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Phase 4 Question Knowledge > Random Knowledge to review > Flashcards

Random Knowledge to review Flashcards

1
Q

Sudden chest pain + neurology important condition?

A

Rule out aortic dissection

Expanding aorta can compress sympathetic trunk etc- Horner’s syndrome

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2
Q

Vomiting/Diarrhoea effects on pH etc?

A

Vomiting causes alkalosis

Diarrhoea causes acidosis due to bicarbonate loss, also hypokalaemia due to loss of potassium

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3
Q

Mesenteric ischaemia triad?

A

CVD, high lactate, soft but tender abdomen

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4
Q

In what condition should adenosine be avoided in?

A

Bronchospasm

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5
Q

Management of major bleeding (eg variceal haemorrhage, intracranial harmorrhage) due to high INR?

A

Stop warfarin

Give intravenous vitamin K 5mg

Prothrombin complex concentrate
(FFP if not available)

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6
Q

Beck’s triad of features for cardiac tamponade?

A

Beck’s triad-

Hypotension

Raised JVP

Muffled heart sounds

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7
Q

What to do if high risk of cardioversion failure in elective AF rhythm control?

A

Amiodarone for 4 weeks prior to electrical cardioversion

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8
Q

How can a brisk upper GI bleed present?

A

Fresh PR blood rather than malena can happen if quick bleed- variceal (usually malena)

High urea levels indicate an upper GI bleed especially if raised out of proportion to creatinine

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9
Q

Which condition is closely related to primary sclerosing cholangitis?

A

Ulcerative colitis

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10
Q

Which liver enzyme is raised in an obstructive picutre?

A

ALP

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11
Q

What is the hallmark symptom of refeeding syndrome?

A

Hypophosphatemia- may result in significant muscle weakness and cardiac failure

Hypokalaemia

Hypomagnesaemia

Abnormal fluid balance

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12
Q

Criteria for patients being high risk of refeeding syndrome?

A

One or mote of the following:

BMI < 16kg/m2

unintentional weight loss >15% over 3-6 months

little nutritional intake > 10 days

hypokalaemia, hypophosphataemia or hypomagnesaemia prior to feeding (unless high)

Two or more of the following:

BMI < 18.5 kg/m2

unintentional weight loss > 10% over 3-6 months

little nutritional intake > 5 days

history of: alcohol abuse, drug therapy including insulin, chemotherapy, diuretics and antacids

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13
Q

Torsades de pointes treatment?

A

IV magnesium

Can be precipitated by hypomagnesaemia

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14
Q

Is high urea associated with a lower or upper GI bleed?

A

Upper GI Bleed

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15
Q

Smoking cessation?

A

Patients offered nicotine replacement therapy (NRT), varenicline or bupropion

Varenicline and bupropion CI in pregnancy

Bupropion CI in epilepsy

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16
Q

How to calculate pack years?

A

Number of packs smoked per day x the number of years they smoked for

20 in a pack, if smoking 15 a day example would be
0.75x30 years

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17
Q

Statin contrindications?

A

Pregnancy

Macrolides- erythromycin, clarithromycin

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18
Q

CURB65 score criteria?

A

Confusion

Urea >7

Resp rate >30

Systolic <90 Diastolic <60

> 65 years olf

CRB65 pre hospital

CURB65 in hospital

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19
Q

When is infliximab used in Crohn’s disease?

A

In refractory disease or fistulating Crohn’s

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20
Q

What should be assessed before starting azathioprine or mercaptopurine in Crohn’s disease?

A

+TMPT actvity

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21
Q

Spirometery results in idiopathic pulmonary fibrosis?

A

FEV1:FVC ratio >70%, decreased FVC

Impaired gas exchange (reduced TLCO)

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22
Q

Painful shin rash + cough?

A

?Sarcoidosis

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23
Q

Main side effect ACEi?

A

Dry cough

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24
Q

What are the high risk factors for pneumothorax?

A

Haemodynamic compromise

Significant hypoxia

Bilateral pneumothorax

Underlying lung disease

≥ 50 years of age with significant smoking history

Haemothorax

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25
Q

What does polymorphic ventricular tachycardia with oscillatory changes mean?

A

Torsades de pointes

Polymorhpic means different size QRS comples, oscillatory characteristic of torsades up and down in relation tot baseline

Give magnesium sulfate

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26
Q

Causes of a long QT interval?

A

Causes of long QT interval

Congenital:
Jervell-Lange-Nielsen syndrome
Romano-Ward syndrome

Antiarrhythmics: amiodarone, sotalol, class 1a antiarrhythmic drugs

Tricyclic antidepressants

Antipsychotics

Chloroquine

Terfenadine

Erythromycin

Electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia

Myocarditis

Hypothermia

Subarachnoid haemorrhage

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27
Q

Hypercalcaemia features?

A

Bones, stones, abdo groans and psychiatric moans

Corneal calcification

Shortened QT interval

Hypertension

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28
Q

Contraindications for chest drain insertion?

A

INR>1.3

Platelet count < 75

Pulmonary bullae

Pleural adhesions

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29
Q

Adverse effects of loop diuretics?

A

Hypotension

Hyponatremia

Hypokalaemia, hypomagneaemia

Hypochloraemic alkalosis

Ototoxicity

Renal impairment (from dehydration + direct toxic effect)

Hyperglycaemia (less common than wiht thiazides)

Gout

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30
Q

PPI adverse effects?

A

Hyponatremia, hypomagnasaemia

Osteoporosis–> increased fracture risk

Increased risk of C diff

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31
Q

Which side is aspiration pneumonia more common?

A

The right lung

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32
Q

Functions of vitamin C?

A

Antioxidant

Collagen synthesis

Facilitates iron absorption

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33
Q

Vitamin C deficiency? (Scurvey)

A

Defective synthesis of collagen- capillary fragility (bleeding) and poor wound healing

Features:

Gingivitis, loose teeth

Poor wound healing

Bleeding from gums, haematuria, epistaxis

General malaise

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34
Q

Most commonly affected valves in infective endocarditis?

A

Mitral in normal people

Tricuspid in IVDU

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35
Q

Which cancers is Lynch syndrome (HNPCC) associated with?

A

Female- CEO-P
Colon
Endometrial
Ovarian
Pancreatic

Male (CP)
Colon
Pancreatic

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36
Q

Primary Biliary Cholangitis Ms?

A

IgM

Anti-mitochondrial antibodies

Middle aged females

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37
Q

Post-MI complications?

A
  1. Death during/ immediately after MI = V-fib
  2. Pleuritic chest pain relieved by sitting forward days after MI = fibrinous pericarditis
  3. New pansystolic murmur + SOB days after MI = mitral regurgitation due to papillary muscle rupture
  4. Acute severe hypotension, raised JVP, muffled heart sounds days after MI = tamponade due to ventricular free wall rupture
  5. Harsh pansystolic murmur heard best in tricuspid area days after MI = ventricular septal rupture
  6. Persistent ST elevation weeks-months later + signs of LV dysfunction (poor CO, pulmonary oedema) = LV aneurysm
  7. Pleuritic chest pain relieved by sitting forward weeks after MI = Dressler’s syndrome
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38
Q

What is the cause of mitral stenosis?

A

Rheumatic fever mainly

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39
Q

Causes of upper zone fibrosis?

A

CHARTS

C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

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40
Q

Causes of fibrosis affecting the lower zones?

A

Idiopathic pulmonary fibrosis

Most connective tissue disorders- SLE (except ankylosing spondylitis)

Drug induced: amiodarone, belomycin, methotrexate

Asbestosis

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41
Q

Statin doses and CI?

A

20mg for primary prevention

80mg for secondary prevention (even if cholesterol normal it seems)

Contraindications-
Macrolides (erythromycin, clarithromycin)- statin stopped until patients complete the course

Pregnancy

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42
Q

A major ECG change in AF?

A

Absence of P waves

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43
Q

Boerhaave syndrome?

A

Mackler triad: vomiting, thoracic pain and subcutaneous emphysema

Middle aged men with background of alcohol abuse

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44
Q

Side effects of ACEi and CI?

A

Cough

Angioedema

Hyperkalaemia

First-dose hypertension

CI:

Preganancy/breastfeeding

Renovascular disease- renal impairment

Aortic stenosis- hypotension

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45
Q

Monitoring after starting ACEi?

A

U+E checked before treatment initiated and after increasing the dose

Rise in creatinine and potassium may be expected

Up to 30% increase in serum creatinine and potassium increase up to 5.5 mmol/l acceptable

Significant renal impairment may occur in patients who have undiagnosed bilateral renal artery stenosis

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46
Q

GI bleed key blood result?

A

Isolated raised urea

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47
Q

Indications for surgery in infective endocarditis?

A

Severe valvular incompetence

Aortic abscess

Infections resistant to antibiotics/fungal infections

Cardiac failure refractory to standard medical treatment

Recurrent emboli after antobiotic therapy

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48
Q

Which anatomical landmark allows the categorisation of an upper GI or lower GI bleed?

A

The ligament of Treitz

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49
Q

AF + valvular heart disease?

A

Absolute indication for anticoagulation

If CHA2DS2-VASc score suggests no need for anticoagulation ensure transthoracic echocardiogram has been done to exclude valvular heart disease

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50
Q

Stepping down treatment in asthma?

A

Step down treatment every 3 months or so if appropriate. When reducing ICS reduce by 25-50% at a time

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51
Q

Murmurs best heard?

A

RILE

Right sided murmurs best heard on inspiration

Left sided murmurs best heard on expiration

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52
Q

HbA1c target when adding a medication that can cause hypoglycaemia?

A

53 mmol/mol (7.0%)

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53
Q

Hypercalcaemia effect on QT interval on ECG?

A

Shorterned QT interval

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54
Q

HF- which two drugs to monitor potassium?

A

If they are on both an ACE inhibitor and an aldosterone antagonist both can cause hyperkalaemia- monitor potassium

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55
Q

Which artery supplies the AV node?

A

Right coronary artery (inferior myocardial infarction)

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56
Q

Main angina drugs?

A

Coronaries Need Blood (CNB)
CCBs
Nicorandil/Nitrates
Beta-Blockers

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57
Q

Drug induced gynaecomastia?

A

Spironolactone- most common

Cimetidine

Digoxin

Cannabis

Finasteride

GnRH agonists- goserelin, buserelin

Oestrogens, anabolic steroids

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58
Q

Which antibiotics cause C.difficile?

A

C’s for C.Diff- Co-amoxiclav, Ciprofloxacin, Clindamycin, Cephalosporins (ceftriaxone)

And PPIs

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59
Q

Which drug causes hyperthyroidism?

A

Amiodarone

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60
Q

Which drugs cause hypothyroidism?

A

Lithium

Amiodarone

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61
Q

Cushing’s syndrome vs Addison’s electrolyte disturbances?

A

Cushing’s- too much cortisol- hypernatremia and hypokalaemia

Addisons- too little cortisol- hyponatremia and hyperkalaemia

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62
Q

PSC malignancy risks?

A

Cholangiocarcinoma

Increased risk of colorectal cancer

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63
Q

T1DM initial insulin management?

A

Daily basal-bolus injection regimes

Twice-daily insulin detemir, rapid acting before meals

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64
Q

Drugs causing a raised prolactin (galactorrhoea)?

A

Metoclopramide, domperidone

Phenothiazines

Haloperidol

Very rare: SSRI/ Opioids

Dopamine acts as primary prolactin releasing inhibitory factor- domapine agonists such as bromocriptine can be used to control galactorhoea

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65
Q

Corticosteroid side effects?

A

Glucocorticoid side effects-

-Endocrine- impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia

-Cushing’s syndromem

MSK- osteoporosis, proximal myopathy, avascular necrosis of the femoral head

Immunosuppression- increased susceptibility to severe infection, reactivation of TB

Psychiatric- insomnia, mania, depression, psychosis

GI- peptic ulceration, acute pancreatitis

Opthalmic- glaucoma, caataracts

Suppression of growth in children

Intracranial hypertension

Neutrophillia

Mineralcorticoid side-effects-
Fluid retention
Hypertension

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66
Q

Selected points on steroids?

A

Patients on long term steroids should have their doses doubled during intercurrent illness

Longer term systemic corticosteroids suppress endogenous steroids- do not stop abruptly to prevent Addisonian crisis

Suggested gradual withdrawal of steroids if
40mg prednisolone daily for more than one week
Recieved more than 3 weeks of treatment
Recieved repeated courses

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67
Q

Major complication of carbimalzole therapy?

A

Agranulocytosis

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68
Q

Distinguish between Graves and De Quervain’s?

A

Pain in Quervain’s- painful goitre

Goitre not painful in Graves

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69
Q

Thiazolidinediones (pioglitazone) side effects?

A

Weight gain
Liver impairment- monitor LFTs
Fluid retention- CI in heart failure
Increased risk of fractures
Bladder cancer

Fat Bastards Won’t Feel Lighter

F- Fracture
B- Bladder ca
W- Weight gain
F- Fluid retention (CI in HF)
L- LFT derangement

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70
Q

Acute asthma managment adults?

A

Oh
Shit,
I
Hate
My
Asthma

Oxygen, Salbutamol nebulisers, Ipratropium bromide nebulisers, Hydrocortisone IV or Prednisolone Oral, Magnesium sulfate IV, Aminophylline/IV salbutamol

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71
Q

After which MI is bradyarrhythmias more common?

A

Inferior myocardial infarctions, occlusion of the right coronary artery which supplies the AV node

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72
Q

Adverse effects of thiazide diuretics?

A

Indapamide ad chlortalidone are examples

Dehydration
Postural hypotension
Hypokalaemia
Hyponatremia
Hypercalcaemia- also hypocalciuria which may be useful in reducing the incidence of renal stones
Gout
Impaired glucose tolerance
Impotence

Rare:
Thrombocytopenia
Agranulocytosis
Photosensitivity rash
Pancreatitis

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73
Q

PTX high risk characteristics?

A

Haemodynamic compromise

Significant hypoxia

Bilateral pneumothorax

Underlying lung disease

≥ 50 years of age with significant smoking history

Haemothroax

If any present with symptoms- insert a chest drain

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74
Q

Hypertension, HypoK?

A

Primary hyperaldostronism- with no symptoms of Cushing’s eg weight gain, moonface

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75
Q

Management of SVT?

A
  1. Vagal manouvres
  2. IV adenosine 6mg
  3. IV adenosine 12mg
  4. IV adenosine 18mg
  5. Electrical cardioversion

Adenosine CI in asthmatics so use verapamil

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76
Q

ACEi side effects?

A

Cough

Angioedema

Hyperkalaemia

First dose hypotension- more common in patients taking diuretics

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77
Q

ACEi cautions and contraindications?

A

Pregnancy and breastfeeding

Renovascular disease- may result in renal impairment

Aortic stenosis

Hereditary idiopathic angiodema

Specialist advice sought before starting ACEi in patients with potassium over 5

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78
Q

ACEi monitoring?

A

U+E checked before treatment initiated and after increasing dose

Rise in creatinine and potassium

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79
Q

Causes of raised prolactin?

A

The P’s

Pregnancy
Prolactinoma
Physiological
Polycystic ovarian syndrome
Primary hypothyroidism
Phenothiazines, metocloPramide, domPeridone

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80
Q

Hypo or hyperkalaemia with a diuretic?

A

If potassium sparing- hyperkalaemia

Any other diuretic- hypokalaemia

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81
Q

Can digoxin cause gynaecomastia?

A

Yes

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82
Q

Beck’s triad cardiac tamponade?

A

Raised JVP, muffled heart sounds, hypotension

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83
Q

Diastolic murmur + AF?

A

?Mitral stenosis

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84
Q

BB side effects?

A

Bronchospasm

Cold peripheries

Fatigue

Sleep disturbances, including nightmares

Erectile dysfunction

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85
Q

Easy way to remember CHA2DS2-VASc?

A

SADCHAVS

Stroke 2
Age >75 2
Diabetes 1
Congestive heart failure 1
HTN 1
Age >65 1
Vascular Hx 1
Sex Female 1

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86
Q

Can severe obesity cause restrictive lung disease?

A

Yes

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87
Q

Young adult with severe hypertension and systolic murmur?

A

Coarctation of the aorta

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88
Q

Posterior STEMI ECG?

