PTS extra Info Flashcards
If weight loss and palpable mass what condition
Cancer
Characteristics of tension headache
Nausea
Vomiting
Pain in temples
What are the intracellular TLRs
3,7,8 and 9
What does TLR4 detect
LPS on gram negative bacteria
What TLR detects gram positive bacteria(lipoteichoic acid)
TLR-2
What does TLR-7 detect
Single stranded RNA intracellularly
What does TLR-10 detect
Listeria and influenza A
What does TLR-11 exist in
Rats and mice
What does TLR-5 detect
Flagellin
What test is used for type 4 hypersensitivity
Patch test
What test is used for type 1 hypersensitivity
Skin prick testing
What pathogen is most commonly isolated in chronic diarrhoea associated with HIV
Campylobacter
What do blood tests show in pagets disease
Elevated ALP
Normal PTH, calcium, phosphate
Normal 25hydroxyvitamin D
What shape is pseudomonas aeruginosa
Rod shaped
What is the most common cause of reactive arthritis (stomach related)
Campylobacter
What is the most specific antibody for sjogren’s
Anti-La
Side effect of methotrexate
Folic acid inhibitor
Can cause bone marrow suppression
How to know if someone is severely osteoporotic
T score <2.5
And
Known pathological fracture E.g low energy distal radius fracture
Do you see temporal arthritis in polymyalgia rheumatica
Yes
What is excessive GH secretion prior to adolescence called
Gigantism
What is excessive GH secretion after adolescence called
Acromegaly
What is the most common subtype of thyroid carcinoma
Papillary
Where are catecholamines produced and secreted from
Adrenal medulla
What class of immunoglobulin is involved in Graves’ disease
IgG
What immunoglobulin activates b cells
IgD
What immunoglobulin is involved in the immune function of mucous membranes
IgA
What is the gold standard test for graves
Immunoglobulin thyrotropin receptor antibody (TRaB)
What immunoglobulin is found on B cells
IgM
What is another name for the ACTH stimulation test
Synacthen test
Gold standard test for carcinoid syndrome
Elevated serum Chomagranin-A (+ octreoscan)
Where in the body are catecholamines secreted from
Adrenal medulla
Function of IDH1
Makes a protein that helps break down fats for energy and protect cells from harmful molecules
What is pes cavus
A high arched foot
How does giant cell arteritis cause blindness
It is caused by emboli occluding the retinal artery and causes a descending painless temporary loss of vision (amaurosis fugax)
Symptoms of temporal lobe complex partial seizures
Aura(deja vu, hallucinations and funny smells
Post ictal confusion
What vitamin is deficient in wernicke encephalopathy
Vitamin B1 (thiamine)
Is glandular fever/mononucleosis a risk factor for multiple sclerosis
Yes
What is indicated to do in viral meningitis
Analgesia, antipyretic and hydration
What can a pancoast tumour cause
Horners syndrome
Symptoms of horners syndrome
Anhydrosis (reduced sweating)
Miosis(pupil constriction)
Ptosis(eyelid droop)
What causes horners syndrome
Damage to sympathetic nerves
Where do the spinothalamic nerves decussate
1-2 levels above their point of entry into the spinal cord
Where do most of the tracts decussate apart from spinothalamic
High up in the CNS (thalamus or pyramids)
Does injury of cerebral artery affect ipsilaterally or contra laterally
Contralaterally
Most common cause of guillain barré syndrome
Campylobacter jejuni
Examples of autonomic symptoms of cluster headaches
Rhinorrhea
Miosis
Ptosis
Bloodshot eyes
Lacrimation
1st line treatment for migraines
Sumatriptan
What is sumatriptan and how does it work
A serotonin 5-HT1 receptor agonist and causes vessel constriction
What drug is used for migraine prophylaxis
Propranolol (beta blocker)
What headache prophylaxis is verapamil used for
Cluster headache prophylaxis
What type of neuromuscular disorder is Lambert Eaton myasthenia syndrome
A pre synaptic neuromuscular disorder
Is pernicious anaemia autoimmune
Yes
Symptoms of lambert Eaton myasthenia syndrome
Hyporeflexia
Weakness improves after exercise unlike MG
What is mydriasis
Black centre of eyes are larger than normal
AKA dilated pupils
What is mydriasis usually seen in
Oculomotor lesion
Do oculomotor lesions affect ipsilateral or contralateral
Ipsilateral
Common non motor symptoms of Parkinson’s disease
REM sleep disorder
Postural hypotension
Constipation
Depression
Urinary urgency
Anosmia
What is levodopa given in
Parkinson’s disease
What are baclofen and carbamazepine used to commonly treat
Cramps in motor neurone disease
Gold standard for multiple sclerosis
MRI to look for plaques
Lumbar puncture to look for oligoclonal bands in the CSF
Characteristic features of Charcot Marie tooth disease
Champagne bottle symptoms
Under 10
Pes cavus(high arches)
Decreased touch and vibration sensation in feet
What is Charcot Marie tooth disease
Group of inherited conditions that damage the peripheral nerves
What are champagne bottle symptoms
Lack of sensation in the arms and feet
Wasting of muscles in lower legs
No issues above knees
What is keppra prescribed in
Juvenile myoclonus epilepsy
First line for tonic clonic seizures
Valproate unless child bearing age
Second line for tonic clonic seizures
Lamotrigine
When is topiramate used
It is an epilepsy medication used for myoclonic seizures
Can carbamazepine be used in focal seizures
Yes
Mechanism behind vascular dementia
Damage due to recurrent strokes
What causes Alzheimer’s
Plaques and neurofibrillary tangles in the brain
What does Trendelenburg’s test assess
Strength of hip abductors
Simmonds test assess
Achilles tendon rupture
Lachman test assesses
ACL
Jibe test assesses
Supraspinatus muscle
What type of drug is haloperidol
Antipsychotic for Huntington’s disease
What type of drug is sertraline
An antidepressant
Function of sulpiride
Depresses nerve function in Huntington’s
Function of diazepam
Aids anxiety and helps sleep in Huntingtons
What receptors does myasthenia graves affect
Nicotinic acetylcholine receptors
When is brain natriuretic peptide (BNP) released
It is release by the ventricles of the heart in response to excessive stretching of cardiomyocytes
How does warfarin work
By inhibiting vitamin K epoxide reductase
How do LMWHs work
Via activation of anti thrombin III
Chronic heart failure drug management
- ACE-inhibitor and beta blocker
2.aldosterone antagonist E.g spironolactone
What is the Cushing reflex
A physiological nervous system response to acute elevations of intracranial pressure
What is the Cushing triad
Widening pulse pressure(increasing systolic and decreasing diastolic)/hypertension
Bradycardia
Irregular respirations
Aortic dissection symptoms
Tall and long fingers
Sunken chest
High arched palate
What heart artery is blocked if you see dissociation between p and QRS complex and bradycardia
Right coronary artery
Another name for ultrasound compression scan for DVT
Doppler ultrasound
What is the difference between cholangitis and cholecystitis
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
Risk factors for peptic ulcer disease
H.pylori
NSAIDS E.g diclofenac
Corticosteroids E.g prednisolone
Bisphosphonates e.g alendronate
Where are colorectal cancers usually found in order
1.Rectum
2.sigmoid colon
3.caecum
Side effects of sulphonylureas e.g gliclazide
Hypoglycaemia
Weight gain
What can a B6 deficiency cause
Polyneuropathy
What can B6 deficiency cause
Polyneuropathy
What can the TB drug isoniazid cause
B6 deficiency
What are kayser fleischer rings indicative of
Wilson’s disease (copper deposition)
Brown Sequard syndrome symptoms
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
Most common visual defect in optic neuritis
Central scotoma
What drug is given to increase bioavailability when giving levodopa in Parkinson’s
Carbidopa
Management of essential tremor
Propranolol and primidone
What drug reduces morbidity and mortality in bacterial meningitis
Dexamethasone
What condition is myasthenia gravis associated with
Thymoma (benign growth of thymus gland)
Inheritance of Charcot Marie tooth syndrome
Autosomal dominant
Lines of treatment for focal seizures
1.Carbamazepine
2. Levetiracetam
Lines of treatment for tonic clonic seizures
- Sodium valproate/Lamotrigine
2.Topiramate
First line of treatment for absence seizures
Sodium valproate
What are bony bridges between adjacent vertebrae indicative of in ankylosing spondylitis
Syndesmophytes
What is complete fusion of vertebral column indicative of in ankylosing spondylitis
Bamboo spine
