Question practice Flashcards
1
Q
Oral bisphosphonates side effect
A
Oesophagitis
2
Q
Acne management
A
- Single topical therapy (topical benzyl peroxide or retinoid)
- Topical combination (topical antibiotic, benzoyl peroxide, topical retinoid)
- Oral antibiotics - Tetracyclines (doxycycline)
-Erythromycin if pregnant - Oral isotretinion
If female, consider COCP
3
Q
Lateral medullary syndrome px
A
Cerebellar signs - DANISH
Contralateral sensory loss
Ipsilateral Horner’s
Due to PICA lesion
4
Q
Angina Mx:
A
All should have Aspirin & GTN PRN
- B-blocker or rate-limiting CCB (verapamil or diltiazem)
- B-blocker + dihydropyridine CCB (amlodipine, modified-release nifedipine)
If on monotherapy and can’t add b-blocker or CCB -> Either:
- Long acting nitrate
- Ivabradine
- Nicorandil
- Ranolazine
5
Q
AF management
A
<48h:
Anti-coagulate + DC cardioversion (within 48h)
- Amiodarone if structural heart disease
> 48h:
Anti-coagulate for 3 weeks then cardioversion
6
Q
UTI Mx if pregnant
A
Nitrofurantoin
Amoxicillin if near term
Avoid trimethoprim (teratogenic)
7
Q
What are steps in paeds ABCDE of unresponsive patient?
A
- Shout for help
- Open airway
- Look, listen, feel for breathing
- Give 5 rescue breaths
- Check for signs of circulation (infants use brachial or femoral pulse, children use femoral pulse)
- 15 chest compressions:2 rescue breaths (see above
8
Q
What antibiotic for MRSA?
A
IV vancomycin
9
Q
Mx for Bowen’s disease
A
Topical 5-fluorouracil
10
Q
What is a Colles fracture
A
Distal radius fracture with dorsal displacement
11
Q
What is a monteggia fracture?
A
Ulnar fracture + dislocation of proximal radioulnar joint
12
Q
Rosecea Mx
A
PRN Brimonidine to reduce redness
Mild-to-moderate -> topical ivermectin
- Alternative is oral metronidazole or azelaic acid
Moderate-to-severe -> topical ivermectin + oral doxycycline
13
Q
S1 nerve root compression
A
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
14
Q
Most common bacterial exacerbation in COPD?
A
Haemophilus influenzae
15
Q
Most common bacterial cause of acute epiglottis?
A
Haemophilus influenza type B
16
Q
Most common bacterial cause of otitis externa in a swimmer?
A
Pseudomonas aeruginosa
17
Q
Myeloma pneumonic?
A
C - hyperCalcaemia
R - Renal damage -> thirst, dehydration
A - Anaemia
B - Bleeding -> thrombocytopenia
B - Back pain
I - Infection susceptibility
18
Q
Urine osmolality in cranial and nephrogenic diabetes insipidus after water deprivation test and desmopressin?
A
Cranial - low urine osmolality after fluid deprivation but high after desmopressin
Nephrogenic - low urine osmolality after fluid deprivation and after desmopressin
19
Q
Types of melanoma?
A
- Superficial spreading
- Nodular
- Lentigo maligna
- Acral lentiginous
20
Q
Pulmonary embolism first line drug?
A
DOAC - apixiban or rivaroxaban for at least 3 months
21
Q
Paraneoplastic features of lung cancers?
A
Small cell -> ADH, ACTH, Lambert-Eaton syndrome
Squamous cell -> PTH-related protein causing hypercalcaemia, clubbing, HPOA, hypertension due to ectopic TSH
Adenocarcinoma -> Gynaecomastia, hypertrophic pulmonary osteoarthropathy (HPOA)
22
Q
Mx of aortic aneurysms dependant on size?
A
<4.5cm (small) -> 12 monthly assessment
4.5 - 5.4 (medium) -> 3 monthly assessment
>5.4 (large) -> urgent referral
23
Q
Most common drugs to cause acute interstitial nephritis?
