Practice qs Flashcards
What structure initiates and controls ongoing voluntary movements?
basal ganglia
What characteristics of a headache make it likely to be a tension headache?
prolonged period of time
NO ASSOCIATED SYMPTOMS
bilateral dull pain
What are the 3 classic symptoms of aortic stenosis?
exercise induced chest pain
dyspnoea
presyncope
What are heart sounds and murmurs are a sign of aortic stenosis?
high-pitched crescendo decrescendo systolic ejection murmur, radiating to the carotids
2nd heart sound soft
slow-rising carotid pulse
What investigation can diagnose aortic stenosis?
echocardiogram
Cardiac muscle only has the capacity to enlarge by what process?
hypertrophy
What 2 types of hypertrophy can occur in the heart muscle?
pathological eg hypertension (increases cardiac afterload > increases workload > enlarges)
physiological ie in response to exercise
What are the 4 characteristic signs of multiple myeloma?
anaemia + hypercalcaemia + renal failure + lytic lesions
+ raised globulin levels
What are the causes of macrocytic anaemia?
B12 deficiency, myelodysplastic syndrome
liver dysfunction, alcoholism, hypothyroidism, certain drugs
What are the causes of microcytic anaemia?
iron deficiency,
What does the hypoglossal nerve innervate?
extrinsic and intrinsic muscle of the tongue
What is the most likely gram +ve cocci cause of meningitis?
streptococcus pneumoniae
What are the typical signs of diabetic peripheral neuropathy?
uncontrolled diabetes +
bilateral distal symmetrical sensory loss in both feet
burning, paraesthesia, tingling
What is the most specific antibody for rheumatoid arthritis?
anti-CCP
When is weakness caused by myasthenia gravis more marked?
in the evening or after exertion
What is the most sensitive screening test for LV failure?
BNP
What are some characteristic signs of Cushing’s syndrome?
HTN
weight gain + bruising (cortisol excess)
abdominal striae
severe > hypokalaemia (activation of mineralcorticoid receptor)
What are some acute infarct markers?
creatinine kinase
troponin
What is BNP an indication of?
heart failure
What might a LBBB indicate?
past infarct
What are the symptoms of Addison’s?
adrenal insufficiency > low cortisol + aldosterone
= tanned, tired, tearful, thin, throwing up
fatigue, weakness, weight loss, malaise \+ hyponatraemia + hyperkalaemia/calcaemia hyperpigmentation low mood thirst hypotension
Who is diverticulitis likely to affect?
elderly
When might nitrates be high?
UTI
What can a D-dimer test do in the diagnosis of a DVT/PE?
exclude only
What is a potential complication of a mallory-weiss tear?
significant blood loss/haemorrhage
shock/collapse
How is a mallory-weiss tear usually treated?
endoscopic haemostasis
What characterises bulimia nervosa?
Recurrent episodes of binge eating followed by inappropriate compensatory
behaviour with a sense of lack of control
What are the potential complications of bulimia nervosa?
kidney failure cardiac symptoms prolonged qt interval dehydration dental problems muscle spasms osteoporosis
What is the pathophysiology of grave’s disease?
autoimmune stimulation of TSH receptors by circulating IgG autoantibodies leading to increased stimulation of the thyroid gland
After TFTs, what other investigations can be done to diagnose grave’s?
thyroid USS
iodine thyroid scan
What are the signs of liver failure?
jaundice finger clubbing palmar erythema bruising spider naevi oedema anorexia
What are the 3 stages of alcoholic liver disease?
- alcoholic fatty liver
- alcoholic hepatitis
- alcoholic cirrhosis
What are the complications of liver cirrhosis?
HCC
portal HTN
oesophageal varices
How liver failure lead to ascites?
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
What are 2 example of anti-epileptic drugs and their side effects?
sodium valproate/carbamazepine
teratogenic (mainly valproate), cognitive disturbance, heart disease
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?
mitral regurgitation
What would be seen on the echocardiogram of a pt with infective endocarditis?
vegetations on the heart valves
What are the signs of IE?
murmur splinter haemorrhages Roth spots Osler's nodes Janeway lesions
What are the risk factors for IE?
elderly IVDU poor dental hygiene cardiac surgery prosthetic heart valves congenital heart disease pacemaker
What is the diagnostic criteria for giant cell arteritis?
age >50
temporal artery tenderness
new headache
giant cells/neutrophils on biopsy
What is a serious complication of GCA?
acute blindness
What is the management for GCA?
corticosteroids eg prednisolone
methotrexate
monitor and reduce likelihood of osteoporosis
Give an example of a 5-alpha-reductase inhibitor?
finasteride
What are the risk factors for breast cancer?
genetic predisposition late menopause + early menarche never breast fed increasing age HRT never having borne a child/1st child after 30
Which genes and their chromosomes increase the likelihood of developing breast cancer?
