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Passmed finals > Quesmed 4 > Flashcards

Quesmed 4 Flashcards

1
Q

Features of optic neuritis

A

Loss of colour vision
Painful eye
Loss of area of vision
RAPD (relative afferent pupillary defect) i.e. pupil dilates when it should contract when light is shone into it

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2
Q

Management of optic neuritis

A

Largely supportive but can take steroids (what drugs might you want to give alongside steroids?)

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3
Q

Which heart defect is most commonly associated with Turner’s?

A

Bicuspid aortic valve

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4
Q

Surgery for BCC?

A

Mohs micrographic surgery

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5
Q

Features of Fragile X syndrome

A 
Large testicles 
Large jaw 
Learning difficulties 
Echolalia
Social anxiety
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6
Q

First-line Mx of carpal tunnel?

A

Nightly wrist splint

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7
Q

Features of anterior uveitis

A 
Irregular pupil 
Red-eye
Painful
Blurred vision
Photophobia 
Associated with HLA-B27
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8
Q

Patient with headache, photophobia, nausea and vomiting, and a red watery right eye

He reports that these symptoms started 3 hours ago

On examination of his right eye he has a fixed, mid-dilated pupil with a cloudy cornea. His visual acuity is counting fingers in his right eye. Intraocular pressure is 58 mmHg (normal range 11 - 21 mmHg) in his right eye. Intraocular pressure in his left eye is 14 mmHg.

What is the definitive treatment for this condition?

A

BILATERAL iridotomy

Both eyes are at risk so you treat both

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9
Q

Congenital disorder associated with learning difficulties, duodenal atresia and atrioseptal defect?

A

Trisomy 21

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10
Q

Most common genetic cause of trisomy 21

A

Meiotic non-dysjunction

Leads to too much genetic material

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11
Q

4 features of tetralogy of Fallot

A

Pulmonary stenosis
Overriding aorta
Ventricular septal defect
Right ventricle hypertrophy

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12
Q

Which aspect of tetralogy of Fallot determines the level of cyanosis?

A

Pulmonary stenosis

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13
Q

Management of a simple clavicle fracture, non-displaced

A

Sling for 2 weeks then physiotherapy

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14
Q

Features of vestibular neuritis

A

Often follows URTI

Short history of vertigo with no hearing loss

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15
Q

Features of labyrinthitis

A

Often follows URTI

Short history of vertigo WITH hearing loss and tinnitus

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16
Q

Mx of anti-phospholopid syndrome

A

Low dose aspirin

If this fails (repeated DVTs and PEs), you can add warfarin

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17
Q

The definitive diagnosis of biliary atresia

A

Cholangiography (it will fail to show the biliary tree because its all blocked)

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18
Q

Treatment of duodenal atresia

A

Kasai procedure

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19
Q

What is Todd’s palsy?

A

A weakness of the area after a seizure

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20
Q

How do focal seizures of the frontal lobe typically present?

A 
Todd's palsy 
JACKSONIAN MARCH (from legs, up abdo into arm)
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21
Q

Features of temporal lobe epilepsy

A

Lip smacking
Deja vu
Sudden terror

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22
Q

Features of atonic seizures

A

Sudden loss of muscle tone, causing the patient to fall, whilst retaining consciousness

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23
Q

Features of myoclonic seizures

A

Sudden jerk of a limb, trunk, or face

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24
Q

Features of juvenile arthritis

A 
Bilateral pain 
Anterior uveitis
Salmon pink rash 
Anorexia
Weight loss
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25
Q

Diabetes induced by steroids, what do you do?

A

Lifestyle changes ASWELL as starting a sulphonyurea

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26
Q

Management of bronchiolitis

A

Supportive care
Oxygen therapy which may escalate to mechanical ventilation
Corticosteroid therapy (PO prednisolone)
Ribavirin

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27
Q

When might you admit a child with bronchiolitis?

A

Respiratory distress
Low O2 sats (<92%)
Central cyanosis
Appearing very unwell

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28
Q

1st line Mx of hyperesmesis gravidarum

A

Thiamine supplements to prevent Wernickes encephalopathy

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29
Q

Mx of hyperesmesis gravidarum

A

Thiamine supplements
IV fluid
Anti-emetics (e.g. cyclizine)

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30
Q

Diagnosis of BPPV

A

Hallpike manoeuvre

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31
Q

Treatment of BPPV

A

Epley manoeuvre

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32
Q

Patient with blurred vision, the appearance of a cataract on examination and systemic weight loss and weakness, what underlying systemic condition do they have?