What deformities can develop in severe late stage rheumatoid arthritis
Swan neck deformity
Boutonnières deformity
Ulnar derivation
Z-thumb deformity
If a patients heart is skipping a beat what do you do
Valsalvar manoeuvre
Acute management of MI
MONAC
Morphine
O2( if sats <94%)
Nitrates
Aspirin
Clopidogrel(or fondaparinux)
What drugs should be provided following MI (no contraindications)
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
What does prinzmetal angina show on ECG
ST elevation
What does unstable angina show on ECG
Can be normal or show ST depression and flat T waves
What is used in broad complex tachycardia
Amiodarone
What is the first medication given in anaphylaxis
Adrenaline
2nd step in anaphylaxis
Establish airway
High flow O2
What is prinzmetal angina
Spasm in the coronary artery
4 cardiac defects in tetralogy of fallot
Ventricular septal defect
Pulmonary stenosis
Right ventricular hypertrophy
Overriding/misplaced aorta
What side effect can calcium channel blockers (CCB) cause
Leg swelling
What does aortic regurgitation sound like
Collapsing water hammer pulse
Early diastolic murmur
What do you see on a chest x ray of mitral stenosis
Enlarged left and right ventricles
Mitral stenosis sound
Soft s1 sound
What is essential hypertension
Hypertension that occurs independent of any identifiable cause
What is secondary hypertension
Hypertension that occurs as a result of an identifiable cause
Examples of secondary hypertension
Renal artery stenosis
Chronic renal disease
Primary hyperaldosteronism
Stress
Sleep apnea
Hyper- or hypothyroidism
Pheochromocytoma
Preeclampsia
Aortic coarction
What ECG abnormality is associated with Wolff Parkinson white syndrome
Delta wave
First line for angina
GTN spray
Beta blocker E.g bisoprolol
Or calcium channel blocker E.g verapamil/diltiazem
STEMI management
Dual antiplatelets( aspirin+ clopidogrel)
Anticoagulation (heparin)
PCI
What is given after ACE-I and beta blocker in heart failure
Spironolactone
What is given in atrial fibrillation patients to prevent stroke
DOAC E.g apixaban or warfarin
Treatment for pericarditis
NSAIDs and colchicine
Features of specific focal seizures (temporal lobe)
Automatisms (lip smacking)
Deja vu
Emotional disturbance
Olfactory, taste or auditory hallucinations
Features of specific focal seizures (frontal lobe)
Motor features E.g Jacksonian features, dysphasia or Todd’s palsy
What is Todd’s palsy
When a seizure is followed by a brief period of temporary paralysis
Features of specific focal seizures (parietal lobe)
Sensory symptoms such as tingling and numbness
Motor symptoms
Features of specific focal seizures (occipital lobe)
Visual symptoms such as spots and lines in the visual field
What seizures does carbamazepine worsen
Absence
Treatment of myoclonic seizures
Sodium valproate unless of a child bearing age where levetiracetam or topiramate should be used
What type of seizure does carbamazepine worsen
Generalised seizures
Metoclopramide drug type and uses
Dopamine receptor antagonist
Anti-emetic
Prokinetic( induced gastric contractions)
What drug can make parksonian patients symptoms worse
Metoclopramide
Symptoms of space occupying lesion space
Worse in the morning and when you cough
Causes seizure
Is the OCP contraindicated in migraines
Yes
When to give thrombolyis after ischaemic stroke
Sooner than 4.5 hours after symptom onset
What is red wine linked with
Headache
Can myasthenia gravis cause diplopia and blurred vision
Yes
Parkinson’s mnemonic
TRAP
Tremors (resting)
Rigidity
Akinesia (bradykinesia)
Postural instability( shuffling gait)
What is de quervains thyroiditis associated with
Viral infection (Mumps/flu)
Painful swelling of thyroid gland
What can an anterior spinal artery infarct occur after
Damage to aorta E.g
Aneurysm repair and dissection
What condition is commonly associated with myasthenia gravis
Thymic hyperplasia
Management of myasthenia gravis
Prednisolone (acutely)
Cholinesterase inhibitors E.g pyridostigmine(long term)
What are postural hypotension and gastroparesis common complications of
Poorly controlled diabetes
First line medication for trigeminal neuralgia
Carbamazepine
Structural bodily change in granulomatosis with polyangitis(wegeners)
Saddle shaped nose
Medications for prophylaxis of migraine
Propranolol
Amytriptiline
Anticonvulsants(topiramate)
Botulinum type toxin A
Routine investigations for dementia
MMSE (mini mental state exam)
MRI
CSF analysis
Confusion screen
What dementia does stepwise deterioration indicate
Vascular dementia
Symptoms of huntingtons
Hyperkinesia
Chorea (irregular involuntary jerky)
Depression
dementia
Restless
Non megaloblastic anaemia causes
Hypothyroidism
Alcoholism
Reticulocytosis
Megaloblastic anaemia causes
B12/folate deficiency
What type of anaemia is autoimmune haemolytic anaemia
Normocytic anaemia
Difference between multiple myeloma and MGUS
Multiple myeloma has >10% plasma cells in the bone marrow whilst MGUS has <10%
Clinical features of multiple myeloma
CRAB HAI
hyperCalcaemia
Renal impairment
Anaemia
Bone pathology
Hyper viscosity
Amyloidosis
Infection
Difference between sideroblastic and iron deficiency anaemia
Both very similar but sideroblastic has high serum ferritin and iron levels
Signs of sideroblastic anaemia
Basophillic granules staining positive for iron (pappenheimer bodies)
Most common inherited thrombophillia
Factor V leiden
Abrupt stopping of what drug can cause addisonian crisis
Long term corticosteroids prednisolone
What can cause slapped cheek syndrome(erythema infectiosum)
Parvovirus B19 infection
Most likely diagnosis when APTT is raised but PT and platelet count are normal
Von willebrand’s disease
Name of Hodgkins Lymphoma staging system
Ann arbor
Tyrosine kinase inhibitor used in Chronic myeloid leukaemia
Imatinib
What condition does blast cells and Auer rods suggest
Acute myeloid leukaemia
What is chronic myeloid leukaemia a cancer of
Erythrocytes
Neutrophils
Mast cells
Platelets
What does mutation in JAK-2 gene cause
Polycaethemia rubra vera
What is the most common paediatric cancer
ALL(acute lymphoblastic leukaemia)
What is the monoclonal antibody treatment for Non Hodgkin’s lymphoma
Rituximab
Pathophysiology of spherocytosis
It causes defects in the red cell membrane, resulting in them having increased permeability to sodium
What are smudge cells present in
Chronic lymphocytic leukaemia
How does tyrosine kinase inhibitor work in CML
Stops excessive cellular replication of eosinophils, neutrophils and basophils
What does raised urea and creatinine suggest in myeloma
Renal impairment
What type of drug is apixaban and what is it used in
Anticoagulant
Used in deep vein thrombosis for 6 months
What is an indicator of poor prognosis in ALL
White cell count of >20
What chemotherapy is used in Hodgkin’s lymphoma
ABVD chemotherapy
Long term complications of ABVD chemo
Infertility
Cardiomyopathy
Peripheral neuropathy
Lung damage
What haematological condition does a binomial age incidence (2-5 and >50) indicative of
Acute lymphoblastic leukaemia
What are Heinz bodies and Bite cells indicative of
G6PD deficiency
What does microcytic, hypochromic anaemia with target cells indicate
Beta-Thalassaemia major
HbA
2 alpha chains and 2 beta chains
HbF
2 alpha chain and 2 gamma chains
HbA2
2 alpha chains and 2 delta chains
What condition does low haemoglobin and high reticulocyte count indicate
Sickle cell disease
What anaemia can metallic aortic valves cause
Non-immune haemolytic anaemia
What does high total iron binding capacity with low ferritin indicate
Iron deficiency anaemia
What does prolonged Pt and APTT with low platelets indicate
Disseminated intravascular coagulation (DIC)
Does HIV predispose someone to developing non-Hodgkin lymphoma
Yes
What does the lymph node in the neck feel like in lymphomas
Rubbery, nontender
Is pain in an enlarged lymph node after drinking alcohol seen in Hodgkin’s or non Hodgkin’s
Hodgkin’s lymphoma
Inheritance pattern for sideroblastic anaemia
X-linked
Examples of mucous membranes von willebrand causes bleeding in
Epistaxis(nosebleed)
Menorrhagia
If INR is above 8 and major bleeding what is the management
Stop warfarin
Give IV vitamin K
Give dried prothrombin complex
If INR is above 8 and minor bleeding what is the management
Stop warfarin
Give vitamin K
Management of sickle cell disease
IV fluids
Analgesia
Oxygen
Hydroxycarbamide
Presentations of immune thrombocytopenic purpura
