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1
Q

Acute treatment of Menieres disease

A

prochloperazine

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2
Q

prophylaxis in menieres disease

A

betahistine

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3
Q

drugs causing sensorineural hearing loss

A

gentamicin
chemotherapy
NSAIDs/aspirin (in overdose)

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4
Q

inheritance of otosclerosis

A

autosomal dominant

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5
Q

bilateral vestibular neuromas

A

neurofibromatosis type 2

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6
Q

virus closely associated with nasal carcinoma

A

epstein barr virus

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7
Q

naseptin is contraindicated in patients with what allergy

A

peanuts

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8
Q

drug for chronic hyperkalaemia in dialysis patients

A

calcium resonium

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9
Q

what is dusulepin

A

TCA

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10
Q

results of high dose dexamethasone suppression test in patients with cushing’s disease (pituitary adenoma)

A

ACTH = suppressed
Cortisol = suppressed
(high dose exerts negative feedback on the ACTH producing tumour cells)

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11
Q

when in the fundus palpable at the umbilicus

A

24 weeks

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12
Q

when is the fundus palpable at the xiphsternum

A

36 weeks

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13
Q

what is pulsus paradoxus seen in

A

cardiac tamponade

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14
Q

diagnosis of mycoplasma pneumoniae

A

serology

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15
Q

what type of diabetes insipidus does lithium cause

A

nephrogenic

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16
Q

what genetic condition is associated with Hirschsprung’s

A

Down’s syndrome

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17
Q

what is reduced in wilson’s disease

A

caeruloplasmin

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18
Q

what is CREST a subtype of

A

limited systemic sclerosis

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19
Q

moderate asthma attack (4)

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

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20
Q

severe asthma attack (4)

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

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21
Q

life-threatening asthma attack (6)

A

PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

ANY OF THESE SIGNS MEANS THIS IS LIFE THREATENING ASTHMA ATTACK

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22
Q

1st line anticoagulant for APS

A

warfarin

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23
Q

screening test for haemochromatosis

A

transferrin saturation

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24
Q

antidote for dabigatran

A

idarucizumab

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25
Q

treatment of schistosomiasis

A

praziquantel

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26
Q

gram -ves (15)

A

pseudomonas
legionella

neisseria meningitidis
neisseria gonorrhoea

haemophilius influenzae
bordetella pertussis

e.coli
klebsiella
proteus

salmonella
e.coli 0157
shigella

campylobacter
helicobacter

bacteroides

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27
Q

gram +ves (16)

A

strep pneumoniae (a-haemolytic)
strep viridans (a-haemolytic)

GBS (e.g. strep pyogenes) (b-haemolytic)
GAS (b-haemolytic)

enterococcus (non-haemolytic)

staph aureus (coagulase positive)
staph epidermidis (coagulase negative)

diptheriodis
corynebacterium diptheriae

listeria monocytogenes

bacillus cereus
bacillus anthracis

anaerobic streptococci

clostridium difficile
clostridium tetani
clostridium perfingen

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28
Q

most common cause of mitral stenosis

A

rheumatic fever

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29
Q

how do you assess the plasma concentration of digoxin

A

digoxin concentrations should be measured within 8-12 hours of the last dose to assess for the plasma concentration

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30
Q

primary prevention dose of atorvastatin

A

20mg

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31
Q

secondary prevention dose atorvastatin

A

80mg

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32
Q

drugs that cause long-QT

A

A - anti-arrhythmics (amiodarone, sotalol, flecainide)
B - Antibiotics (fluoroquinolones, macrolides, aminoglycosides)
C - antipsychotics (haloperidol, quetiapine, risperidone)
D - Antidepressants (SSRIs, TCAs)
D - Diuretics
E - antiemetics (ondansetron)

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33
Q

non-pharmacological causes of long QT interval (7)

A

hypocalcaemia
hypokalaemia
hypomagnesaemia
myocarditis
myocardial infarction
SAH
hypothermia

