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1
Q

what is type 1 hypersensitivity?

A

short onset
ige
allergy etc

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2
Q

what is type 2 hypersensitivity?

A

igG/igM
hours - days
haemolytic anaemia

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3
Q

what is type 3 hypersensitivity?

A

weeks
immune complex
SLE

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4
Q

what is type 4 hypersensitivity?

A

T cells
weeks
rash
stevens johnson

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5
Q

how does ADH affect portal blood pressure?

A

decreases portal blood flow

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6
Q

blood supply to foregut eg stomach is provided by ___

A

coeliac artery

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7
Q

Humeral neck fracture = damage to what?

A

axillary nerve / artery / vein

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8
Q

midshaft humeral neck fracture = damage to what?

A

radial nerve

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9
Q

suprachondular humeral fracture = damage to what?

A

median nerve
brachial artery
maybe ulnar

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10
Q

what is odansetron?

A

5HT3 antagonist

antiemetic

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11
Q

what is cyclizine?

A

H1 antagonist

antiemetic

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12
Q

what is metoclopramide?

A

D2 antagonist

anti emetic

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13
Q

metaplasia vs dyspasia?

A 
metaplasia = transformation into another cell type
dysplasia = dodgy change
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14
Q

what biomarker for ovarian cancer?

A

ca125

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15
Q

what is cea a biomarker for?

A

colon/bowel

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16
Q

what is epithelium in oesophagus made from?

A

stratified squamous

non keratinised

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17
Q

where is transitional epithelium?

A

bladder

called transitional because it looks different when bladder is bigger

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18
Q

what is the most important IMMEDIATE treatment for sepsis?

A

fluids

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19
Q

what does hyperparathyroidism look like on ECG?

A

high PTH = high calcium

tall T and short QT

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20
Q

drugs ending in -azole are?

A

antifungals

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21
Q

definition of sensitivity and specificity?

A 
sensitivity = number of true positives 
specificity = number of true negatives
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22
Q

define prevalence and incidence?

A 
prevalence = number of cases today
incidence = number of new cases today
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23
Q

how to calculate the amount of units in alcohol?

A

% x ml / 1000

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24
Q

autonomy is..

A

allowing patients with capacity to have an input in their care
(must have capacity to have autonomy)

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25
Q

diadepesis is?

A

when neutrophils attract other inflammatory cells

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26
Q

treatment for hypercalcaemia?

A

fluids

if severe / symptoms you can use bisphosphonates & calcitonin
(calcitonin is released from C cells in the thyroid and lowers blood calcium)

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27
Q

cold peripheries are associated with what thyroid pathology?

A

hypothyroid (cold intolerance)

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28
Q

the MRC score is for..

A

breathlessness

1 is fine, 5 is cannot leave house

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29
Q

what is Felty’s syndrome?

A

rheumatoid arthritis
splenomegaly
neutropenia

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30
Q

what does a claw hand / unable to cross fingers / forearm flexor wasting / poor grip indicate damage to?

A

ulnar nerve

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31
Q

what does unable to open jam jar / poor grip / thenar muscle wasting indicate damage to?

A

median nerve

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32
Q

what is the usual 1st line SSRI for depression?

& a side effect?

A

fluoxetine

sleep disturbance / random dreams / ulcers

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33
Q

what is citalopram? what is a side effect?

A

SSRI for depression/anxiety

arrythmias

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34
Q

what are venlafaxine and duloxetine?

A

SNRI - serotonin noradrenaline reuptake inhibitors
primarily use for depression
raised BP

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35
Q

what class is amytriptilline?

A

TCA - tricyclic antidepressant

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36
Q

which antidepressants cannot be taken with lots of cheese etc?

A

MAOI - monoamine oxidase inhibitors eg phenelzine

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37
Q

what should you do before prescribing antidepressants?

A
  • warn the patient they can cause increased anxiety/suicide for first few weeks
  • warn patient they take 3-4 weeks to work
  • make sure pt knows where to find help if they suicidal
  • consider other treatment eg CBT
  • tell patient not to stop them abruptly, they need to be tapered
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38
Q

what is sertraline?

