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jack's phase 2a cards > Pre Exam Gap Buster > Flashcards

Pre Exam Gap Buster Flashcards

1
Q

Which inflammatory marker is absent in Seronegative Spondyloarthropathy?

A

Rheumatoid Factor

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2
Q

Name a Life-Threatening Exacerbation of Rheumatoid Arthritis.

A

Felty’s Syndrome

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3
Q

How is the disease progression of rheumatoid arthritis monitored?

A

Through ESR and CRP

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4
Q

What is the pathophysiology of a Sub-Dural Haemorrhage?

A

Trauma/Deceleration causes shearing of the dural venous sinuses.

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5
Q

Why must you wait 12 hours after a SAH to perform a lumbar puncture?

A

Xanthochromia is most likely to be observed at this point.

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6
Q

What results would you see on lumbar puncture is Gullain Barre Syndrome?

A

Normal WCC and Raised Protein

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7
Q

What must always be monitored in patients with Gullain Barre?

A

Respiratory Rate - These patients are at high risk of respiratory distress. (Forced Expiratory Volume)

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8
Q

What is the treatment for an acute migraine attack?

A

Oral/Nasal Triptan, NSAIDs (Aspirin 900mg).

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9
Q

What is the pathophysiology of Parkinson’s Disease?

A

There is a loss of dopaminergic neurons in the Substantia nigra which impairs the Nigrostriatal pathway leading to problems initiating movement.

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10
Q

What is the main drawback of the standard treatment for Parkinson’s disease?

A

Levodopa loses its effectiveness over time.

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11
Q

What is used to decolourise and counterstain in a gram stain after crystal violet and iodine have been applied?

A

Acetate is used to decolourise and Safranin is used to counterstain.

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12
Q

What is the mechanism of action for trimethoprim?

A

These are folate inhibitors.

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13
Q

How long are the Tuberculosis antibiotics given for?

A

Rifampicin - 6 months
Isoniazid - 6 months
Pyrazinamide - 2 months
Ethambutol - 2 months

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14
Q

Why does meningitis present with a non-blanching petechial rash?

A

Due to DIC

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15
Q

What is the long-term side effect of Chemotherapy?

A

Tumour Lysis Syndrome

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16
Q

Why can iron studies be unreliable?

A

Ferritin is an acute-phase protein which also increases in times of inflammation.

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17
Q

What does ferrous sulphate do?

A

Turns stools black

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18
Q

Name a Tyrosine Kinase Inhibitor.

A

Imatinib

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19
Q

What is the inheritance pattern of Haemophilia A & B

A

X-Linked Recessive

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20
Q

Why is Desmopressin given in haemophiliacs

A

It releases factor 8 which is trapped in the endothelium.

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21
Q

What can happen if the treatment of CML is not successful?

A

It can progress to AML

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22
Q

What is the Tensilon Test?

A

IV Endrophonium bromide (Anticholinesterase) - Acetylcholine in the synapse increases leading to transient improvement in weakness (Myasthenia Gravis)

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23
Q

What is the target INR for Atrial Fibrillation?

A

2-3

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24
Q

What is the Scoring System used in AF (Anticoagulation)?

A

CHA2DS2-VASC
Congestive Heart Disease - 1
Hypertension - 1
Age > 75 - 2
Diabetes Mellitus - 1
Stroke/TIA/Thrombo-embolus - 2
Vascular Disease - 1
Age 65-75 - 1
Sex Category (Female) - 1

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25
Q

Acute Pancreatitis - What is the name for bruising around the belly button?

A

Cullen’s Sign

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26
Q

What treatments are patients with heart failure started on to slow progression?

A

ACE inhibitors & Beta Blockers

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27
Q

What are the ECG changes associated with Acute Pericarditis?

A

Concave ST-Elevation in all leads + PR depression.

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28
Q

What is Beck’s Triad

A

Triad of Cardiac Tamponade
Low Blood Pressure
Distended Jugular Veins
Muffled Heart Sounds

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29
Q

What is seen Histologically in Parkinsons’ disease?

A

Loss of dopaminergic neurons in the substantia nigra, presence of Lewy bodies.

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30
Q

What is the single greatest risk factor for developing atherosclerosis?

A

HYPERTENSION

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31
Q

Where are MHC-1 Proteins Found?

A

On all nucleated cells.

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32
Q

What is the treatment for SIADH?

A

Tolvaptan - ADH receptor antagonist.

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33
Q

What is the treatment for severe hypocalcemia?