BRCA1 gene - chromosome 17
BRCA2 gene - chromosome 13
What is the most common type of breast cancer?
ductal carcinoma
Where can breast cancer metastasise to?
lung
bone
brain
liver
What chemotherapy drugs are used for breast cancer?
tamoxifen (pre-menopause)
anastrozole (post-menopause)
What organisms can cause UTIs?
staph saprophiticus (gram +ve cocci) e. coli (gram -ve rod, lactose fermenting) klebsiella pneumoniae (gram -ve cocci)
What antibiotics can be used to treat UTIs?
trimethoprim
nitrofurantoin
In GORD pts often suffer from chest pain after eating. What might the differentials be for this?
MI
PE
pericarditis
What are 2 complications of GORD?
peptic stricture
Barrett’s oesophagus
What are 3 red flag signs for GORD complications?
weight loss
haematemesis
dysphagia
What is chronic bronchitis?
inflammation of the bronchi leading to mucociliary dysfunction and therefore lower ventilation
What are the 2 signs of COPD on LFTs?
FEV1/FVC <0.7
FEV1 < 80% of predicted
What is essential HTN?
primary cause unknown
How might the size of a kidney change with HTN?
reduced
What investigations might be requested and what cause may they show for HTN?
urinalysis > protein/albumin:creatinine/haematuria
bloods > creatinine/eGFR
fundoscopy/ophthalmoscopy > retinal haemorrhage, papilloedema
ECG/echo > left ventricular hypertrophy
What hormone changes result in a thyroid storm?
rapid increase in T4
What can be the complications of a thyroid storm if not treated?
delirium
coma
death
What factors can precipitate a thyroid storm?
stress
infection
surgery
What medications can be given orally to treat a thyroid storm?
carbimazole
propanolol
potassium iodide
How does hydrocortisone work in the treatment of a thyroid storm?
inhibits peripheral conversion of T4 to T3
What type of anaemia occurs in myeloma?
normocytic normochromic
Why give bisphosphonates to pts with myeloma?
to reduce fractures and bone pain
How much fluid should pts with myeloma drink daily?
3L
Name 2 1st line drugs used in the treatment for chronic hepatitis?
oral ribavirin (antiviral) SC pegylated interferon alpha A, B
What type of drug would be prescribed for renal colic?
analgesics eg diclofenac
What lifestyle modifications can be made to reduce reoccurrence of kidney stones?
reduce BMI normal/low Ca2+ intake low Na+ intake normal dairy low animal protein intake
Give 3 signs of brainstem compression?
deep/irregular breathing
ipsilateral pupil dilation
bilateral limb weakness
coma
How long do SABAs work for?
4hrs
Give 2 examples of LABAs?
salmeterol
formoterol
What makes LABAs last longer in tissues?
they are lipophilic
Name 4 types of melanoma?
nodular
superficial spreading
lentigo maligna
acral
Define ulcer
breach of the mucosal surface
How long is a normal QT interval?
0.08 - 0.10 seconds
What BP reading leads to a diagnosis of stage 1 HTN? and stage 2?
stage 1: >140/90 (>135/85 at home)
stage 2: >160/100 (>150/95 at home)
What is the normal cardio-thoracic ratio?
<1:2
heart is normally less than half the diameter of the chest
What are 2 possible causes of acromegaly?
benign pituitary tumour
ectopic carcinoid tumour
What investigations should be done to diagnose acromegaly?
glucose tolerance test
MRI of pituitary
(serum GH not diagnostic > pulsatile and increases due to stress, pregnancy and puberty)
Name 3 types of drugs used to treat acromegaly?
somatostatin analogues
GH receptor antagonist
dopamine agonist
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?
amaurosis fugax
= involvement of ipsilateral ophthalmic artery
What symptoms indicate Bell’s palsy rather than stroke?
no forehead sparing !
drooling difficulty speaking dry eyes phonophobia decrease in taste
What is the key feature of MG?
fatiguability with use
What is the key feature of MND?
BOTH UMN and LMN symptoms
What signs come first in MG? What is the order of signs after this?
eye signs: ptosis, diplopia
then dysphagia + dysarthria
then weakness of muscles of facial expression
then limb and trunk involvement
What are some of the causes of GORD?
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
What are the symptoms of GORD?
heartburn increased belching food/acid regurgitation odynophagia increased salivation chronic cough
What are the complications of GORD?
barrett’s oesophagus
peptic stricture
What ECG changes are seen in an MI?
ST elevation/depression
Q wave changes
inverted T wave
How does spironolactone work?
potassium sparing diuretic
inhibits aldosterone receptors in the distal tubules
Which CVS condition puts you at very high risk of a stroke? Why?
AF
blood collects in the atria and forms clots
What are the 3 key aspects of Conn’s?
HTN associated with hypokalaemia
HTN <40yrs
HTN despite being on 3+ antihypertensives
metabolic acidosis
What happens to renin and aldosterone levels in primary and secondary hyperaldosteronism?
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)
How do pts with Cushing’s present?