Normal APTT and PT
Reduced platelets
Petechiae (bruising)
Another name for systemic sclerosis
Scleroderma
What condition is anti-centromere specific for
Limited systemic sclerosis/scleroderma
What is polyarteritis nodosa
Rare small and medium vessel vasculitis
What does polyarteritis nodosa affect
Skin
Kidneys
Heart
Nervous system
GI tract
NOT LUNGS
What is polyarteritis nodosa associated with
Hepatitis B infection
Systemic symptoms
Who is polyarteritis nodosa common in
Men
Patients between 40-60
Dose of prednisolone for giant cell arteritis
60mg
What does jaw claudication mean
Pain on chewing food
Symptoms/signs of giant cell arteritis
Temporal headache
Jaw claudication
Amaurosis fugax( transient monocular blindness)
Thickened tender temporal artery
Scalp tenderness
Treatment for dermatomyositis
Corticosteroids (prednisolone)
Two MSK condition a that show muscle weakness/reduction in power
Polymalgia rheumatica
Dermatomyositis
What scan is first line in polymyalgia rheumatica
Dual energy X-ray absorptiometry (DEXA)
Indicative investigations for polymyalgia rheumatica
ESR and CRP
What is given in giant cell arteritis
High dose prednisolone(60mg)
Bisphosphonate (alendronic acid)
Proton pump inhibitor
What antibiotic and DMARD cannot be used together
Trimethoprim and methotrexate
Because they both inhibit folate metabolism
Methotrexate use in someone who wants to start a family
Wash out for at least 6 months before conception
Low dose steroids are safe in the event of disease
What condition does ‘tired all the time’ indicate
Coeliac disease
Or a thyroid condition
Endoscopic findings of coeliac disease (jejunal/duodenal)
Villus atrophy
Crypt hyperplasia
Lymphocytes
What antibody is primary sclerosis cholangitis associated with
ANCA
Particularly pANCA
Mildly raised ALP and ALT
First line treatment of UC
Topical aminosalicylate E.g mesalazine,sulfasalazine
What does a high SAAG indicate
Ascites is due to raised portal pressure E.g in Hepatic cirrhosis
What is SAAG
Serum ascites albumin gradient
Autoimmune hepatitis signs
Jaundice
Fatigue
Loss of appetite
Heptomegaly
Splenomegaly
Abdominal pain
Liver function test results in autoimmune hepatitis
Raised ALT and bilirubin
Normal/mildly raised ALP
What antibody is present usually in type 1 autoimmune hepatitis
Anti-smooth muscle antibodies
First line treatment for Crohns
Prednisolone and azathioprine(immunosuppressant)
What type of bleed does high urea indicate
Upper gastrointestinal bleed
Typical finding of hepatic encephalopathy
Asterixis
Clinical features of liver failure
Hepatic encephalopathy
Abnormal bleeding
Ascites
Jaundice
Signs of hepatic encephalopathy
Drowsiness confusion
Restlessness, asterixis
Coma
Altered mood, sleep disturbances
What condition can cause respiratory(productive cough) and liver/pancreatic symptoms
Alpha 1 antitrypsin deficiency
If triple therapy doesn’t work in H.Pylori infection what do you do
Replace clarithromycin with metronidazole and treat for 7 days with new triple therapy
Prophylaxis against cirrhosis
Non selective beta blockers E.g propanolol
Where are bile salts absorbed and if they aren’t what can this result in
Terminal ileum
Increase the risk of gallstones
Signs of ulcerative colitis on colonoscopy
Crypt abcsesses
Goblet cell depletion
Inflammation limited to mucosa
Continuous inflammation
What GI condition is linked to uveitis
Ulcerative colitis
What 2 genes predisposes someone to coeliac disease
HLA DQ2
HLA DQ8
What GI condition is a peri anal fistula associated with
Crohns
What causes Gilbert syndrome
Decreased activity of the enzyme that conjugates bilirubin (UGT1A1)
When does Gilbert’s syndrome present
At times of stress, fasting, illness or exercise
What is Gilbert syndrome characterised by
Unconjugated hyperbillirubinaemia
Gold standard investigation for coeliac disease
Oesophagogastroduodenoscopy (OGD) with duodenal and jejunal biopsy
What is seen on an OGD in coeliac
Villous atrophy
Crypt hyperplasia
If you see mucus in stool what condition does it indicate
Coeliac
If someone’s eyes go yellow sometimes and only abnormal LFT being bilirubin what condition does this indicate
Gilberts
Blood test for primary biliary cirrhosis
Blood test for anti-mitochondrial antibodies
Action of N-acetyl cysteine (paracetamol overdose)
Replenishes supply of glutathione that conjugates NAPQI to non-toxic compounds
Investigation to confirm ascending cholangitis
Contrast enhanced dynamic CT
What can ERCP cause
Chronic pancreatitis
If you have IBD and primary sclerosis cholangitis what condition does this put you at a greater risk of
Colorectal malignancy
What are skin bronzing, hepatomegaly, arrhythmias,erectile dysfunction, weakness and abdominal pain symptoms of
Haemochromatosis
Most common symptom of metastatic prostate cancer
Lower back pain
What is a common complication after transurethral resection of prostate(TURP) and what is the management of this
Clot retention
Cystoscopy and evacuation of blood clots
What can cause functional incontinence
Use of lots of sedating medication
Gold standard investigation for identifying renal calculi/stones
non contrast CT KUB (Kidneys, ureter, bladder)
First line investigation for prostate cancer
MRI
What does an elevated and tender testicle with absent Cremasteric reflex indicate
Testicular torsion
What does spiralling of spermatic cord indicate
Whirlpool sign and so testicular torsion
What is an undescended testis a risk for
Testicular cancer
What does a ‘bag of worms’ and a slight ache in the testis indicate
Variocele
Treatment for epididymo-orchitis due to STI
IM ceftriaxone and oral doxycycline
First line for chlamydia
Doxycycline 100mg BD for 7 days
Risk factors for testicular torsion
Bell clapper deformity
Larger testicle
Trauma or exercise
Cryptorchidism
Treatment of urgency incontinence
Oxybutynin and bladder training
First choice antibiotic for women with acute pyelonephritis
Cefalexin
Can also use co-amoxiclav if no penicillin allergy
What are most renal calculi/stones made up of
Calcium oxalate (75%)
Magnesium ammonium phosphate(15%)
What does prehn’s sign differentiate
Between testicular pain caused by epididymitis or testicular torsion
Is Prehns sign positive or negative in testicular torsion
Negative- exacerbation of pain
What is a positive prehns sign
Pain relief upon lifting the affected scrotum
What does the left testicular vein drain into
Left renal vein
What does the right testicular vein drain into
Inferior vena cava
What type of drug is diclofenac
NSAID
What brain haemorrhage is PKD associated with
Subarachnoid haemorrhage-ruptured berry aneurysm
What does PKD stand for
Polycystic kidney disease
What diet advice should be given to someone with stage 4 chronic kidney disease
Low protein,phosphate, potassium and sodium
What tumour marker is associated with testicular cancer
Alpha-fetoprotein (AFP)
What can increase the risk of urethral strictures
Previous instrumentation
If a renal stone fails to pass spontaneously what is the management
Extracorporeal shock wave lithotripsy (ESWL)
Symptoms of epidydimo-orchitis
Scrotal pain
Penile discharge
Acute and swollen scrotum
Increased perfusion on ultrasound
First line drug for acute bacterial prostatitis
Ciproflaxin 500mg twice daily
Or ofloxacin 200mg twice daily
What can occur following orchiectomy
Reduced fertility
Are renal cancers resistant to chemotherapy
Generally yes
How are T1 renal cancers managed
Partial nephrectomy
How are T2 and above renal cancers managed
Radical nephrectomy
Management for acute urinary retention
Urethral catheter
Cure for T2N0M0 bladder cancer (transitional cell muscle invasive bladder cancer
Total cystectomy
Cure for a T1N0M0 bladder cancer (superficial bladder cancer)
TURBT +- chemo or immunotherapy
Example of 5-alpha-reductase inhibitors
Finasteride
Symptoms of chronic urinary retention
Inability passing urine
Suprapubic pain
Distended bladder on background of history of retention in the past
Management of chronic urinary retention
Urinary catheterisation
Can corticosteroids cause diabetes
Yes
2nd line medication for diabetes
Metformin+ pioglitazone
Metformin+sulfonylurea
Metformin + SGLT2
Metformin+ DPP4 inhibitor
What is a side effect of pioglitazone
Fluid retention
What test results show sub clinical hypothyroidism
Elevated TSH
Normal thyroid hormones
What does levothyroxine increase the risk of developing
Osteoporosis
Examples of potassium sparing diuretics
