerger’s test used? What is it?

A

assesses adequacy of arterial supply to the leg

pt supine, elevate both legs to 45o and hold for 1-2 minutes > observe colour of feet
(pallor > ischaemia)
poorer the supply > lower the angle the legs need to e raised to become pale

sit pt up, hang legs over side of bed at 90o, colour returns to legs
skin goes blue (deoxygenated through ischaemic tissue) > red (reactive hyperaemia)

done simultaneously, changes most obvious when compared to normal leg

206
Q

When is the Bowstring test used? What is it?

A

assesses sciatic nerve pathology/lumbar nerve root compression

pt supine, raise leg straight
slightly flex knee 20o, place on your shoulder
apply pressure to the tibial nerve in the popliteal area
+ve > pain after popliteal compression indicates tension on sciatic nerve

207
Q

What electrolyte imbalance can spironolactone cause?

A

potassium sparing
> hyperkalaemia
other electrolytes may be depleted

208
Q

Side effects of loop diuretics?

A

inhibits reabsorption from the AL of the LoH
inhibits NaKCl2 transporter

dizziness
hyponatraemia, hypo everything else
hyperuricaemia
gout, syncope, dehydration

209
Q

Side effects of thiazide diuretics?

A

hypercalcaemia
HYPOnatraemia
HYPOkalaemia
hyperuricaemia

dizziness, blurred vision, headache

210
Q

Nystagmus is most noticeable when looking towards to away from the lesion?

A

towards

211
Q

Pronator drift is a test of what lesion?

A

UMN

212
Q

What is rivastigmine used to treat?

A

acetylcholinesterase inhibitor > Alzheimer’s, Parkinson’s

213
Q

What type of dementia is usually accompanied by hallucinations?

A

Lewy body

214
Q

What vaccine do pts with coeliac disease need as part of their management? Why?

A

pneumococcal vaccine

reduced splenic function > increased risk of infection

215
Q

What is INR?

A

international normalised ratio > how long it takes the blood to form a clot using a PT test
determines effects of oral anticoagulants

normal = <1.1

216
Q

What can increase INR?

A 
vitamin K deficiency
warfarin
DIC
increased alcohol intake
major lifestyle changes e.g. changing diet, how much you exercise
217
Q

Describe microbe of e.coli?

A

gram -ve bacilli
lactose fermenting (+ve MacConkey agar test, red pink)
motile with flagellum > H antigen present

218
Q

How should carotid bruit be investigated?

A

duplex US

219
Q

What is Romberg’s test?

A

assesses sensory ataxia caused by 2/3 of proprioception (dorsal columns), vestibular dysfunction and vision

pt stands 2 feet together, arms by side
stand with eyes open then eyes closed and maintain balance
dr should stand close to avoid injury
scored by counting seconds pt is able to stand with eyes closed

220
Q

How can truncal ataxia be assessed?

A

pt stands with arms crossed

221
Q

What factors can effect a PEFR reading?

A

beta-blockers
moving house
recent travel to polluted area
obesity - decreases PEFR

222
Q

Complications of GORD?

A

oesophageal carcinoma
Barrett’s oesophagus
anaemia
benign strictures

223
Q

What is achalasia? What are the sx?

A

LOS fails to open during swallowing
food/drink can’t pass into the stomach and gets stuck/regurgitated

vomiting undigested food
progressive dysphagia - becomes impossible
chocking, coughing fits
heartburn, chest pain
repeated chest infections
drooling vomit, saliva
gradual significant weight loss
224
Q

With what antibiotic, used to treat diverticulitis, is alcohol contraindicated? What are the sx if alcohol is consumed?

A

metronidazole

flushing, headache, vomiting, palpitations

225
Q

Appropriate management in a STEMI? Which surgical intervention is not recommended?

A

morphine
aspirin
PCI
beta-blocker

NOT CABG

226
Q

What should a normal fasting glucose level be? What is the diabetic threshold?

A

<5.5mmol/L

>7mmol/L = diabetic

227
Q

Which cancers most often lead to bone metastasis, in order of incidence?

A 
prostate
breast
kidney
lung
thyroid
228
Q

What is acute angle-closure glaucoma?

