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Year 4 Medical School > Questions on all medical specialities > Flashcards

Questions on all medical specialities Flashcards

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USMLE® Step 1 flashcards
1
Q

Age of diagnosis of peri-menopause or menopause in women with typical symptoms without investigations?

A

A diagnosis of peri-menopause and menopause can be made in women over 45 years with typical symptoms, without performing any investigations.

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2
Q

Classic triad of Vasa Praevia

A

The classic triad of vasa praevia is **rupture of membranes ** followed by painless vaginal bleeding and fetal bradycardia

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3
Q

Causes of papilloedema

A

space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
HYPERcapnia

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4
Q

normal pressure hydrocephalus - triad of?

A

Urinary incontinence + gait abnormality + dementia

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5
Q

indications for immediate CT head?

A
  • GCS < 13 on initial assessment
  • GCS < 15 at 2 hours post-injury
  • suspected open or depressed skull fracture
  • any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
  • post-traumatic seizure.
  • focal neurological deficit.
  • more than 1 episode of vomiting
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6
Q

Mx otitis externa

A

Oral ciprofloxacin + dexamethasone

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7
Q

Myotome for plantar flexion (gastrocnemius)

A

S1

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8
Q

myotome for dorsiflexion (tib anterior)

A

L5

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9
Q

myotome for knee extension (quad fem)

A

L4

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10
Q

myotome for hip flexion (iliopsoas)

A

L2

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11
Q

myotome for finger abduction

A

T1

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12
Q

myotome for finger flexion

A

C8 (FDS)

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13
Q

myotome for elbow extension (triceps)

A

C7

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14
Q

myotome for elbow flexion (biceps)

A

C6

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15
Q

myotome for shoulder abduction (deltoid)

A

C5

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16
Q

S1 dermatome area

A

Heel

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17
Q

L5 dermatome area

A

Dorsum (top) of foot

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18
Q

L4 dermatome area

A

medial malleolus (lots of L’s)

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19
Q

L1 dermatome area

A

Inguinal Ligament (remember L1 = L1gament)

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20
Q

T10 dermatome area

A

belly-butTEN - belly button area

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21
Q

T7 dermatome area

A

Xiphoid process

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22
Q

T4 dermatome area

A

nipple area (“teet 4”)

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23
Q

C8 dermatome area

A

pinky

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24
Q

C7 dermatome area

A

Middle finger (C7= “no heaven” i.e. go to hell)

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25
Q

C6 dermatome area

A

thumb

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26
Q

C5 dermatome area

A

lateral shoulder including regimental patch

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27
Q

C4 dermatome area

A

Collar

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28
Q

Combined oral contraceptive pill - increased/reduced risk of which cancers?

A

increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer

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29
Q

ACUTE ASTHMA CLASSIFICATION - what is the PEFR in each grade of exacerbation?

moderate
severe
life-threatening

A

moderate - PEFR 50-75%
severe - PEFR 33-50%
life-threatening - PEFR <33%

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30
Q

Most commonly affected valve in infective endocarditis?

A

MITRAL

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31
Q

Main differences between Serotonin syndrome and NMS

A

Serotonin syndrome - presents over hours, CK rarely raised, caused by SSRIs, MAOi

NMS - presents over days, raised CK, caused by antipsyhoctics

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32
Q

Diagnosis of chalmydia

A
  1. Nucleic acid amplification tests (NAATs) e.g. PCR, TMA - more sensitive & less demanding
  2. Urine - first void urine sample ( first 15-20 ml of urine passed after holding urine > 1 hour). Sensitivity ~ 96% in men but only ~ 86% in women. Urine sample first line in men.

Self-collected low vaginal / introital swab OR Rectal/ pharyngeal /eye swabs fir NAAT testing. Vulvovaginal swab first line in women.

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33
Q

Mx multiple sclerosis

A
  1. disease-modifying drugs and biologic therapy
  2. Treat relapses with Methylprednisolone
  3. Symptomatic - treat neuropathic pain with amitriptyline or gabapentin, depression with SSRIs, urge incontinence with anticholinergics like oxybutynin, spasticity with baclofen
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34
Q

Treatment in Alzheimer’s disease

A

1st line for mild/moderate - Donepazil, galatamine or rovastigmine

2nd line for mild/moderate OR 1st line in severe - Memantine

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35
Q

Bronchiolitis

  • most common virus
  • Ages affected
  • 2 main symptoms
  • management
A
  • RSV
  • Most common up to age 1 year, can rarely occur up to age 2 years
  • Sx Respiratory distress, apnoeas
  • Mx is Supportive - ensure adequate intake, nasal saline drops, nasal suctioning, O2 if SPO2 < 92% and ventilatory support if required
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36
Q

Croup

  • most common virus
  • management
A

Parainfluenza virus.

first line - oral dexamethasone and oxygen. if not responding then nebulised adrenaline and budesonide. if still not responding then intubate and ventilate.

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37
Q

Mx Anterior Uveitis

A

steroids (any route) - first line
cycloplegic-myadriatic eye drops - first line
DMARDs and TNF inhibitors
Severe cases - Laser therapy, cryotherapy or surgery (vitrectomy)

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38
Q

Antibodies found in:

PSC
Autoimmune hepatitis
Dermatomyositis
SLE

A

Anti-mitochondrial → PSC
Anti-Smooth Muscle → autoimmune hepatitis
Anti-MI-2 and Anti-Jo-1 → dermatomyositis
ANA → SLE and others

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39
Q

Reversal of the following anticoagulation:

  1. Rivaroxaban and apixaban
  2. Dabigatran
  3. Warfarin
  4. Heparin
A

andexanet alfa
Idarucizumab
Prothrombin Complex (PCC)
Protamine sulphate

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40
Q

Difference between Labyrinthitis and Neuronitis?

A

Labyrinthitis -> Loss of hearing
Neuronitis -> No loss of hearing

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41
Q

Budd-Chiari syndrome:
Triad of symptoms
Causes
Investigations

A

Sx - sudden onset abdominal pain, ascites, and tender hepatomegaly.