Spironolactone
Amiloride
Commonest cause of anovulation in women
Polycystic ovarian syndrome (PCOS)
Most common cause of hypopituitarianism
Pituitary adenoma
What 2 organs can cystic fibrosis affect
Lungs and pancreas
Diagnostic investigation for cranial diabetes insipidus
Water deprivation test with desmopressin stimulation
Side effect of psychiatric medications E.g Risperidone and Haloperidol
Disturbances in prolactin levels
What does sensory loss in a stocking distribution suggest
Diabetic neuropathy
What is kussmaul breathing
Deep sighing
Presentation of De quervain’s thyroiditis
Painful smooth goitre
Investigation to assess for DKA
Capillary blood gas and capillary blood ketones
Symptoms of DKA
Vomiting
Dehydration
Abdominal pain
Hyperventilation(kussmall, deep sighing)
Hypovolaemic shock
Fruity breath( smell of acetone)
Symptoms of Cushing
Central obesity
Easy bruising
Poor wound healing
Abdominal striae
Reduced power in muscles of arms and legs
Commonest cause of adreno-cortical failure(Addisons disease)
Autoimmune adrenalitis
Symptoms of Addisons disease
Hypotension
GI symptoms
Syncope
Fatigue and weakness
Pigmentation(due to increase in ACTH pre cursors)
How to differentiate between an endogenous and exogenous cause of hypoglycaemia
Serum C-peptide
(If raised shows endogenous production/if not raised shows insulin has been administered by patient)
What pharmacological treatment should be given in symptomatic hyperglycaemia
Insulin or a sulphonylurea
What does a young patient with new bed wetting indicate
DKA
What condition is described by the presentation of lung cancer and easy bruising
Ectopic ACTH release
What endocrine disease can TB cause
Addisons disease
What is a pre diabetic fasting glucose
Between 6.1-7 mmol/L
What kidney medication is associated with gynaecomastia
Spironolactone as it decreases testosterone production and induces peripheral conversion of testosterone to oestradiol
Causes of cranial diabetes insipidus
Head trauma
Inflammatory conditions E.g sarcoidosis
Cranial infections E.g meningitis
Vascular conditions E.g sickle cell
Nephrogenic causes of diabetes insipidus
Drugs E.g lithium
Metabolic disturbances hyperCalcaemia/glycaemia or hypokalaemia
Chronic renal disease
What cause of hypothyroidism is characterised by positive anti-TPO (thyroid peroxidase)
Hashimoto’s thyroiditis
Most common cause of hypothyroidism with negative anti-TPO findings
Iodine deficiency
What is the desmopressin stimulation test used to do
Distinguish between central and nephrogenic diabetes insipidus as in cranial the kidney will respond to desmopressin whilst in nephrogenic the kidneys won’t
First line treatment for diabetic neuropathy
Pregabalin
If you see symptoms of cushings what investigation is done
Low dose dexamethasone
NOT high dose as this is done once cushings in confirmed
Signs of heart failure ABCDE
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Pleural effusion
Sore throat, fever, yellow skin, presence of numerous abnormal monocytes indicates…
Epstein-Barr virus
Second line for Crohns
IV Hydrocortisone for severe flare ups
Anti-TNF antibodies E.g infliximab
What is given to reverse morphine overdose
Naloxone
What does the Cushing triad indicate
Rising intracranial pressure (ICP)
If vagal manoeuvres fail what do you do in tachycardia
Give adenosine
If adverse features are shown (shock,syncope, acute pulmonary oedema or myocardial infarction) in tachycardia what is indicated to do
DC cardioversion
First line imaging for aortic dissection
CT angiogram of chest, abdomen and pelvis
What ECG change does an occlusion in the LAD result in
Leads V1-4
Example of an AVRT
Wolff-Parkinson White syndrome
What does AVRT stand for
Atrioventrical reentrant tachycardia
What does AVNRT stand for
Atrioventricular nodal reentrant tachycardia
Who is Wolff-Parkinson white most common in
Young males
What can Wolff-Parkinson White syndrome result in
Supra ventricular tachycardia
ECG changes Wolff-Parkinson White syndrome
Short PR interval
Delta wave
Broad QRS
Commonest cause of sudden cardiac death in young people
Hypertrophic cardiomyopathy
Inheritance pattern of hypertrophic cardiomyopathy
Autosomal dominant
Sound heard in aortic stenosis
Ejection systolic murmur (2nd intercostal space)
First line in someone with bradycardia with adverse signs
Intravenous atropine
Second line for bradycardia with adverse symptoms
IV adrenaline
Aortic dissection management
Type A: surgical management (aortic graft)
Type B: blood pressure control E.g IV labetalol
What angina is described by anginal pain that occurs at rest or beyond 15 minutes
Unstable angina
What is the target INR
3
Signs of infective endocarditis
Hypotension
Tachycardia
What is becks triad
Set of symptoms due to cardiac tamponade
Cardiac tamponade symptoms
Shortness of breath
Tachycardia
Confusion
Chest pain
Abdominal pain
Becks triad signs for cardiac tamponade
Hypotension
Quiet heart sounds
Raised JVP
Management for aortic stenosis
Over 75: TAVI(transcatheter aortic valve implantation)
Under 75: surgical aortic valve replacement
Classic triad of symptoms for aortic stenosis
Heart failure
Syncope
Angina
What are the symptoms of oral thrush
Sore throat
Erythematous oropharynx with white patches
What respiratory condition medication can cause oral candidiasis (thrush)
Beclomethasone inhaler-regular steroid preventer inhaler
Why do steroid inhalers cause infection
Steroid inhalers have an immunosuppressive effect and can increase susceptibility to infection
Management of asthma
- Short acting inhaled B2 agonist (salbutamol)
- Add low dose inhaled corticosteroid (ICS)
- Add long acting B2 agonist (salmeterol)
- Trial oral leukotriene receptor agonist, high dose steroid, oral B2 agonist
Treatment of tension pneumothorax
Needle decompression followed by chest drain (5th ICS mid axillary line)
Symptoms of a pneumothorax
Sudden onset shortness of breath
Pleuritic chest pain (sharp pain when you breath in)
Investigation to confirm pulmonary embolism
CT pulmonary Angiogram (CTPA)
Management for a patient over 40 with unexplained haemoptysis
Referred urgently to respiratory clinic under 2 week wait referral
Signs of tension pneumothorax
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
Presentation of mesothelioma on chest X-ray and a CT chest
Pleural thickening with distinct plaques
Management of migraine
Prophylaxis: propanolol(if contraindicated topiramate)
Oral triptan E.g sumatriptan in addition to paracetamol or NSAID
Most common cause of a surgical third nerve palsy
Posterior communicating artery aneurysm
What does a history of progressive tremors that run in the family and get worse with anxiety and better after alcohol indicate
Benign essential tremor
Impairment of what nerve causes wrist drop
Radial nerve
Impairment of what nerve causes foot drop
Peroneal nerve
Investigation to diagnose Wilson’s disease
Urinary and plasma copper levels, plasma caeruloplasmin levels
What would you expect to see in a Urinary and plasma copper levels, plasma caeruloplasmin levels test in Wilson’s disease
Serum copper low
Serum caeruloplasmin low
Urinary copper high
Management of chorea in Huntingtons disease
Tetrabenzazine
Investigations for subarachnoid haemorrhage
CT brain scan followed by lumbar puncture 12 hours post headache if CT normal
What does more than 1 episode of vomiting after head injury indicate
That a CT head should be performed within 1 hour
What is Guillian-Barre syndrome normally triggered by
Recent illnesses (E.g campylobacter, EBV)
Can be idiopathic (40%)
Clinical signs of Guillian-Barre syndrome
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
Why is protein raised and glucose low in bacterial meningitis
Glucose is low as bacteria use it as an energy source
Protein is raised due to bacterial replication
Investigation to confirm cauda equina
Whole spine MRI
What medication shouldn’t be used in migraine prophylaxis if someone has diabetes
Amitriptyline
If someone has diabetes and asthma what medication should be used as prophylaxis in migraine
Topiramate
What neurological condition does an isolated rise in CSF protein indicate
Guillain-Barre syndrome
Can antipsychotics cause drug induced Parkinsonism
Yes E.g haloperidol
Medical management of Guillain-Barré syndrome
Intravenous immunoglobulin
If ineffective plasmapheresis
What does a bilateral medial temporal lobe involvement on MRI support a diagnosis of
Encephalitis