A

Changes is V1-3
Tall R waves- V2 paticularly
Horizontal ST depressiion
Upright T waes

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89
Q

Cells in Barrett’s oesophagus?

A

Squamous epithelium replaced with columnar epithelium

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90
Q

Wilson’s disease, Haemochromatosis and Alpha-1-antitrypsin?

A

Liver + Brain- Wilson’s
Liver + Joints/ED- Haemochromatosis
Liver + Lungs = Alpha-1-antitrypsin

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91
Q

Adrenal insufficiency tanned?

A

Addison’s (primary) is associated with hyperpigmentation wheras secondary adrenal insufficiency is not

This is due to it being related to increased ACTH production

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92
Q

What are the two most common causes of hypercalcaemia?

A

Primary hyperparathyroidism

Malignancy

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93
Q

Unsynchonised vs synchronised shocks?

A

Unsynchronised shocks used in cardiac arrest- VF/pulselessVT

Synchronised shocks used in arryhtmias that are unstable

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94
Q

Test used to check for H.Pylori eradication?

A

Urea breath test

Should not be performed within 4 weeks of treatment with an antibacterial or within 2 weeks if an antisecretory drug (PPI)

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95
Q

Tricuspid regurgitation vs mitral regurgitation?

A

Tricuspid louder during inspiration, unlike mitral regurgitation

RILE:
Right sided murmurs louder on inspiration
Left sided murmurs louder on expiration

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96
Q

Who should adenosine be avoided in?

A

Asthmatics due to bronchospasm

Adverse effects:
Chest pain
Bronchospasm
Transient flushing

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97
Q

Features of hypokalaemia on ECG?

A

U waves
Small or absent T waves (occasionally inversion)
Prolong PR interval
ST depression
Long QT

U have no Pot and no T, but a long PR and a long QT

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98
Q

Decompensation risk factors?

A

ABCDI

Alcohol, bleeding, constipation, drugs, infection

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99
Q

Hepatorenal syndrome triad?

A

Cirrhosis, ascites, AKI bit attributable to any other cause

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100
Q

Inducers and inhibitors INR ways to remember?

A

Inducers: cause decrease in INR
“SCARS”
* S → Smoking
* C → Chronic alcohol intake
* A → Antiepileptics: Phenytoin, Carbamazepine, Phenobarbitone (all barbiturates)
* R → Rifampicin
* S → St John’s Wort

Inhibitors: cause increase in INR
“ASS-ZOLES”
* A → Antibiotics: Ciprofloxacin, Erythromycin, Isoniazid, Clarithromycin
* S → SSRIs: Fluoxetine, Sertraline
* S → Sodium Valproate
* - Zoles → Omeprazole, Ketoconazole, Fluconazole

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101
Q

Alcohol withdrawl timeline?

A

Symptoms- 6-12 hours

Seizures- 36 hours

Delirium tremens- 72 hours

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102
Q

Switching antidespressants?

A

Direct switch from most (sertraline, citalopram, escitalopram, paroexetine) to SSRI

If fluoxetine longer half life so leave a gap of 4-7 days after withdrw before starting new SSRI

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103
Q

Choice of SSRI in children and adolescents?

A

Fluoxetine

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104
Q

Other name for obsessive compulsive personality disorder?

A

Anankastic personality disorder

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105
Q

Lithium monitoring after change in dose?

A

Take levels a week later then weekly until the levels are stable

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106
Q

Most effective form of contraception?

A

Implantable Nexplanon etonogestrel

Lasts 3 years

No oestrogen so can be used in history of VTE/Migraine

Can be inserted straight after a termination

Additional contraceptive needed for first 7 days if not inserted on day 1-5

Main issue- irregular/heavy bleeding

UKMEC 4 current breast cancer

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107
Q

How long after medical termination should a pregnancy test be performed?

A

2 weeks after a medical termination

3 weeks after a medically managed miscarridge

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108
Q

Abortion act?

A

1967, in 1990 it was adjusted reducing the upper limit from 28 weeks to 24 weeks

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109
Q

What is a multi-level pregnancy test?

A

One that detects the level of hCG not just a positive or negative result

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110
Q

When can an intrauterine contraceptive be inserted after surgical termination?

A

Immediately after evacuation of the uterine cavity

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111
Q

Routine recall for HPV screening?

A

Every 3 years between the ages of 25 and 49

Every 5 years between the ages of 50 and 64

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112
Q

Alternative name for methylphenidate?

A

Ritalin

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113
Q

Corticosteroids and meingitis?

A

Do not use corticosteroids in children younger than 3 months with suspected or confirmed bacteria meningitis

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114
Q

N+V in pregnancy?

A

Natural remedies- ginger/acupuncture

Antihistamines should be used first line- promethazine

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115
Q

Should all pregnant and breastfeeding women take vit D?

A

Yes

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116
Q

Blood pressure during pregnancy?

A

Falls in first trimester and until 20-24 weeks then ususally increases to pre-pregnancy levels by term

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117
Q

What level is hypertension in pregnancy defined as?

A

140/90

Or increase about booking of 30/15

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118
Q

Types of hypertension in pregnancy?

A

Pre-existing- elevated over 140/90 before pregnancy- no proteinuria, no oedema
If takes an ACEi or ARB for pre-existing hypertension this should be stopped immediately and labetalol started

Pregnancy-induced hypertensio- occuring in the second half of the pregnancy

Pre-eclampsia- pregnancy induced hypertension in association with proteinuria >0.3/24h
Oedema may occur

Oral labetalol
Oral nifedipine if asthmatic

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119
Q

Raised AFP in pregnancy association?

A

Abdominal foetal wall defects (omphalocele, gastrochisis)
Neural tube defects
Multiple pregnancy

Deacreased in:
Down’s
Trisomy 18
Maternal diabetes mellitus

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120
Q

Example of a GnRH agonist?

A

Goserelin

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121
Q

HRT in VTE risk?

A

Transdermal

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122
Q

In HRT what increases the breast cancer risk?

A

The addition of the progestogen

Dual HRT risk- breast ca

Oestrogen only risk- endometrial ca

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123
Q

Pregnancy of unknown location what points towards an ectopic?

A

Serum bHCG levels >1500

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124
Q

Indications for more folic acid?

A

MORE
M- metabolic- T1DM, Coeliac
O- Obesity BMI>30
R- Relative
E- Epilepsy- taking antiepileptics

+Haem- sickle cell

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125
Q

Folic acid supplementation?

A

All women should take 400mcg of folic acid until 12th week of pregnancy

Women at higher risk of child with NTD should take 5mg folic acid from before conception until 12th week

Women higher risk if-
Either partner has NTD, previous NTD pregnancy, FH NTD

Antiepileptic drugs, coeliac, diabetes or thalassemia

BMI>30

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126
Q

COCP UKMEC 4?

A

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

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127
Q

VEAL CHOP for cardiotopography?

A

VEAL CHOP

Variable decelerations –> Cord compression

Early decelerations –> Head compression

Accelerations –> Okay

Late decelerations –> placental insufficiency

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128
Q

Two key worrying things from a foetal CTG?

A

Terminal bradycardia- Baseline fetal heart rate drops below 100 BPM for more than 10 minutes.

Terminal deceleration- when the heart rate drops and does not recover for more than 3 minutes

These are indicatiors for an emergency caesarean section

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129
Q

What urine rate is classed as oliguria?

A

A urine output less than 0.5 ml/kg/hour

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130
Q

Key ways of identifying AKI?

A

Reduced urine output- less than 0.5ml/kg/hour

Fluid overload

A rise in molecules that the kidney normally excretes/maintains a careful balance of- examples- potassium, urea, creatinine

Can lead to symptoms/signs:

Reduced urine otput
Pulmonary/peripheral oedema
Arrhythmias- secondary to changes in potassium and acid-base balance
Features of uraemia- pericarditis or encephalopathy

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131
Q

Drugs safe to continue in AKI?

A

Paracetamol
Warfarain
Statins
Aspirin
Clopidogrel
Beta-blockers

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132
Q

Drugs to be stopped in AKI as worsen renal function?

A

NSAIDs
Aminoglycosides
ACEi
ARB
Diuretics

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133
Q

Drugs to be stopped in AKI as increased risk of toxicity?

A

Metformin

Lithium

Digoxin

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134
Q

Urea:Creatinine ratio in AKI?

A

urea / (creatine divided by 1000) - do the divide by 1000 so its same units
>100 - pre renal cause
<100 - ATN

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135
Q

Causes of hyperkalaemia?

A

AKI

Drugs: potassium sparing diuretics, ACEi, ARB, Spironolactone, Ciclosporin, heparin

Metabolic acidosis

Addison’s disease

Rhabdomyolysis

Massive blood transfusion

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136
Q

Hyperkalaemia stages?

A

Mild- 5.5-5.9
Moderate- 6-6.4
Severe- >6.5

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137
Q

Hyperkalaemia ECG?

A

Peaked or tall tented t waves

Loss of P waves

Broad QRS complexes

Sinusoidal wave pattern

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138
Q

Management of hyperkalaemia?

A

Stabilisation of the cardiac membrane- IV calcium gluconate (does not lower serum potassium levels)

Combined insulin/dextrose infusion, nebulised salbutamol (causes a short term shift in potassium from ECF compartment to ICF compartment)

Removal of potassium from the body-
Calcium resonium (orally or enema)- enemas more effective as potassium secreted by the rectum
Loop diuretics
Dialysis- haemofiltration/haemodyalysis considered for AKI patients with persistent hyperkalaemia

Practically of >6.5 emergency treatment of:
IV Calcium gluconate
Insulin/dextrose infusion

Stop exacerbating drugs ACEi
Treat underlying cause
Lower total body posassium- calcium resonium, loop diuretics, dialysis

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139
Q

Nephrogenic diabetes insipidus treatment?

A

Thiazides

Low salt/protein diet

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140
Q

Central (cranial) diabetes insipidus treatment?

A

Desmopressin

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141
Q

Paediatric fluids calculation (non-neonates)?

A

100ml for first 10 kg
50ml for next 10kg (11-20)
20ml for every extra kilo

Up to a max of around 2L

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142
Q

Adult maintenance fluids calculation?

A

25-30ml/kg/day of water
1mmol/kg/day of potassium, sodium and chloride
50-100g/day of glucose to limit starvation ketosis

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143
Q

Risk of using 0.9% saline if large volumes of fluid required?

A

Hyperchoraemic metabolic acidosis

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144
Q

Which common drug can cause rhabdomyolysis?

A

Statins (especially if co-prescribed with clarithromycin)

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145
Q

Most common renal cause of AKI?

A

Acute tubular necrosis (ATN)

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146
Q

Two causes of ATN?

A

Ischaemia- shock, sepsis

Nephrotoxins- aminoglycosides, myoglobin secondary to rhabdomyolysis, radioconstrast agents, lead

Muddy-brown casts in urine

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147
Q

Type 1 vs Type 2 respiratory failure?

A

Type 1- just one gas is effected (eg just the oxygen or CO2 out of range)

Type 2 - two gasses effected (both oxygen and CO2 out of range)

Could be wrong- correct is-

Type 1- Low oxygen with normal or low CO2

Type 2- Low oxygen with High CO2

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148
Q

If renin high but aldosterone high, unlikely to be primary hyperaldostronism what else is most likely?

A

Renal artery stenosis

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149
Q

Things in urine and their meaning?

A

Hyaline casts- normal- paticularly in patients taking loop diuretics

Brown granlar casts- acute tubular necrosis

Bland urinary sediment- prerenal uraemia

Red cell casts- nephritic syndrome

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150
Q

Haematuria referral?

A

In younger- usually renal referral

In older- usually urology referral

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151
Q

Kidney condition associated with berry aneurysms?

A

ADPKD

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152
Q

Why is nephrotic syndrome associated with an increased risk of thromboembolism?

A

Nephrotic syndrome leads to a loss of antithrombin III and plasminogen in the urine

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153
Q

How are diabetics screened for diabetic nephropathy?

A

Annually using albumin:creatinine ratio (ACR)
Early morning specimen

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154
Q

Anaemia signs- paticularly due to CKD?

A

Usually caused by iron deficiency or erythropoitein deficiency in CKD

Tachycardia, fatigue, pallor and an aortic flow murmur

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155
Q

Example regime/ drugs for immunosuppression?

A

Initial: Ciclosporin/ tacrolimus

Maintenance- Ciclosporin/tacrolimus with Mycophenolate mofetil (MMF) or Sirolimus (rapamycin)

Add steroids if more than one steroid responsive acute rejection episode

Immunosuppression means more likely to get malignancy such as skin cancer

Some of the drugs can cause cardiovascular issues

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156
Q

Difference between somatisation and hypochondriasis (illness anxiety disorder)?

A

Somatisation- multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results

Hypochondriasis- persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results

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157
Q

How long should a PPI be stopped before upper endoscopy?

A

2 weeks

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158
Q

Gold standard investigation for GORD (after endoscopy)?

A

24 hour oesophageal pH monitoring

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159
Q

Group B step presentation neonates?

A

Most common cause of early onset neonatal sepsis

Classically- fever, tachycardia and respiratory distress within hours of birth

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160
Q

Risk factors for GBS transmission?

A

Prematurity

Prolonged rupture of the membranes

Previous sibling GBS infection

Maternal pyrexia (secondary to chorioamnionitis)

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161
Q

Conditions associated with MALT lymphoma?

A

H.pylori infections- 95%

Hashimoto’s thyroiditis

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162
Q

Most common causes of hypercalcaemia?

A

Primary hyperparathyroidism- in non-hospitalised

Malignancy- in hospitalised patients- can be PTHrP from tumour in SCLC, bone metasteses or myeloma

For this reason measuring PTH levels is the key investigation for patients with hypercalcaemia

Other causes-
Sarcoidosis
Vit D intoxication
Acromegaly
Thyrotoxicosis
Drugs- thiazides, calcium-containing antacids
Dehydration
Addison’s disease
Paget’s disease of the bone

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163
Q

First investigation for heart failure?

A

NT-proBNP

If levels high (>2000) then specialist assessment (including transthoracic ECHO) within 2 weeks

If levels raised (400-2000) then specialist assessment (including transthoracic ECHO) within 6 weeks

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164
Q

When is the majority of hydrocortisone treatment given for Addison’s?

A

Majority given in the first half of the day

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165
Q

Addison’s during illness?

A

Hydrocortisone doubled, fludrocortisone stay the same

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166
Q

Manouvre for shoulder dystocia?

A

McRobert’s manoeuvre

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167
Q

Features of life-threatening asthma?

A

33 92 CHEST:
PEFR <33
Sats < 92%
Confusion/Cyanosis
Hypotension
Exhaustion
Silent chest
Transiently normal CO2

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168
Q

Urge or stress incontinence management?

A

Bladder retraining exercises- minimum of 6 weeks

1st line- oxybutinin, darifenacin, tolterodine

If old, frail avoid oxybutinin and give mirabegron due to risk of anticholinergic side effects

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169
Q

Way to screen for postnatal depression?

A

Edinburgh Postnatal Depression Scale

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170
Q

SSRIs that can be used in postnatal depression?

A

Sertraline and paroxetine

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171
Q

Up to when can the COCP not be used after pregnancy due to VTE risk?

A

Up to day 21

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172
Q

What causes roseola infantum (sixth disease)?

A

Human herpes virus 6

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173
Q

When should levonorgestrel dose be doubled?

A

Those with a BMI >26 or weight over 70kg

Also if taking enzyme inducing drugs but copper IUD preferable in this situation

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174
Q

Levonorgestrel extra bits?

A

If vomiting occurs within 3 hours then dose should be repeated

Can be used more than once in a menstrual cycle if clinically indicated

Hormonal contraception can be started immediately after using

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175
Q

SSRI that causes QT prolongation/ torsades de pointes?

A

Citalopram

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176
Q

Clinical features of Down’s syndrome?

A

Face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
Flat occiput
Single palmar crease, pronounced ‘sandal gap’ between big and first toe
Hypotonia
Congenital heart defects (40-50%, see below)
Duodenal atresia
Hirschsprung’s disease

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177
Q

Later complications of Down’s syndrome?