A

IV Calcium Gluconate

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34
Q

What is a prominent side effect of calcium channel blockers?

A

Ankle Swelling

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35
Q

Why is Verapamil contraindicated in Heart Failure?

A

It has negatively inotropic effects

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36
Q

Which coronary artery infarction would cause 3rd Degree heart block?

A

AVN is supplied by RCA in 90% of hearts so an infarct in this region is likely to cause bradycardia and 3rd Degree heart block.

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37
Q

What part of the GI tract is most likely to perforate due to obstruction?

A

Caecum

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38
Q

What part of the GI tract is most often affected by Crohn’s Disease?

A

Ileum

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39
Q

What is the most common causative organism in Ascending Cholangitis?

A

E.Coli

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40
Q

What are Kayser-Fleischer rings?

A

Dark rings which encircle the cornea of the eye due to deposition of copper in Wilson’s Disease.

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41
Q

What is the 1st line treatment for Reactive Arthritis?

A

NSAIDs

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42
Q

How can Osteomalacia be differentiated from Osteoporosis/penia?

A

In Osteomalacia there are abnormal blood test findings.

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43
Q

Give a side effect of SGLT2 inhibitors

A

Increased risk of Candida + UTI.

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44
Q

What is the most common cause of Guillan Barre syndrome?

A

Campylobacter infection.

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45
Q

Would acidosis or alkalosis be seen in an Asthma Attack?

A

Alkalosis due to hyperventilation.

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46
Q

What are the constituents of Co-Amoxiclav?

A

Amoxicillin + Clavulanic Acid (Beta Lactamase inhibitor which increases the spectrum).

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47
Q

How do you manage acute AF in an unstable or recently presenting patient?

A

DC Cardioversion + Amiodarone if unsuccessful (Unstable) / Flecainide (Stable

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48
Q

What is the anion gap?

A

Estimates unmeasured plasma anions. It is the difference between plasma cations (Na+, K+) and anions (Cl-, HCO3-). It is helpful in determining the cause of metabolic acidosis.

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49
Q

What causes of metabolic acidosis also increase the anion gap?

A

Lactic Acid (Shock, Infection, Ischemia)
Renal Failure
Diabetic Ketoacidosissis
Drugs/Toxins

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50
Q

Blood Film Finding: Acute Lymphoblastic Leukemia

A

Blast Cells

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51
Q

What differentiates Acute Myeloid Leukemia from ALL?

A

Auer Rods on BM biopsy - Crystalline Cytoplasmic inclusion bodies.

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52
Q

Characteristic Finding for CML?

A

Philadelphia Chromosome t(9;22)

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53
Q

Blood Film Finding: Chronic Lymphoblastic Leukemia

A

Smudge Cells - cells damaged in preparation

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54
Q

What are the Characteristic cells in Hodgkin’s Lymphoma?

A

Reed-Sternberg Cells

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55
Q

Blood Film Finding: Multiple Myeloma

A

Rouleaux Formation

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56
Q

What are Heinz Bodies and when are they seen?

A

Structures formed due to the breakdown of haemoglobin in cells. Due to oxidative damage from toxins, or due to thalassemia and G6PD deficiency.

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57
Q

What is CREST Syndrome?

A

Limited Scleroderma:
Calcinosis
Raynaud’s Phenomenon
Oesophagal Dysfunction
Sclerodactyly
Telangiectasias - dilatation of capillaries leading to red marks on the skin surface.

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58
Q

What is Phaeochromocytoma?

A

Catecholamine-secreting tumours are usually chromaffin cells in the adrenal medulla.

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59
Q

What are the symptoms of Phaeochromocytoma?

A

Episodic headaches, sweating, tachycardia, Anxiety, Chest pain.
Blood Pressure may or may not increase.

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60
Q

Testing/Treatment of Phaeochromocytoma

A

Test - 24hr Urine Metanephrines & Abdominal CT.
Treat - Alpha Blockade before surgery, Beta Blockers.

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61
Q

Which T2DM treatments can cause hypoglycemia?

A

Pioglitazone (increases insulin sensitivity).
Sulfonylurea (increases insulin secretion).

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62
Q

What is the characteristic sign of extravascular haemolytic anaemia?

A

Splenomegaly

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63
Q

By what mechanisms can Microangiopathic Haemolytic anaemia occur?

A

DIC & Prosthetic Valves

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64
Q

Name an infective cause of Haemolytic Anaemia.

A

Malaria P.Falciparum

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65
Q

What is the clinical presentation of Beta Thalassemia Major?