A

SSRI

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39
Q

presentation of depression?

A 
Low mood
Anhedonia, a lack of pleasure in activities
Low energy
Anxiety and worry
Irritability
Avoiding social situations
Hopelessness about the future
Poor sleep, particularly early morning waking
Poor appetite or over eating
Poor concentration
Physical symptoms such as abdominal pain
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40
Q

risk factors for depression?

A

stressful life events eg loss of a partner
family history
living alone
chronic disease
parental drug/alcohol abuse / childhood neglect
alcohol
Cushing’s / overuse of steroids

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41
Q

what 2 questionnaires can be used to assess depression?

A

PHQ 9

GAD 7

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42
Q

what 2 questionnaires can be used to assess depression?

A

PHQ 9

GAD 7

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43
Q

how are BRCA 1 and BRCA 2 inherited?

A

autosomal dominant

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44
Q

BRCA1 and BRCA 2 increase the risk of which cancers?

A 
breast
ovarian
prostate 
skin 
digestive tract
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45
Q

what is the function of BRCA 1 and BRCA2 proteins?

A

repair double stranded breaks in DNA

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46
Q

a ‘triple negative’ breast cancer does not express receptors for:

A

progesterone
oestrogen
her 2

triple neg usually BRCA 1

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47
Q

5 risk factors for breast cancer?

A 
alcohol 
smoking 
obesity
BRCA1/2, TP53 etc 
family history
radiation (eg several CXR)
chemotherapy eg for Hodgkins 
diabetes
female
dense/glandular breasts
gynaecomastia
ashkenazi jew
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48
Q

what are the signs of breast cancer?

A 
nipple inversion
dimples
palpable lump
nipple/areolar exczema 
unilateral nipple discharge 
axillary lump
change in breast size
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49
Q

T classification for breast cancer?

A

1 - less than 2cm
2 - 2-5cm
3 - 5cm +
4 - metastasised

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50
Q

treatment for oestrogen receptor positive breast cancer?

A

tamoxifen - for pre menopausal (selective oestrogen receptor antagonist/SERT)
letrozole/aromatase inhibitor for post menopausal (after menopause aromatase is the main source of oestrogen)

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51
Q

treatment of HER-2 receptor positive breast cancer?

A

herceptin (trastuzumab)

side affect - affects heart function

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52
Q

what is goosrhelin?

A

GnRH agonist

can be used in oestrogen receptor pos breast cancer

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53
Q

what 4 main things do they look for at the 8 week baby check?

A

hip dysplasia
congenital cataract
undescended testes
congenital heart disease eg VSD

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54
Q

what contraception can you use immediately after giving birth?

A

implant
injection
progesterone only pill
condoms

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55
Q

what contraception can you not use in the weeks following giving birth?

A 
vaginal ring
combined pill
patch
diaphragm/cap
coil - unless you put it in within 48hrs
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56
Q

what are caspases?

A

enzymes that destroy the organelles in apoptosis

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57
Q

what type of necrosis is there in MI and tubular necrosis?

A

coagulative

denatured

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58
Q

what happens in caseous necrosis?

A

eg TB

macrophage form giant mutlinucleated cells

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59
Q

define ‘neoplasm’?

A

autonomous abnormal growth of cells
persists when stimulus removed
benign or malignant

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60
Q

what is the stroma around a neoplasm?

A

supportive tissue

eg fibroblasts, blood vessels

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61
Q

what is the difference between the way benign and malignant tumours grow on mucosa?

A

benign - exophytic - grow up and out

malignant - endophytic - grow down into and ulcerate

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62
Q

what is a papilloma?

A

benign

not glandular

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63
Q

carcinogenesis vs oncogenesis?

A

carcin - only for malignant

onco - benign or malignant

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64
Q

what specifically increases the risk of seminoma?

A

undescended testes

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65
Q

how do sulphamethoxazole and trimethoprim work?

A

stop the production of folic acid

66
Q

how does metronidazole work?