First line treatment for acute bacterial meningitis
IM benzylpenicillin and urgent hospital transfer
What % of extradural haemaotomas are supratentorial
> 95%
What should be done after a lumbar puncture in likely subarachnoid haemorrhage
CT angiogram to identify if the cause is due to an aneurysm
What is aplastic anaemia
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
What is pancytopenia
Lower than normal red and white blood cells and platelets in the blood
First line prophylactic antibiotic for splenectomy
Phenoxymethylpenicillin
Second line antibiotics for splenectomy in penicillin allergies
Clarithromycin
Erythromycin
Bedside test done in SLE
Urine dipstick to look for proteinuria
Test to diagnose herniated discs
Straight leg raise
What does anti phospholipid syndrome occur secondary to commonly
SLE
Acronym to remember symptoms of scleroderma
CREST
Symptoms of antiphospholipid syndrome
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
Investigations for antiphospholipid syndrome
Blood test:
1. Anti-cardiolipin antibodies
2.Anti-beta2-GPI antibodies
3. Positive lupus anticoagulant assay
FBC m- Thrombocytopenia
What diabetes is insulin given in
Type 1
Side effects of corticosteroids diabetes related E.g dexamethasone or prednisolone
Insulin resistance
Steroid induced hyperglycaemia
What antibiotic is used in septic arthritis
IV Flucloxacillin
WITHIN 1 hour
Treatment of DIC
All-trans retinoic acid (ATRA)
Common complication of hyperthyroidism
Atrial fibrillation
Treatment for acromegaly
- Transphenoidal surgery
- Somatostatin analogues (ocreotide)
- GH antagonist (Pegvisomant)
- Dopamine agonist (cabergoline)
What drug can cause nephrogenic diabetes insipidus
Lithium
Main complication of giving IV fluids in someone with dehydration
Cerebral oedema
Examples of PY12 inhibitors
Clopidogrel
Ticagrelor
Prasugrel
Symptoms of Crohn’s disease
No visible blood in stool
Pallor
Weight loss
Angular chelitis (red patches at corners of his mouth)
Storage symptoms
FUN
Frequency
Urgency
Nocturia
Voiding symptoms (bladder)
SHIPP
Straining
Hesitancy
Incomplete emptying
Poor stream
Post micturition dribbling
Does benign prostatic hyperplasia show storage or voiding symptoms
Both
Common causes of UTIs
KEEPS
Klebsiella
E.coli-most common
Enterococcus
Proteus/pseudomonas
Staphylococcus saprophyticus
Clinical picture of minimal change disease
Hypoalbuminaemia
Peripheral oedema
Proteinuria
What U&E component should you be most worried about in AKI
Potassium as it can lead to cardiac arrest
What are Bence Jones proteins found in
Myeloma
Side effects of amitriptyline
Blurred vision
Confusion
Dry mouth
Urinary retention
What food decreases warfarins effect
Spinach
What is co amoxiclav a combination of
Amoxicillin and clavulanic acid
Complication of c.difficile
Pseudomembranous colitis-inflammation of colon
Most commonly affected valve in infective endocarditis
Tricuspid
2nd line of osteoporosis
Denosumab
Antibody involved in goodpastures syndrome
Anti-glomerular basement membrane
What other thyroid condition does de quervain present similar too
Graves disease
What does carbimazole do
Inhibits thyroid peroxidase
What diabetes drug can cause lactic acidosis
Metformin
Investigation for carcinoid syndrome
24 hour urinary 5HIAA
Metabolite of serotonin
5HIAA
What mediates the effects of carcinoid syndrome
Serotonin (neurotransmitter)
What organism is commonly found in diabetic foot ulcers
Pseudomonas aeruginosa
What endocrinology condition is atrial fibrillation a complication of
Hyperthyroidism
Management of DKA
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
Major complication of DKA
Cerebral oedema
Management of carcinoid syndrome
Somatostatin analogue
Example of somatostatin analogue
Ocreotide
What can hyperprolactinaemia cause in females
Amenorrhoea
Galactorrhoea
Infertility
What can hyperprolactinaemia cause in males
Gynacomastia
Erectile dysfunction
Reduced sex drive
Less body hair
What axis do steroids suppress
Hypothalamic-pituitary-adrenal axis
Causing adrenal failure and addisonian crisis
What antibody is found in ulcerative colitis
P-ANCA
1st line treatment for paracetamol overdose
N-acetyl cysteine
What valvular pathology has a crescendo-decrescendo systolic murmur pattern
Aortic stenosis
Bundle branch block acronym
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
ECG for right bundle branch block
R wave in V1 and slurred S wave in V6
ECG for left bundle branch block
Slurred S wave in V1 and R wave in V6
Stages of hypertension
Stage 1 >140/90
Stage 2>160/100
Stage 3>180/110
Most common cause of peptic ulcers
H.Pylori
Causes of peptic ulcers
H.Pylori
Increased stomach acid production
Recurrent NSAID use
Mucosal ischaemia
First line investigation for (large bowel) obstruction
Abdominal X-ray
Can coeliac patients present with a rash on extensor surfaces
Yes
What is achalasia
A swallowing disorder where peristalsis is reduced resulting in food being brought back up
Risk factors for oesophageal cancers
Achalasia
Alcohol
Obesity
Smoking
Where are the majority of colon cancers found
Distal colon
Causes of diverticulum
Low fibre diet
Obesity
NSAIDs
Smoking
GI condition linked with mouth ulcers
Crohns
Findings of coeliac disease on duodenal biopsy
Crypt hyperplasia
Villous atrophy
Is hypervolaemia or hypovolaemia more likely to cause AKI
Hypovolaemia
Best investigation for pyelonephritis
Midstream urine microscopy, culture and sensitivity
What is reiter’s syndrome
Reactive arthritis and the triad of conjunctivitis, urethritis, and arthritis after an infection
First line treatment for thrombotic thrombocytopenia purpura
Plasma exchange
Thromboprophylaxis regimen following hip surgery
Dalteparin acutely and then maintenance treatment with apixaban
First line treatment for severe/complicated malaria
IV artesunate
First line treatment for uncomplicated malaria/non falciparum malaria
Oral chloroquine
Definition of granuloma
Aggregate of epithelioid histiocytes
What does high GGT and presence of AMA suggest
Primary biliary cholangitis
What condition other than biliary colic is made worse by eating a fatty meal
Ascending cholangitis
Side effect of alendronic acid
Oesophagitis
First line management of ankylosing spondylitis
Ibuprofen
Can a fever be present in pseudogout
Yes
What type of tremor occurs in Parkinson’s disease
Resting tremor-tremor is absent on movement
Action of pyridostigmine and neostigmine
Block active site of acetylcholinesterase increasing the amount of Ach available to the post synaptic membrane
Within how long of the onset of symptoms of acute ischaemic stroke should adult patients receive alteplase treatment
<4.5 hours
Most common cause of exacerbation of COPD
Haemophilus influenzae
What does SpO2 <92% indicate
A life threatening asthma attack
What asthma medication can cause a fine tremor
Salbutamol inhaler
Most common lung cancer in non smokers
Adenocarcinoma
Classic symptoms of pulmonary embolism
Pleuritic chest pain( worse on deep breaths)
Shortness of breath
Haemoptysis
Example of acid fast bacilli condition
TB
Treatment for Heart failure
ACE inhibitor (or ARB)
Beta blocker
Mineralcorticoid receptor agonist
SGLT-2 inhibitor
What is the recommended time frame for a PCI after arrival to hospital
2 hours
Treatment of acute pericarditis
NSAIDs
First line imaging for infective endocarditis
Transthoracic echocardiogram
Most sensitive diagnostic test for infective endocarditis
Transoesophageal echocardiogram
Management for aortic dissection
Emergency surgical intervention
CHA2DS2VASc score points
Congestive cardiac failure
Hypertension
Age >75
Diabetes
Stroke/TIA
Vascular disease
Age 65-74
Sex (female=1 point)
Initial management of a narrow complex tachycardia
Carotid sinus massage
If fails 6mg adenosine
ECG features of Wolff-Parkinson-White syndrome
Short PR interval
Delta waves
Narrow complex tachycardia
Anticoagulant used in metallic heart valves
Warfarin
If a patient has stage 1 hypertension and type 2 diabetes what drug is given
ACE inhibitors E.g lisonopril regardless of age
Because ACE inhibitors are renoprotective in type 2 diabetes
Commonest cause of mitral stenosis
Rheumatic heart disease
What does a new left bundle branch block alongside chest pain suggest
Acute coronary syndrome
Non cardiac cause of atrial fibrillation
Excessive Alcohol intake
Cardiac tamponade management
Pericardiocentesis
How long after a MI can you drive
1 week
