Questions on all medical specialities Flashcards

Question

C6 dermatome area

Answer 1

lateral shoulder including regimental patch

Answer 2

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

Answer 3

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

Answer 4

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

Answer 5

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.

Answer 6

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

Answer 7

1st line for mild/moderate - Donepazil, galatamine or rovastigmine 2nd line for mild/moderate OR 1st line in severe - Memantine

Answer 8

- 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

Answer 9

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

Answer 10

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

Answer 11

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

Answer 12

andexanet alfa Idarucizumab Prothrombin Complex (PCC) Protamine sulphate

Answer 13

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

Answer 14

Sx - sudden onset abdominal pain, ascites, and tender hepatomegaly. Causes - Polycythemia, thrombophilia, APS, pregnancy, COCP Ix - Ultrasound with Doppler flow

Answer 15

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

Answer 16

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

Answer 17

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

Answer 18

Tall P waves Flattened T waves ST depression Prominent U waves

Answer 19

A. First episode - ORAL vancomycin 10 days B. Recurrent - ORAL fidaxomicin C. Life-threatening - ORAL vancomycin and IV metronidazole

Answer 20

Weight gain - insulin, glitazones, sulfonylureas Weight loss - GLP-1 mimetics (exenatide), SGLT2 inhibitors (Dapagliflozin) Metformin and DPP4 inhibitors (sitaglipptin) are weight neutral

Answer 21

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

Answer 22

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" 2. 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)

Answer 23

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

Answer 24

MEN-2a - Parathyroid: hyperplasia/adenomas MEN-2b - Mucosal neuromas Both MEN2a and MEN2b: Thyroid: medullary thyroid cancer Adrenal: pheochromocytoma

Answer 25

Retinal/vitreous - Retinal detachment, posterior vitreous detachment, vitreous haemrrhage Optic nerve damage - GCA, CRVO, CRAO, Amaurosis fugax, Ischaemic optic neuropathy

Answer 26

Asbestos -> mesothelioma Small cell (20%) Vs non-small cell (80%) Non-small cell -> adenocarcinoma, squamous cell carcinoma, large-cell carcinoma,

Answer 27

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

Answer 28

ABOVE the medial malleolus Compression bandaging

Answer 29

Fever > 38 Exudates on tonsil absence of cough tender anterior lymphadenopathy score > 3 --> high likelihood of bacterial tonsilitis

Answer 30

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.

Answer 31

Sigmoid volvulus

Answer 32

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

Answer 33

Chronic pancreatitis

Answer 34

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

Answer 35

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

Answer 36

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

Answer 37

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.

Answer 38

VBG - initial respiratory alkalosis, progress to metabolic acidosis Symptoms: 1. vomiting 2. tinnitus 3. dehydration

Answer 39

Infraspinatus Supraspinatus Teres minor Subscapularis

Answer 40

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

Answer 41

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

Answer 42

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

Answer 43

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

Answer 44

short ACTH stimulation (Synacthen test)

Answer 45

Urine metanephrines

Answer 46

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.

Answer 47

ALD NASH Hepatitis B Hepatitis C

Answer 48

Nasal sumatriptan for relief. Verapamil for prevention.

Answer 49

Potent topical corticosteroid + topical vitamin D

Answer 50

Co-trimoxazole Sulfalazine (UC)

Answer 51

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.

Answer 52

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

Answer 53

first line - Phenoxymethylpenicillin for 10 days if penicillin allergic - give Clarithomycin or Erythromycin for 5 days

Answer 54

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

Answer 55

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

Answer 56

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

Answer 57

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")

Answer 58

1. c-myc gene 2. EBV 3. "Starry-sky" appearance 4. Non-Hodgkin Lymphoma

Answer 59

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

Answer 60

Polycythaemia Rubra Vera

Answer 61

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

Answer 62

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

Answer 63

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.

Answer 64

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

Answer 65

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

Answer 66

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.

Answer 67

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

Answer 68

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

Answer 69

arrhythmias, cardiac failure and seizures

Answer 70

Low phosphate levels Low magnesium levels Low potassium levels Hyperglycaemia

Answer 71

acetylcholine receptor antibody Muscle-specific kinase (MuSK) antibodies

Answer 72

Helicobacter pylori (H. pylori) infection main cause of ulcers in both the stomach and duodenum

Answer 73

Diffuse systemic sclerosis > anti-SCL-70 antibodies Limited systemic sclerosis (CREST syndrome) > anti-centromere antibodies

Answer 74

anti-dsDNA (specific and predict a poor prognosis with renal disease) ANA (sensitive but not specific)

Answer 75

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.

Answer 76

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

Answer 77

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.

Answer 78

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

Answer 79

Autoimmune haemolytic anaemia. Subtypes - Warm and cold.