A

stops the production of nucleic acid

only works in anaerobes

67
Q

how do macrolides such as erythromycin, clarithromycin, azithromycin work?

A

target ribosome - inhibit protein synthesis

68
Q

what kind of drug is doxycycline and what does it do?

A

tetracycline

targets the ribosome to stop protein synthesis

69
Q

what abx do you need to be careful of in penicillin allergy?

A

cephalosporin

carbopenems

70
Q

amoxicillin covers __

A

gram pos
strep
listeria
enterococcus

71
Q

by changing from amoxicllin – co amoxiclav what are you now covering for?

A

staph
haemophilus
e coli

72
Q

what kind of bacteria does doxycycline cover?

A

very broad spec

gram pos and neg and atypical

73
Q

define sepsis?

A

body launches a large immune response against a pathogen
= systemic vasodilation
affects organ function

74
Q

what makes up the triad of haemolytic uraemic syndrome?

A

haemolytic anaemia
AKI
thrombocytopenia

75
Q

how does haemolytic uraemic syndrome develop?

A

following infection with ecoli 0157 or shigella
– caused by the shiga toxin

more likely if they have abx or loperamide, this is why gastroenteritis not routinely treated like that

76
Q

presentation of haemolytic uraemic syndrome?

A 
oliguria 
Haematuria
Abdominal pain
Lethargy
Confusion
Hypertension
Bruising
following a period of blood diarrhoea
77
Q

what is the treatment for haemolytic uraemic syndrome?

A

antihypertensives
blood products (to combat haemolysis)
dialysis

78
Q

what blood product would you give in anaemia?

A

packed red cells

used to restore the oxygen carrying capacity

79
Q

what is cryoprecipitate for?

A

anticoagulation reversal

80
Q

when is whole blood usually given?

A

generally only in acute/prehospital

81
Q

causes of erectile dysfunction?

A 
antidepressants 
trauma eg pelvis fracture
MI
hypertension
diabetes 
prostatectomy 
alcohol
82
Q

what is the investigation for thyroid cancer?

A

fine needle aspiration for cytology

this is sensitive for all thyroid cancers except follicular

83
Q

what happens in hyperthyroid crisis?

A 
tachycardia 
extreme pyrexia 
abdo symptoms 
confusion/agitation
associated with graves 
immediate treatment is carbimazole
84
Q

immediate treatment for type II heart block?

A

atropine

85
Q

Graves is associated with pretibial myxoedema but what is that?

A

discoloured, non-pitting swelling of the lower legs, usually found bilaterally and can be sore or itchy

86
Q

8 risk factors for angina?

A

biologically male
fam history
genetic hyperlipidaemia
age

HTN
type 2 diabetes mellitus 
smoking
cholesterol
obesity
87
Q

Systemic features of ankylosing spondylitis?

5As

A 
anterior uveitis 
autoimmune bowel disease 
apical lung fibrosis 
aortic fibrosis 
amyloidosis
88
Q

what is prophylaxis for migraine?

A

propanolol
topiramate
amitryptilline

89
Q

how is adrenaline administered in anaphylaxis?

A

1 in 1000 IM

90
Q

3 risk factors for Crohn’s?

A 
family history
HLA b27 
caucasian
ashkenazi Jewish
smoking
NSAIDs
91
Q

non malignant causes of lymphadenopathy?

A 
infection
sarcoidosis
SLE
phenytoin 
EBV associated lymphoproliferative disease
92
Q

3 symptoms of leukaemia?

A 
lymphadenopathy 
weight loss
anorexia
fatigue 
bleeding 
infections 
abdo pain
93
Q

As well as the blood film what can you use to confirm the diagnosis of leukaemia?

A

immunophenotyping

94
Q

3 risk factors for TB?

A 
IVDU
homeless
immunosupressed
close contact with infected people
alcoholic 
from a country of high incidence
95
Q

what kind of diuretic is furosemide and how does it work?

A

loop diuretic

inhibits the sodium potassium transporter in the ascending loop of henle

96
Q

what kind of diuretic is bendroflumethiazide and how does it work?

