Random Flashcards
which substance overdose is linked to hyponatraemia
MDMA
what are features of MDMA overdose
neurological: agitation, anxiety, confusion, ataxia
cardiovascular: tachycardia, hypertension
hyponatraemia
this may result from either syndrome of inappropriate ADH secretion or excessive water consumption whilst taking MDMA
hyperthermia
rhabdomyolysis
what is the main side effect of giving oral magnesium
diarrhoea
What formula is used to calculate IV fluid needs after a burn
parkland formula
most common causes of epididymitis
chlamydia/ gonorrhoea for younger sexually active
e coli for older
what metabolic disorder does prolonged diarrhoea cause
metabolic acidosis with hypokalaemia
normal anion gap
what cell is primarily affected in MS
oligodendrocytes
what is the management for paralytic ileus
NG tube + IV fluids
what is the treatment for spinal cord compression
high dose oral dexamethasone before surgery
surgery to decompress but if too elderly and multiple lesions, beam radiotherapy
pain worse after eating (ulcer)
gastric
what can you give for gout if you cant use colchicine or nsaids
steroids
treatment for supraspinatus tendinopathy
physio
what pain medication can you not give postoperatively if the patient has respiratory disorders
opioids
in SIADH, where is water reabsorbed more
collecting duct
which airway device protects from aspiration of stomach contents
tracheal tube
which airway device is used in cardiac arrest
i-gel (supraglottic) airway
what do you do before CTPA
chest xray
what should you do for all thyroid nodules
US
how do you assess lung function in myasthenia gravis
FVC
if symptomatic gallstones disease but gallstone is in gallbladder and not common bile duct, what do you do
laparoscopic cholecystectomy - would be ERCP if in common bile duct
what is initial management of superior vena cava obstruction
dexamethasone
what is management for superficial thrombophlebitis
oral NSAID + compression stockings (do ABPI before)
what type of drug is oxybutinin
anti cholinergic
what are typical features of anastomotic leak
abdominal pain, fever, tachycardia, and often features of peritonitis.
what are features of atelectasis
Low-grade fever, reduced oxygen saturation, and diminished breath sounds (often bibasal).
Commonly occurs within the first 48 hours after surgery.
what are features of lumbar spinal stenosis
Symptoms triggered by walking:
Weakness and numbness after walking ~100 meters are classic for neurogenic claudication.
Relieved by leaning forward:
Flexion of the lumbar spine increases the canal diameter, reducing nerve compression.
Ability to cycle without symptoms:
Differentiates LSS from vascular causes like peripheral arterial disease.
Weakness of hip flexion bilaterally:
Indicates nerve root compression affecting the lumbosacral region (L2–L4).
how do you manage small bowel obstruction (due to adhesions)
conservative management - NG tube and IV fluids and aspiration of stomach contents
what is the purpose of cricoid pressure when breathing oxygen from a face mask before induction of anaesthesia
prevents the passage of gastric contents into the airway
what are indications of an oropharyngeal airway
Unconscious patients without a gag reflex (e.g., during anesthesia or in an unresponsive trauma patient).
Temporary support in airway obstruction or to facilitate bag-valve-mask ventilation.
what are contraindications for oropharyngeal airway
Conscious or semi-conscious patients (risk of vomiting or laryngospasm).
what are indications of nasopharyngeal airway
Semi-conscious patients with intact gag reflex.
Situations where an OPA is contraindicated (e.g., trismus or oral trauma).
what are contraindications of nasopharyngeal airway
Basal skull fracture or severe nasal trauma (risk of intracranial placement).
what are indications of supraglottic airway devices (i-gel or laryngeal mask)
Elective airway management during anesthesia.
Rescue airway device in difficult intubation scenarios.
Short-term ventilation in emergencies.
what are contraindications for supraglottic airway devices
High risk of aspiration (e.g., full stomach or regurgitation).
Airway obstruction below the glottis.
what are indications of endotracheal tube
Airway protection from aspiration (e.g., reduced consciousness or vomiting).
Mechanical ventilation (e.g., in respiratory failure or during major surgery).
Severe airway obstruction (e.g., due to trauma, swelling, or burns).
Administration of specific anesthetic gases.
what are indications of tracheostomy tube
Long-term ventilation (>7–10 days).
Upper airway obstruction (e.g., tumor, trauma, or edema).
Facilitation of airway clearance in chronic conditions (e.g., neuromuscular diseases).
Reduced dead space for ventilation in severe respiratory failure.
what are contraindications of tracheostomy tube
Active infection or unstable neck anatomy (relative contraindications).
what are indications of cricothyroidotomy (emergency airway)
“Cannot intubate, cannot ventilate” scenarios.
