Random Flashcards
What are the 5 post-surgical causes of pyrexia? [5]
Wind: Pneumonia and atelectasis (1-2 days post-op)
Water: Urinary tract infection (UTI) (>3 days)
Wound: Surgical site infections (> 5 days)
Wonder drugs: Drug-induced fever, commonly due to anaesthesia
Walking: Deep vein thrombosis (DVT) (>1 week)
What is the most common site of carcinoid tumour?
Carcinoid tumours are rare, slow-growing neuroendocrine malignancies arising from enterochromaffin cells.
The most common site of carcinoid tumours is the appendix; other common sites include the ileum, rectum, testis, ovary, and bronchi.
What is the MoA of cyclizine? [1]
H1 antagonist
A patient has a major haemorrhage.
You decide you treat using TXA.
Describe how you would administer this drug [1]
Tranexamic acid is given as an IV bolus followed by an infusion in cases of major haemorrhage
A 30 year old male presents to Accident & Emergency with an acute onset of abdominal cramps, vomiting and non-bloody diarrhoea. These started an hour after having a cheese platter at a friend’s house.
What is the most likely source of infection? [1]
Staphylococcus aureus
Staphylococcal enteritis is associated with consumption of unpasteurised milk, unrefrigerated meat and dairy products. It usually presents with profuse vomiting and non-bloody diarrhoea within 1 to 6 hours due to a preformed toxin.
What is the cause of this ECG abnormality? [1]
On this ECG the only evident abnormality (apart from the AF) is the down-slopping ST segments seen in leads V4-V6, I and aVL. These down-slopping ST-segments (or reverse ticks) are characteristic of digoxin treatment. It can be difficult to distinguish this appearance from ST depression associated with an NSTEMI. In NSTEMI the ST depression is horizontal (not down-slopping). Digoxin is often used in the treatment of atrial fibrillation (especially if there’s co-existing heart failure) in the elderly population
Name and describe the cause of this ECG abnormality [1]
Cardiac tamponade occurs when a pericardial effusion causes haemodynamically significant cardiac compression. Signs include the classic beck’s triad which is comprise of; muffled heart sounds, low blood pressure and a raised JVP/distended neck veins. Another common finding is electrical alternans which is seen above, it is caused by the swinging of the heart in the pericardial fluid as it is being compressed. Common causes of pericardial tamponade include; following procedures such as post pacemaker implantation or post cardiac surgery, after trauma or due to a spontaneous bleed in anticoagulated patients
Periodic acid-Schiff positive particles upon duodenal biopsy is diagnostic of []
Periodic acid-Schiff positive particles upon duodenal biopsy is diagnostic of Whipple’s disease
A patient presents with polydipsia and polyuria.
They also have blood tests that show hypernatraemia with high serum osmolality and low urine osmolality that only returns to normal upon administration of desmopressin.
What is the most likely diagnosis? [1]
Hereditary haemochromatosis is a cause of cranial diabetes insipidus
What medication do you give for a pregnant person with antiphospholipid syndrome? [2]
What anti-coagulation used when not pregnant? [1]
Antiphospholipid syndrome in pregnancy:
- aspirin + LMWH
Normally:
- Long-term warfarin with a target INR of 2-3 is used to prevent thrombosis.
What are the specific antiphospholipid antibodies are? [3]
Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein I antibodies
What changes in electrolytres are associated with PPIs? [2]
hyponatraemia, hypomagnasaemia
What is Behcet’s syndrome? [1]
What are the common presenting features? [+]
Which cardiac disease is it associated with [1]
Systemic inflammatory disorder. Causes:
- oral and genital ulceration
- vascuilitis
- skin lesions
- associated with acute pericarditis
Name something on FBC that would indicate a worse prognosis of pancreatitis? [1]
Hypocalcaemia
Describe what is meant by mesenteric adenitis [3]
Self limiting inflammatory disorder that affects mesenteric lymph nodes that follows a URTI
- Presents similarly to appendicitis
What are the treatment options for an overdose of a BB? [2]
1. Adenosine
2. Glucagon
Which drug or drug class are used for N&V for chemotherapy patients? [1]
5HT3 antagonists like Ondansetron are successfully used in the treatment of chemotherapy related nausea and vomiting.
Which of the following is contraindicated when taking alcohol?