A

thiazide

inhibits sodium potassium pump in the Distal convoluted tubule

97
Q

what is acetazolamide and how does it work?

A

carbonic anhydrase inhibitor diuretic

works at proximal distal tubule

98
Q

what is amiloride and how does it work?

A

diuretic

inhibits ENaC on apical membrane at distal tubule

99
Q

what is a good antibiotic for skin infections eg cellulitis?

A

flucloxacillin

100
Q

what is the most important part of the U&E to monitor in AKI?

A

potassium

101
Q

what infection do owls eye bodies indicate?

A

CMV

102
Q

what is:

paraprotein in urine, racoon eyes, macroglossia?

A

amyloidosis

103
Q

What is the name of the test for sjorens?

dry mucous membranes

A

schirmers test

104
Q

which of the coeliac antibodies are most specific & sensitive?

A

TTG - sensitive

EMA - specific

105
Q

in vWF deficiency how does the clotting tests change?

A

Like haemophilia, high APTT as vWF deficiency affects the intrinsic pathway

106
Q

a posterior duodenal ulcer can lead to bleeding from which artery?

A

gastroduodenal

107
Q

why does isoniazid cause peripheral neuropathy?

A

because it depletes vit B6

108
Q

at what Well’s score do you do a CTPA or USS not a D dimer?

A

2 or more

109
Q

in tension pneumothorax where do you put your wide bore cannula?

A

2nd intercostal space on the midclavicular line just above the rib
(left or right is fine)

110
Q

what kind of hypersensitivity is asthma?

A

type I

111
Q

what drug for Raynauds?

A

nimodipine

112
Q

in tertiary hyperPTH what is high/low?

A

high PTH
high Ca
high phosphate

caused by chronic secondary hyperPTH, usually needs surgery

113
Q

how is G6PD deficiency inherited?

A

x linked recessive

114
Q

what is the treatment for vWF deficiency?

A

1 - packing
2 - TXA
3 - vasopressin analogue
4 - vWF

115
Q

where do you hear the aortic valve/a murmur radiating to the carotids?

A

2nd intercostal space

left sternal border

116
Q

what mutation is most common in CF?

A

f508 deletion

chromosome 7

117
Q

what diet should people with CF follow?

A

high calorie high fat

118
Q

what 4 bones does pagets commonly affect?

A

vertebrae
pelvis
skull
femur

119
Q

what investigations (3) in pagets?

A

X ray to see bone lesions
calcium and phosphate - normal
ALP - high

120
Q

what about driving after a TIA?

A

you dont need to tell the DVLA, but don’t drive for 1 month

121
Q

what is first and second line treatment for chlamydia?

A

first - doxycycline 1 week

second - azithromycin 3 days

122
Q

prophylaxis for a. migraine and b. cluster headache?

A

migraine : amitriptyline, propanolol, topiramate (amy, poppy and tally get migraines)

cluster: verapamil, lithium and prednisolone (vere, leo and fred)

123
Q

what chromosome is CF on?

A

7

124
Q

what chromosome is wilson’s on?

A

13

125
Q

what chromosome is alpha 1 antitrypsin on?

A

14

126
Q

what chromosome is haemachromotosis on?

A

6

127
Q

what is the best imaging for bowel obstruction?

A

CT

128
Q

What hypersensitivity is hypersensitivity pneumonitis?

A

3

129
Q

define positive predictive value?

A

proportion of positive results that are true positives

130
Q

who gets osteosarcoma?

A

young people/children

131
Q

who gets ITP & when?

A

children get it acutely following an illness

adults with SLE etc get it chronically

presents with purpura/rash

132
Q

4 typical presenting features of TTP?

A

purpura
fever
fluctuating cerebral function
haemolytic anaemia

133
Q

what are the clotting tests like in DIC?

A

high PT, APTT, TT

134
Q

how does aplastic anaemia present?

A

bleeding, especially from gums and blisters in mouth

increased susceptibility to infections

135
Q

when you test for DI how is the desmopressin given?