A

Myotonic dystrophy

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33
Q

Antibody in CREST syndrome

A

Anti-centromere

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34
Q

Antibody in systemic sclerosis

A

Anti-Scl 70

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35
Q

Management of positive test for MRSA pre-surgery

A

Chlorhexidine wash and intranasal mupirocin

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36
Q

What does tissue factor pathway inhibitor do?

A

Forms a quaternary structure with the tissue factor which is inactive and stops it activating the clotting cascade

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37
Q

What type of fracture cannot be caused by a mechanical fall?

A

Spiral fracture

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38
Q

Non-emergency management of hyperkalaemia (<6mmol)

A

Calcium resonate

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39
Q

Features of a ventricular septal defect

A

SOB
Palpable thrill
Pansystolic murmur along the left sternal border

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40
Q

What type of murmur is a ‘blowing murmur’ in SBAs?

A

Innocent murmur

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41
Q

What are the 2 sections of the first stage of labour?

A

Stage 1 latent = 0-3cm

Stage 2 active = 3-10cm

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42
Q

Features of GORD in a young infant

A

Milky vomits but still feeding well

Crying and arching their back when laid flat

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43
Q

Management of GORD in infants

A

Burp them after feeds and keep them upright
Gaviscon

Surgical option = fundoplication

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44
Q

What drug can you give pre C-section at term?

A

Omeprazole

Reduces risk of aspiration and GORD in the surgery

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45
Q

1st line analgesia for renal colic

A

IM diclofenac or PR I believe

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46
Q

Mx of recurrent VT e.g. after MI

A

Implantable defibrillator

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47
Q

A 20-year-old contact lens wearer presents to eye casualty with severe eye pain around her right eye and decreased visual acuity.

She describes the pain as 10/10 in severity and complains of a sensation of a foreign body being stuck in her eye.

Examination of the right eye is difficult due to photophobia but there is significant tearing and discharge. There is no history of eye trauma but she recently swam in a lake whilst wearing her lenses.

Which of the following is the most likely cause of this patient’s presentation?

A

Acanthamoeba keratitis

Vision threatening

Pain out of proportion to presentation

Seen in contact lense wearers who’ve gone swimming

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48
Q

Best treatment for essential tremor

A

Propranolol

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49
Q

Patient with LIF pain and positive pregnancy test but TVUSS can’t find a foetus, what is this called?

A

Pregnancy of unknown origin

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50
Q

Management of pregnancy of unknown origin

A

Serial B-HCG levels

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51
Q

Gold standard Ix for achalasia

A

Manometry

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52
Q

Causes of galactorrhoea

A

SSRI and anti-psychotics, opiates and cocaine, stress, alcohol, pituitary tumours and other metabolic conditions such as hypothyroidism, liver disease and chronic renal impairment

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53
Q

Which antibiotic can trigger acute intermittent porphyria?

A

Trimethoprim

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54
Q

Management of acute attack of porphyria

A 
Stopping triggers
Treating symptoms
IV electrolyte replacement
Heart rate control with beta blockers
Antiemetics
Analgesia (avoiding oxycodone)
Reducing 5-aminolevulinic acid synthase 1 activity
Carbohydrate loading
IV Haematin
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55
Q

Features of an interventricular septum rupture (LAD STEMI most at risk)

A

Haemodynamic instability, with hypotension and biventricular failure
Harsh, holosystolic murmur

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56
Q

Pathophysiology and features of autoimmune encephalitis

A 
Personality change 
Memory issues 
Follows viral illness 
Confusion
Seizures

Leads to demyelination in the brain

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57
Q

Management of appendicitis thats settled

A

Fluids
Antibiotics
Book for elective surgery in a few weeks time

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58
Q

Pathophysiology and features of autoimmune encephalitis

A 
Personality change 
Memory issues 
Follows viral illness 
Confusion
Seizures

Leads to demyelination in the brain

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59
Q

Management of appendicitis thats settled

A

Fluids
Antibiotics
Book for elective surgery in a few weeks time

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60
Q

What is a thickened pancreas a sign of?

