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Phase 2A Ikenna > PTS extra Info > Flashcards

PTS extra Info Flashcards

1
Q

If weight loss and palpable mass what condition

A

Cancer

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2
Q

Characteristics of tension headache

A

Nausea
Vomiting
Pain in temples

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3
Q

What are the intracellular TLRs

A

3,7,8 and 9

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4
Q

What does TLR4 detect

A

LPS on gram negative bacteria

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5
Q

What TLR detects gram positive bacteria(lipoteichoic acid)

A

TLR-2

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6
Q

What does TLR-7 detect

A

Single stranded RNA intracellularly

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7
Q

What does TLR-10 detect

A

Listeria and influenza A

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8
Q

What does TLR-11 exist in

A

Rats and mice

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9
Q

What does TLR-5 detect

A

Flagellin

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10
Q

What test is used for type 4 hypersensitivity

A

Patch test

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11
Q

What test is used for type 1 hypersensitivity

A

Skin prick testing

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12
Q

What pathogen is most commonly isolated in chronic diarrhoea associated with HIV

A

Campylobacter

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13
Q

What do blood tests show in pagets disease

A

Elevated ALP
Normal PTH, calcium, phosphate
Normal 25hydroxyvitamin D

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14
Q

What shape is pseudomonas aeruginosa

A

Rod shaped

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15
Q

What is the most common cause of reactive arthritis (stomach related)

A

Campylobacter

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16
Q

What is the most specific antibody for sjogren’s

A

Anti-La

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17
Q

Side effect of methotrexate

A

Folic acid inhibitor
Can cause bone marrow suppression

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18
Q

How to know if someone is severely osteoporotic

A

T score <2.5
And
Known pathological fracture E.g low energy distal radius fracture

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19
Q

Do you see temporal arthritis in polymyalgia rheumatica

A

Yes

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20
Q

What is excessive GH secretion prior to adolescence called

A

Gigantism

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21
Q

What is excessive GH secretion after adolescence called

A

Acromegaly

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22
Q

What is the most common subtype of thyroid carcinoma

A

Papillary

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23
Q

Where are catecholamines produced and secreted from

A

Adrenal medulla

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24
Q

What class of immunoglobulin is involved in Graves’ disease

A

IgG

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25
Q

What immunoglobulin activates b cells

A

IgD

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26
Q

What immunoglobulin is involved in the immune function of mucous membranes

A

IgA

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27
Q

What is the gold standard test for graves

A

Immunoglobulin thyrotropin receptor antibody (TRaB)

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28
Q

What immunoglobulin is found on B cells

A

IgM

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29
Q

What is another name for the ACTH stimulation test

A

Synacthen test

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30
Q

Gold standard test for carcinoid syndrome

A

Elevated serum Chomagranin-A (+ octreoscan)

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31
Q

Where in the body are catecholamines secreted from

A

Adrenal medulla

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32
Q

Function of IDH1

A

Makes a protein that helps break down fats for energy and protect cells from harmful molecules

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33
Q

What is pes cavus

A

A high arched foot

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34
Q

How does giant cell arteritis cause blindness

A

It is caused by emboli occluding the retinal artery and causes a descending painless temporary loss of vision (amaurosis fugax)

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35
Q

Symptoms of temporal lobe complex partial seizures

A

Aura(deja vu, hallucinations and funny smells
Post ictal confusion

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36
Q

What vitamin is deficient in wernicke encephalopathy

A

Vitamin B1 (thiamine)

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37
Q

Is glandular fever/mononucleosis a risk factor for multiple sclerosis

A

Yes

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38
Q

What is indicated to do in viral meningitis

A

Analgesia, antipyretic and hydration

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39
Q

What can a pancoast tumour cause

A

Horners syndrome

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40
Q

Symptoms of horners syndrome

A

Anhydrosis (reduced sweating)
Miosis(pupil constriction)
Ptosis(eyelid droop)

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41
Q

What causes horners syndrome

A

Damage to sympathetic nerves

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42
Q

Where do the spinothalamic nerves decussate

A

1-2 levels above their point of entry into the spinal cord

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43
Q

Where do most of the tracts decussate apart from spinothalamic

A

High up in the CNS (thalamus or pyramids)

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44
Q

Does injury of cerebral artery affect ipsilaterally or contra laterally

A

Contralaterally

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45
Q

Most common cause of guillain barré syndrome

A

Campylobacter jejuni

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46
Q

Examples of autonomic symptoms of cluster headaches

A

Rhinorrhea
Miosis
Ptosis
Bloodshot eyes
Lacrimation

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47
Q

1st line treatment for migraines

A

Sumatriptan

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48
Q

What is sumatriptan and how does it work

A

A serotonin 5-HT1 receptor agonist and causes vessel constriction

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49
Q

What drug is used for migraine prophylaxis

A

Propranolol (beta blocker)

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50
Q

What headache prophylaxis is verapamil used for

A

Cluster headache prophylaxis

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51
Q

What type of neuromuscular disorder is Lambert Eaton myasthenia syndrome

A

A pre synaptic neuromuscular disorder

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52
Q

Is pernicious anaemia autoimmune

A

Yes

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53
Q

Symptoms of lambert Eaton myasthenia syndrome

A

Hyporeflexia
Weakness improves after exercise unlike MG

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54
Q

What is mydriasis

A

Black centre of eyes are larger than normal
AKA dilated pupils

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55
Q

What is mydriasis usually seen in

A

Oculomotor lesion

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56
Q

Do oculomotor lesions affect ipsilateral or contralateral

A

Ipsilateral

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57
Q

Common non motor symptoms of Parkinson’s disease

A

REM sleep disorder
Postural hypotension
Constipation
Depression
Urinary urgency
Anosmia

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58
Q

What is levodopa given in

A

Parkinson’s disease

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59
Q

What are baclofen and carbamazepine used to commonly treat

A

Cramps in motor neurone disease

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60
Q

Gold standard for multiple sclerosis

A

MRI to look for plaques
Lumbar puncture to look for oligoclonal bands in the CSF

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61
Q

Characteristic features of Charcot Marie tooth disease

A

Champagne bottle symptoms
Under 10
Pes cavus(high arches)
Decreased touch and vibration sensation in feet

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62
Q

What is Charcot Marie tooth disease

A

Group of inherited conditions that damage the peripheral nerves

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63
Q

What are champagne bottle symptoms

A

Lack of sensation in the arms and feet
Wasting of muscles in lower legs
No issues above knees

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64
Q

What is keppra prescribed in

A

Juvenile myoclonus epilepsy

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65
Q

First line for tonic clonic seizures

A

Valproate unless child bearing age

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66
Q

Second line for tonic clonic seizures

A

Lamotrigine

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67
Q

When is topiramate used

A

It is an epilepsy medication used for myoclonic seizures

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68
Q

Can carbamazepine be used in focal seizures

A

Yes

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69
Q

Mechanism behind vascular dementia

A

Damage due to recurrent strokes

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70
Q

What causes Alzheimer’s

A

Plaques and neurofibrillary tangles in the brain

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71
Q

What does Trendelenburg’s test assess

A

Strength of hip abductors

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72
Q

Simmonds test assess

A

Achilles tendon rupture

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73
Q

Lachman test assesses

A

ACL

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74
Q

Jibe test assesses

A

Supraspinatus muscle

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75
Q

What type of drug is haloperidol

A

Antipsychotic for Huntington’s disease

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76
Q

What type of drug is sertraline

A

An antidepressant

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77
Q

Function of sulpiride

A

Depresses nerve function in Huntington’s

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78
Q

Function of diazepam

A

Aids anxiety and helps sleep in Huntingtons

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79
Q

What receptors does myasthenia graves affect

A

Nicotinic acetylcholine receptors

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80
Q

When is brain natriuretic peptide (BNP) released

A

It is release by the ventricles of the heart in response to excessive stretching of cardiomyocytes

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81
Q

How does warfarin work

A

By inhibiting vitamin K epoxide reductase

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82
Q

How do LMWHs work

A

Via activation of anti thrombin III

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83
Q

Chronic heart failure drug management

A
  1. ACE-inhibitor and beta blocker
    2.aldosterone antagonist E.g spironolactone
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84
Q

What is the Cushing reflex

A

A physiological nervous system response to acute elevations of intracranial pressure

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85
Q

What is the Cushing triad

A

Widening pulse pressure(increasing systolic and decreasing diastolic)/hypertension
Bradycardia
Irregular respirations

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86
Q

Aortic dissection symptoms

A

Tall and long fingers
Sunken chest
High arched palate

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87
Q

What heart artery is blocked if you see dissociation between p and QRS complex and bradycardia

A

Right coronary artery

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88
Q

Another name for ultrasound compression scan for DVT

A

Doppler ultrasound

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89
Q

What is the difference between cholangitis and cholecystitis

A

Cholangitis is the inflammation of the common bile duct due to biliary obstruction, while cholecystitis is the inflammation of the gallbladder and the cystic duct

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90
Q

Risk factors for peptic ulcer disease

A

H.pylori
NSAIDS E.g diclofenac
Corticosteroids E.g prednisolone
Bisphosphonates e.g alendronate

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91
Q

Where are colorectal cancers usually found in order

A

1.Rectum
2.sigmoid colon
3.caecum

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92
Q

Side effects of sulphonylureas e.g gliclazide

A

Hypoglycaemia
Weight gain

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93
Q

What can a B6 deficiency cause

A

Polyneuropathy

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94
Q

What can B6 deficiency cause

A

Polyneuropathy

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95
Q

What can the TB drug isoniazid cause

A

B6 deficiency

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96
Q

What are kayser fleischer rings indicative of

A

Wilson’s disease (copper deposition)

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97
Q

Brown Sequard syndrome symptoms

A

Patients present with an ipsilateral loss of light touch, vibration sensation and motor function in addition to the loss of contralateral pain and temperature sensation (right side in this patient) below the level of the lesion

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98
Q

Most common visual defect in optic neuritis

A

Central scotoma

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99
Q

What drug is given to increase bioavailability when giving levodopa in Parkinson’s

A

Carbidopa

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100
Q

Management of essential tremor

A

Propranolol and primidone

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101
Q

What drug reduces morbidity and mortality in bacterial meningitis

A

Dexamethasone

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102
Q

What condition is myasthenia gravis associated with

A

Thymoma (benign growth of thymus gland)

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103
Q

Inheritance of Charcot Marie tooth syndrome

A

Autosomal dominant

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104
Q

Lines of treatment for focal seizures

A

1.Carbamazepine
2. Levetiracetam

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105
Q

Lines of treatment for tonic clonic seizures

A
  1. Sodium valproate/Lamotrigine
    2.Topiramate
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106
Q

First line of treatment for absence seizures

A

Sodium valproate

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107
Q

What are bony bridges between adjacent vertebrae indicative of in ankylosing spondylitis