Causes - Polycythemia, thrombophilia, APS, pregnancy, COCP

Ix - Ultrasound with Doppler flow

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42
Q

Duke’s criteria for infective endocarditis

A
  1. Major criteria - +ve blood culture for infective organisms on 3 sets of blood cultures + signs on ECHO
  2. Minor criteria:
    predisposing heart condition or IV drug use
    microbiological evidence does not meet major criteria
    fever > 38ºC
    vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
    immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots

Scores

IE definitely present:
2 major criteria present OR
1 major criteria, 3 minor criteria OR
5 minor criteria

IE possibly present:
1-4 minor criteria AND
No other more likely diagnosis

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43
Q

Treatment of H.pylori

A

Eradication may be achieved with a 7-day course of:
a proton pump inhibitor + amoxicillin + (clarithromycin OR metronidazole)
if penicillin-allergic: a proton pump inhibitor + metronidazole + clarithromycin

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44
Q

oliguria is defined as

A

a urine output of less than 0.5 ml/kg/hour

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45
Q

ECG features of hypokalaemia

A

Tall P waves
Flattened T waves
ST depression
Prominent U waves

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46
Q

Clostridium difficile infection - treatment for:

a. First episode

b. Recurrent episode

c. Life-threatening

A

A. First episode - ORAL vancomycin 10 days

B. Recurrent - ORAL fidaxomicin

C. Life-threatening - ORAL vancomycin and IV metronidazole

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47
Q

T2DM drugs causing:

  • weight gain
  • weight loss
  • weight neutral
A

Weight gain - insulin, glitazones, sulfonylureas

Weight loss - GLP-1 mimetics (exenatide), SGLT2 inhibitors (Dapagliflozin)

Metformin and DPP4 inhibitors (sitaglipptin) are weight neutral

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48
Q

ABPI readings and their meaning

A

Vessel calcification: >1.4
Normal: 1.0 -1.4
Acceptable: 0.9 -1.0
Some arterial disease: 0.8 -0.9
Moderate arterial disease: 0.5 -0.8
Severe arterial disease: <0.5

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49
Q

Hip fractures - management by

  1. Type of #
  2. Classification (name and type)
A
  1. Intracapsular (much more serious as femoral head > need to replace the joint) > GARDEN CLASSIFICATION ONLY FOR INTRACAPSULAR FRACTURES

> Undisplaced - Cannulated screw or hemiarthroplasty > “GARDEN 1 AND 2 SCREW”

> Displaced - total hip replacement or hemiarthroplast > “GARDEN 3 AND 4 REPLACE”

  1. Extracapsular (only need to fix the bone parts in place, dont need to replace the whole joint)

> Trochanteric - dynamic hip screw (can slide)

> Subtrochnteric - intramedullary device (fixed in place)

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50
Q

in which 3 organs does MEN-1 manifest its tumours in?

A

Parathyroid: hyperplasia/adenomas
Pancreas: gastrinoma, insulinoma
Pituitary: prolactinoma

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51
Q

in which 4 organs does MEN-2 manifest its tumours?

A

MEN-2a - Parathyroid: hyperplasia/adenomas

MEN-2b - Mucosal neuromas

Both MEN2a and MEN2b:

Thyroid: medullary thyroid cancer

Adrenal: pheochromocytoma

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52
Q

Differentials of Sudden Loss of Vision by cause

A

Retinal/vitreous - Retinal detachment, posterior vitreous detachment, vitreous haemrrhage

Optic nerve damage - GCA, CRVO, CRAO, Amaurosis fugax, Ischaemic optic neuropathy

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53
Q

what is the key diagnostic investigation for NEC in neonates/infants?

A

AXR

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54
Q

which type of lung cancer/tumour is associated with asbestos exposure?

what are the 2 other main types of lung cancer and their subtypes?

A

Asbestos -> mesothelioma

Small cell (20%) Vs non-small cell (80%)

Non-small cell -> adenocarcinoma, squamous cell carcinoma, large-cell carcinoma,

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55
Q

Paediatric IV maintenance fluid prescribing (from age >=28 days) - doses?

A

Children (>28 days of age)

100 ml/kg/day for the first 10kg of weight (0-10kg)
50 ml/kg/day for the next 10kg of weight (11-20kg)
20 ml/kg/day for weight over 20kg

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56
Q

Where are venous leg ulcers located inthe leg and how are they managed?

A

ABOVE the medial malleolus

Compression bandaging

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57
Q

Centor criteria and score meaning

A

Fever > 38
Exudates on tonsil
absence of cough
tender anterior lymphadenopathy

score > 3 –> high likelihood of bacterial tonsilitis

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58
Q

What is meconium ileus and what is it pathognomonic for?

A

The first stool that a baby passes 24 hours after birth.

pathognomonic for cystic fibrosis - meconium is thick and sticky causing it to obstruct the bowel.

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59
Q

Coffee bean sign on AXR

A

Sigmoid volvulus

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60
Q

Biomarkers - what are they used to investigate?

Faecal Elastase
Serum Amylase
Serum Lipase

A

Faecal elastase - exocrine function in chronic pancreatitis
Serum amylase - raised in acute pancreatitis
Lipase - raised in acute pancreatitis (longer T1/2 than amylase); deficient in chronic pancreatitis

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61
Q

epigastric pain, classically worse after eating fatty foods and relieved by sitting forward - sign of?

A

Chronic pancreatitis

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62
Q

4 features of Osteogenesis Imperfecta

A

fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections are common

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63
Q

Diagnosis T2DM

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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64
Q

Which type of hypersensitivity reaction do the following immunoglobulins indicate? Give examples of each
IgG
IgM
IgE

A

IgE - type 1 hypersensitivity -> Allergic e.g. anaphylaxis, Asthma
IgG and IgM - type 2,3,5 hypersensitivity -> Cytotoxic e.g. Haemolytic, GBM, graft rejection

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65
Q

Tetralogy of Fallot

4 structural cardiac features
associated manifestation

A

Remember “PROVe”

Pulmonary valve stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect (VSD)

Tet spells - turn blue, become limp, have difficulty breathing, and can lose consciousness.

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66
Q

Symptoms and VBG of Aspirin OD?

A

VBG - initial respiratory alkalosis, progress to metabolic acidosis

Symptoms:
1. vomiting
2. tinnitus
3. dehydration

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67
Q

Rotator cuff muscles?

A

Infraspinatus
Supraspinatus
Teres minor
Subscapularis

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68
Q

Triad of Meig’s syndrome?

A

Ovarian fibroma (a type of benign ovarian tumour)
Pleural effusion
Ascites

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69
Q

WPW is a tachyarrythmia that presents with which 3 ECG features?

A

Delta wave (slurred upstroke of QRS complex)
Broad QRS complex (>0.12 seconds)
Short PR interval (<0.12 seconds)

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70
Q

3 Associations of a scaphoid fracture?

A

Fall on an outstretched hand (FOOSH)
Avascular necrosis
tenderness in anatomical snuffbox

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71
Q

Argyll Robertson pupil - describe its presentation and which condition?

