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
2
Q
Management of optic neuritis
A
Largely supportive but can take steroids (what drugs might you want to give alongside steroids?)
3
Q
Which heart defect is most commonly associated with Turner’s?
A
Bicuspid aortic valve
4
Q
Surgery for BCC?
A
Mohs micrographic surgery
5
Q
Features of Fragile X syndrome
A
Large testicles Large jaw Learning difficulties Echolalia Social anxiety
6
Q
First-line Mx of carpal tunnel?
A
Nightly wrist splint
7
Q
Features of anterior uveitis
A
Irregular pupil Red-eye Painful Blurred vision Photophobia Associated with HLA-B27
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
9
Q
Congenital disorder associated with learning difficulties, duodenal atresia and atrioseptal defect?
A
Trisomy 21
10
Q
Most common genetic cause of trisomy 21
A
Meiotic non-dysjunction
Leads to too much genetic material
11
Q
4 features of tetralogy of Fallot
A
Pulmonary stenosis
Overriding aorta
Ventricular septal defect
Right ventricle hypertrophy
12
Q
Which aspect of tetralogy of Fallot determines the level of cyanosis?
A
Pulmonary stenosis
13
Q
Management of a simple clavicle fracture, non-displaced
A
Sling for 2 weeks then physiotherapy
14
Q
Features of vestibular neuritis
A
Often follows URTI
Short history of vertigo with no hearing loss
15
Q
Features of labyrinthitis
A
Often follows URTI
Short history of vertigo WITH hearing loss and tinnitus
16
Q
Mx of anti-phospholopid syndrome
A
Low dose aspirin
If this fails (repeated DVTs and PEs), you can add warfarin
17
Q
The definitive diagnosis of biliary atresia
A
Cholangiography (it will fail to show the biliary tree because its all blocked)
18
Q
Treatment of duodenal atresia
A
Kasai procedure
19
Q
What is Todd’s palsy?
A
A weakness of the area after a seizure
20
Q
How do focal seizures of the frontal lobe typically present?
A
Todd's palsy JACKSONIAN MARCH (from legs, up abdo into arm)
21
Q
Features of temporal lobe epilepsy
A
Lip smacking
Deja vu
Sudden terror
22
Q
Features of atonic seizures
A
Sudden loss of muscle tone, causing the patient to fall, whilst retaining consciousness
23
Q
Features of myoclonic seizures
A
Sudden jerk of a limb, trunk, or face
24
Q
Features of juvenile arthritis
A
Bilateral pain Anterior uveitis Salmon pink rash Anorexia Weight loss
25
Diabetes induced by steroids, what do you do?
Lifestyle changes ASWELL as starting a sulphonyurea
26
Management of bronchiolitis
Supportive care
Oxygen therapy which may escalate to mechanical ventilation
Corticosteroid therapy (PO prednisolone)
Ribavirin
27
When might you admit a child with bronchiolitis?
Respiratory distress
Low O2 sats (<92%)
Central cyanosis
Appearing very unwell
28
1st line Mx of hyperesmesis gravidarum
Thiamine supplements to prevent Wernickes encephalopathy
29
Mx of hyperesmesis gravidarum
Thiamine supplements
IV fluid
Anti-emetics (e.g. cyclizine)
30
Diagnosis of BPPV
Hallpike manoeuvre
31
Treatment of BPPV
Epley manoeuvre
32
Patient with blurred vision, the appearance of a cataract on examination and systemic weight loss and weakness, what underlying systemic condition do they have?
Myotonic dystrophy
33
Antibody in CREST syndrome
Anti-centromere
34
Antibody in systemic sclerosis
Anti-Scl 70
35
Management of positive test for MRSA pre-surgery
Chlorhexidine wash and intranasal mupirocin
36
What does tissue factor pathway inhibitor do?
Forms a quaternary structure with the tissue factor which is inactive and stops it activating the clotting cascade
37
What type of fracture cannot be caused by a mechanical fall?
Spiral fracture
38
Non-emergency management of hyperkalaemia (<6mmol)
Calcium resonate
39
Features of a ventricular septal defect
SOB
Palpable thrill
Pansystolic murmur along the left sternal border
40
What type of murmur is a 'blowing murmur' in SBAs?
Innocent murmur
41
What are the 2 sections of the first stage of labour?