Severe upper airway obstruction (e.g., foreign body or trauma).
what are contraindications of cricothyroidotomy
Pediatric patients (prefer needle cricothyroidotomy due to anatomy).
urine culture shows mixed growth of organisms with no leucocytes
contaminated sample
what is the management of painful eyes with loss of acuity
emergency assessment
what does triple assessment of breast mean
Clinical examination, breast imaging and core biopsy
CSF fluid analysis for bacterial meningitis
High pressure, raised protein, excess neutrophils
bacterial vs viral meningitis
viral meningitis -
rash
upper resp symptoms
mild course
bacterial -
rapid deterioration
what is average life expectancy
82 years
Chadvasc score
Risk factor Points
C Congestive heart failure 1
H Hypertension (or treated hypertension) 1
A2 Age >= 75 years 2
Age 65-74 years 1
D Diabetes 1
S2 Prior Stroke, TIA or thromboembolism 2
V Vascular disease (including ischaemic heart disease and peripheral arterial disease) 1
S Sex (female) 1
can an F1 consent for a surgical procedure
No, should ask someone higher to do it
what is pre diabetes in HbA1c
41-48 (5.9% - 6.5%)
diagnostic scan for vestibular schwannoma
MRI or internal acoustic meatus
What is the initial investigation in IBD
stool cultures before faecal calprotectin
how would a rotator cuff tear be different to adhesive capsulitis in terms of active and passive movement
rotator cuff tear has weakness and pain during active movement while nothing during passive movement
adhesive capsulitis has reduced passive and active movement
how would subacromial bursitis differ to adhesive capsulitis in terms of movement
subacromial bursitis does not lead to significant stiffness or reduced passive range of motion like adhesive capsulitis does
subacromial bursitis also presents with pain
patient has acute abdomen following abdominal surgery eg abdominal tenderness, reduced sounds, reduced lung breaths. what is diagnostic investigation
CT abdomen
what can happen if you give oxygen in ACS if breathing is fine and oxygen sats are normal
increases mortality
urea:creatinine ratio for pre renal, renal and post renal AKI
pre renal - >20
renal and post renal 10-20 (urea and creatinine rise proportionally
normal - 10-20
‘lens shaped haemorrhage’
lemon shaped, convex, extradural
diagnostic test for norovirus
PCR
if a lady presents with red hard breast and doesnt improve with 2 weeks of antibiotics, what should you do
fast track breast appointment
could be something else other than mastoiditis
what are features of contrast nephropathy
A common complication of angiographic procedures using iodinated contrast.
It typically manifests as an acute rise in creatinine levels 48–72 hours post-procedure.
This patient’s creatinine has risen significantly (from 104 µmol/L to 210 µmol/L), consistent with this timeline.
Risk factors include chronic kidney disease (CKD), diabetes, and concurrent use of nephrotoxic drugs (e.g., ramipril).
most common cause of unilateral smelly discharge from nose of a child
foreign body
what investigation would you do to help diagnose sarcoidosis
x-ray - ACE levels may be raised but high false negative and positive rates
lump on parotid gland present for 30 years but suddenly grows in size over last 3 months. No pain but slight weakness. adenoma or carcinoma
carcinoma
what are phosphate and ALP levels typically in osteomalacia
phosphate low
ALP high
what artery is affected in amaurosis fugax
internal carotid artery/retinal/ophthalmic
same side blindness
what asthma/copd drug is contraindicated in prostatic enlargement
LAMA
what muscle group is affected if trendelenburgs test is positive
abductors
what is given before large volume paracentesis for ascites
albumin
cause of mumps
RNA paramyxovirus
cause of rubella
togavirus
semi dilates non reacting pupil, severe headache, reduced visual acuity, red eye, hazy cornea
AACG
small irregular pupil, blurred vision, red eye, pain
anterior uveitis
irregular pupils with no response to light but a response to accommodation
Argyll robertson pupil
dilated pupil that is slowly reactive to accommodation but poorly reactive to light
holmes adie pupil
common cause of keratitis in contact lens users
pseudomonas
reduced visual acuity, red desaturation, RPAD, pain on movement, central scotoma
optic neuritis
swollen rock hard eye with RPAD
orbital compartment syndrome
test for optic neuritis
MRI with contrast
red swollen eye, severe pain (especially with eye movements), visual disturbance, drowsiness
orbital cellulitis
examination in orbital cellulitis
ct with contrast
floaters, flashers, curtain coming down
vitreous detachment
treatment for primary open angle glaucoma
selective laser trabeculoplasty ->
prostaglandin analogues ->
beta blocker, carbonic anhydrase etc eye drops
insidious peripheral vision loss with reduced visual acuity
primary open angle glaucoma
red eye pain and visual loss after surgery
endophthalmitis
night blindness and peripheral vision loss
retinitis pigmentosa
transient vision loss lasting <24 hours
transient monocular vision loss
painless visual loss with red hues and floaters
vitreous haemorrhage
what scan is done to rule out retinal detachment
US
what should you do for all thyroid nodules
US
what is seborrhoeic dermatitis caused by
malessezia furfur
What are features of transient global amnesia
sudden onset retrograde and anterograde amnesia
confusion
clear consciousness
unaffected motor skills
resolution of symptoms within 24 hours
what rheumatological condition involving the hands does alcohol consumption increase the chances of
dupuytrens contracture
champagne bottle legs
charcot marie tooth
difference between charcot marie tooth type 1 and 2
type 1 is demyelinating and type 2 is axonal
what are features of folliculitis
very itchy red rash with pustules around hair follicles
what is needed for the development of foetal lungs
amniotic fluid
what can oligohydramnios lead to in the foetus
foetal pulmonary hypoplasia
what is a garden 1 type fracture
incomplete, undisplaced fracture
what is a garden 2 type fracture
complete undisplaced fracture
what is a garden type 3 fracture
complete, displaced fracture
what is the most common cause of cancerous axillary lymphadenopathy
breast cancer
diagnostic test for renal artery stenosis
MRA with contrast
unilateral small kidney and persistent hypertension
renal artery stenosis
what are features of sick sinus syndrome
alternating bradycardia and tachycardia
pericarditis symptoms with elevated troponin
myopericarditis
which side of the brain are brocas and wernickes areas located
left side
brocas - Left lower frontal gyrus
wernickes - Left superior temporal gyrus
conduction aphasia - Left arcuate fasciculus
management of goodpastures
plasma exchange
steroids
what is meant by subchondral sclerosis
Increased bone density beneath the cartilage
what is a common cause of nephrotic syndrome in sickle cell
FSGS
what is the treatment for kaposis sarcoma
antiretroviral therapy
most common cause of hypothyroidism
iodine deficiency
where is the most common site of lesion for obstructive hydrocephalus
cerebral aqueduct
what is a common side effect of dopamine agonists to do with mood
causes impulsivity
what is triad of feltys syndrome
rheumatoid arthritis, splenomegaly, neutropenia
most common cause of central retinal vein occlusion
carotid artery doppler
isolated high protein on CSF fluid analysis
Guillian barre
what investigation is used for sjogrens syndrome
schirmers test
what type of allergic reaction is hypersensitivity pneumonitis
type 3
how do you change corticosteroid control for surgery
switch to IV hydrocortisone and stop fludrocortisone
what should you use for mild labour pain in the second stage of labour
inhaled nitric oxide (entonox)
what should you use for severe labour pain in the second stage of labour
IM pethidine
what cause of keratitis is linked to poor contact lens hygiene
acanthamoeba keratitis
what is management for large bowel obstruction due to volvolus
sigmoidoscopic decompression followed by flatus tube insertion
what to do for infective exacerbation of COPD
give amoxicillin, doxycycline or clarithromycin
management for atelectesis
chest physio and pain management
when cant you use DOAC for AF
moderate mitral stenosis
creatinine clearance <15
which cause of sudden vision loss is linked to diabetes
vitreous haemorrhage
how do you treat vitreous haemorrhage
vitrectomy
what drug cant you use alongside sildenafil
nitrates
what are risk factors for subdural haematoma
alcohol and old age
what should be done for persistent molluscum contagiosum in an adult
check for HIV
where do neuropathic ulcers tend to present
pressure points eg heel
how is VTE prophylaxis given
LMWH - unless egfr < 30
IV unfractionated heparin if renal failure
what does hoovers sign assess and when is it used
raise her right leg against resistance whilst keeping it straight. He places his hand under the left heel as she does this, and feels pressure under his hand.
differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
what investigation do you do for testicular cancer
US
how do you monitor LMWH including dalteparin
no routine monitoring but can use anti Xa levels
how do you monitor unfractionated heparin
APTT
How do you help irregular periods whilst using nexplanon
add a COCP alongside the nexplanon for 3 months
what is a common complication of panretinal photocoagulation
decrease in night vision
how do you manage paracetamol overdose if they present after 24 hours but still show jaundice/hepatic tenderness and have ALT above normal limit
NAC
when is liver transplant required for paracetamol overdose
pH<7.3
or all 3 of:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
if someone has a rib fracture but normal analgesia isnt enough, what can be given
regional nerve block
what is most sensitive test for SLE
ANA
what is most specific test for SLE
anti smith
macrocytic anaemia with raised GGT
alcoholic cause
what is the management for severe peripheral arterial disease
endovascular revascularisation -
percutaneous transluminal angioplasty +/- stent
done if stenosis <10cm, aortic iliac disease and high risk patients
surgical revascularisation -
surgical bypass
stenosis >10cm, multifocal lesions, lesions of common femoral artery, purely infrapopliteal disease
do you send an MSU for UTI with haematuria in a women
yes
what electrolyte abnormalities precipitate digoxin toxicity
hypokalaemia
Hypomagnesaemia
Hypercalcaemia
Hypernatraemia
differences between small bowel and large bowel obstruction presentation
SBO - vomiting (bilious) , crampy central/upper abdo pain, constipation
LBO - lower abdo pain, absolute constipation, distention, sometimes bleeding
what is management of lithium toxicity
IV fluids with isotonic saline
if severe, haemodialysis
what is used to stage hodgkins
PET/CT
what is conservative management for post lumbar puncture headache
caffeine and fluids
fluctuating cognition with features of parkinsonism
lewy body
treatment for tropical sprue
tetracycline
for infective endocarditis, what investigation would you do first to assess valves
transthoracic echo over a TOE
You would do a TOE if the TTE is inconclusive
in myeloma, in what exam do you see bence jones proteins, rouleaux formation and increased plasma cells
increased plasma cells - bone marrow aspirate
bence jones - urine
rouleaux formation - peripheral blood smear
what joints in the hand does RA affect
MCP PIP
what joints in the hand does OA affect
CMJ DIP PIP
initial treatment for CLL
fludarabine, cyclophosphamide, rituximab
reduced leucocyte ALP
CML
when is indirect coombs test used
rhesus haemolytic disease of the newborn
how do you treat hypertension in systemic sclerosis
ACE inhibitor
cant have fava (broad) beans
G6PD
what antibiotic cant you use in G6PD
ciprofloxacin - quinolone
What are features of a posterior communicating artery aneurysm
painful third nerve palsy
what are features of an anterior communicating artery aneurysm
personality changes, memory loss, bitemporal hemianopia
confusion and ‘really pink’ mucosa
carbon monoxide poisoning
at which point would you use surgical treatment in perthes
> 6 years old
when is anti D given for an abortion
after 10 weeks
what do you do for thrombosed haemorrhoids after 72 hours
give analgesia rather than surgical correction
what is linked to arnold chiari malformation
syringomelia
girl comes in with a very fine layer of hair across her entire body
malnutrition - lanugo hair
treatment for chronic hypovolemic hyponatraemia without severe symptoms
isotonic saline
treatment for chronic euvolemic hyponatraemia without severe symptoms
fluid restrict 500-1000mls a day
treatment for chronic hypervolaemic hyponatraemia without severe symptoms
fluid restrict 500-1000mls a day
treatment for acute hyponatraemia causing severe symptoms
hypertonic saline
what rate do you give sodium to avoid central pontine myelinolysis
raise of sodium levels by 4-6mmol/24hrs
what are the things that increase hepatotoxicity in paracetamol overdose
chronic alcohol, HIV, anorexia or P450 inducers
pemphigus vulgaris vs bullous pemphigus
bullous pemphigus usually has no mucosal involvement whereas pemphigus vulgaris has
what pH is safe for an NG tube
<5.5
how do you treat magnesium <0.4 with tetany/seizures/arrhythmias
IV magnesium sulphate
patient falls and has a bruise over the mastoid. what should you do next
CT within an hour - sign of basal skull fracture
ptosis + dilated pupil
third nerve palsy
ptosis + constricted pupil
horners
man has urinary incontinence etc and given tamsulosin. prostate is slightly enlarged but PSA is low. what do you give next
anticholinergic (antimuscarinic) drug - tolterodine
PSA being low signifies prostate enlargement is not causing the obstruction
what is diagnostic test for non hodgkins lymphoma
excisional node biopsy
heinz bodies on blood film
G6PD
what vision changes does digoxin cause
yellow-green vision
what vision changes does sildenafil cause
blue vision
what must you do before prescribing alendronic acid
fix hypocalcaemia and vitamin d
what is a common side effect to doxycycline
sensitivity to light
what is a common cause of hypomagnesaemia
proton pump inhibitors
what is the most common abnormality in death of tissue eg due to a crushing injury
hyperkalaemia
what is a common eye condition caused by prematurity, what are its features and why does it happen
retinopathy of prematurity
due to over oxygenation leading to neovascularisation and loss of red reflex
what exam can be used to differentiate vestibular neuronitis to posterior circulation stroke
hiNTS exam
Q: What are the typical symptoms of a posterior circulation stroke?
Vertigo, dizziness
Ataxia or gait instability
Nausea/vomiting
Visual disturbances (e.g., homonymous hemianopia, cortical blindness, or diplopia)
Cranial nerve deficits (e.g., dysphagia, dysarthria, or facial numbness)
Drop attacks (sudden falls without loss of consciousness)
Contralateral weakness or sensory loss
Locked-in syndrome (in severe cases)
how quickly is RBC transfusion done if non urgent
60-90 minutes
done as STAT is urgent scenarios
what is definitive investigation for sickle cell
haemoglobin electrophoresis
which TB drug is linked to gout
pyrazinamide
if someone has hypomagnesaemia and hypokalaemia, which one do you fix first
magnesium
order of pituitary hormone loss due to mass effect
“Go Look For the Adenoma Please”.
G – GH
L – LH
F – FSH
T – TSH
A – ACTH
P – Prolactin function
what is used as prophylaxis against tumour lysis syndrome
allopurinol
what needs to be monitored when administering phenytoin for seizures
cardiac monitoring
parkinsons patient takes medication and develops involuntary writhing movements, chorea and dystonia. what medication
levodopa - has this effect at peak doses
difference between drug induced and idiopathic parkinsons
bilateral tremor in drug induced
‘pepperpot skull’ on xray
primary hyperparathyroidism
patient has a burning pain and redness over a varicose vein. what is it and how do you treat/investigate
superficial thrombophlebitis
investigate with US to exclude DVT
treat with NSAID and compression stockings
what abdominal hernia can result in strangulation without symptoms of obstruction
richter’s hernia
what is a common blood finding in smokers
increased carboxyhaemoglobin
at what % blood loss does hypotension occur
30% (class 3 shock)
typical symptom course of yellow fever
flu like illness -> remission -> jaundice and haematemesis
what electrolyte abnormality does acute pancreatitis cause
hypocalcaemia
what occurs when you correct hypernatraemia too quickly
cerebral oedema
what is a curlings ulcer
ulcer caused by severe stress eg full thickness burns
can bleed and lead to haematemesis
what should be regularly checked (investigation) in marfans syndrome
echo - risk of aortic dissection
features of alport syndrome
renal failure, hearing loss, eye problems
what drug is given in cardiogenic shock
dobutamine - acts on beta 1 receptors in the heart
what scan is done to identify pancoast tumour
CT chest
in what condition would you give mirabegron over oxybutynin
alzhemiers - due to lack of ACh so you dont wanna give any drugs that inhibit it
after a VTE, what should patients with anti phospholipid syndrome be given
lifelong warfarin
when would you not use myomectomy for fibroids
<3cm and not distorting uterine cavity
what is used to determine severity of c diff infection
WCC
what are features of venous sinus thrombosis
typically COCP use + family history of DVT
severe sudden headache
vomiting
nausea
reduced consciousness
how do you investigate venous sinus thrombosis
MRI venography
hyperreflexia rigidity pupil dilation hyperthermia tremor
serotonin syndrome (can be caused by MDMA)
pain and swelling of shoulder after fall. prominent clavicle and ‘step deformity’
