Practice Questions additional points Flashcards
What are 4 symptoms and 4 signs of hyperthyroid disease?
Sx: Weight loss, diarrhoea. fatigue, irritability, heat intolerance, sweating, increased appetite
Signs: Fine tremour, tachycardia, hair loss, ptosis, exophthalmos, pretibial myxoedema, acropachy, Hypertension
Risk factors for T2DM?
Hypercholesterolaemia
Obesity
Smoking
Male
Sedentary Lifestyle
Hypertension
2 Places where alpha adrenoceptors can be found and what they do?
Blood vessels - vasoconstrict
Sphincters - Contract
How do you avoid a hypertension crisis in phaeochromocytoma?
Phentolamine
4 short term side effects of chemotherapy treatment?
Sexual Dysfunction
Infection
Anaemia
Infection risk
Nausea and Vomiting
Alllopecia
What is the treatment for Febrile Neutropenia?
IV
Beta lactam
Piperacillin + Tazobactam (Tazocin)
What is a potential long term side effect of chemotherapy?
Tumour Lysis Syndrome
Why are iron studies a limited investigation when looking for iron deficiency anaemia?
Ferritin is an acute phase protein and therefore it will increase with inflammation
What is a key side effect of ferrous sulphate?
Turns stools black
Nausea and vomiting
Loss of appetite
constipation
diarrhoea
What are some treatments for haemophillia A?
Desmopressin
IV replacement of Factor VIII
List 3 signs you may see on an abdominal examination of a patient with a small bowel obstruction?
Abdominal Distension
Tinkling Bowel Sounds
Hyper resonant percussion
What is seen on an abdominal XRAY in a sigmoid Volvulus?
Coffee Bean Sign
What are some features seen systemically in a patient with Ulcerative colitis?
Uveitis/Episcleritis
Pyoderma Gangrenosum
Erythema Nodosum
Arthritis
What tests could you do other than biopsy and FBC/U&E to diagnose UC?
Faecal Calprotectin
P-ANCA
What are some investigations you would do to rule out other conditions in IBS?
tTg antibodies for coeliac
Faecal Calprotectin for IBD
What are some common exacerbating factors for IBS?
Stress
Fatty foods
Spicy Foods
Caffeine
Processed Foods
What are some complications of acute pancreatitis?
Acute Respiratory Distress Syndrome (ARDS)
Sepsis
Hypovolaemic Shock
DIC
Systemic Inflammatory Response Syndrome
What are some signs that may be found on examination of the hands in chronic liver disease?
Dupytrens Contracture
Palmer Erythema
Leukonychia
Finger Clubbing
Asterixis
What is the survival rate of pancreatic Cancer?
Very poor Prognosis
<3% 5 year Survival
What are the causes of Clubbing?
CLUBBING (L has ABCDEF)
C:cyanotic Heart Disease
L: Lung Disease
- Abscesses
- Bronchiectasis
- Cystic Fibrosis
- DONT SAY COPD
- Empyema
- Fibrosis
U: Ulcerative Colitis + IBD (Crohns)
B: Biliary Tract Disease
B: Birth Defects
I: Infective Endocarditis
N: Neoplasm (lung cancer or mesothelioma)
G: Gastrointestinal Malabsorption Syndrome (Coeliac Disease)
What are the causes of Clubbing?
CLUBBING (L has ABCDEF)
C:cyanotic Heart Disease
L: Lung Disease
- Abscesses
- Bronchiectasis
- Cystic Fibrosis
- DONT SAY COPD
- Empyema
- Fibrosis
U: Ulcerative Colitis + IBD (Crohn’s)
B: Biliary Tract Disease
B: Birth Defects
I: Infective Endocarditis
N: Neoplasm (lung cancer or mesothelioma)
G: Gastrointestinal Malabsorption Syndrome (Coeliac Disease)
where do diverticula most commonly occur?
Sigmoid colon due to smallest luminal diameter and therefore the highest pressure to cause the mucosal herniation
What is the most common cause of portal hypertension that is not due to liver cirrhosis?
Schistosomiasis infection
What are the 2 forms of Fungi?
Yeast - single cells and use budding
Mould - Multicellular and use hyphae or spores
What are fungi cell walls made from?
Chitin
Glucan
What are the targets of antifungal drugs?
Target cell wall: Beta-glucan
Echinocandins
Target Cell membrane: Ergosterol
Polyenes - Amphotericin, Nystain
Ergosterol synthetic pathway inhibitors - Azoles
What is candida albicans?
A vaginal or oral yeast infection
What is aspergillus Fumigatus?
A lung Infection
What is the prepatent period?
Interval between infection of a helminth and the appearance of eggs in stools
What is the major helminth of concern? Where is it contracted?
Schistosomiasis
Contracted via freshwater swimming or drinking infected water in endemic africa
“Medical student comes back from elective, swimming in malawi”
What 2 conditions are related to Schistosomiasis?
Can cause portal hypertension without causing Hepatocellular cirrhosis
Can lead to bladder Squamous Cell Carcinoma
Classical presentation of renal stones?
Loin to groin
Patient cant lie still
Intermittent pain due to peristalsis
What small cell vasculitis presents similarly to IgA nephropathy and post strep glomerulonephritis and will have IgA deposition in extra-nephritic tissue?
Henloch Schonlein Purpura
Suggest some complications of CKD?
CVD
Arrhythmias
Anaemia
Osteodystrophy
Neuropathy/Encephalopathy
Give some treatments to help the symptoms of CKD?