A

Syndesmophytes

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108
Q

What is complete fusion of vertebral column indicative of in ankylosing spondylitis

A

Bamboo spine

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109
Q

What deformities can develop in severe late stage rheumatoid arthritis

A

Swan neck deformity
Boutonnières deformity
Ulnar derivation
Z-thumb deformity

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110
Q

If a patients heart is skipping a beat what do you do

A

Valsalvar manoeuvre

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111
Q

Acute management of MI

A

MONAC
Morphine
O2( if sats <94%)
Nitrates
Aspirin
Clopidogrel(or fondaparinux)

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112
Q

What drugs should be provided following MI (no contraindications)

A

ACE inhibitor-ramipril. Or ARB-candesartan
Dual anti platelet therapy E.g clopidogrel and aspirin
Beta blocker E.g propanolol
Statin E.g atorvastatin

Calcium channel blockers E.g verapamil only given if beta blockers are contra-indicated

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113
Q

What does prinzmetal angina show on ECG

A

ST elevation

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114
Q

What does unstable angina show on ECG

A

Can be normal or show ST depression and flat T waves

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115
Q

What is used in broad complex tachycardia

A

Amiodarone

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116
Q

What is the first medication given in anaphylaxis

A

Adrenaline

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117
Q

2nd step in anaphylaxis

A

Establish airway
High flow O2

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118
Q

What is prinzmetal angina

A

Spasm in the coronary artery

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119
Q

4 cardiac defects in tetralogy of fallot

A

Ventricular septal defect
Pulmonary stenosis
Right ventricular hypertrophy
Overriding/misplaced aorta

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120
Q

What side effect can calcium channel blockers (CCB) cause

A

Leg swelling

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121
Q

What does aortic regurgitation sound like

A

Collapsing water hammer pulse
Early diastolic murmur

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122
Q

What do you see on a chest x ray of mitral stenosis

A

Enlarged left and right ventricles

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123
Q

Mitral stenosis sound

A

Soft s1 sound

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124
Q

What is essential hypertension

A

Hypertension that occurs independent of any identifiable cause

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125
Q

What is secondary hypertension

A

Hypertension that occurs as a result of an identifiable cause

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126
Q

Examples of secondary hypertension

A

Renal artery stenosis
Chronic renal disease
Primary hyperaldosteronism
Stress
Sleep apnea
Hyper- or hypothyroidism
Pheochromocytoma
Preeclampsia
Aortic coarction

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127
Q

What ECG abnormality is associated with Wolff Parkinson white syndrome

A

Delta wave

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128
Q

First line for angina

A

GTN spray
Beta blocker E.g bisoprolol
Or calcium channel blocker E.g verapamil/diltiazem

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129
Q

STEMI management

A

Dual antiplatelets( aspirin+ clopidogrel)
Anticoagulation (heparin)
PCI

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130
Q

What is given after ACE-I and beta blocker in heart failure

A

Spironolactone

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131
Q

What is given in atrial fibrillation patients to prevent stroke

A

DOAC E.g apixaban or warfarin

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132
Q

Treatment for pericarditis

A

NSAIDs and colchicine

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133
Q

Features of specific focal seizures (temporal lobe)

A

Automatisms (lip smacking)
Deja vu
Emotional disturbance
Olfactory, taste or auditory hallucinations

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134
Q

Features of specific focal seizures (frontal lobe)

A

Motor features E.g Jacksonian features, dysphasia or Todd’s palsy

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135
Q

What is Todd’s palsy

A

When a seizure is followed by a brief period of temporary paralysis

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136
Q

Features of specific focal seizures (parietal lobe)

A

Sensory symptoms such as tingling and numbness
Motor symptoms

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137
Q

Features of specific focal seizures (occipital lobe)

A

Visual symptoms such as spots and lines in the visual field

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138
Q

What seizures does carbamazepine worsen

A

Absence

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139
Q

Treatment of myoclonic seizures

A

Sodium valproate unless of a child bearing age where levetiracetam or topiramate should be used

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140
Q

What type of seizure does carbamazepine worsen

A

Generalised seizures

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141
Q

Metoclopramide drug type and uses

A

Dopamine receptor antagonist
Anti-emetic
Prokinetic( induced gastric contractions)

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142
Q

What drug can make parksonian patients symptoms worse

A

Metoclopramide

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143
Q

Symptoms of space occupying lesion space

A

Worse in the morning and when you cough
Causes seizure

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144
Q

Is the OCP contraindicated in migraines

A

Yes

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145
Q

When to give thrombolyis after ischaemic stroke

A

Sooner than 4.5 hours after symptom onset

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146
Q

What is red wine linked with

A

Headache

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147
Q

Can myasthenia gravis cause diplopia and blurred vision

A

Yes

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148
Q

Parkinson’s mnemonic

A

TRAP
Tremors (resting)
Rigidity
Akinesia (bradykinesia)
Postural instability( shuffling gait)

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149
Q

What is de quervains thyroiditis associated with

A

Viral infection (Mumps/flu)
Painful swelling of thyroid gland

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150
Q

What can an anterior spinal artery infarct occur after

A

Damage to aorta E.g
Aneurysm repair and dissection

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151
Q

What condition is commonly associated with myasthenia gravis

A

Thymic hyperplasia

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152
Q

Management of myasthenia gravis

A

Prednisolone (acutely)
Cholinesterase inhibitors E.g pyridostigmine(long term)

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153
Q

What are postural hypotension and gastroparesis common complications of

A

Poorly controlled diabetes

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154
Q

First line medication for trigeminal neuralgia

A

Carbamazepine

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155
Q

Structural bodily change in granulomatosis with polyangitis(wegeners)

A

Saddle shaped nose

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156
Q

Medications for prophylaxis of migraine

A

Propranolol
Amytriptiline
Anticonvulsants(topiramate)
Botulinum type toxin A

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157
Q

Routine investigations for dementia

A

MMSE (mini mental state exam)
MRI
CSF analysis
Confusion screen

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158
Q

What dementia does stepwise deterioration indicate

A

Vascular dementia

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159
Q

Symptoms of huntingtons

A

Hyperkinesia
Chorea (irregular involuntary jerky)
Depression
dementia
Restless

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160
Q

Non megaloblastic anaemia causes

A

Hypothyroidism
Alcoholism
Reticulocytosis

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161
Q

Megaloblastic anaemia causes

A

B12/folate deficiency

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162
Q

What type of anaemia is autoimmune haemolytic anaemia

A

Normocytic anaemia

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163
Q

Difference between multiple myeloma and MGUS

A

Multiple myeloma has >10% plasma cells in the bone marrow whilst MGUS has <10%

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164
Q

Clinical features of multiple myeloma

A

CRAB HAI
hyperCalcaemia
Renal impairment
Anaemia
Bone pathology
Hyper viscosity
Amyloidosis
Infection

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165
Q

Difference between sideroblastic and iron deficiency anaemia

A

Both very similar but sideroblastic has high serum ferritin and iron levels

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166
Q

Signs of sideroblastic anaemia

A

Basophillic granules staining positive for iron (pappenheimer bodies)

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167
Q

Most common inherited thrombophillia

A

Factor V leiden

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168
Q

Abrupt stopping of what drug can cause addisonian crisis

A

Long term corticosteroids prednisolone

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169
Q

What can cause slapped cheek syndrome(erythema infectiosum)

A

Parvovirus B19 infection

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170
Q

Most likely diagnosis when APTT is raised but PT and platelet count are normal

A

Von willebrand’s disease

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171
Q

Name of Hodgkins Lymphoma staging system

A

Ann arbor

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172
Q

Tyrosine kinase inhibitor used in Chronic myeloid leukaemia

A

Imatinib

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173
Q

What condition does blast cells and Auer rods suggest

A

Acute myeloid leukaemia

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174
Q

What is chronic myeloid leukaemia a cancer of

A

Erythrocytes
Neutrophils
Mast cells
Platelets

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175
Q

What does mutation in JAK-2 gene cause

A

Polycaethemia rubra vera

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176
Q

What is the most common paediatric cancer

A

ALL(acute lymphoblastic leukaemia)

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177
Q

What is the monoclonal antibody treatment for Non Hodgkin’s lymphoma

A

Rituximab

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178
Q

Pathophysiology of spherocytosis

A

It causes defects in the red cell membrane, resulting in them having increased permeability to sodium

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179
Q

What are smudge cells present in

A

Chronic lymphocytic leukaemia

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180
Q

How does tyrosine kinase inhibitor work in CML

A

Stops excessive cellular replication of eosinophils, neutrophils and basophils

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181
Q

What does raised urea and creatinine suggest in myeloma

A

Renal impairment

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182
Q

What type of drug is apixaban and what is it used in

A

Anticoagulant
Used in deep vein thrombosis for 6 months

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183
Q

What is an indicator of poor prognosis in ALL

A

White cell count of >20

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184
Q

What chemotherapy is used in Hodgkin’s lymphoma

A

ABVD chemotherapy

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185
Q

Long term complications of ABVD chemo

A

Infertility
Cardiomyopathy
Peripheral neuropathy
Lung damage

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186
Q

What haematological condition does a binomial age incidence (2-5 and >50) indicative of

A

Acute lymphoblastic leukaemia

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187
Q

What are Heinz bodies and Bite cells indicative of

A

G6PD deficiency

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188
Q

What does microcytic, hypochromic anaemia with target cells indicate

A

Beta-Thalassaemia major

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189
Q

HbA

A

2 alpha chains and 2 beta chains

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190
Q

HbF

A

2 alpha chain and 2 gamma chains

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191
Q

HbA2

A

2 alpha chains and 2 delta chains

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192
Q

What condition does low haemoglobin and high reticulocyte count indicate

A

Sickle cell disease

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193
Q

What anaemia can metallic aortic valves cause

A

Non-immune haemolytic anaemia

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194
Q

What does high total iron binding capacity with low ferritin indicate

A

Iron deficiency anaemia

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195
Q

What does prolonged Pt and APTT with low platelets indicate

A

Disseminated intravascular coagulation (DIC)

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196
Q

Does HIV predispose someone to developing non-Hodgkin lymphoma

A

Yes

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197
Q

What does the lymph node in the neck feel like in lymphomas

A

Rubbery, nontender

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198
Q

Is pain in an enlarged lymph node after drinking alcohol seen in Hodgkin’s or non Hodgkin’s