Stage 1 latent = 0-3cm
| Stage 2 active = 3-10cm
42
Features of GORD in a young infant
Milky vomits but still feeding well
| Crying and arching their back when laid flat
43
Management of GORD in infants
Burp them after feeds and keep them upright
Gaviscon
Surgical option = fundoplication
44
What drug can you give pre C-section at term?
Omeprazole
| Reduces risk of aspiration and GORD in the surgery
45
1st line analgesia for renal colic
IM diclofenac or PR I believe
46
Mx of recurrent VT e.g. after MI
Implantable defibrillator
47
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?
Acanthamoeba keratitis
Vision threatening
Pain out of proportion to presentation
Seen in contact lense wearers who've gone swimming
48
Best treatment for essential tremor
Propranolol
49
Patient with LIF pain and positive pregnancy test but TVUSS can't find a foetus, what is this called?
Pregnancy of unknown origin
50
Management of pregnancy of unknown origin
Serial B-HCG levels
51
Gold standard Ix for achalasia
Manometry
52
Causes of galactorrhoea
SSRI and anti-psychotics, opiates and cocaine, stress, alcohol, pituitary tumours and other metabolic conditions such as hypothyroidism, liver disease and chronic renal impairment
53
Which antibiotic can trigger acute intermittent porphyria?
Trimethoprim
54
Management of acute attack of porphyria
```
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
```
55
Features of an interventricular septum rupture (LAD STEMI most at risk)
Haemodynamic instability, with hypotension and biventricular failure
Harsh, holosystolic murmur
56
Pathophysiology and features of autoimmune encephalitis
```
Personality change
Memory issues
Follows viral illness
Confusion
Seizures
```
Leads to demyelination in the brain
57
Management of appendicitis thats settled
Fluids
Antibiotics
Book for elective surgery in a few weeks time
58
Pathophysiology and features of autoimmune encephalitis
```
Personality change
Memory issues
Follows viral illness
Confusion
Seizures
```
Leads to demyelination in the brain
59
Management of appendicitis thats settled
Fluids
Antibiotics
Book for elective surgery in a few weeks time
60
What is a thickened pancreas a sign of?
Recurrent autoimmune pancreatitis
| IgG4 disease
61
Types of gallstone and RF for each
Pigment (<10%) Associated with haemolysis, stasis and infection.
Cholesterol (90%) Associated with female sex, increasing age and obesity.
Mixed
62
Ix for ?pyelonephritis
Urine MC&S
| Urine dip
63
Mx of pyelonephritis
IV antibiotics and fluids
64
Sx of pyelonephritis
```
Abdominal pain
Fever
UTI symptoms
Unwell
Blood in urine
```
65
Which TB drug causes hepatotoxicity (jaundice and abdominal pain)
Pyrazinamide
66
What might suggest a Dx of MSA rather than Parkinson's disease?
Postural hypotension
67
Features of autoimmune hepatitis
Abdominal pain
Hepatomegaly
Jaundice
Raised ALT/AST/GGT
68
Features of Bell's palsy
Non-forehead sparing facial weakness
69
Ix and Mx for Bells palsy
Otoscopy to check for Ramsey Hunt syndrome
| Prednisolone
70
Mx of Paget's disease
Analgesia
Pamidronate
Yearly ALP measurements
71
1st line Mx of prostatitis
Oral ciprofloxacin
72
Features of prostatitis
Urgency
Pain in perianal region
Boggy prostate
73
What is melanosis coli?
Discolouration of the bowel
| Often as a result of laxative abuse (anorexia etc.)
74
Easily ruptured blisters =>
Pemphigus vulgaris
75
Easily ruptured blisters on the back of the hands with hypertrichosis =>
Porphyria cutanea tarda
Hypertrichosis = very hairy
Photosensitivity hence on the back of the hands
76
Oral contraceptive you can start after giving birth
Progesterone only pill
77
How long does it take for the POP to kick in?
2 days
78
Features associated with psoriatic arthritis
Subungal keratosis (thickening of the skin under the nails)
Silvery plaques
Painful joints
Increased risk of CVD
79
HLA associated with T1DM
HLA-DR3
80
Common electrolyte abnormality in bronchiolitis and how might it present?
Hyponatraemia
| Seizure
81
What do they look at in the Gleason score?
Glands
82
What do you do if you are transfusing blood and the patient becomes febrile but alright otherwise?