A

Pupil is constricted and does not react to light, but does react to accommodation reflex. Feature of SYPHILIS.

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72
Q

Gold standard diagnostic investigation for Addison’s disease?

A

short ACTH stimulation (Synacthen test)

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73
Q

Gold standard investigation for detecting Phaeochromocytoma?

A

Urine metanephrines

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74
Q

After which week of gestation should the SFH correlate with the gestational age in a normal pregnancy?

And how much is a normal rate of increase in SFH per week?
Where would you expect the fundus to be palpable at 20 weeks and 36 weeks?

A

16 weeks.

After 24 weeks you would only expect the fundal height to increase by 1cm a week.

You would expect the fundus to be palpable at the umbilicus from 20 weeks and at the xiphoid sternum from 36 weeks.

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75
Q

4 most common causes of liver cirrhosis?

A

ALD
NASH
Hepatitis B
Hepatitis C

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76
Q

treating cluster headaches?

A

Nasal sumatriptan for relief.
Verapamil for prevention.

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77
Q

First line management for Psoriais?

A

Potent topical corticosteroid + topical vitamin D

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78
Q

which medications are associated with acute pancreatitis?

A

Co-trimoxazole
Sulfalazine (UC)

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79
Q

In the context of myasthenia gravis, which associated condition may be diagnosed on CT chest?

A

thymoma

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80
Q

Vestibular Schwannoma - presentation and Management

A

The most common symptoms reported include asymmetric or unilateral hearing loss and progressive ipsilateral tinnitus.

Larger tumours may cause a mass effect leading to signs of raised intracranial pressure and lead to focal neurology including compression of the fifth cranial nerve, seventh cranial nerve and eighth cranial nerve.

Other symptoms include: dizziness, headaches and disequilibrium.

Surgery is the definitive management of the condition. Small lesions that are not growing may be monitored - initially with a 6 month interval scan.

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81
Q

Meniere’s disease presentation

A

Discrete attacks of tinnitus, vertigo, hearing loss and a feeling of aural fullness.

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82
Q

Management of Tonsilitis in children?

A

first line - Phenoxymethylpenicillin for 10 days

if penicillin allergic - give Clarithomycin or Erythromycin for 5 days

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83
Q

CHA2DS2-VASc SCORE - what does each letter stand for?

What do the scores indicate?

A

C – Congestive heart failure
H – Hypertension
A2 – Age >75 (Scores 2)
D – Diabetes
S2 – Stroke or TIA previously (Scores 2)
V – Vascular disease
A – Age 65-74
S – Sex (female)

Scores:

0: no anticoagulation
1: consider anticoagulation
>1: offer anticoagulation

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84
Q

Tumour markers for which type of cancer

Ca-125
Ca19-9
AFP
HCG
VMA (vanillylmandelic acid)
CEA (carcinoembryonic antigen)

A

Ca-125 - ovarian cancer
Ca19-9 - pancreatic and biliary cancer, colon cancer
AFP - hepatocellular carcinoma, germ cell tumours (testicular cancer)
HCG - hydadiaform moles
VMA - phaeochromocytoma
CEA - bowel cancer

85
Q

What is Rhesus incompatibility and how is it treated?

A

When a mother is Rhesus Positive -> this is not a problem!

When a mother is Rhesus NEGATIVE, she can develop antibodies against Rh-D positive infant’s blood - treat by giving Anti-D injections:

one dose at 28 weeks gestation
second dose 72 hours post-partum if baby is RH-D POSITIVE

86
Q

Which conditions and medications are absolute contraindications to breastfeeding?

A

The absolute contraindications to breastfeeding are:

Infants of mothers with TB infection
Infants of mothers with uncontrolled/unmonitored HIV
Infants of mothers who are taking medications which may be harmful - amiodarone, lithium, sitagliptin, methotrexate, tetracycline (“all little sisters must take care”)

87
Q

Burkitt’s lymphoma

Associated gene
Causative pathogen
Appearance on lymph node biopsy
Type of cancer

A
  1. c-myc gene
  2. EBV
  3. “Starry-sky” appearance
  4. Non-Hodgkin Lymphoma
88
Q

Genes associated with leukemia:
AML
CML

A

AML - DNMT3A gene
CML - Philadelphia chromosome BCR/ABL gene

89
Q

JAK-2 mutation associated with which condition?

A

Polycythaemia Rubra Vera

90
Q

Which murmurs are

  1. Systolic
  2. Diastolic
A

Systolic murmurs - AS, PS, MR, TR
Diastolic murmurs - AR, MS, PR, TS

91
Q

What is central pontine myelinolysis a complication of?

A

Correcting HYPONATRAEMIA with hypertonic saline (3%) at a rate FASTER than 10mmol/L/day

92
Q

Tuberculosis

type of pathogen
diagnostic tests
management of acute pulmonary TB
side effects of therapy and prevention?

A

Acid-fast bacilli of mycobacterium tuberculosis

Mantoux test and Zeihl Neelsen stain (gram stain ineffective)

quadruple therapy - “RIPE” - RIFAMPACIN, ISONIAZID, PYRAZIMAMIDE, ETHAMBUTOL
isoniazid causes peripheral neuropathy and pyridoxine (vitamin B6) is usually co-prescribed prophylactically to help prevent this.

93
Q

Brucellosis

type of pathogen?
transmission and associations
clinical features
treatment

A

Type - gram-negative, intracellular bacillus of Brucella
Transmission and association - animal farming, animal to human contact, middle east/north africa, returning travellers, vets
Clinical features - non-specific pyreia of unknown origin, weight loss, night sweats, lymphadenopathy, myalgia, hepatosplenomegaly
treatment - Doxycyclin, Rifampicin and Gentamicin

94
Q

What is Achalasia?
Symptoms?
Investigations?
Treatment?

A

a condition of unknown aetiology which causes failure of the lower oesophageal sphincter to relax.

Symptoms - dysphagia, food regurgitation, aspiration, retrosternal pain/heartburn.

Endoscopy, barium swallow

Botox injection or CCB’s first > then surgery

95
Q

What are fibroids?

Symptoms?

Management?

A

Benign smooth muscle tumors of the myometrium of the uterus.

Menorrhagia and dysmenorrhoea

Non-surgical - NSAIDs, anti-fibrinolytics, Mirena IUS

Surgical - Myomectomy, ablation and uterine artery embolisation (fertility-preserving) or hysterectomy.