A

Hodgkin’s lymphoma

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199
Q

Inheritance pattern for sideroblastic anaemia

A

X-linked

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200
Q

Examples of mucous membranes von willebrand causes bleeding in

A

Epistaxis(nosebleed)
Menorrhagia

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201
Q

If INR is above 8 and major bleeding what is the management

A

Stop warfarin
Give IV vitamin K
Give dried prothrombin complex

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202
Q

If INR is above 8 and minor bleeding what is the management

A

Stop warfarin
Give vitamin K

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203
Q

Management of sickle cell disease

A

IV fluids
Analgesia
Oxygen
Hydroxycarbamide

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204
Q

Presentations of immune thrombocytopenic purpura

A

Normal APTT and PT
Reduced platelets
Petechiae (bruising)

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205
Q

Another name for systemic sclerosis

A

Scleroderma

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206
Q

What condition is anti-centromere specific for

A

Limited systemic sclerosis/scleroderma

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207
Q

What is polyarteritis nodosa

A

Rare small and medium vessel vasculitis

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208
Q

What does polyarteritis nodosa affect

A

Skin
Kidneys
Heart
Nervous system
GI tract
NOT LUNGS

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209
Q

What is polyarteritis nodosa associated with

A

Hepatitis B infection
Systemic symptoms

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210
Q

Who is polyarteritis nodosa common in

A

Men
Patients between 40-60

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211
Q

Dose of prednisolone for giant cell arteritis

A

60mg

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212
Q

What does jaw claudication mean

A

Pain on chewing food

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213
Q

Symptoms/signs of giant cell arteritis

A

Temporal headache
Jaw claudication
Amaurosis fugax( transient monocular blindness)
Thickened tender temporal artery
Scalp tenderness

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214
Q

Treatment for dermatomyositis

A

Corticosteroids (prednisolone)

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215
Q

Two MSK condition a that show muscle weakness/reduction in power

A

Polymalgia rheumatica
Dermatomyositis

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216
Q

What scan is first line in polymyalgia rheumatica

A

Dual energy X-ray absorptiometry (DEXA)

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217
Q

Indicative investigations for polymyalgia rheumatica

A

ESR and CRP

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218
Q

What is given in giant cell arteritis

A

High dose prednisolone(60mg)
Bisphosphonate (alendronic acid)
Proton pump inhibitor

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219
Q

What antibiotic and DMARD cannot be used together

A

Trimethoprim and methotrexate
Because they both inhibit folate metabolism

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220
Q

Methotrexate use in someone who wants to start a family

A

Wash out for at least 6 months before conception
Low dose steroids are safe in the event of disease

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221
Q

What condition does ‘tired all the time’ indicate

A

Coeliac disease
Or a thyroid condition

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222
Q

Endoscopic findings of coeliac disease (jejunal/duodenal)

A

Villus atrophy
Crypt hyperplasia
Lymphocytes

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223
Q

What antibody is primary sclerosis cholangitis associated with

A

ANCA
Particularly pANCA
Mildly raised ALP and ALT

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224
Q

First line treatment of UC

A

Topical aminosalicylate E.g mesalazine,sulfasalazine

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225
Q

What does a high SAAG indicate

A

Ascites is due to raised portal pressure E.g in Hepatic cirrhosis

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226
Q

What is SAAG

A

Serum ascites albumin gradient

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227
Q

Autoimmune hepatitis signs

A

Jaundice
Fatigue
Loss of appetite
Heptomegaly
Splenomegaly
Abdominal pain

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228
Q

Liver function test results in autoimmune hepatitis

A

Raised ALT and bilirubin
Normal/mildly raised ALP

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229
Q

What antibody is present usually in type 1 autoimmune hepatitis

A

Anti-smooth muscle antibodies

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230
Q

First line treatment for Crohns

A

Prednisolone and azathioprine(immunosuppressant)

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231
Q

What type of bleed does high urea indicate

A

Upper gastrointestinal bleed

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232
Q

Typical finding of hepatic encephalopathy

A

Asterixis

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233
Q

Clinical features of liver failure

A

Hepatic encephalopathy
Abnormal bleeding
Ascites
Jaundice

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234
Q

Signs of hepatic encephalopathy

A

Drowsiness confusion
Restlessness, asterixis
Coma
Altered mood, sleep disturbances

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235
Q

What condition can cause respiratory(productive cough) and liver/pancreatic symptoms

A

Alpha 1 antitrypsin deficiency

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236
Q

If triple therapy doesn’t work in H.Pylori infection what do you do

A

Replace clarithromycin with metronidazole and treat for 7 days with new triple therapy

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237
Q

Prophylaxis against cirrhosis

A

Non selective beta blockers E.g propanolol

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238
Q

Where are bile salts absorbed and if they aren’t what can this result in

A

Terminal ileum
Increase the risk of gallstones

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239
Q

Signs of ulcerative colitis on colonoscopy

A

Crypt abcsesses
Goblet cell depletion
Inflammation limited to mucosa
Continuous inflammation

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240
Q

What GI condition is linked to uveitis

A

Ulcerative colitis

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241
Q

What 2 genes predisposes someone to coeliac disease

A

HLA DQ2
HLA DQ8

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242
Q

What GI condition is a peri anal fistula associated with

A

Crohns

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243
Q

What causes Gilbert syndrome

A

Decreased activity of the enzyme that conjugates bilirubin (UGT1A1)

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244
Q

When does Gilbert’s syndrome present

A

At times of stress, fasting, illness or exercise

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245
Q

What is Gilbert syndrome characterised by

A

Unconjugated hyperbillirubinaemia

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246
Q

Gold standard investigation for coeliac disease

A

Oesophagogastroduodenoscopy (OGD) with duodenal and jejunal biopsy

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247
Q

What is seen on an OGD in coeliac

A

Villous atrophy
Crypt hyperplasia

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248
Q

If you see mucus in stool what condition does it indicate

A

Coeliac

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249
Q

If someone’s eyes go yellow sometimes and only abnormal LFT being bilirubin what condition does this indicate

A

Gilberts

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250
Q

Blood test for primary biliary cirrhosis

A

Blood test for anti-mitochondrial antibodies

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251
Q

Action of N-acetyl cysteine (paracetamol overdose)

A

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

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252
Q

Investigation to confirm ascending cholangitis

A

Contrast enhanced dynamic CT

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253
Q

What can ERCP cause

A

Chronic pancreatitis

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254
Q

If you have IBD and primary sclerosis cholangitis what condition does this put you at a greater risk of

A

Colorectal malignancy

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255
Q

What are skin bronzing, hepatomegaly, arrhythmias,erectile dysfunction, weakness and abdominal pain symptoms of

A

Haemochromatosis

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256
Q

Most common symptom of metastatic prostate cancer

A

Lower back pain

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257
Q

What is a common complication after transurethral resection of prostate(TURP) and what is the management of this

A

Clot retention
Cystoscopy and evacuation of blood clots

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258
Q

What can cause functional incontinence

A

Use of lots of sedating medication

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259
Q

Gold standard investigation for identifying renal calculi/stones

A

non contrast CT KUB (Kidneys, ureter, bladder)

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260
Q

First line investigation for prostate cancer

A

MRI

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261
Q

What does an elevated and tender testicle with absent Cremasteric reflex indicate

A

Testicular torsion

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262
Q

What does spiralling of spermatic cord indicate

A

Whirlpool sign and so testicular torsion

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263
Q

What is an undescended testis a risk for

A

Testicular cancer

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264
Q

What does a ‘bag of worms’ and a slight ache in the testis indicate

A

Variocele

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265
Q

Treatment for epididymo-orchitis due to STI

A

IM ceftriaxone and oral doxycycline

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266
Q

First line for chlamydia

A

Doxycycline 100mg BD for 7 days

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267
Q

Risk factors for testicular torsion

A

Bell clapper deformity
Larger testicle
Trauma or exercise
Cryptorchidism

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268
Q

Treatment of urgency incontinence

A

Oxybutynin and bladder training

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269
Q

First choice antibiotic for women with acute pyelonephritis

A

Cefalexin
Can also use co-amoxiclav if no penicillin allergy

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270
Q

What are most renal calculi/stones made up of

A

Calcium oxalate (75%)
Magnesium ammonium phosphate(15%)

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271
Q

What does prehn’s sign differentiate

A

Between testicular pain caused by epididymitis or testicular torsion

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272
Q

Is Prehns sign positive or negative in testicular torsion

A

Negative- exacerbation of pain

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273
Q

What is a positive prehns sign

A

Pain relief upon lifting the affected scrotum

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274
Q

What does the left testicular vein drain into

A

Left renal vein

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275
Q

What does the right testicular vein drain into

A

Inferior vena cava

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276
Q

What type of drug is diclofenac

A

NSAID

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277
Q

What brain haemorrhage is PKD associated with

A

Subarachnoid haemorrhage-ruptured berry aneurysm

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278
Q

What does PKD stand for

A

Polycystic kidney disease

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279
Q

What diet advice should be given to someone with stage 4 chronic kidney disease

A

Low protein,phosphate, potassium and sodium

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280
Q

What tumour marker is associated with testicular cancer

A

Alpha-fetoprotein (AFP)

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281
Q

What can increase the risk of urethral strictures

A

Previous instrumentation

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282
Q

If a renal stone fails to pass spontaneously what is the management

A

Extracorporeal shock wave lithotripsy (ESWL)

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283
Q

Symptoms of epidydimo-orchitis

A

Scrotal pain
Penile discharge
Acute and swollen scrotum
Increased perfusion on ultrasound

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284
Q

First line drug for acute bacterial prostatitis

A

Ciproflaxin 500mg twice daily
Or ofloxacin 200mg twice daily

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285
Q

What can occur following orchiectomy

A

Reduced fertility

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286
Q

Are renal cancers resistant to chemotherapy

A

Generally yes

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287
Q

How are T1 renal cancers managed

A

Partial nephrectomy

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288
Q

How are T2 and above renal cancers managed

A

Radical nephrectomy

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289
Q

Management for acute urinary retention

A

Urethral catheter

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290
Q

Cure for T2N0M0 bladder cancer (transitional cell muscle invasive bladder cancer

A

Total cystectomy

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291
Q

Cure for a T1N0M0 bladder cancer (superficial bladder cancer)

A

TURBT +- chemo or immunotherapy

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292
Q

Example of 5-alpha-reductase inhibitors

A

Finasteride

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293
Q

Symptoms of chronic urinary retention

A

Inability passing urine
Suprapubic pain
Distended bladder on background of history of retention in the past

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294
Q

Management of chronic urinary retention

A

Urinary catheterisation

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295
Q

Can corticosteroids cause diabetes

A

Yes

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296
Q

2nd line medication for diabetes

A

Metformin+ pioglitazone
Metformin+sulfonylurea
Metformin + SGLT2
Metformin+ DPP4 inhibitor

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297
Q

What is a side effect of pioglitazone

A

Fluid retention

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298
Q

What test results show sub clinical hypothyroidism

A

Elevated TSH
Normal thyroid hormones

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299
Q

What does levothyroxine increase the risk of developing

A

Osteoporosis

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300
Q

Examples of potassium sparing diuretics

A

Spironolactone
Amiloride

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301
Q

Commonest cause of anovulation in women

A

Polycystic ovarian syndrome (PCOS)

