Progress Test Flashcards
What do the following symptoms raise suspicion of:
self-mutilating behaviours e.g. headbanging, nail biting in someone with learning difficulties and a PMH of gout?
Lesch-Nyhan Syndrome
What are the symptoms of central retinal vein occlusion?
Sudden painless loss of vision
Severe retinal haemorrhage on fundoscopy - appearance is compared to a cheese and tomato pizza.
What metabolic derangement does pyloric stenosis cause?
Hypocholeraemic, hypokalaemic alkalosis
What does a blood film look like post splenectomy?
Howell-jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes
What is the definition of chronic insomnia?
3 months of trouble falling asleep at least 3 nights per week
In what patient should ovarian cancer be suspected? What is the tumour marker associated?
Any older female with new onset nonspecific abdominal pain or bloating
CA125
At what age should a child be competent with a spoon and NOT spill a cup ?
2 years old
What are the symptoms of croup? Who does it typically affect and when?
Barking cough, worse at night, fever and coryzal symptoms
Presents around 2 years old and more common in autumn months
Parainfluenza is the main cause
What does herpes simplex keratitis show on fluorescein eye stain?
Dendritic ulcer
What is duodenal atresia?
neonatal bilious vomiting with a double bubble sign on abdominal xray
What is the most common cause of hepatocellular carcinoma (i) worldwide (ii) in europe?
(i) hep B
(ii) hep C
What is a common cause of tumour lysis syndrome?
Burkitts lymphoma
What is the only method of contraception which has a proven link to weight gain?
depo provera
What are the features of SVC obstruction?
Dyspnoea, swelling of face neck and arms - conjunctival and periorbital oedema
Headache, often worse in mornings
Visual disturbance
Pulseless jugular venous distension
What are the 4 stagings of ovarian cancer?
I = confined to ovary II = outside ovary but within pelvis III = outside pelvis but within abdomen IV = distant metastasis
What should be offered to woman at 34 weeks pregnancy with pre-eclampsia?
Delivery once a course of corticosteroids has been completed
What 2 diseases can exhibit genetic anticipation?
Huntington’s and myotonic dystrophy
What disease should be considered in young females who develop AKI after initiation of ACEi?
fibromuscular dysplasia
What incision is used for a pancreatectomy?
rooftop incision
What causes a subdural haemorrhage?
Damage to bridging veins between cortex and venous sinuses
What is the cause of gastroenteritis from rice?
bacillus cereus
What are axillary freckles indicative of?
Neurofibromatosis type 1
What drug can cause aplastic anaemia? What are the features of aplastic anaemia?
Phenytoin
- normocytic anaemia, leukopenia, thrombocytopenia
What features are on ECG of a patient with Wolff Parkinson White syndrome?
Short PR interval
Wide QRS with delta wave
L or R axis deviation
How do you manage bilateral adrenocortical hyperplasia?
Spironolactone
What are examples of atypical antipsychotics? What side effects can they cause?
Clozapine (agranulocytosis), olanzapine (dyslipidaemia), risperidone etc
- weight gain
What drug can cause (I) yellow green vision (ii) blue tinted vision?
(i) digoxin
(ii) sildenafil
What is a monteggia fracture?
dislocation of proximal radio-ulnar joint in association with an ulnar fracture. Commonly seen in children aged 4-10 years
Manteggia ulnar = man united
What is a Galeazzi fracture?
Fracture of distal radius with associated dislocation of distal radio-ulnar joint
Galeazzi radius = galaxy rangers
What are the 4 stages of the Keith-Wagener classification of hypertensive retinopathy?
I = arteriolar narrowing and tortuosity. Increased light reflex - silver wiring II = arteriovenous nipping III = cotton wool exudates, flame and blot haemorrhages IV = pappiloedema
What is used to reverse heparin?
Protamine sulfate
What are side effects of tricyclics?
Drowsy, dry mouth, blurred vision, constipation, urinary retention, lengthening of QT interval
What are the signs and symptoms of nasopharyngeal carcinoma?
- otalgia
- unilateral serous otitis media
- nasal obstruction, discharge and/or epistaxis
- cranial nerve palsies
- cervical lymphadenopathy
What should patients with T1DM or autoimmune thyroid disease be screened for at diagnosis?
Coeliac disease
What is the first line surgical intervention for women where uterine atony is main/only cause of haemorrhage?
Intrauterine balloon tamponade
If a woman has a small unruptured (<35mm) ectopic pregnancy with no visible heartbeat, a serum B-hCG level of <1500, no intrauterine pregnancy and no pain, what is the first line treatment?