HTN abdominal striae, bruising moon face buffalo hump, central obesity weight loss in extremities severe > hypokalaemia increased body hair, acne
How do pts with Addison’s disease present?
hyper pigmentation
central weight loss
hypotension
When is a water deprivation test with desmopressin used? How is it done, what does it show?
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
What is the full diagnostic criteria for DM?
Fasting plasma glucose >7mmol/L
HbA1c of ≥48mmol/mol
Symptoms and random plasma glucose >11mmol/L
What rhyme is used to remember to signs and symptoms of hypercalcaemia?
bones, stones, groans and psychiatric moans
What ECG changes are seen in hyperkalaemia?
absent p wave, prolonged PR, tall tented T wave, wide QRS
What is the classical triad of symptoms associated with Carcinoid syndrome? What is it?
cardiac involvement, diarrhoea and flushing
paraneoplastic syndrome > tumour cells produce 5-HT
Which antibodies are specific to coeliac disease?
IgA tissue transglutaminase (tTGA)
IgA endomysial antibody (EMA)
What investigation should be done if a pheochromocytoma is suspected?
plasma metanephrines (breakdown products of adrenaline) 24hr urine catecholamines
What is the difference between Cushing’s syndrome and disease?
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
What is the immediate management for a pt with suspected DKA? What needs to be closely monitored?
IV fluids
then IV insulin
monitor K+ carefully as can drop dramatically
What is the most appropriate investigation to confirm Cushing’s?
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
What electrolyte disturbance would make you think SIADH?
excessive ADH > excessive water is reabsorbed into the blood > dilutes sodium > hyponatraemia
What is the 1st line investigation for stable angina?
stress ECG > changes occur when ischaemia is induced
What is the 1st line treatment for trigeminal neuralgia? 2nd line?
1st line = carbamazepine
2nd line = gabapentin
Which medication used to treat TB can interact with the OCP?
rifampicin (RIPE)
What signs are positive in meningitis?
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
A smoker presents with Horner’s syndrome and resp symptoms. What is the most likely cause?
pancoast tumour in the apex of the lung
What is the 1st line treatment for Parkinson’s? What 2 medications is it derived from and why?
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
What is the 1st line treatment for pregnant women with an uncomplicated UTI?
nitrofurantoin (usually would be trimethroprim but this is teratogenic)
What happens to TSH and T4 levels in secondary hyperthyroidism? Why?
high TSH + T4
due to pituitary gland pathology
The blockage of what vein could cause a left varicocele? What might the blockage be due to?
left renal vein
drains the left gonadal vein from the left testes > congestion in lgv > varicocele
could be due to left renal cell carcinoma
What kind of diet can lower a pt’s INR? Why?
leafy greens - spinach, kale
high in vitamin K > interacts with warfarin and lowers INR
Name a protective factor for osteoporosis?
high BMI > puts stress on bones > increases BMD
Define cachexia?
extreme weight loss and muscle wasting
What is Courvoisier’s sign?
painless jaundice + palpable gallbladder > pancreatic/biliary neoplasm until proven otherwise
What are the key signs of giant cell arteritis?
sudden blindness
scalp tenderness
headache
What do owl’s eye intranuclear lesions in the bowel suggest?
CMV infection
What type of crystals are found in the joint aspiration for gout and pseudo gout?
gout > needle shaped negatively birefringent
pseudo (more commonly affects knees) > rhomboid shaped positively birefringent crystals
A warm swollen and tender joint is always what until proven otherwise?
septic arthritis
What is the 1st line treatment for BPH?
tamulosin: alpha-1 blocker
When is a lumbar puncture useful for diagnosing an SAH?
after 12 hrs > as this is when you see xantochromia (yellow CSF)
What is seen on a CT head that would indicate SAH?
star sign
What is the treatment pathway for T2DM?
1st line = metformin + lifestyle changes
+ sufonylurea
+ insulin if no improvement
Painless haematuria in the absence of a UTI is what until proven otherwise?
bladder cancer
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. Hodgkin’s lymphoma
b. AML
c. multiple myeloma
d. CLL
What tests are done to diagnose acromegaly?
IGF-1 test
if +ve > oral glucose tolerance test to confirm
What is Rovsing’s sign?
palpation of LIF increases pain in RIF > +ve > indicates appendicitis
ST elevation in what leads indicates an inferior STEMI?
II, III, aVF
What are the key signs of cardiac tamponade?
quiet heart sounds cool peripheries bibasal coarse crackles (early pulmonary oedema) hypotension tachycardia history of chest trauma low voltage QRS complexes
Where does the fluid lie within the testes in a hydrocele?
tunica vaginalis
What can cause a hydrocele?