96
Q

Haemochromatosis:
1. pathophysiology
2. associated gene
3. main diagnostic marker

A
  1. Iron storage disorder that results in excessive total body Iron and deposition of Iron in tissues.
  2. Human Haemochromatosis Protein (HFE) gene is located on chromosome 6
  3. serum Ferritin - high
97
Q

What is the pathological process in Glomerulonephritis?

Give 8 types of glomerulonephritis.

A

An umbrella term applied to conditions that cause inflammation of or around the glomerulus and nephron.

Types:
Membranous glomerulonephritis
Minimal change disease
Focal segmental glomerulonephritis
IgA nephropathy
Rapidly progressing glomerulonephritis
Lupus nephritis
Post-infectious glomerulnephritis
Anti-glomerular basement membrane antibody (Anti-GBM) disease

98
Q

Complications of refeeding syndrome?

A

arrhythmias, cardiac failure and seizures

99
Q

4 blood markers of Refeeding syndrome?

A

Low phosphate levels
Low magnesium levels
Low potassium levels
Hyperglycaemia

100
Q

What are the 2 autoantibodies found in MG?

A

acetylcholine receptor antibody

Muscle-specific kinase (MuSK) antibodies

101
Q

What is the Urea Breath Test for?

What does this condition cause?

A

Helicobacter pylori (H. pylori) infection

main cause of ulcers in both the stomach and duodenum

102
Q

Faecal occult blood test - what is this for?

A

CRC

103
Q

Systemic sclerosis - antibodies?

A

Diffuse systemic sclerosis > anti-SCL-70 antibodies

Limited systemic sclerosis (CREST syndrome) > anti-centromere antibodies

104
Q

Antibodies for SLE?

A

anti-dsDNA (specific and predict a poor prognosis with renal disease)

ANA (sensitive but not specific)

105
Q

Which condition do Anti-CCP antibodies indicate?

A

Rheumatoid arthritis

A positive anti-CCP is even more specific than RF for rheumatoid arthritis and can support the diagnosis, though does not confirm it.

106
Q

Serology of Hepatitis B virus?

A

HBsAg (hepatitis B surface antigen) - active infection

Antibodies to HBsAg (anti-HBs) i.e. surface antibodies - indicates vaccination

HBeAg (hepatitis B E antigen) - indicates high infectivity (acute phase of the infection)

Core antibodies (HBcAb) – implies past or current infection

Antibodies to hep B core antigen (anti-HBc) indicate past infection

Patients with acute infection have raised IgM
Patients with past infection have raised IgG

107
Q

in which part of the body do Koplik spots appear ?
which disease do they present with?
treatment for this condition?

A

Koplik spots in measles appear in mouth

Measles is self resolving after 7 – 10 days of symptoms. Children should be isolated until 4 days after their symptoms resolve. Measles is a notifiable disease and all cases need to be reported to public health. 30% of patients with measles develop a complication.

108
Q

Central-retinal artery occlusion (CRAO)

Presentation
Appearance on fundoscopy

A

Presentation - sudden painless loss of vision in one eye (or significantly reduced visual acuity).

Fundoscopy - pale retina with a cherry red spot at the macula

109
Q

What is the direct Coombs test an investigation for?

what are the 2 subtypes for this condition?

A

Autoimmune haemolytic anaemia.

Subtypes - Warm and cold.

110
Q

Benign Paroxysmal Positional Vertigo
Investigation
Treatment

A

Dix-Hallpike manoeuvre (positive if observe nystagmus)
Epley manoeuvre.

111
Q

What is placental abruption and what is the presentation?

A

when the placenta separates from the wall of the uterus during pregnancy.

Placental abruption is a significant cause of antepartum haemorrhage.

Sudden onset severe abdominal pain that is continuous, shock, CTG abnormalities

112
Q

Pre-eclampsia - what is it?

A

a multisystem syndrome developing during the second half of pregnancy. It is characterised by hypertension and proteinuria or in the absence of proteinuria the finding of maternal organ dysfunction (renal/hepatic/neurological/haematological)

113
Q

Main diagnosis to exclude in pregnant woman with fresh bright red vaginal bleeding that is painless AFTER 24 weeks gestation?

A

Placenta Praevia

114
Q

Guillain-Barré Syndrome

3 causative pathogens
management

A

causative pathogens - campylobacter jejuni, cytomegalovirus and Epstein-Barr virus.

manage:
IV immunoglobulins
Plasma exchange (alternative to IV IG)
Supportive care
VTE prophylaxis (pulmonary embolism is a leading cause of death)

115
Q

Crueztfeld-Jacob Disease - presentation?

A

rapidly progressive dementia, psychiatric impairment, and myoclonus (quick, involuntary muscle jerks).

116
Q

3 Key investigations for Tuberculosis?

A

Sputum culture - most sensitive for active TB

Mantoux test - most commonly used for latent TB

Interferon‑gamma release assay - if mantoux +ve

117
Q

Key investigation for Legionella pneumonia?

A

Urinary antigen enzyme immunoassay test

118
Q

Presentation of an Addisonian Crisis

A

Reduced consciousness
HypOtension
HypOglycaemia, hyponatraemia, HypERkalaemia
Patients can be very unwell

119
Q

Investigations for Addison’s disease

A
  1. Electrolyte imbalance: Hyponatraemia and hyperkalaemia – low Na+ and high K+
  2. Plasma ACTH
    In primary adrenal failure the ACTH level is high as the pituitary is trying very hard to stimulate the adrenal glands without any negative feedback in the absence of cortisol.
    In secondary adrenal failure the ACTH level is low as the reason the adrenal glands are not producing cortisol is that they are not being stimulated by ACTH.
  3. Short Synacthen test – give synthetic ACTH and see how adrenal gland cortisol secretion responds. If fail to see cortisol rise during test to 420nmol/L, can be confident there is adrenal insufficiency.
  4. Adrenal antibodies – request if suspect autoimmune disease. Negative test doesn’t rule out autoimmune disease.
  5. CT/MRI adrenals if suspecting an adrenal tumour, haemorrhage or other structural pathology (not recommended by NICE for autoimmune adrenal insufficiency).
120
Q

10 signs and symptoms of Addison’s disease (primary adrenal insufficiency)

A
  1. Syncope and hypotension → from low aldosterone
  2. Weight loss, fatigue, anorexia, weakness → from low cortisol → dysregulated glucose metabolism
  3. Craving salty foods
  4. Diarrhoea
  5. Myalgia (muscle pain)
  6. Muscle wasting
  7. Hyperpigmentation – new scars, buccal, palmar creases i.e. person looks tanned.
  8. Postural hypotension → defined as a systolic drop of more than 20 mmHg and diastolic drop of 10mmHg when lying down for 5 minutes and then standing up, by 3 minute’s time after standing up
  9. Dehydration (from diarrhoea)
  10. Loss of body hair (from lower androgens)
121
Q

MMR vaccine - when is it given?