Methotrexate
What are the different depths of burns?
SUPERFICIAL EPIDERMAL (1st degree) = red and painful
PARTIAL THICKNESS, sup dermal (2nd degree) = pale pink, painful and blistered
PARTIAL THICKNESS deep dermal (2nd degree) = typically white but may have non-blanchingerythema, reduced sensation
FULL THICKNESS (3rd degree) = white/brown/black. No blisters and no pain
What are the symptoms of Edwards syndrome?
Baby born with micrognathia, low-set ears, rocker-bottom feet and overlapping of fingers
When do people typically get otosclerosis? What are the associated symptoms?
20-40 years
- conductive deafness, tinnitus, normal tympanic membrane and positive family history
What is a typical presentation of placental abruption?
- shock out of keeping with visible loss
- pain constant
- tense, tender uterus
- normal lie and presentation
- foetal heart - absent/distressed
- coagulation problems
- beware = pre-eclampsia, DIC, anuria
What is a typical presentation of placental praevia?
- shock in proportion with visible loss
- no pain
- uterus NOT tender
- lie and presentation may be abnormal
- foetal heart = normal
- coagulation problems rare
- small bleeds before large
What is the most common cause of headache in children?
Migraine
How does lidocaine work?
blockage of Na channels
What is a cause of red eye that is NOT painful?
episcleritis
What is Kussmaul’s sign? What is the significance?
Raised JVP that doesn’t fall with inspiration
- it differentiates cardiac tamponade and constrictive pericarditis. It occurs in constrictive pericarditis
What is a key risk factor for development of avascular necrosis of femoral head?
Long term steroid use
What helps to accelerate return of normal bowel function after abdominal surgery?
epidural analgesia
What is the acute management of supraventricular tachycardia?
vagal manoeuvres e.g. valsalva
IV adenosine (verapimil in asthmatics)
electrical cardioversion
What is the treatment of primary open-angle glaucoma?
1st line = prostaglandins analogue eye drop (LANTANOPROST)
2nd line = B blocker (TIMOLOL)
3rd = laser or surgery may be tried
What is the T2DM BP target when (i) no organ damage (ii) end-organ damage present?
(i) less than 140/80 mmHg
(ii) less than 130/80 mmHg
In T1DM, what are the blood glucose targets on (i) waking (ii) before meals and other times of the day?
(i) 5-7 mmol/L
(ii) 4-7 mmol/L
What is the regime for the contraceptive patch?
Wear one patch a week for 3 weeks and don’t wear a patch on week 4
What vaccinations are required for COPD patients?
annual influenza
one-off pneumococcal
What is the difference between lichen (i) planus (ii) sclerosus?
(i) purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
(ii) itchy white spots typically seen on vulva of elderly women
What is the best measure of ovulation?
measure progesterone 7 days before period
e.g. in a 28 day cycle - on day 21
on a 35 day cycle - on day 28
What does hypercalcaemia do to the QT interval?
Shortens it
What are the side effects of (i) metformin (ii) sulfonylureas (glimerpiride) (iii) glitazones (pioglitazone)?
(i) GI upset and lactic acidosis
(ii) hypos, increased appetite and weight, SIADH, liver dysfunction
(iii) weight gain, fluid retention, liver dysfunction, fractures
How would you describe basal cell carcinomas? Where are they localised to on the body?
Pearly shaped rodent ulcers with telangiectasia that do NOT metastasise
- localised to face, scalp, nose or ears
What cohort of patients are at an increased risk of developing squamous cell carcinomas?
those who are immunosuppressed
What is an indication for surgery in bronchiectasis?
localised disease
How is coeliac diagnosed?
Using IgA TTG antibodies
What is the management for degenerative cervical myelopathy?
urgently refer for assessment by specialist spinal services. Decompressive surgery is only effective treatment
What test is used to test for achilles tendon rupture?
Simmonds test
What are risk factors for ovarian cancer?
FHx = mutations of BRCA1 or 2
Many ovulations e.g. late menopause or early menarche, nullparity
- if ovarian cancer is suspected measure CA125 and if elevated perform urgent USS of abdo + pelvis
When should young people (0-24 years) be referred for immediate specialist assessment for leukaemia?
Unexplained petechiae or hepatosplenomegaly
In what population of patients are antioxidant dietary supplements NOT recommended?
smokers
- beta carotene can increase risk of lung cancer
Should pneumococcal vaccine be given before an elective splenectomy? If so, when?
Give 2 weeks before surgery
Where are diverticula most commonly found?
sigmoid colon
What are the 6 tests to confirm brain death?
pupillary reflex corneal reflex occulovestibular reflex cough reflex absent response to supraorbital pressure no spontaneous respiratory effort
What are stress ulcers in Burns patients referred to as?
Curlingo ulcer - may cause haematemesis
How do you treat an inguinal hernia in children (i) under 6 weeks old (ii) under 6 months (iii) under 6 years?
(i) correct within 2 days
(ii) correct within 2 weeks
(iii) correct within 2 months
What is the treatment for prophylaxis of migraines?
topiramate or propranolol
- avoid propranolol in asthmatics
What is ROSIER and what is it used for?
Recognition of stroke in emergency room is used in the initial differentiation of acute stroke from stroke mimics
What is seborrhoeic dermatitis?
Inflammatory reaction to malassezia furfur
What is the most common symptom in children with Crohns?
Abdominal pain
What is the most common inherited thrombophilia?
factor V leiden
What is the difference in presentation of transposition of great arteries and tetralogy of fallot?
Both are cyanotic heart diseases but TGA presents within the first days of life and TOF presents at 1-2 months
What is the grading of the Salter Harris system for paediatric fractures involving the growth plate?
I = fracture through physis only (xray often normal) II = fracture through physis and metaphysis III = fracture through physis and metaphysis to include the joint IV = fracture involving physis, metaphysis and epiphysis V = crush injury involving physis (xray may resemble type I)
What is the difference in dosage of atorvastatin for primary prevention and secondary prevention of CVD?
Primary is 20mg whereas secondary is 80mg
What effect can amiodarone have on the skin?
makes it a grey skin appearance
Following possible exposure of rabies what is the management?
immunoglobulin and vaccination
In what cohort of patients is pioglitazone contraindicated in and why?
Heart failure as it can cause fluid retention
What is an umbilical granuloma? What is the management?
Overgrowth of tissue which occurs during healing process of umbilicus. Common in first weeks of life. A small red growth of tissue in the centre of the umbilicus that is usually wet and leaks small amounts of clear/yellow fluid
Treated by regular application of salt to the wound. 2nd line = cauterise with silver nitrate
Under what age is a child always considered to be unable to consent for sexual intercourse?
under 13 years old
What is clindamycin treatment associated with?
A high risk of c.diff infection
How does posterior hip dislocation present?
shortened and internally rotated leg
How do patients with syringomyelia present?
‘Cape-like’ (neck + arms) loss of sensation to temperature but preserved light touch, proprioception and vibration
- also get spastic weakness, paraesthesia, neuropathic pain, upgoing plantars and bowel and bladder dysfunction
What are side effects of ethambutol? What is given alongside to prevent these occuring?
Optic neuropathy and development of colour blindness
- pyridoxine (B6) is given concurrently
What can penicillamine cause in patients with Wilson’s disease?
Membranous glomerulonephropathy
What are early signs of haemochromatosis?
fatigue, erectile dysfunction, arthralgia
What is the adrenaline dose in patients aged 6 months to 6 years?
150 mcg (0.15ml in 1,000)
What are the positive clinical and positive lab findings required for tumour lysis syndrome?
LAB:
- raised uric acid, potassium and phosphate
- low calcium
CLINICAL
- raised serum creatinine (1.5x upper limit of normal)
- cardiac arrhythmia/sudden death
- seizure
What is Wernicke’s aphasia? What causes it?
Due to a lesion of the superior temporal gyrus
Patients are unable to produce fluent speech but comprehension and repetition is impaired
What is the appropriate referral of a woman over 30 with an unexplained breast lump?
Suspected cancer pathway referral
What are sinister signs in a headache which merit urgent CT head?
Reduction in consciousness and vomiting more than once
How long can HIV post exposure prophylaxis be given after the event?
up to 72 hours
What is the most effective analgesia in the acute management of renal colic?
Diclofenac IM
What is marfans syndrome caused by?
A mutation in a protein called fibrillin 1
What is Ziehl-neelsen stain typically used for?
To identify mycobacteria e.g. mycobacterium tuberculosis
What is the rules for informing the DVLA after a provoked seizure?
Should inform them and await their guidance before driving again
What are the signs of retinal detachment?
Peripheral curtain over vision and spider web flashing lights in vision
What is cervical rib?
