Quickfire

Question 1

What test is done in hypoglycaemia to look for a non insulin/SU endocrine cause?

Answer 1

Cortisol level to look for Addisons disease

Question 2

What score is used to assess hypo awareness?

Answer 2

GOLD score

Question 3

POAG - drugs, their action and SE

Answer 3

Prostaglandin analogues - latanoprost - increase outflow - eye redness, change in iris colour, growth of eye lashes

Beta blocker - timolol - reduce production - bradycardia, hypotension

Carbonic anhydrase inhibitors - acetazolamide - decrease production - hypokalaemia, increased urination, burning sensation

Cholinergic agonist - pilocarpine - increased outflow - pain, miosis, blurred vision

Question 4

Treatment for severe eczema, severe psoriasis

Answer 4

Eczema - phototherapy, Abx, ciclosporin

Psoriasis - narrow band UVB, methotrexate, cyclosporin

Question 5

Only MND drug

Answer 5

Riluzole

Question 6

Score to predict whether unstable angina will become STEMI

Answer 6

GRACE score

Question 7

How to treat recurrent PE

Answer 7

IVC filter

Question 8

CREST - scleroderma

Answer 8

Calcinosis
Raynauds
Esophageal dysfunction
Sclerodactylyl
Telengectasia

Question 9

Causes of dilated pupil

Answer 9

Amphetamines, cocaine, 3rd nerve palsy, brain herniation, epilepsy, stroke

Question 10

Causes of constricted pupil

Answer 10

Opioid overdose, horners syndrome, brainstem haemorrhage

Question 11

Cause of 3rd nerve palsy

Answer 11

Aneurysm, DM, pituitary apoplexy, tumour, stroke

Question 12

Neuroleptic malignant syndrome

Answer 12

MFEVER
Myoglobin 
Fever
Enzyme - creatinine kinase 
Vitals 
Encephalopathy 
Rigidity 

Cool, dantrolene, resuscitate, treat AKI, stop drug

Question 13

Lifestyle factors for HTN

Answer 13

Low salt diet, reduce caffeine, exercise, smoking, diet, alcohol

Question 14

What tests to do if suspect type 1 diabetes

Answer 14

HbA1c
Random blood glucose
Ketone
Urinalysis - glucose 
C-Peptide (low), Auto-antibodies (+ve)

Question 15

Signs of rheumatoid hands

Answer 15

Ulnar drift
Boutonnieres deformity
Swann necking

Question 16

Signs of osteoarthritis hands

Answer 16

Heberdens nodes
Bouchard nodes
squaring of the thumb

Question 17

Blow to the lateral ankle - what kind of fracture

Answer 17

Potts fracture - fracture of the medial malleolus then fracture of either lateral malleolus of distal fibula

Question 18

Truelove and witts UC severity

Answer 18

Increased bowel movements
Fever
Gross blood in stools
Low Hb
Raised HR >100
Raised ESR

Question 19

Components of capacity

Answer 19

Understand
Retain
Weigh up
Communicate

Question 20

ECG changes in hyperkalaemia

Answer 20

Small p wave
prolonged PR interval
Prolonged QT interval 
Tented T wave 
AV dissociation

In late stage - sine wave pattern, asystole

Question 21

What pathway is PT (INR) and APTT

Impact of anticoagulants and anti-platelets

Answer 21

PT - extrinsic
APTT - intrinsic

Anticoagulants increase both and increase bleeding time
Anti-platelets increase bleeding time but not APTT, PT

Question 22

Gout vs pseudo gout crystals

Answer 22

Gout – needle negative birefringent crystals

Pseudogout – rhomboid positively birefringent crystals

Question 23

Bloods in a confusion screen

Answer 23

FBC, U+E, LFT, CRP, TFT, Bone profile, B12/Folate, glucose, Coag

Question 24

Bloods for anaemia screen

Answer 24

FBC, U+E, TFT, B12/folate, Ferritin, Serum iron, Total iron-binding capacity

Question 25

Bloods for sepsis screen

Answer 25

FBC, U+E, CRP, lactate and blood cultures Then do sample/ culture of where think infection is

Question 26

Bloods for hypo/hypercalcaemia screen

Answer 26

U+E, LFT, Vit D, Bone profile, PTH, Ionised calcium

Question 27

Bloods for hyponatraemia screen

Answer 27

U+E, TFT, cortisol, serum + urine osmolality, urine NA/K

Question 28

Cause of isolated raised ALP

Answer 28

Bone mets, renal osteodystrophy, recent fracture, Vit D deficiency

Question 29

Causes of low albumin

Answer 29

Nephrotic syndrome, acute phase reaction, liver failure (cirrhosis)

Question 30

Pneumocystis pneumonia treatment

Answer 30

Co-trimoxazole love you ed <3

Question 31

Area most likely to bleed in epistaxis

Answer 31

Littles area

Question 32

What antiemetics to use when

Answer 32

Gastric stasis, gastroparesis - metoclopramide Post surgery - ondansetron, dexamethasone Travel sickness, raised ICP - cyclizine Palliative, drug induced - haloperidol or levomepromazine

Question 33

DI test and management

Answer 33

Fluid deprivation test, treat with desmopressin, NSAID and thiazide

Question 34

Dyspepsia red flags

Answer 34

Weight loss, dysphagia, melaena, haematemesis, IDA

Question 35

Diabetes total daily dose calculation

Answer 35

0.2 units/kg OD regime - long acting analogue e.g. Lantus, Tresiba, Levemir BD 0.1 unit/kg (Novomix) Bolus dose 1unit for every 10g of carb

Question 36

How does reactive arthritis present, main cause and treatment

Answer 36

Cant see (uveitis), cant pee (urethritis/balanitis), cant bend knee Chlamydia can cause reactive arthritis (Reiters syndrome), also campylobacter Do aspiration - High WBC, no growth on culture Give Abx, NSAID 1st line, can give steroid injections

Question 37

Thiamine - what vitamin

Answer 37

Vitamin B1

Question 38

DSM-V for delirium

Answer 38

Inattention, acute change, evidence of cause, cognitive deficit

Question 39

Causes of acanthosis nigricans

Answer 39

GI cancer and Addisons disease

Question 40

Hep B serology

Answer 40

Surface antigen/ antibody - active infection or vaccinated Core antibody - IgM +ve = acute infection, IgG = chronic, if surface antigen negative, IgG +ve = past infection E antigen - level of infectivity (if E antibody +ve, antigen -ve means are in less infective phase Hep B DNA - viral load

Question 41

Abx for gastroenteritis if bacterial

Answer 41

Ciprofloxacin

Question 42

Drug causes of erythroderma

Answer 42

sulphonamides, allopurinol, carbamazepine

Question 43

What is angina and when is it unstable

Answer 43

Chest pain on exertion, relieved by rest or nitrates | Unstable if new, getting worse or occurring at rest

Question 44

When HbA1c cannot be used

Answer 44

Haemoglobinopathies e.g. sickle cell, G6PD, haemolytic anaemia, splenectomy

Question 45

What to give for TCA overdose

Answer 45

IV bicarbonate