Slow down the transfusion
83
Young patient, resting tremor, ataxic and dysarthric (difficult speech), first degree heart block, most likely Dx?
Wilson's disease
84
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?
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
What is raised in Gilbert's disease?
Unconjugated hyperbilirubinaemia
86
Pathology of tertiary hyperparathyroidism
Actually makes a new PTH nodule due to chronic low Ca in CKD
87
Which type of lung cancer secretes PTHrP?
Squamous cell carcinoma
Often central -> wheeze
Bone pain and hypercalcemia
88
Most common side effect of salbutamol
Tachycardia
89
1st line anti-hypertensive drug for T2DM <80yo
ACEi
90
What is Cushing's triad for raised ICP?
Bradycardia
Hypertension
Irregular breathing
91
Features of Addison's disease
Postural hypotension
Abdominal pain
Weight loss
Fatigue and malaise
92
Mx of hyperkalaemia
ECG
10ml of 10% Calcium gluconate
10U actrapid in 100ml of 20% glucose
Nebulised salbutamol in the interim if necessary
93
Cause of pigment loss internally (in mouth for example)
Vitiligo
94
Acute onset PCOS Sx =>
Androgen secreting tumour
95
Low testosterone with low LH/FSH =>
Hypogonadotrophic hypogonadism
96
Causes of loss of red reflex in eye
Retinoblastoma
Congenital cataract
Coats disease (leakage into the back of the eye)
97
How might tumour lysis syndrome present?
Recent chemotherapy
Abdominal pain
Weakness
Feeling unwell
Reduced urine output
98
Key Ix in tumour lysis syndrome?
ECG because potential hyperkalaemia
99
Features of eosinophilic granulomatosis with polyangiitis
Adult-onset asthma
| Bilateral nasal polyps
100
Definitive Mx of WPW
Catheter ablation of the accessory pathway
101
Heriditary blindness presenting as loss of peripheral vision Dx and findings on fundoscopy
Retinitis pigmentosa
| May see peripheral pigment deposits on fundoscopy
102
What drop in DAS score to determine if the response was moderate?
0.7
103
Treatment for trichomonas
Metronidazole
104
Treatment of eczema herpeticum
IV aciclovir
105
What is ophthalmia neonatorum?
Neonatal conjunctivitis
| Often result of STI from mother
106
What is chemosis?
Swelling of eyelids
107
What derangement of electrolytes can thiazide diuretics cause?
Hypokalaemia
108
Causes of hyperkalaemia
```
DREAD
Drugs
Renal failure and rhabdomyolysis
Endocrine
Addisons
DKA
```
109
Which antibiotic can prolong QT?
Clarithromycin
110
Indications for dialysis
AEIOU = Acidosis, Electrolytes (hyperK+), Intoxication (Drug OD), Oedema, Uraemic symptoms (encephalopathy)
111
Complications of Paget's disease
Hearing loss
Pain
Deformity and fractures
Nerve compression
112
Prophylaxis of variceal bleeds
Propranalol
113
What is Kussmaul sign?
Paradoxical rise in JVP with inspiration
114
Antibodies in AI hepatitis
ASMA
115
How might AI hepatitis present?
```
Jaundice
Fatigue
Hepatomegaly
Raised ALT
Raised ASMA
```
116
Indications for TIPPS
Refractory ascites
| Secondary prevention for oesophageal varices (if other methods have failed)
117
2 sharp spikes before each QRS complex =>
Dual-chamber pacing
118
Indications for pacemaker
Complete heart block
Bradycardia
Any arrhythmia that fails to respond to medical therapy
119
Features of cerebellar stroke
Poor coordination
Difficulty following instructions
Homonymous hemianopia
120
Herald patch is associated with
Pityriasis rosacea
121
Most likely bone to fracture in a punch injury
5th metacarpal fracture
| Boxer's fracture
122
Why does amiodarone bother the thyroid so much?
Its 37.5% iodine
123
What should you do if you get hypothyroidism in amiodarone administration
Check levels of TSH and also thyroid antibodies to see if there's a malignancy going on
Give levothyroxine
124
Mx of young pt with symptomatic 1cm pneumothorax
Aspirate with 16G cannula
125
Management of asymptomatic type 1 heart block
Nothing needed
126
When should you refer a child with undescended testes?