Treatment for third degree heart block and mobitz type 2 heart block
Permanent pacemaker
What syndrome is aortic regurgitation commonly found in
Marfan syndrome
Aortic regurgitation sound
Soft/early diastolic murmur
What infection does a throat infection indicate
Strep throat
ECG finding in myocarditis
Sinus tachycardia
T wave inversion
What causes an NSTEMI
Incomplete blockade of the coronary arteries
What does downsloping ST segments indicate
Digoxin use
Most common cause of infective endocarditis
Staph aureus
First line treatment in supra ventricular tachycardia
Vagal manoeuvre E.g valsalva
Presentation of pneumocystis pneumonia
Fever
Non productive cough
Breathlessness on exertion
Definitive diagnostic investigation for pneumocystis pneumonia
Bronchoscope with bronchoalvdolar lavage
Signs of pulmonary fibrosis
Cyanosis
Clubbing
Fine end inspiratory crackles
Symptoms of pulmonary fibrosis
Dry cough
Shortness of breath
Fatigue
Arthalgia
Where does lung cancer metastasise to
Brain
Breast
Adrenals
Bone
Stable pneumothorax drain site
5th intercostal space, midaxillary line
Tension pneumothorax drain site
Second intercostal space midclavicular line
Initial Treatment for hyperCalcaemia
IV 0.9% sodium chloride infusion
What does sudden onset shortness of breath and pleuritic pain suggest
Pulmonary embolism
What is supraventricular tachycardia
Narrow complex <120ms
HR >100bpm
Example of valsalva manouvre
Blow into syringe
Example of vagal manouvre
Carotid sinus massage
What does pink frothy sputum indicate
Left heart failure
What is elevated in heart failure
NT-proBNP
Pathophysiology of Wolff-Parkinson-white
Accessory pathway between atria and ventricles via bundle of Kent
This enables premature excitation of part of the ventricle
Gold standard management of wolff Parkinson white
Radio frequency ablation
What type of drug is aspirin
Salicylate
What is a previous history of haemorragic stroke a contraindication for
Thrombolysis treatment
Who should be offered the pneumococcal vaccine
Patients aged 65 and older
At risk groups E.g immunosupressed/ chronic lung conditions
What is creon
Pancrelipase
Best treatment for cystic fibrosis
Creon
Can cystic fibrosis cause pancreatic insufficiency
Yes
What are fibronodular opacities found in
TB
Symptoms of TB
Cough
Fever
Weight loss
Coughing up bright red blood
In what Resp conditions is clubbing seen in
Bronchiectasis
pulmonary fibrosis
Lung adenocarcinoma
Diagnostic test for pulmonary fibrosis
High resolution CT scan
What condition is normally caught abroad in Asian countries
TB
Diagnostic test for heart failure
Transthoracic echocardiogram
Most common lung cancer in non smokers
Lung adenocarcinoma
Symptoms of lung adenocarcinoma
Clubbing
Hypertrophic pulmonary osteoarthropathy (painful wrist swelling)
Triad of pneumocystis jirovecii presentation
Shortness of breath
Cough (non productive)
Fever
What condition does kerley b lines and the signet ring sign indicate
Bronchiectasis
Is being male or female a risk factor for sleep apnoea
Male
Treatment for sarcoidosis
Oral prednisone
What is sarcoidosis
A multi system disease characterised by granuloma formation resulting in widespread inflammatory changes and complications
Most common symptoms of sarcoidosis
Dry cough
Dyspnoea
Reduced exercise tolerance
ECG pattern seen in pulmonary embolism
Sinus tachycardia with right ventricular strain
Initial management for pulmonary embolism in haemodynamically unstable
Thrombolysis
Initial management for pulmonary embolism in haemodynamically stable
Low molecular weight heparin
Followed by warfarin
What does recurrent chest infections, sinusitis and pancreatic insufficiency ie type 1 diabetes suggest
Cystic fibrosis
Diagnostic test for cystic fibrosis
Heel prick in newborn
Sweat test in older patients
Triad of symptoms for wernicke’s encephalopathy
Ataxia
Confusion
Opthalmoplegia
Treatment of wernicke’s encephalopathy
High dose intravenous thiamine (Pabrinex IV)
What causes horners syndrome
Interruption of the sympathetic nerve supply to the eye
Causes of horners syndrome
Pancoast tumour
Stroke
Carotid artery dissection (neck pain)
Treatment for at least a 70% carotid stenosis in TIA
Carotid endarectomy
What causes vasovagal syncope
Prolonged standing
Heat
Emotion
Presentation of vasovagal syncope
Patient loses consciousness and regains it back very quickly
What to do if patient has a head injury with signs of intercranial major bleed and is on warfarin
Stop warfarin
Start IV vitamin K
Give prothrombin complex concentrate
Surgical intervention for subarachnoid haemorrhage
Endovascular coiling
Treatment for cluster headaches
High flow oxygen
What do you see on western blot in lumbar puncture for multiple sclerosis
Distinct bands of IgG (oligoclonal bands)
Where is the lesion that causes superior homonymous quadrantopia
Temporal lobe
As well as common peroneal palsy what else can cause foot drop
L5 radiculopathy
Difference between common peroneal palsy and L5 radiculopathy
L5 radiculopathy shows weakness in inversion whilst peroneal causes weakness in eversion
What does a lesion in the posterior cerebral artery cause
Homonymous hemianopia with macular sparing
In guillain barré syndrome what investigation let’s the doctor know intubation can be done
Bedside spirometry
Most useful diagnostic test for encephalitis
CSF viral PCR
Most commonly will show HSV (herpes simplex virus)
Treatment for status ellipticus (seizure for more than 5 minutes)
IV lorazepam
What prompts a CT head within 1 hour (head related)
Greater than 1 episode of vomiting
Examples of anticoagulants
Warfarin
Apixaban
LMWH
Examples of antiplatelet drugs
Aspirin
Clopidogrel
How can amaurosis fugax be described
Dark curtain falling over eye
What not to do on long term oxygen support
Smoke as it is a fire hazards
1st line investigation for mesothelioma
CXR then CT
Gold standard investigation for mesothelioma
Biopsy
What direction are CT scans done
Feet up
So left is actually right
What conditions are associated with small cell lung cancer
SIADH
Lambert Eaton
Cushings
What non small cell lung cancer affects smokers
Squamous cell carcinoma
What condition is associated with non small cell lung cancer
HyperCalcaemia of malignancy due to PTH secretion
Main bronchial carcinomas
NSCC
SCC
Adenocarcinoma
Main risk factor for Adenocarcinoma
Asbestos exposure
What can a pancoast tumour cause
Horners syndrome
Hoarse voice-compression of recurrent laryngeal nerve
Pembertons sign- flushing of face when hands above head
Diagnostic test for pulmonary hypertension
Right heart catheter
What is cor plumonale
Right atrial dilation
Right ventricular hypertrophy
Treatment for pulmonary hypertension
Sildenafil(viagra)
If you see haemoptysis and haematuria what condition does this indicate
Goodpastures disease
As it causes pulmonary and renal pathology
Diagnostic test for Goodpastures
Serology-anti GBM
What does TB show on biopsy
Caseating granuloma
1st line investigation for pleural effusion
CXR-blunting of costophrenic angles
Main symptoms of pneumothorax
One sided sharp/sudden pleuritic chest pain
Shortness of breath
What does a ground glass appearance of lungs indicate on high resolution ct
Idiopthaic pulmonary fibrosis
What type of cough do type 1 respiratory failure (restrictive) diseases generally have
Dry cough
What type of cough do type 2 respiratory failure (obstructive) diseases generally have
Wet/productive cough
Treatment of idiopathic pulmonary fibrosis
Pirfenidone and nintedanib
What lung cancer is associated with paraneoplastic syndromes
Small cell lung cancer
Immune thrombocytopenia treatment
Prednisolone
What two neurological conditions present with a chronic headache that is worse with coughing, straining on the toilet and bending down
Idiopathic intracranial hypertension
Brain tumour
Symptoms of wernicke’s encephalopathy
Nystagmus/opthalmoplegia
Confusion
Ataxia
What can cause wernicke’s encephalopathy (vitamin b1 deficiency)
Alcohol abuse
Pathophysiology of lambert Eaton syndrome
Autoantibodies against presynaptic voltage gated calcium channels
What is an atonic seizure
When a person loses control of their muscles and they just drop
What is the first step in managing a stroke
CT to differentiate between hameorragic and ischaemic stroke
Typical presentation of extradural haematoma
Loss of consciousness then a quick regain of consciousness
Where is the lesion that causes inferior quadrantopia
Parietal lobe
