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General Finals & SBA Review > QUESMED > Flashcards

QUESMED Flashcards

1
Q

Recurrent ulcers in the mouth and groin aswell as erythema nodosum on the shins and painful eyes (uveitis) =>

A

Bechets disease

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2
Q

A 42 year old woman presents with a 9 week history of pain, swelling and morning stiffness in her hands and feet. She denies any recent diarrhoea or illness. She had a recent sexually transmitted infection (STI) screen which was normal. She is concerned about her nails which she describes as ‘peeling’. On examination, her fingers and toes are swollen. Which condition is this?

A

Psoriatic arthritis

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3
Q

Pseudogout joint aspiration features

A

Positively bifringent rhomboid shaped crystals

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4
Q

RF for pseudogout

A

Hypothyroidism
Joint damage
Diabetes

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5
Q

Management of acute pseudogout

A

Colchicine

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6
Q

First line treatment of newly diagnosed rheumatoid arthritis

A

DMARD (methotrexate) and steroids

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7
Q

When would you consider hydroxychlorquine in RA?

A

In mild disease

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8
Q

First line treatment of polymyositis?

A

Steroids

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9
Q

Symptoms of polymyositis

A

Central weakness
No rash
No pain

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10
Q

Which part of the spine does RA usually affect?

A

The cervical portion

Usually spares thoracic and lumbar regions

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11
Q

Which imaging might an anaesthetist want for a RA patient before surgery?

A

Cervical spine x-ray
This is because of risk of current damage and subluxation
During airway manipulation, the anaesthetist may cause minor neck trauma that can dislocate the cervical vertebrae and cause damage, even death if the vertebrae migrates upwards!

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12
Q

Young patient with septic arthritis, most likely cuase

A

STI (gonorrhoea or chlamydia)

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13
Q

Triad of disseminated gonorrhoea infection

A

Skin lesions
Polyarthralgias
Tenosynovitis

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14
Q

Treatment of gonorrhoea

A

Ceftriaxone

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15
Q

Sjogren’s increased your likelihood of contracting which malignancy?

A

MALT

mucosa-associated lymphoid tissue

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16
Q

How might MALT present?

A

Bilateral parotid swelling

Cervical lymphadenopathy

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17
Q

Young male patient with painful right testicle with intact reflexes, malaise and fever, ulcerating rash on the shins, potential Dx and which Ix to confirm?

A

Polyarteritis nodosa

Need a skin biopsy

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18
Q

Which virus is linked with polyarteritis nodosa?

A

Hepatitis B

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19
Q

Parietal lobe damage (e.g. from brain metastases) can present with what feature?

A

Visual inattention

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20
Q

Damage to which area of the brain can result in Wernickes aphasia?

A

Left posteriori superior temporal gyrus

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21
Q

Which area of the brain is damaged in Gerstmann’s syndrome?

A

Inferior parietal lobe

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22
Q

Symptoms of Gerstmann’s syndrome

A

agraphia (difficulty in writing)
acalculia (difficulty with math)
aphasia (language disorders)
agnosia (difficulty to perceive objects)

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23
Q

Symptoms of hypocalcaemia

A

Parasthesia

Tingling of hands and face

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24
Q

Iatrogenic cause of hypocalcaemia

A

Thyroidectomy

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25
Q

Symptoms of multiple myeloma

A

Constipation
Depression
Back pain
Anaemia

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26
Q

Symptoms of measles

A

Development of a fever above 40 degrees
Coryzal symptoms
Conjunctivitis followed by a rash about 2-5 days after onset of symptoms (often starts behind the ears and spreads)
Koplik spots are small grey discolourations of the mucosal membranes in the mouth and appear 1-3 days after symptoms begin during the prodrome phase of infection. They are pathognomonic for measles infection.

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27
Q

Complications of measles

A

Acute otitis media
Bronchopneumonia
Encephalitis

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28
Q

What antibody test can you do for measles?

A

ELISA

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29
Q

Management of measles

A

Supportive
Notifiable disease
Off school as infective for up to 10 days

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30
Q

What is the potential pathophysiology of motor neuron disease?

A

Glutamate signals for calcium to enter motor neurones

Excessive calcium kills the neurones

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31
Q

Symptoms of motor neuron disease

A

Mix up UMN and LMN signs

No sensory involvement

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32
Q

Fasting growing, most aggressive thyroid cancer and how might it present?