A
Penicillin
Rifampicin
NSAIDs
Allopurinol
Furosemide
24
Q
Types of emergency contraception?
A
Levonorgestrel - within 72h
Ulipristal - within 120h (avoid if asthmatic)
IUD - within 5 days
25
Neutropenic sepsis mx
Immediate antibiotics (piperacillin with tazobactam)
26
SSRI side effect in pregnancy?
First trimester -> congenital heart defects
Third trimester -> persistant pulmonary hypertension
27
What does the circumflex coronary artery supply?
Left atrium
Posterior aspect of the left ventricle
28
What does the left anterior descenidng artery supply?
Anterior aspect of the left ventricle
Anterior aspect of the septum
29
Artery, heart area and ECG leads?
Left coronary artery - anterolateral - I, aVL, V3-6
Left anterior descending - anterior - V1-4
Circumflex - lateral - I, aVL, V5-6
Right coronary artery - inferior - II, III, aVF
30
Secondary prevention of M.I? (6 A's)
6 A's:
- Aspirin
- Another Antiplatelet (Ticagrelor or Clopidegrel)
- Atorvostatin
- ACEi
- Atenolol (b-blocker)
- Aldosterone antagonist
31
Management of Raynaud's?
Dihydropyridine CCB - Nifedipine
32
Scaphoid fracture - Px, Mx and main complication?
Px - Tenderness in anatomical snuffbox
Mx - Plaster for 10 days then further x-rays
Complication - Avascular necrosis
33
Initial mx in SVT and VT?
SVT:
1. vagal manouvere
2. Adenosin
VT:
Stable -> IV amiodarone
Unstable -> DC cardioversion
34
Rome criteria of IBS?
2 or more of following, at least one day per week in last 3 months:
- Related to defecation
- Associated with change in stool frequency
- Associated with change in stool appearance (form)
35
Mitral stenosis px
- Malar flush
- Tapping apex beat
- Mid-diastolic murmur
- AF
36
Hyperaldosteronism px?
- Hypertension
- Hypokalaemia -> muscle weakness
- Metabolic alkalosis
37
Causes of hyperaldosteronism
Primary:
- Bilateral adrenal hyperplasia
- Adrenal adenoma secreting aldosterone (Conn's syndrome)
- Familial
Secondary:
- Renal artery stenosis
- Heart failure
- Liver cirrhosis and ascites
38
Ix of hyperaldosteronism in primary and secondary?
Ix - Aldosterone to renin ratio (ARR)
Primary - high aldosterone and low renin
Secondary - high aldosterone and high renin
38
Ix of hyperaldosteronism in primary and secondary?
Ix - Aldosterone to renin ratio (ARR)
Primary - high aldosterone and low renin
Secondary - high aldosterone and high renin
39
Mx of hyperaldosteronism?
Aldosterone antagonists:
- Eplerenone
- Spironolactone
+ underlying cause
40
Drug which slows ADPKD progression?
Tolvaptan - vasopressin receptor 2 antagonist
41
Why do we do a CT in dermatomyositis workup?
Because it is a common paraneoplastic manifestation
42
Nephoritc or nephritic?
- Membranous glomerulonephrtiis
- IgA nephropathy
Membranous glomerulonephritis - nephrotic
IgA nephropathy - nephritic
43
First line drug in diabetic patient with hypertension?
ACEi or ARB
- ARB if african-caribbean
44
First line drugs in neuropathic pain? (4)
Amitriptyline, Duloxetine, gabapentin or pregabalin
45
Indications for spironolactone?
Ascites
Hypertension (step 4)
Heart failure
Nephrotic syndrome
Conn's syndrome
46
What type of drug is desmopressin?
Vasopressin V2 receptor agonist (synthetic ADH)
47
What drug can be used in ADPKD?
Tolvaptan (vasopressin receptor 2 antagonist)
48
Initial Ix for polycystic kidney disease?