A

drainage in eye blocked > fluid pressure inside eye rises quickly = SERIOUS!

sudden severe eye pain
red eye
reduced/blurred vision
N&V, headache

229
Q

What is Wernicke’s encephalopathy? What triad of sx is it characterised by?

A

thiamine (vit B1) deficiency > affects PNS + CNS, life-threatening!
common in alcoholics + malabsorption

characterised by opthalmoparesis with nystagmus, ataxia + confusion

230
Q

What will LFTS show in acute liver failure?

A

raised bilirubin and PT

reduced albumin

231
Q

What are the TLco levels in asthma?

A

raised and increase with bronchodilator treatment

232
Q

What factors can increase TLco?

A

polycythaemia
asthma
increased pulmonary blood volume e.g. in exercise, L heart failure

233
Q

When is TLco decreased?

A

any condition that affects the effective alveolar surface area
e.g. restrictive lung disease, COPD, PE, cardiac insufficiency, pulmonary HTN, heart failure, anaemia

234
Q

What are the long term medications used for rate control and rhythm control in AF?
What is their target INR?

A

rate control

  • warfarin (AV nodal slowing + anticoagulant)
  • beta-blocker
  • CCB
  • if these fail, try digoxin, then amiodarone

rhythm control - for younger, symptomatic, fit pts

  • cardioversion + beta-blockers (suppress arrhythmia)
  • pharmacological cardioversion: fleicainide/amiodarone
  • warfarin (reduce TE risk)

target INR = 2-3

235
Q

Acute and chronic management of heart failure?

A

Acute: 100% O2, nitrates, IV opiates, IV furosemide, consider inotropic drug

Chronic:
ACEi (if not, ARB)
beta-blockers (all pts on ACEi and beta-blockers)
loop diuretic

236
Q

Does the trachea deviate towards or away from a collapsed lung?

A

towards

237
Q

What are the pre-hepatic causes of jaundice?

A

increased rate of haemolysis:

malaria, sickle cell, thalassaemia, haemolytic anaemia, blood transfusion

238
Q

What are the intra-hepatic caused of jaundice?

A

reduced ability of the liver to metabolise + excrete bilirubin

hepatitis A, B, C, AI
alcoholic liver disease
cirrhosis
glandular fever
drug misuse
primary biliary cirrhosis
gilberts
HCC
239
Q

What are the post-hepatic causes of jaundice?

A

obstruction of biliary system

gallstones
Ca of head of pancreas
biliary cancer
pancreatitis

240
Q

What are the effects on stools, urine and LFTs in each type of jaundice?

A

pre-hepatic: all normal, isolated raised bilirubin, no itching

hepatic: normal stools, dark urine, raised bilirubin in urine, abnormal LFTs

post-hepatic: pale stools, dark urine, no urobilinogen in urine, abnormal LFTs

241
Q

No cause identified of a stage 2 AKI. Investigation after FBC, U&Es, LFTS are done?

A

renal US

242
Q

What is haemochromatosis? What gene mutation is it caused by?

A

secondary iron overload
increased intestinal iron absorption > iron deposits in joints, liver, pancreas, heart, pituitary, adrenals, skin > fibrosis > organ failure
HFE gene mutation on chromosome 6, autosomal recessive

243
Q

What are the signs of haemochromatosis?

A

classic triad = bronze skin, hepatomegaly + diabetes

hypogonadism secondary to pituitary dysfunction > erectile dysfunction, reduced libido
arthralgia (2nd + 3rd MCP joint, hands, knee)
liver > cirrhosis, lethargy
heart > dilated cardiomyopathy, heart failure

244
Q

Investigations for haemochromatosis?

A

RAISED FERRITIN + iron, transferrin saturation >45%, TIBC reduced
blood glucose > DM?
HFE genotype

Liver + cardiac MRI > detects iron overload
liver biopsy/ecg/echo

245
Q

Treatment for haemochromatosis?

A

venesection needed for life
consider desferrioxamine if not tolerated
HCC surveillance, treat diabetes

246
Q

When an troponin be raised?

A

PE, heart failure, MI, sepsis

247
Q

1st line investigation for restrictive lung disease?

A

CT scan

248
Q

What is Hashimoto’s thyroiditis? What effect does it have on thyroid hormones?