A

Subfertility: males are almost always infertile due to impaired spermatogenesis. Females are usually subfertile, and have an increased incidence of problems with pregnancy and labour
Learning difficulties
Short stature
Repeated respiratory infections (+hearing impairment from glue ear)
Acute lymphoblastic leukaemia
Hypothyroidism
Alzheimer’s disease
Atlantoaxial instability

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178
Q

When are pregnant women screened for anaemia

A

The booking visit (often at 8-10 weeks)

28 weeks

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179
Q

Anaemia cut offs in pregnancy?

A

Cut offs for is a woman should recieve iron therapy:
First trimester- <110g/L
Second trimester- <105g/L
Postpartum- <100g/L

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180
Q

What is the most important thing to do for someone who presents with an infection that is taking clozapine?

A

Arrange a full blood count to check for agranulocytosis/neutropenia- life threatening side effect of clozapine

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181
Q

Hypercalcaemia symptoms?

A

Stones- kidney or biliary stones

Bones- bony pain

Groans- Abdominal pains

Thrones- constipation or frequent urination

Tones- Muscle weakness and hypotrefelxia

Psychiatric moans- depression, anxiety, confusion

(Bendroflumethiazide (thiazide like diuretics) cuse hypercalcaemia, hyponatraemia, hypokalaemia and hypomagnesaemia)

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182
Q

How do thiazide like diuretics work?

A

Inhibit sodium reabsorption at the begininning of the distal convoluted tubule

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183
Q

Thiazide like diuretics side effects?

A

Common adverse effects
dehydration
postural hypotension
hypokalaemia
due to increased delivery of sodium to the distal part of the distal convoluted tubule → increased sodium reabsorption in exchange for potassium and hydrogen ions
hyponatraemia
hypercalcaemia
the flip side of this is hypocalciuria, which may be useful in reducing the incidence of renal stones
gout
impaired glucose tolerance
impotence

Rare adverse effects
thrombocytopaenia
agranulocytosis
photosensitivity rash
pancreatitis

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184
Q

Are statins contraindicated in pregnancy?

A

Yes

Also contraindicated with macrolides (erythromycin, clarithromycin)

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185
Q

Alcohol units for men and women?

A

14 units per week for both

1 unit= 10ml of alcohol

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186
Q

When should beta blockers be stopped in acute heart failure?

A

If the patient has a heart rate <50, second or third degree AV block or shock

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187
Q

Does SIADH lead to signs of fluid overload?

A

No because the fluid is equally distributed throughout the body

The blood does become diluted through leading to a hyponatremia

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188
Q

Furosemide side effects?

A

OH DANG

O-otoxicity
H-hypokalaemia
D-Dehydration
A-allergy
N-nephritis
G-GOut

Hyponatremia as well

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189
Q

How to know if DKA has resolved ?

A

pH over 7.3
Blood ketones <0.6
Bicard >15

If not like this 24 hours after admission they need review from a senior endocrinologist

Both ketonemia and acidosis should resolve within 24 hours

If the criteria are met and patient is eating and drinking switch to subcut insulin

Patient reviewed by diabetes specialist nurse prior to discharge

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190
Q

If CHADSVASC suggests no need for anticoagulation (0) what needs to be done?

A

Do a transthoracic echocardiogram to exclude valvular heart disease, which is requires anticoagulation in combination with AF

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191
Q

C.difficile management?

A

Current antibiotic therapy reviewed and antibiotics stopped if possible

1st- Oral vancomycin- 10 days
2nd- Oral fidaxomicin
3rd- Oral vancomycin +/- IV metronidazole

If life threatening stragiht to 3rd

Isolation in a side room

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192
Q

Insulinoma triad?

A

Whipple’s triad

Symptoms and signs of hypoglycemia

Plasma glucose <2.5mmol/L

Reversibility of symptoms on the administation of glucose

Most importantly C-peptide levels do not fall on the administation of insulin if the patient has an insulinoma as endogenous levels are not reduced through negative feedback

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193
Q

What should a UC patient who had 2 or more severe exacerabtions in the past year be given to maintain remission?

A

Either oral azathioprine or oral mercaptopurine

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194
Q

Metabolic alkalosis + hypokalaemia?

A

?prolonged vomiting

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195
Q

Management of h.pylori?

A

PPI+ Amoxicillin + Clarithromyin OR Metronidazole

If pen allergic
PPI+Clarithromycin+metronidazole

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196
Q

When shoud urea breath test not be performed?

A

Within 4 weeks of treatment with an antibacterial or within 2 weeks of an antisecretory drug (PPI)

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197
Q

Which test should be used to check for H.pylori eradication?

A

Urea breath test

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198
Q

CRP and infection?

A

CRP can lag behind other blood results such as WCC

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199
Q

Multiple endocrine neoplasia?

A

MEN Type 1- 3Ps- Parathyroid (hyper), Pituitary, Pancreas (insulinoma, gastrinoma- causing peptic ulcer)
(Also adrenal and thyroid)- most common presentation hypercalcemia

MEN Type IIa- 2Ps- Parathyroid, Phaeochromocytoma

MEN type IIb- 1P- Phaeochromocytoma. Also neuromas and marfanoid body habitus

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200
Q

Zollinger-Ellison Syndrome?

A

Excessive levels of gastrin secondary to gastrin-secreting tumour. Can be part of MEN 1 syndrome

Features: multiple gastroduodenal ulcers, diarrhoea, malabsorpiton

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201
Q

Afro-carribean + HF?

A

Hydralazine + Nitrates

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202
Q

HF treatment?

A

ACEi and BB- start one drug at a time

2nd- Add an aldosterone antagonist- spironolactone/eplerenone- remember to monitor potassium if also on ACEi as both cause hyperkalaemia

3rd-
Ivabradine- sinus rhythm >75/min and left ventricular fraction <35%

Sacubitril-valsartan- left ventricular fraction <35%- symptomatic on ACEi/ARB- initiated following ACEi/ARB washout period

Digoxin- Indicated in coexistant atrial fibrillation

Hydralazine + nitrate- afro-carribean

Cardiac resynchronisation therapy- widened QRS (LBBB) on ECG

Also a role for SGLT-2 inhibitors

Annual influenza vaccine
Offer one-off pneumococcal vaccine

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203
Q

Drug to slow heart rate contraindicated in asthmatics?

A

IV adenosine

Verapamil prederable

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204
Q

Statin interactions?

A

Macrolides (erythromycin, lcarithromycin)

Pregnancy

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205
Q

Oesophageal cancer types?

A

UK/US- adenocarcinoma- GORD, Barrett’s

Developing- squamous cell cancer- smoking, alcohol

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206
Q

Postpartum contraception from when?

A

Day 21

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207
Q

How to define menhorrhagia?

A

Used to be over 80ml per menses but now is defined as an amount that the woman considers to be excessive

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208
Q

Extrapyramidal side-effects (EPSEs)?

A

Parkinsonism

Acute dystonia- torticollis, oculogyric crisis- managed with procyclidine

Akathisia

Tardive dyskinesia- occurs after longer term use

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208
Q

Side effects antipsychotics?

A

Typical- Extrapyramidal side-effects and hyperprolactinaemia common
Haloperidol, Chlorpromazine

Atypical- Above less common. Metabolic effects.
Clozapine, Risperidone, Olanzapine

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209
Q

What causes epiglottitis?

A

Haemophilus influenzae type B

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210
Q

Features of epiglottitis?

A

Features:
Rapid onset
High temp, generally unwell
Stridor
Drooling of saliva
Tripod position- easier to breath if leaning forward and extending their neck in a seated position

Diagnosis made by direct visualisation by senior/airway trained staff

X-ray signs-
Lateral view- thumb sign
Posterior-anterior view- steeple sign

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211
Q

Can you breastfeed on antiepileptic drugs?

A

Yes on nearly all of them

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212
Q

Constipation management in children?

A

MSO

Movicol paediatric plain

Stimulant- Senna

Osmotic- lactulose

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213
Q

Less severe vs more severe depression PHQ-9?

A

Less severe is a PHQ-9 score of <16

More severe is a PHQ-9 score of >16

Less severe depression- not routine for antidepressant first line unless patient preference
Guided self help
Group CBT
Individual CBT
SSRI

More severe-
SSRI and Individual CBT combination

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214
Q

Do stage 1 hypertension get treated?

A

Only if <80 and 1 of: target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater

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215
Q

What does sudden deterioration with ventilation suggest?

A

Tension pneumothroax

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216
Q

What reverses the effect of dabigatran?

A

Idarucizumab

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217
Q

Which scoring system to use after endoscopy for upper GI bleed?

A

Rockall score- gives a percentage risk of rebleeding and mortality

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218
Q

When to use the Glasgow-Blatchford score?

A

At the first assessment of a GI bleed to decide if managed as outpatient or inpatient- patients with a score of 0 can be considered for early discharge

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219
Q

Risks of HRT?

A

Increased VTE risk with oral- none with transdermal

Stroke- slight increase with oral

CHD

Breast cancer- increased risk

Ovarian cancer- increased risk

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220
Q

Non-HRT menopause management?

A

Vasomotor symptoms- fluoxetine, citalopram or venlafaxine

Vaginal dryness- vaginal lubricant

Psychological symptoms- self-help, CBT or antidepressants

Urogenital atrophy- vaginal oestrogens

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221
Q

Things wrong with pulses?

A

Pulsus paradoxus- greater than 10mmHg fall in systolic BP during inspiration- faint or absent pulse on inspiration- severe asthma, cardiac tamponade

Slow rising pulse- aortic stenosis

Collapsing pulse- aortic regurgitation, patent ductus arteriosus, hyperkinetic states

Pulsus alternans- regular alternation of the force of arterial pulse- severe LVF

Bisderiens pulse- mixed aortic valve disease- both stenosis and regurgitation- causes two systolic peaks

Jerky puse- HOCM

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222
Q

Subacute thyroiditis (De Quervain’s)?

A

De QuerPains Vains- viral post viral

There are typically 4 phases;
phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to normal

globally reduced uptake of iodine-131

Self limiting

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223
Q

Obesity management?

A

Conservative- diet, exercise

Medical- orlistat, liraglutide

Surgical

Orlistat for over BMI 28 with risk facors or over BMI30

Liraglutide criteria- BMI 35 or over and in the prediabetic range- HbA1c 42-47 mmol/mol

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224
Q

Murmurs?

A

Ejection systolic-
Louder on expiration- aortic stenosis, HOCM
Louder on inspration- pulmonary stenosis, atrial septal defect
Tetralogy of Fallot

Pansystolic-
Mitral/tricuspid regurgitation- tricuspid louder on inspiration, mitral isn’t
Ventricular septal defect

Late systolic-
Mitral valve prolapse
Coarctation of the aorta

Early diastolic-
Aortic regurgitation
Graham-Steel murmur

Mid-late diastolic-
mitral stenosis
Austin-Flint mrmur

Continuous machinary like murmur-
Patent ductus arteriosus

Right sided murmur- inspiration
Left sided murmur- expiration

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225
Q

Best markers for acute liver monitoring/acute liver failure?

A

Prothrombin time

Albumin level

Prothrombin has shorter half life so it is a better marker

Liver enzymes not reliable as take time to change

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226
Q

Features and causes of acute liver failure?

A

Causes-
paracetamol overdose
Alcohol
viral hepatitis (usually A or B)
acute fatty liver of pregnancy

Features
jaundice
coagulopathy: raised prothrombin time
hypoalbuminaemia
hepatic encephalopathy
renal failure is common (‘hepatorenal syndrome’)

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227
Q

First line non-hormonal treatment for menorrhagia?

A

Tranexamic acid

Mefenamic acid (paticularly if dysmenorrhoea as well)

If require contraception:
Mirena
COCP
Long acting progestogens

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228
Q

Who is adenomyosis more common in?

A

Older, multiparous women towards the end of their reproductive years

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229
Q

ECG changes associated with hypothermia?

A

Bradycardia- <60bpm
J waves
First degree heart block
Long QT
Atrial and ventricular arrythmias

Jeez it’s bloody freezing
J waves, irregular rhythms, bradycardia, first degree heart block

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230
Q

Prophylaxis of variceal haemorrhage?

A

Propanolol

Endoscopic variceal band ligation

Transjugular intrahepatic portosystemic shunt

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231
Q

Which drug is contrainidcated in VT?

A

Verapamil

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232
Q

What is the safe triangle for insertion of a chest drain?

A

Anterior edge of latissius dorsi
Lateral border of the pectoralis major
A line superior to the horizontal level of the nipple (5th intercostal space)

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233
Q

CRB65 score + interpretation?

A

Confusion
Resp rate >=30/min
BP <90/<60
Age over 65

0- low risk- treatment at home
1 or 2- intermediate risk- hospital assessment considered
3 or 4- urgent admission to hospital

CURB65- Urea >7
0-1- consider home
2 or more hospital based
3 or more intensive care assessment

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234
Q

Pneumonia treatment

A

Low severity:
Amoxicillin
Macrolide or tetracycline if pen allergic

Moderate/high-severity
Dual therapy- amoxicillin and a macrolide

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235
Q

Follow up for pneumonia?

A

All pneumonia should have a repeat chest x-ray at 6 weeks after clinical resolution to ensure no underlying secondary abnormalities such as a lung tumour

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236
Q

Added benefits to mirtazapine?

A

Increased appetite and sedation effects

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237
Q

Ketones over what for DKA?

A

> 3mmol/l

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238
Q

What is pseudomembranous colitis?

A

C.difficle colitis- another name for it

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239
Q

What do you need to check before treatment with azathioprine?

A

Thiopurine methyltransferase deficiency (TMPT)

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240
Q

Extra azathioprine bits?

A

Generally considered safe in pregnancy

Adverse effects-
Bone marrow depression
N+V
Pancreatitis
Increased risk of non-melanoma skin cancer

Significant interaction may occur with allopurinol- potentially use lower doses

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241
Q

Are chemotherapy patients at an increased risk of gout?

A

Yes- due to increased urate production

Chemotherapy causes rapid cell death leading to the release of purines that are metabolised into uric acid

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242
Q

Sulfasalazine extra bits?

A

Considered safe to use in both pregnancy and breastfeeding unlike other DMARDs

Caution- G6PD deficiency, allergy to aspirin or sulphonamides

Adverse effects
Oligospermia
Stevens-Johnson syndrome

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243
Q

Antiphospholipid syndrome features?

A

Venous/arterial thrombosis
Recurrent miscarridges
Livedo reticularis
(Pre-eclampsia, pulmonary hypertension)

Investigations-
Antibodies- anticardiolopin antibodies
anti-beta2 glycoprotein antibodies
lupus anticoagulan

Thrombocytopenia

Prolonged APTT

Management:
Primary thtromboprophylaxis- low-dose aspirin

Secondary thromboprohylaxis- initial venous thrmboemloic events- lifelong warfarin with a target INR of 2-3
Reccurent VTE events- add aspiring INR to 3-4

Arterial thrombosis- lifelong warfarin with target INR 2-3

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244
Q

Which conditions is closely related to temporal arteritis?

A

Polymyalgia rheumatica

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245
Q

What is a raised anti-CCP associated with?

A

Rheumatoid arthritis

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246
Q

Which blood result is notably normal in polymyalgia rheumatica?

A

Creatine kinase

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247
Q

Methotrexate indications?

A

Inflammatory arthritis- especially rheumatoid
Psoriasis
Some chemotherapy- ALL

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248
Q

Adverse effects of methotrexate?

A

Mucositis

Myelosuppression

Pneumonitis- most commonn pulmonary manifestation- non-productive cough, dyspnoea, malaise, fever

Pulmonary fibrosis

Liver fibrosis

Avoid pregnancy for at least 6 months after treatment stopped

BNF also advises men using methotrexate need to use effective contraception for at least 6 months after treatment

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249
Q

Prescribing methotrexate general advice?

A

Methotrexate had high potential for patient harm

Methotrexate is taken weekly, rather than daily

FBC, U&E, LFT regularly monitored- FBC, renal and LFTs before strting treatment and weekly until therapy stable, then every 2-3 months

Folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose

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250
Q

Interactions of methotrexate?

A

Trimethoprim or co-trimoxazole- increases the risk of marrow aplasia

High dose aspirin- reduced methotrxate excretion

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251
Q

Mechanism of action for bisphosphonates?

A

They inhibit osteoclasts by reducing recruitment and promoting apoptosis

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251
Q

Methotrexate toxicity treatment?

A

Folinic acid

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252
Q

Adverse effects of bisphosphonates?