A

The MMR vaccine is given in two injections. The first injection is given when your child is between 12 and 15 months old. The second injection is given between the ages of 3 and 6 years.

122
Q

Parvovirus B19 - causes which paediatric condition and how does it present?

A

Slapped cheek

diffuse bright red rash on both cheeks, as though they have “slapped cheeks”.

Self-limiting illness (1-2 weeks)

123
Q

Roseola infantum:

  1. caused by which pathogen?
  2. Typical presentation (symptom, character, duration)
  3. Most commonly associated with which paediatric presentation?
A
  1. HHV-6
  2. It presents 1 – 2 weeks after infection with a high fever (up to 40ºC) that comes on suddenly, lasts for 3 – 5 days and then disappears suddenly.
  3. Febrile seizures
124
Q

Wrist drop (Saturday night palsy) is caused by damage to which nerve?

A

RADIAL

125
Q

7 red flags for cauda equina

A
  1. Saddle anaesthesia (loss of sensation in the perineum – around the genitals and anus)
  2. Loss of sensation in the bladder and rectum (not knowing when they are full)
  3. Urinary retention or incontinence
  4. Faecal incontinence
  5. Bilateral sciatica
  6. Bilateral or severe motor weakness in the legs
  7. Reduced anal tone on PR examination
126
Q

Criteria for management of abdominal aortic aneurysm

A
  1. If aneurysm < 3cm then no action required
  2. If aneurysm > 3cm – 4.4cm -> lifestyle advice and seen by vascular team within 12 weeks + screening every 12 months
  3. If aneurysm 4.5cm – 5.4cm -> lifestyle advice and seen by vascular team within 12 weeks + screening every 3 months
  4. If aneurysm ≥ 5.5cm -> urgent 2-week wait referral to vascular team
127
Q

Rotterdam criteria for diagnosing PCOS?

A

3 key features:
Oligo-ovulation or anovulation
Hyperandrogenism
Polycystic ovaries on ultrasound scan

128
Q
  1. Define Premature Ovarian Sufficicency (POI).
  2. What will hormonal analysis show?
  3. Give 3 symptoms.
  4. Management POI
A
  1. menopause before the age of 40 years
  2. Raised LH & FSH, low oestradiol.
  3. Irregular menstrual periods, lack of periods (secondary amenorrhoea), hot flushes/night sweats/vaginal dryness (due to low oestrogen)
  4. Manage - hormone replacement therapy (HRT)
129
Q

Define Recurrent Miscarriage

A

Recurrent miscarriage is defined as the loss of 3 or more consecutive pregnancies.

130
Q

Define the following:

Incomplete miscarriage
Complete miscarriage

A

Incomplete miscarriage - retained products of conception remain in the uterus after the miscarriage

Complete miscarriage – a full miscarriage has occurred, and there are no products of conception left in the uterus (all have been expelled).

131
Q

Define the following:
Missed miscarriage
Threatened miscarriage
Inevitable miscarriage

A

Missed miscarriage – the fetus is still in the uterus but no longer alive. The miscarriage is ‘missed’ as often the woman is asymptomatic so does not realise something is wrong.

Threatened miscarriage – mild vaginal bleeding with a closed cervix and a fetus that is alive. There may be little or no pain.

Inevitable miscarriage – heavy vaginal pain and bleeding with an open cervix → inevitable that the foetus is lost.

132
Q

Management of gout (acute flare and prophylactic)

A
  1. Aspirate fluid from affected joint, XR the affected joint
  2. Acute flare - Naproxen, Colchicine, prednisolone
  3. Prophylactic (preventative) - Allopurinol and Febuxostat
133
Q

Difference between type of crystals in gout and pseudogout?

A

Gout:
Needle shaped crystals
Negatively birefringent of polarised light
Monosodium urate crystals

Pseudogout:
Rhomboid shaped crystals
Positive birefringent of polarised light
Calcium pyrophosphate crystals

134
Q

Neuroleptic malignant syndrome:
Cause
3 symptoms
Management
Major complication

A

Cause - antipsychotic medication
Symptoms - hyperthermia, lead-pipe rigidity, tremor
Manage - stop antipsychotic immediately
Complication - rhabdomyolysis

135
Q

Acute and chronic side effects of antipsychotics?

Side-effect related to Dopamine Antagonism - which antipsychotics cause this and which don’t?

A

Acute: dystonia, akathisia, parkinsonism (bradykinesia, tremor and rigidity)

Chronic: tardive dyskinesia (“tardive” means delayed and “dyskinesia” means unusual movements like jerking, lip smacking)

Dopamine antagonism - Hyperprolactinemia - caused by Risperidone; not caused by Aripiprazole.

136
Q

3 ECG features of HYPERkalaemia

A

Tall peaked T waves
Flattening or absence of P waves
Broad QRS complexes

137
Q

Management of HYPERkalaemia

A
  1. Calcium gluconate (stabilised cardiac muscle to reduce risk of arrythmias) + Nebulised salbutamol (causes intracellular K+ shift)
  2. Insulin and dextrose (drives glucose into cells and takes K+ with it, reducing blood K+
138
Q

Acute NSTEMI treatment

A

“(B)ATMAN”

Aspirin - loading dose 300mg
Ticagrelor
Morphine
Anticoagulant - low molecular weight heparin or fondaparinux
Nitrates (GTN)

Give Oxygen only if their saturations are dropping, aim for SPO2 >90%

139
Q

4 first-line medications for Chronic Heart Failure

A

“ABAL”

ACE inhibitor (ramipril)
Beta Blocker (bisprolol)
Aldosterone antagonist (spironolactone)
Loop diuretic (furosemide)

140
Q

4 medications for Secondary prevention of CVD

A

4A’s

Aspirin
Atorvastatin
Atenolol
ACEi (ramipril)

141
Q

What is the cause of Wernicke-Korsakoff syndrome?
4 key features of Wernicke’s encephalopathy
4 key features of Korsakoff syndrome

A

Cause - Thiamine (B1) deficiency secondary to alcohol excess
Symptoms Wernicke’s - Confusion , oculomotor disturbances, ataxia. Reversible.
Symptoms Korsakoff - Confabulation, memory impairment (anterograde or retrograde amnesia), behavioural changes, irreversible.