A

AI destruction of the thyroid gland by lymphocytes/thyroid autoantibodies > hypothyroidism
can lead to myxoedema coma > extreme hypothyroidism > life-threatening

elevated TSH, decreased T4, normal/low T3

249
Q

What auto-antibodies are found in the blood in pts with Hashimoto’s thyroiditis?

A

anti-TPO antibodies (thyroid peroxidase)

sometimes TgAB (antithyroglobulin)

250
Q

What is Chvostek’s sign?

A

test of hypocalcaemia

tap skin over the facial nerve about 2cm anterior to the EAM
+ve = ipsilateral contraction of the facial muscles (graded response: mouth > nose > eye)
due to hyper excitability of the nerve

251
Q

What is Trousseau’s sign?

A

test of hypocalcaemia
(more specific than Chvostek’s sign)

blood pressure cuff on pt’s arm and inflate to 20mmHg above systolic BP for 3-5 mins
= increases irritability of nerves
+ve > flexion of wrist, MCPJs and thumb (carpal spasm) with extension of IPJs induced by ischaemia

252
Q

Mechanism of corticosteroids?

A

Up-regulate anti-inflammatory genes and down-regulate pro-inflammatory genes

253
Q

Causes of pancreatitis?

A 
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps/malignancy
Autoimmune
Scorpion sting
Hypertryglicerides/calcaemia
ERCP
Drugs e.g. diuretics, antimicrobials, immunosuppressants, anti-convulsants
254
Q

What are the contraindications to thrombolysis?

A 
clotting disorders
haemorrhage, IC bleed
onset of Sx >4.5hrs ago/unknown time of onset
trauma
BP > 185/110
peptic ulcer
255
Q

What will the urine dipstick of a pt with a UTI show?

A

raised wbc
+ve nitrites
blood

256
Q

When is an urgent endoscopy indicated?

A 
dysphagia
anaemia
weight loss, anorexia
recent onset
meleana, haematemesis
257
Q

Alternative investigation to diagnose a hiatus hernia if endoscopy is contraindicated?

A

barium swallow

258
Q

2nd line treatment for hiatus hernia?

A

histamine 2 receptor antagonist e.g. ranitidine

259
Q

2nd line investigation for SAH, if CT does not show a bleed?

A

LP 12hrs later to look for xanthochromia (yellow CSF)

260
Q

What eye symptoms do pituitary adenomas cause?

A

bitemporal hemianopia

causes compression on the optic chiasm

261
Q

A pt presents with foot drop. To which spinal cord root does the motor defect localise?

A

due to weakness in ankle dorsiflexion

L4-5 root > peroneal nerve > innervates tibialis anterior muscle

262
Q

What type of CT is 1st line for stroke imaging?

A

non-contrast

if confirmed, may have contrast added through angiography to visualise vessels

263
Q

1st line medication foe depression?

A

citalopram (SSRI)

264
Q

Haematemesis + hx of excess alcohol?

A

ruptured oesophageal varices

265
Q

1st line treatment for eczema?

A

emollient cream

266
Q

1st line treatment for acute relapse of MS?

A

methylprednisolone

267
Q

What virus is shingles caused by?

A

reactivation of varicella zoster virus

268
Q

What is methylprednisolone?

A

corticosteroid

suppression of inflammatory and allergic disorders,
cerebral oedema associated with malignancy

269
Q

Acute management of meningitis while waiting for transfer to hospital?

A

IM benzylpenicillin

270
Q

In herpes zoster opthalmicus, there is reactivation of the herpes zoster virus in which CN?

A 
HZO = shingles involving the eye
trigeminal nerve (V1)
271
Q

What is cardiac syncope?

A

Sudden collapse into unconsciousness due to a disorder of heart rhythm in which there is a slow or absent pulse

272
Q

Black racoon eyes + clear fluid on otoscopy is indicative of? 1st line investigation?

A

base of skull fracture

CT head

273
Q

What occurs with a lesion in Broca’s area compared to Wernicke’s area?

A

Broca: non-fluent, motor, frontal lobe, speech is slow and broken = aphasia
Wernicke’s: fluent, sensory, temporal lobe, speech normal and excessive but makes little sense

274
Q

What is Charcot-Marie-Tooth disease?