A

Oesophageal reacions

Osteonecrosis of he jaw- substationally greater risk for patients receiving IV bisphosphonates in the treatment of cancer than for patients receiving oral bisphosphonates for osteoporosis or Paget’s disease

increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate

acute phase response: fever, myalgia and arthralgia may occur following administration

Hypocalcaemia- usually clinically unimportant

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253
Q

Counselling for taking oral bisphosphonates?

A

‘Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet’

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254
Q

Bispohosphonates and prexisting deficiency?

A

Hypocalcemia/vitamin D deficiency should be corrected before giving bisphosphonates. However, when starting bisphosphonate treatment for osteoporosis, calcium should only be prescribed if dietary intake is inadequate. Vitamin D supplements are normally given.

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255
Q

Duration of bisphosphonate treatment?

A

The duration of bisphosphonate treatment varies according to the level of risk. Some authorities recommend stopping bisphosphonates at 5 years if the following apply:
patient is < 75-years-old
femoral neck T-score of > -2.5
low risk according to FRAX/NOGG

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256
Q

Most common site for metatarsal stress fracture?

A

2nd metatarsal shaft

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257
Q

Reactive arthritis triad?

A

Arthralgia, urethritis and uveitits (Arthritis, urethritis, conjunctivitis)
Develops following an infection where the organism cannot be recovered from the joint

Can’t see, can’t pee can’t climb a tree

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258
Q

Organisms for reactive arthritis?

A

Shigella, salmonella, campylobacter- post-dysenteric

Post-STI- chlamydia trachomatis

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259
Q

Management reactive arthritis?

A

Analgesia, NSAIDs, intra-articular steroids

Sulfasalazine and methotrexate for persistent disease

Symptoms rarely last more than 12 months

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260
Q

Do ganglion cysts transilluminate?

A

Yes

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261
Q

Most common organism in osteomyelitis?

A

Staph. aureus

In patients with sickle-cell it is salmonella

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262
Q

Difference between Raynaud’s disease and Raynaud’s phenomenon?

A

Raynaud’s disease is primary- typically women under 30 years old

Raynaud’s phenomenon is secondary

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263
Q

Secondary causes of Raynaud’s phenomenon?

A

Connective tissue disorders- scleroderma (most common), RA, SLE

Leukaemia

Use of vibrating drugs
COCP

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264
Q

Cardiac condition associated with discitis?

A

IE- assess patients with transthoracic echo

Discitis usually due to bacteraemia and seeding that could also have occured elsewhere

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265
Q

Complication of discitis?

A

Epidural abscess- can cause lower limb neurology

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266
Q

What to do if a patient is deemed high risk on a QFracture or FRAX scre?

A

They should have a DEXA scan to assess bone mineral density

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267
Q

A mutation in which protein causes Marfan’s syndrome?

A

Fibrillin-1

Autosomal dominant

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268
Q

Features of Marfan’s syndrome?

A

all stature with arm span to height ratio > 1.05
high-arched palate
arachnodactyly
pectus excavatum
pes planus
scoliosis of > 20 degrees
heart:
dilation of the aortic sinuses (seen in 90%) which may lead to aortic aneurysm, aortic dissection, aortic regurgitation
mitral valve prolapse (75%),
lungs: repeated pneumothoraces
eyes:
upwards lens dislocation (superotemporal ectopia lentis)
blue sclera
myopia
dural ectasia (ballooning of the dural sac at the lumbosacral level)

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269
Q

Sjogren’s syndrome malignancy association?

A

Marked increased risk of lymphoid malignancy 40-60 fold

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270
Q

What are the 4 As of ankylosing spondylitis?

A

Apical fibrosis
Anterior uveitis
Aortic valve incompetence
Achilles tendonitis

Other features - the ‘A’s
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)

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271
Q

Ankylosing spondylitis X-Ray?

A

Sacroiliitis: subchondral erosions, sclerosis

Squaring of lumbar vertebrae

Bamboo spine (late and uncommon)

Syndesmophytes

CXR- apical fibrosis

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272
Q

Is measles a notifiable disease?

A

Yes

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273
Q

Is HIV a notifiable disease?

A

No

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274
Q

Only absolute contraindication for ECT?

A

Raised ICP

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275
Q

How long before surgery should oestrogen contraceptives be stopped?

A

4 weeks before

Can switch to the POP

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276
Q

Nerve problems?

A

C1, 2 - Look at your shoe- Neck flexion/extension
C3 - A fallen tree - Neck lateral flexion
C4 - I’m not sure - Shoulder elevation
C5 - Arms out wide - Shoulder flexion, abduction, & lateral rotation
C6, 7, 8 - Close the gate - Shoulder extension, adduction & medial rotation
C5, 6 - Pick up sticks - Elbow flexion
C7, 8 - Lay them straight - Elbow extension
C5, 6 - Flick my wrists - Forearm supination
C7, 8 - The time is late - Forearm pronation
C6, 7 - Fly up to heaven - Wrist flexion & extension
C7 - Paper - Finger extension
C8 - Rock - Finger flexion (though some sources say C7, 8 does both finger extension and flexion)
T1 - Scissors - Finger abduction & adduction

(T1-12 - Supplies chest wall and abdominal muscles)
(L1 - Contributes to hip flexion & adduction)

Kicking a ball:
L2, 3 - Lift my knee - Hip flexion
L3, 4 - Kick the door - Knee extension (& knee-jerk reaction)
L4, 5 - Foot points to the sky - Ankle dorsiflexion

Bringing foot back to the floor:
L4, 5 - Extend my thigh - Hip extension
L5, S1, (S2) - Kick my bum (Run to poo) - Knee flexion
S1, 2 - Stand on my shoes - Ankle plantarflexion (& ankle jerk)
(Babinski plantar reflex/extensor response in UMN lesion is L5, S1, S2)

L2, 3, 4 - Modestly close the door - Hip adduction & internal/medial rotation
L4 - S2 - The opposite is true - Hip abduction & external/lateral rotation

[ SUPPLIES ]
C3, 4, 5 - Keeps the diaphragm alive â→ Innervates the diaphragm
S2, 3, 4 - Keeps s*** off the floor â→ Innervates bowel, bladder, sex organs, anal sphincter, pelvic muscles. (& anal wink reflex)

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277
Q

Two main fractures at risk of compartment syndrome?

A

Supracondylar fractures and tibial shaft fractures

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278
Q

Chromosome present in CML?

A

Philadelphia chromosome- translocation 9 and 22

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279
Q

Most common cause of AIN and examples of them?

A

Drugs:
Penicillins
NSAIDs
Furosemide
Rifampicin
Allopurinol

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280
Q

What to do in DVT if US scan negative but d-dimer positive?

A

Stop anticiagulation and re-scan in 1 week

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281
Q

Which must be replaced first B12 or Folate?

A

BeFore

Replace B12 before Folate to avoid subacute degeneration of the spinal cord

282
Q

Treatment B12 deficiency?

A

If no neurological involvement 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months

283
Q

Extra factors in a Z socre DEXA?

A

AGE

Age
Gender
Ethnicity

284
Q

What suggests achillies tendon rupture?

A

Playing sport
Audible pop
Sudden onset significant pain in cal or ankle/ inability to walk/continue

Positive Simmond’s sign

285
Q

Risk factors for achilles tendon disorders?

A

Quinolone use (ciprofloxacin)
Hypercholesterolaemia

286
Q

Indications for dialysis?

A

AEIOU
A- acidosis <7.1
E- electrolyte derangement (refractory hyperkalaemia)
I- Intoxication/ingestion (alcohol/salicylates/lithium)
O- overload of fluid (cogestive cardiac failure)
U- uraemia (uraemic pericarditis or encephalopathy)

287
Q

Can testosterone deficiency cause osteoporosis?

A

Yes

288
Q

Which bones are most likely to be affected in Paget’s disease of the bone?

A

Skull, spine/pelvis and long bones of the lower extremities are most commonly affected

289
Q

What is the most common optic compilcation of temporal arteritis?

A

Anterior ischemic optic neuropathy- results from occlusion of the posterior ciliary artery. Swollen pale disc and blurred margins.

290
Q

Which is the strange indication for dialysis in AKI?

A

Pulmonary oedema

Also:
Hyperkalaemia
Uraemia
Metabolic acidosis

291
Q

Most common anaemia worldwide?

A

Iron deficiency anaemia

292
Q

Stages if hyperkalaemia?

A

mild: 5.5 - 5.9 mmol/L
moderate: 6.0 - 6.4 mmol/L
severe: ≥ 6.5 mmol/L

Treat as severe if moderate/mild with ECG changes

293
Q

Red flags for cancer- back pain?

A

Trauma/Thoracic back pain

Unexplained weight loss

Neuro sx

Age <20>50

Fever (night sweats)

IVDU

Steroid use

Hx of cancer

Back pain at night

294
Q

Monteggia fracture/ Galeazzi fracture?

A

Monteggia Ulnar (Manchester United), Galeazzi radius (Glasgow Rangers)

Fractures of proximal ulnar/radius wih an associated dislocation of the proximal radioulnar joint (Manchester), distal radioulnar joint (Glasgow)

Galeazzi distal- Glasgow further away than Manchester- Monteggia proximal

295
Q

Pre renal uraemia vs acute tubular necrosis?

A

Check diagram on passmed

296
Q

Straight leg raise pain cause?

A

Sciatic nerve pain

297
Q

Abdominal pain and neurological signs condition to consider?

A

Lead poisoning

Features
abdominal pain
peripheral neuropathy (mainly motor)
neuropsychiatric features
fatigue
constipation
blue lines on gum margin (only 20% of adult patients, very rare in children)

298
Q

Antibiotic of choice for neutropenic sepsis?

A

Piperacillin with tazobactam (Tazocin)

299
Q

What can cause thrombotic crises in sickle cell?

A

Precipitated by infection, dehydration or deoxygenation

300
Q

Post menopausal women taking high dose steroids?

A

Steroids over 7.5 or equivalent for the next 3 months

Need bisphosphonates/ calcium/vit D- don’t wait for the results of a DEXA scan

301
Q

Most common causative organism for neuropenic sepsis?

A

Staph epidermidis- associated with central line infections

302
Q

Normal blood result in PMR?

A

Creatine kinase is normal

303
Q

ADPKD treatment?

A

Tolvaptan

304
Q

Constipation management overview?

A

1st- Bulk forming- Isphaghula Husk
2nd line- hard stools- osmotic- macrogol
2nd line- soft stools with tenesmus- stimulant= senna

Opioid induced- osmotic- macrogol + stimulant- senna

Faecal impaction- high dose macrogol +/- disimpaction/ enema/ suppositry

305
Q

Best test to diagnose Addison’s disease?

A

Short synacthen test

306
Q

Trousseau’s sign?

A

Carpal spasm on inflation of BP cuff to pressure above systolic

Hypocalcaemia causes it

307
Q

Coeliac disease which vaccine every 5 years?

A

Pneumococcal due to hyposplenism

308
Q

Cotard syndrome?

A

Person thinking they are dead or non-existent

309
Q

Treatment for threatworm?

A

Mebendazole

Me got bendy worm in my azole

310
Q

Schneider’s first rank symptoms?

A

Auditory hallucinations of a specific type:
two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient’s behaviour

Thought disorders
thought insertion
thought withdrawal
thought broadcasting

Passivity phenomena:
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others

Delusional perceptions
a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.

311
Q

Platelets transfusion problem?

A

Stored at room temperature- if given can introduce infection as more risk of bacterial contamination

312
Q

Common cause of reactive thrombocytosis?

A

Iron deficiency anaemia- results in high platelets in IDA. Also bleeding, hyposplenism (can happen in coeliac), infections and malignancies

Also, potential for low retuculocytes

313
Q

Key random investigation for IDA?

A

Anti-transglutaminase antibodies- rule out coeliac

314
Q

Abdominal pain + Neurological signs?

A

Consider lead poisoning

Also consider acute intermittent porphyria

315
Q

DKA treatment?

A

FIGPICK

F- Fluids
I- Insulin
G- Glucose
P- Potassium
I- Infection
C- Chart fluid balance
K- Ketones

316
Q

In hyperparathyroidism PTH result?

A

In primary hyperparathyroidism the PTH level can be inappropriately normal as apposed to raised when a high calcium is also taken into account

317
Q

Management of diabetic neuropathy?

A

First line- amitriptyline, duloxetine, gabapentin or pregabalin

Tramadol can be used as a rescue therapy for exacebations

Pain management clinics useful for patients with resistant problems

318
Q

Differentiate between the different causes of Cushing’s disease?

A

On the high dose test-

If it is low ACTH low Cortisol- Cushings disease from pituitary- pituitary even though tumour retains some negative deefback

if it is low ACTH high cortisol- cushing’s syndrome- adrenal adenomas

if it is high ACTH high cortisol- ectopic ACTH syndrome

319
Q

Hashimoto’s thyroiditis?

A

Hypothyroidism + Goitre + anti-TPO

320
Q

Test use to identify pheochromocytoma?

A

24-hour urinary metanephrine

321
Q

What to do if scaphoid fracture suspected and initial imaging inconclusive?

A

Arrange further imaging for 7-10 days time as scaphoid fracture can take time to show up radiologically

322
Q

Normal anion gap vs raised anion gap conditions?

A

Normal anion gap (hyperchloraemic metabolic acidosis):
- GI bicarbonate loss- prolonged diarrhoea (can cause hypokalaemia as well), fistula
- Renal tubular acidosis
-Drugs- acetazolamide
- Ammonium chloride injection
-Addison’s disease

Raised anion gap:
- Lactate- shock, sepsis, hypoxia
- Ketones- DKA, alcohol
- Urate- renal failure
- Acid poisoning- salicylates, methanol

323
Q

What metabolic disturbance is renal tubular acidosis associated with?

A

Hyperchloraemic metabolic acidosis (normal anion gap)

Type 1 RTA- inability to generate acid urine (secrete H+) in distal tubule- causes hypokalaemia

type 2 RTA- ecreaed HCO3- reabsorption on proximal tubule- causes hypokalaemia

RTA 3- very rare

RTA 4 (hyperkalaemic)- reduction in aldosterone leads to a reduction in proximal tubular ammonium excretion- hyperkalaemia

324
Q

Age range for toxic multinodular goitre?

A

Older women over 50, on the back of a long standing goitre, develops gradally

325
Q

Amiodarone therapy and thyroid?

A

Causes hyperthyroidism

326
Q

Gastroparesis diabetes complication?

A

Bloating, early satiety, chronic nausea, vomiting

Caused by poor glucose control leading to autonomic neuropathy

Leads to erratic blood glucose control due to slow emptying of the stomach

Management options- metocopramide, domperidone or erythromycin

327
Q

Two drugs particularly linked with ED?

A

SSRIs, beta-blockers

328
Q

When to refer to endocrinology with ED?

A

If testosterone low and

one of FSH, LH or prolactin levels are also abnormal

Check testosterone levels in all men presenting with ED

329
Q

Proctitis?

A

Rectal inflammation particularly seen after radiotherapy for prostate cancer

Similar to symptoms of UC, bloody diarrhoea, tenesmus, painful diarrhoea

330
Q

Difference between primary and secondary hyperparathyroidism?

A

Primary- solitary adenoma prodrucing too much PTH leading to icnreased calcium, decreased phosphate and elevated PTH

Secondary- Parathyroid gland hyperplasia (must often with a background of chronic renal failure). The kidneys cannot get rif of the phosphate and fail to activate vit D meaning less calcium absorption and low calcium meaning PTH is raised as calcium is low and phosphate is high because it cannot be excreted

331
Q

Lab results for osteomalacia?

A

Calcium- decreased
phosphate- decreased
ALP-increased
PTH- increased

In primary hyperparathyroidism, CKD (secondary hyperparathyroidism)- ALP increased and PTH increased

Paget’s only ALP increased

332
Q

What is osteomalacia in children?

A

Rickets

Caused by low vit D levels

Or CKD/drug induced/liver disease

333
Q

Antiphospholipid syndrome?

A

Characterised by a predisposition to both venous and arterial thromboses, recurrent fetal loss and thrombocytopenia

Linked wiht SLE

Causes a paradoxical rise in APTT

Investigations- antibodies- anticardiolipin, anti-beta2 glycoprotein, lupus anticoagulant
Thrombocytopenia
Prolonged APTT

Management-
Primary thromboprohylaxis- low dose aspirin

Secodary- intial VTE events- lifelong warfarin with target of 2-3

334
Q

Tumour lysis syndrome electroytes?