Ultrasound scan
49
Haemoptysis + AKI / proteinuria / haematuria?
Goodpasture's syndrome (anti-GBM disease)
50
What is type 1 respiratory failure and ABG result?
Hypoxia without hypercapnia (low pO2 and low/normal pCO2)
Respiratory alkalosis if CO2 decreases
51
What is type 2 respiratory failure and ABG result?
Hypoxia with hypercapnia (low O2 and high pCO2)
Respiratory acidosis
52
Difference between IgA nephropathy and post-streptococcal glomerulonephritis?
IgA nephropathy - 1-2 days after infections
Post-streptococcal glomerulonephritis - 1-2 weeks after infection
53
Drug used to maintain remission of Crohn's disease?
1. Azathioprine or mercaptopurine
2. Methotrexate
3. Surgery (80% receive)
54
SSRI + NSAID s/e?
G.I bleed risk
-> give PPI
55
What antidepressant if on warfarin or heparin?
Avoid but consider mirtazapine
56
Most common organism in bronchiectasis?
Haemophilus influenza
57
Antibiotic for legionella?
Macrolides - Clarithromycin
58
Antibiotic for pneumocystis jiroveci pneumonia?
Co-trimoxazole
(mix of trimethoprim and sulfamethoxazole)
59
Motor neuron disease with only upper motor neuron symptoms?
Primary lateral sclerosis
60
Difference between Grade 1 and Grade 2 haemorrhoids and their Mx?
Grade 1 haemorrhoids:
Internal haemorrhoids which do not prolapse on straining
Mx - topical corticosteroids.
Grade 2 haemorrhoids:
Internal haemorrhoids which prolapse on straining, but spontaneously reduce
Mx - rubber band ligation, sclerotherapy, or infrared photocoagulation
61
Sign of psoriatic arthritis?
Known psoriasis
Nail pitting
Onycholysis
Dactylitis -
Enthesitis
62
Antibiotic for suspected meningitis in a baby?
<3mo - cefotaxime + amoxicillin / ampicillin
>3mo - Cefotaxime or Ceftriaxone
63
Infarction of what coronary vessel associated with heart block?
Right coronary artery supplies the AV node
64
Management of major bleeding on warfarin?
Stop warfarin
Give IV vitK 5mg
Give prothrombin complex concentrate
65
Chronic heart failure Mx?
1. ACEi + b-blocker (one started at a time)
2. Aldosterone antagonist (eplerenone) or SGLT2i
3. Options include:
- Sinus rhythm >75 & LVEF <35 % -> Ivabradine
- LVEF < 35% -> Sacubitril-valsartan
- Afro-Caribbean -> Hydralazine + nitrate
- Co-existant AF -> Digoxin
LVEF = Left ventricular ejection fraction
66
Mx of tension pneumothorax?
Immediate large bore (14G or 16G) inserted into the second intercostal space mid-clavicular line
67
When to consider adjuvant dexamethasone in menignitis?
In pneumococcal meningitis
Avoid if:
- Septic shock
- Meningococcal septicaemia
- Immunocompromised
- Following surgery
68
What does a decrease in haptoglobin indicate?
Intravascular haemolysis
69
Lynch syndrome causes?
Colon cancer
Endometrial cancer
70
Drug Mx for heart failure with reduced ejection fraction in patient with no symptoms (NYHA 1)?
ACEi
71
Drug change in patient who develops gynaecomastia from spironolactone?
Eplerenone
72
What heart failure drugs are bad if renal impairment?
ACEi, ARB
Spironolactone
73
When are rate-limiting CCB contraindicated?
Heart failure
Severe bradycardia
Second- or third-degree atrioventricular block
74
What kind of drug is nicorandil?
Potassium channel activator
Used in anigna
75
Ulcerative colitis severity & numer of stools?
<4 stools a day = Mild
4 - 6 stools = Moderate
>6 stools a day, with blood = Severe
76
Ix of Lyme disease
Enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi are the first-line test
77
Mx of suspected / confirmed Lyme disease?