Compression of the thoracic outlet by the fibrous band of the rib can result in both neuro + circulatory compromise
When manual tasks are performed in which the hand works overhead the signs and symptoms will be maximal and this is the basis of the Adsons test
What are the xray changes in osteoarthritis?
decreased joint space
subchondral sclerosis
subchondral cysts
osteophytes forming at joint margins
What is the first line test for acromegaly?
Serum IGF levels
When is antiretroviral therapy for HIV started?
At the time of diagnosis
What is a major cardiac complication of kawasaki disease?
Coronary artery aneurysms and should be screened for with an echo
What is an important complication of fluid resuscitation in young patients with DKA?
cerebral oedema
What is Rosvigs sign in appendicitis?
RIF pain in palpation of LIF
What is necrotising enterocolitis?
One of leading causes of death among premature infants. Initial symptoms include feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis
What is the most common cause of constrictive pericarditis in the developing world?
TB
What is the first step in neonatal resuscitation?
dry the baby, remove any wet towels and start the clock/note the time
What can IBD cause?
pyoderma gangrenosum
What is Jarisch-Herxheimer reaction?
Seen sometimes in patients with syphillis following 1st IM benzylpenicillin dose. Fever rash and tachycardia
Typically occurs within a few hours of treatment. No treatment is needed other than antipyretics if required
What are the features of Noonans syndrome?
Webbed neck, short stature, pectus excavatum, pulmonary stenosis
What should an inferior MI and aortic regurgitation murmur raise the suspicion of?
Ascending aortic dissection
What is West’s syndrome?
Infantile spasms (look like colic) and hypsarrhythmia on EEG
After a change in dose of lithium, when should levels be checked?
a week later and 12 hours after last dose
What is Dresslers syndrome?
tends to occur 2-6 weeks post MI
- characterised by a combination of fever, pleuritic pain, pericardial effusion and raised ESR
- treated with NSAIDs
What is the commonest cause of stridor in neonates and children?
Laryngomalacia
What are the symptoms of cardiac tamponade?
The Becks Triad
- hypotension
- muffled heart sounds
- raised JVP
What is the treatment for acute alcohol withdrawal?
1st line = chlordiazepoxide
Lorazepam is preferred in patients with hepatic failure
What is the definition of gestational hypertension?
new onset HTN diagnosed after 20 weeks without significant proteinuria
Treatment = oral labetalol (contraindicated in asthma),
2nd line = nifedipine and methyldopa
What is used in eclampsia?
IV magnesium sulphate
In newly diagnosed adults with T1DM what should the first line insulin regime be?
A basal-bolus using twice daily insulin detemir
What is the rules for patients taking methotrexate and contraception?
during and for at least 3 months after treatment in both men and women
How does Turner’s syndrome present?
affects females, short stature, webbed neck, primary amenorrhoea, high arched palate, bicuspid aortic valve, coarctation of the aorta
- it has increased use of autoimmune diseases and Crohns disease
What may cause bubbly urine?
enterovesic fistual
What anaesthetic agent are people with myasthenia gravis resistant to?
suxamethonium
What are the severities of COPD?
MILD stage 1 = FEV1 over 80% predicted
MODERATE stage 2 = FEV1 50-79% predicted
SEVERE stage 3 = FEV1 30-49% predicted
V.SEVERE stage 4 = FEV1 less than 30% predicted
What is eczema herpeticum? How is it treated?
severe primary infection of skin by HSV 1 or 2
Most commonly seen in children with atopic eczema
- it is potentially life threatening so admit for IV aciclovir
What tests should be done during management of TB?
LFTs should be checked prior to starting treatment and throughout
- visual acuity and renal function should also be checked prior to starting ethambutol
What conditions are people with Downs syndrome at increased risk of developing?
Hypothyroid
T1DM
Subfertility
ALL
What kind of crystals are found in pseudogout?
positively birefringent rhomboid shaped crystals
What are the signs of a threatened miscarriage?
painless per-vaginal bleeding + a closed cervical os
What is the diagnostic criteria triad for hyperemesis gravidarum?
- 5% pre-pregnancy weight loss
- dehydration
- electrolyte imbalance
How does biliary colic present?
Abdominal pain after eating, along with nausea and vomiting. Classically occurs after heavy meals. Pain in the abdomen that radiates to the intrascapular region
What is post thrombotic syndrome?
Venous outflow obstruction and venous insufficiency
Painful heavy calves, pruritus, swelling, varicose veins and venous ulceration
Treatment = compression stockings and elevating leg
For a diagnosis of PTSD, how long do symptoms have to be present?
for at least 1 month
What are the 4 features of tetralogy of fallot?
VSD
Right ventricular hypertrophy
Pulmonary stenosis
Overriding aorta
How do you differentiate between a red eye caused by (i) glaucoma (ii) uveitis?
(i) severe pain, haloes, ‘semi-dilated’ pupil
(ii) small, fixed oval pupil, ciliary flush
How is long QT syndrome managed?
Avoid drugs which prolong
Beta blockers
Implantable cardioverter defibs in HIGH RISK cases
What is subclavian steal syndrome?
Associated with stenosis or occlusion of the subclavian artery, proximal to the origin of the vertebral artery
As a result the increased metabolic needs of the arm then cause retrograde flow and symptoms of CNS vascular insufficiency
What is the treatment for patients with obstructive urinary calculi and signs of infection?
Urgent renal decompression and IV antibiotics due to risk of sepsis
What is primary sclerosing cholangitis is a risk factor for?
Cholangiocarcinoma
Where is the pain in a patient who has common bile duct stones?
Epigastric rather than RUQ
What can the concurrent use of methotrexate and trimethoprim cause?
Bone marrow suppression and severe/fatal pancytopaenia
Briefly describe (i) Scarlet fever (ii) Measles (iii) Pityriasis rosea.
(i) Strawberry tongue, facial sparing
(ii) starting on the face and spreading to the body. Koplik spots
(iii) herald patch (usually on the trunk) followed by erythematous, oval scaly patches which follow characteristic distribution (fir-tree appearance)
What test is used to diagnose a squint?
Corneal light reflection test
What are the risk factors for developmental dysplasia of the hip?
Female sex (6x greater risk) Breech presentation Positive FHx First born child Oligohydramnios Birth weight over 5kg Congenital calcaneovalgus foot deformity
What can be seen in the urine of patients taking loop diuretics?
Hyaline casts
What is used to calculate the volume of IV fluid required for resuscitation over the first 24 hours after burns?
Parklands formula
= 4 x mass in kg x % of body burned
How does Henoch-Schonlein Purpura classically present?
Abdominal pain, arthritis, haematuria and purpuric rash over buttocks and extensor surfaces of arms and legs
What is the most common cause of post partum haemorrhage? How is it treated?
Uterine atony
Bimanual uterine compression
2nd line = IV oxytocin and/or ergometrine
3rd = IM carboprost, then intramyometrial
4th = rectal misoprostol
5th = surgical intervention (balloon tamponade)
What are the target O2 sats in carbon monoxide poisoning?
100%
What is the grading system for hepatic encephalopathy?
I = irritability II = confusion, inappropriate behaviour III = incoherent, restless IV = coma
What acid base imbalance does aspirin cause?
respiratory alkalosis
What are the side effects of (i) tamulosin (ii) finasteride?
(i) dizzy, postural hypotension, dry mouth, depression
(ii) erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
What is the first line antibiotic treatment for syphillis?
IM benzylpenicillin (alternative is doxycycline)
What is the PHQ-9 score?
9 question survey used to establish the severity of depression
What is the 1st and 2nd line treatment for MRSA?
1st = vancomycin 2nd = linezolid
What is the management of HIV+ pneumocystis jiroveci pneumonia?
co-trimoxazole
What is the triad of symptoms in gastric volvulus?
Vomiting
Pain
Failed attempts to pass NG tube
If a patient makes a good response to antidepressant therapy, how long should they continue treatment for?
At least 6 months to reduce risk of relapse
What bacteria causes syphilis?
Treponema pallidum
What is the most common complication of a myomectomy?
adhesions
What is the most important treatment for gastric MALT lymphoma?
eradicate H. pylori
What is the most common cause of epididymitis in males over 35?
E.coli
Describe (i) varicoceles (ii) epididymal cysts.
(i) more common on left side. Described as a ‘bag of worms’ and associated with subfertility
(ii) are separate from the body of the testicle and often found posterior to the testicle
What is the treatment for a pneumothorax (i) less than 1cm (ii) 1-2cm (iii) greater than 2cm?
(i) if not severely SoB then admit and observe with O2
(ii) aspirate
(iii) chest drain insertion
What does erratic blood glucose control, bloating and vomiting suggest?
Gastroparesis
What is Trousseau’s sign?
Carpopedal spasm caused by inflating the BP cuff to a level above systolic BP in patients with hypocalcaemia
What are the symptoms of hypocalcaemia?
Perioral paraesthesia, impaired orientation, anxiety, seizures, increased muscle tone and skin abnormalities
What are 2 distinctive features of Kartageners syndrome?
recurrent chest infections and subfertility
