QuesMed Corrections Flashcards
What is the 1st line investigation for IBD?
Faecal calprotectin (non-invasive)
If faecal calprotectin is raised, what is next investigation?
Colonoscopy
Which type of IBD is a risk factor for gallblabder carcinoma?
UC - due to its association with primary sclerosing cholangitis
Is MS more common in men or women?
Women (typically <50)
What type of disease is MS?
Demyelinating
How can MS present on examination?
- Cerebellar ataxia → wide gait
- Poor coordination
- Optic neuritis
- Eye movement abnormalities e.g. double vision, opthalmoplegia
Give the stepwise management of mild-moderate UC
- Oral mesalazine
- oral prednisolone
- oral tacrolimus
Give the stepwise management of acute severe IBD
- IV corticosteroids
- IV ciclosporin or surgery
What is the main cause of short bowel syndrome?
Surgical resection
What class of drug is given as 2ary prophylaxis of oesophageal varices
Propanolol
What type of IBD are peri-anal fistulas more common in?
Crohn’s
What is a peri-anal fistula?
A peri-anal fistula is an abnormal tract between the anal canal and surface of skin.
Is the most common type of fistula and often appears following an abscess.
What is paralytic ileus?
Neurogenic disruption of the normal peristaltic activity of the bowel
Presentation of paralytic ileus vs mechanical bowel obstruction?
Presentation similar but lack of intestinal movements in paralytic ileus → silent bowel sounds & lack of colicky pain
Risk factors for paralytic ileus?
- Obese
- Anticholinergics
- Opiates
- Operation with bowel handling
- Lack of mobilisation post-operatively
What 2 classes of drugs are a risk for paralytic ileus?
- Opiates
- Antimuscarinics
Which 3 Abx leavesa metallic taste in the mouth?
- clarithromycin
- metronidazole
- tetracycline
What is the 1st line diuretic for ascites in liver cirrhosis?
Spironolactone
What is the investigation of choice to visualise the bile ducts?
MRCP
What malignancy can Schistosomiasis predispose to?
Bladder cancer (squamous cell carcinoma)
Pharmacological agent for acute alcohol withdrawal?
Chlordiazepoxide (benzo) → to reduce withdrawal symptoms e.g. seizures
Pharmacological agent for chronic alcohol use?
Thiamine (B1)
What is haemolytic uraemic syndrome?
HUS is a rare but serious disease that affects the kidneys and blood clotting functions of infected people. Infection with HUS causes destruction of red blood cells, which can then cause kidney failure.
Can present with haemolytic anaemia, AKI, and thrombocytopenia
What infection can HUS occur as a complication of?
HUS occurs as a complication of a diarrhoea infection → usually E. coli due to production of Shiga toxin
Why are patients with chronic liver disease susceptible to hypoglycaemia?
as there is an impairment of the liver’s ability to produce glycogen
What is the definitive investigation for coeliac disease?
duodenal biopsy (healing would be seen after instigation of gluten-free diet)
What 3 drugs can cause cholestatic jaundice?
- Co-amoxiclav
- Flucloxacillin
- Nitrofurantoin
How does digoxin toxicity affect potassium levels?
hyperkalaemia
How can hypokalaemia precipitate digoxin toxicity?
Hypokalaemia can precipitate digoxin toxicity as this increases the Na+/K+ pump due to less competition for digoxin binding
Why is verapamil contraindicated in WPW?
contraindicated in WPW syndrome as they block the AV node and result in impulses from the atria to be passed to the ventricles via the aberrant pathway
How can thiazides affect acid base balance?
Can cause hypokalaemic metabolic alkalosis
What type of valves are known to cause non-immune haemolytic anaemia?
Metallic aortic valves are known to cause non-immune haemolytic anaemia in some cases (due to shear stress against foreign material of valve).
What combination of medications can predispose to complete heart block?
beta blocker + non-dihydropyridine CCB (e.g. verapamil)
Rheumatic fever is a delayed reaction to what infection?
Strep A (most commonly S. pharyngitis)
What is the most common valvular defect following rheumatic heart disease? What murmur does this cause?
Mitral stenosis → mid-diastolic murmur heard over the apex
Pathophysiology of an aortic dissection?
Tear in tunica intima of wall of aorta, creating a false lumen which fills with large volumes of blood
What may be seen on the CXR of a patient with aortic dissection?
Widened mediastinum
Which antiarrhythmic increases the risk of statin-induced rhabdomyolysis?
Amiodarone (class III)
Which artery most likely supplies the AV node?
Right coronary artery
What is heart failure with preserved ejection fraction typically caused by?
ventricular stiffness 2ary to long-standing HTN or ventricular hypertrophy
Describe ECG changes in hypokalaemia
- ST segment depression
- U waves
- Small or absent T waves (occasionally inversion)
Describe ECG changes in hyperkalaemia
- Small or absent P waves
- Tall, tented T waves
- Broad bizarre QRS complexes
Describe the murmur heard in aortic regurgitation
Early diastolic heard in the aortic area (get patient to lean forwards)
Give 2 major causes of aortic regurgitation?
- Infective endocarditis
- Aortic dissection
How do nitrates affect intracellular calcium?
Nitrates cause a decrease in intracellular calcium.
How do NSAIDs affect the anti-hypertensive effects of ACEi?
NSAIDs reduce the anti-hypertensive effects of ACEi.
Combined use of PPIs and thiazide diuretics can lead to which electrolyte abnormality?
Severe hyponatraemia
Which diuretics can predispose to gout?
- Thiazide/thiazide-like
- Loop
Give 3 possible signs seen in PE
- Sinus tachycardia (most common)
- Signs of right heart strain
- T wave inversion in anterior leads
Why does warfarin have a small volume of distribution
protein bound
How do antacids affect the absorption of ACEi?
Reduce
What is Dressler’s syndrome?
A 2ary pericarditis that usually occurs 1-6 weeks post MI
Management of Dressler’s?
High dose aspirin
Stepwise management of SVT?
- Vagal manoeuvres
- Verapamil
- Adenosine (if no contraindications e.g. asthma)
What is P pulmonale? What condition does it indicate?
A tall, peaked p wave on an ECG trace - reflects right atrial enlargement seen in cor pulmonale
Oral hypoglycaemics vs insulin in DKA
Oral hypoglycaemic drugs (e.g. sulfonylureas) class of drugs) have no role in the treatment of DKA.
Insulin is the mode of treatment.
Which ECG leads represent the lateral view of the heart?
V5-6
What class of medication is amiloride?
K+ sparing diuretic
How will the INR be affected in liver damage?
Raised - due to reduced clotting factors (blood will clot more slowly)
How does levofloxacin affect the P450 system?
It is an enzyme inhibitor
How does the body correct acidosis if kidney function is poor?
Hyperventilation
What is the most common cause of clubbing?
Lung cancer
What is a dermoid cyst?
Dermoid cysts occur when tissue collects under the skin and may contain hair, teeth or nerves. The often form on your head and neck.
What is a sebaceous cyst also known as?
Epidermoid cyst
What is an epidermoid cyst?
Sebaceous cysts fill with sebum and form within sebaceous glands, which are part of the skin and hair follicles. They often have a ‘punctum’ (small dark-coloured comedone opening on the surface).
Which cyst has a ‘punctum’?
Epidermoid
What GI disease can show discrete areas of inflammation in the bowel with a nodular cobblestone appearance?
Crohn’s disease
What is atrial dilatation commonly associated with?
Pressure and/or volume overload e.g. HTN, mitral valve dysfunction
What arrhythmia is atrial dilatation associated with?
AF
What is the likely site of pathology if there is sudden loss of vision in the left visual field of both eyes but central vision is good?
Right occipital lobe → occipital lobe lesions cause homonymous hemianopia with macular sparing
Who’s duty is it to issue the MCCD (medical certificate for confirmation of death)?
the doctor who has attended in the last illness to issue the MCCD i.e. a doctor who has cared for the patient during the illness that led to death and is familiar with their PMH.
If no doctor who cared for the patient can be found, who is the death referred to?
Coroner
Within how many days prior to death must the doctor have see the patient to issue the MCCD?
28
What lung condition is being a heating engineer a risk factor for?
asbestos
What is a seroma?