acromioclavicular dislocation
‘hill-sachs lesion’
glenohumeral dislocation
what abnormal peak flow reading can occur in obese patients
reduced expiratory reserve volume - reduced FEV1 and FVC but normal ratio
what type of eye drops can cause fungal infections
steroid
hoarseness that cant be identified by ENT consultant
pancoasts tumour
for VZV in pregnancy would you give oral or IV aiciclovir
oral
what is an unresolved left varicocoele linked to
renal cancer (left renal and left testicular vein are linked)
scan for renal cancer
US initially
contrast CT definitive
when do we see fine and coarse tremor in lithium usage
fine - chronic lithium use
coarse - toxicity
what antibodies are found in lambert eaton syndrome
voltage gated calcium antibodies
offensive discharge from anus but otherwise well
fistula
what drugs are used in MS for spasticity
baclofen or gabapentin
what investigations must you do in infants <3 months with fever
FBC
blood count
CRP
urine testing
chest xray if resp signs
stool culture if diarrheoa
what is a pancoasts tumour
rare type of lung cancer that is apical
when would atropine not work
complete heart block
should use pacemaker instead
what drug is used for peripheral vasoconstriction
noradrenaline not adrenaline
how to calculate likelihood ratio for a positive result ie how much the odds of disease increase when the test is positive
Sensitivity/(1-Specificity)
how to calculate likelihood ratio for a negative result ie how much the odds of disease decrease when the test is negative
(1-Sensitivity)/Specificity
what is relative risk
experimental event rate / control event rate
How does the hiNTs test work
(Head impulse, Nystagmus, Test of skew)
Head impulse: In peripheral vertigo, this test will show a corrective saccade (positive result) if the vestibulo-ocular reflex is disrupted. This occurs when the head is turned toward the affected side, causing the eyes to make a saccade to re-fixate on the target. If the reflex is intact (in a healthy individual or on the unaffected side), the eyes will stay fixed on the target when the head turns toward the normal side.
Nystagmus: In peripheral vertigo, horizontal nystagmus may also be present, unlike the direction-changing nystagmus seen in central vertigo cases.
Test of skew: When a patient focuses on their nose while their eyes are alternately covered, vertical misalignment may occur in central vertigo, leading to corrective movements. This finding is absent in peripheral causes.
is lithium use linked to hyper or hypothyroidism
hypothyroidism
patient has intracranial bleed and suddenly becomes unresponsive, what is it and how do you investigate
hydrocephalus
CT brain
heel pain that is worse on walking on tiptoes
plantar fasciitis
what cancer does tamoxifen increase
endometrial
what is the cause of continuous dribbling after child birth
vesicovaginal fistulae
what investigation would you do to identify vesicovaginal fistulae
urinary dye studies
what is CA 15-3 linked to
breast cancer
treatment for ITP
pred first then IVIG
what is the order of mean median and mode in skewed distributions
alphabetical order: mean - median - mode
‘>’ for positive, ‘<’ for negative
stat test for comparing 2 sets of information (before and after) following an intervention
wilcoxon signed rank
what drug is given after fibrinolysis
fondaparinux
what is CA19-9 linked to
mainly pancreatic cancer
what drug is given for HER positive breast cancer
Trastuzumab (Herceptin)
why cant you give opioids after abdo surgery
because you want the abdomen to recover
opioids slow down GI
what should be given for breathlessness in palliative care
morphine + lorazepam (for anxiety)
if loculus pleural effusion in palliative care, what do you do
dont treat pleural effusion -> treat symptoms eg breathlessness
what symptoms does hydrops fetalis present with
foetal anaemia results in oedema, high output cardiac failure, ascites, polyhydramnios
what is a severe contraindication to regional anaesthesia eg spinal or epidural block
concurrent use of warfarin etc -> increased risk of bleeding
what factor is affected in haemophillia A and B
factor 8 in A (A-te)
factor 9 in B
what is the classic course of disease with infectious mononucleosis
long ish prodrome of fatigue malaise sore throat before onset of fever and lymphadenopathy
lymphadenopathy tends to be generalised
how does primary HSV infection present
malaise fever, extensive painful oral ulcers, submandibular lymphadenopathy
short incubation period
what risk factors need folic acid to be taken at a higher dose for preg
Previous child with NTD
Diabetes mellitus
Women on antiepileptic
Obese (body mass index >30kg/m²)
HIV +ve taking co-trimoxazole
Sickle cell
when would you give statin 80mg over 20mg
secondary prevention - doesnt need to have had an ischaemic event
eg patient with ischaemic heart disease
cerebrovascular diease
peripheral arterial disease
which lobe does herpes simplex encephalitis tend to effect
temporal
multiple white matter lesions particularly in periventricular or juxtacortical distribution
MS
how do you initially manage acute limb ischaemia
analgesia, IV heparin and vascular review
how do you work out serum osmolality
2*Na + glucose + urea
what are the 6 tests to confirm brain death
pupillary reflex,
corneal reflex,
oculo-vestibular reflex,
cough reflex,
absent response to supraorbital pressure,
and no spontaneous respiratory effort
what is the treatment of choice for neutropenic sepsis
empirical tazocin
what type of drug is adapalene
retinoid
what anticoagulant can actually lead to thrombosis
heparin - heparin induced thrombocytopaenia
antibodies form to heparin resulting in increased activation of platelets leading to increased consumption and thrombosis
how do you manage umbilical hernias in children
Usually self-resolve, but if large or symptomatic perform elective repair at 2-3 years of age. If small and asymptomatic perform elective repair at 4-5 years of age.