A

Recurrent autoimmune pancreatitis

IgG4 disease

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61
Q

Types of gallstone and RF for each

A

Pigment (<10%) Associated with haemolysis, stasis and infection.
Cholesterol (90%) Associated with female sex, increasing age and obesity.
Mixed

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62
Q

Ix for ?pyelonephritis

A

Urine MC&S

Urine dip

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63
Q

Mx of pyelonephritis

A

IV antibiotics and fluids

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64
Q

Sx of pyelonephritis

A 
Abdominal pain
Fever
UTI symptoms 
Unwell  
Blood in urine
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65
Q

Which TB drug causes hepatotoxicity (jaundice and abdominal pain)

A

Pyrazinamide

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66
Q

What might suggest a Dx of MSA rather than Parkinson’s disease?

A

Postural hypotension

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67
Q

Features of autoimmune hepatitis

A

Abdominal pain
Hepatomegaly
Jaundice
Raised ALT/AST/GGT

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68
Q

Features of Bell’s palsy

A

Non-forehead sparing facial weakness

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69
Q

Ix and Mx for Bells palsy

A

Otoscopy to check for Ramsey Hunt syndrome

Prednisolone

70
Q

Mx of Paget’s disease

A

Analgesia
Pamidronate
Yearly ALP measurements

71
Q

1st line Mx of prostatitis

A

Oral ciprofloxacin

72
Q

Features of prostatitis

A

Urgency
Pain in perianal region
Boggy prostate

73
Q

What is melanosis coli?

A

Discolouration of the bowel

Often as a result of laxative abuse (anorexia etc.)

74
Q

Easily ruptured blisters =>

A

Pemphigus vulgaris

75
Q

Easily ruptured blisters on the back of the hands with hypertrichosis =>

A

Porphyria cutanea tarda
Hypertrichosis = very hairy
Photosensitivity hence on the back of the hands

76
Q

Oral contraceptive you can start after giving birth

A

Progesterone only pill

77
Q

How long does it take for the POP to kick in?

78
Q

Features associated with psoriatic arthritis

A

Subungal keratosis (thickening of the skin under the nails)
Silvery plaques
Painful joints
Increased risk of CVD

79
Q

HLA associated with T1DM

80
Q

Common electrolyte abnormality in bronchiolitis and how might it present?

A

Hyponatraemia

Seizure

81
Q

What do they look at in the Gleason score?

82
Q

What do you do if you are transfusing blood and the patient becomes febrile but alright otherwise?

A

Slow down the transfusion

83
Q

Young patient, resting tremor, ataxic and dysarthric (difficult speech), first degree heart block, most likely Dx?

A

Wilson’s disease

84
Q

An 82-year-old gentleman presents to eye casualty. Since this morning, he has experienced flashes of light in his peripheral vision, accompanied by floaters. On examination, his visual fields are intact and visual acuity is 6/9 bilaterally.

What is the most likely diagnosis?

A

Posterior vitreous detachment

Basically with age, the vitreous can be displaced and lead to peripheral changes

DDx = retinal detachment but this will alter the visual fields!

No treatment for posterior vitreous detachment and is a normal part of aging

85
Q

What is raised in Gilbert’s disease?

A

Unconjugated hyperbilirubinaemia

86
Q

Pathology of tertiary hyperparathyroidism

A

Actually makes a new PTH nodule due to chronic low Ca in CKD

87
Q

Which type of lung cancer secretes PTHrP?

A

Squamous cell carcinoma
Often central -> wheeze
Bone pain and hypercalcemia

88
Q

Most common side effect of salbutamol

A

Tachycardia

89
Q

1st line anti-hypertensive drug for T2DM <80yo

90
Q

What is Cushing’s triad for raised ICP?

A

Bradycardia
Hypertension
Irregular breathing

91
Q

Features of Addison’s disease

A

Postural hypotension
Abdominal pain
Weight loss
Fatigue and malaise

92
Q

Mx of hyperkalaemia

A

ECG
10ml of 10% Calcium gluconate
10U actrapid in 100ml of 20% glucose
Nebulised salbutamol in the interim if necessary

93
Q

Cause of pigment loss internally (in mouth for example)

94
Q

Acute onset PCOS Sx =>

A

Androgen secreting tumour

95
Q

Low testosterone with low LH/FSH =>

A

Hypogonadotrophic hypogonadism

96
Q

Causes of loss of red reflex in eye

A

Retinoblastoma
Congenital cataract
Coats disease (leakage into the back of the eye)

97
Q

How might tumour lysis syndrome present?