PITS:parietal inferior, temporal superior
First line agents for terminating seizures
Benzodiazepines E.g IV lorazepam
Acronym for cerebellar dysfunction
DANISH
Signs/symptoms of polycythamia rubra Vera
Itching after hot baths
Leg swelling
Splenomegaly (left upper quadrant mass)
Facial redness/plethora
Diagnostic test for polycythaemia rubra vera
JAK2 mutation screen
Management for fluid overload in transfusion
Stop transfusion and give 40mg IV furosemide
What does ring sideroblastic indicate
Myelodysplasia-which can develop into AML
What type of anaemia are non megaloblastic and megaloblastic
Macrocytic
Features of anaemia
Palpitations
Pallor
Breathlessness
What condition does Cabot rings indicate
Pernicious anaemia
Test for pernicious anaemia
Methylmalonic acid and anti intrinsic factor antibody
What do Howell jolly bodies indicate
Hyposplenism
What can fava beans trigger
Acute haemolytic anaemia in those with G6PD deficiency
Inheritance pattern of G6PD
X-linked
Diagnostic investigation for haemophilia A
Factor VIII assay
Management of haemophilia A
Minor bleed: desmopressin
Major bleed: factor VIII
Diagnostic investigation for myeloma
Serum protein electrophoresis
Treatment for beta thalassaemia major
Fortnightly blood transfusions
Common signs of chronic myeloid leukaemia
Massive Splenomegaly
Bleeding
Gout
What to do if someone with iron deficiency anaemia has no obvious source of bleeding
Refer for urgent gastroscopy and colonoscopy as this indicates potential GI cancer
In what anaemia is lactic dehydrogenase raised
Haemolytic anaemia
What are schistocytes
Fragmented red blood cells
What are schistocytes found in
Haemolytic anaemia
Common finding on bloods following surgery E.g appendicectomy
Neutrophilia
What neurological condition can DIC occur secondary too
Meningococcal sepsis
Coagulation profile of DIC
Decreased fibrinogen
Decreased platelets
Elevated D-dimer
What anaemia can cause neurological symptoms E.g paraesthesia-tingling/pins and needles , weakness and acute degeneration of cord
B12 deficiency- Pernicious anaemia
Foods that provide vitamin B12
Meat and dairy
Complications of polycaethemia rubra Vera
Arterial and venous thrombosis/thromboembolism
What does a lymph node biopsy show in lymphoma
Reed sternberg cells
Example of LMWH
Dalteparin
What is a hallmark sign of parvovirus B19
Reticulocytopenia
What 2 antibiotics used together can cause bone marrow suppression
Trimethoprim + methotrexate
1st line investigation for giant cell arteritis
ESR
Example of nephrotoxic drug
NSAIDs E.g naproxen
Cause vasoconstriction of afferent renal arterioles
Antibodies associated with systemic sclerosis
Anti-centromere
Scl-70 (anti-topoisomerase 1)
Anti-RNA polymerase III
First line treatment for polymyalgia rheumatica
Oral prednisolone
What are the anti phospholipid antibodies
Lupus anticoagulant
Anticardiolipin antibody
AntiB2-glycoprotein I antibody
What is raised in polymyositis and dermatomyositis
Creatine kinase
Lactate dehydrogenase
Aldolase
ALT
AST
Treatment for polymyositis and dermatomyositis
Corticosteroids (prednisolone)
First line investigation for polymyositis and dermatomyositis
Muscle biopsy/muscle derived serum elevation
What do you see on chest x ray in wegeners granulomatosis
Bilateral nodular and cavitating infiltrates
What 3 systems does wegeners granulomatosis affect
Upper respiratory tract
Lower respiratory tract
Renal- proteinuria/frothy urine
In systemic sclerosis what system should be monitored
Renal as it can cause a renal crisis
What condition has to be screened for before starting biologics E.g infliximab
TB
Diagnostic test for giant cell arteritis
Temporal artery biopsy
1st line treatment for all spondyloarthropathies
NSAID
DMARD E.g methotrexate
What pulmonary complication is associated with antiphospholipid syndrome
Pulmonary embolism
X-ray features of osteoarthritis
LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral/subarticular sclerosis
First line management of osteoarthritis
NSAIDs
What DMARD can cause pneumonitis
Methotrexate
If you see painful, red , hot and swollen singular joint E.g metatarsophalangeal/metacarpophalangeal what condition does this indicate
Gout
What drug should be avoided in antiphospholipid syndrome
Combined oral contraceptive pill
Where is pseudogout most common
In the knee
Presentation of diffuse systemic sclerosis
CREST symptoms same as limited sclerosis
But also GI and resp involvement
ECG presentation in wegeners
Widespread ST elevation due to myocarditis
What respiratory failure does polymyositis cause
Type 2 respiratory failure
Low oxygen, high CO2
Main side effect of oral bisphosphonates E.g alendronic acid
Oesophagitis
Ulcers
Strictures
Presents as dysphasia or dyspepsia
If NSAID can’t be given to a patient with Crystal arthropathy what is given
Colchicine
Reason for not being able to give NSAIDs in Crystal arthropathy
Chronic kidney disease which can worsen
Side effects of colchicine
Diarrhoea
Nausea
Vomiting
Gold standard investigation for ulcerative colitis
Colonoscopy with biopsy
MRCP (magnetic resonance cholangio pancreatography)
Test for coeliac disease
Total IgA and IgA tissue transglutaminase (tTG)
What sign is associated with pancreatic cancer
Courvoisiers sign
Management of gastroparesis
Metoclopramide
Pathophysiology of giardiasis
Degeneration of ganglion cells in myenteric plexus
Typical presentation of pharyngeal pouch
Dysphagia
Regurgitation
Halitosis (bad breath)
What can a perforated duodenal ulcer show on chest x ray
Free air under the diaphragm
Treatment for a flare up of Ulcerative colitis
Admit and start high dose IV steroids (hydrocortisone)
Treatment for confirmed peptic ulcer disease that is H.Pylori negative
Full dose PPI for 4-8 weeks
What liver condition is ulcerative colitis associated with
Primary sclerosing cholangitis (post hepatic)
What type of drug is ondansetron
5HT antagonist
What is ondansetron used for
Nausea and vomiting
What drug is given in a variceal bleed
Terlipressin which causes vasoconstriction of dilated blood vessels
Specific blood test for primary biliary cholangitis
Antimitochondrial antibodies
What does mucosal inflammation with yellow plaques suggest
C.dificile
What criteria assesses the severity of pancreatitis
Modified Glasgow criteria
What is alpha fetoprotein a marker of
Hepatocelluar cancer
Progression from hepatitis B
Treatment for hepatic encephalopathy
Lactulose (laxative)
What is red beefy tongue (glossitis) and angular stomata’s found in
Pernicious anaemia
Diagnostic investigation for hiatus hernia
Barium swallow x-ray
What condition is a complication of coeliac disease
Small bowel lymphoma and Adenocarcinoma
Ascites first line treatment
Spironolactone + fluid/salt restriction
Diagnostic test of pancreatitis
Serum Amylase
What is found on biopsy of ulcerative colitis
Crypt abscesses
Loss of goblet cells
What does bird beak on barium swallow indicate
Achalasia
If a patient is septic with renal colic what is the management
Nephrostomy
How does renal cell carcinoma cause leg swelling
By causing inferior vena cava occlusion
Can renal cancer cause variocele
Yes
Diagnosis of prostatitis
DRE: tender warm swollen prostate
MSU
STI Screening
Most common bladder cancer uk
Transitional cell carcinoma of bladder
Most common bladder cancer from schistosomiasis
Squamous cell carcinoma of bladder
What is hydrocele
Accumulation of fluid within the tunica vaginalis
What is variocele
Varicosity of pampiniform plexus
What is the most common renal cell cancer
Renal clear cell cancer
Treatment for hydrocele
Nothing for 12 months as it will resolve spontaneously
First line in testicular cancer
Scrotal USS
First line pain relief in renal colic
Diclofenac
What forms staghorn calculi
Struvite
What do anaesthetics do to the detrusor muscle
Decrease detrusor contraction so less micturition
Treatment for kidney stones if too big
ESWL (extracorporeal shock wave lithotripsy)
PCNL( percutaneous nephrolithotomy)
Gold standard investigation for all UTIs
MSU MCS(microscopy, culture and sensitivity)
What type of urine does protein cause
Frothy urine
If PCI cannot be done in frost 2 hours of stemi what should be done
Fibrinolysis with IV tenecteplase
First line in heart failure
NT-proBNP levels
What is a bounding pulse a sign of
Hypercapnia
Septic shock
Most common cause of secondary hypoadrenalism
Long term corticosteroid use
Causes of SIADH
Alcohol withdrawal
Head injury
Pneumonia