what is ambylopia
lazy eye
what condition presents with disproportionate microcytic anaemia (severe microcytic anaemia)
beta thalessemia trait
what factors effect egfr result
pregnancy
muscle mass
eating red meat
what type of dementia is associated with motor neurone disease
frontotemporal dementia
what dementias can present with hallucinations?
parkinsons dementia and LBD
how do you differentiate between LBD and parkinsons dementia
parkinsons dementia will have motor symptoms for at least a year before emergence of dementia
what is treatment for LBD
donepezil
memantine
after giving aspirin 300mg and then switching to clopidogrel after stroke, what should you do if the patient does not want to take clopidogrel
switch to aspirin 75mg
what type of shock is linked to tension pneumothorax
obstructive shock
what drug makes absence seizures worse
carbamazepine
what is lidocaine used as
local anaesthetic
lidocaine is mixed with adrenaline. where should it not be applied
near extremities due to risk of ischaemia
in stats, what is the difference between reliability and validity
reliability is about consistency
validity is about accuracy
can be consistently inaccurate -> reliable but not valid
which type of renal tubular acidosis causes renal stones
type 1
after you treat a UTI in a pregnant women, what must you do
send a culture to test for cure
what are features of progressive bulbar palsy (a type of motor neurone disease)
palsy of tongue and chewing/swallowing muscles
worst prognosis
what skin condition is seen in antiphospholipid syndrome
livedo retivularis
feeling of lump in throat with some hoarseness and chest discomfort with meal times
Laryngopharyngeal reflux
what can be different when an elderly person presents with an MI
no chest pain
what are you also likely to be allergic to if you are allergic to sulfasalazine
aspirin
what effect on the thyroid does amiodarone have
both hypo and hyperthyroidism
what type of hearing loss is seen in menieres disease
unilateral sensorineural hearing loss
what is the diagnostic test for leptospirosis
serology
severe reaction to muscle relaxants such as suxamethonium. Positive family history
pseudocholinesterase deficiency
what is used to assess successful oesophageal intubation
capnography
Capnography measures the concentration of carbon dioxide in exhaled air and displays it on the anaesthetic monitor. By observing a characteristic rise in carbon dioxide concentration during exhalation, and a drop during inhalation, successful tracheal intubation can be confirmed.
what should you give if CD4 count is <200 in HIV but no symptoms
prophylactic cotrimoxazole
at what age would you use mammogram/US to investigate breast lump
<35 US
even if you think its a fibroadenoma what must you do
US - scan for malignancy
what marker can help diagnose anaphylaxis
tryptase
what is the treatment for lichen planus
potent topical corticosteroids
you just prescribed metformin, how long should you wait before increasing the dose
1 week
how do you treat someone who has primary herpes infection in final trimester
oral aciclovir daily until delivery
red itchy greasy flakey rash on nasolabial folds
seborrhoeic dermatitis
what ocular condition is linked to seborrhoeic dermatitis
blepharitis
treatment for chronic plaque psoriasis
TOPICAL corticosteroid + vitamin D
what type of colorectal cancer is most common
adenocarcinoma
if you cant give IM diclofenac for renal stones, what else would you give
IV paracetamol
what drug is used for hiccups in palliative care
chlorpromazine
where do you see pain in supraspinatus tendonitis
60-120 degrees
what does this show
calcification of the supraspinatus tendon (the little white bit in the corner)
if someone has a cardiac arrest, should you assess death straight away?
no, wait 15 minutes incase they have spontaneous return of circulation
in what cases can you do CPR after a DNACPR
DNACPRs are contextual to the anticipated cause of death and choking is not a common cause of death in terminal breast cancer. This is referred to as a, ‘not envisaged arrest’ and the guidance is that you should resuscitate. Choking and being hit by a bus are the two most commonly used examples to illustrate this question.
they are contextual to the condition being treated
where can you not cannulate if the person is a diabetic
the foot
for someone going into moderate-major surgery that takes regular pred, what do you need to give
hydrocortisone
when starting allopurinol, what do you give with it
nsaid/colchicine cover
how do you treat genital herpes
ORAL aciclovir
what ASA is linked to bmi>40
grade 3
how do you treat local anaesthetic toxicity
IV lipid emulsion 20%
what drugs are linked to malignant hyperthermia
Volatile liquid anaesthetics
(isoflurane, desflurane, sevoflurane)
what type of drug is hyoscine
muscarinic receptor antagonist
when cant you drive with schizophrenia
must not drive and must notify the DVLA, until stable and well for 3 months and following a suitable psychiatry report
if a cystic fibrosis patient has pseudomonas infection, how do you manage
oral ciprofloxacin - should try and erradicate
if vestibular neuronitis is chronic, what is the preferred treatment
vestibular rehabilitation exercises
what test do you do to compare the means of two groups
two sample t test
how much data is within 2 standard deviations of the mean
95%
in an RCT, if people drop out, what should you do
include them in results - intention to treat analysis
‘sunburst appearance’ bone cancer
osteosarcoma
‘fluffy popcorn calcification’ bone cancer
chondrosarcoma
what coloured discharge do gonorrhoea and chlamydia typically produce
chlamydia -clear/white
gonorrhoea -yellow/green
what should you do during cyanotic spells in tetralogy of fallot
pick the child up and bring their knees to their chest
deafness + rash on hands and feet when born
congenital syphillis
what is given for immunity against respiratory syncytial virus (bronchiolitis)
palivizumab
if qrisk is >10% what should you do
offer lifestyle measures before statin
when can IgA anti TTG be negative for coeliacs
if they have IgA deficiency
still consider coeliacs
if CURB65 score is <2 what do you do
discharge home with oral antibiotics
what are serum markers in tertiary hyperparathyroidism
PTH calcium and PHOSPHATE high
how do you work out alcohol units
volume * % /1000
persistent ST elevation in the same leads that MI occurred weeks after MI
aneurysm
what is the management for non lactational mastitis
co-amoxiclav and review after 48 hours
treatment for palliative colicky pain in malignant bowel obstruction
hyoscine
baby that keeps yawning after birth, irritable
opioid withdrawal
what ABVD drug is linked to cardiomyopathy
doxorubicin
features of Lymphogranuloma venereum
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
may occasionally form fistulating buboes
stage 3: proctocolitis
what do you do in terms of platelet control for a dental procedure
continue as normal
how do you treat myasthenia gravid
pyridostigmine
other than hyponatraemia, what does legionella present with
lymphopaenia and deranged LFTs
what is long term treatment for psoriasis
vitamin D analogue
topical steroids only used for acute flair
when would you consider metformin for T1DM
BMI>25
what do you need to give before appendicectomy
prophylactic antibiotics
what serum marker is raised in PBC
IgM
which site is most commonly affected by crohns
ileum
what drug do you give for MRSA if you cant give vancomycin
linezolid
how do you define malignant hypertension
Systolic blood pressure >= 180mmHg or diastolic blood pressure >= 120mmHg.
Evidence of acute organ damage
metastatic SCC in a lymph node , where has it come from
nasopharynx
if you have chronic pancreatitis, how often should you check for diabetes
annual hba1c
RBBB with hypoxia chest pain, recent surgery
pulmonary embolism
treatment for retinoblastoma
enucleation
what is a common side effect of tamsulosin
postural hypotension
what is management for paraphimosis (On examination, he has an enlarged glans with a retracted, oedematous foreskin. The patient reports extreme pain on palpation of the glans and foreskin)
emergency admission for manual decompression or surgical decompression if this fails
what oesophageal cancer are smoking/drinking related to
squamous cell
which UTI drug can you not use in G6PD
nitorfurantoin
risk factors of chemotherapy related nausea
female
young age
morning sickness
first cycle of chemo
if someone is choking and they become unconscious, what should you do
start cpr call ambulance
what investigations would you do for idiopathic intracranial hypertension
CT
LP - shows high open pressure
Inspection reveals a swollen painful left breast with significant skin dimpling and erythema with overlying oedema and nipple inversion.
What is the most likely diagnosis?
inflammatory breast cancer
‘peau d’orange’
what type of study is used for investigating exposure factors for rare diseases
case control
if someone presents with features of ovarian cancer and ascites, what do you do
straight referral, no need to do CA 125 as suspicion is high
when is amniocentesis offered
after 15 weeks
when is chorionic villous sampling offered
11-14 weeks
heart failure + wide QRS management
pacemaker
what is management of hyperglycaemia during enteral feeding
give insulin
what should you do before giving donepezil
ECG - prolongs QT interval
initial management for venous sinus thrombosis
LMWH
how do you treat steroid induced hyperglycaemia
sulfonylurea
symptoms of chronic mesenteric ischaemia
pain after eating
weight loss
hepatic bruits
management for feeding part of paralytic ileus
total parenteral nutrition
for neurogenic bladder eg due to multiple sclerosis, how do you treat
intermittent self catheterisation
a cancer in what location leads to laryngeal nerve damage
left main bronchus
what is nephrolithiasis
kidney stones
how is morphine excreted
renally
eosinophilia, anaemia, diarrhoea
hookworm
‘see saw breathing’
airway obstruction
management of airway obstruction manoeuvre
jaw thrust
how do you treat MRSA colonisation in an ulcer
topical bacterial decolonisation
lower back pain radiating from buttocks to knee, worsening when walking
spinal canal stenosis
fracture after boxing
metatarsal fracture
does viral meningitis present with neck stiffness
no
what investigations do you do for AAA
US initially
what primarily facilitates platelet adhesion
Von willebrand factor
how would you differentiate staphylococcal scalded skin syndrome to toxic epidermal necrolysis
SSSS doesnt effect the mucosal surfaces
TEN causes oral ulcers
what is the mechanism of secretions in palliative care
pooling of saliva due to poor swallowing
how will the patient be if they had Vfib
unconscious
what is antibiotic prophylaxis in SBP
ciprofloxacin
super high ALT, what should you think
hepatitis
how is digoxin excreted
renally
painful third nerve palsy cause
posterior communicating artery aneurysm
how do you differentiate between direct and indirect inguinal hernia
to distinguish between the two you can try to reduce the hernia and then press on the deep inguinal ring situated on the mid-point of the inguinal ligament. If the hernia stops protruding after this it means that its exit point is the deep inguinal ring, making it an indirect hernia. On the other side, if the hernia still protrudes, like in this case it means that it is a direct hernia.