142
Q

What are the 3 symptoms of Cushing’s triad and what is this a sign of?

A

Sign of raised Intracerebral Pressure (ICP).

Symptoms:
1. raised systolic BP
2. reduced pulse
3. reduced RR

143
Q

What is the shape of the following 2 intracranial bleeds on a CT scan AND which vessels are they associated with?

  1. Subdural haemorrhage
  2. Extradural/epidural haemorrhage
A

Subdural - banana or crescent shape (expands into a bigger space) > bridging veins.

Extradural - lemon or bi-convex shape (confined to a more limited space) > middle meningeal artery (MMA)

144
Q

6 risk factors for Necrotising Enterocolitis (NEC) in neonates

A

Prematurity
low birth weight
Formula feeds
Respiratory distress and assisted ventilation
Sepsis
Congenital heart disease e.g. Patent ductus arteriosus

145
Q

Which anticoagulation is (1) safe and (2) teratogenic in pregnancy?

A

(1) Safe - Dalteparin (LMWH)

(2) Teratogenic - Warfarin

146
Q

What is the reason for avoiding Augmentin in 3rd trimester of pregnancy?

A

risk of NEC (necrotising Enterocolitis)

147
Q

Why are NSAIDs not recommended in pregnancy?

A

NSAIDS close the foetal ductus arteriosus so do not take in 3rd trimester

148
Q

3 key features of Turner’s syndrome and management

A

Wide-spaced nipples, short stature and webbed neck.

Management :
1. Growth Hormone (GH) therapy - to prevent short stature
2. Oestrogen and Progesterone replacement - to establish female secondary sex characteristics, regulate the menstrual cycle
3. Fertility treatment

149
Q

9 Ophthalmic symptoms of anterior uveitis

A

Painful eye (rather than pain on eye movement which indicates scleritis)
Red eye
Reduced visual acuity
flashers and floaters
Miosis (pupil constriction)
Photophobia
Abnormally shaped pupil
Hypopyon (collection of WBCs in the anterior chamber)
INCREASED LACRIMATION

150
Q

Management of Acute Angle Closure Glaucoma (AACG) - both in secondary care and definitive

A
  1. Pilocarpine eyedrops
  2. Acetazolamide (oral or IV)
  3. Hyperosmotic agents such as glycerol or mannitol
  4. Timolol (to reduce production of aqueous humour)
  5. Laser Iridotomy (definitive management)
151
Q

How does Charcot’s triad (RUQ pain, feve, jaundice) present for each of the following conditions:

  • Cholangitis
  • Cholelithiasis
  • Cholecystitis
  • Choledocholithiasis
A

Cholangitis (obstructed CBD) - Full triad of symptoms.

Cholelithiasis (gallstones) - only pain; no fever and no jaundice.

Cholecystitis (inflammation of gallbladder) - Pain and fever, no jaundice.

Choledocholithiasis - Jaundice and pain but no fever.

152
Q

In which condition do you get a positive Murphy’s sign?

What is the underlying pathophysiology?

A

Cholecystitis - positive Murphy’s sign.

pathophysiology - inflammation and infection of the gallbladder

153
Q

7 differentials of raised Creatine Kinase?

A

Myositis
Rhabdomyolysis
Acute Kidney Injury
Strenuous exercise
Myocardial infarction
Statins
Neuroleptic malignant syndrome (most cases)

154
Q

What is the key diagnostic investigation for myositis (dermato/poly)?

A

Creatine Kinase (raised usually <1000U/L)

155
Q

Management of MND?

A

There are no effective treatments for halting or reversing the disease progression.

Riluzole – can slow disease progression and extend survival by a few months in AML. Currently licenced and used in UK.

NIV – used at home to support breathing at night, improves survival and QOL.

156
Q

Treatment for Myasthenia Gravis

A
  1. Reversible acetylcholinesterase inhibitors – pyridostigmine or neostigmine
  2. Immunosuppression – first line Azathioprine
  3. Thymectomy – in case of thymoma
157
Q

Describe the pathophysiology of Myasthenia Gravis

A

An autoimmune condition of the neuromuscular junction.

Antibodies attack the post-synaptic Ach receptor at the NMJ which causes muscle weakness that gets progressively worse with activity (more muscle weakness the more the muscles are used) and improves with rest (as more receptors are freed up for use again).

158
Q

UMN and LMN signs in MND

A

UMN - hypertonia, hyper-reflexia, upgoing plantars

LMN - muscle wasting, fasciculations, hypotonia, hyporeflexia

159
Q

Describe the pathophysiology of MND, and its associated genes

A

Progressive degeneration of upper and lower motor neurons, until they ultimately stop functioning. Sensation remains intact.

Associated genes in familial MND - SOD1, FUS and C9ORF72.

160
Q

Main function of the parathyroid glands AND which organs does it act on?

A

main function - to raise blood calcium

acts on: bones, gut, kidneys

160
Q

10 signs and symptoms of Grave’s hyperthyroidism

A

Heat intolerance
Diaphoresis (sweating)
Tremor
Weight loss
Fatigue (as if constantly exercising)
Goitre
Exophthalmos
Nervous and anxious
Tachycardia
Palpitations

160
Q

Causes of Hypo and Hyper-thyroidism

A

Hyperthyroidism - Grave’s disease, Toxic Multinodular Goitre

Hypothyroidism - Hashimoto’s thyroiditis

161
Q

What is the cause of Glaucoma?

Which type of glaucoma is gradual onset?

A

Glaucoma refers to the optic nerve damage that is caused by a significant rise in intraocular pressure. The raised intraocular pressure is caused by a blockage in aqueous humour trying to escape the eye.

Primary Open Angle Glaucoma - gradual onset.

162
Q

Bacterial Vaginosis

  1. Key symptoms
  2. Diagnosis
  3. Treatment
  4. Complications
A
  1. vaginal discharge with associated fishy odour
  2. diagnosis - clue cells, vaginal pH >4.5
  3. treat with metronidazole or clindamycin
  4. PPROM
163
Q

Ramsay Hunt Syndrome:

  1. caused by which pathogen?
  2. treated how?
A
  1. VZV
  2. Prednisolone and Acyclovir (within first 72 hours) + lubricating eye drops
164
Q

Management of Bell’s Palsy?