A seroma is a build-up of clear fluid inside the body that happens most often after surgery. Seromas typically appear 7-10 days after surgery when drainage tubes have been removed.
How long after surgery does lymphoedema develop
Within 3 years
What type of anaemia do blood thinners increase your risk of?
Iron-deficiency anaemia
Presentation of ischaemic colitis?
GI bleeding
Severe abdominal pain
Which Abx is indicated in Giardia?
Metronidazole
What risk factor can 15% of OA cases be directly traced back to?
injury e.g. fractures, breaks
What is fibromyalgia?
Fibromyalgia is a condition that causes widespread pain and extreme tiredness. It can also cause sleep, memory and mood issues. It can start after a stressful event like an injury, illness, or death of a loved one.
How does excess ADH affect plasma sodium?
Causes hyperkalaemia
What is Sjogrens syndrome?
Sjögren’s syndrome is a condition that affects parts of the body that produce fluids, like tears and spit (saliva).
What condition is Sjogren’s syndrome associated with?
Rheumatoid arthritis
Ocular manifestations of myasthenia gravis?
Ocular myasthenia gravis only affects the muscles that move the eyes and eyelids.
Symptoms include double vision trouble focusing, and drooping eyelids (symptoms worse later in day).
WHhat is the most common tumour of the cerebellopontine angle?
Acoustic neuroma
What is an acoustic neuroma? What are the most common presenting complaints?
It is a benign tumour that develops on the vestibular or cochlear nerves. The most common presenting symptoms are unilateral hearing loss, tinnitus and imbalance.
What is vestibular neuronitis?
A disorder characterised by sudden onset attacks of vertigo and nystagmus caused by inflammation of the vestibular nerve.
Hearing is NOT affected.
What does vestibular neuronitis typically follow?
Viral URTI
Which 2 CCBs can cause bradycardia
Non-dihydropyridine calcium-channel blockers → diltiazem and verapamil
Which 2 drug classes should not be used together due to risk of bradycardia/arrest?
Beta blockers + non-dihydropyridine CCBs
How does fludrocortisone increase BP?
Fludrocortisone works to increase BP in postural hypotension by retaining sodium which can lead to water retention and swelling.
Which scan is used to assess the risk of fractures?
DEXA bone density scan
What vitamin deficiency are associated with reduced muscle strength?
Vitamin D → Low serum levels of vitamin D are associated with reduced muscle strength which can lead to muscle atrophy. Back pain can also be a symptom of low vitamin D levels.
Best imaging for bony mets?
MRI
What imaging modality is 1st line in assessing the extent of spinal trauma?
CT scans
What combination of medications can lead to complete heart block?
beta blocker + non-dihydropyridine CCB (e.g. verapamil)
ECG features in SVT vs VT
SVT:
- Absent p waves
- Ventricular rate >100
- Regular rhythm
- Narrow QRS complexes
VT:
- Regular rhythm
- Wide QRS of equal amplitude (monomorphic)
- Absent p waves
Explain the FEV1/FVC ration in restrictive lung disease
Reduced FVC and FEV1 resulting in a normalised FEV1/FVC ratio
What type of cancer are most Pancoast tumours?
NSCLC - most commonly squamous cell cancers
SCLC can cause SIADH. How may this present?
Hyponatraemia → headache, drowsiness, seizures, coma
How does sodium affect seizures?
Low sodium → increased risk of seizures
What does high bicarbonate in a hypercapnic patient indicate?
Chronic retention of COPD
The diagnosis of T2DM depends on whether the patient is symptomatic or not. If the patient is symptomatic, what is required for diagnosis?
only one positive HbA1c, fasting glucose, or random glucose is needed for diagnosis
The diagnosis of T2DM depends on whether the patient is symptomatic or not. If the patient is asymptomatic, what is required for diagnosis?
two separate readings are required for diagnosis (NICE recommends the same modality that was used for the original test is used e.g. 2x separate HbA1c readings)
How does hypocalcaemia present?
paraesthesia, muscle spasms, seizures
What is the most common type of thyroid cancer?
Papillary thyroid cancer (80%) → occurs more frequently in females