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302
Q

Most common cause of hypopituitarianism

A

Pituitary adenoma

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303
Q

What 2 organs can cystic fibrosis affect

A

Lungs and pancreas

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304
Q

Diagnostic investigation for cranial diabetes insipidus

A

Water deprivation test with desmopressin stimulation

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305
Q

Side effect of psychiatric medications E.g Risperidone and Haloperidol

A

Disturbances in prolactin levels

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306
Q

What does sensory loss in a stocking distribution suggest

A

Diabetic neuropathy

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307
Q

What is kussmaul breathing

A

Deep sighing

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308
Q

Presentation of De quervain’s thyroiditis

A

Painful smooth goitre

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309
Q

Investigation to assess for DKA

A

Capillary blood gas and capillary blood ketones

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310
Q

Symptoms of DKA

A

Vomiting
Dehydration
Abdominal pain
Hyperventilation(kussmall, deep sighing)
Hypovolaemic shock
Fruity breath( smell of acetone)

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311
Q

Symptoms of Cushing

A

Central obesity
Easy bruising
Poor wound healing
Abdominal striae
Reduced power in muscles of arms and legs

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312
Q

Commonest cause of adreno-cortical failure(Addisons disease)

A

Autoimmune adrenalitis

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313
Q

Symptoms of Addisons disease

A

Hypotension
GI symptoms
Syncope
Fatigue and weakness
Pigmentation(due to increase in ACTH pre cursors)

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314
Q

How to differentiate between an endogenous and exogenous cause of hypoglycaemia

A

Serum C-peptide
(If raised shows endogenous production/if not raised shows insulin has been administered by patient)

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315
Q

What pharmacological treatment should be given in symptomatic hyperglycaemia

A

Insulin or a sulphonylurea

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316
Q

What does a young patient with new bed wetting indicate

A

DKA

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317
Q

What condition is described by the presentation of lung cancer and easy bruising

A

Ectopic ACTH release

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318
Q

What endocrine disease can TB cause

A

Addisons disease

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319
Q

What is a pre diabetic fasting glucose

A

Between 6.1-7 mmol/L

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320
Q

What kidney medication is associated with gynaecomastia

A

Spironolactone as it decreases testosterone production and induces peripheral conversion of testosterone to oestradiol

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321
Q

Causes of cranial diabetes insipidus

A

Head trauma
Inflammatory conditions E.g sarcoidosis
Cranial infections E.g meningitis
Vascular conditions E.g sickle cell

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322
Q

Nephrogenic causes of diabetes insipidus

A

Drugs E.g lithium
Metabolic disturbances hyperCalcaemia/glycaemia or hypokalaemia
Chronic renal disease

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323
Q

What cause of hypothyroidism is characterised by positive anti-TPO (thyroid peroxidase)

A

Hashimoto’s thyroiditis

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324
Q

Most common cause of hypothyroidism with negative anti-TPO findings

A

Iodine deficiency

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325
Q

What is the desmopressin stimulation test used to do

A

Distinguish between central and nephrogenic diabetes insipidus as in cranial the kidney will respond to desmopressin whilst in nephrogenic the kidneys won’t

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326
Q

First line treatment for diabetic neuropathy

A

Pregabalin

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327
Q

If you see symptoms of cushings what investigation is done

A

Low dose dexamethasone
NOT high dose as this is done once cushings in confirmed

328
Q

Signs of heart failure ABCDE

A

Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Pleural effusion

329
Q

Sore throat, fever, yellow skin, presence of numerous abnormal monocytes indicates…

A

Epstein-Barr virus

330
Q

Second line for Crohns

A

IV Hydrocortisone for severe flare ups
Anti-TNF antibodies E.g infliximab

331
Q

What is given to reverse morphine overdose

A

Naloxone

332
Q

What does the Cushing triad indicate

A

Rising intracranial pressure (ICP)

333
Q

If vagal manoeuvres fail what do you do in tachycardia

A

Give adenosine

334
Q

If adverse features are shown (shock,syncope, acute pulmonary oedema or myocardial infarction) in tachycardia what is indicated to do

A

DC cardioversion

335
Q

First line imaging for aortic dissection

A

CT angiogram of chest, abdomen and pelvis

336
Q

What ECG change does an occlusion in the LAD result in

A

Leads V1-4

337
Q

Example of an AVRT

A

Wolff-Parkinson White syndrome

338
Q

What does AVRT stand for

A

Atrioventrical reentrant tachycardia

339
Q

What does AVNRT stand for

A

Atrioventricular nodal reentrant tachycardia

340
Q

Who is Wolff-Parkinson white most common in

A

Young males

341
Q

What can Wolff-Parkinson White syndrome result in

A

Supra ventricular tachycardia

342
Q

ECG changes Wolff-Parkinson White syndrome

A

Short PR interval
Delta wave
Broad QRS

343
Q

Commonest cause of sudden cardiac death in young people

A

Hypertrophic cardiomyopathy

344
Q

Inheritance pattern of hypertrophic cardiomyopathy

A

Autosomal dominant

345
Q

Sound heard in aortic stenosis

A

Ejection systolic murmur (2nd intercostal space)

346
Q

First line in someone with bradycardia with adverse signs

A

Intravenous atropine

347
Q

Second line for bradycardia with adverse symptoms

A

IV adrenaline

348
Q

Aortic dissection management

A

Type A: surgical management (aortic graft)
Type B: blood pressure control E.g IV labetalol

349
Q

What angina is described by anginal pain that occurs at rest or beyond 15 minutes

A

Unstable angina

350
Q

What is the target INR

A

3

351
Q

Signs of infective endocarditis

A

Hypotension
Tachycardia

352
Q

What is becks triad

A

Set of symptoms due to cardiac tamponade

353
Q

Cardiac tamponade symptoms

A

Shortness of breath
Tachycardia
Confusion
Chest pain
Abdominal pain

354
Q

Becks triad signs for cardiac tamponade

A

Hypotension
Quiet heart sounds
Raised JVP

355
Q

Management for aortic stenosis

A

Over 75: TAVI(transcatheter aortic valve implantation)
Under 75: surgical aortic valve replacement

356
Q

Classic triad of symptoms for aortic stenosis

A

Heart failure
Syncope
Angina

357
Q

What are the symptoms of oral thrush

A

Sore throat
Erythematous oropharynx with white patches

358
Q

What respiratory condition medication can cause oral candidiasis (thrush)

A

Beclomethasone inhaler-regular steroid preventer inhaler

359
Q

Why do steroid inhalers cause infection

A

Steroid inhalers have an immunosuppressive effect and can increase susceptibility to infection

360
Q

Management of asthma

A
  1. Short acting inhaled B2 agonist (salbutamol)
  2. Add low dose inhaled corticosteroid (ICS)
  3. Add long acting B2 agonist (salmeterol)
  4. Trial oral leukotriene receptor agonist, high dose steroid, oral B2 agonist
361
Q

Treatment of tension pneumothorax

A

Needle decompression followed by chest drain (5th ICS mid axillary line)

362
Q

Symptoms of a pneumothorax

A

Sudden onset shortness of breath
Pleuritic chest pain (sharp pain when you breath in)

363
Q

Investigation to confirm pulmonary embolism

A

CT pulmonary Angiogram (CTPA)

364
Q

Management for a patient over 40 with unexplained haemoptysis

A

Referred urgently to respiratory clinic under 2 week wait referral

365
Q

Signs of tension pneumothorax

A

Distended neck veins
No audible breath sounds
Tracheal deviation
Tachycardia and hypotension
Hyper-resonant percussion note on affected side
Reduced chest expansion on affected side

366
Q

Presentation of mesothelioma on chest X-ray and a CT chest

A

Pleural thickening with distinct plaques

367
Q

Management of migraine

A

Prophylaxis: propanolol(if contraindicated topiramate)

Oral triptan E.g sumatriptan in addition to paracetamol or NSAID

368
Q

Most common cause of a surgical third nerve palsy

A

Posterior communicating artery aneurysm

369
Q

What does a history of progressive tremors that run in the family and get worse with anxiety and better after alcohol indicate

A

Benign essential tremor

370
Q

Impairment of what nerve causes wrist drop

A

Radial nerve

371
Q

Impairment of what nerve causes foot drop

A

Peroneal nerve

372
Q

Investigation to diagnose Wilson’s disease

A

Urinary and plasma copper levels, plasma caeruloplasmin levels

373
Q

What would you expect to see in a Urinary and plasma copper levels, plasma caeruloplasmin levels test in Wilson’s disease

A

Serum copper low
Serum caeruloplasmin low
Urinary copper high

374
Q

Management of chorea in Huntingtons disease

A

Tetrabenzazine

375
Q

Investigations for subarachnoid haemorrhage

A

CT brain scan followed by lumbar puncture 12 hours post headache if CT normal

376
Q

What does more than 1 episode of vomiting after head injury indicate

A

That a CT head should be performed within 1 hour

377
Q

What is Guillian-Barre syndrome normally triggered by

A

Recent illnesses (E.g campylobacter, EBV)
Can be idiopathic (40%)

378
Q

Clinical signs of Guillian-Barre syndrome

A

Progressive ascending symmetrical limb weakness (affecting lower limbs first)
Lower motor neurone signs in lower limbs
Respiratory muscles can be affected in severe cases
Bilateral facial palsy can occur

379
Q

Why is protein raised and glucose low in bacterial meningitis

A

Glucose is low as bacteria use it as an energy source
Protein is raised due to bacterial replication

380
Q

Investigation to confirm cauda equina

A

Whole spine MRI

381
Q

What medication shouldn’t be used in migraine prophylaxis if someone has diabetes

A

Amitriptyline

382
Q

If someone has diabetes and asthma what medication should be used as prophylaxis in migraine

A

Topiramate

383
Q

What neurological condition does an isolated rise in CSF protein indicate

A

Guillain-Barre syndrome

384
Q

Can antipsychotics cause drug induced Parkinsonism

A

Yes E.g haloperidol

385
Q

Medical management of Guillain-Barré syndrome

A

Intravenous immunoglobulin
If ineffective plasmapheresis

386
Q

What does a bilateral medial temporal lobe involvement on MRI support a diagnosis of

A

Encephalitis

387
Q

First line treatment for acute bacterial meningitis

A

IM benzylpenicillin and urgent hospital transfer

388
Q

What % of extradural haemaotomas are supratentorial

A

> 95%

389
Q

What should be done after a lumbar puncture in likely subarachnoid haemorrhage

A

CT angiogram to identify if the cause is due to an aneurysm

390
Q

What is aplastic anaemia

A

When the bone marrow fails to produce blood cells of all lineages leading to reduced production of red blood cells, white blood cells and platelets