A

Anaplastic
Invades local structures (may be breathless or difficulty swallowing)
Lump in the neck that raises on swallowing but NOT tongue protrusion

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33
Q

The most common type of thyroid cancer

A

Papillary

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34
Q

Periosteal onion skinning suggests

A

Ewing’s sarcoma

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35
Q

Only real chest x-ray finding in asthma

A

Hyperinflation

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36
Q

Chest sign of asthma

A

Widespread wheeze

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37
Q

What is the doctrine of double effect?

A

If someone is on max morphine on end of life care but still has pain, you can prescribe more morphine to treat that pain in the knowledge that it may hasten their death

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38
Q

Symptoms of prolactinoma

A

In women = lack of libido, galactorrhiea and infertility
In men = gynaecomastia, lack of lidido, less body hair
Also mass-producing effects such as headache and bitemporal hemianopia

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39
Q

Mx of symptomatic aortic aneurysm (back pain and epigastric tenderness)

A

Elective surgery

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40
Q

What is Mirrizzi’s syndrome?

A

Stone in the cystic duct compresses the bile duct and causes obstructive jaundice

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41
Q

Features of Mirrizzi’s syndrome

A

Recurrent abdominal pains
Jaundice
Dark urine
Pale stools

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42
Q

Signs of COPD on respiratory examination

A

Prolonged expiratory phase, reduced chest expansion and widespread wheeze on auscultation.

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43
Q

Management of life-threatening asthma

A

Oxygen
Salbutamol and ipratropium nebulisers
Steroids
Urgent senior support

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44
Q

What is a myoclonic seizure?

A

Sudden jerking of a limb (say the neck)

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45
Q

Treatment of myoclonic seizures

A

Sodium valproate

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46
Q

What do you need to screen for before initiating biological therapies in rheumatoid arthritis?

A

TB (may get reactivated)

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47
Q

What does rituximab target?

A

CD20 on B cells

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48
Q

Management of alcohol dependence

A

CBT
Oral acamprosate or naltrexon
Consider admission if the dependence is severe (young pt, 30 units a day, vulnerable patients)

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49
Q

Medication for BPH with a PMH of postural hypotension?

A

Finasteride

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50
Q

First-line treatment of BPH

A

Tamsulosin

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51
Q

Most common ECG abnormality in anorexia nervosa

A

Prolonged QT interval

Due to electrolye disturbance

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52
Q

Symptoms of Reye’s syndrome

A

Reduced GCS
Mild anaemia
A transaminitis (high liver enzymes because its basically liver failure)
Raised bilirubin
A prolonged international normalised ratio
Raised lactate
Raised C-reactive protein

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53
Q

The typical history of Reye’s syndrome

A

Child under 12yo
Had viral illness
Given aspirin

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54
Q

Most common causes of HF in the Western world

A

Coronary artery disease
Hypertension
Valvular disease

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55
Q

Symptoms of pulmonary oedema

A

Shortness of breath on exertion
Orthopnoea
Paroxysmal nocturnal dyspnoea
Nocturnal cough (± pink frothy sputum)

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56
Q

Which classification system to grade heart failure?

A

New York Hear Association

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57
Q

A good measure to do that can help to rule out heart failure

A

BNP

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58
Q

Blurry vision that gets worse over the course of the day

Patient appears tired at the end of each day

A

Myasthenia Gravis

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59
Q

Absent p waves
Widened QRS complexes
Peaked t waves

A

Hyperkalaemia

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60
Q

Treatment for pseudogout in one joint in patient with CKD

A

Intra-articular steroid injection

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61
Q

Renal impairment and high HBA1c, symptoms of diabetes, whats the first line treatment?

A

Basal insulin therapy because of their renal impairment

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62
Q

Humeral fracture can damage which nerve, leading to inability to extend wrist and loss of sensation on the back of the hand

A

Radial

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63
Q

Mx of acute angle glaucoma

A

Topical pilocarpine
IV acetozolamide
Peripheral laser iridotomy = definitive

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64
Q

Features of acute closed angle glaucoma

A

Fixed dilated pupil
Hard orbit when pressed
Red and watery
Blurred vision

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65
Q

How quickly does baby blues present?

A

First 2 weeks after birth

Resolves spontaneously

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66
Q

When does post partum depression typically present?

