Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mesenteric ischaemia triad?

A

CVD, high lactate, soft but tender abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In what condition should adenosine be avoided in?

A

Bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Beck’s triad of features for cardiac tamponade?

A

Beck’s triad-

Hypotension

Raised JVP

Muffled heart sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which condition is closely related to primary sclerosing cholangitis?

A

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which liver enzyme is raised in an obstructive picutre?

A

ALP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Torsades de pointes treatment?

A

IV magnesium

Can be precipitated by hypomagnesaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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

A

Upper GI Bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Smoking cessation?

A

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

Varenicline and bupropion CI in pregnancy

Bupropion CI in epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Statin contrindications?

A

Pregnancy

Macrolides- erythromycin, clarithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When is infliximab used in Crohn’s disease?

A

In refractory disease or fistulating Crohn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A

+TMPT actvity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Spirometery results in idiopathic pulmonary fibrosis?

A

FEV1:FVC ratio >70%, decreased FVC

Impaired gas exchange (reduced TLCO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Painful shin rash + cough?

A

?Sarcoidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Main side effect ACEi?

A

Dry cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hypercalcaemia features?

A

Bones, stones, abdo groans and psychiatric moans

Corneal calcification

Shortened QT interval

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Contraindications for chest drain insertion?

A

INR>1.3

Platelet count < 75

Pulmonary bullae

Pleural adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

PPI adverse effects?

A

Hyponatremia, hypomagnasaemia

Osteoporosis–> increased fracture risk

Increased risk of C diff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which side is aspiration pneumonia more common?

A

The right lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Functions of vitamin C?

A

Antioxidant

Collagen synthesis

Facilitates iron absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Most commonly affected valves in infective endocarditis?

A

Mitral in normal people

Tricuspid in IVDU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which cancers is Lynch syndrome (HNPCC) associated with?

A

Female- CEO-P
Colon
Endometrial
Ovarian
Pancreatic

Male (CP)
Colon
Pancreatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Primary Biliary Cholangitis Ms?

A

IgM

Anti-mitochondrial antibodies

Middle aged females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the cause of mitral stenosis?

A

Rheumatic fever mainly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

A major ECG change in AF?

A

Absence of P waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Boerhaave syndrome?

A

Mackler triad: vomiting, thoracic pain and subcutaneous emphysema

Middle aged men with background of alcohol abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

GI bleed key blood result?

A

Isolated raised urea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

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

A

The ligament of Treitz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Murmurs best heard?

A

RILE

Right sided murmurs best heard on inspiration

Left sided murmurs best heard on expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

HbA1c target when adding a medication that can cause hypoglycaemia?

A

53 mmol/mol (7.0%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Hypercalcaemia effect on QT interval on ECG?

A

Shorterned QT interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which artery supplies the AV node?

A

Right coronary artery (inferior myocardial infarction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Main angina drugs?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Drug induced gynaecomastia?

A

Spironolactone- most common

Cimetidine

Digoxin

Cannabis

Finasteride

GnRH agonists- goserelin, buserelin

Oestrogens, anabolic steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which antibiotics cause C.difficile?

A

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

And PPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Which drug causes hyperthyroidism?

A

Amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Which drugs cause hypothyroidism?

A

Lithium

Amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

PSC malignancy risks?

A

Cholangiocarcinoma

Increased risk of colorectal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

T1DM initial insulin management?

A

Daily basal-bolus injection regimes

Twice-daily insulin detemir, rapid acting before meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Major complication of carbimalzole therapy?

A

Agranulocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Distinguish between Graves and De Quervain’s?

A

Pain in Quervain’s- painful goitre

Goitre not painful in Graves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

After which MI is bradyarrhythmias more common?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Hypertension, HypoK?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

ACEi side effects?

A

Cough

Angioedema

Hyperkalaemia

First dose hypotension- more common in patients taking diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

ACEi monitoring?

A

U+E checked before treatment initiated and after increasing dose

Rise in creatinine and potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Causes of raised prolactin?

A

The P’s

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Hypo or hyperkalaemia with a diuretic?

A

If potassium sparing- hyperkalaemia

Any other diuretic- hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Can digoxin cause gynaecomastia?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Beck’s triad cardiac tamponade?

A

Raised JVP, muffled heart sounds, hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Diastolic murmur + AF?

A

?Mitral stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

BB side effects?

A

Bronchospasm

Cold peripheries

Fatigue

Sleep disturbances, including nightmares

Erectile dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Can severe obesity cause restrictive lung disease?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Young adult with severe hypertension and systolic murmur?

A

Coarctation of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Posterior STEMI ECG?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Cells in Barrett’s oesophagus?

A

Squamous epithelium replaced with columnar epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What are the two most common causes of hypercalcaemia?

A

Primary hyperparathyroidism

Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Unsynchonised vs synchronised shocks?

A

Unsynchronised shocks used in cardiac arrest- VF/pulselessVT

Synchronised shocks used in arryhtmias that are unstable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Who should adenosine be avoided in?

A

Asthmatics due to bronchospasm

Adverse effects:
Chest pain
Bronchospasm
Transient flushing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Decompensation risk factors?