391
Q

What is pancytopenia

A

Lower than normal red and white blood cells and platelets in the blood

392
Q

First line prophylactic antibiotic for splenectomy

A

Phenoxymethylpenicillin

393
Q

Second line antibiotics for splenectomy in penicillin allergies

A

Clarithromycin
Erythromycin

394
Q

Bedside test done in SLE

A

Urine dipstick to look for proteinuria

395
Q

Test to diagnose herniated discs

A

Straight leg raise

396
Q

What does anti phospholipid syndrome occur secondary to commonly

A

SLE

397
Q

Acronym to remember symptoms of scleroderma

A

CREST

398
Q

Symptoms of antiphospholipid syndrome

A

CLOT
Clots-thromboembolism/arterial embolism
Livedo reticularis- mottled lace appearance of skin on lower limbs
Obstetric loss- recurrent miscarriages, pre eclampsia and premature birth
Thrombocytopenia

399
Q

Investigations for antiphospholipid syndrome

A

Blood test:
1. Anti-cardiolipin antibodies
2.Anti-beta2-GPI antibodies
3. Positive lupus anticoagulant assay

FBC m- Thrombocytopenia

400
Q

What diabetes is insulin given in

A

Type 1

401
Q

Side effects of corticosteroids diabetes related E.g dexamethasone or prednisolone

A

Insulin resistance
Steroid induced hyperglycaemia

402
Q

What antibiotic is used in septic arthritis

A

IV Flucloxacillin
WITHIN 1 hour

403
Q

Treatment of DIC

A

All-trans retinoic acid (ATRA)

404
Q

Common complication of hyperthyroidism

A

Atrial fibrillation

405
Q

Treatment for acromegaly

A
  1. Transphenoidal surgery
  2. Somatostatin analogues (ocreotide)
  3. GH antagonist (Pegvisomant)
  4. Dopamine agonist (cabergoline)
406
Q

What drug can cause nephrogenic diabetes insipidus

A

Lithium

407
Q

Main complication of giving IV fluids in someone with dehydration

A

Cerebral oedema

408
Q

Examples of PY12 inhibitors

A

Clopidogrel
Ticagrelor
Prasugrel

409
Q

Symptoms of Crohn’s disease

A

No visible blood in stool
Pallor
Weight loss
Angular chelitis (red patches at corners of his mouth)

410
Q

Storage symptoms

A

FUN
Frequency
Urgency
Nocturia

411
Q

Voiding symptoms (bladder)

A

SHIPP
Straining
Hesitancy
Incomplete emptying
Poor stream
Post micturition dribbling

412
Q

Does benign prostatic hyperplasia show storage or voiding symptoms

A

Both

413
Q

Common causes of UTIs

A

KEEPS
Klebsiella
E.coli-most common
Enterococcus
Proteus/pseudomonas
Staphylococcus saprophyticus

414
Q

Clinical picture of minimal change disease

A

Hypoalbuminaemia
Peripheral oedema
Proteinuria

415
Q

What U&E component should you be most worried about in AKI

A

Potassium as it can lead to cardiac arrest

416
Q

What are Bence Jones proteins found in

A

Myeloma

417
Q

Side effects of amitriptyline

A

Blurred vision
Confusion
Dry mouth
Urinary retention

418
Q

What food decreases warfarins effect

A

Spinach

419
Q

What is co amoxiclav a combination of

A

Amoxicillin and clavulanic acid

420
Q

Complication of c.difficile

A

Pseudomembranous colitis-inflammation of colon

421
Q

Most commonly affected valve in infective endocarditis

A

Tricuspid

422
Q

2nd line of osteoporosis

A

Denosumab

423
Q

Antibody involved in goodpastures syndrome

A

Anti-glomerular basement membrane

424
Q

What other thyroid condition does de quervain present similar too

A

Graves disease

425
Q

What does carbimazole do

A

Inhibits thyroid peroxidase

426
Q

What diabetes drug can cause lactic acidosis

A

Metformin

427
Q

Investigation for carcinoid syndrome

A

24 hour urinary 5HIAA

428
Q

Metabolite of serotonin

A

5HIAA

429
Q

What mediates the effects of carcinoid syndrome

A

Serotonin (neurotransmitter)

430
Q

What organism is commonly found in diabetic foot ulcers

A

Pseudomonas aeruginosa

431
Q

What endocrinology condition is atrial fibrillation a complication of

A

Hyperthyroidism

432
Q

Management of DKA

A

If patient is alert and not vomiting- oral intake+give subcutaneous insulin injection
If patient vomiting confused or dehydrated give IV fluids 0.9% NaCl, potassium and insulin infusion

433
Q

Major complication of DKA

A

Cerebral oedema

434
Q

Management of carcinoid syndrome

A

Somatostatin analogue

435
Q

Example of somatostatin analogue

A

Ocreotide

436
Q

What can hyperprolactinaemia cause in females

A

Amenorrhoea
Galactorrhoea
Infertility

437
Q

What can hyperprolactinaemia cause in males

A

Gynacomastia
Erectile dysfunction
Reduced sex drive
Less body hair

438
Q

What axis do steroids suppress

A

Hypothalamic-pituitary-adrenal axis
Causing adrenal failure and addisonian crisis

439
Q

What antibody is found in ulcerative colitis

A

P-ANCA

440
Q

1st line treatment for paracetamol overdose

A

N-acetyl cysteine

441
Q

What valvular pathology has a crescendo-decrescendo systolic murmur pattern

A

Aortic stenosis

442
Q

Bundle branch block acronym

A

WILLIAM MARROW
R wave resembles an M/Slurred S wave resembles a W
Marrow=RR=right bundle branch block
William=LL=Left bundle branch block

443
Q

ECG for right bundle branch block

A

R wave in V1 and slurred S wave in V6

444
Q

ECG for left bundle branch block

A

Slurred S wave in V1 and R wave in V6

445
Q

Stages of hypertension

A

Stage 1 >140/90
Stage 2>160/100
Stage 3>180/110

446
Q

Most common cause of peptic ulcers

A

H.Pylori

447
Q

Causes of peptic ulcers

A

H.Pylori
Increased stomach acid production
Recurrent NSAID use
Mucosal ischaemia

448
Q

First line investigation for (large bowel) obstruction

A

Abdominal X-ray

449
Q

Can coeliac patients present with a rash on extensor surfaces

A

Yes

450
Q

What is achalasia

A

A swallowing disorder where peristalsis is reduced resulting in food being brought back up

451
Q

Risk factors for oesophageal cancers

A

Achalasia
Alcohol
Obesity
Smoking

452
Q

Where are the majority of colon cancers found

A

Distal colon

453
Q

Causes of diverticulum

A

Low fibre diet
Obesity
NSAIDs
Smoking

454
Q

GI condition linked with mouth ulcers

A

Crohns

455
Q

Findings of coeliac disease on duodenal biopsy

A

Crypt hyperplasia
Villous atrophy

456
Q

Is hypervolaemia or hypovolaemia more likely to cause AKI

A

Hypovolaemia

457
Q

Best investigation for pyelonephritis

A

Midstream urine microscopy, culture and sensitivity

458
Q

What is reiter’s syndrome

A

Reactive arthritis and the triad of conjunctivitis, urethritis, and arthritis after an infection

459
Q

First line treatment for thrombotic thrombocytopenia purpura

A

Plasma exchange

460
Q

Thromboprophylaxis regimen following hip surgery

A

Dalteparin acutely and then maintenance treatment with apixaban

461
Q

First line treatment for severe/complicated malaria

A

IV artesunate

462
Q

First line treatment for uncomplicated malaria/non falciparum malaria

A

Oral chloroquine

463
Q

Definition of granuloma

A

Aggregate of epithelioid histiocytes

464
Q

What does high GGT and presence of AMA suggest

A

Primary biliary cholangitis

465
Q

What condition other than biliary colic is made worse by eating a fatty meal

A

Ascending cholangitis

466
Q

Side effect of alendronic acid

A

Oesophagitis

467
Q

First line management of ankylosing spondylitis

A

Ibuprofen

468
Q

Can a fever be present in pseudogout

A

Yes

469
Q

What type of tremor occurs in Parkinson’s disease

A

Resting tremor-tremor is absent on movement

470
Q

Action of pyridostigmine and neostigmine

A

Block active site of acetylcholinesterase increasing the amount of Ach available to the post synaptic membrane

471
Q

Within how long of the onset of symptoms of acute ischaemic stroke should adult patients receive alteplase treatment

A

<4.5 hours

472
Q

Most common cause of exacerbation of COPD

A

Haemophilus influenzae

473
Q

What does SpO2 <92% indicate

A

A life threatening asthma attack

474
Q

What asthma medication can cause a fine tremor

A

Salbutamol inhaler

475
Q

Most common lung cancer in non smokers

A

Adenocarcinoma

476
Q

Classic symptoms of pulmonary embolism

A

Pleuritic chest pain( worse on deep breaths)
Shortness of breath
Haemoptysis

477
Q

Example of acid fast bacilli condition

A

TB

478
Q

Treatment for Heart failure

A

ACE inhibitor (or ARB)
Beta blocker
Mineralcorticoid receptor agonist
SGLT-2 inhibitor

479
Q

What is the recommended time frame for a PCI after arrival to hospital

A

2 hours

480
Q

Treatment of acute pericarditis

A

NSAIDs

481
Q

First line imaging for infective endocarditis

A

Transthoracic echocardiogram

482
Q

Most sensitive diagnostic test for infective endocarditis

A

Transoesophageal echocardiogram

483
Q

Management for aortic dissection

A

Emergency surgical intervention

484
Q

CHA2DS2VASc score points

A

Congestive cardiac failure
Hypertension
Age >75
Diabetes
Stroke/TIA
Vascular disease
Age 65-74
Sex (female=1 point)

485
Q

Initial management of a narrow complex tachycardia

A

Carotid sinus massage
If fails 6mg adenosine

486
Q

ECG features of Wolff-Parkinson-White syndrome

A

Short PR interval
Delta waves
Narrow complex tachycardia

487
Q

Anticoagulant used in metallic heart valves

A

Warfarin

488
Q

If a patient has stage 1 hypertension and type 2 diabetes what drug is given

A

ACE inhibitors E.g lisonopril regardless of age
Because ACE inhibitors are renoprotective in type 2 diabetes