1. Doxycycline
2. Amoxicillin (if pregnant)
Disseminated disease -> ceftriaxone
78
'Halo sign' seen on mammography of breast?
Breast Cyst
79
First-line mx for generalised anxiety disorder?
Sertraline
80
Amount of protein for exudative vs transudative pleural effusion?
Exudative = >30g/L
Transudative = <30g/L
81
Drugs which commonly cause urticaria? (4)
Aspirin
Penicillin
NSAIDs
Opiates
82
What type of resections for rectum cancer?
1. Anterior resection
2. Abdominoperineal resection if invades pelvic floor, anal canal or anal sphincter
83
MRI with or without contrast for M.S?
MRI with contrast
84
Insect bite causing a skin lesion?
Dermatofibroma
85
What is pituitary apoplexy?
Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction
86
Mx of pituitary apoplexy?
IV steroids
(due to loss of ACTH)
87
Drugs for Oestrogen receptor positive breast cancer?
Pre- or peri- menopause -> Tamoxifen
Post-menopasual -> Anastrozole
88
Drug for HER2+ breast cancer?
Herceptin (trastuzumab)
89
Causes of erythema nodosum? (5)
Infection - streptococci, tuberculosis, brucellosis
Systemic disease - sarcoidosis, IBD, Behcet's
Malignancy/lymphoma
Drugs - penicillins, sulphonamides, COCP
Pregnancy
90
Mx of non-falciparum malaria? (Plasmodium vivax or Plasmodium ovale)
Artemisinin-based combination therapy (ACT) or Chloroquine
+
Primaquine following acute mx (destroy liver hypnozoites and prevent relapse)
Avoid ACT if pregnant
91
Features of PTSD? (4)
- Re-experiencing
- Avoidance
- Hyper-arousal (exaggerated startle response)
- Emotional numbing
92
What are gliptins?
DPP-4 inhibitors - these reduce the peripheral breakdown of incretins such as GLP-1
93
Causes of steven-johnson syndrome?
penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
94
Blood-film of sideroblastic anaemia?
Basophilic stippling of red blood cells
95
Three features of Meig's syndrome?
- A benign ovarian tumour
- Ascites
- Pleural effusion
96
Difference between schizoid and schizotypical personality disorder?
Schizoid = Cold-personality, doesn't want friends
Schizotypal = Crazy, delusions, no-one wants to be their friend
97
Mx of P.E?
Stable - LMWH
Unstable - Thrombolyse
98
What can alpha-blockers be prescribed for?
BPH
Hypertension
99
Bone lesions and type of metastasis?
(Sclerotic vs Lytic)
Prostate = sclerotic / blastic (induces bone growth)
Breast = mixed pattern
Kidney, thyroid, lung = lytic
100
Mx of anterior uveitis?
Urgent opthamology review
Steroid and cycloplegic (mydriatic) eye drops
101
Immunofluorescence reveals IgG and C3 at basement membrane
Bullous pemphigoid
102
What antibiotic to avoid in congenital long QT syndrome?
Clarithromycin
103
What antibiotic should be avoided with methotrexate?
Trimethoprim
(include co-trimoxazole)
104
Mx of tumour lysis syndrome?
IV allopurinol or IV rasburicase
105
Px of tumour lysis syndrome?
2-3 days after chemo
AKI
High potassium, high phosphate, high uric acid, low calcium
106
Findings at 12 weeks scan suggesting trisomy 21?
↑ HCG, ↓ PAPP-A, thickened nuchal translucency
107
Mx of acute haemolytic transfusion reaction
Stop the transfusion and give IV fluids
108
Drug to reduce the rate of CKD progression in ADPKD
Tolvaptan
109
Mx of non-haemolytic transfusion reaction?
Slow or stop infusion + paracetamol
110
How to differentiate between haemolytic and non-haemolytic transfusion reaction
Haemolytic = hypotension
Non-haemolytic = normal BP
111
Malignant hyperthermia management?