A

High potassium, high phosphate, low calcium

Suspect in any patient presenting with an AKI in the presence of a high phosphate and high uric acid level

335
Q

Preventative drugs for tumour lysis syndrome?

A

Allopurinol/ Rasburicase

Do not give together

Give IV fluids as well

336
Q

What must you look for along with TTG antibodies when investigating coeliac disease?

A

Total IgA- check for IgA deficiency

Also perform an endoscpic intestinal biospy-
Findings supportive of coeliac-
Villious atrophy
Crypt hyperplasia
Increase in intraepithelial lymphocytes
Lamina propria infiltration with lymphocytes

337
Q

CXR finding in aortic dissection?

A

Widened mediastinum

338
Q

Is a third heart sound normal under 30?

A

Yes

HOCM- 4 letters, 4th heart sound

339
Q

Which condition has a 4th heart sound?

A

HOCM- 4 letters, 4th heart sound

340
Q

POP how late can pill be?

A

Most are a 3 hour window

Cerazette/Cerelle (desogestrel containing) are 12 hours

341
Q

Paeds resus fluids?

A

10ml/kg over less than 10 minutes

342
Q

Why is Coomb-positive in aquired haemolytic anaemias?

A

Positive in immune causes

Negative in non immune causes

343
Q

Haemophilia blood test results?

A

Haemophilia A- deficiency in factor VIII
Haemophilia B- deficiency in factor IX

Features: haemoarthroses, haematomas, prolonged bleeding after surgery/trauma

Blood tests- Key-
Prolonged APTT

Bleeding time, thrombin time, prothrombin time a normal

344
Q

Typical findings in hyposplenism?

A

Howell-Jolly bodies
Siderocytes

345
Q

Post splenectomy sepsis reccomendations?

A

Vaccinations- administered 2 weeks before or after splenectomy- pneumococcal, haemophilius type b, meningococcal type C

Antibiotic prophylaxis

Travel- pharmacological and mechanical protection if going to malaria-endemic areas

346
Q

Heparin-induced thrombocytopenia (HIT)?

A

Immune mediated- antibodies form against complexes of platelet factor 4 (PF4) and heparin

Develops 5-10 days after treatment

Low platelets

Despite low platelets, it is a prothrombotic condition- DVT etc can be a sign

347
Q

What does heparin act on?

A

All heparins generally act by activating atithrombin III

Unfractionated heparin forms a complex which inhibits thrombin and factors Xa, IXa, XIa and XIIa. LMWH however only increases the action of antithrombin II on factor Xa

348
Q

What is the mechanism of action of aspirin for the antiplatelet effect?

A

Inhibits the production of thromboane A2

349
Q

Difference between dabigatran and other DOACs?

A

Dabigatran a direct thrombin (Factor IIa) inhibitor

Other DOACs- direct factor Xa inhibitors- rivaroxaban, apixaban and edoxaban

Dabigatran reversal- idarucizumab

Other DOACs- andexanet alfa

350
Q

Reversal agents for anticoagulants?

A

Dabigatran-> idarucizumab

Factor Xa (rivaroxaban)-> Andexanet alfa

Heparins-> Protamine sulphate

Warfarin -> Vit K

351
Q

Neutropenia causes?

A

Viral- HIV, EBV, Hepatitis

Drugs- cytotoxics, carbimaxole, cozapine

benign ethnic neutropaenia
common in people of black African and Afro-Caribbean ethnicity
requires no treatment
haematological malignancy
myelodysplastic malignancies
aplastic anemia
rheumatological conditions
systemic lupus erythematosus: mechanisms include circulating antineutrophil antibodies
rheumatoid arthritis: e.g. hypersplenism as in Felty’s syndrome
severe sepsis
haemodialysis

352
Q

In addition to repeated transfusions, which other therapy is important in beta thalassaemia-major?

A

Iron chelation therapy- desferrioxamine

The repeat transfusions cause iron overload

353
Q

What is first line treatment for warm autoimmune haemolytic anaemia?

A

Steroids +/- rituximab

354
Q

Warm vs cold autoimmune haemolytic anaemia?

A

Cold weather is MMMiserable= cold AIHA -> IgM + caused by mycoplasma or infectious mononucleosis

Warm wrather is Great= warm AIHI -> IgG + caused by CLL or SLE

355
Q

Difference between aplastic crises and sequestration crises in sickle cell anaemia?

A

Aplastic- infection with parvovirus- sudden fall in haemoglobin
Reduced reticulocyte count due to bone marrow suppression

Sequestration crises- sickling within organs such as spleen causes a pooling of blood and worsening of anaemia
Associated with an increased reticulocyte count

356
Q

Urine output AKI?

A

<0.5ml/kg/hour for 6 consecutive hours

357
Q

At what level of hyperkalaemia do you give treatment straight away?

A

≥6.5 mmol/L (severe) or symptomatic

If below that and asymptomatic do an ECG

Peaked/tall tented T waves
Loss of P waves
Broad QRS complexes
Sinusoidal pattern

358
Q

What is BP target for diabetes and CKD?

A

Less than 130/80

ACEi is the medication of choice

359
Q

Copper coil and PID?

A

Contraindicated

360
Q

Strange ACEi side effect?

A

Rare- angiodema

Tongue and facial swelling

Can occur anytime after starting treatment- potentially weeks-months

361
Q

ACEi side effects?

A

A- Angiodema
C- Cough
E- Elevated potassium

i- First dose hypertension

U+E checked before treatment started and after increasing the dose
Acceptable is a rise in creatinine 30% and increase in potassium to 5.5

362
Q

ACEi contraindictions/cautions?

A

Pregnancy and breastfeeding- avoid
Renovascular diseae- may result in renal impairment
Aortic stenosis- may result in hypotension

363
Q

Depth of malignant melanoma scoring system name?

A

Breslow depth

364
Q

Treatment for venous ulcer?

A

Compression bandaging

365
Q

Allergen testing?

A

If it goes in you, do a prick test

If it goes on you, do a patch test

366
Q

How does a tension pneumothorax cause cardiac arrest?

A

Cardiac outflow obstruction

367
Q

Cause of epiglottitis?

A

H.Influenzae type B

368
Q

Triad for RCC?

A

Haematuria
Loin pain
Abdo mass

369
Q

Atypical UTI features (children)

A

Seriously ill

Poor urine flow

Abdominal or bladder mass

Raised creatinine

Septicaemia

Failure to respond to antibiotics within 48 hours

Infection with non-e.coli organisms

370
Q

When do women get their doses of anti-D?

A

28 and 34 weeks

371
Q

Four A’s of extra skeletal features in ankylosing spondylitis?

A

Anterior uveitis
Amyloidosis
Apical lung fibrosis
Aortitits/ aortic valve insufficiency

372
Q

Best X-ray for ankylosing spondylitis?

A

Pelvic x-ray to identify sacro-ilitis

373
Q

Psoriatic arthritis?

A

Pencil and cup, plantar spur- both begin with P

Nail changes- pitting, onycholysis, soft tissue inflammation

374
Q

Rosacea treatment?

A

Simple measure- high factor sunscreen

Predominant erythema/flushing limited telangiectasia- topical brimonidine

Mild to moderate papules/pustules- topical ivermectin

Moderate to severe papules/pustules- topical ivermectin + oral doxycycline

Refer if symptoms not improved with primary care management- laser therapy may be appropriate for patient with telangiectasia

Patients with a rhinophyma

375
Q

Topical steroids?

A

Mild- hydrocortisone

Moderate- Eumovate (clobetasone butyrate 0.05%)

Potent- Betnovate (betamethasone valerate 0.1%)

Very potent- Dermovate (Clobetasol propionate 0.05%)

Helps- hydrocortisone

Every- Eumovate

Budding- Betnovate

Dermatologist- Dermovate

376
Q

Adverse effects topical steroids?

A

Skin thinning

Hypopigmentation

Excessive hair growth

377
Q

Retinoid treatment contraindication?

A

Retinoid therapy

378
Q

Erythema nodosum causes?

A

NO DOSUM

NO- Idiopathic

D- Drugs (penicillin, sulphonamides)
O- Oral contraceptive/pregnancy
S- Sarcoidosis/TB
U- Ulcerative colitis/Crohn’s/ Behcet’s
M- Microbiology (streptococcus, mycoplasma, EBV etc)

379
Q

Urticaria treatment?

A

1st- on-sedating antihistamines (loratidine or cetirizine)

2nd- sedating, can be considered for night-time use if trouble sleeping- chlorphenamine

If severe or resistant- prednisolone

380
Q

Acanthosis nigricans causes?

A

Mainly caused by insulin resistance/hyperinsulinemia

T2DM
GI cancer
Obesity
PCOS
Acromegaly
Cushing’s disease
Hpothyroidism
Familial
Prader-Willi syndrome
Drugs- COCP, nicotinic acid

381
Q

What would you find in a peripheral blood film of myeloma?

A

Rouleaux formation

382
Q

Difference between aplastic crisis and sequestration crisis in SCA?

A

Aplastic crisis- reduced reticulocytes- often precipitated by exposure to parvovirus B19

Sequestration crisis- increased reticulocytes

383
Q

CLL transforms to what?

A

Non-hodgkin’s lymphoma- Richter’s transformation

384
Q

Beta-thalassemia major features?

A

Presents in first year of life with failure to thrive and hepatosplenomegaly

Microcytic anaemia

HbA2 & HbF raised

HbA absent

Treatment- repeated transfusion that can ead to iron overload- use iron chelation- desferrioxamine

385
Q

Dabigatran reveral agent?

A

Idarucizumab

386
Q

IgA blood transfusion reactions?

A

Think anaphylaxis

Low IgA

387
Q

Erythema nodosum causes?

A

NODOSUM

Normal (idiopathic)
Oncology
Drugs
Oral Contraceptives
Sarcoidosis
Ulcerative colitis/Crohns
Microbiology - Tb, Viral, Bacterial, Fungal

+Pregnancy

388
Q

In which type of patient does TACO usually present?

A

On a background of heart failure -> causes fluid overload -> give loop diuretics

There will be a high BP

389
Q

Difference in treatment for scalp psoriasis vs normal psoriasis?

A

Scalp psoriasis- 1st line is potent topical steroid only

If no improvement after 4 weeks then either use a different formulation of the potent corticosteroid (shampoo/mousse)

390
Q

Burkitt’s lymphoma genetic changes?

A

C-myc gene translocation

EBV heavily associated

391
Q

Triad for reactive arhritis?

A

Urethritis, conjunctivitis, arthritis- mainly large joints

Following an initial infection- typically develops after 4 weeks with symptoms lasting 4-6 months

392
Q

Foot sign for reactive arthritis?

A

Keratoderma blenorrhagica- waxy yellow/brown papules on palms and soles

393
Q

Pontine haemorrhage?

A

Pin point pupils point to pons

Pontine haemorrhage?

Peduced GCS
Pinpoint pupils
Paralysis

394
Q

Idiopathic vs drug induced Parkinson’s differentiator?

A

Idiopathic asymmetrical

Drug induced more likely bilateral symptoms

+ history of dopamiergic drugs

395
Q

Parkinson’s triad?

A

Bradykinesia, tremor and rigidity

396
Q

How to differentiate between essential tremor and Parkinson’s disease if difficult?

A

123I-FP-CIT single photon emission computed tomography (SPECT)

397
Q

Drug to improve motor symptoms in Parkinson’s?

A

Levodopa

398
Q

What to do if a Parkinson’s patient cannot take levodopa orally?

A

Prescribe a dopamine agonist patch as a rescue medication to prevent acute dystonia

399
Q

Bacterial white cell appearance on LP in meningitis?

A

Polymorphs- also cloudy, low glucose (less than 0.5plasma) and high protein white cells 10-5000

400
Q

Which antiemetic is more likely to cause extrapyramidal side effects?

A

Metoclopramide

401
Q

Why are bibasal crackles more common in left sided heart failure than right sided heart failure?

A

Left sided- backs up into lungs

Right sided backs up into liver area and body- raised JVP, ankle oedema and hepatomegaly

402
Q

What differentiate acne rosacea from seborrhoeic dermatitis?

A

In SD the nasolabial folds are involved, they are not in rosaccea

403
Q

Treatment for seborrhoeic dermatitis?

A

Ketonazole

404
Q

What is present in about 80-90% of patients with psoriatic arthropathy?

A

Nail changes- also in psoriasis

Pitting
Onycholysis
Subungual hyperkeratosis
Loss of the nail

405
Q

What is HHS characteristed by?

A
  1. Severe hyperglycaemia
  2. Dehydration/ renal faiilure
  3. Mild/absent ketonuria

Can remember as:

HHS
Hypovolaemia
Hyperglycaemis
Significantly raised serum osmolality
Absence of ketoacidosis

Patients at risk of VTE- give prophylaxis- vascular complications due to hyperviscosity

406
Q

Causes of cranial DI?

A

Idiopathic

Post head injury

Pituitary surgery

Craniopharyngiomas

Haemochromatosis

Causes of nephrogenic:
Genetic
Electrolytes
Lithium

407
Q

Treatment for vestibular neuronitis?

A

Buccal/ IM prochlorperazine if severe

Short course of prochorperazine, or an antihistamine may alleviate less severe cases

Vestibular rehabilitation exercises are preffered for patients who experience chronic symptoms

408
Q

When should urine culture be sent in UTI?

A

Women aged over 65 years

Recurrent UTI (2 episodes in 6 months or 3 in 12 months)

Pregnant women

Men

Visible or non-visible haematuria

409
Q

Palliative care treatment for acute agitation/ confusion/ delirium/ hallucinations?

A

Oral haloperidol

410
Q

Infectious mononucleosis triad?

A

Fever, sore throat, lymphadenopathy

Other features include:
malaise, anorexia, headache
palatal petechiae
splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
hepatitis, transient rise in ALT
lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
haemolytic anaemia secondary to cold agglutins (IgM)
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

Avoid playing contact sports for 4 weeks after having gladnular fever to reduce the risk of splenic rupture

411
Q

Investigation for pulsatile tinnitus?

A

Magnetic resonance angiography (MRA)

412
Q

Antivirals for influenza?

A

1st- Oseltamivir
2nd- Zanamivir

Indications:
> 65 years old
pregnant women
chronic disease of respiratory, cardiac, renal, hepatic or neurological nature
diabetes
immunosuppression
morbid obesity

413
Q

Diagnostic manouvre for BPPV?

A

Dix-Hallpike- provokees a rotatry nystagmus

414
Q

Erythromycin vs clarythromycin in pregnancy?

A

Erythromycin is safe

Clarythromycin is contraindicated

415
Q

Managment of cellulitis?

A

Eron Class I-
1st- flucloxacillin
Penicillin allergic- clarithromycin, erythromycin in pregnancy

Eron class III-IV-
Admit
Oral/IV co-amoxiclav

416
Q

Proper name for hayfever?

A

Allergic rhinitis

417
Q

Grittiness in eye/ bits in eye?

A

Blepharitis

Symptom usually bilateral

418
Q

Drugs that make psoriasis worse?

A

BLANQ-
Beta blocker
Lithium
Alcohol
NSAIDs
Quinines

419
Q

How does herpes simplex keratitis commonly present?

A

A dendritic corneal ulcer

Red, painful eye
Photophobia
Epiphora
Visual acuity decrease

Immediate referral to an opthalmologist
Topical aciclovir

420
Q

What is keratitis?

A

Inflammation of the cornea

421
Q

What are adapalene and tretinoin?

A

Retinoids

Contraindicated in pregnancy

422
Q

Distribution for hand, foot and mouth?

A

Hands, feet, mouth and buttocks

423
Q

Viruses that causes hand, foot and mouth disease?

A

Coxsackie A16 and Enterovirus 71

Mild systemic upset- fever, sore throat
Oral ulcers
Later followed by vesicles on the palms and soles of the feet

424
Q

Treatment for IIH?

A

Weight loss- potentially add on drugs to help

Acetazolamide

Topiramate

425
Q

Presenting features of cystic fibrosis?