- Patent processus vaginalis
- Testis tumour
- Trauma
- Infection
- Testicular torsion
- Generalised oedema
What are 2 key differential diagnosis of a hydrocele?
testicular torsion
strangulated hernia
What investigation can be done to diagnose a hydrocele? And 2 tests to exclude a malignant teratoma but confirm the hydrocele?
scrotal US
serum alpha-fetoprotein
serum hCG
What are 2 classes of bronchodilators as an alternative to beta agonists?
muscarinic antagonists
methylxanthines
What are the features of a life-threatening asthma attack?
cyanosis/PaO2 <8kPa PEFR < 33% silent chest confusion exhaustion bradycardia
Risk factors for an arterial ulcer?
smoking
atherosclerosis
DM
hypercholesterolaemia
What are the signs of an arterial ulcer?
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
What 2 investigations should be carried out to diagnose an arterial ulcer?
doppler US
ankle brachial pressure index
What are the treatment options for an arterial ulcer?
Keep ulcer clean + covered
- Analgesic e.g. ibrupofen/ morphine
- Vascular reconstruction
What are the differences between an arterial and venous ulcer?
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
What is the name of the criteria used to diagnose Irritable Bowel Syndrome?
rome III criteria
What class of drug can be given to relieve bloating and the associated pain in IBS?
antispasmodics/cholinergics
Which microorganisms can cause IE?
Staphylococcus Aureus
- Pseudomonas Aeruginosa
- Streptococcus Viridans
What is the criteria used to diagnose IE?
modified duke’s
How long are abx given for IE?
4-6wks
Signs of IE?
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
What is the antibody for Goodpasture’s syndrome?
anti-GBM
Treatment for mild-moderate UC?
mesalazine
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.?
24% O2 venturi mask
What benign lesion of the colon has a
high risk of malignant transition?
villous adenoma
1st line investigation for chronic liver disease, after bloods?
US abdo
Acute management of gout?
oral diclofenac
colchicine
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?
radial
What is Charcot foot?
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
What is Paget’s disease of bone?
new bone tissue gradually replaces old bone tissue
> affected bones become fragile and misshapen
commonly affects pelvis, skull, spine and legs
What substance is likely to be depleted in myocytes after a STEMI?
ATP
A deficiency in which protein produced by the liver is a risk factor for HCC?
alpha-1-antitrypsin
What is pretibial myxoedema? What is it seen in?
red, swollen skin on shins, texture like orange peel
Grave’s dermopathy
What effect does gaining weight and starting smoking have on liver enzymes?
increases them
What effect does coeliac, Crohn’s and hepatitis have on serum albumin?
coeliac > decrease
Crohn’s > decrease
Hepatitis > increase
What is the role of albumin?
synthesised in the liver helps to bind water, cations, fatty acids and bilirubin
key in maintaining the oncotic pressure of blood
When can albumin levels fall?
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.
What conditions can cause a glove and stocking polyneuropathy?
HTN, diabetes, vitamin B12 deficiency, lead poisoning
What is a prolactinoma? What is the 1st line treatment?
benign tumour of the pituitary gland, produces excess prolactin
initial treatment > bromocriptine (dopamine agonist > inhibits release of prolactin)
What is the 1st and 2nd line treatment for primary generalised epilepsy?
1st > sodium valproate (CI IN PREGNANCY)
2nd > lamotrigine
What is the 1st and 2nd line treatment for partial/focal epilepsy?
1st > carbamezapine
2nd > lamotrigine
What is a normal JVP?
<3cm
What can cause a high JVP?
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)
How does a pt with cor pulmonale present?
SoB, peripheral oedema, syncope, chest pain, increased breathlessness on exertion > non-specific!
usually sx of the underlying lung disease are more apparent
What are the signs of cor pulmonale?
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
How does encephalitis present?
headache
fever
clouding of consciousness
possibly neck stiffness, photophobia, seizures, focal neurology
How does psoriatic arthritis present?
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
What treatment alternative is there for stroke if the 4.5hrs for thrombosis has passed?
thrombectomy
Which virus is associated with nasopharyngeal carcinoma?
EBV
What is the acute management of AF?
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
What does the NHS diabetes risk assessment tool assess?
risk of developing diabetes type 2 in the next 10 yrs
What does FRAX assess?
10-yr probability of fracture
What does CHA2DS2VASC assess?
1 yr risk of a stroke in an AF pt
What does Wells score assess? What does a score <2 exclude?
probability of a DVT
Well’s <2 + negative d-dimer > excludes need for US
What is the most common type of inherited colorectal cancer?
hereditary non-polyposis colorectal carcinoma (HNPCC)
What is a delta wave on ECG? What does it indicate?
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
2ndary preventative treatment of heart failure?
furosemide
What are the ECG findings for pericarditis?
widespread saddle-shaped ST elevation in all leads = diagnostic
PR depression
What is a Mantoux test?
screening for TB
+ve > raised hardened area measuring >6mm in diameter where the fluid was injected
strongly +ve: >15mm diameter
What is Wolff-Parkinson White syndrome? What are the ecg findings?