A

inherited, damage the peripheral nerves

presents with:

  • distal muscle weakness and sensory loss/tingling, proximal progression over time
  • awkward gait
  • highly arched/very flat feet
275
Q

What is the HAS-BLED score?

A

Estimates risk of major bleeding for patients on anticoagulation to assess risk-benefit in AF care

HTN
Abnormal liver/renal function
Stroke history
-
Bleeding hx/predisposition
Labile INR
Elderly >65
Drugs/alcohol

0-2 > low risk of bleeding
3+ > high risk of bleeding

276
Q

When might lungs be hyper-resonant in an asthmatic pt?

A

acute asthma attack > lungs become hyper-inflated

277
Q

What is the most common type of lung cancer in non-smokers and associated with asbestos exposure?

A

adenocarcinoma

278
Q

Which type of lung cancer is most strongly associated with cigarette smoking?

A

squamous cell carcinoma

279
Q

What are the common sites for lung cancer to metastasise to?

A 
adrenal glands
bone
brain
liver
lymph nodes

(breast uncommon)

280
Q

What bacteria can cause atypical pneumonia?

A

mycoplasma pneumonia
chlamydophila pneumonia legionella pneumonia

> not detectable on gram stains, can’t be cultured using standard methods

281
Q

What is the most common community acquired cause of pneumonia?

A

strep pneumonia

282
Q

What is the most common hospital acquired cause of pneumonia?

A

staph aureus

283
Q

Side effects of all RIPE medications?

A

Rifampicin > red/orange urine (r = red)
Isoniazid > neuropathy
Pyrazinamide > arthralgia
Ethambutol > optic neuritis (e = eyes)

284
Q

Which chromosome is affected in CF?

A

7

CFTR protein

285
Q

What is the 1st line treatment for syphilis?

A

benzathine penicillin

286
Q

What is the difference between primary, secondary and tertiary prevention?

A

primary > reduce initial occurrence of disease e.g. immunisation, NHS health check
secondary > treat disease asap to halt disease progression and prevent long term problems e.g. anti platelet therapy after MI
tertiary > aim to reduce impact of ongoing problem and improve quality of life e.g. diabetic eye screening

287
Q

What does a cerebellar stroke present with?

A

ataxia
headache
vertigo
vomiting

288
Q

Most common cancers to spread to the brain?

A 
lung
breast
skin
kidney
bowel
289
Q

What enzyme is raised in temporal arteritis?

A

ALP

290
Q

Which spinal cord roots does the median nerve originate from?

A

C5-T1

291
Q

What are the features of RA on x-ray?

A

Loss of joint space
Erosions
Soft tissue swelling
Soft bones (osteopenia)

292
Q

What does the Glasgow-Blatchford score calculate?

A

upper GI bleed

293
Q

What medication is used to treat ACUTE attacks of gout?

A

colchicine

294
Q

How do alcoholism/chronic liver disease affect MCV?

A

increase it

295
Q

Most common cause of hepatitis in travellers?

A

A

  • faecal-oral route
  • does not cause chronic liver disease
296
Q

What type of antigen/antibody implies current infection of hepatitis? How do you determine if it is acute or chronic?

A

surface antigen e.g. HBsAg

Acute <6mo
Chronic >6mo

297
Q

What is Meig’s syndrome?

A

triad of benign ovarian tumour + ascites + pleural effusion

298
Q

What is the typical gallstones pt?

A

Fat, female, forty, fertile

OCP also a RF

299
Q

What is neutrophilia? What infection can unusually cause this?

A

high neutrophil count

AIDS - targets immune system > neutropenia

300
Q

How does pernicious anaemia present?

A

common in women around 60yrs

anaemia sx
peripheral neuropathy 
lemon tinged skin (jaundice + pallor)
mouth ulcers
depression
dementia
301
Q

How does acute lymphoblastic leukaemia present?

A

commonly found in children, associated with Down’s

anaemia, bleeding, infection
hepatosplenomegaly
peripheral lymphadenopathy

complications > CNS involvement, SVC obstruction

302
Q

What is a key sign of DIC?

A

distinct trigger e.g. sepsis, major surgery, trauma

303
Q

What is polycythaemia?