A

if patient presents within the first 72 hours of developing symptoms - give:

  1. Prednisolone (50mg for 5 days)
  2. Lubricating eye drops (to prevent eye on the affected side from drying out)
  3. Tape can be used to keep the eye closed at night.
165
Q

Management of a Pneumothorax ?

A
  1. if NO shortness of breath and LESS THAN 2cm rim of air on the CXR - no treatment required, will resolve spontaneously
  2. If shortness of breath and MORE THAN 2cm rim of air on the CXR - emergency aspiration (if aspiration fails twice, insert chest drain)
  3. Unstable patients, bilateral or secondary pneumothoraces generally require a chest drain.
166
Q

Treatment for Syphilis?

A

A single deep intramuscular dose of benzathine penicillin

167
Q

Treatment for Gonorrhoea?

A

A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known.

A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known.

168
Q

Treatment of Chlamydia?

A

First line - doxycycline 100mg twice a day for 7 days.

Doxycycline is contraindicated in pregnancy and breastfeeding - give azithromycin or erythromycin.

169
Q

Four Key X-ray Changes in Osteoarthritis

A

L – Loss of joint space
O – Osteophytes (bone spurs)
S – Subarticular sclerosis (increased density of the bone along the joint line)
S – Subchondral cysts (fluid-filled holes in the bone)

170
Q

5 features Benzodiazepine OD?

A

Excessive sedation
Anterograde amnesia
Lethargy
Ataxia
Slurred speech
Respiratory depression

171
Q

Key features and VBG of Opiate OD?

A
  1. Respiratory depression
  2. Pinpoint pupils
  3. Cyanosis if severe

VBG - respiratory acidosis.

172
Q

5 Features of Cocaine OD?

A
  1. Anxiety, agitation
  2. Paranoid psychosis
  3. HYPERthermia
  4. seizures
  5. Cardiac conduction abnormalities -> arrhythmias
173
Q

3 tumour markers in testicular cancer?

A

Alpha-fetoprotein (AFP)

Human chorionic gonadotropin (HCG)

Lactate dehydrogenase (LDH)

174
Q

Treatment of DKA?

A
  1. Fluids - IV fluid resuscitation 0.9% saline, 1L STAT then 4L with added K+ over the next 12 hours → most important immediate intervention is IV fluids BEFORE infusing insulin as dehydration is more life-threatening than hyperglycaemia
  2. Insulin - Actrapid/Novorapid
  3. Glucose - add dextrose infusion if BM falls below 14mmol/L
  4. Potassium - correct as required
  5. Infection - treat underlying triggers like infection/sepsis
  6. Chart - fluid balance
  7. Ketones - monitor blood ketones (or serum HCO3- if ketones unavailable)
175
Q

Management of Cardiac Tamponade? (haemodynamic instability and dropping BP)

A

Pericardiocentesis ( fluid is aspirated and subsequently drained from the pericardium)

175
Q

What are the symptoms of Beck’s triad (classic presentation of cardiac tamponade)?

A
  1. Raised JVP
  2. Muffled heart sounds
  3. Hypotension
176
Q

Management of Aspirin Overdose?

A
  1. Activated charcoal if ingestion <1 hours ago
  2. IV fluid, sodium bicarbonate and potassium chloride
  3. The aim is to maintain good kidney function and to alkalise the urine in order to increase salicylate excretion.
  4. Monitored with serial VBGs
  5. Dialysis if blood Salicylate levels are very high
177
Q

Ascending Cholangitis Presentation

A

Charcot’s triad:
Right upper quadrant pain
Fever
Jaundice

178
Q

Haemolytic uraemic syndrome is a triad of which symptoms?

A

Triad of microangiopathic haemolytic anaemia, thrombocytopenia and AKI.

179
Q

What is the most common organism causing Haemolytic Uraemic Syndrome in children?

A

Shiga toxin-producing E.coli (STEC)

180
Q

Investigations in HSP?

A
  1. FBC - for thrombocytopenia, sepsis and leukaemia
  2. Renal Profile
  3. Serum Albumin - for nephrotic syndrome
  4. CRP - for sepsis
  5. Blood cultures - for sepsis
  6. Urine dip - for proteinuria
  7. Urine protein:creatinine ratio - to quantify proteinuria
  8. Blood Pressure for HTN
181
Q

Management of HSP?

A
  1. Supportive - analgesia, rest, hydration
  2. Steroids
  3. Close monitoring - Blood Pressure and Urine dip for renal involvement
182
Q

What are the 4 main features of HSP?

A
  1. Purpura (100%)
  2. Arthritis or arthralgia (75%)
  3. Abdominal pain (50%)
  4. Kidneys affected - IgA nephritis, haematuria, proteinuria and nephrotic syndrome. (50%)
183
Q

Differentials of Non-blanching rashes?

A
  • Meningiococcal septicaemia (or other bacterial sepsis)
  • HSP
  • Acute Leukemia
  • Haemolytic Uraemic Syndrome (HUS)
  • Idiopathic thrombocytopenic purpura (ITP)
  • Mechanical - Strong coughing, vomiting or breath holding can produce petechiae in a “superior vena cava distribution ”, above the neck and most prominently around the eyes.
  • Traumatic - Tight pressure on the skin, for example in non-accidental injury
  • Viral illness - typically influenze and enterovirus
184
Q

Treatment for the different types of incontinence:

  1. Urge incontinence (overactive bladder)
  2. Stress incontinence
A
  1. Urge

Bladder retraining (gradually increasing the time between voiding) for at least six weeks is first-line
Anticholinergic medication, for example, oxybutynin, tolterodine and solifenacin
Mirabegron is an alternative to anticholinergic medications
Invasive procedures where medical treatment fails - Botox type A injection into bladder wall

  1. Stress

Avoiding caffeine, diuretics and overfilling of the bladder
Avoid excessive or restricted fluid intake
Weight loss (if appropriate)
Supervised pelvic floor exercises for at least three months before considering surgery
Surgery
Duloxetine is an SNRI antidepressant used second line where surgery is less preferred

185
Q

What is the cause of:

  1. Urge incontinence
  2. Stress incontinence
  3. Overflow incontinence
A
  1. Urge - overactivity of the detrusor muscle of the bladder. Urge incontinence is also known as overactive bladder. The typical description is of suddenly feeling the urge to pass urine, having to rush to the bathroom and not arriving before urination occurs.
  2. Stress - weakness of the pelvic floor and sphincter muscles. This allows urine to leak at times of increased pressure on the bladder. The typical description of stress incontinence is urinary leakage when laughing, coughing or surprised.
  3. Overflow - this is chronic urinary retention due to an obstruction to the outflow of urine. Chronic urinary retention results in an overflow of urine, and the incontinence occurs without the urge to pass urine.
186
Q

Difference between Nephrotic and Nephritic syndrome?