A

Neonatal period: meconium ileus, prolonged jaundice
Recurrent chest infections
Malabsorption: steatorrhoea, failure to thrive
Liver disease

Other features:
Short stature
Diabetes mellitus
Delayed puberty
Rectal prolapse
Nasal polyps
Male infertility, female subfertility

426
Q

What do CF patient’s lungs get colonised with?

A

Burkholderia cepacia- it is a CI to lung transplantation in CF patients

427
Q

Drug treatment for CF?

A

Lumacaftor/ Ivacaftor

428
Q

Most common complication post ERCP?

A

Pancreatitis

429
Q

Adrenaline doses?

A

Anaphylaxis- 0.5mg 1:1000

1:10000 for cardiac arrests

430
Q

5 P’s acronym for delirium in the elderly?

A

Pee
Poo
Pus
Pills/poison
Pain

431
Q

Inguinal vs Fermoral hernia?

A

In relation to the pubic tubercle:

MILF- Medial inguinal, lateral femoral

432
Q

Side effects of heparins?

A

Bleeding
Thrombocytopenia- heparin induced thrombocytopenia is a prothrombotic condition so requires anticoagulation
Osteoporosis and increased fracture risk
Hyperkalaemia

433
Q

Reversal of heparin?

A

Protamine sulphate

434
Q

Management of renal stones?

A

Renal stoenes
Watchful waiting if <5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20mm shockwavev lithotripsy or ureteroscopy
>20mm percutaneous nephrolithotomy

Uretic stones
Shockwave lithotripsy +/- alpha blockers
10-20mm ureteroscopy

435
Q

When oral vancomycin and IV metronidazole in C.diff?

A

Only if life threatening-
Hypotension
Massive systemic upset
Paritial or complete ileus
Toxic megacolon

Oral vancomycin 1st
Oral fidaxomicin 2nd
Thirs- Vanc+met

436
Q

Features of clostridium difficle?

A

Diarrhoea
Abdo pain
Raised WCC is characteristic
If severe- toxic megacolon

437
Q

Small Cell Lung Cancer paraneoplastic syndromes?

A

S- SiADH
C- Cushing’s syndrome
L- Lambert-Eaton syndrome
C- Cerebellar syndrome

438
Q

Lung cancer + Gynae?

A

Adenocarcinoma

439
Q

What does the pneumococcal vaccine prevent?

A

Streptococcus pneumoniae- due to the risk of hyposplenism

440
Q

Upper or lower lobe fibrosis?

A

Upper lobe- Coal miners pneumoconiosis, sarcoidosis, silicosis, TB, Ank Spon

Lower lobe- Asbestosis, rheumatoid, idiopathic pulmonary fibrosis

441
Q

CT head showing temporal lobe changes?

A

Think herpes simplex encephalitis

442
Q

Which circulation should be occluded for thrombectomy to be appropriate?

A

The proximal anterior circulation

Also proximal posterior circulation- but consider instead of offer

443
Q

Extrapyramidal side effects treatments?

A

Tardive dyskinesia- Tetrabenazine
Akathesia- propanalol
Acute dystonia- procyclidine

444
Q

Which extrapyramidal side effect comes on after being on antipsychotics for a while?

A

Tardive dyskinesia- involuntary movements- chewing and pouting of the jaw, sticking tongue out

Treat with tetrabenazine

445
Q

Stepping down asthma treatment?

A

Aim for a 25-50% reduction in the dose of inhaled corticosteroid

446
Q

Which are the rate limiting CCBs for use in angina?

A

Verapamil, Diltiazem- use these if doing a CCB monotherapy

If used in combination with a BB then use a longer-acting dihydropyridine CCB- amlodipine/modified release nifedipine

No BB+verpamil for risk of complete heart block

447
Q

What to do about adding third drugs in angina?

A

Add the nitrate stuff if on monotherapy and can’t tolerate a CCB/BB

Only add it as the third drug if waiting for an assessment for PCI or CABG

448
Q

Investigation for thyroid lumps?

A

Initial investigation- TSH + USS

If TSH normal/elevated -> consider fine needle aspiration depending on USS

If TSH low- nuclear medicine scan. Cold nodule -> Consider fine needle aspiration, hot nodule -> treat hyperthyroidism

449
Q

What should be avoided in Lewy body dementia?

A

Neuroleoptics- haloperidol- may cause irreversible parkinsonism

Antisphychotics to be avoided in patients with dementia

HARM drugs should be avoided
H- Haloperidol
A- Antipsychotics
R- pRochlorperazine
M- Metoclopramide

450
Q

How to differentiate between Lewy body dementia and Parkinson’s

A

Cognitive impairment before parkinsonism- lewy body dementia- usually both within a year from each other

Motor symptoms present at least one year before cognitive symptoms- Parkison’s disease

There are characteristic hallucinations in Lewy body dementia

451
Q

Kidney disease + eosinophillia?

A

Acute interstital nephritis

Raised urinary WCC and eosinophils alongside impaired renal function

452
Q

What is xanthochromia?

A

The result of red blood cell breakdown

In diagnosis of SAH, if CT head is done more than 6 hours after onset and normal, do an LP at least 12 hours after symptom onset and look for xanthochromia

RBCs not indicative as can result from a traumatic tap

Normal or raised opening pressure also a sign

453
Q

Most common signs of Sheehan’s syndrome?

A

Lack of postpartum milk production and amenorrhoea following delivery

454
Q

Anorexia features?

A

Most things low

G’s and C’s raised- growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

455
Q

In what demographic is Bell’s palsy more common?

A

Pregnant women

456
Q

Which part of the tongue is affected in Bell’s palsy?

A

Anterior 2/3

457
Q

What gene do you test for in haemochromatosis?

A

HFE mutation

Typical iron profile:
Transferrin saturation- high
Raised ferritin
Low TIBC

Treatment:
Venesection
Desferrioxamine

458
Q

Investigation for varicose veins?

A

Venous duplex ultrasound will demonstrate retrograde venous flow

459
Q

Which childhood disease is associated with febrile convulsions?

A

Roseola infantum- caused by human herpes virus 6 (HHV6)- affecfts children aged 6 months to 2 years

High fever- lasting a few days followed by-
Maculopapular rash
Nagayama spots
Diarrhoea and cough commonly seen

460
Q

Felty’s syndrome?

A

Complication of RA:
SANTA
Splenomegaly
Anaemia
Neutropenia
Thrombocytopenia
Arthritis

Rheumatoid arthritis, Splenomegaly and a low WCC

461
Q

What is paralytic ileus?

A

Inability to pass stool, abdo pain, nausea and vomiting after surgery

462
Q

Differentiator between small bowel obstruction and large bowel obstruction?

A

In small bowel obstruction, significant nausea and vomiting- then constipation

In large bowel obstruction, constipation first then nausea and vomiting occuring later

Small bowel obstruction also associated with an increase in amylase
In acute pancreatitis should be over 3x the normal limit

463
Q

Most common cause of large bowel obstruction?

A

Colorectal cancer- often constitutional symptoms are present such as weihgt loss, night sweats, changes in bowel habits, rectal bleeding

464
Q

Most common cause of small bowel obstruction?

A

Adhesions (following previous surgery), 2nd is hernias

465
Q

Hypercalcaemia management?

A

Rehydration with normal saline
Following rehydration bisphosphonates may be used- take 2-3 days to work

Other options-
calcitonin- quicker effect than bisphosphonates
steroids in sarcoidosis

466
Q

What are the presenting features for cardiac tamponade?

A

Persistent hypotension, raised JVP and tachycardia despite fluid resuscitation

Beck’s triad- hypotension, raised JVP and muffled heart sounds

467
Q

First line treatment for trigeminal neuralgia?

A

Carbamazepine

468
Q

Mechanism of action for fondaparinux?

A

Activates antithrombin III which inhibits factor Xa

469
Q

When to use CPAP vs BiPAP?

A

Type 1 respiratory failure- CPAP
Type 2 respiratory failure- BiPAP

470
Q

Does Hodgkin’s lymphoma cause deragned blood tests?

A

Lymphocytes can be normal

Findings on blood tests:
Eosinophilia
Normocytic anaemia
LDH raised

On lymph node biopsy the presence of Reed-Sternberg cells are diagnostic

Hodgkin lymphom is the one with the classic alcohol pain

471
Q

How to distinguish biliary colic from cholecystitis or cholangitis?

A

There is an absence of deranged LFTs or raised inflammatory markers (CRP)

472
Q

Treatment for biliary colic?

A

Elective laparocopic cholecystectomy

473
Q

Mycoplasma pneumoniae?

A

A cause of atypical pneumonia that typically affects younger patients- associated with characteristic complications of erythema multiforme and cold autoimmune haemolytic anaemia.

Prolonged and gradual onset- flu like symptoms precede a dry cough, bilateral consolidationon x-ray

Complications-
Cold agglutins (IgM)- may cause haemolytic anameia,
Erythema multiforme
Immune mediated neurological disease

Diagnosis- mycoplasma serology
Positive cold agglutination test- peripheral blood smear may show RBC agglutination

Management- doxycycline or a macrolide

474
Q

Legionella pneumophilia?

A

Typically colonises water tanks and hence questions may contain air-conditioning systems or foreign holidays- no person-person transmission

Flu like symptoms including fever
Dry cough
Relative bradycardia
Confusion
Lymphopaenia
Hyponatremia
Deranged LFTs
Pleural effusion

Investigations-
Diagnostic test of choice- urinary antigen

Chest x-ray findings are non specific may include- mid to lower zone predominance of patchy consolidation

Treat with erythromycin/ clarithromycin

475
Q

Standard preparation for pregnancy advice?

A

Folic acid 400 micrograms starting 3 months before conception up to 12 weeks gestation

Those with epilepsy, diabetes, BMI over 30 or a history of NTD require 5mg

476
Q

Pre-eclampsia prevention?

A

Women with 1 or more high risk/ 2 or more moderate risk should takte 75-150mg of aspirin daily from 12 weeks gestation until the birth

477
Q

Associations with pseudogout?

A

Increasing age

Haemochromatosis
Hyparathyroidism
Low magnesium, low phosphate
Acromegaly, Wilson’s disease

478
Q

Tests for SLE?

A

ANA 99%- very sensitive, low specificity

Anti-dsDNA- highly specific, but less sensitive

479
Q

Treatment of choice for SLE?

A

Hydroxychloroquine

480
Q

Cardiac manifestation of SLE?

A

Pericarditis

481
Q

Most likely causes for acute otitis media?

A

Inside of ear lined by similar epithelium to lungs- same bacteria as COPD, bronchectasis and epiglottis

Streptococcus pneumoniae, haemophilius influenzae and moraxella cartarrhalis

482
Q

Main complication of a Colles fracture?

A

Median nerve injury- acute carpal tunnel syndrome presenting with weakness or loss of thumb/index finger flexion

483
Q

Features of a Colles fractures?

A

Fall on outstretched hand

Dorsally displaced distal radius- dinner fork deformity

484
Q

Which condition is Finkelstein’s test positive?

A

De Quervain’s tenosynovitis- examinar pulls thumb of the patient in ulnardeviation longitudinal traction causes pain

485
Q

Prophylaxis of variceal haemorrhage?

A

Propanolol

486
Q

What are patients with perianal fistulae given in Crohn’s?

A

Metronidazole

487
Q

Caseous granuloma vs non-caseating granuloma?

A

Caseous granuloma- TB

Non-caseating granuloma- sarcoidosis

488
Q

Tuberculosis investigations?

A

CXR- upper lobe cavitation classical finding of reactivated
bilateral hilar lymphadenopathy

Sputum smear- 3 specimens needed- rapid/inexpensive- all mycobacteria will stain positive Ziehl-Neelsen- sensitiveity decresed from 50-80 to 20-30 in those with HIV

Sputum culture- gold standard- more sensitive than a sputum smear can assess drug sensitivities

489
Q

Diagnosis of latent TB?

A

Positive tuberculin skin test or Interferon-Gamma release assay (IGRA) combined with a normal chest c-ray

2 choices for treating latent TB:
3 months of isoniazid (with pyridoxine) and rifampicin
6 months of isoniazid (with pyridoxine)

490
Q

Tuburculosis management?

A

Initial phase- first 2 months (RIPE)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Continuation phase- next 4 months
Rifampicin
Isoniazid

Meningeal tuberculosis- prolonged to at least 12 months with the addition of steroids

491
Q

Adverse effects TB drugs?

A

Rifampicin-
potent liver enzyme inducer
hepatitis, orange secretions
flu-like symptoms

Isoniazid-
peripheral neuropathy- prevent with Vit B6
Hepatitis, agranulocytosis
Liver enzyme inhibitior

Pyrazinamide-
Hyperuricaemia causing gout
Arthralgia, myalgia
Hepatitis

Ethambutol
Optic neuritis- check visual acuity before starting treatment

492
Q

Name for vitamin B6?

A

Pyridoxine

493
Q

What is malaria caused by?

A

Different types of plasmodium protozoa- spread by the female Anopheles mosquito:

Plasmodium falciparum- nearly all severe cases of malaria
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

494
Q

Clinical features of falciparum malaria?

A

Paroxysms of fever, chills and sweating- symptoms occur every 48 hours corresponding to the erythrocyctic cycle of the plasmodium falciparum

Fever- cyclical, sweating, rigors
GI- anorexia, nausea, vomiting
Resp- cough, mild tachy
MSK- body aches and pains
Neuro- headache
Cardio- tachy
Haem- thrombocytopenia

Shizonts on a blood film

Uncomplicated- artemisinin-based combination therapies
Severe- IV artesunate

495
Q

Non-falciparum malaria treatment?

A

Artemisinin-based combination therapy (ACT) or chloroquine

If given chloroquine- should be followed with primaquine

496
Q

S.aureus pneumonia?

A

Commonly occurs after influenzae type infection

497
Q

SAH investigation?

A

Non-contrast CT- if done within 6 hours of symptom onset and normal- consider an alternative diagnosis- no LP

If done more than 6 hours after symptom onset and is normal- do an LP, do it at least 12 hours following onset of symptoms to allow xanthochromia to develop

498
Q

How to prevent vasospasm in SAH?

A

Oral nimodipine

499
Q

What is the double duct sign seen in?

A

Pancreatic cancer

500
Q

Which CA is associated with pancreatic cancer?

A

CA 19-9

501
Q

ACEi electrolyte disturbance?

A

Hyperkalaemia

502
Q

ACEi side effects?

A

Cough
Angioedema- may occur up to a year after starting treatment
Hyperkalaemia
First dose hypertension- more common in patients taking diuretics

503
Q

Occupational asthma causes?

A

Isocyanates are the most common cause- spray painting

Flour

Serial measurements of peeak expiratory flow are reccomended at work and away from work

504
Q

Which two drugs are highest risk for medication overuse headache?

A

Opioids and triptans

Simple analgesics and triptans should be withdrawn abruptly

Opioid analgesics should be gradually withdrawn

505
Q

Test to distinguish between unilateral adenoma and bilateral hyperplasia (hyperaldrostronism)?

A

Adrenal venous sampling (AVS)

Treatment for bilateral adrenocortical hyperplasia- aldosterone antagonist- spironolactone

506
Q

Gynaecomastia most common drugs?

A

Spironolactone makes you Sexy
Metoclopromide makes you Milky

507
Q

Actinic keratoses treatment?

A

Avoid sun, sun cream

Fluorouracil cream- 2-3 week course

508
Q

Rheumatoid arthritis scoring system for disease activity?

A

DAS28

509
Q

Methotrexate monitoring?

A

FBC and LFTs- due to the risk of myelosuppression and liver cirrhosis
Other side effects- pneumonitis

510
Q

How to manage flare of rheumatoid arthritis?

A

Corticosteroids- oral or intramuscular

511
Q

DMARD examples?

A

Methotrexate

Sulfasalazine

Leflunomide

Hydroxychloroquine

512
Q

Indication for TNF-inhibitors in RA?

A

Inadequate response to at least two DMARDs including methotrexate

Etanercept- can cause demyelination- risks include reactivation of TB

Infliximab

513
Q

X-ray A-E approach

A

Lines/Devices

ABCDE-
Airway
Breathing spaces (lungs)
Diaphragm
Evil areas (ABCDE again)-
(apices
bones/tissue
cardiac-look behind it
Devices/below diaphragm
Everything - take the whole image in again)

514
Q

Two main fractures associated with compartment syndrome?

A

Supracondylar fractures and tibial shaft injuries

515
Q

How often is methotrexate taken?