A

increase in rbc production

304
Q

Myeloma is incurable but can be managed with a combination of what?

A

chemotherapy
steroids
thalidomide (immunomodulatory)
bisphosphonates, radiotherapy

305
Q

What medication is used to treat hypocalcaemia?

A

calcium gluconate

306
Q

Renal stones smaller than what will pass their own?

A

<5mm

only need to be managed with analgesia

307
Q

What is a nucleic acid amplification test used for?

A

test urine for STIs

308
Q

What eGFR measurements are needed to make a diagnosis of CKD?

A

normal >90

2 measurements >3mo apart with an eGFR<60
<15 = end stage renal failure > dialysis, await transplant

309
Q

Ototoxicity is a potential SE of what antibiotic?

A

gentamicin

310
Q

What is the most common type of renal cell carcinoma?

A

clear cell

311
Q

Name a drug and its class used in the treatment of prostate cancer?

A

goserelin - GnRH agonist

312
Q

Management of acute pulmonary oedema?

A 
high flow O2
IV furosemide
IV morphine/GTN
notify senior, urgent CXR
then consider escalating for CPAP
313
Q

What makes a UTI complicated?

A

being male, pregnant, a child or immunocompromised, recurrent UTIs, structural abnormality

314
Q

What hormones are produced by the anterior and posterior pituitary?

A

anterior:
(GHRH +/somatostatin -) > GH > (bones, muscles, organs)
(GnRH) > FSH > (testes/ovaries > testosterone/oestrogen)
(GnRH) > LH
(TRH) > TSH > (thyroid > thyroid hormones)
(PRH +/dopamine -) > prolactin > (breasts)
(CRH) > ACTH > (adrenal cortex > cortisol)

posterior:
ADH > (kidney)
oxytocin > (breasts/uterus)

315
Q

What are the key signs of hyperparathyroidism?

A

signs of hypercalcaemia

= bones, (renal) stones, (abdominal) groans, psychiatric moans (depression, anxiety) , thrones (polyuria)

316
Q

What are the PTH, calcium and phosphate levels in primary, secondary and tertiary hyperparathyroidism?

A

primary (e.g. PT adenoma) > raised PTH and Ca, low phosphate
> removal of adenoma

secondary (hyperplasia in response to hypocalcaemia, usually in CKD) > raised PTH, low Ca and phosphate
> correct hypocalcaemia

tertiary (autonomous hyperplasia) > raised PTH, Ca and phosphate
> parathyroidectomy

317
Q

Acute management of hypercalcaemia?

A

IV fluids
bisphosphonates
measurement of U&E/Ca
prednisolone

318
Q

What is myxoedema coma?

A

hypothyroid emergency

altered mental state, hypothermic, hypotensive, bradycardia

319
Q

How is Addison’s treated?

A

hydrocortisone + fludrocortisone replacement

treat cause

320
Q

1st line medications to treat HF?

A

b-blocker + acei improve prognosis

321
Q

What leads are affected in a inferior, lateral, anterior and septal STEMI?

A

inferior: II, III, aVF
lateral: I, aVL, V5, 6
anterior: V3, 4
septal: V1, 2

322
Q

Complications of MI?

A 
Death
Arrhythmias
Rupture (septum, papillary muscles)
Tamponade
Heart failure
Valve disease
Aneurysm of ventricle
Dressler's syndrome
Embolism
Recurrence/mitral regurgitation
323
Q

How do statins work?

A

HMG-CoA reductase inhibitors

324
Q

Coeliac disease on endoscopy?

A

villous atrophy
lymphocytic infiltration
crypt hyperplasia

325
Q

What is pyoderma gangrenosum?

A

rare, inflammatory skin disease with painful pustules/modules that become ulcers that progressively grow

326
Q

What is ranitidine?

A

H2 receptor blocker

327
Q

What it Truelove and Witt’s criteria? What does it include?

A

severe flare-up of UC

>6 stools passed in 1 day + 1 of:
HR >90
Temp >37.5
Hb<10,5
ESR >30
> Iv steroids in hospital
328
Q

Most common cause of sudden cardiac death in <30s?

A

hypertrophic cardiomyopathy

329
Q

What does an S4 heart sound mean?