Small cell lung cancer
What electrolyte disturbance can cause wrist flexing
Hypocalcaemia
UC treatment
Mild:mesalazine
Moderate: prednisolone
Severe:IV hydrocortisone
Gold standard for Wilson’s
Liver biopsy
If someone has been to spain what condition and bacteria
Legionnaires disease
Legionella pneumophila
Inheritance of von willebrand
Autosomal dominant
Low vitamin D and high ALP indicates what condition
Osteomalacia
What collagen isn’t made properly in ehler danlos syndrome
Type 2 Collagen
What is marfan syndrome related to
Fibrillin 1
Why is levodopa given in parkinsons and not dopamine
Because levodopa can cross the blood brain barrier
What does a jerky pulse indicate
Hypertrophic cardiomyopathy
Indication for surgical repair in an infective endocarditis patient
Prolonged PR interval on ECG with evidence of aortic valve involvement on echocardiogram
X day changes in COPD
Barrel chest
Flattened hemidiaphragm
Hyperkalaemia acronym
Go
Go absent p waves
Go long pr prolongation
Go tall tall tented t waves
Go wide wide qrs
Symptoms of hyperosmolar hyperglycaemic state
Severe hyperglycaemia
Hypotension
Hyperosmolality
Treatment for hyperosmolar hyperglycaemic state
Fluid replacement with 0.9% saline
Give insulin
Prophylaxis-Low molecular weight heparin
Causes of aortic dissection
Marfans
Ehler danlos syndrome
Cocaine use
Smoking
What is given alongside TB drugs
Pyridoxine(vitamin B6)
What conditions does normocytic anaemia indicate
Chronic kidney disease (if you see hyperkalaemia)
Chronic disease
If a person has a particular pain in bellybutton/periumbilical region what sign is this
Cullens sign
Differential for coeliac
Topical sprue
Most severe complication of UC
Toxic megacolon
What is murphys sign
When there is pain on deep inspiration when palpating right subcostal area
What condition does murphys sign indicate
Acute cholecystitis
Wilson’s disease symptoms
Parksonian symptoms
Hepatitis
Young age
How long after testicular torsion does surgery need to happen
6 hours
What cancer is Von Hippel lindau linked with
Renal cell carcinoma
If you see urine dipstick with positive leukocytes and nitrates what condition
UTI
Minimal change treatment
PO Prednisolone
Child associated renal cancer
Wilms tumour
What is membranous nephropathy
A type of nephrotic syndrome
What is seen in polymyositis
Positive ANA antibodies
Elevated creatine kinase
Where do pancoast tumours usually arise
Left lung apex
Treatments for kidney conditions
Treat cause
GIVE FLUIDS
Stop nephrotoxic drugs
Triad for glomerulonephritis/nephritic syndrome
Haematuria
Oliguria-reduced urine output
Fluid retention=hypertension
How to know if it is IGA nephropathy
Young
Quick onset of symptoms
Painless Haematuria
How to know if post strep glomerulonephritis
Older
2 weeks ago and then symptoms come on later
Haematuria
Reduced urine output
Triad for nephrotic syndrome
Proteinuria
Peripheral oedema
Low serum albumin
Nephrotic syndrome in adult
Focal segmental glomerulonephritis
Nephrotic syndrome in children
Minimal change
Extra dural haemorrhage shape
Biconvex
Egg
Sub dural haemorrhage shape
Crescent
Subarachnoid haemorrhage shape
Star
Extra articular manifestations of ankylosing spondylitis
Anterior uveitis
Autoimmun bowel disease
Amyloidosis
Extra articular manifestations of ankylosing spondylitis
Anterior uveitis
Autoimmune bowel disease
Amyloidosis
Extra articular manifestations of ankylosing spondylitis
Anterior uveitis
Autoimmune bowel disease
Amyloidosis
Key factors of schober bedside test
Locate L5 vertebrae and mark
Ask patient to bend as far as they can
Distance of less than 20 cm indicates ankylosing spondylitis
X ray findings of ankylosing spondylitis
Bamboo spine
Syndesmophytes
Fusion of joints
Ossification
Treatment for all spondyloarthropathies
NSAIDs
Steroids in flares
Types of asthma exacerbation
PEFR
Moderate- 50-75%
Acute severe- 33-50%
Life-threatening- less than 33%
Indicators of good asthma control
• 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
What are the symptoms that precede a migraine called
Aura
Mechanism of adrenaline
Stimulation/ agonist of beta adrenergic receptors
Physiological response to mediators of anaphylaxis
Vasodilation
Hypotension
Increased vascular permeability
Tachycardia
Risk factors for Crohn’s disease
Family history
Smoking
Caucasian/jewish
HLA-B27
NSAIDs
Non malignant causes of lymphadenopathy
Infection
Sarcoidosis
EBV
Symptoms in cll
Lymphadenopathy
Weight loss
Anaemia
Fatigue
Infections
Bleeding
Findings in FBC of CLL
Anaemia
Lymphocytosis
Treatments for CLL
Chemotherapy
Radiotherapy
Slenomectomy
What can CLL become
Non Hodgkin’s lymphoma
Richter transformation
Signs/symptoms of cushings
Mood change
Acne
Osteoporosis
Moon face
Thinking of skin
Abdominal striae
Central obesity
Oligomenorrhoea
Non pharmacological managements for OA
Patient education
Physiotherapy
Occupational therapy
Weight loss
Improved diet
Topical and oral management of OA
Topical- NSAIDS
Oral- NSAIDS, paracetamol
What is in the ABCD2 score
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
Risk factors for TB
IVDU
homeless
Immunosuppression
Alcoholic
Close contact with infected patients
What is seen on CXR in TB
Bilateral hilar lymphadenopathy
Ghon focus
Parkinsons plus symptoms
Lewy body dementia
Multiple symptom atrophy
Signs of meningitis and SAH
Kernig sign
Brudzinski’s sign
Most common infectious cause of pericarditis
Coxsackie 19 virus
What are most causes of pericarditis
Idiopathic
DANISH cerebellar symptoms
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Speech-slurred
Hypotonia
Nerve roots for carpal tunnel syndrome
C5-T1
10 year risk of having osteoporotic fracture
FRAX score
When is a uti complicated
A man
Pregnant lady
Child
Someone immunocompromised
Recurrent UTIs
Structural abnormality
Complications of long term steroid therapy
Diabetes
Immunosuppression
Osteoporosis
Proximal muscle weakness
Thinned skin
Can antibiotics increase INR
Yes by inhibiting warfarins metabolism
What does tram tracks on x ray mean
Bronchiectasis
What diabetic drug increases glucose excretion
Dapagliflozin
Mechanism of atorvastatin
HMG-CoA reductase inhibitors
Function of calcium gluconate
Stabilisation of cardiomyocyte membrane potentials
What White cells are phagocytic
Eosinophils
Dendritic cells
Neutrophils
Macrophages
What antibody is specific to dermatomyositis
Anti Mi 2
What is raised in hepatocellular carcinoma
Alpha-fetoprotein
Small bowel obstruction management
Nil by mouth,IV fluids and NG tube aspiration
What is the Philadelphia chromosome fusion gene
BCR-ABL
What is anti jo1 specific to
Polymyositis
What drug minimises the risk of tumour lysis syndrome
Allopurinol
What is a preserved ejection fraction
50-75%
What is a preserved ejection fraction
50-75%
What is a preserved ejection fraction
50-75%
What LUTS symptoms are irritating
Storage symptoms
Function of b-lactam antibiotics
Inhibit transpeptidation reactions needed to cross link peptidoglycans in the cell wall
What chromosome is affected in haemochromatosis
Chromosome 6
What bowel obstruction does constipation then vomiting indicate
Large bowel
What bowel obstruction does vomiting then constipation indicate
Small bowel
What medication blocks re absorption of glucose in the kidney
SGL2 inhibitors
What is positive predictive value
Proportion of positive results that are true positive
Most common primary bone tumour in children and young adults
Osteosarcoma
Most significant risk factor for aortic dissection
Hypertension
Most common cause of cushings syndrome
Long term high dose glucocorticoid use
1st line investigation in upper GI ulcers
Urea breath test
Protocol for taking blood cultures in infective endocarditis
3 cultures
3 different sites
Different times
Another name for bacterial meningitis
Meningococcal septicaemia
Benzodiazepine used to manage effects of alcohol withdrawal
Chlordiazepoxide
Delirium tremens
Medical emergency from alcohol withdrawal
Presentation of delirium tremens
Confusion
Ataxia
Delusions and hallucinations
Tremor
Tachycardia
What can myeloid dysplasia cause
AML
What malignancy can sjogrens cause
Lymphoma
What malignancy can sjogrens cause
Lymphoma
What malignancy can sjogrens cause
Lymphoma
Marker for Addisons
Anti 21 hydroxylase
TLR for viral double stranded DNA
TLR 3
What does painless jaundice indicate
Pancreatic cancer
Courvoisier sign
What is courvoisier sign
Palpable enlarged gallbladder and painless jaundice