A

Typically start 1 month post partum and peak at 3 months

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67
Q

Mx of post-partum depression

A

CBT
Risk assessment
Consider inpatient admission with baby is severe

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68
Q

Symptoms of anterior uveitis

A

Painful red eye
Irregularly shaped pupil
Blurry vision
History of back pain or IBD etc. (HLA related)

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69
Q

Conditions that can predispose to anterior uvietis (HLA-B27 conditions)

A 
Ankylosing spondylitis
Idiopathic juvenile arthritis
Multiple sclerosis
SLE
Inflammatory bowel disease
Granulomatosis with polyangiitis
Reactive arthritis
Infections: herpes, tuberculosis, syphilis, HIV
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70
Q

Symptomatic patient, diabetes cut off for diagnosis

A

Random blood glucose =11.1mmol/l
Fasting plasma glucose =7mmol/l
2 hour glucose tolerance =11.1mmol/l
HbA1C =48mmol/mol (6.5%)

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71
Q

Smoking is a risk factor for which oesophageal cancers?

A

Both adenocarcinoma and squamous cell carcinoma

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72
Q

Difference between superficial dermal and superficial epidermal burn

A

Dermal may see blistering, more seen in scalds from liquids
Epidermal = more from flash burns

Both typically heal in 10-14 days (painful) but with minimal scarring

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73
Q

What are ecchymoses?

A

Areas of bleeding under the skin (bruising)

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74
Q

First line management of ?hip fracture?

A

ABCDE

Anterior and lateral hip x-rays

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75
Q

What is the management of grade 1/2 intracapsular hip fractures?

A

Garden 1/2 fractures can be treated with ORIF and cancellous screws

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76
Q

2.5yo with waddling gait and big thigh muscles, what is the inheritance pattern?

A

X-linked recessive

Duchenne’s muscular dystrophy

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77
Q

Pt with Hickmann line, pyrexial and tachycardic but haemodynamically stable. New onset heart murmur in tricuspid area, which antibiotic would you start?

A

IV vancomycin

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78
Q

Immediate management of Quinsy in the community?

A

Immediate referral to hospital

Infection can easily spread or cause airway compromise

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79
Q

Signs of Quinsy

A

Deviated uvula
Swelling
Very painful sore throat
Inability to open the mouth easily

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80
Q

Common causes of heart failure

A

Coronary artery disease
Hypertension
Valvular disease

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81
Q

What is high output heart failure?

A

The insufficiency of the heart to supply the metabolic demands of the body is due to the needs being increased = ANAEMIA

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82
Q

What is low output heart failure?

A

The body is normal but the heart can’t give enough = dilated cardiomyopathy, restrictive

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83
Q

Causes of high output heart failure?

A

PAT
Pregnancy
Anaemia
Thyrotoxicosis!

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84
Q

Causes of low output heart failure

A

Pump failure, ARRYTHMIAS, excess after-load or excess pre-load

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85
Q

What is diastolic low output heart failure?

A

Impaired ventricular FILLING during diastole

Because its all crusty, restricted or big and unable to be filled easily

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86
Q

What is systolic low output heart failure?

A

Impaired ventricular contraction during systole

When it’s weak or really dilated

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87
Q

Causes of systolic heart failure?

A

Ischaemic heart disease
Dilated cardiomyopathy
Myocarditis
Infiltration (e.g. in haemochromatosis or sarcoidosis)

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88
Q

Causes of diastolic heart failure?

A

Hypertrophic obstructive cardiomyopathy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis

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89
Q

BNP>2000ng/L Mx

A

2w referral for specialist assessment and an echo

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90
Q

Cut off for ejection fraction

A

40%

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91
Q

40%< ejection fraction but heart failure =

A

Preserved ejection fraction heart failure

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92
Q

Which Ix to test ejection fraction?

A

Echo

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93
Q

HIV pt with generalised weakness, head CT shows a single, lobulated lesion, most likely cause and treatment?

A

HIV related primary CNS lymphoma

Treatment = commence cART and whole brain irradiation

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94
Q

Which part of the nephron do thiazide diuretics work on?

A

DCT on the sodium, potassium channels

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95
Q

What can taking bendroflumethiazide do when also taking metformin?

A

Can increase glucose levels because it interacts with K+ channels, reducing insulin release

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96
Q

What type of drug is baclofen?

A

Its a muscle relaxant

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97
Q

What is baclofen used for in MND?

A

Reduce spasticity

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98
Q

In AKI, what can happen to baclofen levels?

A

Rise, because excreted by kidneys

Can result in drowsiness/LOC

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99
Q

In renal tubular acidosis, why do you get an acidosis?

A

Impaired acid excretion leads to hyperchloraemic metabolic acidosis.
This leads to activation of the Renin Angiotensin system leading to potassium wasting and hypokalaemia

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100
Q

What is type 1 renal tubular acidosis

A

DISTAL RTA

The inability of the kidneys to excrete H+ ions

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101
Q

What is type 2 renal tubular acidosis?

A

Proximal RTA
Issue with the proximal tubule (usually caused by Fanconi syndrome)
Can reabsorb a bit of HCO3-
Urine will be acidic

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102
Q

What is type 4 renal tubular acidosis?

A

Mineralocorticoid deficiency
Normal urine pH
Hyperkalaemia (because switch less K+ for Na+)
Low blood pressure

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103
Q

What might the heart rate be in inferior MI?

A

Bradycardia

Because AV block (can’t message between them so just go at basal ventricular rate)

104
Q

Cut off INR for absolute contraindication for surgery?

A

INR 1.5

105
Q

Absolute contraindications for laparoscopic surgery

A

Obvious indication for open therapeutic intervention – Perforation, peritonitis, known intra-abdominal injury, complications of previous surgery, shock, evisceration or abdominal wall dehiscence

Acute intestinal obstruction associated with a massive (>4 cm) bowel dilatation – Can obscure the view making intervention harder.

Uncorrected coagulopathy – INR should be corrected to at least < 1.5, although some surgeons prefer INR to be even lower than this.

Tense or distended abdomen – Suspected intra-abdominal compartment syndrome
Trauma with hemodynamic instability
Clear indication of bowel injuries (e.g. presence of bile or evisceration)

106
Q

Severe chest pain when swallowing, especially cold drinks, what does this suggest?

A

Oesophageal spasm

107
Q

Diagnosis of oesophageal spasm

A

Barium swallow showing corkscrew oesophagus

108
Q

Birth defects associated with folic acid antagonists

A

Anencephaly, cleft lip/palate, skull defects

109
Q

One attempt at endoscopy with band ligation for variaces, still bleeding the next day, what do you do?

A

If haemodynamically stable -> repeat endoscopy with therapeutic intention
If unstable, consider balloon tamponade
If refractory, consider transjugular intrahepatic portosystemic shunt (TIPS)

110
Q

Scoring system for upper GI bleed?

A

Glasgow-Blatchford score

111
Q

Viral cause of roseola

A

HHV6

112
Q

High fever for 5 days, single seizure, as the fever subsides a maculopapular rash appears, Dx?

A

Febrile convulsion (most likely caused by roseola)

113
Q

Redman syndrome is also known as…

A

Erythoderma

114
Q

Definition of erythroderma

A

> 90% body surface red and potentially scaling

115
Q

Most common site of occlusion in acute mesenteric ischaemia

A

Superior mesenteric artery

116
Q

Triad of acute mesenteric ischaemia

A

Shock
Diffuse abdominal pain
Insignificant abdominal examination

117
Q

Management of transient synovitis

A

Supportive

118
Q

Features of transient synovitis

A

Recent infection
Both septic arthritis and transient synovitis cause acute onset limp where the child avoids bearing weight and presents with fever.

Generally, the features of transient synovitis are milder than septic arthritis (mild/absent fever versus high fever, mild vs severe pain).

119
Q

How long do symptoms have to last to consider juvenile idiopathic arthritis?

A

6w<

Morning stiffness, starting at the hands and feet and progressing to the spine

120
Q

Features of Klinefelter’s syndrome

A

Small, firm testis
Gynaecomastia
Delayed puberty
Tall (because delayed puberty, keep growing at child rate)

121
Q

Causes of delayed puberty

A

Androgen insensitivity
Klinefelter’s syndrome
Chronic illness (e.g. CF or coeliac)

122
Q

Most common cause of delayed puberty

A

Late bloomers

Parent’s probably had later puberty

123
Q

Microcytic anaemia in a patient taking isoniazid but with normal iron levels, cause =?

A

Sideroblastic anaemia
Caused by isoniazid treatment
Hypochromic, microcytic but with normal iron!

124
Q

What is sideroblastic anaemia?

A

Inability to produce RBC very well

Get a hypochromic, microcytic anaemia

125
Q

What is herpes labialis?

A

Cold sores

126
Q

Which type of pneumonia is linked to cold sores?

A

Streptococcus pneumoniae

127
Q

Most common causative organism for lobar pneumonia?

A

Streptococcus pneumoniae

128
Q

What might you find on examination for pneumonia?

A 
Bronchial breathing over one lobe
Increased vocal resonance 
Reduced chest expansion
Increased RR 
Pleuritic chest pain
129
Q

Risk factors for anorexia nervosa

A 
Dieting
Maternal encouragement of weight loss
Family history of eating disorders
Adolescent period
Personal history of anxiety disorders
Depressive disorders or obsessive-compulsive disorders
Perfectionist traits
At-risk professions such as sportspeople, dancers or models
130
Q

Chronic ketamine use is associated with which bladder condition?