IV dantrolene
112
HPV involves in genital warts and cervical cancer?
Genital warts - 6 & 11
Cervical cancer - 16 & 18
113
When is metformin contra-indicated?
eGFR < 30
CKD 4 or CKD 5
114
Mx of bloody diarrhoea with a fever?
Ciprofloxacin
115
Muddy brown granular casts on urinalysis and microscopy?
Acute tubular necrosis
116
Contraindication for bisphosphonates?
If eGFR < 35
117
What hypertension mx is contra-indicated in gout?
Thiazide-like diuretic
118
Mx of Lice and scabies?
Lice - Malathion
Scabies - Permethin
119
When can different emergency contraceptions be taken til?
Levonorgestrel - 72 hours
Ulipristal - 120 hours
IUD - 5 days, or 5 days from predicated ovulation
120
When can different emergency contraceptions be taken til?
Levonorgestrel - 72 hours
Ulipristal - 120 hours
IUD - 5 days, or 5 days from predicated ovulation
121
Where is iron, folate and B12 absorbed?
Iron - Duodenum
Folate - Jejunum
B12 - Ileum
Dude I Just Feel Ill Bro
122
Difference between high and low pressure chronic urinary retention?
High pressure:
- Presence of hydronephrosis
- Impaired renal function
Low pressure = none of above
123
Bacterial keratitis in contact lens wearer?
Pseudomonas aeruginosa
124
Investigation of achalasia and pharyngeal pouch?
Achalasia -> Oesophageal manometry testing
Pharyngeal pouch -> Barium swallow with fluoroscopy
125
Factors associated with increased risk of placental abruption?
Maternal trauma
Multiparity
Increased maternal age
126
Drug to lower phosphate?
Sevelamer
(this is a non-calcium based phosphate binder)
127
Threadworms micro name?
Enterobius vermicularis
128
Mx of two consecutive inadequate cervical smears?
Colposcopy
129
What is syringomyelia?
CSF collection in the spinal cord
Due to:
- Chiari malformation: strong association
- Trauma
- Tumours
- Idiopathic
130
Px of syringomyelia?
Cape-like (neck, shoulders & arms) loss of sensation to temperature but other senses are normal
Burn hands without realising
131
Ix of syringomyelia?
MRI spine with contrast (exclude tumour or tethered cord)
+
MRI brain (look for Chiari malformation - strong association)
132
Mx of aortic stenois?
Asymptomatic -> observe
Asymptomatic but valvular gradient >40mmHg or LVSD -> replace
Symptomatic -> replace
133
Mx of baby GORD?
1. Advice
- 30 degrees head up for feeds
- Small and more frequent feeds
- Trial thicker feeds
2. Trial Alginate (Gaviscon)
3. PPI if either:
- Distressed behaviour
- Difficulty feeding
- Faltering growth
134
Nifedipine s/e?
Peripheral vasodilation -> reflex tachycardia
135
What is diaphoresis?
Excessive and abnormal sweating
136
Glaucoma Ix?
Slit lamp - Corneal oedema?
Tonometry - Measures Intra-ocular pressure
Gonioscopy - Differentiates between acute and chronic open glaucoma
137
What is the Synacthen test used in?
Ix for Addison's disease
ACTH stimulation test to see if cortisol levels rise
138
Hypo or hyper-natraemia in SIADH?
Hyponatraemia
Excess ADH release -> More water reabsorption -> dilute plasma -> hyponatraemia
139
Affect of ramipril and salbutamol on potassium levels?
Ramipril -> hyperkalaemia
Salbutamol -> hypokalaemia
140
What does each zone of the adrenal gland secrete?
Zona glomerulosa -> aldosterone
Zona fasciculata -> cortisol
Zona reticularis -> androgens
141
Gold standard test for pheochromocytoma?
Elevated plasma free metanephrines
(higher sensitivity and specificity than 24-hour urinary metanephrines)
142
Aldosterone-to-renin ratio in primary and secondary hyperaldosteronism?