Answer 80

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

Answer 81

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

Answer 82

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)

Answer 83

Placenta Praevia

Answer 84

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)

Answer 85

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

Answer 86

Sputum culture - most sensitive for active TB Mantoux test - most commonly used for latent TB Interferon‑gamma release assay - if mantoux +ve

Answer 87

Urinary antigen enzyme immunoassay test

Answer 88

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

Answer 89

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).

Answer 90

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)

Answer 91

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.

Answer 92

Slapped cheek diffuse bright red rash on both cheeks, as though they have “slapped cheeks”. Self-limiting illness (1-2 weeks)

Answer 93

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

Answer 94

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

Answer 95

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

Answer 96

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

Answer 97

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)

Answer 98

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

Answer 99

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).

Answer 100

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.

Answer 101

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

Answer 102

Gout: Needle shaped crystals Negatively birefringent of polarised light Monosodium urate crystals Pseudogout: Rhomboid shaped crystals Positive birefringent of polarised light Calcium pyrophosphate crystals

Answer 103

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

Answer 104

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.

Answer 105

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

Answer 106

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+

Answer 107

"(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%

Answer 108

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

Answer 109

4A's Aspirin Atorvastatin Atenolol ACEi (ramipril)

Answer 110

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.

Answer 111

Sign of raised Intracerebral Pressure (ICP). Symptoms: 1. raised systolic BP 2. reduced pulse 3. reduced RR

Answer 112

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)

Answer 113

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

Answer 114

(1) Safe - Dalteparin (LMWH) (2) Teratogenic - Warfarin

Answer 115

risk of NEC (necrotising Enterocolitis)

Answer 116

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

Answer 117

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

Answer 118

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

Answer 119

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)

Answer 120

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.

Answer 121

Cholecystitis - positive Murphy's sign. pathophysiology - inflammation and infection of the gallbladder

Answer 122

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

Answer 123

Creatine Kinase (raised usually <1000U/L)

Answer 124

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.

Answer 125

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

Answer 126

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).

Answer 127

UMN - hypertonia, hyper-reflexia, upgoing plantars LMN - muscle wasting, fasciculations, hypotonia, hyporeflexia

Answer 128

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.

Answer 129

main function - to raise blood calcium acts on: bones, gut, kidneys

Answer 130

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

Answer 131

Hyperthyroidism - Grave's disease, Toxic Multinodular Goitre Hypothyroidism - Hashimoto's thyroiditis

Answer 132

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.

Answer 133

1. vaginal discharge with associated fishy odour 2. diagnosis - clue cells, vaginal pH >4.5 3. treat with metronidazole or clindamycin 4. PPROM

Answer 134

1. VZV 2. Prednisolone and Acyclovir (within first 72 hours) + lubricating eye drops

Answer 135

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.

Answer 136

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.

Answer 137

A single deep intramuscular dose of benzathine penicillin

Answer 138

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.

Answer 139

First line - doxycycline 100mg twice a day for 7 days. Doxycycline is contraindicated in pregnancy and breastfeeding - give azithromycin or erythromycin.

Answer 140

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)

Answer 141

Excessive sedation Anterograde amnesia Lethargy Ataxia Slurred speech Respiratory depression

Answer 142

1. Respiratory depression 2. Pinpoint pupils 3. Cyanosis if severe VBG - respiratory acidosis.

Answer 143

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

Answer 144

Alpha-fetoprotein (AFP) Human chorionic gonadotropin (HCG) Lactate dehydrogenase (LDH)

Answer 145

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)

Answer 146

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

Answer 147

1. Raised JVP 2. Muffled heart sounds 3. Hypotension

Answer 148

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

Answer 149

Charcot's triad: Right upper quadrant pain Fever Jaundice

Answer 150

Triad of microangiopathic haemolytic anaemia, thrombocytopenia and AKI.

Answer 151

Shiga toxin-producing E.coli (STEC)

Answer 152

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

Answer 153

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

Answer 154

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

Answer 155

- 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

Answer 156

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 2. 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

Answer 157

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.

Answer 158

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

Answer 159

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

Answer 160

- 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.

Answer 161

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

Answer 162

1. Crypt hyperplasia 2. Mucosal inflammation 3. Villous atrophy

Answer 163

* 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.

Answer 164

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)

Answer 165

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

Answer 166

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

Answer 167

Midline of neck. Moves up and down with tongue movement.

Answer 168

Congenital Rubella (main cause) Congenital Cytomegalovirus

Answer 169

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

Answer 170

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

Answer 171

Pathogen - Borrelia burgdorferi Transferred by Ticks. Erythema Migrans.

Answer 172

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.

Answer 173

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

Answer 174

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

Answer 175

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

Answer 176

An indication of reduced lumbar flexion. >20cm → indicates restriction in lumbar movement. <5cm is suggestive of ankylosing spondylitis.

Answer 177

Mania - lasts for at least 7 days, psychotic sx present Hypomania - lasts <7 days (3-4), no psychotic sx

Answer 178

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