Metronidazole
Amoxicillin
Clarithromycin
Doxycycline
Ciprofloxacin
Never take alcohol when on the METROpolitan line
You treat a 3 year old for a UTI with nitrofurantoin.
The mum comes back because reporting suspected side effects of the drug.
What would you expect to see? [2]
Nitrofuratoin can trigger an episode of G6PD
yellowing of the patient’s eyes and increased fatigue
classic finding on blood film is Heinz bodies
What conditions do you consider COPD patients to have LTOT? [3]
Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
Renal colic: if NSAIDs are contraindicated or not giving sufficiency pain relief NICE recommend []
Renal colic: if NSAIDs are contraindicated or not giving sufficiency pain relief NICE recommend IV paracetamol
How long before a urea breath test should you stop:
- Antibiotics
- PPIs
Abx: 4 weeks
PPIs: 2 weeks
By which mechanism does loperamide act through to slow down bowel movements?
Reduction in gastric motility through stimulation of alpha receptors
Reduction in gastric motility through inhibition of dopamine receptors
Reduction in gastric motility through simulation of GABA receptors
Reduction in gastric motility through stimulation of opioid receptors
Reduction in gastric motility through inhibition of somatostatin receptors
By which mechanism does loperamide act through to slow down bowel movements?
Reduction in gastric motility through stimulation of alpha receptors
Reduction in gastric motility through inhibition of dopamine receptors
Reduction in gastric motility through simulation of GABA receptors
Reduction in gastric motility through stimulation of opioid receptors
Reduction in gastric motility through inhibition of somatostatin receptors
Which cancers do you see raised platelets in? [5]
Cancers with raised platelets - LEGO-C
-Lung
-Endometrial
-Gastric
-Oesophageal
-Colorectal
What is the first [1] and second [1] line treatment for PCV?
First: Venesection
Aspirin to reduce the risk of thrombus formation
Chemotherapy (typically hydroxycarbamide) to help control the disease
If Wells score determines that DVT is unlikely, what is the next appropriate step in management? [1]
Perform a D-dimer: if positive - do US
Over 55 - what HTN tx? [1]
CCB
What is the difference in presentation of Buergers (thromboanglitis obliterans) and Takayus arthritis? [2]
Buergers:
- smoking history
- young male
- blue fingertips
TA:
- Large vessel vasculitis
- Mainly aorta affected - aneurysms or blocked
State the four different grades of haemorrhoids [4]
1st degree: no prolapse
2nd degree: prolapse when straining and return on relaxing
3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back
4th degree: prolapsed permanently
H.U.S is comprised of a trio of which three clinical presentations? [3]
AKI
Microangiopathic haemolytic anaemia (destruction of RBC in small vessels)
Thrombocytopaenia
What is the most likely cause of low risk STI E-O? [1]
What is the treatment? [1]
E-coli
- 14 days of quinolone
What is the treatment for sigmoid volvulus? [1]
Hartmann’s procedure
What is Courvoisier’s law [1]
if gallbladder is palpable in a jaundiced patient, it is unlikely to be due to gallstones, because stones would have given rise to chronic inflammation and subsequently fibrosis of gallbladder therefore, rendering it incapable of dilatation.
Small cell lung cancer can cause a paraneoplasia in the brain. Name and describe it [2]
Limibic encephalitis - anti-Hu antibodies agaisnt limbic system
What are the top three causes of SIADH? [3]
SSRIs
Post-op
Small cell lung cancer
You hear a murmur on left lower sternal edge. What are the three options that cause them? [3]
What other findings would help to differentiate them? [3]
Aortic stenosis:
- Left lower sternal edge (and aortic area)
- Ejection systolic
- Louder on expiration
HOCM
- Left lower sternal edge (and apex)
- Ejection systolic / mid-late systolic
- Valsalva increase murmur
Tricuspid Regurgitation
- Left lower sternal edge
- Pansystolic
- Louder on inspiration
A patient presents with haemoptysis. You perform a CXR and CT.
What is the likely causative agent? [1]
aspergillosis - air crescent sign
Haemopytsis, renal problems and flat nose = ?
Granulomatosis with Polyangiitis
A patient has long history of alcohol excess. You perform a FBC and this is their results.
What is the best management option? [1]
Terlipressin. This patient’s presentation is suggestive of hepatorenal syndrome (HRS), a type of functional kidney impairment that occurs in patients with advanced liver disease.