6mo old
127
Mx of pt with COPD and atopic dermatitis not controlled with salbutamol alone
ICS and LABA because atopic dermatitis hints towards allergic picture!
128
Fungal rash after gym, light colour of skin is...
Pityriasis versicolour
129
Ix for ?latent TB (say someone in the house has been Dx with active TB)
Interferon Gamma release assay (IGRA)
130
Features of an indirect inguinal hernia
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
TSH, T4 and T3 levels in subclinical hyperthyroidism
Low TSH
| Normal T4 and T3
132
Cause of continuous urine leak
Vesicovaginal fistula (often after traumatic childbirth)
133
Mx of an anal fissure
Diet and hydration
Stool softeners
Topical GTN
134
1st line Mx of migraine attack
Sumatriptan
135
Prevention of migraines
Avoid triggers
| Propranalol prophylaxis
136
Contraindications for thrombolysis
Loads
| But important = recent surgery, high INR, ongoing bleeding
137
Treatment of an overdose of amitriptyline
Sodium bicarbonate
138
Treatment of Kawasaki's disease
Aspirin and IVIG
139
Parkinson's patient on long-term levo-dopa develops writhing spasms in the morning, what is this a result of?
Long term levo-dopa
| Remember that Parkinsons causes tremors but not writhing movements, this is due to excess peripheral dopamine
140
How long does measles stay infective for?
4 days before the rash starts and 4 days after
141
Ix for ?bladder cancer
```
CT urogram (rules out upper tract disease which you can't visualise with cystoscopy)
Flexible cystoscopy
```
142
Range where you need to use Light's criteria if transudative or exudative
25-35g/L
143
Worrying risk of carbimazole
Agranulocytosis
| Look out for sore throat!
144
Features of SCC of skin
Ulcerative often scaly
145
What are symptoms of a missed miscarriage?
Closed Os
Maybe a little bleeding
USS shows a dead foetus still present in the uterus
146
RF for Hodgkin's lymphoma
HIV
| EBV
147
Acute management of a severe attack of MS
IV methylprednisolone
148
Cut off CHADSVASC to consider anti-coag in a male vs female patient
```
Male = 1
Female = 2
```
149
Scoring system for UC severity
Truelove and Witts
150
Mx of DKA
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
Features of transient tachypnea of the newborn
Hyperinflated lungs
Fluid level in the lungs on x-ray
SOB
Respiratory depression
152
Mx of transient tachypnoea of the newborn
Oxygen and supportive
| Steroids to avoid this condition before birth
153
Inheritance of G6PD
X-linked recessive
154
Rhesus D negative woman, has a sensitising event (e.g car accident), now reduced foetal movements
Dx and what should have been done?
Haemolytic disease of the newborn
| Should have given anti-D prophylaxis
155
Haemochromatosis is a RF for what joint condition?
Pseudogout!
156
How does pseudogout present
Red, hot swollen joint
| Very tender
157
Ix for pseudogout
Joint aspiration
| Looking for rhomboid crystals positively bifringent
158
Most accurate way to measure GFR
Inulin clearance
159
Antibodies in AI hepatitis
ANA
| ASMA
160
Antibodies in PBC
AMA
161
Cut off to treat carotid stenosis
70%
162
Drowsy child, mild suprapubic tenderness, looks very unwell, parameters all normal but a bit of a fever, worry and Mx
Sepsis
Sepsis 6
Cephalaxin
163
Stages of hypertensive retinopathy
Grade 1 = Silver wiring
Grade 2 = AV nipping
Grade 3 = Flame haemorrhages + cotton wool spots and hard exudates
Grade 4 = Papilloedema
164
Which pneumonia causes hyponatraemia
Legionella
165
Difference between placenta accreta and increta
Increta goes into the muscle (myometrium)
166
Antibodies in myasthenia gravis
Against post-synaptic ACh
167
What should you always do before starting donepezil or other ACh related drugs?
ECG
Looking for QTc prolongation, which, if present means you could kick them into Torsades de Pointes, so don't use the drug!
168
Psycho approach to managing dementia
Cognitive stimulation therapy
169
Staghorn calculi most likely to be made from...
Struvite (magnesium)
170
What is diabetic ketosis?
All the features of DKA but not acidotic
171
Ongoing Ix for asthma attack
PEFR and continuous O2 saturations to ensure they are not deteriorating