A

Presentation within the first year of life with a failure to thrive.

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66
Q

What is the treatment for Immune Thrombocytopenia?

A

Steroids (Prednisolone)

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67
Q

What Hepatobiliary Condition is Sjorgens Syndrome most associated with?

A

Primary Biliary Cirrhosis

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68
Q

Which Blood Marker is Markedly Raised in Paget’s Disease of Bone?

A

ALP (Alkaline Phosphatase)

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69
Q

Name three TNF-alpha Inhibitors.

A

Etanercept, Infliximab, Adalimumab.

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70
Q

What hormone is elevated in testicular cancer?

A

HCG - Human Chorionic Gonadotrophin

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71
Q

What is the treatment for UC?

A

Mesalazine

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72
Q

Outline the stepwise treatment pathway for asthma.

A

Initially: SABA
2: SABA + ICS (low dose)
3: SABA + ICS + LTRA
4: SABA + LABA + ICS + LTRA
5 - Refer for Specialist Input

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73
Q

Name a Leukotriene Receptor Antagonist

A

Montelukast

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74
Q

Which UTI antibiotic is teratogenic in the first trimester?

A

Trimethoprim

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75
Q

In which inflammatory bowel disease are skip lesions seen?

A

Crohn’s Disease

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76
Q

What is Shober’s Test

A

A test used to diagnose the restriction of lumbar spine flexion, it is particularly useful in ankylosing spondylitis. A line is drawn with the patient standing upright than bent forwards to assess the degree of flexion.

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77
Q

Name a Triptan

A

Sumatriptan

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78
Q

Which adrenergic receptor is responsible for smooth muscle relaxation?

A

Beta-Adrenergic

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79
Q

What scoring system is used to assess a patient’s risk of stroke in the next 7 days?

A

ABCD2 Score:
Age >60 - 1
Blood Pressure (High) - 1
Clinical Features of TIA - 2 if weak + dysphasic.
Duration - >1hr = 2 , <1hr = 1
Diabetes - 1
>=4 High risks of stroke, >=6 35.5% in 7 days.
Patients who have had a TIA must receive Aspirin 300mg.

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80
Q

Treatment for Acute Severe Asthma

A

5mg Salbutamol nebulised with oxygen.
PO Prednisolone or IV hydrocortisone.
If PEF remains <75% Repeat prednisolone then give ipratropium.

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81
Q

Test for Hepatitis A

A

Rise in AST/ALT, IgM signifies recent infection, IgG is present for life.

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82
Q

What does HBsAg ALONE imply

A

Vaccination, if within 30 days of HepB vaccination.
HBsAg is the antigen used in the HepB vaccine.

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83
Q

What might prompt a HIV test?

A

A patient with an unexpected condition with no clear underlying cause or recurring infection.

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84
Q

What is the most common AIDs opportunistic infection?

A

Pneumocystis Pneumonia

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85
Q

Microbiology: Types of Haemolysis

A

Alpha (Partial Green) Haemolysis:
Strep. Viridans + Strep. Pneumonia (Optochin Sensitive).
Beta Haemolysis (Complete Clearance):
Lancefield Test - A (Pyogenes), B (Agalacticae)
Gamma Haemolysis:
Streptococcus Bovis

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86
Q

What is the first-line antibiotic for Streptococcus Pneumoniae?

A

Amoxicillin

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87
Q

What is the CURB65 Score?

A

The score used to make a decision on where to treat a patient with Pneumonia:
Confusion - 1
Urea > 7 - 1
Resp Rate > 30 - 1
Blood Pressure <90Sys <60Dias
0 - Treat at Home.
1, 2 - Consider Hospital Treatment.
3, 4 - ITU treatment.

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88
Q

First-line antibiotic for Staph. Aureus

A

Flucloxacillin - Ciprofloxacin

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89
Q

What antibiotic is given for atypical pneumonia?

A

Erythromycin

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90
Q

Treatment for Pneumocystis Pneumonia

A

Co-Trimoxazole + Prednisolone

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91
Q

Treatment for Pseudomonas Auriginosa

A

Piperacillin

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92
Q

Why is IV dexamethasone given sometimes in meningitis?

A

To protect Neurological function.

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93
Q

What drug is given for Meningitis prophylaxis?

A

Oral Ciprofloxacin Meningitis prophylaxis.

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94
Q

What is Charcoal Cefazolin Sodium Deoxycholate Agar used for?