A

Ketamine cystitis
Features of dysuria and blood
Cystoscopy shows thickened bladder walls and inflammation

131
Q

Screening for AAA 3.3cm

A

Once yearly USS

132
Q

Screening for AAA 4.7cm

A

Repeat USS every 3mo

133
Q

Mx of AAA size 5.7cm

A

2w surgery

134
Q

Procedure for malrotation in children

A

Ladd’s procedure, twisting and fixing

Removing Ladd’s bands of adhesion and also removing the appendix while you are in there

135
Q

Symptoms of malrotation

A

Bilious vomiting
Constipation
Distended abdomen

136
Q

Causes of obstructive shock

A

Cardiac tamponade
Pulmonary embolism

These STOP the flow from the heart

137
Q

pathophysiology of neurogenic shock

A

Mass peripheral vasodilation due to loss of neurogenic tone

138
Q

Diagnosis of aplastic anaemia

A

Anaemia: haemoglobin <10 g/dL
Thrombocytopenia: paltelets <50 x 10^9/L
Neutropenia: absolute neutrophil count <1.5 x 10^8/L

139
Q

Management of twin to twin transfusion syndrome

A

Specialist centre -> in utero laser of problem vessels

140
Q

What type of drug is acetazolamide?

A

Carbonic anhydrase inhibitor

Used in glaucoma to reduce acqeous humour production

141
Q

Recurrent episodes of self-limiting high fever and painful serositis associated with a typical lower limb erysupelas-like rash Dx?

A

Familial Mediterranean fever

142
Q

Gene in Mediterranean Fever

A

MEFV on chromosome 16

143
Q

What long-term therapy should patients with familial Meditarranean fever be put on?

A

Colchicine to reduce long standing inflammation and reduce chance of amyloidosis

144
Q

Electrolyte measurements in tumour lysis syndrome

A

Hyperkalaemia, hyperuricaemia, hyperphosphataemia -> drives HYPOcalcaemia

145
Q

Normal calcium levels

A

2.2 - 2.6

146
Q

Causes of HYPOcalcaemia

A

Vit D deficiency (e.g. ostomalacia or malabsorption => coeliac/chronic pancreatitis)
hypoparathyroidism
Hyperphosphateaemia

147
Q

Causes of malabsorption

A

Gastrectomy
Short bowel syndrome
Coeliac disease
Chronic pancreatitis

148
Q

Signs of hypocalcaemia =?

A 
SPASM 
Spasms 
Parathesia
Anxiety
Seizures
Muscle tone increase
149
Q

Ix for hypocalcaemia

A

ECG (looking for arrhythmia)

Bone profile (calcium, phosphate, albumin, total protein, ALP)

PTH

Vitamin D

Amylase (if suspected pancreatitis)

X-rays (if suspected osteomalacia)

150
Q

Long standing hearing loss and painless otorrhoea, foul smelling discharge, that is not improving with repeated courses of antibiotics

A

Cholesteatoma
benign growth of keratinising squamous epithelium trapped in the middle ear cavity
Can be acquired (repeated chronic otitis media) or congenital

151
Q

Features of cor pulmonale

A

Hx of COPD or other chronic lung disease

RHF = pitting oedema, ascites, tender smooth hepatomegaly, raised JVP

152
Q

Ulnar deviation, Z thumb deformity, smooth mass in LUQ that moves with ventilation =>

A

Felty’s syndrome!

153
Q

DDx of splenomegaly

A

Haematological: CML, myelofibrosis, haemolysis

Infective: tropical (malaria, leishmaniasis) and non-tropical (Epstein barr virus)

Other: portal hypertension, infiltration (e.g. sarcoidosis, amyloidosis), Felty’s syndrome

154
Q

H.pylori positive with an associated MALT lymphoma found on endoscopy, what is the management?

A

Amoxicillin, clarithromycin and omeprazole to try to eliminate the H.pylori

155
Q

If H.pylori eradication fails when treating a MALT lymphoma, which drug can you use?

A

Rituximab

156
Q

Skin change seen in chronic venous insufficency, dark pigmentation caused by chronic haemosiderin deposition.
Dry skin and often have venous ulcers
Dx?