Primary - High aldosterone and low renin
Secondary - High aldosterone and high renin
143
What is Rocker-bottom feet seen in?
Edward syndrome (trisomy 18)
144
Anti-platelet after ischemic stroke?
Aspirin 300mg daily for two weeks
Followed by clopidogrel 75mg daily lifelong
If clopidogrel unsuitable -> Modified-release dipyridamole (200 mg twice a day) should be prescribed with combined with aspirin 75 mg
145
Absolute contra-indications to laparoscopic surgery?
- Haemodynamic instability/shock
- Raised intracranial pressure
- Acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm)
- Uncorrected coagulopathy
146
Ix for osteomyelitis?
MRI
(Better than biopsy)
147
First-line mx of T2DM with eGFR<30?
Sulphonylurea (gliclazide)
148
Why is urea important in G.I bleed?
High urea levels indicate an upper GI bleed over lower GI bleed
149
What is Ca15-3 a tumour marker for?
Breast cancer
150
Anaemia due to methotrexate?
Megaloblastic macrocytic anaemia secondary to folate deficiency due to methotrexate
151
Mx of a UTI of a pregnant women close to term?
Cefalexin or amoxicillin
152
What is Ebstein's anomaly?
Low insertion of the tricuspid valve resulting in a large atrium and small ventricle
Often caused by lithium in utero
153
Genital herpes Ix?
Nucleic acid amplification tests (NAAT) on swab
154
Ix for post-streptococcal glomerulonephritis?
raised anti-streptolysin O titres
155
Chest pain + neurological symptom?
Dissection
- Carotid or Aortic
156
Ix for pancreatic cancer?
High resolution CT scan
157
Dx of very unwell patient with low platelets and schistocytosis?
Thrombotic thrombocytopenic purpura (TTP)
158
How to differentiate alopecia areata from tinea capitus?
Alopecia areata has no skin changes at hair loss
Tine capitus has skin changes at hair loss
159
Isoniazid from TB mx side effect?
Peripheral neuropathy
160
What CCB causes ankle oedema?
Dihydropyridine calcium channel blockers
161
Phaeochromocytoma initial Mx?
Alpha-blocker (e.g. phenoxybenzamine),
Then a beta-blocker (e.g. propranolol)
162
What hypertension drugs are contra-indicated in pregnancy?
ARBS
ACEi
-> cause fetotoxicity
163
Vitamin B3 deficiency cause?
Pellagra - dermatitis, diarrhoea, dementia
Vitamin b3 is also called niacin
164
When should aspirin be given from 12 weeks in pregnancy?
History of hypertension in previous pregnancy
CKD
Diabetes (T1 or T2)
Autoimmune disease (SLE or Anti-phospholipid syndrome)
165
cANCA condition?
Granulomatosis with polyangiitis
166
pANCA conditions?
Eosinophilic granulomatosis with polyangiitis (Churg-strauss syndrome)
Microscopic polyangiitis
Others:
Ulcerative colitis (70%)
Primary sclerosing cholangitis (70%)
Anti-GBM disease (25%)
Crohn's disease (20%)
167
Extended and abducted shoulder dislocation?
Anterior
168
Flexed and adducted shoulder dislocation?
Posterior
169
What is Erb's palsy?
C5/C6 injury (upper trunk) -> 'waiter's tip'
Cause - shoulder dystocia, fall on shoulder
170
What is Klumpke's palsy?
Lower brachial nerve palsy (C8-T1)
171
Bile acid malabsorption drug?
Cholestyramine
172
Secondary prophylaxis of hepatic encephalopathy?
Lactulose + rifamixin
173
Contra-indication to triptan use?
Ischaemic heart disease / CVD disease
174
What is mycoplasma pneumoniae associated with?
Erythema multiforme
175
Mx of paediatric faecal impactation
1. Macrogol laxative - Movicol + polyethylene glycol
2. + stimulant if no response in 2 weeks