A

Growing Campylobacter

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95
Q

What five antibiotics can cause C.Diff and which antibiotic can be given to treat it?

A

Co-Amoxiclav, Clarithromycin, Ciprofloxacin, Clindamycin, Cephalosporins.
Vancomycin can be used to treat.

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96
Q

AKI Criteria

A

Rise in Creatinine - >26 umol/L within 48 hours.
Rise in Creatinine - >1.5 x Baseline within 7 Days
Urine Output - <0.5mL/Kg/h for >6 consecutive hours.

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97
Q

What are Transudative Pleural Effusions?

A

Caused by factors which alter hydrostatic pressure, pleural permeability and oncotic pressure. HF, Liver Cirrhosis, Hypoalbuminemia. <30g/L

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98
Q

What are Exudative Pleural Effusions?

A

Changes to the Local Factors which influence the formation and absorption of pleural fluid.
Malignancy, Infection, Trauma. >30g/L

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99
Q

What does purulent sputum suggest?

A

Empyema

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100
Q

What are Light’s Criteria?

A

Light’s criteria are more accurate for the diagnosis of exudative effusions.
The fluid is considered an exudate if any of the following are present:
The ratio of pleural fluid to serum protein is greater than 0.5
The ratio of pleural fluid to serum LDH is greater than 0.6
The pleural fluid LDH value is greater than two-thirds of the upper limit of the normal serum value

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101
Q

What are the diagnosis for Acute Severe Asthma?

A

Unable to complete sentences in one breath.
Resp Rate >25/min
Pulse Rate >110bpm
PEF 33%-50% of predicted or best.

102
Q

What is the Well’s Score?

A

Clinical Probability of PE:
Signs of DVT - 3
HR > 100 - 1.5
Bed-Ridden/Major Surgery - 1.5
Previous DVT/PE - 1.5
Haemoptysis - 1
Cancer Treatment - 1
Most Likely Diagnosis - 3
>4 = PE Likely

103
Q

What may a CXR in COPD show?

A

Flat Hemidiaphragm, Barrel Chest, Hypertension, Bullae

104
Q

Rheumatoid Arthritis: Hand Deformities

A

Ulnar Deviation, Swan-Neck Deformity, Boutonierre’s Nodes

105
Q

Blood Cultures Protocol: Infective Endocarditis

A

3 Cultures from 3 Different Sites at 3 different times.

106
Q

3 Anatomical Areas where Urothiliases are likely to become lodged.

A

Ureteropelvic junction, the Ureteral crossing of Iliac Vessels, Ureterovesical Junction.

107
Q

Side Effects of Bisphosphonates

A

Oesophagitis, Oesophageal Ulcers, Osteonecrosis of Jaw.

108
Q

How should be Bisphonates be taken?

A

Take first thing in a morning on an empty stomach, sit upright for 30 minutes after taking them.

109
Q

Risk Factors for Osteoporosis

A

S- Steroid Use
H- Hyper(para)thyroidism
A- Alcohol + Tobacco
T- Thin BMI >18.5
T- Testosterone Low
E- Early menopause <40
R- Renal Failure

110
Q

Physical Examination Test - Meningitis

A

Kernig’s Test - Severe knee stiffness.
Brudzinski’s Test - Knees rise with neck (Stiffness).

111
Q

Primary Care Treatment for Meningitis

A

IM Benzylpenicillin

112
Q

Which LFT is suggestive of Alcohol abuse?

A

GGT - Gamma-glutamyl Transferase

113
Q

Causes of Microcytic Anaemia

A

Iron Deficiency, Thalassemia, Lead Poisoning

114
Q

Which Valve is most likely to be affected in patients who are IVDU?

A

Tricuspid Valve

115
Q

What layer of the skin is affected by Cellulits?

A

Subcutaneous Layer

116
Q

Which Swab is used for suspected bacterial infections?

A

Black (charcoal) Swab

117
Q

What is the PHQ-9 score used for?

A

Assessing the severity of depression.

118
Q

What diseases are screened for with the Heel-Prick Test?

A

Sickle Cell, Cystic Fibrosis, Congenital Hypothyroidism, Inherited Metabolic Diseases.

119
Q

What Vaccines are given at 8 Weeks?

A

Diptheria, Tetanus, Pertussis, Polio, Haemophilus influenzae, Hepatitis B.

120
Q

Name two side effects of Metformin.

A

Lactic Acidosis, GI Upset.