489
Q

Commonest cause of mitral stenosis

A

Rheumatic heart disease

490
Q

What does a new left bundle branch block alongside chest pain suggest

A

Acute coronary syndrome

491
Q

Non cardiac cause of atrial fibrillation

A

Excessive Alcohol intake

492
Q

Cardiac tamponade management

A

Pericardiocentesis

493
Q

How long after a MI can you drive

A

1 week

494
Q

Treatment for third degree heart block and mobitz type 2 heart block

A

Permanent pacemaker

495
Q

What syndrome is aortic regurgitation commonly found in

A

Marfan syndrome

496
Q

Aortic regurgitation sound

A

Soft/early diastolic murmur

497
Q

What infection does a throat infection indicate

A

Strep throat

498
Q

ECG finding in myocarditis

A

Sinus tachycardia
T wave inversion

499
Q

What causes an NSTEMI

A

Incomplete blockade of the coronary arteries

500
Q

What does downsloping ST segments indicate

A

Digoxin use

501
Q

Most common cause of infective endocarditis

A

Staph aureus

502
Q

First line treatment in supra ventricular tachycardia

A

Vagal manoeuvre E.g valsalva

503
Q

Presentation of pneumocystis pneumonia

A

Fever
Non productive cough
Breathlessness on exertion

504
Q

Definitive diagnostic investigation for pneumocystis pneumonia

A

Bronchoscope with bronchoalvdolar lavage

505
Q

Signs of pulmonary fibrosis

A

Cyanosis
Clubbing
Fine end inspiratory crackles

506
Q

Symptoms of pulmonary fibrosis

A

Dry cough
Shortness of breath
Fatigue
Arthalgia

507
Q

Where does lung cancer metastasise to

A

Brain
Breast
Adrenals
Bone

508
Q

Stable pneumothorax drain site

A

5th intercostal space, midaxillary line

509
Q

Tension pneumothorax drain site

A

Second intercostal space midclavicular line

510
Q

Initial Treatment for hyperCalcaemia

A

IV 0.9% sodium chloride infusion

511
Q

What does sudden onset shortness of breath and pleuritic pain suggest

A

Pulmonary embolism

512
Q

What is supraventricular tachycardia

A

Narrow complex <120ms
HR >100bpm

513
Q

Example of valsalva manouvre

A

Blow into syringe

514
Q

Example of vagal manouvre

A

Carotid sinus massage

515
Q

What does pink frothy sputum indicate

A

Left heart failure

516
Q

What is elevated in heart failure

A

NT-proBNP

517
Q

Pathophysiology of Wolff-Parkinson-white

A

Accessory pathway between atria and ventricles via bundle of Kent
This enables premature excitation of part of the ventricle

518
Q

Gold standard management of wolff Parkinson white

A

Radio frequency ablation

519
Q

What type of drug is aspirin

A

Salicylate

520
Q

What is a previous history of haemorragic stroke a contraindication for

A

Thrombolysis treatment

521
Q

Who should be offered the pneumococcal vaccine

A

Patients aged 65 and older
At risk groups E.g immunosupressed/ chronic lung conditions

522
Q

What is creon

A

Pancrelipase

523
Q

Best treatment for cystic fibrosis

A

Creon

524
Q

Can cystic fibrosis cause pancreatic insufficiency

A

Yes

525
Q

What are fibronodular opacities found in

A

TB

526
Q

Symptoms of TB

A

Cough
Fever
Weight loss
Coughing up bright red blood

527
Q

In what Resp conditions is clubbing seen in

A

Bronchiectasis
pulmonary fibrosis
Lung adenocarcinoma

528
Q

Diagnostic test for pulmonary fibrosis

A

High resolution CT scan

529
Q

What condition is normally caught abroad in Asian countries

A

TB

530
Q

Diagnostic test for heart failure

A

Transthoracic echocardiogram

531
Q

Most common lung cancer in non smokers

A

Lung adenocarcinoma

532
Q

Symptoms of lung adenocarcinoma

A

Clubbing
Hypertrophic pulmonary osteoarthropathy (painful wrist swelling)

533
Q

Triad of pneumocystis jirovecii presentation

A

Shortness of breath
Cough (non productive)
Fever

534
Q

What condition does kerley b lines and the signet ring sign indicate

A

Bronchiectasis

535
Q

Is being male or female a risk factor for sleep apnoea

A

Male

536
Q

Treatment for sarcoidosis

A

Oral prednisone

537
Q

What is sarcoidosis

A

A multi system disease characterised by granuloma formation resulting in widespread inflammatory changes and complications

538
Q

Most common symptoms of sarcoidosis

A

Dry cough
Dyspnoea
Reduced exercise tolerance

539
Q

ECG pattern seen in pulmonary embolism

A

Sinus tachycardia with right ventricular strain

540
Q

Initial management for pulmonary embolism in haemodynamically unstable

A

Thrombolysis

541
Q

Initial management for pulmonary embolism in haemodynamically stable

A

Low molecular weight heparin
Followed by warfarin

542
Q

What does recurrent chest infections, sinusitis and pancreatic insufficiency ie type 1 diabetes suggest

A

Cystic fibrosis

543
Q

Diagnostic test for cystic fibrosis

A

Heel prick in newborn
Sweat test in older patients

544
Q

Triad of symptoms for wernicke’s encephalopathy

A

Ataxia
Confusion
Opthalmoplegia

545
Q

Treatment of wernicke’s encephalopathy

A

High dose intravenous thiamine (Pabrinex IV)

546
Q

What causes horners syndrome

A

Interruption of the sympathetic nerve supply to the eye

547
Q

Causes of horners syndrome

A

Pancoast tumour
Stroke
Carotid artery dissection (neck pain)

548
Q

Treatment for at least a 70% carotid stenosis in TIA

A

Carotid endarectomy

549
Q

What causes vasovagal syncope

A

Prolonged standing
Heat
Emotion

550
Q

Presentation of vasovagal syncope

A

Patient loses consciousness and regains it back very quickly

551
Q

What to do if patient has a head injury with signs of intercranial major bleed and is on warfarin

A

Stop warfarin
Start IV vitamin K
Give prothrombin complex concentrate

552
Q

Surgical intervention for subarachnoid haemorrhage

A

Endovascular coiling

553
Q

Treatment for cluster headaches

A

High flow oxygen

554
Q

What do you see on western blot in lumbar puncture for multiple sclerosis

A

Distinct bands of IgG (oligoclonal bands)

555
Q

Where is the lesion that causes superior homonymous quadrantopia

A

Temporal lobe

556
Q

As well as common peroneal palsy what else can cause foot drop

A

L5 radiculopathy

557
Q

Difference between common peroneal palsy and L5 radiculopathy

A

L5 radiculopathy shows weakness in inversion whilst peroneal causes weakness in eversion

558
Q

What does a lesion in the posterior cerebral artery cause

A

Homonymous hemianopia with macular sparing

559
Q

In guillain barré syndrome what investigation let’s the doctor know intubation can be done

A

Bedside spirometry

560
Q

Most useful diagnostic test for encephalitis

A

CSF viral PCR
Most commonly will show HSV (herpes simplex virus)

561
Q

Treatment for status ellipticus (seizure for more than 5 minutes)

A

IV lorazepam

562
Q

What prompts a CT head within 1 hour (head related)

A

Greater than 1 episode of vomiting

563
Q

Examples of anticoagulants

A

Warfarin
Apixaban
LMWH

564
Q

Examples of antiplatelet drugs

A

Aspirin
Clopidogrel

565
Q

How can amaurosis fugax be described

A

Dark curtain falling over eye

566
Q

What not to do on long term oxygen support

A

Smoke as it is a fire hazards

567
Q

1st line investigation for mesothelioma

A

CXR then CT

568
Q

Gold standard investigation for mesothelioma

A

Biopsy

569
Q

What direction are CT scans done

A

Feet up
So left is actually right

570
Q

What conditions are associated with small cell lung cancer

A

SIADH
Lambert Eaton
Cushings

571
Q

What non small cell lung cancer affects smokers

A

Squamous cell carcinoma

572
Q

What condition is associated with non small cell lung cancer

A

HyperCalcaemia of malignancy due to PTH secretion

573
Q

Main bronchial carcinomas

A

NSCC
SCC
Adenocarcinoma

574
Q

Main risk factor for Adenocarcinoma

A

Asbestos exposure

575
Q

What can a pancoast tumour cause

A

Horners syndrome
Hoarse voice-compression of recurrent laryngeal nerve
Pembertons sign- flushing of face when hands above head

576
Q

Diagnostic test for pulmonary hypertension

A

Right heart catheter

577
Q

What is cor plumonale

A

Right atrial dilation
Right ventricular hypertrophy

578
Q

Treatment for pulmonary hypertension

A

Sildenafil(viagra)

579
Q

If you see haemoptysis and haematuria what condition does this indicate

A

Goodpastures disease
As it causes pulmonary and renal pathology

580
Q

Diagnostic test for Goodpastures

A

Serology-anti GBM

581
Q

What does TB show on biopsy

A

Caseating granuloma

582
Q

1st line investigation for pleural effusion

A

CXR-blunting of costophrenic angles

583
Q

Main symptoms of pneumothorax

A

One sided sharp/sudden pleuritic chest pain
Shortness of breath

584
Q

What does a ground glass appearance of lungs indicate on high resolution ct

A

Idiopthaic pulmonary fibrosis

585
Q

What type of cough do type 1 respiratory failure (restrictive) diseases generally have

A

Dry cough

586
Q

What type of cough do type 2 respiratory failure (obstructive) diseases generally have

A

Wet/productive cough

587
Q

Treatment of idiopathic pulmonary fibrosis

A

Pirfenidone and nintedanib

588
Q

What lung cancer is associated with paraneoplastic syndromes

A

Small cell lung cancer

589
Q

Immune thrombocytopenia treatment

A

Prednisolone

590
Q

What two neurological conditions present with a chronic headache that is worse with coughing, straining on the toilet and bending down

A

Idiopathic intracranial hypertension
Brain tumour

591
Q

Symptoms of wernicke’s encephalopathy

A

Nystagmus/opthalmoplegia
Confusion
Ataxia

592
Q

What can cause wernicke’s encephalopathy (vitamin b1 deficiency)

A

Alcohol abuse

593
Q

Pathophysiology of lambert Eaton syndrome

A

Autoantibodies against presynaptic voltage gated calcium channels

594
Q

What is an atonic seizure

A

When a person loses control of their muscles and they just drop

595
Q

What is the first step in managing a stroke

A

CT to differentiate between hameorragic and ischaemic stroke

596
Q

Typical presentation of extradural haematoma

A

Loss of consciousness then a quick regain of consciousness

597
Q

Where is the lesion that causes inferior quadrantopia

A

Parietal lobe
PITS:parietal inferior, temporal superior

598
Q

First line agents for terminating seizures

A

Benzodiazepines E.g IV lorazepam

599
Q

Acronym for cerebellar dysfunction

A

DANISH

600
Q

Signs/symptoms of polycythamia rubra Vera

A

Itching after hot baths
Leg swelling
Splenomegaly (left upper quadrant mass)
Facial redness/plethora

601
Q

Diagnostic test for polycythaemia rubra vera

A

JAK2 mutation screen

602
Q

Management for fluid overload in transfusion

A

Stop transfusion and give 40mg IV furosemide

603
Q

What does ring sideroblastic indicate

A

Myelodysplasia-which can develop into AML

604
Q

What type of anaemia are non megaloblastic and megaloblastic

A

Macrocytic

605
Q

Features of anaemia

A

Palpitations
Pallor
Breathlessness

606
Q

What condition does Cabot rings indicate

A

Pernicious anaemia

607
Q

Test for pernicious anaemia

A

Methylmalonic acid and anti intrinsic factor antibody

608
Q

What do Howell jolly bodies indicate

A

Hyposplenism

609
Q

What can fava beans trigger

A

Acute haemolytic anaemia in those with G6PD deficiency

610
Q

Inheritance pattern of G6PD

A

X-linked

611
Q

Diagnostic investigation for haemophilia A

A

Factor VIII assay

612
Q

Management of haemophilia A

A

Minor bleed: desmopressin
Major bleed: factor VIII

613
Q

Diagnostic investigation for myeloma

A

Serum protein electrophoresis

614
Q

Treatment for beta thalassaemia major

A

Fortnightly blood transfusions

615
Q

Common signs of chronic myeloid leukaemia

A

Massive Splenomegaly
Bleeding
Gout

616
Q

What to do if someone with iron deficiency anaemia has no obvious source of bleeding

A

Refer for urgent gastroscopy and colonoscopy as this indicates potential GI cancer

617
Q

In what anaemia is lactic dehydrogenase raised

A

Haemolytic anaemia

618
Q

What are schistocytes

A

Fragmented red blood cells

619
Q

What are schistocytes found in

A

Haemolytic anaemia

620
Q

Common finding on bloods following surgery E.g appendicectomy

A

Neutrophilia

621
Q

What neurological condition can DIC occur secondary too

A

Meningococcal sepsis

622
Q

Coagulation profile of DIC

A

Decreased fibrinogen
Decreased platelets
Elevated D-dimer

623
Q

What anaemia can cause neurological symptoms E.g paraesthesia-tingling/pins and needles , weakness and acute degeneration of cord

A

B12 deficiency- Pernicious anaemia

624
Q

Foods that provide vitamin B12

A

Meat and dairy

625
Q

Complications of polycaethemia rubra Vera

A

Arterial and venous thrombosis/thromboembolism

626
Q

What does a lymph node biopsy show in lymphoma

A

Reed sternberg cells

627
Q

Example of LMWH

A

Dalteparin

628
Q

What is a hallmark sign of parvovirus B19

A

Reticulocytopenia

629
Q

What 2 antibiotics used together can cause bone marrow suppression

A

Trimethoprim + methotrexate

630
Q

1st line investigation for giant cell arteritis

A

ESR

631
Q

Example of nephrotoxic drug

A

NSAIDs E.g naproxen
Cause vasoconstriction of afferent renal arterioles

632
Q

Antibodies associated with systemic sclerosis

A

Anti-centromere
Scl-70 (anti-topoisomerase 1)
Anti-RNA polymerase III

633
Q

First line treatment for polymyalgia rheumatica

A

Oral prednisolone

634
Q

What are the anti phospholipid antibodies

A

Lupus anticoagulant
Anticardiolipin antibody
AntiB2-glycoprotein I antibody

635
Q

What is raised in polymyositis and dermatomyositis

A

Creatine kinase
Lactate dehydrogenase
Aldolase
ALT
AST

636
Q

Treatment for polymyositis and dermatomyositis

A

Corticosteroids (prednisolone)

637
Q

First line investigation for polymyositis and dermatomyositis

A

Muscle biopsy/muscle derived serum elevation

638
Q

What do you see on chest x ray in wegeners granulomatosis

A

Bilateral nodular and cavitating infiltrates

639
Q

What 3 systems does wegeners granulomatosis affect

A

Upper respiratory tract
Lower respiratory tract
Renal- proteinuria/frothy urine

640
Q

In systemic sclerosis what system should be monitored

A

Renal as it can cause a renal crisis

641
Q

What condition has to be screened for before starting biologics E.g infliximab

A

TB

642
Q

Diagnostic test for giant cell arteritis

A

Temporal artery biopsy

643
Q

1st line treatment for all spondyloarthropathies

A

NSAID
DMARD E.g methotrexate

644
Q

What pulmonary complication is associated with antiphospholipid syndrome

A

Pulmonary embolism

645
Q

X-ray features of osteoarthritis

A

LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral/subarticular sclerosis

646
Q

First line management of osteoarthritis

A

NSAIDs

647
Q

What DMARD can cause pneumonitis

A

Methotrexate

648
Q

If you see painful, red , hot and swollen singular joint E.g metatarsophalangeal/metacarpophalangeal what condition does this indicate

A

Gout

649
Q

What drug should be avoided in antiphospholipid syndrome

A

Combined oral contraceptive pill

650
Q

Where is pseudogout most common

A

In the knee

651
Q

Presentation of diffuse systemic sclerosis

A

CREST symptoms same as limited sclerosis
But also GI and resp involvement

652
Q

ECG presentation in wegeners

A

Widespread ST elevation due to myocarditis

653
Q

What respiratory failure does polymyositis cause

A

Type 2 respiratory failure
Low oxygen, high CO2

654
Q

Main side effect of oral bisphosphonates E.g alendronic acid

A

Oesophagitis
Ulcers
Strictures

Presents as dysphasia or dyspepsia

655
Q

If NSAID can’t be given to a patient with Crystal arthropathy what is given

A

Colchicine

656
Q

Reason for not being able to give NSAIDs in Crystal arthropathy

A

Chronic kidney disease which can worsen

657
Q

Side effects of colchicine

A

Diarrhoea
Nausea
Vomiting

658
Q

Gold standard investigation for ulcerative colitis

A

Colonoscopy with biopsy
MRCP (magnetic resonance cholangio pancreatography)

659
Q

Test for coeliac disease

A

Total IgA and IgA tissue transglutaminase (tTG)

660
Q

What sign is associated with pancreatic cancer

A

Courvoisiers sign

661
Q

Management of gastroparesis

A

Metoclopramide

662
Q

Pathophysiology of giardiasis

A

Degeneration of ganglion cells in myenteric plexus

663
Q

Typical presentation of pharyngeal pouch

A

Dysphagia
Regurgitation
Halitosis (bad breath)

664
Q

What can a perforated duodenal ulcer show on chest x ray

A

Free air under the diaphragm

665
Q

Treatment for a flare up of Ulcerative colitis

A

Admit and start high dose IV steroids (hydrocortisone)

666
Q

Treatment for confirmed peptic ulcer disease that is H.Pylori negative

A

Full dose PPI for 4-8 weeks

667
Q

What liver condition is ulcerative colitis associated with

A

Primary sclerosing cholangitis (post hepatic)

668
Q

What type of drug is ondansetron

A

5HT antagonist

669
Q

What is ondansetron used for

A

Nausea and vomiting

670
Q

What drug is given in a variceal bleed

A

Terlipressin which causes vasoconstriction of dilated blood vessels

671
Q

Specific blood test for primary biliary cholangitis

A

Antimitochondrial antibodies

672
Q

What does mucosal inflammation with yellow plaques suggest

A

C.dificile

673
Q

What criteria assesses the severity of pancreatitis

A

Modified Glasgow criteria

674
Q

What is alpha fetoprotein a marker of

A

Hepatocelluar cancer
Progression from hepatitis B

675
Q

Treatment for hepatic encephalopathy

A

Lactulose (laxative)

676
Q

What is red beefy tongue (glossitis) and angular stomata’s found in

A

Pernicious anaemia

677
Q

Diagnostic investigation for hiatus hernia

A

Barium swallow x-ray

678
Q

What condition is a complication of coeliac disease

A

Small bowel lymphoma and Adenocarcinoma

679
Q

Ascites first line treatment

A

Spironolactone + fluid/salt restriction

680
Q

Diagnostic test of pancreatitis

A

Serum Amylase

681
Q

What is found on biopsy of ulcerative colitis

A

Crypt abscesses
Loss of goblet cells

682
Q

What does bird beak on barium swallow indicate

A

Achalasia

683
Q

If a patient is septic with renal colic what is the management

A

Nephrostomy

684
Q

How does renal cell carcinoma cause leg swelling

A

By causing inferior vena cava occlusion

685
Q

Can renal cancer cause variocele

A

Yes

686
Q

Diagnosis of prostatitis

A

DRE: tender warm swollen prostate
MSU
STI Screening

687
Q

Most common bladder cancer uk

A

Transitional cell carcinoma of bladder

688
Q

Most common bladder cancer from schistosomiasis

A

Squamous cell carcinoma of bladder

689
Q

What is hydrocele

A

Accumulation of fluid within the tunica vaginalis

690
Q

What is variocele

A

Varicosity of pampiniform plexus

691
Q

What is the most common renal cell cancer

A

Renal clear cell cancer

692
Q

Treatment for hydrocele

A

Nothing for 12 months as it will resolve spontaneously

693
Q

First line in testicular cancer

A

Scrotal USS

694
Q

First line pain relief in renal colic

A

Diclofenac

695
Q

What forms staghorn calculi

A

Struvite

696
Q

What do anaesthetics do to the detrusor muscle

A

Decrease detrusor contraction so less micturition

697
Q

Treatment for kidney stones if too big

A

ESWL (extracorporeal shock wave lithotripsy)
PCNL( percutaneous nephrolithotomy)

698
Q

Gold standard investigation for all UTIs

A

MSU MCS(microscopy, culture and sensitivity)

699
Q

What type of urine does protein cause

A

Frothy urine

700
Q

If PCI cannot be done in frost 2 hours of stemi what should be done

A

Fibrinolysis with IV tenecteplase

701
Q

First line in heart failure

A

NT-proBNP levels

702
Q

What is a bounding pulse a sign of

A

Hypercapnia
Septic shock

703
Q

Most common cause of secondary hypoadrenalism

A

Long term corticosteroid use

704
Q

Causes of SIADH

A

Alcohol withdrawal
Head injury
Pneumonia
Small cell lung cancer

705
Q

What electrolyte disturbance can cause wrist flexing

A

Hypocalcaemia

706
Q

UC treatment

A

Mild:mesalazine
Moderate: prednisolone
Severe:IV hydrocortisone

707
Q

Gold standard for Wilson’s

A

Liver biopsy

708
Q

If someone has been to spain what condition and bacteria

A

Legionnaires disease
Legionella pneumophila

709
Q

Inheritance of von willebrand

A

Autosomal dominant

710
Q

Low vitamin D and high ALP indicates what condition

A

Osteomalacia

711
Q

What collagen isn’t made properly in ehler danlos syndrome

A

Type 2 Collagen

712
Q

What is marfan syndrome related to

A

Fibrillin 1

713
Q

Why is levodopa given in parkinsons and not dopamine

A

Because levodopa can cross the blood brain barrier

714
Q

What does a jerky pulse indicate

A

Hypertrophic cardiomyopathy

715
Q

Indication for surgical repair in an infective endocarditis patient

A

Prolonged PR interval on ECG with evidence of aortic valve involvement on echocardiogram