A

Weekly

516
Q

What should be co-prescribed with methotrexate?

A

Folic acid 5mg once weekly taken more than 24 hours after methotrexate dose

517
Q

Methotrexate interactions?

A

Trimethoprim
Co-trimoxazole

High dose aspirin

518
Q

Methotrexate toxicity treatment?

A

Folinic acid

519
Q

NYHA heart failure classification?

A

Stage I - No limitation on ordinary physical activity
Stage II - Normal at rest. Ordinary physical activity causes breathlessness
Stage III - Normal at rest. Less-than-ordinary activity causes breathlessness
Stage IV - Symptoms at rest

520
Q

Cure for aspirin overdose

A

IV sodium bicarbonate if big overdose and requiring alkalinisation

If recent give activated charcoal

521
Q

Aspirin overdose presentation?

A

Nausea, vomiting, tinnitus and headache

522
Q

Way to remember reflex routes?

A

C5+C6 I grab some sticks (biceps reflex),
C7+C8 I lay them straight (triceps reflex)
L3+L4 I kick the door (knee jerk reflex),
S1+S2 I tie my shoe (ankle reflex),

523
Q

C3, 4, 5

A

Keeps the diaphragm alive

524
Q

S2, 3, 4

A

Keeps shit off the floor

525
Q

Nerve responsible for the ankle reflex?

A

S1, 2

526
Q

Rosacea with predominant erythema/flushing treatment?

A

Topical brimonidine gel

527
Q

Rosacea with mild/moderate pustules and severe oustules>

A

Mild to moderate- topical ivermectin

Moderate to severe- topical ivermectin + oral doxycycline

528
Q

Hepatitis B serology?

A

HBs antigen (HBsAg)- have you got it now

HBs- are you immune

HBc- have you had it before (negative if immunised)

529
Q

How to see if someone is a retainer (hypoxic drive in COPD)?

A

Raised bicarbonate

530
Q

ROME for blood gas interpretation?

A

Respiratory = Opposite
low pH + high PaCO2 i.e. acidosis, or
high pH + low PaCO2 i.e. alkalosis

Metabolic = Equal
low pH + low bicarbonate i.e. acidosis, or
high pH + high bicarbonate i.e. akalosis

531
Q

How is legionella pneumophillia best diagnosed?

A

Urinary antigen test

Wee-gionella

Treat with erythromycin/ clarithromycin

532
Q

How does sigmoid volvulus present?

A

Constipation
Abdominal bloating
Abdominal pain
N+V

Diangosed on abdo film- sigmoid volvulus- coffee bean sign

533
Q

Sigmoid volvulus management?

A

Rigid sigmoidoscopy with rectal tube insertion

534
Q

Refferal criteria for N+V in pregnancy?

A

Continued N+V and unable to keep down liquids or oral antiemetics

Continued N+V with ketonuria and/or weight loss (greater than 5% body weight despite treatment with oral antiemetics

Confirmed or suspected comorbidity

535
Q

Diagnosis of hyperemesis gravidarum?

A

5% pre-pregnancy weight loss

Dehydration

Electrolyte imbalance

536
Q

Why can metocopramide/domperidone not be used for more than 5 days in hyperemesis gravidarum?

A

Risk of extrapyramidal side effects

537
Q

Antinatal testing- Down’s, Edward’s, Patau

A

Stuff that goes up in Down’s- HIT- hCG, Inhibin A, Translucency

If low hCG then it is Edwards or Patau

PIES- Pataus increase, Edward’s decrease

538
Q

Which type of pneumonia is associated with Guillain-Barre and other immune-mediated neurological diseases?

A

Mycoplasma pneumoniae

539
Q

Some important interactions to know?

A

Adverse effects of CCBs- ankle swelling

Quinolones- eg ciprofloxacin- risk of tendon rupture- further increased if also using steroids

Quinolones prolong the QT interval/ reduce seizure threshold

540
Q

Influenze before pneumonia- pneumonia causative organism?

A

S.Aureus

541
Q

Adverse effects of alpha 1 antagonists?

A

Tamsulosin, alfuzosin

Dizziness, postural hypotension, dry mouth, depression

542
Q

Which drugs increase the risk of idiopathic intracranial hypertension?

A

COCP

Steroids

Tetracyclines

Retinoids (iso/tretinoin)/ Vit A

Lithium

543
Q

Centor/FeverPain criteria?

A

The Centor criteria are: score 1 point for each (maximum score of 4)
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

The FeverPAIN criteria are: score 1 point for each (maximum score of 5)
Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza

544
Q

Treatment for tonsillitis?

A

If antibiotics are indicated then either phenoxymethylpenicillin or clarithromycin (if the patient is penicillin-allergic) should be given

545
Q

ACE inhibitors in CKD indication?

A

They should be used first-line in patients with coexistent hypertension and CKD, if the ACR is > 30 mg/mmol

If the ACR > 70 mg/mmol they are indicated regardless of the patient’s blood pressure

546
Q

Important marker for CKD?

A

Albumin:creatinine ratio (ACR)

547
Q

Paget’s disease of the bone presentation?

A

Bone pain + isolated raise in ALP

First line treatment- oral bisphosphonates

Skull, spine/pelvis and long bones of the lower extremities most commonly affected

Bowing of tibia, bossing of skull

548
Q

When to perform an immediate electrical cardioversion in AF?

A

In unstable, decompensated cases of AF

549
Q

What is given at the same time as amiodarone for cardioversion?

A

Heparin

550
Q

Salter-Harris classification memory aid?

A

SALTEr

Type 1- S- Straight
2- A- Above
3- L- Lower
4- T- Through (above and below)
5- Er- Everything (Crush)

551
Q

DVLA and diabetes driving?

A

Notify the DVLA if using insulin- can potentially still drive

If on tablets that may induce hypo + one or more episodes of hypo in previous 12 months- notify the DVLA

If on insulin, no more than one hypo for cat 1 (cars), no hypos at all for cat 2 (lorries)

552
Q

CA for breast?

A

CA15-3

CA19-9 for pancratic cancer

553
Q

Testicular cancer tumour markers?

A

Seminomas- hCG

Non-seminomas- AFP and/or beta-hCG

554
Q

Extrapyramidal side effects treatments?

A

Akathisia- propanolol
Acute dystonia- procyclidine
Tardive dyskinesia- tetrabenezine
NMS- dantrolene, bromocriptine
SS- cyprohepatadine

555
Q

Investigations for aortic dissection?

A

CT angiography of chest, abdomen and pelvis- a false lumen is a key finding

CXR- widened mediastinum

Transoesophageal echocardiography (TOE)- more suitable for unstable patients too risky for the CT scanner

556
Q

Placental abruption management?

A

Fetus alive and < 36 weeks
fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

Fetus alive and > 36 weeks
fetal distress: immediate caesarean
no fetal distress: deliver vaginally

Fetus dead
induce vaginal delivery

557
Q

SAH associated cardiac problem?

A

Torsades de pointes- long QT interval- polymorphic ventricular tachycardia

558
Q

When to use contrast in CT?

A

If needed quick- non contrast- stroke
If detailed info -contrast

Contrast paticularly for blood suppy- cancers etc

If what you are trying to visualise has no blood supply- more likely to be non-contrast

559
Q

How long to continue SSRIs after resolution of symptoms?

A

Depression- 6 months

OCD- 12 months

560
Q

SSRI contraindications?

A

NSAIDs
Warfarin/heparin
Aspirin
Triptans- increased risk of serotonin syndrome
MAOIs- increased risk of serotonin syndrome

561
Q

How much glucose to prescribe with fluids?

A

50-100g per day

562
Q

Does hypercalcaemia cause polyuria and polydipsia?

A

Yes- can be due to diabetes insipidus

563
Q

Pain and rash?

A

?shingles

564
Q

Shingles treatment?

A

Infectious until vesicles have crusted over- avoid pregnant women and the immunosuppressed

Analgesia- paracetamil and NSAIDs
Oral corticosteroids may be considered in immunocompetent adults with localized shingles if the pain is severe and not responding to above

Antivirals within 72 hours for majority of patients unless <50 with mild rash

Antivirals reduce the incidence of post-herpetic neuralgia

565
Q

Reasons to delay a lumbar puncture in suspected meningitis?

A

Signs of severe sepsis or a rapidly evolving rash

Severe respiratory/cardiac compromise

Significant bleeding risk

Signs of raised intracranial pressure:
focal neurological signs
papilloedema
continuous or uncontrolled seizures
GCS ≤ 12

566
Q

Prostate cancer first line investigation?

A

Multiparametric MRI is the first line now

Results are reported on a 5 point Likert scare- if 3 or more then a multiparametric MRI-influenced prostate biopsy is offered

1-2 discuss pros/cons of having the biopsy

567
Q

Kidney problem with raised eosinophils?

A

Acute interstitial nephritis

568
Q

Most common cause of viral hepatitis in adults?

A

Enteroviruses

569
Q

Contraindications for sildenafil?

A

Nicorandil and nitrates- can cause excessive hypotension

Hypotension

Recent stroke or MI

570
Q

Side effects of sildenafil (PDE5 inhibitors)?

A

Visual disturbances- blue discolouration
Nasal congestion
Flushing
GI side effects
Headache
Priapism

571
Q

First line treatment for opioid detoxification?

A

Methadone or buprenorphine

572
Q

Treatment for proliferative diabetic retinoathy?

A

Panretinal laser photocoagulation- reduction in visual field and decrease in night vision are side effects

Intravitreal VEGF inhbitiors

If severe or vitreous haemorrhage- vitreoretinal surgery

573
Q

Medication of choice for suppressing lactation?

A

Cabergoline

574
Q

Causes of keratitis (inflammation of the cornea)?

A

Bacterial- typically s.aureus, pseudomonas aeruginosa see in contact lens wearers

Fungal

Amoebic-
Acanthamoebic keratitis- incrased incidence if eye exposure to soil or contaminated water

575
Q

Is aspirin an anticoagulant or an antiplatelet?

A

Antiplatelet

576
Q

TIA mimics that require exclusion?

A

Hypoglycaemia

Intracranial haemorrhage- all patients on anticoagulants r with similar risk factors should be admitted for urgent imaging to exclude haemorrhage

577
Q

TIA management?

A

Resolved TIA, awaiting specialist review within 24 hours- aspirin

Reviewed by specialist, initial 21 days when at high risk of further events- aspirin + clopidogrel

Long-term secondary prevention after 21 days- clopidogrel

If patient has AF anicoagulate as soon as intracranial haemorrhage has been excluded

Statins

578
Q

Further investigation in TIA?

A

Atheroslerosis in the carotid may be a source of emboli in some patients- if a patient considered a candidate for carotid intervention they should have carotid imagine performed within 24 hours of assessment- carotid duplex ultrasound or either CT angiography or MR angiography

Carotid endarterectomy is recommended if the patient has suffered a stroke or TIA in the carotid territory and is not severely disabled- should only be considered if the stenosis >50%

579
Q

What is most likely to infect a staghorn calculus of the left kidney?

A

Proteus mirabilis

Protein Stag

580
Q

What is it important to give before replacing potassium?

A

Magnesium if it is low- a lack of magnesium impedes the absorption of potassium

581
Q

Main five symptoms that suggest a more sinister cause for a headache?

A

Vomiting more than once with no other cause
New neurological deficit (motor or sensory)
Reduction in conscious score (GCS score)
Valsalva (associated with coughing or sneezing) or positional changes
Progressive headache with a fever

582
Q

TCA overdose?

A

Early features: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision

Features of severe: arrhythmias, seizures, metabolic acidosis, coma
ECG changes include- sinus tachycardia, widening of QRS, prolongation of QT interval

Management- IV bicarbonate- first line for hypotension or arrythmias

583
Q

Benzodiazepine overdose treatment?

A

Flumazenil
The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil. It is generally only used with severe or iatrogenic overdoses

584
Q

Heparin reveral agent?

A

Protamine sulphate

585
Q

Beta blockers overdose management?

A

If bradycardic- atropine
In resistant cases- glucagon

586
Q

What is ethylene glycol known as?

A

Antifreeze

587
Q

Antifreeze overdose treatment?

A

Ethanol

Fomepizole is now preferred first line to ethanol

588
Q

Carbon dioxide poisoning management?

A

100% oxygen

Hyperbaric oxygen

589
Q

Lead poisoning treatment?

A

Dimercaprol, calcium edetate

590
Q

Iron overdose treatment?

A

Desferrioxamine, a chelating agent

591
Q

Cyanide treatment?

A

Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

592
Q

Treatment for UTI in pregnant women?

A

1st- Nitrofurantoin (should be avoided near term)
2nd- Amoxicillin or cefalexin

7 days of treatment

Trimethoprim should be avoided in pregnancy as it is teratogenic

If asymptomatic treat then a further urine culture should be send as a test of cure

593
Q

Opiates key conversion?

A

Morphine PO to IV- 2:1

Codeine to morphine PO- 10:1

594
Q

Opiate in palliative care for patients with mild-moderate renal impairment?

A

Oxycodone

595
Q

Urticaria treatment?

A

Management
non-sedating antihistamines (e.g. loratadine or cetirizine) are first-line
this should be continued for up to 6 weeks following an episode of acute urticaria
a sedating antihistamine (e.g. chlorphenamine) may be considered for night-time use (in addition to day-time non-sedating antihistamine) for troublesome sleep symptoms
prednisolone is used for severe or resistant episodes

596
Q

Which cancer develops in around 10% of PSC patients?

A

Cholangiocarcinoma

597
Q

Key features of optic neuritis?

A

CRAP

Central scotoma
Relative afferent pupillary defect (RAPD)
Affected colour vision
Painful eye movements

598
Q

Optic neuritis?

A

Causes- MS, diabetes, syphilis

Features:
Unilateral decrease in visual acuity over hours or days
Poor discrimination of colours, red desaturation
Pain worse on eye movement
Relative afferent pupillary defect
Central scotoma

Investigation- MRI brain and orbits with gadolinium contrast

Management- high dose steroids

599
Q

Cyclical fever + systemic upset?

A

Malaria

600
Q

Treatment of malaria?

A

IV Artesunate

601
Q

COCP UKMEC 3?

A

Examples of UKMEC 3 conditions include
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease

602
Q

COCP UKMEC 4?

A

Examples of UKMEC 4 conditions include
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

603
Q

When should a trial of diet and exercise be done for gestational diabetes?

A

If the fasting plasma glucose is <7 mmol/l

6-6.9 with evidence of complications- macrosomia or hydramnios

604
Q

Long term oxygen therapy in COPD?

A

If 2 measurements of pO2 <7.3

605
Q

Pleural effusion transudate vs ecudate memory aid?

A

Way to remember causes of exudate and transudates:
Exudate >30g/L - all the I’s
Infiltration (malignancy)
Ischaemia
Infection

Exudate <30g/L - all the F’s
heart Failure
liver Failure
nePHrotic syndrome

606
Q

Indications for chest drain in pleural infection?

A

If the fluid is purulent or turbid/cloudy a chest tube should be placed to allow drainage

If the fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection a chest tube should be placed

607
Q

Which two blood results are lowered in legionella pneumonia?

A

Lymphopenia

Hyponatremia

608
Q

Diagnostic test for legionella?

A

Urinary antigen

Treat with erythromycin/clarithromycin

609
Q

Trousseau’s sign?

A

Carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic

Seen in patients wit hypocalcaemia

610
Q

Endocarditis causes?

A

S.aureus- now most common cause of infective endocarditis, paticularly common in acute presentation and IVDUs

Streptococcus viridans

Staph epidermidis- indwelling ines and patients following prosthetic valve surgery

611
Q

Markers present in primary biliary cholangitis?

A

IgM

Anti-mitochondrial antibodies

Middle aged females

First line treatment is ursodeoxycholic acid

Pruritus- cholestyramine

612
Q

NICE guidelines for induction of labour- Bishop score?

A

If the Bishop score is ≤ 6

vaginal prostaglandins or oral misoprostol

mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean

If the Bishop score is > 6

amniotomy and an intravenous oxytocin infusion

613
Q

What should all patients with TB be offered?

A

HIV test

614
Q

Stopping of voluntary movement or staying still in an unusual position?

A

Catatonia

615
Q

Schneider’s first rank symptoms?