A

Lipodermatosclerosis

157
Q

Most likely cause of atraumatic vertebral collapse in an elderly man

A

Metastatic malignancy

158
Q

Mx of verebral collapse causing cord compression

A

Oral steroids
Surgical decrompression
(aim within 48hr)

159
Q

First line treatment of UC

A

Topical or oral ASA (mesalazine)

160
Q

Extensive UC management

A

Mesalazine + prednisolone

161
Q

Management of acute severe UC

A

IV corticosteroids

162
Q

1st line treatment of GBS?

A

IV immunoglobulin

163
Q

Low sodium to high, your pons will…

A

DIE

164
Q

High sodium to low, your brain will…

A

Blow

165
Q

Most common cause of blindness worldwide

A

Trachoma

166
Q

Cause of trachomas (think Sudan eye disease)

A

Chlamydia trachomatis

167
Q

Man works with livestock and drinks unpasteurised milk. Now has arthralgia and hepatosplenomegaly -cause?

A

Brucellosis

168
Q

Treatment of brucellosis

A

Dual antibiotic therapy

Doxycyclin and gentamicin

169
Q

Presentation of brucellosis

A 
Fever 
Weight loss
Night sweats
Lymphadenopathy 
Joint pain 
Spinal tenderness 
PUO!
170
Q

Feel unusually prominent foetal parts on abdomen, what does this suggest?

A

Oligohydramnios

Potentially due to fetal renal agensis, use of ACEi in pregnancy, malnutrition

171
Q

Causes of polyhydramnios

A 
Maternal diabetes 
Foetal renal disorders
TTTS
Foetal anaemia 
Diaphragmatic hernia of foetus, duodenal atresia (can't swallow amniotic fluid)
172
Q

Causes of metabolic alkalosis

A 
Loss of chloride = 
Vomiting
NG suction
Diuretics (thiazides, loop diuretics)
Diarrhoea (e.g. chloride secreting villous adenoma)
Cystic fibrosis

Loss of potassium =
Primary hyperaldosteronism
Cushing’s syndrome

Other causes =
Carbonate overuse
Massive transfusion

173
Q

Genetics of Turner’s syndrome

A

XO

174
Q

Signs and symptoms of ectopic pregnancy

A 
Lower abdominal pain
Vaginal bleeding 
Cervical motion tenderness 
Positive B-HCG test 
Shoulder tip pain 
Vaginal bleeding
175
Q

DDx of painful vaginal bleed

A

Miscarriage

Ectopic pregnancy

176
Q

Medical management of ectopic pregnancy

A

One off methotrexate

177
Q

Treatment of measles

A

Supportive care

178
Q

Signs and symptoms of measles

A

Grey spots on mucosa Blanching, maculopapular rash all over
Fever
Cough
Runny nose

179
Q

Causes of high anion gap

A 
MUD PILES 
Metformin
Uraemia 
DKA
Paracetamol
Iron 
Lactic acidosis
Ethylene
Salicylates
180
Q

Causes of metabolic acidosis with normal anion gap

A 
ABCD 
Addisons (adrenal insufficiency)
Bicarbonate loss (GI/renal)
Chloride excess
Diuretics
181
Q

A TCA overdose can cause what ABG picture?

A

Metabolic acidosis with raised anion gap

182
Q

Which drug should be co-prescribed with methotrexate?

A

Folic acid

Helps reduce toxicity and side effects

183
Q

Management of anaphylaxis

A 
Stop offending drug 
Administer IM adrenaline 1:1000 0.5ml 
IV hydrocortisone 200mg 
IV chlorphenamine 10mg 
IV NaCl1 500ml
184
Q

Tachycardic, hypotensive, decreased consciousness, metabolic acidosis, normal anion gap =>

A

Severe diarrhoea

185
Q

Herepes zoster on face in one dermatome (shingles), eye involvement if the rash is where?

A

Nose tip = Hutchinson’s sign

186
Q

1st line Mx of lactic acidosis in metformin use

A

500ml 0.9% saline bolus

187
Q

Causes of lactic acidosis

A 
Tissue hypoxia (Type A)
Shock (e.g. cardiogenic, hypovolaemic, haemorrhagic)
Hypoxia
Acute mesenteric ischaemia
Limb ischaemia
Severe anaemia
Seizures
Vigorous exercise
Abnormalities in metabolism of lactate (Type B)
Diabetic ketoacidosis
Cancer
Liver disease
Inborn errors in metabolism
Drugs:
Metformin - impairs liver metabolism of lactate
Aspirin
188
Q

Frontal headache, impotence, bitemporal hemianopia, Ix?

A

Head MRI for pituitary adenoma

189
Q

Which AF patients get rate control

A

HR > 90

190
Q

Which AF patients get cardioversion?