A

Recent chemotherapy

Abdominal pain
Weakness
Feeling unwell
Reduced urine output

98
Q

Key Ix in tumour lysis syndrome?

A

ECG because potential hyperkalaemia

99
Q

Features of eosinophilic granulomatosis with polyangiitis

A

Adult-onset asthma

Bilateral nasal polyps

100
Q

Definitive Mx of WPW

A

Catheter ablation of the accessory pathway

101
Q

Heriditary blindness presenting as loss of peripheral vision Dx and findings on fundoscopy

A

Retinitis pigmentosa

May see peripheral pigment deposits on fundoscopy

102
Q

What drop in DAS score to determine if the response was moderate?

103
Q

Treatment for trichomonas

A

Metronidazole

104
Q

Treatment of eczema herpeticum

A

IV aciclovir

105
Q

What is ophthalmia neonatorum?

A

Neonatal conjunctivitis

Often result of STI from mother

106
Q

What is chemosis?

A

Swelling of eyelids

107
Q

What derangement of electrolytes can thiazide diuretics cause?

A

Hypokalaemia

108
Q

Causes of hyperkalaemia

A 
DREAD
Drugs 
Renal failure and rhabdomyolysis 
Endocrine 
Addisons 
DKA
109
Q

Which antibiotic can prolong QT?

A

Clarithromycin

110
Q

Indications for dialysis

A

AEIOU = Acidosis, Electrolytes (hyperK+), Intoxication (Drug OD), Oedema, Uraemic symptoms (encephalopathy)

111
Q

Complications of Paget’s disease

A

Hearing loss
Pain
Deformity and fractures
Nerve compression

112
Q

Prophylaxis of variceal bleeds

A

Propranalol

113
Q

What is Kussmaul sign?

A

Paradoxical rise in JVP with inspiration

114
Q

Antibodies in AI hepatitis

115
Q

How might AI hepatitis present?

A 
Jaundice 
Fatigue
Hepatomegaly 
Raised ALT 
Raised ASMA
116
Q

Indications for TIPPS

A

Refractory ascites

Secondary prevention for oesophageal varices (if other methods have failed)

117
Q

2 sharp spikes before each QRS complex =>

A

Dual-chamber pacing

118
Q

Indications for pacemaker

A

Complete heart block
Bradycardia
Any arrhythmia that fails to respond to medical therapy

119
Q

Features of cerebellar stroke

A

Poor coordination
Difficulty following instructions
Homonymous hemianopia

120
Q

Herald patch is associated with

A

Pityriasis rosacea

121
Q

Most likely bone to fracture in a punch injury

A

5th metacarpal fracture

Boxer’s fracture

122
Q

Why does amiodarone bother the thyroid so much?

A

Its 37.5% iodine

123
Q

What should you do if you get hypothyroidism in amiodarone administration

A

Check levels of TSH and also thyroid antibodies to see if there’s a malignancy going on
Give levothyroxine

124
Q

Mx of young pt with symptomatic 1cm pneumothorax

A

Aspirate with 16G cannula

125
Q

Management of asymptomatic type 1 heart block

A

Nothing needed

126
Q

When should you refer a child with undescended testes?

127
Q

Mx of pt with COPD and atopic dermatitis not controlled with salbutamol alone

A

ICS and LABA because atopic dermatitis hints towards allergic picture!

128
Q

Fungal rash after gym, light colour of skin is…

A

Pityriasis versicolour

129
Q

Ix for ?latent TB (say someone in the house has been Dx with active TB)

A

Interferon Gamma release assay (IGRA)

130
Q

Features of an indirect inguinal hernia

A

When you cover the deep ring, they wont come back again (they go through the inguina ring whereas direct inguinal hernias go through the muscle wall so they come back again!