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
What can a nucleic acid amplification test be used to test for?
malaria, TB, SARS
When might serum lactate levels be raised?
any condition that decreases the amount of oxygen available to the body/increased lactate production e.g. strenuous exercise, systemic shock, acute mesenteric ischaemia
What medication if a risk factor for developing gout?
diuretics
What is fondaparinux? What is its mechanism of action?
activates antithrombin II = anticoagulant
inhibits activated factor X
used for DVT prophylaxis
Apraxic gait involves what?
magnetic/shuffling gait
difficulty getting started
often seen in frontal lobe disorders e.g. dementia
What is cardiac tamponade?
blood/fluid/pus/gas fills the pericardial space
> reduced ventricular filling > haemodynamic compromise = EMERGENCY
Causes of cardiac tamponade?
trauma, HIV > young people malignancy, CKD > elderly MI infection e.g. TB connective tissue disease e.g. SLE, RA radiation, drugs
How does cardiac tamponade present?
anxiety, fatigue, altered mental status, oedema, waxing/waning
dyspnoea, tachycardia, tachypnoea, cold/clammy extremities
often features of pericarditis
What are the signs of cardiac tamponade?
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
What are the signs of haemolytic anaemia?
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
Causes of haemolytic anaemia?
AI, infection, 2ndary to systemic disease
roc membrane defects, enzymes defects, thalassaemia, sickle cell
When is the posterior sag test used? What is it?
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
When is Thomas’ test used? What is it?
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
When is the Trendelenburg test used? What is it?
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
When is Buerger’s test used? What is it?
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
When is the Bowstring test used? What is it?
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
What electrolyte imbalance can spironolactone cause?
potassium sparing
> hyperkalaemia
other electrolytes may be depleted
Side effects of loop diuretics?
inhibits reabsorption from the AL of the LoH
inhibits NaKCl2 transporter
dizziness
hyponatraemia, hypo everything else
hyperuricaemia
gout, syncope, dehydration
Side effects of thiazide diuretics?
hypercalcaemia
HYPOnatraemia
HYPOkalaemia
hyperuricaemia
dizziness, blurred vision, headache
Nystagmus is most noticeable when looking towards to away from the lesion?
towards
Pronator drift is a test of what lesion?
UMN
What is rivastigmine used to treat?
acetylcholinesterase inhibitor > Alzheimer’s, Parkinson’s
What type of dementia is usually accompanied by hallucinations?
Lewy body
What vaccine do pts with coeliac disease need as part of their management? Why?
pneumococcal vaccine
reduced splenic function > increased risk of infection
What is INR?
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
What can increase INR?
vitamin K deficiency warfarin DIC increased alcohol intake major lifestyle changes e.g. changing diet, how much you exercise
Describe microbe of e.coli?
gram -ve bacilli
lactose fermenting (+ve MacConkey agar test, red pink)
motile with flagellum > H antigen present
How should carotid bruit be investigated?
duplex US
What is Romberg’s test?
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
How can truncal ataxia be assessed?
pt stands with arms crossed
What factors can effect a PEFR reading?
beta-blockers
moving house
recent travel to polluted area
obesity - decreases PEFR
Complications of GORD?
oesophageal carcinoma
Barrett’s oesophagus
anaemia
benign strictures
What is achalasia? What are the sx?
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
With what antibiotic, used to treat diverticulitis, is alcohol contraindicated? What are the sx if alcohol is consumed?
metronidazole
flushing, headache, vomiting, palpitations
Appropriate management in a STEMI? Which surgical intervention is not recommended?
morphine
aspirin
PCI
beta-blocker
NOT CABG
What should a normal fasting glucose level be? What is the diabetic threshold?
<5.5mmol/L
>7mmol/L = diabetic
Which cancers most often lead to bone metastasis, in order of incidence?
prostate breast kidney lung thyroid
What is acute angle-closure glaucoma?
drainage in eye blocked > fluid pressure inside eye rises quickly = SERIOUS!
sudden severe eye pain
red eye
reduced/blurred vision
N&V, headache
What is Wernicke’s encephalopathy? What triad of sx is it characterised by?
thiamine (vit B1) deficiency > affects PNS + CNS, life-threatening!
common in alcoholics + malabsorption
characterised by opthalmoparesis with nystagmus, ataxia + confusion
What will LFTS show in acute liver failure?
raised bilirubin and PT
reduced albumin
What are the TLco levels in asthma?
raised and increase with bronchodilator treatment
What factors can increase TLco?
polycythaemia
asthma
increased pulmonary blood volume e.g. in exercise, L heart failure
When is TLco decreased?
any condition that affects the effective alveolar surface area
e.g. restrictive lung disease, COPD, PE, cardiac insufficiency, pulmonary HTN, heart failure, anaemia
What are the long term medications used for rate control and rhythm control in AF?
What is their target INR?
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
Acute and chronic management of heart failure?
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
Does the trachea deviate towards or away from a collapsed lung?
towards
What are the pre-hepatic causes of jaundice?
increased rate of haemolysis:
malaria, sickle cell, thalassaemia, haemolytic anaemia, blood transfusion
What are the intra-hepatic caused of jaundice?