A

ABCDI

Alcohol, bleeding, constipation, drugs, infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Hepatorenal syndrome triad?

A

Cirrhosis, ascites, AKI bit attributable to any other cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Alcohol withdrawl timeline?

A

Symptoms- 6-12 hours

Seizures- 36 hours

Delirium tremens- 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Choice of SSRI in children and adolescents?

A

Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Other name for obsessive compulsive personality disorder?

A

Anankastic personality disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Lithium monitoring after change in dose?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Abortion act?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is a multi-level pregnancy test?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

When can an intrauterine contraceptive be inserted after surgical termination?

A

Immediately after evacuation of the uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

112
Q

Alternative name for methylphenidate?

A

Ritalin

113
Q

Corticosteroids and meingitis?

A

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

114
Q

N+V in pregnancy?

A

Natural remedies- ginger/acupuncture

Antihistamines should be used first line- promethazine

115
Q

Should all pregnant and breastfeeding women take vit D?

A

Yes

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

117
Q

What level is hypertension in pregnancy defined as?

A

140/90

Or increase about booking of 30/15

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

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

120
Q

Example of a GnRH agonist?

A

Goserelin

121
Q

HRT in VTE risk?

A

Transdermal

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

123
Q

Pregnancy of unknown location what points towards an ectopic?

A

Serum bHCG levels >1500

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

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

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)

127
Q

VEAL CHOP for cardiotopography?

A

VEAL CHOP

Variable decelerations –> Cord compression

Early decelerations –> Head compression

Accelerations –> Okay

Late decelerations –> placental insufficiency

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

129
Q

What urine rate is classed as oliguria?

A

A urine output less than 0.5 ml/kg/hour

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

131
Q

Drugs safe to continue in AKI?

A

Paracetamol
Warfarain
Statins
Aspirin
Clopidogrel
Beta-blockers

132
Q

Drugs to be stopped in AKI as worsen renal function?

A

NSAIDs
Aminoglycosides
ACEi
ARB
Diuretics

133
Q

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

A

Metformin

Lithium

Digoxin

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

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

136
Q

Hyperkalaemia stages?

A

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

137
Q

Hyperkalaemia ECG?

A

Peaked or tall tented t waves

Loss of P waves

Broad QRS complexes

Sinusoidal wave pattern

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

139
Q

Nephrogenic diabetes insipidus treatment?

A

Thiazides

Low salt/protein diet

140
Q

Central (cranial) diabetes insipidus treatment?

A

Desmopressin

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

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

143
Q

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

A

Hyperchoraemic metabolic acidosis

144
Q

Which common drug can cause rhabdomyolysis?

A

Statins (especially if co-prescribed with clarithromycin)

145
Q

Most common renal cause of AKI?

A

Acute tubular necrosis (ATN)

146
Q

Two causes of ATN?

A

Ischaemia- shock, sepsis

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

Muddy-brown casts in urine

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

148
Q

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

A

Renal artery stenosis

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

150
Q

Haematuria referral?

A

In younger- usually renal referral

In older- usually urology referral

151
Q

Kidney condition associated with berry aneurysms?

A

ADPKD

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

153
Q

How are diabetics screened for diabetic nephropathy?

A

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

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

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

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

157
Q

How long should a PPI be stopped before upper endoscopy?

A

2 weeks

158
Q

Gold standard investigation for GORD (after endoscopy)?

A

24 hour oesophageal pH monitoring

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

160
Q

Risk factors for GBS transmission?

A

Prematurity

Prolonged rupture of the membranes

Previous sibling GBS infection

Maternal pyrexia (secondary to chorioamnionitis)

161
Q

Conditions associated with MALT lymphoma?

A

H.pylori infections- 95%

Hashimoto’s thyroiditis

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

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

164
Q

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

A

Majority given in the first half of the day

165
Q

Addison’s during illness?

A

Hydrocortisone doubled, fludrocortisone stay the same

166
Q

Manouvre for shoulder dystocia?

A

McRobert’s manoeuvre

167
Q

Features of life-threatening asthma?

A

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

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

169
Q

Way to screen for postnatal depression?

A

Edinburgh Postnatal Depression Scale

170
Q

SSRIs that can be used in postnatal depression?

A

Sertraline and paroxetine

171
Q

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

A

Up to day 21

172
Q

What causes roseola infantum (sixth disease)?

A

Human herpes virus 6

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

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

175
Q

SSRI that causes QT prolongation/ torsades de pointes?

A

Citalopram

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

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

178
Q

When are pregnant women screened for anaemia

A

The booking visit (often at 8-10 weeks)

28 weeks

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

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

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)

182
Q

How do thiazide like diuretics work?

A

Inhibit sodium reabsorption at the begininning of the distal convoluted tubule

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

184
Q

Are statins contraindicated in pregnancy?

A

Yes

Also contraindicated with macrolides (erythromycin, clarithromycin)

185
Q

Alcohol units for men and women?

A

14 units per week for both

1 unit= 10ml of alcohol

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

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

188
Q

Furosemide side effects?

A

OH DANG

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

Hyponatremia as well

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

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

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

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

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

194
Q

Metabolic alkalosis + hypokalaemia?