A

Nephritic syndrome - characterized by glomerular capillary damage leading to haematuria, pyuria (WBC in urine), water retention and subsequent hypertension and oedema.

Nephrotic syndrome - Characterised by massive proteinuria (>3.5g/day), hypoalbuminaemia and oedema

187
Q

Criteria for well’s score?

A
  1. Active cancer
  2. Bedridden recently >3 days or major surgery within last 12 weeks
  3. Calf swelling >3 cm compared to the other leg (Measured 10 cm below tibial tuberosity)
  4. Haemoptysis
  5. Clinical signs of DVT - Localized tenderness along the deep venous system, Entire leg swollen, Collateral (nonvaricose) superficial veins present, Pitting oedema confined to symptomatic leg
  6. Previously documented DVT or PE
  7. HR > 100 BPM
188
Q

Investigations in IBD?

A
  • Blood test - raised inflammatory markers, raised platelets, low albumin, low B12/folate, negative stool culture (not infection), anaemia , CRP indicates active disease
  • Faecal Calprotectin - marker of bowel inflammation - positive with IBD and certain drugs like NSAIDs.
  • Abdominal XR - thumb printing
    Small bowel/pelvic MRI - inflamed, strictures, skip lesions, fistulae, abscesses
  • Endoscopy (OGD and Colonoscopy) - GOLD STANDARD - disease distribution, severity and biopsies taken
  • Histology of biopsy - Crohn’s has more extensive and transmural pattern.
189
Q

6 differences between UC and Crohn’s

A

UC
Limited to colon and rectum
continuous disease from rectum
Superficial inflammation
non-stricturing
associated with PSC
pseudo-polyps

Crohn’s
from mouth to anus
skip lesions (not continuous)
full transmural inflammation
strictures, fisulae, fissures and collections
cobblestone mucosa
perianal disease

190
Q

What are the 3 defining HISTOLOGICAL features of Coeliac disease?

A
  1. Crypt hyperplasia
  2. Mucosal inflammation
  3. Villous atrophy
191
Q

Diagnosis of Coeliac disease?

A
  • Gold-standard - Duodenal biopsy done at endoscopy. Findings: variable - increased epithelial lymphocytes, crypt hyperplasia and villous atrophy. Use Marsh Classification – Marsh 0 normal, Marsh 3 inflammatory response raised (Marsh 3 typical of CD).
  • Serology - IgA anti tissue transglutaminase antibody (tTGA) first-line and IgA anti-endomysial antibody when tTGA is weak (NICE). Can have false-positive and false-negative serology. Some patients test negative for antibodies, so test them with biopsy. Some patients can have false-positive raised serology but biopsy is negative.

*Genetics - a negative gene test cannot exclude CD, a positive gene test alone cannot confirm CD.

192
Q

Management of IBD?

A

Gold-standard: “Bottom-up” –

  1. begin with antibiotics and aminosalicylates (Mesalazine)
  2. progress to immunomodulators and corticosteroids (azathioprine and methotrexate)
  3. final option is surgery (curative in UC not Crohn’s) and biologics (anti-TNF or anti-IL)
193
Q

Management of IBS?

A
  1. General healthy diet - limit caffeine and alcohol, low FODMAP diet, probiotic supplements
  2. first line - Loperamide for diarrhoea/Laxatives for constipation
  3. second line - TCA’s (amitryltyline)
  4. third line - SSRI’s
  5. CBT to help deal with symptoms
194
Q

Management of SAH?

A

*Intubation and ventilation if reduced consciousness
*Surgical - clipping or coiling of aneurysm
*Nimodipine (CCB) for vasospasm
*Antieplieptic for seizure
*LP or shunt for hydrocephalus

195
Q

Describe key features of a Thyroglossal Cyst in the neck

A

Midline of neck.

Moves up and down with tongue movement.

196
Q

Which virus causes sensorineural hearing loss?

A

Congenital Rubella (main cause)
Congenital Cytomegalovirus

197
Q

Most common cause of
1. Otitis Media
2. Otitis Externa
3. Rheumatic fever
4. Septic arthritis

A

Otitis media - Streptococcus Pneumoniae
Otitis externa - Pseudomonas aeruginosa
Rheumatic fever - streptococcus pyegenes
Staphylococcus aureus

198
Q

Adult IV dose of adrenaline in Anaphylaxis

A

0.5ml of 1 in 1,000
(or 500mcg of 1 in 1,000)

199
Q

Pathogen causing Lyme Disease
Vector of the disease?
Characteristic rash?

A

Pathogen - Borrelia burgdorferi
Transferred by Ticks.
Erythema Migrans.

200
Q

Colle’s fracture - definition (which bone etc) and association.
Reverse Colle’s fracture (Smith’s) - definition

A

Colle’s fracture - posterior displacement of distal radius relative to the wrist. Also called dinner fork deformity. Association - FOOSH.

Reverse Colle’s/Smith’s - volar/anterior displacement of distal end of radius.

201
Q

Definition and Triad of pyelonephritis
Most common pathogen?

A

Definition - inflammation of kidneys resulting from bacterial infection.
Triad - fever, loin or back pain, N&V
Most common - E.coli

202
Q

Torsades de Pointes
- Describe the ECG presentation
- Management?

A

Polymorphic Broad Complex tachycardia with Long QT interval.
Management - Magnesium sulphate 2mg over 10 minutes.

203
Q

Migraine management?

A

First-line: offer combination therapy with
an oral triptan and an NSAID, or
an oral triptan and paracetamol.

Prophylaxis: Topiramate or Propranolol.

204
Q

Schober’s test - what does this test show and what condition is it suggestive of?

A

An indication of reduced lumbar flexion.

> 20cm → indicates restriction in lumbar movement.

<5cm is suggestive of ankylosing spondylitis.

205
Q

2 differences between mania and hypomania

A

Mania - lasts for at least 7 days, psychotic sx present

Hypomania - lasts <7 days (3-4), no psychotic sx

206
Q

4 side effects of Clozapine

A
  1. Agranulocytosis
  2. Intestinal obstruction -> constipation
  3. weight gain
  4. diabetes and heart conditions

Year 4 Medical School (2 decks)

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