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
What are the post-hepatic causes of jaundice?
obstruction of biliary system
gallstones
Ca of head of pancreas
biliary cancer
pancreatitis
What are the effects on stools, urine and LFTs in each type of jaundice?
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
No cause identified of a stage 2 AKI. Investigation after FBC, U&Es, LFTS are done?
renal US
What is haemochromatosis? What gene mutation is it caused by?
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
What are the signs of haemochromatosis?
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
Investigations for haemochromatosis?
RAISED FERRITIN + iron, transferrin saturation >45%, TIBC reduced
blood glucose > DM?
HFE genotype
Liver + cardiac MRI > detects iron overload
liver biopsy/ecg/echo
Treatment for haemochromatosis?
venesection needed for life
consider desferrioxamine if not tolerated
HCC surveillance, treat diabetes
When an troponin be raised?
PE, heart failure, MI, sepsis
1st line investigation for restrictive lung disease?
CT scan
What is Hashimoto’s thyroiditis? What effect does it have on thyroid hormones?
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
What auto-antibodies are found in the blood in pts with Hashimoto’s thyroiditis?
anti-TPO antibodies (thyroid peroxidase)
sometimes TgAB (antithyroglobulin)
What is Chvostek’s sign?
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
What is Trousseau’s sign?
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
Mechanism of corticosteroids?
Up-regulate anti-inflammatory genes and down-regulate pro-inflammatory genes
Causes of pancreatitis?
Idiopathic Gallstones Ethanol Trauma Steroids Mumps/malignancy Autoimmune Scorpion sting Hypertryglicerides/calcaemia ERCP Drugs e.g. diuretics, antimicrobials, immunosuppressants, anti-convulsants
What are the contraindications to thrombolysis?
clotting disorders haemorrhage, IC bleed onset of Sx >4.5hrs ago/unknown time of onset trauma BP > 185/110 peptic ulcer
What will the urine dipstick of a pt with a UTI show?
raised wbc
+ve nitrites
blood
When is an urgent endoscopy indicated?
dysphagia anaemia weight loss, anorexia recent onset meleana, haematemesis
Alternative investigation to diagnose a hiatus hernia if endoscopy is contraindicated?
barium swallow
2nd line treatment for hiatus hernia?
histamine 2 receptor antagonist e.g. ranitidine
2nd line investigation for SAH, if CT does not show a bleed?
LP 12hrs later to look for xanthochromia (yellow CSF)
What eye symptoms do pituitary adenomas cause?
bitemporal hemianopia
causes compression on the optic chiasm
A pt presents with foot drop. To which spinal cord root does the motor defect localise?
due to weakness in ankle dorsiflexion
L4-5 root > peroneal nerve > innervates tibialis anterior muscle
What type of CT is 1st line for stroke imaging?
non-contrast
if confirmed, may have contrast added through angiography to visualise vessels
1st line medication foe depression?
citalopram (SSRI)
Haematemesis + hx of excess alcohol?
ruptured oesophageal varices
1st line treatment for eczema?
emollient cream
1st line treatment for acute relapse of MS?
methylprednisolone
What virus is shingles caused by?
reactivation of varicella zoster virus
What is methylprednisolone?
corticosteroid
suppression of inflammatory and allergic disorders,
cerebral oedema associated with malignancy
Acute management of meningitis while waiting for transfer to hospital?
IM benzylpenicillin
In herpes zoster opthalmicus, there is reactivation of the herpes zoster virus in which CN?
HZO = shingles involving the eye trigeminal nerve (V1)
What is cardiac syncope?
Sudden collapse into unconsciousness due to a disorder of heart rhythm in which there is a slow or absent pulse
Black racoon eyes + clear fluid on otoscopy is indicative of? 1st line investigation?
base of skull fracture
CT head
What occurs with a lesion in Broca’s area compared to Wernicke’s area?
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
What is Charcot-Marie-Tooth disease?
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
What is the HAS-BLED score?
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
When might lungs be hyper-resonant in an asthmatic pt?
acute asthma attack > lungs become hyper-inflated
What is the most common type of lung cancer in non-smokers and associated with asbestos exposure?
adenocarcinoma
Which type of lung cancer is most strongly associated with cigarette smoking?
squamous cell carcinoma
What are the common sites for lung cancer to metastasise to?
adrenal glands bone brain liver lymph nodes
(breast uncommon)
What bacteria can cause atypical pneumonia?
mycoplasma pneumonia
chlamydophila pneumonia legionella pneumonia
> not detectable on gram stains, can’t be cultured using standard methods
What is the most common community acquired cause of pneumonia?
strep pneumonia
What is the most common hospital acquired cause of pneumonia?
staph aureus
Side effects of all RIPE medications?
Rifampicin > red/orange urine (r = red)
Isoniazid > neuropathy
Pyrazinamide > arthralgia
Ethambutol > optic neuritis (e = eyes)
Which chromosome is affected in CF?