what drugs are linked to increased mortality in alzheimers patients
antipsychotics
what location of fracture can affect the radial nerve
shaft of the humerus
what location of fracture can affect the median nerve
supracondylar
what acid base disturbance is linked to diarrhoea
hypokalaemic metabolic acidosis
what is management for acute angle closure glaucoma
Administer pilocarpine, timolol, and brimonidine eye drops
definitive management is laser peripheral iridotomy
how do you manage severe urticaria
non sedating antihistamine + short course of pred
‘fixed retroverted uterus’
endometriosis
most common site of lymphatic spread for ovarian cancer
para aortic lymph nodes
most common site for haematological spread for ovarian cancer
liver
how does lidocaine work
Blockage of sodium channels disrupting the action potential
most common mechanism of ankle sprain
inversion
‘hyperinflation and fluid in the horizontal fissure’
transient tachypnoea of the newborn
treatment for undisplaced intracapsular NOF fracture
internal fixation if they have fewer comorbidities
HA if they have more comorbidities
how do you manage non fasted patient airway for surgery
endotracheal tube
how is chlordiazepoxide given in alcohol withdrawal
tapering dose - decrease as you give
standard error of mean calc
standard deviation/root(num of patients)
what are features of Rett syndrome
almost exclusively affects girls
normal development followed by regression of previously acquired skills
what is gold standard vein to use for CABG
internal thoracic vein
what are features of central cord syndrome
increased motor (corticospinal) weakness in U limbs compared to L limbs
varying degrees of sensory loss
effects spinothalamic tract too
what are features of anterior cord syndrome
paralysis/weakness below level of injury, affecting both U and L limbs
loss of pain + temp below injury
patient has spinal injury resulting in respiratory depression. what level is the injury
C3-C5
level of the phrenic nerve which controls the diaphragm
does von willebrands disease always present with prolonged APTT
no can be normal
persistent swelling after DVT, brown discolouration
post thrombotic syndrome
what regional anaesthesia is used prior to knee surgery
femoral nerve block
what is indirect bilirubin
unconjugated bilirubin
what type of graft is usually used for extensive burns
split thickness graft
full thickness is used if reconstruction is necessary eg a facial burn
if using apixaban, after DVT do you need to give LMWH
no apixaban is sufficient
what type of diet intake should you have after small bowel resection
low fat high protein
what electrolyte abnormality can chronic alcohol use cause
hypomagnesaemia
what is the dose for anaphylaxis
0.5mg 1:1000 IM adrenaline
how do you differentiate steven johnson syndrome to toxic epidermal necrolysis
SJS usually affects <10% of body whereas TEN affects more
what is the first line investigation for a stone in the salivary gland
US
treatment for head of pancreas cancer
whipples resection (pancreaticoduodenectomy)
do you use short or long acting insulin in general gestational diabetes
short
how do you treat lymphogranuloma venerum
doxycycline
Painless ulcer and painless lymphadenopathy
syphillis
Painless ulcer and painful lymphadenopathy
LGV
Painful ulcer and painful lymphadenopathy
Chancroid/HSV*
*Ragged edge, large size, deep, or variable shape point toward chancroid
*erythematous edge, small size, superficial, or circular shape point toward HSV
what type of MRI do you use in TIA
MRI brain with diffusion-weighted imaging
(not contrast MRI)
what do you give for shingles pain that doesnt respond to analgesia
short course of pred
what prophylaxis do you need to give in nephrotic syndrome
LMWH
what is a common side effect of topical steroids
skin depigmentation
focal impaired seizure with weird sensation in abdomen before it starts
temporal lobe
imaging for heart failure
echo
where do thiazide diuretics work
distal convoluted tube on NaCl symporter
what does renal biopsy in GPA show
crescents in bowmans capsule
when would you use a chest drain for Pulmonary embolism
purulent/cloudy fluid
pH<7.2 and clear
most common cause of wet gangrene
clostridium perfringens
most common cause of necrotising fasciitis
group A strep
what is diagnostic test for covid
PCR
what is the treatment for covid
remdesevir
dex
treatment for diptheria
IM penicillin
how is giardia diagnosed
stool microscopy
how is giardia managed
metronidazole
what is the treatment for mycobacterium avium intracellular
rifabutin ethambutol clarithromycin
what is a common complication of pcp pneumonia
pneumothorax
treatment for leprosy
rifampicin, dapsone, and clofazimine
what causes lyme disease
borrelia burgdoferi
positive treponemal test + neg non trepo
successfully treated
management for myasthenic crisis
plasmapheresis
IVIG
management for anterior uveitis
cycloplegic drops and steroid drops
how is scleritis managed
same day assessment
NSAID first line
steroids in severe cases
what type of drug is memantine
NMDA receptor antaognist