131
Q

TSH, T4 and T3 levels in subclinical hyperthyroidism

A

Low TSH

Normal T4 and T3

132
Q

Cause of continuous urine leak

A

Vesicovaginal fistula (often after traumatic childbirth)

133
Q

Mx of an anal fissure

A

Diet and hydration
Stool softeners
Topical GTN

134
Q

1st line Mx of migraine attack

A

Sumatriptan

135
Q

Prevention of migraines

A

Avoid triggers

Propranalol prophylaxis

136
Q

Contraindications for thrombolysis

A

Loads

But important = recent surgery, high INR, ongoing bleeding

137
Q

Treatment of an overdose of amitriptyline

A

Sodium bicarbonate

138
Q

Treatment of Kawasaki’s disease

A

Aspirin and IVIG

139
Q

Parkinson’s patient on long-term levo-dopa develops writhing spasms in the morning, what is this a result of?

A

Long term levo-dopa

Remember that Parkinsons causes tremors but not writhing movements, this is due to excess peripheral dopamine

140
Q

How long does measles stay infective for?

A

4 days before the rash starts and 4 days after

141
Q

Ix for ?bladder cancer

A 
CT urogram (rules out upper tract disease which you can't visualise with cystoscopy)
Flexible cystoscopy
142
Q

Range where you need to use Light’s criteria if transudative or exudative

143
Q

Worrying risk of carbimazole

A

Agranulocytosis

Look out for sore throat!

144
Q

Features of SCC of skin

A

Ulcerative often scaly

145
Q

What are symptoms of a missed miscarriage?

A

Closed Os
Maybe a little bleeding
USS shows a dead foetus still present in the uterus

146
Q

RF for Hodgkin’s lymphoma

147
Q

Acute management of a severe attack of MS

A

IV methylprednisolone

148
Q

Cut off CHADSVASC to consider anti-coag in a male vs female patient

A 
Male = 1
Female = 2
149
Q

Scoring system for UC severity

A

Truelove and Witts

150
Q

Mx of DKA

A

500ml bolus of NaCl until SBP >90
Then 1L of NaCl and move onto insulin (fluid first, its what kills you)
Fixed rate insulin pump, 0.1U/kg/hr
When glucose falls below 14, give a bit of dextrose to stop them going hypo

151
Q

Features of transient tachypnea of the newborn

A

Hyperinflated lungs
Fluid level in the lungs on x-ray
SOB
Respiratory depression

152
Q

Mx of transient tachypnoea of the newborn

A

Oxygen and supportive

Steroids to avoid this condition before birth

153
Q

Inheritance of G6PD

A

X-linked recessive

154
Q

Rhesus D negative woman, has a sensitising event (e.g car accident), now reduced foetal movements
Dx and what should have been done?

A

Haemolytic disease of the newborn

Should have given anti-D prophylaxis

155
Q

Haemochromatosis is a RF for what joint condition?

A

Pseudogout!

156
Q

How does pseudogout present

A

Red, hot swollen joint

Very tender

157
Q

Ix for pseudogout

A

Joint aspiration

Looking for rhomboid crystals positively bifringent

158
Q

Most accurate way to measure GFR

A

Inulin clearance

159
Q

Antibodies in AI hepatitis

160
Q

Antibodies in PBC

161
Q

Cut off to treat carotid stenosis

162
Q

Drowsy child, mild suprapubic tenderness, looks very unwell, parameters all normal but a bit of a fever, worry and Mx

A

Sepsis
Sepsis 6
Cephalaxin

163
Q

Stages of hypertensive retinopathy

A

Grade 1 = Silver wiring
Grade 2 = AV nipping
Grade 3 = Flame haemorrhages + cotton wool spots and hard exudates
Grade 4 = Papilloedema

164
Q

Which pneumonia causes hyponatraemia

A

Legionella

165
Q

Difference between placenta accreta and increta

A

Increta goes into the muscle (myometrium)

166
Q

Antibodies in myasthenia gravis

A

Against post-synaptic ACh

167
Q

What should you always do before starting donepezil or other ACh related drugs?

A

ECG
Looking for QTc prolongation, which, if present means you could kick them into Torsades de Pointes, so don’t use the drug!

168
Q

Psycho approach to managing dementia

A

Cognitive stimulation therapy

169
Q

Staghorn calculi most likely to be made from…

A

Struvite (magnesium)

170
Q

What is diabetic ketosis?

A

All the features of DKA but not acidotic

171
Q

Ongoing Ix for asthma attack

A

PEFR and continuous O2 saturations to ensure they are not deteriorating

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