7
CFTR protein
What is the 1st line treatment for syphilis?
benzathine penicillin
What is the difference between primary, secondary and tertiary prevention?
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
What does a cerebellar stroke present with?
ataxia
headache
vertigo
vomiting
Most common cancers to spread to the brain?
lung breast skin kidney bowel
What enzyme is raised in temporal arteritis?
ALP
Which spinal cord roots does the median nerve originate from?
C5-T1
What are the features of RA on x-ray?
Loss of joint space
Erosions
Soft tissue swelling
Soft bones (osteopenia)
What does the Glasgow-Blatchford score calculate?
upper GI bleed
What medication is used to treat ACUTE attacks of gout?
colchicine
How do alcoholism/chronic liver disease affect MCV?
increase it
Most common cause of hepatitis in travellers?
A
- faecal-oral route
- does not cause chronic liver disease
What type of antigen/antibody implies current infection of hepatitis? How do you determine if it is acute or chronic?
surface antigen e.g. HBsAg
Acute <6mo
Chronic >6mo
What is Meig’s syndrome?
triad of benign ovarian tumour + ascites + pleural effusion
What is the typical gallstones pt?
Fat, female, forty, fertile
OCP also a RF
What is neutrophilia? What infection can unusually cause this?
high neutrophil count
AIDS - targets immune system > neutropenia
How does pernicious anaemia present?
common in women around 60yrs
anaemia sx peripheral neuropathy lemon tinged skin (jaundice + pallor) mouth ulcers depression dementia
How does acute lymphoblastic leukaemia present?
commonly found in children, associated with Down’s
anaemia, bleeding, infection
hepatosplenomegaly
peripheral lymphadenopathy
complications > CNS involvement, SVC obstruction
What is a key sign of DIC?
distinct trigger e.g. sepsis, major surgery, trauma
What is polycythaemia?
increase in rbc production
Myeloma is incurable but can be managed with a combination of what?
chemotherapy
steroids
thalidomide (immunomodulatory)
bisphosphonates, radiotherapy
What medication is used to treat hypocalcaemia?
calcium gluconate
Renal stones smaller than what will pass their own?
<5mm
only need to be managed with analgesia
What is a nucleic acid amplification test used for?
test urine for STIs
What eGFR measurements are needed to make a diagnosis of CKD?
normal >90
2 measurements >3mo apart with an eGFR<60
<15 = end stage renal failure > dialysis, await transplant
Ototoxicity is a potential SE of what antibiotic?
gentamicin
What is the most common type of renal cell carcinoma?
clear cell
Name a drug and its class used in the treatment of prostate cancer?
goserelin - GnRH agonist
Management of acute pulmonary oedema?
high flow O2 IV furosemide IV morphine/GTN notify senior, urgent CXR then consider escalating for CPAP
What makes a UTI complicated?
being male, pregnant, a child or immunocompromised, recurrent UTIs, structural abnormality
What hormones are produced by the anterior and posterior pituitary?
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)
What are the key signs of hyperparathyroidism?
signs of hypercalcaemia
= bones, (renal) stones, (abdominal) groans, psychiatric moans (depression, anxiety) , thrones (polyuria)
What are the PTH, calcium and phosphate levels in primary, secondary and tertiary hyperparathyroidism?
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
Acute management of hypercalcaemia?
IV fluids
bisphosphonates
measurement of U&E/Ca
prednisolone
What is myxoedema coma?
hypothyroid emergency
altered mental state, hypothermic, hypotensive, bradycardia
How is Addison’s treated?
hydrocortisone + fludrocortisone replacement
treat cause
1st line medications to treat HF?
b-blocker + acei improve prognosis
What leads are affected in a inferior, lateral, anterior and septal STEMI?
inferior: II, III, aVF
lateral: I, aVL, V5, 6
anterior: V3, 4
septal: V1, 2
Complications of MI?
Death Arrhythmias Rupture (septum, papillary muscles) Tamponade Heart failure
Valve disease Aneurysm of ventricle Dressler's syndrome Embolism Recurrence/mitral regurgitation
How do statins work?
HMG-CoA reductase inhibitors
Coeliac disease on endoscopy?
villous atrophy
lymphocytic infiltration
crypt hyperplasia
What is pyoderma gangrenosum?
rare, inflammatory skin disease with painful pustules/modules that become ulcers that progressively grow
What is ranitidine?
H2 receptor blocker
What it Truelove and Witt’s criteria? What does it include?
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
Most common cause of sudden cardiac death in <30s?
hypertrophic cardiomyopathy
What does an S4 heart sound mean?
forceful atrial contraction due to stiff/hypertrophic ventricles
What is a silent MI? Who is most likely to suffer from one?
heart attack with few/no sx or sx not recognised as signs of an MI > can go unnoticed
common in diabetic pts
What is Prinzmetal angina?
Sx, ECG findings, due to and triggered by?
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
What is the Sepsis 6?