121
Q

HbA1c Levels for Healthy Individuals, Pre-Diabetics & Diabetics

A

Healthy <42mmol/mol
Pre-Diabetic 42<HbA1c>47mmol/mol
Diabetic >47</HbA1c>

122
Q

What is the main cause of AF in the developed world and developing world?

A

Developed World = Heart Failure
Developing World = Rheumatic Fever

123
Q

What is the ORBIT Score?

A

Predicts bleeding in patients on anticoagulation for atrial fibrillation:
O - Older than 75 - 1
R - Reduced Haemoglobin - 2
B - Bleeding History - 2
I - Insufficient Kidney Function - 1
T - Treatment with an antiplatelet agent - 1
3 - Medium Risk (Anything Higher is High Risk)

124
Q

What is used to treat Crohn’s Disease to maintain remission?

A

Azathioprine

125
Q

What is the biliary association of UC?

A

Primary Sclerosing Cholangitis

126
Q

What does the U Wave on an ECG represent?

A

Purkinje Fibre depolarisation

127
Q

What can Falsely Increase PSA?

A

Intense Physical Activity, Sexual Activity

128
Q

Name 5 Factors that contribute to the Glasgow-Blatchford Score.
(Upper GI bleeding Severity)

A

Urea, Haemoglobin, Blood Pressure, Heart Rate, Melena.

129
Q

What is Pharmacokinetics?

A

What the body does to the drug - How the plasma concentration changes over time?

130
Q

What is Pharmacodynamics?

A

What the drug does to the body - the events after binding to the receptor and drug interactions.

131
Q

Pharmacokinetic Concepts

A

ADME
Absorption (IV vs PO).
Distribution (Bloodstream to Tissues).
Metabolism (CYP450 + Renal).
Excretion (Speed that drugs leave the system)

132
Q

What is Virchow’s Triad?

A

Three broad categories are thought to increase the risk of thrombosis:
Venous Stasis
Hypercoagulability
Venous Damage

133
Q

Heparin Mechanism of Action

A

Glycosaminoglycan binds to antithrombin and increases its activity - also indirectly downregulates thrombin.

134
Q

What is Cushing’s Reflex?

A

ICP > mAP leads to increased difficulty to provide vascular perfusion - BP increases to accommodate and HR falls due to baroreceptor activation.
HTN -> presses on brainstem resp. centre -> irregular breathing

135
Q

What is the difference in the presentation of Gastric Ulcers/Duodenal Ulcers?

A

The abdominal pain associated with Gastric tends to get worse upon eating whereas Duodenal ulcers tend to be relieved.

136
Q

What do ECG J waves indicate?

A

Hypothermia

137
Q

Treatment for Diabetic Neuropathy

A

Amitryptiline, Duloxetine, Pregabalin, Gabapentin

138
Q

ECG: Short PR + Slurred Upstroke QRS

A

Wolff-Parkinson White - Requires accessory pathway ablation. DELTA WAVES

139
Q

What is the Tumour Marker for HCC?

A

Alpha-Fetoprotein (AFP)

140
Q

What is Ramsay Hunt Syndrome?

A

Varicella Zoster infection of the facial nerve.

141
Q

Treatment of Acute Gout

A

NSAIDs + Colchicine

142
Q

Prevention of Gout

A

Allopurinol + Febuxostat

143
Q

What is Gilbert’s syndrome?

A

Genetic disease where the body is unable to process bilirubin.

144
Q

COPD treatment

A

1-SABA
2-LAMA (Tiotropium)
3-LABA (salmeterol) /ICS

145
Q

What is Sarcoidosis?

A

Inflammatory disease where granulomas form.
(NON—CASEATING)

146
Q

Which electrolyte disturbance can Spironolactone cause?

A

Hyperkalemia as Spironolactone - Potassium Sparing

147
Q

What electrolyte disturbance does Conn’s Syndrome cause?

A

Hypokalemia

148
Q

What CD4+ Level is AIDS defining?

A

<200

149
Q

Which transaminase is most specific for acute liver damage?

A

ALT

150
Q

How can C-Peptide differentiate between Type 1 and Type 2 Diabetes Mellitus?

A

It decreases in Type 1 diabetes, it persists in Type 2.

151
Q

Name a Sulfonylurea

A

Gliclazide

152
Q

What is HHS?

A

Hyperosmolar Hyperglycemic State - it mainly occurs in Type 2 diabetics where blood glucose rises and results in polyuria, this reduces the circulatory volume and increases the Osmolarity of the blood - this dehydrates the tissues (i.e the brain) which leads to a reduction in the level of consciousness.