A

Passivity phenomena

Thought disorders

Delusional perceptions

Auditory hallucination

616
Q

Criteria for diagnosing AKI?

A

Rise in creatinine of 26µmol/L or more in 48 hours OR

> = 50% rise in creatinine over 7 days OR

Fall in urine output to < 0.5ml/kg/hour for more than 6 hours in adults (8 hours in children) OR

> = 25% fall in eGFR in children / young adults in 7 days.

617
Q

Staging criteria for AKI?

A

Stage 1- Increase in creatinine to 1.5-1.9 times baseline, or
Increase in creatinine by ≥26.5 µmol/L, or
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours

Stage 2- Increase in creatinine to 2.0 to 2.9 times baseline, or
Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours

Stage 3- Increase in creatinine to ≥ 3.0 times baseline, or
Increase in creatinine to ≥353.6 µmol/L or
Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or
The initiation of kidney replacement therapy, or,
In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2

618
Q

Mangement of periarrest tahcycardia (VT)?

A

Classify as stable or unstable

If unstable- then synchronised DC shocks- up to 3 given

Then broad complex or narrow complex tachycardia-

Broad complex-
Regular- assume VT- loading dose of amiodarone followed by 24 hour infusion
Irregular- seek expert help. Could be AF with BBB or torsades de pointes

Narrow complex-

Regular- vagal manoeuvres followed by IV adenosine- if unsuccessful consider disgnosis of artial flutter and control rate

Irregular- probable atrial fibrillation- if onset <48hours consider electrical or chemical cardioversion- beta-blockers are usually first-line unless there is a contraindication

619
Q

Colorectal cancer referral guidelines?

A

Updated so faecal immunichemical test (FIT) testing is used in preferance to doing a colonoscopy first line

FIT positive- refer on the suspected cancer pathway

FIT negative- safety netting
refer if ongoing significant concern

620
Q

Criteria for doing a FIT test?

A

An abdominal mass
Change in bowl habit
Iron-deficiency anaemia
40 or over with unexplained weight loss and abdo pain
Aged under 50 with rectal bleeding and either of the following unexplained symptoms- abdo pain, weight loss

Aged 50 and over with any of the following uexplained symptoms- rectal bleeding, abdo pain, weight loss or

Aged 60 and over with anaemia even in the absence of iron deficiency

Rectal mass, anal mass or anal ulceration can be referred without a FIT test

621
Q

NHS bowel cancer screening test?

A

National screening programme offering screening every 2 years to all men and women aged 60 to 74 years in England, 50 to 74 in Scotland. Patients over 74 may still request screening

Can detect and quantify blood in stool, patients with abnormal results offered a colonoscopy

The FIT test is also recommended for patients with new symptoms who do not meet the 2-week criteria listed above, for example:
patients >= 50 years with unexplained abdominal pain OR weight loss
patients < 60 years with changes in their bowel habit OR iron deficiency anaemia
patients >= 60 years who have anaemia even in the absence of iron deficiency

622
Q

First line management for a chronic anal fissure?

A

Topical glyceryl trinitrate (GTN)

If GTN not effective after 6 weeks then secondary care referral should be considered for sugery (sphincterotomy)

623
Q

What is the screening for AAA?

A

A single abdominal ultrasound for men aged 65 years old

624
Q

GCS?

A

Motor response

  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None

Verbal response

  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None

Eye opening

  1. Spontaneous
  2. To speech
  3. To pain
  4. None
625
Q

Fungal nail infections?

A

Causative organisms- most likely dermatophytes- Trichophyton rubrum

Ix- nail clippings/scraping of the affected nail- done in all patients if antifungal treatment is being considered

Management- no treatment if asymptomatic and patient not bothered by the appearance

If dermatophyte or candida confirmed-
Limited involvement- topical amorolfine nail lacquer- 6 months for fingernails, 9-12 for toenails

If more extensive- oral terbinafine for dermatophtes is first line- 6 weeks- 3 months fingernail, 3-6 months for toes

If candida and extensive- oral itraconazole is reccomended first line

626
Q

Erythema nodosum causes?

A

NO : idiopathic
D : drugs → penicillin sulphonamides
O : oral contraceptives / pregnancy
S : sarcoidosis / TB
U : ulcerative colitis / Crohn’s disease / Behçet’s disease
M : micro → strep, mycoplasma, EBV and more

627
Q

Thiazides electrolyte disturbances?

A

HyperGLUC
Glycaemia
Lactate
Uraemia
Calcemia

And hyponatremia, hypokalaemia, hypomagnesium

628
Q

Campylobacter jejuni?

A

Fever, abdo tenderness and bloody diarrhoea- commonest facterial cause of infectious intestinal disease in the UK tranmitted by the faecal oral route

Doesn’t require treatment unless severe- first line clarithromycin

GB can follow

629
Q

What bacteria causes travellers diarrhoea?

A

Enterotocigenic e.coli

630
Q

Aspirin (salicylate overdose)?

A

Causes resp acidosis eary as hyperventilation- stimuates respiration, tinnitus, lethargy, sweating N+V

631
Q

Asthma?

A

Oh
S***,
I
Hate
My
Asthma

1) Oxygen
2) Salbutamol nebulisers
3) Ipratropium bromide nebulisers
4) Hydrocortisone IV or Oral Prednisolone
5) Magnesium Sulfate IV
6) Aminophylline / IV salbutamol

632
Q

Treatment of eclampsia?

A

Magnesium sulphate

Given once decision to deliver has been made

Urine output, reflexes, resp rate, and O2 sats should be monitored

Resp depression can occur- calcium gluconate is the first line treatment for magnesium sulphate induced resp depression

Treatment should continue for 24 hours after last seizure or delivery

633
Q

In hypercalcaemia due to malignancy, what is low?

A

PTH

634
Q

Water deprivation test in nephrogenic DI?

A

Water deprivation test: nephrogenic DI
urine osmolality after fluid deprivation: low
urine osmolality after desmopressin: low

635
Q

Burkitt’s lymphoma appearance on biopsy?

A

Starry sky appearance

636
Q

Hodgkin’s vs non-hodgkin’s differentiators?

A

Alcohol pain in Hodgkin’s

B symptoms earlier in Hodgkins than non-Hodgkins

Extra nodal disease more common in non-Hodgkins lymphoma than Hodgkin’s

637
Q

Treatment for non-Hodgkin’s lymphoma?

A

Rituximab is used in combination with conventional chemotherapy regimes (CHOP)

Patients should be screened for hep B before treatment with rituximab as it can cause reactivation of hep B in patients with prior exposure

638
Q

Syphilis tests?

A

A way to remember tests if it helps anyone:

If the syphilis test has an ‘A’ in it, it will Always be raised (in infected and those with resolved infection)
If the syphilis test has an ‘R’ in it, it will be raised in Recent (i.e. current infection)

639
Q

Ramadan and DM type 2?

A

Long acting carb for meal before sunrise

Blood glucose monitor to check

Metformin- one third before sunrise, 2/3 after sunset

640
Q

CN 3 palsy?

A

Ptosis + dilated pupil

641
Q

Horner’s presentation?

A

Ptosis + constricted pupil

642
Q

Most useful prognostic marker in paracetamol overdose?

A

An elevated prothrombin time- liver creates clotting factors so elevated prothrombin time indicates it is failing

643
Q

Paracetamol overdose treatment?

A

If presenting within 1 hour may benefit from activated charcoal- reduces absorption of the drug

Acetylcysteine- staggered overdose, presenting 8-24 hours after ingestion, >24 ours if they are clearly jaundiced

If paracetamol concentration or ALT remains elevated acetylcysteine should be continued

Acetylcysteine now given over 1 hour rather than 15 mins

644
Q

King’s college hospital criteria for liver transplantation?

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

645
Q

If loads of random S.aureus in the blood?

A

Echocardiogram to look for endocarditis

646
Q

Most common cause of discitis?

A

S.aureus

Imaging: MRI

647
Q

Key features seen in Graves but not other causes of thyrotoxicosis?

A

EYE SIGNS-
Exopthalmos
Opthalmoplegia

Pretibial myxoedema

Thyroid acropachy:
Digital clubbing
Soft tissue swelling of hands and feet
Periosteal new bone formation

648
Q

RA poor prognostic factors?

A

Rheumatoid factor positive
Anti-CCP antibodies
Functional status poor at presentation
X-ray- early erosions
Extra articular features- nodules
HLA DR4
Insidious onset

649
Q

Kidney transplant in a dermatology question?

A

Squamous cell carcinoma

Growing, bleeding, firm, indurated plaque or nodule

650
Q

Bone protection for people taking steroids?

A

Bisphosphonate + ensure calcium and vitamin D replete

651
Q

Gatroparesis?

A

Can be a complication of diabetes- due to neuropathy

Leads to poor gastric emptying and poor glucose control

Metoclopramide is a pro kinetic drug so best to give- it improves gastric emptying- also domperidone and erythromycin- both prokinetic agents

652
Q

Drusen on fundoscopy?

A

Dry age related macular degeneration

653
Q

Bitemporal hemianopia?

A

Bitemporal hemianopia

lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

654
Q

Teratomas vs seminomas age group?

A

Teratomas in the troops (under 30), seminomas in the sergeants (over 30)

655
Q

Common features of frontotemporal dementia?

A

Onset before the age of 65

Insidious onset

Relatively preserved memory and visuospatial skills

Personality change and social conduct problems

656
Q

Is CKD a risk factor for osteoporosis?

A

Yes

657
Q

Antibiotic causing ototoxicity?

A

Gentimicin

658
Q

Important equipment to know if you are in the airway- intubation?

A

Capnography- CO2 monitor

659
Q

Adverse effects of lithium?

A

Adverse effects
nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia

660
Q

Pulmonary embolism most common ECG finding?

A

Sinus tachycardia

Less commonly is S1Q3T3

661
Q

Score used to identify severe cases of pancreatitis?

A

The Glasgow score

Some features indicating severe pancreatitis:
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

662
Q

Carpal tunnel syndrome in pregnancy?

A

Wrist splint

663
Q

Insecticide poisoning?

A

DUMBELS

D: defaecation & diaphoresis
U: urinary incontinence
M: miosis (pupil constriction)
B: bradycardia
E: emesis
L: lacrimation
S: salivation

664
Q

When should antivirals be given in chicken pox exposure in pregnancy?

A

Check maternal varicella antibodies first

Give antivirals 7-14 days after exposure, not immediatley

665
Q

Treatment for myasthenia gravis?

A

Pyridostigmine

666
Q

Which condition is a thymoma associated with?

A

Myasthenia gravis

667
Q

Management of hiccups in palliative care?

A

Chlorpromazie

Haloperidol, gabapenin also used

668
Q

Upper limit for feeling first foetal movement?

A

24 weeks gestation

Foetal movements usually start at 18-20 weeks gestation

669
Q

Osteomyelitis organism in sickle cell?

A

Salmonella

Most common cause normally s.aureus

MRI normally imaging of choice in osteomyelitis

670
Q

CT head/MRI showing temporal changes?

A

Think herpes simplex encephalitis

671
Q

COCP, POP and emergency contraceptives are reduced in efficacy by which type of drugs?

A

Drugs that induce enzyme activity-

Carbamazepine, phenytoin, rifampicin etc

672
Q

Most common causative organism for cellulitis?

A

Streptococcus pyogenes

Less common- staph aureus

673
Q

Criteria for managing cellulitis?

A

Eron classification

674
Q

Management of cellulitis?

A

1st- Oral flucloxaclillin

2nd- Oral clarithromycin/ erythromycin in pregnancy- in patients allergic to penicillin

675
Q

Management if mineral bone disease in CKD?

A

Reduce dietary intake of phosphate is the first line

Give vit D

Calcoum based binders- problems include hypercalcemia and vascular calcification

Sevelamer- non-calcium based binder- binds to dietary phosphate to prevent its absorption

676
Q

Definitive management of variceal haemorrhage?

A

Endoscopic band ligation

677
Q

Aortic vs mitral valves target INR?

A

Aortic- 3.0- lower as better blood flow across the valve

Mitral- 3.5- higher

678
Q

Classic triad of nephritic syndrome?

A

Haematuria, oliguria and hypertension

679
Q

Congenital inguinal hernia?

A

Repair soon after diagnosis as at risk of incarceration

680
Q

Infantile umbilical hernia?

A

Vast majority resolve without intervention before the age of 4-5 years old

681
Q

Vitamin D analogue example?

A

Calcipotriol, calcitriol

Can be used long term unlike steroids (for psoriasis etc)

682
Q

Goodpastures?

A

Rapidly progressive glomerulonephritis- proteinuria + haematuria

With pulmonary haemorrhages

Anti-glomerular basement membrane antibodies against type IV collagen

683
Q

AIN vs ATN?

A

Both causes of intrinsic AKI- not nephritic or nephrotic as that is for the glomerulus- these don’t affect that

ATN- most common AKI cause- ischaemia or nephrotoins- aminoglycosides or rhabdomyolysis- raised urea, creatinine, potassium, muddy brown casts

AIN- fever, rash, arthralgia- drugs- NSAIDs, penicilllins, SLE etc- eosinophilia, sterile pyuria, white cell casts

684
Q

What should be corrected before giving bisphosphonates?

A

Vitamin D and calcium if they are low

685
Q

IV acetylcysteine complication?

A

Anaphylactoid reaction (bronchospasm, urticaria, hypotension).

Stop infusion- treat reaction- start infusion again at slower rate

686
Q

When would you not give dexamethasone in meningitis?

A

Use it for bacterial meningitis

Do not use it in- viral, systemic infection (sepsis) and meningiococcal disease (non-blanching rash)

687
Q

What is a hernia that cannot be reduced called?

A

An incarcerated hernia- they are at risk of strangulation

688
Q

Do you shock in regular bradycardia with signs of shock?

A

No, atropine up to 3mg then transcutaneous pacing if required

Bradycardia is ok unless symptomatic

689
Q

Falciparum malaria?

A

Triad of fever, chills and sweating

Thrombocytopenia

Treat with artesunate

690
Q

Definitive diagnostic test for sickle cell?

A

Haemoglobin electrophoresis

691
Q

What is the use of the mantoux test?

A

Screen for latent TB

Gamma interferon blood test may also be used

692
Q

Gold standard for diagnosing active TB?

A

Sputum culture

693
Q

How is a sputum smear stained when looking for TB?

A

Ziehl-Neelsen stain for acid fast bacilli- all mycobacteria stain positive

Sensitivity decreased in those with HIV

694
Q

Osgood-Schlatter’s disease?

A

Osgood-SchlaTTer

Pain over the tibial tubercle

695
Q

Life threatening C.Diff?

A

ORAL vancomycin + IV metronidazole

Trying to kill bacteria in the gut so has to be oral stuff- metronidazole is IV

696
Q

First line investigation for prostate cancer?

A

Multiparametric MRI- it has replacecd the TRUS biopsy

Results reported using the 5-point Likert scale-

If the Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered

If the Likert scale is 1-2 then NICE recommend discussing with the patient the pros and cons of having a biopsy

697
Q

Test to distinguish between vestibular neuronitis and a posterior circulation stroke?

A

The HiNTs exam

698
Q

TNF-inhibitors for RA?

A

If inadequate response to two DMARDs- etanercept, infliximab, adalimumab

Risk of reactivation of TB- do chest x-ray before you give them

699
Q

Blood disturbances for acute pancreatitis?

A

Hypocalcaemia

Raised WBC and CRP

700
Q

What to do for DVT if d-dimer positive but leg ultrasound negative?

A

Stop anticoagulation and arrange an ultrasound scan in 1 week

701
Q

MORTAR for carpal tunnel?

A

MORTAR

Myxoedema (hypothyroid)
Oedematous states (eg. pregnancy, HF)/Obesity
Rheumatoid arthritis
Trauma
Acromegaly
Repetitive stress jobs

& idiopathic as well

702
Q

What is the surgical intervention for carpal tunnel syndrome called?

A

Surgical decompression (flexor retinaculum division)

703
Q

Test that must be offered for patients with TB?

A

HIV test

704
Q

Acetylcholinesterase inhibitors?

A

River in Donegal

Rivastigmine, Donepezil, Galantamine

705
Q

Alzheimer’s drugs?

A

1st- acrtylchonesterase inhibitors (rivastigmine, donepezil, galantamine)

2nd- Memantine

Phase 4 Question Knowledge (33 decks)

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