Bloods culture + septic screen Urine output - monitor hourly Fluid resuscitation Antibiotics IV Lactate measurement O2 - keep stats >94%
Tx for hepatic encephalopathy?
oral lactulose + neomycin/rifaximin
What is the difference between bacterial and viral meningitis?
Bacterial: cloudy, very high WBC, very high protein (>200), low glucose
Viral: clear, raised wbc (predominantly lymphocytes), normal-high protein (<200), normal glucose
What is the most commonly affected area of the bowel in Crohn’s?
terminal ileum
What does the painful arc test for? How is the test done?
impingement of supraspinatus
arm outstretched in front and actively elevate and bring arm back down
+ve = pain between 60-120o
What does Jobe’s/empty can test look for? How is the test done?
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
What does Gerber’s lift off test look for? How is the test done?
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/
What does the Scarf test look for? How is the test done?
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
What is Phalen’s test?
hold both hands in palmar flexion (reverse prayer sign)
+ve = pain, numbness, tingling in medial nerve distribution = carpal tunnel syndrome
Anterior vs middle vs posterior cerebral stroke symptoms?
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
What is a pneumothorax? What is the difference between a simple and tension PT?
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
What signs in a breast exam are red flags for breast cancer?
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
What is a Ghon focus? What disease are they found in?
What is a Goon complex?
granuloma in lung from previous TB infection seen on CXR
parenchymal granuloma + involved hilarious lymph node on same side = Ghon complex
When is a narrow base gait found? What is this gait called?
associated with diplegic gait
caused by cerebral palsy
What is the most commonly injured rotator cuff muscle?
supraspinatus
What is Schober’s test?
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
On CXR, tramline opacities and ring shadows are found. What are they and what are they indicative of?
bronchiectasis
tramline opacities: mucus build up in airways perpendicular to XR beam
ring shadows: dilated airways
What organism is linked to antibiotic treatment? What GI SE can it have? What does the gram stain look like?
clostridium difficile
causes GI illness including non-bloody diarrhoea
gram +ve anaerobic bacillus
Unilateral acute testicular pain with active sexual hx?
epididymis-orchitis
secondary to chlamydia trachomatis infection
What test is used to differentiate between testicular torsion and epididymo-orchitis?
Prehn’s test
lift affected testicle > relieves pain of epidiymitis, doesn’t relieve testicular torsion
What is Meniere’s disease? What test is likely to be +ve in Meniere’s?
condition of inner ear
cause sudden attacks of vertigo, tinnitus, pressure felt deep inside ear, hearing loss
Romberg’s test likely to be +ve
Anterior dislocation of shoulder - what nerve injury may occur? How will this present?
axillary nerve
weakness in abduction
What is costochrondritis?
inflammation of the cartilage of the sternum
can mimic a heart attack
What is tiotropium?
LAMA
Causes of pericardial effusion?
cancer, metastasis infection inflammation e.g. from a heart attack, surgery/injury AI e.g. RA, SLE aortic dissection
Presentation of pituitary gland vs adrenal adenomas?
adrenal > non-functioning (don’t produce hormones)
pituitary > massive endocrine dysfunction, headaches, visual changes
What autoantibodies are often present in primary sclerosis cholangitis?
anti-endothelial cell ab
pANCA
What is L’Hermitte’s sign? What is it indicative of?
sudden electric shock sensation passing down the back of the neck radiating into the limbs
in MS
What is Uhthoff’s phenomenon? What is it indicative of?
worsening of symptoms with heat
in MS
What is Lambert Eaton syndrome? It is associated with what kind of tumours?
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
In Buerger’s test, what is the angle below which a +ve result indicates critical ischaemia?
20o
Do UMN and LMN lesions in the facial nerve cause facial palsy on the ipsilateral or contralateral side?
LMN: ipsilateral
UMN: contralateral
What tumours is MG associated with?
thymic tumours
What is tolvaptan?
ADH V2-receptor antagonist
for ADPKD, hyponatraemia 2ndary to SIADH
Which is the only valve you would need the bell to listen to?
mitral
What is bromocriptine?
dopamine agonist
pituitary tumours, PD
Mallory bodies on biopsy?
alcoholic liver disease
Which antibody would highly suggest Goodpasture’s?
anti-GBM
What raised, hardened, purplish skin lesions seen on the nose, ears, cheeks, lips and forehead are pathognomonic for sarcoidosis?
lupus pernio
What CHA2DS2-VASC score usually required anticoagulation?
2
any score should be considered apart from gender alone
1st line treatment for pheochromocytoma?
phenoxybenzamine
treats HTN and heavy sweating
= alpha-blocker
Which types of renal calculi are radiolucent on XR?
uric acid stones
cysteine, unless they contain Ca
Least cardioselective beta-blocker?
propanolol
Indications for emergency dialysis in a pt with AKI?
severe metabolic acidosis
refractory pulmonary oedema
severe uraemia
refractory hyperkalaemia