A

New onset AF

Triggered AF

191
Q

What Ix might you consider after a diagnosis of myasthenia gravis?

A

CT chest

Because myasthenia gravis is strongly associated with abnormalities of the thymus

192
Q

Who performs the booking appointment for pregnancy?

A

Midwife who will support throughout the pregnancy

193
Q

What blood tests are offered for expectant mothers?

A

HIV
Hepatitis B
Syphilis

194
Q

What dose of ICS may you add first line in chronic asthma management in adults?

A

400 MICROGRAMS

195
Q

Mx of mild Parkinsons disease

A

Ropinerole

196
Q

Mx of Parkinson’s disease

A

Levodopa and carbidopa

197
Q

Treatment of severe aortic stenosis

A

Surgical (if young)

Transcatheter aortic valve implantation (TAVI) if older

198
Q

What Ix must you do to determine severity of a heart murmur, e.g. aortic stenosis?

A

Echocardiogram

199
Q

What is TAVI?

A

Transcather aortic valve implantation

200
Q

Triad of symptoms of aortic stenosis

A

Syncope
Heart failure
Angina

201
Q

Symptoms of aortic stenosis

A 
Syncope
Angina
Heart failure
Exertional dyspnoea
Decreased exercise tolerance
202
Q

Buttocks and back pain, vascular cause

A

Ilioaortic disease (claudication)

203
Q

Mx of claudication

A 
Doppler
ABPI
RF modification
Statins
Aspirin
Clopidogrel

Potential further options = bypass

204
Q

Standard treatment for chronic HF

A 
ACEi (improve heart remodelling)
Beta blockers (improve heart efficiency)
Diuretics (symptomatic)
205
Q

QRISK 15% means…

A

15% chance of heart attack in the next 10 years

206
Q

What should you consider prescribing for a patient with QRISK 11%?

A

A statin

Atorvastatin 20mg once nightly (because the cholesterol enzyme is more active at night!)

207
Q

Mx of patient with high QRISK score

A

Life modifications
Regular testing of lipids
Statin (e.g. atorvastatin)

208
Q

Secondary causes of hyperlipidaemia

A

Diabetes mellitus
Hypothyroidism (poor clearance of LDL)
Nephrotic syndrome (hypoalbuminaemia leads to hyperlipidaemia)

209
Q

Blood pressure cut offs in ascending order of severity

A
  1. Single reading >140/90 mmHg and average ambulatory readings >135/85 mmHg
  2. Single reading >160/100 mmHg and average ambulatory readings >150/95 mmHg
  3. Single reading with systolic >180 mmHg or diastolic >110 mmHg.
210
Q

Single reading high blood pressure cut off

A

140/90

211
Q

Average ambulatory cut off for high blood pressure

A

135/85

212
Q

What type of drug is carvedilol?

A

Beta blocker

213
Q

Medical management of heart failure

A

Lisinopril (ACEi)
Carvedilol (B blocker)
Furosemide (diuretic)

214
Q

Sx of heart failure, what do you need to do first to screen?

A

Measure BNP

If elevated, refer for trans-thoracic echocardiogram

215
Q

When is BNP released?

A

When the ventricles stretch

It has a high negative predictive

216
Q

When is BNP released?

A

When the ventricles stretch

It has a high negative predictive value, if it isn’t raised, it probably isn’t heart failure

217
Q

Features of HOCM

A

Ejection systolic murmur louder when squatting

Palpitations and feeling faint when exercising

218
Q

What is HOCM?

A

Genetic mutations in sarcomere lead to cardiac hypertrophy

219
Q

What is holiday heart syndrome?

A

Big night out, triggers AF

220
Q

Causes of AF

A

Ischaemic heart disease (most common)
Rheumatic heart disease
Hypertension

Non-cardiac
Dehydration
Infective
Alcohol 
Electrolyte disturbance
221
Q

Classification of AF

A

Acute (lasts <48 hours)
Paroxysmal (lasts <7 days and is intermittent)
Persistent (lasts >7 days but is amenable to cardioversion)
Permanent (lasts >7 days and is not amenable to cardioversion)

222
Q

Cause of mid-systolic click

A

Mitral valve prolapse

223
Q

Complications of HTN

A 
Coronary artery disease
Heart failure
Renal failure
Stroke
Peripheral vascular disease
224
Q

Gene for haemochromatosis

A

HFE

225
Q

What is the pathophysiology of haemochromatosis?