153
Q

What is De Quervain’s Thyroiditis?

A

Subacute thyroiditis - self-limited inflammation of the thyroid gland due to viral infection. There is transient thyrotoxicosis due to the destruction of thyroid follicles (raised ESR/CRP), hypothyroidism then euthyroidism.

154
Q

What is Thyroid Storm?

A

Severe Hyperthyroidism causes severe symptoms such as a loss of consciousness. Precipitated by thyroid surgery, radioiodine or infection/trauma.

155
Q

Name two Cortisol Synthesis inhibitors.

A

Metyrapone, Ketoconazole

156
Q

Name a Somatostatin analogue

A

Octreotide

157
Q

Angina Treatment

A

GTN Spray for Symptom Relief
Beta Blocker or CCB
Isosorbide Mononitrate
Revascularisation

158
Q

Post-MI Discharge Treatment

A

Aspirin and Clopidogrel for a year.

159
Q

What is the most common cause of Pericarditis?

A

Coxsackie Virus

160
Q

Mitral Stenosis Murmur

A

Mid-diastolic Murmur

161
Q

Mitral Regurgitation Murmur

A

Pansystolic Murmur

162
Q

Aortic Stenosis Murmur

A

Ejection Systolic Murmur

163
Q

Aortic Regurgitation Murmur

A

Early Diastolic Murmur

164
Q

What Does Leukemia Cause?

A

Leads to pancytopenia - anaemia, thrombocytopenia, and leukopenia.

165
Q

What do Mature Cells on Blood Film suggest?

A

Chronic Leukemia

166
Q

Richter’s Transformation

A

CLL to Lymphoma

167
Q

Treatment for Lymphoma

A

For Low stage (I, II) - Radiotherapy, Short course ABVD Chemotherapy.
For High Stage (III+) - Radiotherapy + Longer course of Chemotherapy

168
Q

What are Cannonball Metastases?

A

Large Well-Circumscribed pulmonary metastates which commonly occur secondary to RCC, Choriocarcinoma, Prostate, Endometrial and adrenal carcinoma.

169
Q

What is the triple therapy for H.Pylori for patients with penicillin allergy?

A

Clarithromycin, Omeprazole, Metronidazole

170
Q

Test for H.Pylori?

A

Test for antigen in stool or use the urea breath test to see if urease is present (breakdown).

171
Q

Name an H2Receptor Antagonist

A

Ranitidine

172
Q

Coeliac Pathophysiology

A

Alpha-Gliadin is immunogenic - it is broken down by tissue transglutaminase leading to an inflammatory response when anti-TTG is present. HLA DQ2 and DQ8 associated.

173
Q

3 Main Causes of Pancreatitis

A

Gallstones, Ethanol, Trauma

174
Q

Why does acute pancreatitis lead to hypocalcemia?

A

There is an excess release of pancreatic enzymes such as lipase which leads to breakdown of triglycerides into free fatty acids which bind to calcium and decrease its free levels in the plasma.

175
Q

Why is Oral Vancomycin given before IV in C.Diff Infection?

A

Vancomycin cannot cross the blood-gut barrier so is most effective when given orally.

176
Q

What is Uhthoff phenomenon?

A

A transient worsening of neurological symptoms related to a demyelinating disorder, such as multiple sclerosis, when the body becomes overheated in hot weather, exercise, fever, saunas, or hot tubs.

177
Q

Why is nitrofuratoin contraindicated in pregnancy?

A

In the third trimester, it is linked with haemolytic anaemia of the newborn

178
Q

Treatment for Sarcoidosis

A

Oral Steroids (Prednisolone)

179
Q

Most common infective exacerbation in COPD?

A

Haemophilus Influenzae

180
Q

Which Inflammatory Bowel Disease causes Gallstones?

A

Crohn’s Disease - terminal ileitis impairs bile salt reabsorption.

181
Q

What is the most common cause of septic arthritis in sexually active young adults?

A

Neisseria Gonorrhoea

182
Q

Definition of CKD

A

Abnormal Kidney Structure/Function >3months
eGFR <60ml/min/1.73m2
eGFR <90ml/min/1.73m2 + Signs of Renal Damage or Albuminemia.

183
Q

What’s the mechanism of action of N-acetyl cysteine?

A

Replenishes the supply of glutathione that conjugates NAPQI to non-toxic compounds

184
Q

What receptors are affected in myasthenia gravis?