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34
Q

recommended treatment for aortic stenosis

A

valve replacement

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35
Q

big toe dermatome

A

L5

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36
Q

medial malleolus dermatome

A

L4

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37
Q

lateral malleolus dermatome

A

S1

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38
Q

INR target for DVT/PE and AF treated with warfarin

A

2-3

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39
Q

INR target for recurrent DVT/PE and mechanical heart valves

A

3-4

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40
Q

how many days before surgery should warfarin be stopped

A

5 days

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41
Q

management of major bleed + warfarin

A

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*

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42
Q

management of INR > 8.0, minor bleeding + warfarin

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

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43
Q

management of INR > 8.0, no bleeding + warfarin

A

Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

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44
Q

management of INR 5.0-8.0, minor bleeding + warfarin

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

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45
Q

management of INR 5.0-8.0, minor bleeding + warfarin

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

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46
Q

management of INR 5.0-8.0, no bleeding + warfarin

A

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

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47
Q

most common parasite in HIV patients with diarrhoea

A

cryptosporidium

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48
Q

which way does the tongue deviate in hypoglossal nerve injury

A

towards the side of injury

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49
Q

non-sedating antihistamines

A

acrivastine
cetirizine
fexofenadine
loratadine

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50
Q

sedating antihistamines

A

chlorphenamine (Piriton)
cinnarizine
diphenhydramine
hydroxyzine
promethazine

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51
Q

what is given with methotrexate to reduce side effects

A

folic acid

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52
Q

what are porphyrias

A

group of disorders caused by genetic or acquired deficiencies in one of the enzymes in the metabolic pathway for haem
Haem precursors (porphyrins) accumulate and react with light to produce skin problems

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53
Q

enzyme affected in porphyria cutanea tarda

A

Decreased uroporphyrinogen decarboxylase in the liver

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54
Q

enzyme affected in erytrhopoetic protoporphyria

A

Deficiency in ferrochelatas

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55
Q

enzymes affected in acute intermittent porphyria

A

Deficiency in porphobilinogen deaminase

(no skin symptoms)

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56
Q

drugs causing Steven Johnstone syndrome

A

penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill

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57
Q

opioids used in renal failure

A

oxycodone

if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred

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58
Q

what type of paediatric hernia should be surgically treated

A

inguinal
(umbilical usually resolve with time)

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59
Q

what drugs can be used to prevent pathological fractures in bone metastases

A

Bisphosphonates and denosumab

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60
Q

Causes pupillary dilatation in the Horner’s pupil

A

apraclonidine (alpha agonist)

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61
Q

Causes pupillary constriction in Adie’s pupil

A

pilocarpine

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62
Q

what is it called when one pupil is bigger than the other

A

anisocoria

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63
Q

Horner’s syndrome - anhydrosis determines site of lesion:
head, arm, trunk = central lesion:
just face = pre-ganglionic lesion:
absent = post-ganglionic lesion:

A

head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery

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64
Q

SSRI that most commonly causes prolonged QT

A

citalopram

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65
Q

management of orbital cellulitis

A

IV antibiotics and admit

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66
Q

symptomatic management in hyperthyroidism

A

propanolol
(e.g. in pregnancy induced thyroiditis)

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67
Q

calculation for urine osmolality

A

osmolality = 2 (Na+) + 2 (K+) + Glucose + Urea (all in mmol/L);
OR Calculated osmolality = 2 (Na+) + Glucose + Urea (all in mmol/L).

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68
Q

normal urine output

A

0.5 mL/kg/hour
patients should be urinating every 6 hours

69
Q

what is the best investigation for biliary colic

A

ultrasound

70
Q

what is the standard target hba1c

A

48 (for those taking one drug not associated with hypoglycaemia)
53 (for those taking more than one medication or taking a medication associated with hypoglycaemia)

71
Q

criteria for bariatric surgery (5)

A

body mass index (BMI) of 40 or more, or a BMI between 35 and 40 and a serious condition that might improve with weight loss (such as type 2 diabetes or high blood pressure)

all other weight loss methods, such as dieting and exercise have be unsuccessful

you agree to long-term follow-up after surgery

fit enough for GA

care from specialist obesity team

72
Q

Do not use corticosteroids in children younger than _______ with suspected or confirmed bacterial meningitis

A

3 months

73
Q

vaccines in the 6-in-1 vaccination

A

diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B

74
Q

diagnostic test for hirschprungs disease

A

anorectal biopsy

75
Q

most important test in tumour lysis syndrome

A

urate

76
Q

when is neonatal jaundice abnormal

A

within 24hrs of birth
lasts >14 days (full term)
lasts >21 days (preterm)`

77
Q

when is neonatal jaundice normal

A

2-7 days of age
resolves by day 10
baby is well

78
Q

what rate of insulin should be given in DKA?

A

the IV insulin infusion should be started at 0.1 unit/kg/hour

79
Q

SSRI + NSAID =

A

GI bleed risk = give PPI

80
Q

when do post-partum women require contraception

A

21 days after giving birth

81
Q

rash involving the nasolabial folds

A

seborrhoeic dermatitis

(acne rosaecea involved nasolabial folds)

82
Q

what does a bishops score of 5 or less indicate

A

A score of 5 or less suggests that labour is unlikely to start without induction

83
Q

if angina is not controlled by beta-blocker

A

add CCB

84
Q

in angina: if a patient can’t tolerate b-blocker or CCB what treatments can be considered

A

a long-acting nitrate or
ivabradine or
nicorandil or
ranolazine

85
Q

blood stained nipple discharge

A

ductal papilloma

86
Q

pus nipple discharge

A

duct ectasia

87
Q

renal stones with hydronephrosis or signs of sepsis

A

nephrostomy

88
Q

Nephrotic syndrome is associated with a hypercoagulable state due to loss of antithrombin III via the kidneys which can lead to

A

renal vein thrombosis

89
Q

how long is fever in Kawasaki’s disease

A

5+ days

90
Q

treatment in Kawasaki’s disease

A

aspirin

91
Q

when can you attempt external cephalic version for a transverse lie

A

if the amniotic sac has not ruptured

92
Q

Patients who have had an episode of SBP require antibiotic prophylaxis with…

A

ciprofloxacin

93
Q

management of bilateral adrenal hyperplasia

A

spironolactone

94
Q

widespread systolic murmur, hypotension, pulmonary oedema after MI

A

Acute mitral regurgitation due to papillary muscle rupture

95
Q

what pH are NG tubes safe to use

A

pH <5.5 on aspirate

96
Q

Heparin induced thrombocytopenia is a _________ state

A

prothrombotic

97
Q

normal vaginal ph

A

3.8 and 5.0

98
Q

vaginal ph in BV

A

alkali

99
Q

endocrine side effect of atypical antipsychotics

A

Long-term atypical antipsychotics can lead to the development of glucose dysregulation and diabetes

100
Q

prognostic scoring system in pancreatitis

A

P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

101
Q

treatment if arrhythmia in TCA overdose

A

IV bicarbonate

102
Q

staggered paracetamol overdose

A

NAC immediately

103
Q

when do you check lithium levels

A

5-7 days after dose change, 12 hours post-dose

104
Q

> = 75 years following a fragility fracture

A

start bisphosphonates

105
Q

when to take progesterone level

A

7 days prior to the expected next period

106
Q

what amount of paracetamol is considered an overdose

A

> 75mg/kg of paracetamol

107
Q

criteria for transplant in paracetamol overdose

A

pH <7.3, 24hrs after ingestion
OR ALL of the following
PT >100
creatinine >300
encephalopathy

108
Q

causes of haematospermia

A

UTI
Trauma
STI
Cancer (needs excluded)

Refer if more than >3 episodes or if persists for more than a month

109
Q

when to give adrenaline in shockable rhythms

A

every 3-5 mins

110
Q

when to give amiodarone in shockable rhythms

A

after 3rd shock

111
Q

adrenaline dose in cardiac arrest

A

1:10,000 = 1mg in 10ml - IV (100 mcg in 1ml)

112
Q

adrenaline dose in anaphylaxis (>12yrs)

A

Adult and child > 12 years 500 micrograms (0.5ml 1 in 1,000)

113
Q

adrenaline dose in anaphylaxis (6-12yrs)

A

6-12 years 300 micrograms (0.3ml 1 in 1,000)

114
Q

adrenaline dose in anaphylaxis (6 months - 6yrs)

A

6 months - 6 years 150 micrograms (0.15 ml 1 in 1,000)

115
Q

adrenaline dose in anaphylaxis (<6 months)

A

< 6 months 100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)

116
Q

ACEi are contraindicated in what valvular disease

A

moderate-severe aortic stenosis

117
Q

treatment for prostatitis

A

quinolone for 14 days

118
Q

when to give amiodarone in cardiac arrest

A

amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.

a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered

119
Q

when to give adrenaline in cardiac arrest

A

adrenaline 1 mg as soon as possible for non-shockable rhythms

during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock

repeat adrenaline 1mg every 3-5 minutes whilst ALS continues

120
Q

treatment of campylobacter

A

clarithromycin

121
Q

massive PE + hypotension

A

thrombolyse

122
Q

what is subclinical hyperthyroidism associated with

A

atrial fibrillation, osteoporosis and possibly dementia

123
Q

antibiotics that can cause long QT

A

macrolides (clarithromycin
fluroroquinolones (ciprofloxacin)

124
Q

most common side effect of POP

A

irregular bleeding

125
Q

test for H.pylori eradication

A

urea breath test

126
Q

unstable VT with a pulse

A

DC cardioversion

127
Q

when is lactation a reliable form of contraception

A

amenorrhoeic, baby <6 months, and breastfeeding exclusively

128
Q

red flags for back pain

A

Thoracic pain
Age <20 or >55 years
Non-mechanical pain
Pain worse when supine
Night pain
Weight loss
Pain associated with systemic illness
Presence of neurological signs
Past medical history of cancer or HIV
Immunosuppression or steroid use
IV drug use
Structural deformity