A 
Gene mutation (HFE), increased iron absorption, leading to high iron levels
This iron accumulates in organs such as the heart and skin and pancreas. Causing dilated cardiomyopathy, heart failure, tanned skin and diabetes
226
Q

Most common cause of mitral stenosis

A

Rheumatic fever

227
Q

Management of late stage heart failure after max medical treatment

A

Cardiac resynchronisation therapy (CRT)

228
Q

What drug can be used as a pill in the pocket for AF in young people?

A

Flecainide

229
Q

Rate control drugs for AF

A

Beta blockers
Verapamil or diltiazem (CCB)

Digoxin = second line

230
Q

Chest pain and new onset bundle branch block on ECG, what are you concerned about?

A

ACS

Treat urgently with primary percutaneous coronary intervention if possible

231
Q

First line investigation of angina

A

CT coronary angiography

232
Q

Sinus bradycardia with no adverse signs, what do you need to do?

A

Observe and try to identify a cauase (e.g. hypothyroidism)

233
Q

Cut off for bradycardia

A

HR < 60bpm

234
Q

Drug that can induce bradycardia

A

Verapamil + B blocker!

235
Q

Syncope, dizziness, tiredness, what Ix should you do?

A

ECG

236
Q

HR 48 with symptoms of syncope, what should you give?

A

Atropine

Block parasympathetic activity, increasing heart rate

237
Q

Most common heart murmur post MI

A 
Mitral regurgitation (secondary to rupture of papillary muscle)
Ventricular septal defect

These both give a PAN-SYSTOLIC murmur

238
Q

Slow rising pulse is associated with which heart valve murmur?

A

Aortic stenosis

239
Q

Collapsing pulse is associated with which murmur?

A

Aortic regurgitation

240
Q

Causes of aortic regurgitation

A

Rheumatic heart disease
Infective endocarditis
Aortic dissection
IHD

241
Q

Chronic causes of regurgitation murmurs (mitral and aortic)

A

Calcific aortic valve disease (age related)
Congenital disease e.g. bicuspid aortic valve
Rheumatic heart disease - most common cause in the developing world
Infective endocarditis
Rheumatic causes e.g. rheumatoid arthritis, antiphospholipid syndrome
Marfan’s syndrome

242
Q

Electrolyte imbalance that causes prolonged QT interval

A

Hypocalcaemia

Hypokalaemia

243
Q

What electrolyte imbalance is common after thyroidectomy?

A

Hypocalcaemia because loss of parathyroid glands

244
Q

Clinical features of pericarditis

A 
Chest pain (usually pleuritic and worse on lying flat)
Fever
Pericardial friction rub
ECG changes
Widespread saddle-shaped ST elevation
PR depression
Raised troponin
245
Q

Management of stable angina

A

The management of stable angina includes optimising risk factors for cardiovascular disease:

Smoking cessation
Glycaemic control
Hypertension
Hyperlipidaemia
Weight loss
Alcohol intake

First line medical

Aspirin
Statin
Sublingual GTN
Beta blocker or rate limiting calcium channel blocker

Can add a long acting nitrate

246
Q

Medical treatment of chronic heart failure

A

ACEi
Beta blocker
Furosemide
Spironolactone

247
Q

Causes of heart failure

A 
Causes of systolic heart failure
Ischaemic heart disease
Dilated cardiomyopathy
Myocarditis
Infiltration (e.g. in haemochromatosis or sarcoidosis)
Causes of diastolic heart failure
Hypertrophic obstructive cardiomyopathy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis
248
Q

What is high output heart failure?

A

Increased metabolic demands so the heart can’t cope

E.g. anaemia or infection or thyrotoxicosis

249
Q

Clinical features of Brugada syndrome

A

Coved ST elevation followed by inverted T waves = Brugada sign
Episodes of palpitations and dizziness
Syncope

250
Q

Management of Brugada syndrome

A

Implantable cardiodefibrillator

251
Q

ECG changes in posterior STEMI

A

ST elevation in leads 2, 3, aVF

252
Q

ECG changes in NSTEMI

A

ST depression in whichever leads

T wave inversion!

253
Q

The inheritance pattern of HOCM

A

Autosomal dominant

50% chance of son having it!

254
Q

Features of insulinoma

A

Aggression
Raised C-peptide
Low glucose
Signs of hypoglycemia

255
Q

What is a Whipple’s procedure?

A

Pancreaticoduodenectomy

256
Q

COPD management

A

Conservative:
COPD nurse
Chest physio

Medical =
SABA
LABA + ICS if asthma Sx
LABA + LAMA if not

Then all of them

General Finals & SBA Review (8 decks)

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