A

Nicotinic acetylcholine receptors

185
Q

What is the pathophysiology of hereditary spherocytosis?

A

It is caused by defects in the red cell membrane, resulting in them having an increased permeability to sodium

186
Q

What is the Triad of Symptoms for Pyelonephritis?

A

Flank Pain, Fever, Pyuria

187
Q

What is Phren’s Sign?

A

Testicular pain relief on elevation.
Positive = Epididymitis

188
Q

What two drugs are given in BPH?

A

Tamsulosin (Alpha blocker) - smooth muscle relaxation.
Finasteride (5-alpha-Reductase Inhibitor) - lowers the level of testosterone.

189
Q

Which drug can be given in Prostate cancer to remove the androgenic drive?

A

Zoladex

190
Q

When are Hypersegmented Neutrophils seen?

A

In Macrocytic (B12/Folate Deficiency) Anaemia

191
Q

Which Conditions are Polyarteritis Nodosa associated with?

A

HepB, HepC, HIV

192
Q

In which condition is Saddle-Shaped Noses seen?

A

Granulomatosis with Polyangiitis

193
Q

Which Antibodies are raised in Sjogren’s Syndrome?

A

Anti-RO, Anti-La

194
Q

What is Epistaxis?

A

Nosebleed

195
Q

What is Achalasia?

A

A swallowing disorder where the oesophagus muscles do not contract properly and do not help propel food down toward the stomach

196
Q

How long after onset of symptoms can IV Alteplase be given in Ischemic Strokes?

A

4.5hrs

197
Q

Pathophysiology and CT appearance of SAH

A

Rupture of Berry Aneurysm at bifurcation of Circle of Willis - Star Shape

198
Q

Pathophysiology and CT appearance of SDH

A

Rupture of Bridging Veins - Crescent Shape

199
Q

Pathophysiology and CT appearance of EDH

A

Fractured Temporal Bone - Convex CT

200
Q

What is Myasthenia Gravis associated with?

A

Thymic Hyperplasia - 50% will have Thymoma

201
Q

Huntington’s Mechanism of Inheritance

A

Autosomal Dominant (Anticipation)

202
Q

Huntington’s Pathophysiology

A

Expansion of CAG repeats on Chromosome 4 leads to loss of striatum which causes a prodromic illness of irritability, depression and loss of coordination. This progresses to chorea, fits, dementia and death.

203
Q

Horner’s Syndrome Triad

A

Miosis (Pupil Constriction), Partial Ptosis + Enopthalmos (Sunken eye), Anhydrosis (Loss of sweating ipsilaterally).

204
Q

Cystic Fibrosis Mutation

A

CF transmembrane conductance regulator (CFTR) - Chromosome 7

205
Q

Types of Motor Neurone Disease

A

Amyotrophic Lateral Sclerosis - Loss of motor neurons in both the motor cortex and the anterior horn of the spinal cord.
Progressive Bulbar Palsy - Affects cranial nerves IX to XII.
Progressive Muscular Atrophy - anterior horn cell lesion, lower motor neuron only.
Primary Lateral Sclerosis - loss of Betz cells in the motor cortex.

206
Q

MND Drug

A

Riluzole - inhibits the release of glutamic acid.

207
Q

What is caput medusa?

A

The appearance of distended and engorged superficial epigastric veins
It signifies portal hypertension

208
Q

What can be given to prevent tumour lysis syndrome?

A

Allopurinol

209
Q

What type of hypersensitivity reaction is coeliac diease

A

Type IV

210
Q

What is NOT diagnostic for Wilsons disease?

A

High serum copper

211
Q

What is considered a ‘reduced ejection fraction’?

A

<40%

212
Q

How can IgA be differentiated from Post-Streptococcal Glomerulonephritis?

A

IgA nephropathy presents within a shorter time period of infection than SGN.

213
Q

Ankylosing Spondylitis X-Ray Findings

A

Squaring of Vertebrae, Bamboo Spine, Syndesmophytes.

214
Q

Which Blood Marker is Monitored in Anaphylaxis?

A

Serum Mast Cell Tryptase

215
Q

Teratology of Fallot Defects

A

Ventricular Septal Defects, Pulmonary Stenosis, Overriding Aorta, Right Ventricular Hypertrophy

216
Q

What is Addison’s Disease and how do you test and treat it?

A

Adrenal insufficiency - the synacthen test is used and treatment is to replace hormones.

217
Q

Tests for Cushing’s

A

Late Night Salivary Cortisol
Urinary Free Cortisol
48hr Dexamethasone Suppression Test

218
Q

Why does Warfarin cause drug interactions?