716
Q

X day changes in COPD

A

Barrel chest
Flattened hemidiaphragm

717
Q

Hyperkalaemia acronym

A

Go
Go absent p waves
Go long pr prolongation
Go tall tall tented t waves
Go wide wide qrs

718
Q

Symptoms of hyperosmolar hyperglycaemic state

A

Severe hyperglycaemia
Hypotension
Hyperosmolality

719
Q

Treatment for hyperosmolar hyperglycaemic state

A

Fluid replacement with 0.9% saline
Give insulin
Prophylaxis-Low molecular weight heparin

720
Q

Causes of aortic dissection

A

Marfans
Ehler danlos syndrome
Cocaine use
Smoking

721
Q

What is given alongside TB drugs

A

Pyridoxine(vitamin B6)

722
Q

What conditions does normocytic anaemia indicate

A

Chronic kidney disease (if you see hyperkalaemia)
Chronic disease

723
Q

If a person has a particular pain in bellybutton/periumbilical region what sign is this

A

Cullens sign

724
Q

Differential for coeliac

A

Topical sprue

725
Q

Most severe complication of UC

A

Toxic megacolon

726
Q

What is murphys sign

A

When there is pain on deep inspiration when palpating right subcostal area

727
Q

What condition does murphys sign indicate

A

Acute cholecystitis

728
Q

Wilson’s disease symptoms

A

Parksonian symptoms
Hepatitis
Young age

729
Q

How long after testicular torsion does surgery need to happen

A

6 hours

730
Q

What cancer is Von Hippel lindau linked with

A

Renal cell carcinoma

731
Q

If you see urine dipstick with positive leukocytes and nitrates what condition

A

UTI

732
Q

Minimal change treatment

A

PO Prednisolone

733
Q

Child associated renal cancer

A

Wilms tumour

734
Q

What is membranous nephropathy

A

A type of nephrotic syndrome

735
Q

What is seen in polymyositis

A

Positive ANA antibodies
Elevated creatine kinase

736
Q

Where do pancoast tumours usually arise

A

Left lung apex

737
Q

Treatments for kidney conditions

A

Treat cause
GIVE FLUIDS
Stop nephrotoxic drugs

738
Q

Triad for glomerulonephritis/nephritic syndrome

A

Haematuria
Oliguria-reduced urine output
Fluid retention=hypertension

739
Q

How to know if it is IGA nephropathy

A

Young
Quick onset of symptoms
Painless Haematuria

740
Q

How to know if post strep glomerulonephritis

A

Older
2 weeks ago and then symptoms come on later
Haematuria
Reduced urine output

741
Q

Triad for nephrotic syndrome

A

Proteinuria
Peripheral oedema
Low serum albumin

742
Q

Nephrotic syndrome in adult

A

Focal segmental glomerulonephritis

743
Q

Nephrotic syndrome in children

A

Minimal change

744
Q

Extra dural haemorrhage shape

A

Biconvex
Egg

745
Q

Sub dural haemorrhage shape

A

Crescent

746
Q

Subarachnoid haemorrhage shape

A

Star

747
Q

Extra articular manifestations of ankylosing spondylitis

A

Anterior uveitis
Autoimmun bowel disease
Amyloidosis

748
Q

Extra articular manifestations of ankylosing spondylitis

A

Anterior uveitis
Autoimmune bowel disease
Amyloidosis

749
Q

Extra articular manifestations of ankylosing spondylitis

A

Anterior uveitis
Autoimmune bowel disease
Amyloidosis

750
Q

Key factors of schober bedside test

A

Locate L5 vertebrae and mark
Ask patient to bend as far as they can
Distance of less than 20 cm indicates ankylosing spondylitis

751
Q

X ray findings of ankylosing spondylitis

A

Bamboo spine
Syndesmophytes
Fusion of joints
Ossification

752
Q

Treatment for all spondyloarthropathies

A

NSAIDs
Steroids in flares

753
Q

Types of asthma exacerbation

A

PEFR
Moderate- 50-75%
Acute severe- 33-50%
Life-threatening- less than 33%

754
Q

Indicators of good asthma control

A

• No night-time symptoms
• Inhaler used no more than three times per week
• No breathing difficulties, cough or wheeze on most days
• Able to exercise without symptoms
• Normal lung function test

755
Q

What are the symptoms that precede a migraine called

A

Aura

756
Q

Mechanism of adrenaline

A

Stimulation/ agonist of beta adrenergic receptors

757
Q

Physiological response to mediators of anaphylaxis

A

Vasodilation
Hypotension
Increased vascular permeability
Tachycardia

758
Q

Risk factors for Crohn’s disease

A

Family history
Smoking
Caucasian/jewish
HLA-B27
NSAIDs

759
Q

Non malignant causes of lymphadenopathy

A

Infection
Sarcoidosis
EBV

760
Q

Symptoms in cll

A

Lymphadenopathy
Weight loss
Anaemia
Fatigue
Infections
Bleeding

761
Q

Findings in FBC of CLL

A

Anaemia
Lymphocytosis

762
Q

Treatments for CLL

A

Chemotherapy
Radiotherapy
Slenomectomy

763
Q

What can CLL become

A

Non Hodgkin’s lymphoma
Richter transformation

764
Q

Signs/symptoms of cushings

A

Mood change
Acne
Osteoporosis
Moon face
Thinking of skin
Abdominal striae
Central obesity
Oligomenorrhoea

765
Q

Non pharmacological managements for OA

A

Patient education
Physiotherapy
Occupational therapy
Weight loss
Improved diet

766
Q

Topical and oral management of OA

A

Topical- NSAIDS
Oral- NSAIDS, paracetamol

767
Q

What is in the ABCD2 score

A

Age >60
BP >140/90
Clinical features:
Speech disturbance without weakness
Or Unilateral weakness:2 points
Duration:
10-59 min= 1 point
>60 min= 2 points
Diabetes mellitus=1 point

768
Q

Risk factors for TB

A

IVDU
homeless
Immunosuppression
Alcoholic
Close contact with infected patients

769
Q

What is seen on CXR in TB

A

Bilateral hilar lymphadenopathy
Ghon focus

770
Q

Parkinsons plus symptoms

A

Lewy body dementia
Multiple symptom atrophy

771
Q

Signs of meningitis and SAH

A

Kernig sign
Brudzinski’s sign

772
Q

Most common infectious cause of pericarditis

A

Coxsackie 19 virus

773
Q

What are most causes of pericarditis

A

Idiopathic

774
Q

DANISH cerebellar symptoms

A

Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Speech-slurred
Hypotonia

775
Q

Nerve roots for carpal tunnel syndrome

A

C5-T1

776
Q

10 year risk of having osteoporotic fracture

A

FRAX score

777
Q

When is a uti complicated

A

A man
Pregnant lady
Child
Someone immunocompromised
Recurrent UTIs
Structural abnormality

778
Q

Complications of long term steroid therapy

A

Diabetes
Immunosuppression
Osteoporosis
Proximal muscle weakness
Thinned skin

779
Q

Can antibiotics increase INR

A

Yes by inhibiting warfarins metabolism

780
Q

What does tram tracks on x ray mean

A

Bronchiectasis

781
Q

What diabetic drug increases glucose excretion

A

Dapagliflozin

782
Q

Mechanism of atorvastatin

A

HMG-CoA reductase inhibitors

783
Q

Function of calcium gluconate

A

Stabilisation of cardiomyocyte membrane potentials

784
Q

What White cells are phagocytic

A

Eosinophils
Dendritic cells
Neutrophils
Macrophages

785
Q

What antibody is specific to dermatomyositis

A

Anti Mi 2

786
Q

What is raised in hepatocellular carcinoma

A

Alpha-fetoprotein

787
Q

Small bowel obstruction management

A

Nil by mouth,IV fluids and NG tube aspiration

788
Q

What is the Philadelphia chromosome fusion gene

A

BCR-ABL

789
Q

What is anti jo1 specific to

A

Polymyositis

790
Q

What drug minimises the risk of tumour lysis syndrome

A

Allopurinol

791
Q

What is a preserved ejection fraction

A

50-75%

791
Q

What is a preserved ejection fraction

A

50-75%

791
Q

What is a preserved ejection fraction

A

50-75%

792
Q

What LUTS symptoms are irritating

A

Storage symptoms

793
Q

Function of b-lactam antibiotics

A

Inhibit transpeptidation reactions needed to cross link peptidoglycans in the cell wall

794
Q

What chromosome is affected in haemochromatosis

A

Chromosome 6

795
Q

What bowel obstruction does constipation then vomiting indicate

A

Large bowel

796
Q

What bowel obstruction does vomiting then constipation indicate

A

Small bowel

797
Q

What medication blocks re absorption of glucose in the kidney

A

SGL2 inhibitors

798
Q

What is positive predictive value

A

Proportion of positive results that are true positive

799
Q

Most common primary bone tumour in children and young adults

A

Osteosarcoma

800
Q

Most significant risk factor for aortic dissection

A

Hypertension

801
Q

Most common cause of cushings syndrome

A

Long term high dose glucocorticoid use

802
Q

1st line investigation in upper GI ulcers

A

Urea breath test

803
Q

Protocol for taking blood cultures in infective endocarditis

A

3 cultures
3 different sites
Different times

804
Q

Another name for bacterial meningitis

A

Meningococcal septicaemia

805
Q

Benzodiazepine used to manage effects of alcohol withdrawal

A

Chlordiazepoxide

806
Q

Delirium tremens

A

Medical emergency from alcohol withdrawal

807
Q

Presentation of delirium tremens

A

Confusion
Ataxia
Delusions and hallucinations
Tremor
Tachycardia

808
Q

What can myeloid dysplasia cause

A

AML

809
Q

What malignancy can sjogrens cause

A

Lymphoma

809
Q

What malignancy can sjogrens cause

A

Lymphoma

809
Q

What malignancy can sjogrens cause

A

Lymphoma

810
Q

Marker for Addisons

A

Anti 21 hydroxylase

811
Q

TLR for viral double stranded DNA

A

TLR 3

812
Q

What does painless jaundice indicate

A

Pancreatic cancer
Courvoisier sign

813
Q

What is courvoisier sign

A

Palpable enlarged gallbladder and painless jaundice

Phase 2A Ikenna (5 decks)

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