129
Q

how do you screen for coronary artery aneurysm in Kawasaki disease

A

echocardiogram

130
Q

what antenatal steroids are given in preterm labour

A

dexamethasone

131
Q

what type of stoma is flush to the skin

A

colostomy

132
Q

bilious vomiting on the first day of life

A

duodenal atresia

133
Q

criteria for postural hypotension

A

a. A drop in systolic BP of 20mmHg or more (with or without symptoms)
b. A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without symptoms)
c. A drop in diastolic BP of 10mmHg with symptoms (although clinically much less significant than a drop in systolic BP).

134
Q

investigation for reflux nephropathy

A

micturating cystography

135
Q

in SAH when should an LP be done

A

12 hours after onset of symptoms

136
Q

how often are you invited for breast screening?

A

every 3 years

137
Q

treatment of LA toxicity

A

IV 20% lipid emulsion

138
Q

metabolic disturbance in salicylate overdose

A

respiratory alkalosis
then
metabolic acidosis

139
Q

antibiotic for GBS prophylaxis

A

benzylpenicillin

140
Q

elevation of testes worsens the pain (Prehn’s test)

A

testicular torsion

141
Q

elevation of testes eases the pain (Prehn’s test)

A

epididymitis

142
Q

can statins be given in pregnancy

A

no

143
Q

don’t give in GDP6 deficiency

A

sulpha-containing drugs

144
Q

metabolic disturbance in cushings

A

Hypokalaemic metabolic alkalosis

145
Q

metabolic disturbance in cushings

A

Hypokalaemic metabolic alkalosis

146
Q

what eGFR is metformin contraindicated

A

<30

147
Q

worse on resisted wrist extension/suppination whilst elbow extended

A

lateral epicondylitis (golfer’s elbow)

148
Q

Rosacea first-line for patients mild papules and/or pustules

A

topical ivermectin

149
Q

patients with acute, severe, symptomatic hyponatraemia (< 120 mmol/L)

A

hypertonic saline

150
Q

immediate management of acute angle closure glaucoma

A

lie flat
Pilocarpine eye drops (to constrict the pupil) and oral acetazolamide (to reduce aqueous humour production)

151
Q

morphine is ___ times stronger than codeine

A

10

152
Q

symptoms control in non-CF bronchiectasis

A

inspiratory muscle training + postural drainage

153
Q

first line investigation for prostate cancer

A

Multiparametric MRI has replaced TRUS biopsy as the first-line investigation in suspected prostate cancer

154
Q

treatment of otitis externa in diabetics

A

treat with ciprofloxacin to cover Pseudomonas

155
Q

hydrocortisone dose in Addison’s disease

A

the hydrocortisone dose is split with the majority given in the first half of the day

156
Q

when are nitrates contraindicated in ACS

A

if BP less than <90mmHg

157
Q

is podophyllin safe in pregnancy

A

no, cryotherapy should be used for genital warts

158
Q

most common thyroid cancer between 35-40yrs, more common in women

A

papillary thyroid cancer

159
Q

1st line management for menorrhagia

A

IUS

160
Q

spread of follicular thyroid cancer

A

haematogenous

161
Q

spread of papillary and medullary thyroid cancer

A

lymphatics

162
Q

spread of anaplastic thyroid cancer

A

local

163
Q

when can women stop taking contraception

A

Women using non-hormonal methods of contraception can be advised to stop contraception after 1 year of amenorrhoea if aged over 50 years, 2 years if the woman is aged under 50 years

164
Q

which CCBs do you avoid in heart failure with reduced ejection fraction?

A

diltiazem
verapamil

165
Q

sudden-onset vertigo and vomiting, dysphagia, ipsilateral facial pain and temperature loss, contralateral limb pain and temperature loss, and ataxia.

A

posterior inferior cerebellar artery stroke

166
Q

sudden-onset vertigo and vomiting, and ipsilateral facial paralysis and deafness

A

anterior inferior cerebellar artery stroke

167
Q

5 Ds of posterior stroke

A

dizziness, diplopia, dysarthria, dysphagia, dystaxia

168
Q

when is NIV indicated in COPD exacerbation

A

when a person’s arterial blood gases (especially the pH and carbon dioxide levels) are not responding (or worsening) despite optimal medical management.

CRAM CARDS (21 decks)

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