A

It is a CYP450 drug inducer.

219
Q

What medication is contraindicated in patients with migraine?

A

Combined oral contraceptive pill as it increases the risk of stroke in patients with migraine

220
Q

What is the first step in investigating a suspected PE?

A

Calculate the patient’s Wells score.

221
Q

In a patient with a suspected PE, what would be the first step in their management with a Wells score of <4?

A

Offer a D-Dimer test, with results available within 4 hours.

222
Q

What is D-Dimer and what is its significance in the the investigations of a DVT/PE?

A

A fibrin breakdown product.
A negative DD effectively excludes a DVT/PE in those with a low or intermediate clinical probability.
It rules out the need for further imaging if negative.

223
Q

In a patient with a suspected PE, what would be the first step in their management with a Wells score of >4?

A

Admit the patient and arrange an urgent CTPA to rule out a PE!

224
Q

If a CTPA is not immediately available/the results of a DD test are not available within 4 hours, how should you manage a patient with a suspected PE whilst you wait?

A

Start interim anticoagulation therapy, such as heparin.

225
Q

If a patient with a suspected PE has a positive DD result, what is the next step in their management?

A

Admit the patient and arrange an urgent CTPA to rule out a PE!

226
Q

If the DD or CTPA return negative, what is the next step in their management?

A

Stop any interim anticoagulants started.
Consider alternate diagnoses.

227
Q

In a confirmed PE, what is the treatment pathway?

A

Warfarin and heparin until INR >2.
Stop heparin and continue warfarin for a minimum of 3 months, with an aimed INR of 2-3.

228
Q

What may be considered in patients who develop emboli despite adequate anticoagulation?

A

A vena caval filter (with concomitant anticoagulation).

229
Q

What is the treatment for a massive PE?

A

Thrombolysis with a 50mg bolus of alteplase.

230
Q

What is the benefit of tiotropium vs ipratropium bromide?

A

Tiotropium only has to be inhaled once a day, due to its longer half-life, unlike ipratropium which must be taken multiple times a day.

231
Q

What is a potential cause of Horner’s Syndrome?

A

A Pancoast Tumour

232
Q

What is a Pancoast Tumour?

A

A tumour of the apex of the lung.

233
Q

How can a Pancoast tumour cause Horner’s syndrome?

A

Compression and disruption of the sympathetic chain as the tumour grows.

234
Q

Hyperkalemia ECG Changes

A

Flat P, Tall Tented T, Wide QRS

235
Q

Hypokalemia ECG Changes

A

Small/Inverted T Waves, U Waves, Long PR

236
Q

Hypercalcemia ECG Changes

A

Short QT

237
Q

Hypocalcemia ECG Changes

A

Long QT

238
Q

Sulfonylurea Name

A

Gliclazide

239
Q

SGLT2 Name

A

Dapagliflozin

240
Q

What is the Name of the flank bruising in Pancreatitis?

A

Grey Turners Sign

241
Q

What is the Synacthen test?

A

Short ACTH stimulation test.

Check cortisol levels before and 30mins after 250ug IM tetracosactide (synacthen).

Addisons is excluded if the second cortisol is >550nmol/L

242
Q

What are superantigens?

A

Antigens which bind to MHC without matching a specific epitope, therefore leading to nonspecific activation of T-cells.

They can activate up to 20% of the body’s T-cells, compared to a normal antigen which can activate up to 0.001% of the body’s T-cells.

243
Q

Give an example of a condition associated with superantigens.

A

Rheumatic fever.

244
Q

‘Molecules that mimic human proteins, eliciting an immune response’ best describes what?

A

Molecular mimicry method of disease.

245
Q

Give an example of molecular mimicry method of disease.

A

Campylobacter involvement in Guillain Barre.

246
Q

What is the inheritance pattern of G6PD?

A

X linked recessive.

247
Q

What do APTT and PT Measure the Effectiveness of?

A

APTT - Intrinsic Pathway (Haemophilia + VWf)
PT - Extrinsic Pathway (Liver Disease + Warfarin)

248
Q

IBS Symptoms

A

Abdominal Pain relieved by Defecation, can also present with tenesmus.

249
Q

What Benzodiazepam can be used to treat alcohol withdrawal?

A

Chlorodiazepam

250
Q

Which Scoring System is used for UC Flares?

A

True-Love Witts

251
Q

How is Metformin Excreted?

A

By the Kidneys

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