A

forceful atrial contraction due to stiff/hypertrophic ventricles

330
Q

What is a silent MI? Who is most likely to suffer from one?

A

heart attack with few/no sx or sx not recognised as signs of an MI > can go unnoticed

common in diabetic pts

331
Q

What is Prinzmetal angina?

Sx, ECG findings, due to and triggered by?

A

chest pain always occurs at rest, usually between midnight and early morning
quick response to nitrates
clustered attacks of 2 or 3

causes ST elevation

due to coronary artery spasm
can be triggered by stress, cold, smoking, drugs, alcohol, hyperventilation

332
Q

What is the Sepsis 6?

A 
Bloods culture + septic screen
Urine output - monitor hourly
Fluid resuscitation
Antibiotics IV
Lactate measurement
O2 - keep stats >94%
333
Q

Tx for hepatic encephalopathy?

A

oral lactulose + neomycin/rifaximin

334
Q

What is the difference between bacterial and viral meningitis?

A

Bacterial: cloudy, very high WBC, very high protein (>200), low glucose
Viral: clear, raised wbc (predominantly lymphocytes), normal-high protein (<200), normal glucose

335
Q

What is the most commonly affected area of the bowel in Crohn’s?

A

terminal ileum

336
Q

What does the painful arc test for? How is the test done?

A

impingement of supraspinatus

arm outstretched in front and actively elevate and bring arm back down
+ve = pain between 60-120o

337
Q

What does Jobe’s/empty can test look for? How is the test done?

A

supraspinatus pathology

arm outstretched at 90o, thumb down as if pouring a can
apply downward force on arm, pt tries to resist
+ve = pain or arm gives way

338
Q

What does Gerber’s lift off test look for? How is the test done?

A

subscapularis pathology

dorsum of hand on mid-lumbar spine
pt tries to lift hand away from back, give resistance to test for strength
+ve = inability to lift hand off/

339
Q

What does the Scarf test look for? How is the test done?

A

test acromioclavicular joint fro frozen shoulder (adhesive capsulitis)

flex elbow to 90o and place pt’s hand on opposite shoulder
push pt’s arm further into adduction
+ve = pain

340
Q

What is Phalen’s test?

A

hold both hands in palmar flexion (reverse prayer sign)

+ve = pain, numbness, tingling in medial nerve distribution = carpal tunnel syndrome

341
Q

Anterior vs middle vs posterior cerebral stroke symptoms?

A

Middle: CHANGE

  • CL paralysis + sensory loss of face, arms, legs
  • Homonymous hemi/quadrantopia
  • Aphasia, dysarthria
  • Neglect
  • Gaze towards side of lesion

Anterior:

  • CL paralysis + sensory loss of leg
  • cognitive/personality changes

Posterior: 4Ds

  • Diplopia
  • Dizziness
  • Dysphagia
  • Dysarthria
342
Q

What is a pneumothorax? What is the difference between a simple and tension PT?

A

air enters pleural space due to disease/injury > loss of -ve pressure > partial/complete collapse
= spontaneous or traumatic

can progress to a tension PT
> life-threatening
- sudden onset dyspnoea, ipsilateral chest pain, diminished breath sounds, hyper-resonance, hypoxia, hypotension

343
Q

What signs in a breast exam are red flags for breast cancer?

A

peau d’orange
puckering and tethering
new inversion of the nipple
visible mass that moves with pectoral muscle contraction (hands on hips)

normal for young women to have dense lumpy breast tissue

344
Q

What is a Ghon focus? What disease are they found in?

What is a Goon complex?

A

granuloma in lung from previous TB infection seen on CXR

parenchymal granuloma + involved hilarious lymph node on same side = Ghon complex

345
Q

When is a narrow base gait found? What is this gait called?

A

associated with diplegic gait

caused by cerebral palsy

346
Q

What is the most commonly injured rotator cuff muscle?

A

supraspinatus

347
Q

What is Schober’s test?

A

tests for decrease in lumbar spine flexion = sign of ankylosing spondylitis

pt standing, mark both PSIS, draw line at centre of these marks
2nd line marked 5cm below this and 3rd line 10cm above
pt flex forward as if attempting to touch toes
remeasure distance between lines whilst fully flexed
= should increase from 15cm to 20cm

348
Q

On CXR, tramline opacities and ring shadows are found. What are they and what are they indicative of?