A

IM

136
Q

what cardiac related drugs can you not give in heart failure?

A

verapamil, other calcium channel blockers

amlodipine is fine

137
Q

at what QFracture score or FRAX score do you need a DEXA scan?

A

10% or more

or over 50 with a frailty fracture

138
Q

3 times when it’s appropriate to break confidentiality?

A

risk to public safety
patient has given consent
required by law (eg notifiable disease)

139
Q

what does the ABCD2 score mean about TIA?

A

everyone with TIA or ?TIA needs to be seen within 7 days
score of 4 – seen within 24hrs
score of 6 – seen immediately

140
Q

how is spontaneous pneumothorax managed?

A

needle aspiration

141
Q

what is de quervains thyroiditis, when does it develop, what are the symptoms, how is it managed?

A 
hyperthyroidism 
after infection
large painful asymmetrical neck lump
lid lag, tremour, sweating, etc 
supportive management - analgaesia, anti inflammatories, beta blockers
142
Q

in anterior artery stroke which limbs are affected?

A

legs
there can also be sensory impairment
face, speech, vision etc should be fine

143
Q

If there is high unconjugated bilirubin, nomal/low conjugated, what kind of jaundice is this, and what will the urine/stools be like?

A

pre hepatic jaundice
eg haemolytic anaemia, gibsons
urine is pale bc urine has conjugated bilirubin in it (makes it water not fat sol)

144
Q

if both conjugated and unconjugated bilirubin is high what kind of jaundice is this? what might cause it?

A

intrahepatic

liver damage/cirrhosis/PBC

145
Q

what part of the lung is affected in idiopathic pulmonary fibrosis?

A

lower

this is different from most other problems, eg silicon, ankylosing spondylitis, hypersensitivity affect the top

146
Q

at what CD4 do you diagnose AIDS?

A

200 or less

147
Q

what drug do you give for pneumonia, based on the CURB score?

A

mild (CURB of 0-1): amoxicillin
moderate (CURB 2): amoxicillin + clarithromycin
severe (CURB3): co-amoxiclav + clarithromycin
PCP: cotrimoxazole (really you only see this in AIDs)

148
Q

what is ABPI?

A

ankle brachial pressure index
an index of vessel competency
measure ratio of systolic BP in arm vs ankle
ratio less than 0.8 indicates arterial disease

149
Q

what is the lump like in testicular cancer?

A

hard and painless
doesnt transluminate
part of the testicle (different from a hernia)
heavy/dragging sensation

150
Q

what is the most specific blood marker of acute liver damage?

A

ALT

albumin is best for chronic

151
Q

in haemophilia what is the INR?

A

normal

152
Q

what are the ‘irritative’ LUTs?

A

related to storage

nocturia, frequency, urgency, incontinence

153
Q

what is mild UC?

A

4 or less poos a day

small amounts of blood

154
Q

what is moderate UC?

A

4-6 poos

mild-severe blood

155
Q

what is severe UC?

A 
6+ poos
ESR 30+ 
pyrexia 
tachycardia (above 90)
anaemia
156
Q

how is aminosalicylate given in UC?

A

topically in mild-moderate, and orally if no response

157
Q

what are the main differences between arterial and venous ulcers?

A

arterial – caused by peripheral vascular disease. on the feet. dry base. ‘punched out’. painful

venous – caused by blood stasis. ragged edges, on the legs, not painful, oozing, superficial

158
Q

give two points from the wilson and jungner criteria for screening tests?

A
  • condition is an important health problem
  • there is an accepted treatment for patients with the disease
  • there are available facilities for the diagnosis and treatment of the disease
  • there is a recognisable latent or early symptomatic stage of the disease
  • there must be a suitable test or examination
  • and this test must be acceptable to the public
  • we should understand the natural history of the condition, including the progression from latent to declared disease
159
Q

what is cullens sign?

A

bruising around the bellybutton

160
Q

what is fox’s sign?

A

bruising around the inguinal ligament

161
Q

what is grey-turners sign?

A

discolouration, eccymosis of the flank

phase 2a (10 decks)

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