Fe Supplements for anaemia
Vitamin D supplements
Adcal D3
ACEi - blood pressure control
Statins
What is the first line treatment for Ankylosing spondylitis?
NSAIDs
How is rheumatoid arthritis disease progression monitored?
ESR and CRP levels
What is a life-threatening complication of Rheumatoid arthritis?
Felty Syndrome:
RA
Neutropenia
Splenomegaly
What are some extra-articular manifestations of RA?
Skin Nodules
Sjogren’s
Pleural Effusions
Pericarditis and MI
Glomerulonephritis
Deranged Blood results in haematology
What is seen on electron microscopy in Diabetic Nephropathy?
Nephrotic Syndrome picture
Kimmelsteil Wilson Nodules
What is the lifestyle management for nephrotic syndrome?
Low salt, protein and fat diet
Control CVD risk factors
Smoking cessation
Regular exercise
lose weight
Describe the pathogenesis of a subdural haematoma?
Trauma/Deceleration injury causes shearing of Dural venous sinuses or bridging veins
Why must patients with guillain barree syndrome be constantly monitored?
Monitor breathing rate as these patients are at a high risk of respiratory distress
What part of the brain, what pathway and what is the result of Parkinsons diseaes?
Loss of dopaminergic neurones in substantia nigra pars compacta which results in an impaired nigrostriatal pathway and therefore problems initiating movement
What is the spirometry results for an obstructive disease?
FEV1/FVC ratio < 0.7
FEV1<0.8
FVC normal or reduced
What are the common organisms of an infective exacerbation of COPD?
Haemophilus Influenzae
Strep. pneumonia
What might you want to ask about in a patients history when diagnosis asthma?
FHx
Atopic triad (do they have eczema, hayfever)
Drug Hx
Diurnal variation
Wake up at night coughing
What are some signs of a poorly controlled asthma?
Inhaler > 3x per week
regular Exacerbations
Hyperinflated lungs
Wake up at night coughing
What is the FVC and FEV1/FVC ratio for an asthma attack?
FVC = normal
FEV1/FVC = <0.7
What are some risk factors for suicide?
Male gender
Alcohol/Drug misuse
Depression
anxiety
Low Socioeconomic status
Learning Difficulties
Trauma (physical/sexual abuse)
Recent Grief
What are some questions to ask a depressed patient as a risk assessment for suicide or self harm?
Ever thought about killing/self harming yourself
Have you ever acted on this
was it planned or impulsive
written suicide notes
Give 4 classes of drugs that can be used as antidepressants
SSRIs - Sertraline
SNRIs - Duloxetine
TCAs - Amitriptyline
MOAis - Selegiline
What inherited condition can show high volumes of HDL and LDL in blood results?
Familial Hypercholesterolaemia
What are some key complications of CF in adulthood?
Diabetes Mellitus
Infertility
Pancreatic Insufficiency
What bacteria are the main causes of COPD exacerbations?
Haemophilus Influenzae
Strep. Pneumonia
What bacteria are the main causes of recurrent Respiratory Tract infections in CF?
Staph. Aureus
Pseudomonas. Aeruginosa
How does tension pneumothorax lead to cardiorespiratory distress?
Air cannot escape the pleural space and therefore a large tension PTX can lead to kinking of the mediastinal vessels and reduce air/blood flow.
What is the classical triad for critical limb ischaemia?
Pain at rest
Arterial Insufficiency Ulcers
Gangrene
What would the diurnal pattern of PEFR be for patients with asthma?
PEFR will be Lower in the morning and Higher in the Evening
What may be seen on blood film in a Macrocytic megaloblastic anaemia?
Hyper segmented neutrophil Polymorphs
What is the protocol for taking blood for IE?
3 cultures from 3 different sites on 3 different occasions
What other blood tests may you do in a Mallory weiss tear?
FBC
U&E
Coagulation profile
LFTs
Erect CXR
Name some features of the Glasgow Blatchford score?
Heart Rate
Systolic Blood Pressure
Hb
Urea
Gender
Melena
Hx of Syncope
Cardiac Failure Hx
What is the First line management in an Upper GI bleed caused by a MWT if the bleeding is persistent?
Surgical Endoscopy and Clipping OR Thermal Coagulation
High Dose PPI
How should bisphosphonates be taken?
First Thing in the morning
Empty Stomach
Stay upright or standing for 30 mins after
With a full glass of water
Give 4 symptoms of a septic infection?
Fever
Rigors
Night sweats
Weight loss
Dizzy
Confusion
Nausea and vomiting
What are some symptoms of delirium tremens?
Ataxia
Tremors
Confusion
Sweating
Irritability/agitation/aggression
N+V
What are some signs of iron Deficiency anaemia?
Angular Cheilitis
Atrophic Glossitis
Koilonychia
What kind of bacteria is Staphylococcus Aureus?
Gram Positive Cocci
Beta Haemolytic Staphylococcus
What is a possible diet that can reduce the risk of gallstone development?
High grain Diet
What are some factors that can increase the risk of gallstone development?
High fat diet
obesity
T2DM
Rapid weight loss
What blood results are seen on primary hyperparathyroidism?
High PTH
High Ca
Low Phos
What is the biggest cause of gout?
Underexcretion is the greatest cause so things such as thiazides
What is the biggest risk factor for PSC?
Female Gender
(accounts for 90% of the cases)