A

bronchiectasis

tramline opacities: mucus build up in airways perpendicular to XR beam
ring shadows: dilated airways

349
Q

What organism is linked to antibiotic treatment? What GI SE can it have? What does the gram stain look like?

A

clostridium difficile

causes GI illness including non-bloody diarrhoea
gram +ve anaerobic bacillus

350
Q

Unilateral acute testicular pain with active sexual hx?

A

epididymis-orchitis

secondary to chlamydia trachomatis infection

351
Q

What test is used to differentiate between testicular torsion and epididymo-orchitis?

A

Prehn’s test

lift affected testicle > relieves pain of epidiymitis, doesn’t relieve testicular torsion

352
Q

What is Meniere’s disease? What test is likely to be +ve in Meniere’s?

A

condition of inner ear
cause sudden attacks of vertigo, tinnitus, pressure felt deep inside ear, hearing loss

Romberg’s test likely to be +ve

353
Q

Anterior dislocation of shoulder - what nerve injury may occur? How will this present?

A

axillary nerve

weakness in abduction

354
Q

What is costochrondritis?

A

inflammation of the cartilage of the sternum

can mimic a heart attack

355
Q

What is tiotropium?

A

LAMA

356
Q

Causes of pericardial effusion?

A 
cancer, metastasis
infection
inflammation e.g. from a heart attack, surgery/injury
AI e.g. RA, SLE
aortic dissection
357
Q

Presentation of pituitary gland vs adrenal adenomas?

A

adrenal > non-functioning (don’t produce hormones)

pituitary > massive endocrine dysfunction, headaches, visual changes

358
Q

What autoantibodies are often present in primary sclerosis cholangitis?

A

anti-endothelial cell ab

pANCA

359
Q

What is L’Hermitte’s sign? What is it indicative of?

A

sudden electric shock sensation passing down the back of the neck radiating into the limbs
in MS

360
Q

What is Uhthoff’s phenomenon? What is it indicative of?

A

worsening of symptoms with heat

in MS

361
Q

What is Lambert Eaton syndrome? It is associated with what kind of tumours?

A

AI attack on the voltage-gated Ca2+ channel at NMJs

muscle weakness, aching muscles, difficulty lifting/walking up stairs, drooping eyelids/dry eyes/blurred vision, dysphagia, dizziness on standing, dry mouth

associated with small cell lung cancers

362
Q

In Buerger’s test, what is the angle below which a +ve result indicates critical ischaemia?

A

20o

363
Q

Do UMN and LMN lesions in the facial nerve cause facial palsy on the ipsilateral or contralateral side?

A

LMN: ipsilateral
UMN: contralateral

364
Q

What tumours is MG associated with?

A

thymic tumours

365
Q

What is tolvaptan?

A

ADH V2-receptor antagonist

for ADPKD, hyponatraemia 2ndary to SIADH

366
Q

Which is the only valve you would need the bell to listen to?

A

mitral

367
Q

What is bromocriptine?

A

dopamine agonist

pituitary tumours, PD

368
Q

Mallory bodies on biopsy?

A

alcoholic liver disease

369
Q

Which antibody would highly suggest Goodpasture’s?

A

anti-GBM

370
Q

What raised, hardened, purplish skin lesions seen on the nose, ears, cheeks, lips and forehead are pathognomonic for sarcoidosis?

A

lupus pernio

371
Q

What CHA2DS2-VASC score usually required anticoagulation?

A

2

any score should be considered apart from gender alone

372
Q

1st line treatment for pheochromocytoma?

A

phenoxybenzamine
treats HTN and heavy sweating
= alpha-blocker

373
Q

Which types of renal calculi are radiolucent on XR?

A

uric acid stones

cysteine, unless they contain Ca

374
Q

Least cardioselective beta-blocker?

A

propanolol

375
Q

Indications for emergency dialysis in a pt with AKI?

A

severe metabolic acidosis
refractory pulmonary oedema
severe uraemia
refractory hyperkalaemia

Phase 2a (5 decks)

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