A

?prolonged vomiting

195
Q

Management of h.pylori?

A

PPI+ Amoxicillin + Clarithromyin OR Metronidazole

If pen allergic
PPI+Clarithromycin+metronidazole

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)

197
Q

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

A

Urea breath test

198
Q

CRP and infection?

A

CRP can lag behind other blood results such as WCC

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

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

201
Q

Afro-carribean + HF?

A

Hydralazine + Nitrates

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

203
Q

Drug to slow heart rate contraindicated in asthmatics?

A

IV adenosine

Verapamil prederable

204
Q

Statin interactions?

A

Macrolides (erythromycin, lcarithromycin)

Pregnancy

205
Q

Oesophageal cancer types?

A

UK/US- adenocarcinoma- GORD, Barrett’s

Developing- squamous cell cancer- smoking, alcohol

206
Q

Postpartum contraception from when?

A

Day 21

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

208
Q

Extrapyramidal side-effects (EPSEs)?

A

Parkinsonism

Acute dystonia- torticollis, oculogyric crisis- managed with procyclidine

Akathisia

Tardive dyskinesia- occurs after longer term use

208
Q

Side effects antipsychotics?

A

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

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

209
Q

What causes epiglottitis?

A

Haemophilus influenzae type B

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

211
Q

Can you breastfeed on antiepileptic drugs?

A

Yes on nearly all of them

212
Q

Constipation management in children?

A

MSO

Movicol paediatric plain

Stimulant- Senna

Osmotic- lactulose

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

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

215
Q

What does sudden deterioration with ventilation suggest?

A

Tension pneumothroax

216
Q

What reverses the effect of dabigatran?

A

Idarucizumab

217
Q

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

A

Rockall score- gives a percentage risk of rebleeding and mortality

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

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

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

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

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

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

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

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

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’)

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

228
Q

Who is adenomyosis more common in?

A

Older, multiparous women towards the end of their reproductive years

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

230
Q

Prophylaxis of variceal haemorrhage?

A

Propanolol

Endoscopic variceal band ligation

Transjugular intrahepatic portosystemic shunt

231
Q

Which drug is contrainidcated in VT?

A

Verapamil

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)

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

234
Q

Pneumonia treatment

A

Low severity:
Amoxicillin
Macrolide or tetracycline if pen allergic

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

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

236
Q

Added benefits to mirtazapine?

A

Increased appetite and sedation effects

237
Q

Ketones over what for DKA?

A

> 3mmol/l

238
Q

What is pseudomembranous colitis?

A

C.difficle colitis- another name for it

239
Q

What do you need to check before treatment with azathioprine?

A

Thiopurine methyltransferase deficiency (TMPT)

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

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

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

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

244
Q

Which conditions is closely related to temporal arteritis?

A

Polymyalgia rheumatica

245
Q

What is a raised anti-CCP associated with?

A

Rheumatoid arthritis

246
Q

Which blood result is notably normal in polymyalgia rheumatica?

A

Creatine kinase

247
Q

Methotrexate indications?

A

Inflammatory arthritis- especially rheumatoid
Psoriasis
Some chemotherapy- ALL

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

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

250
Q

Interactions of methotrexate?

A

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

High dose aspirin- reduced methotrxate excretion

251
Q

Mechanism of action for bisphosphonates?

A

They inhibit osteoclasts by reducing recruitment and promoting apoptosis

251
Q

Methotrexate toxicity treatment?

A

Folinic acid

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

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’

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.

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

256
Q

Most common site for metatarsal stress fracture?

A

2nd metatarsal shaft

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

258
Q

Organisms for reactive arthritis?

A

Shigella, salmonella, campylobacter- post-dysenteric

Post-STI- chlamydia trachomatis

259
Q

Management reactive arthritis?

A

Analgesia, NSAIDs, intra-articular steroids

Sulfasalazine and methotrexate for persistent disease

Symptoms rarely last more than 12 months

260
Q

Do ganglion cysts transilluminate?

A

Yes

261
Q

Most common organism in osteomyelitis?

A

Staph. aureus

In patients with sickle-cell it is salmonella

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

263
Q

Secondary causes of Raynaud’s phenomenon?

A

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

Leukaemia

Use of vibrating drugs
COCP

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

265
Q

Complication of discitis?

A

Epidural abscess- can cause lower limb neurology

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

267
Q

A mutation in which protein causes Marfan’s syndrome?

A

Fibrillin-1

Autosomal dominant

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)

269
Q

Sjogren’s syndrome malignancy association?

A

Marked increased risk of lymphoid malignancy 40-60 fold

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)

271
Q

Ankylosing spondylitis X-Ray?

A

Sacroiliitis: subchondral erosions, sclerosis

Squaring of lumbar vertebrae

Bamboo spine (late and uncommon)

Syndesmophytes

CXR- apical fibrosis

272
Q

Is measles a notifiable disease?

A

Yes

273
Q

Is HIV a notifiable disease?

A

No

274
Q

Only absolute contraindication for ECT?

A

Raised ICP

275
Q
A

Phase 4 Question Knowledge (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions