Random knowledge to review 2

Question 1

In what condition is donepezil CI?

Answer 1

Bradycardia

Donepezil can cause insomnia as well

Question 2

Centor criteria?

Answer 2

CENTor criteria:

Cough absent
Exudates on tonsils
Nodes- tender cervical lymphadenopathy
Temperature>38

Question 3

Transjugular Intrahepatic Portosystemic Shunt problem?

Answer 3

Last line for upper variceal bleed- bypasses the liver so can cause a build up of toxins that cause confusion

Causes the exacerbation of hepatic encephalopathy

Question 4

What should all men with ED have checked?

Answer 4

Their testosterone levels

Also screen for underlying diabetes and cardiovascular disease

Question 5

Treatment for benzodiazepine overdose?

Answer 5

Flumazenil

Question 6

TB drugs memory aid?

Answer 6

RIPE ONGO
Rifampicin: Orange secretions
Isoniazid: Neuropathy
Pyrazinamide: Gout
Ethambutol: Optic Neuritis

Question 7

How do you prevent the peripheral neuropathy from Isoniazid?

Answer 7

Pyridoxine (vitamin B6)

Question 8

Ethambutol before treatment?

Answer 8

Check visual acuity before and during treatment as can cause optic neuritis

Question 9

Osteoporosis blood derangement?

Answer 9

None

Question 10

When are Howell-Jolly bodies found?

Answer 10

Post-splenectomy

Question 11

At what fasting glucose should insulin be offered straight away for gestational diabetes?

Answer 11

> 7mmol/l

Question 12

Is iron deficiency anaemia a cause of pruritis?

Answer 12

Yes

Question 13

ADPKD drug treatment?

Answer 13

Tolvaptan

Question 14

Letrozole vs Tamoxifen?

Answer 14

Tamoxifen for oestrogen receptor-positive breast cancer

Letrozole/anastrozole for oestrogen receptor-positive breast cancer in those after the menopause

Question 15

What is a Jarisch-Herxheimer reaction?

Answer 15

Fever, rash, chills and headache following antibiotic administration for syphillis, also tachycardia and myalgia

Due to the rapid killing of Treponema pallidum and release of its endotoxins

Supportive management with antipyretics and it resolves within 24 hours

Question 16

What is the first line treatment for syphillis?

Answer 16

IM benzathine benzylpenicillin

Question 17

Treatment for septic arthritis?

Answer 17

Flucloxacillin or clindamycin for penicillin allergic

IV

4-6 weeks overall switch to oral antibiotics after 2 weeks

Question 19

<3 months with fever over 38?

Answer 19

Refer for paediatric assessment

Question 20

Visual hallucinations + dementia?

Answer 20

Lewy body dementia

Question 21

Squint in child?

Answer 21

Refer to secondary care

Means eyes pointing in different directions

Can lead to amblyopia and uncorrects (brain prefers one eye)

Question 22

How many tetanus jabs to be immune lifelong?

Answer 22

5

Question 23

Is anus spared in UC?

Answer 23

Yes

Question 24

Secretions treatment in palliative care?

Answer 24

Hyoscine hyrobromide or hyoscine butylbromide

Question 25

What are the side effects of tamsulosin (alpha-1 adrenergic receptor antagonist)?

Answer 25

Dizziness and postural hypotension

Question 26

What precipitiates lithium toxicity?

Answer 26

Dehydration Renal failure Drugs: diuretics (especially thiazides), ACEi/ARBs, NSAIDs and metronidazole

Question 27

Features of lithium toxicity?

Answer 27

Coarse tremor Hyperreflexia Acute confusion Polyuria Seizure Coma

Question 28

Lithium toxicity management?

Answer 28

Mild-moderate toxicity may respond to volume resuscitation with normal saline- IV fluids with isotonic saline Haemodialysis may be needed if severe toxicity

Question 29

HF management?

Answer 29

1st line: ACEi + BB 2n line: Aldosterone antagonist (spironolactone, eplerenone) or SGLT-2 (ie dapagliflozin) if HFrEF 3rd line: Ivabradine, sacubitril-valsartan (EF<35%), Digoxin (for symptomatic relief), Hydralizine + Nitrate (Afro-Caribbean) Cardiac resynchronisation if wide QRS (LBBB) + Annual flu vaccine and one-off Pneumococcal vaccine

Question 30

Warfarin interactions?

Answer 30

General factors that may potentiate warfarin- Liver disease P450 ezyme inhibitors Cranberry juice Drugs- NSAIDs Inducers of the P450 system will decrease INR Inhibitors will increase the INR

Question 31

P450 inducers (decrease INR)?

Answer 31

Antiepileptics: phenytoin, carbamazepine Barbiturates: phenobarbitone Rifampicin St John's Wort Chronic alcohol intake Griseofulvin Smoking (affects CYP1A2, reason why smokers require more aminophylline)

Question 32

P450 inhibitors (increase INR)?

Answer 32

antibiotics: ciprofloxacin, clarithromycine/erythromycin isoniazid cimetidine,omeprazole amiodarone allopurinol imidazoles: ketoconazole, fluconazole SSRIs: fluoxetine, sertraline ritonavir sodium valproate acute alcohol intake quinupristin

Question 33

Can diabetic foot ulcers/diabetes lead to osteomyelitis?

Answer 33

Yes

Question 34

Diverticular disease management?

Answer 34

Increase dietary fibre intake Mild attacks managed conservativley with antibiotics Absecess drained Reccurrent episodes are indication for a segmental resection

Question 35

Horner's features?

Answer 35

Miosis Ptosis Anhidrosis (loss of sweating on one side)

Question 36

Hip fracture treatments?

Answer 36

Intracapsular- Undisplaced- internal fixation or hemiarthroplasty Displaced- total hip replacement (arthroplasty) to all patients, sometimes hemiarthroplasty if not able to do much before injury Stable intertrochanteric- dynamic hip screw Subtrochanteric, reverse oblique or transverse- intermedullary device

Question 37

Adrenaline doses?

Answer 37

Age Adrenaline dose < 6 months 100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000) 6 months - 6 years 150 micrograms (0.15 ml 1 in 1,000) 6-12 years 300 micrograms (0.3ml 1 in 1,000) Adult and child > 12 years 500 micrograms (0.5ml 1 in 1,000)

Question 38

What does india ink stain on CSF analysis in meningitis point towards?

Answer 38

Cryptococcus neoformans Most common fungal infection of CNSWh

Question 39

What is co prescribed when starting a GnRH agonists (Goserelin) for prostate cancer?

Answer 39

Anti-androgen- cyproterone acetate- prevent a rise in testosterone causing a tumour flare

Question 40

RUQ pain?

Answer 40

RUQ pain only --> biliary colic RUQ pain + fever --> acute cholecystitis RUQ pain + fever + jaundice --> ascending cholangitis (Charcot's triad) Charcot's triad + confusion + hypotension = Reynold's pentad (more severe ascending cholangitis)

Question 41

When should parents call an ambulance in febrile convulsions?

Answer 41

If it lasts longer than 5 minutes Febrile convulsions occur between the ages of 6 months and 5 years

Question 42

What is prescribed if recurrent febrile convulsions occur?

Answer 42

Benzodiazepine rescue medication

Question 43

Palliative care- severe pain with CKD treatment?

Answer 43

Buprenorphine or fentanyl are the opioids of choice for pain relief in pallaiative care patients with severe renal impairment Oxycodone is preferred in mild-moderate renal impairment

Question 44

Hepatitis C investigation?

Answer 44

HCV RNA

Question 45

Which thyroid treatment worsens thyroid eye disease?

Answer 45

Radioiodine treatment

Question 46

Lower GI bleeding cause paeds?

Answer 46

Neonates- NEC or malrotation Infants/young children- intussusception

Question 47

Dopamine receptor antagonist examples?

Answer 47

Bromocriptine, ropinirole, cabergoline, apomorphine

Question 48

MAO-B inhibitors example?

Answer 48

Selegiline

Question 49

COMT inhibitors?

Answer 49

Entacapone, tolcapone

Question 50

VTE prophylaxis in patients with nephrotic syndrome?

Answer 50

Low molecular weight heparin (LMWH) Things like DOACs and Warfarin bind to proteins in the blood- decrease in these proteins in nephrotic syndrome

Question 51

When must a culture (MSU) be sent for non-pregnant women in UTI?

Answer 51

If there is visible or non-visible haematuria Or over 65

Question 52

Vision loss associated with Charles-Bonnet?

Answer 52

Age-related macular degeneration (ARMD) Distortion of straight lines/ reduced acuity are symptoms

Question 53

When to start dapagliflozin?

Answer 53

QRISK over 10%, cardiovascular risk factors

Question 54

HbA1c target for any drug which may cause hypoglycaemia?

Answer 54

53 Example drug would be a sulfonylurea Also 53 for patients already on one drug but HbA1c has risen to 58

Question 55

How do you assess drug sensitivities in TB?

Answer 55

Sputum culture

Question 56

How is pseudogout also known?

Answer 56

Calcium pyrophosphate deposition disease

Question 57

Pseudogout presentation?

Answer 57

Knee, wrist and shoulders most commonly affected Joint aspiration- weakly-positive birefringent rhomboid-shaped crystals X-ray- chondrocalcinosis

Question 58

Gonorrhoea cause?

Answer 58

Neisseria gonorrhoeae

Question 59

Gonorrhoea treatment?

Answer 59

First line- single dose of IM ceftriaxone 1g If sensitivities known and organism sensitive to cirpofoxacin that should be given 500mg orally If ceftriaxone refused then oral cefixime and oral azithromycin should be used

Question 60

Disseminated gonococcal infection classic triad?

Answer 60

Tenosynovitis, migratory polyarthritis and dermatitis Later complications- septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome)

Question 61

Subacute unilateral visual loss, eye pain worse on movements?

Answer 61

?Optic neuritis 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 of the brain and orbits with gadolinium contrast Management- high-dose steroids

Question 62

Abdo diseases children?

Answer 62

Pyloric stenosis - Projectile, non-bilious vomiting at 4-6 wks old Malrotation - Bilious vomiting, abdominal pain, acutely unwell Intestinal atresia - Bilious vomiting if distal to ampulla of Vater, usually hours-days old Hirschsprung's disease - Failure to pass meconium >48 hours, abdominal distension, failure to thrive, sometimes bilious vomiting GORD - Milky vomiting after feeds, crying, arching of back, drawing up of knees into chest, failure to thrive, <8 weeks old GOR - Physiological, regurgitation but no symptoms or complications ('happy spitter') Intussusception - Colicky abdominal pain, drawing up of knees into chest, pale, RUQ sausage-mass, refusing feeds, red-currant stools late sign, non-bilious vomiting that may become bilious if obstruction, at 6-18 months old

Question 63

Can the temporal artery biopsy be false negative?

Answer 63

Yes as there can be skip lesions in temporal arteritis- continue the treatment

Question 64

Vision complication in temporal arteritis?

Answer 64

Anterior ischemic optic neuropathy

Question 65

Reduced fetal movement investigations?

Answer 65

Initially, handheld doppler to confirm fetal heartbeat- if no heartbeat detectable immediate ultrasound should be offered If fetal heartbeat present on doppler- CTG should be used to monitor for at least 20 mins Referral if fetal movements not felt by 24 weeks

Question 66

RA and eye problems?

Answer 66

?Scleritis

Question 67

Scleritis?

Answer 67

RA, SLE, Sarcoidosis associations Features: Red eye Classically painful (in comparison to epscleritis) Watering/photophobia Gradual decrease in vision Management- same day assessment by an opthalmologist Oral NSAIDs first line Oral glucocoriticoids in severe presentations

Question 68

Gliptins side effects?

Answer 68

Pancreatitis

Question 69

Pioglitazone contraindication?

Answer 69

Heart failure

Question 70

Symptoms/signs of hypocalcaemia memory aid?

Answer 70

CATs go numb- Convulsions, Arrythmias, Tetany, Numbness also Trouseau's sign and Chvostek's sign QT prolongation on ECG Blood transfusions can cause hypocalaemia and hyperkalaemia

Question 71

Signs/symptoms of hyperkalaemia?

Answer 71

Metabolic acidosis, arrythmias, muscle weakness, reduced reflexes, diarrhoea ECG features- Absent P waves, prolonged QRS, peaked or tall tented T waves, sine wave pattern

Question 72

Aortic stenosis symptoms?

Answer 72

SAD- syncope, angina, dyspnoea

Question 73

Which UTI medication is contraindicated in pregnancy?

Answer 73

Trimethoprim

Question 74

Initial emergency treatment for acute angle-closure glaucoma?

Answer 74

IV acetazolamide + timolol, pilocarpine and apraclonidine eyedrops

Question 75

Definitive management for acute angle-closure glaucoma?

Answer 75

Laser peripheral iridotomy

Question 76

Typical presentation of coarctation of the aorta?

Answer 76

Acute circulatory collapse at 2 days of age, mid systolic murmur maximal over the back

Question 77

Management of croup?

Answer 77

Single dose of dexamethasone to all children regardless of severity

Question 78

Hand-foot syndrome in sickle cell anameia?

Answer 78

Red blood cells interfere with circuation to hands and feet- causes pain, swelling and erythema

Question 79

Colorectal screening age?

Answer 79

Every 2 years to all men and women aged 60-74 in England Patients over 74 may request screening

Question 80

Tests done in all patients with colorectal cancer for staging?

Answer 80

Carcinoembryonic antigen (CEA) CT of the chest, abdomen and pelvis Entire colon should have been evaluated with a colonoscopy or CT colonography Patients whose tumours lie below the peritoneal reflection should have their mesorectum evaluated with MRI

Question 81

Management of colon cancer?

Answer 81

Nearly always treated with surgery Resectional surgery is the only option for cure in patients with colon cancer Site of cancer Type of resection Anastomosis Caecal, ascending or proximal transverse colon Right hemicolectomy Ileo-colic Distal transverse, descending colon Left hemicolectomy Colo-colon Sigmoid colon High anterior resection Colo-rectal Upper rectum Anterior resection (TME) Colo-rectal Low rectum Anterior resection (Low TME) Colo-rectal (+/- Defunctioning stoma) Anal verge Abdomino-perineal excision of rectum None

Question 82

Panproctocolectomy?

Answer 82

Removes the colon, rectum and anus- often in HNPCC carriers

Question 83

Caecal, ascending or proximal transverse colon colorectal cancer treatment?

Answer 83

Right hemicolectomy- ileo-colic anastomosis

Question 84

Distal transverse, descending colon?

Answer 84

Left hemicolectomy- colo-colon

Question 85

Sigmoid colon?

Answer 85

High anterior resection- colo-rectal

Question 86

Upper rectum?

Answer 86

Anterior resection (TME)- colo-rectal

Question 87

Low rectum?

Answer 87

Anterior resection (Low TME)- colo-rectal (+/- defunctioning stoma)

Question 88

Anal verge

Answer 88

Abdomino-perineal excision of rectum- none

Question 89

What is the resection of the sigmoid colon and an end colostomy fashioned in the operation called?

Answer 89

Hartmann's procedure

Question 90

Hypocalcaemia?

Answer 90

CATS go numb: Hypocalcaemia: Convulsions Arrhythmia (and long QT) Tetany Spasm - Chvostek and Trousseau signs (go) Numb - paraesthesia

Question 91

Imaging for multiple myeloma?

Answer 91

Whole-body MRI

Question 92

Premenstrual syndrome (PMS)?

Answer 92

Emotional and physical symptoms in the luteal phase of the normal menstrual cycle- anxiety, stress, fatigue, mood swings- bloating, breast pain Mild symptoms- lifestyle advice- low alcohol, regular meals, sleep, exercise, no smoking Moderate- may benefit from a new-generation COCP (example is Yasminu- drospirenone 3mg and ethinylestradiol) Severe symptoms may benefit from an SSRI

Question 93

How to tell heart rate/BP in a traumatic injury?

Answer 93

Fast and weak- there's a leak Slow and strong- something in the head wrong

Question 94

Cushing's triad from raised ICP?

Answer 94

Hypertension, bradycardia and irregular breathing Aimed at maintaining cerebral perfusion

Question 95

Which stomas need to be spouted vs not spouted?

Answer 95

Small bowel spouted- so that irritant contents do not come into contact with the skin Colonic stomas do not need to be spouted as their contents are less irritant

Question 96

If having a total colectomy which sort of stoma would be formed?

Answer 96

Ileostomy

Question 97

Location of stomas?

Answer 97

Ileostomy- right iliac fossa, spouted, output- liquid Colostomy- varies, more likely on the left side, flushed, output- solid

Question 98

EBV rash with what?

Answer 98

Amoxicillin

Question 99

EBV triad?

Answer 99

Sore throat, pyrexia, lymphadenopathy Other features: Malaise, anorexia, headache Palatal petechiae Splenomegaly Haemolytic anaemia secondary to cold agglutins (IgM) Maculopapular, pruritic rash with amoxicillin

Question 100

Infectious mononucleosis investigation?

Answer 100

Heterophil antibody test (Monospot tet)

Question 101

When is ECV offered?

Answer 101

36 weeks for nulliparous 37 weeks for multiparous If no contraindications: where caesarean delivery is required antepartum haemorrhage within the last 7 days abnormal cardiotocography major uterine anomaly ruptured membranes multiple pregnancy

Question 102

Hartmann's procedure?

Answer 102

Sigmoid colectomy and formation of end stoma Is the emergency operation for things like acute siverticulitis with perforation

Question 103

Which type of analgesia is best after surgery to reduce the chance of postoperative ileus and promote gastrointestinal motility?

Answer 103

Epidural analgesia- opioid/local anaesthetic

Question 104

Lynch syndrome surgery?

Answer 104

Panproctocolectomy- takes the colon sigmoid and rectum- reduce risk of further malignancies

Question 105

SLE management?

Answer 105

Basics- NSAIDs, sun-block Treatment of choice- hydroxychloroquine If internal organ involvement- renal, neuro, eye, consider prednisolone or cyclophosphamide

Question 106

Temporal arteritis eye problem summary?

Answer 106

Anterior ischaemic optic neuropathy whereby inflammation of the posterior ciliary arteries causes optic nerve infarction and subsequent vision loss

Question 107

Surgeries for the different aortic dissections?

Answer 107

Type A- Aortic route replacement surgery Type B- bed rest and beta blockers

Question 108

C-peptide levels in diabetes?

Answer 108

Type 1 diabetes- c-peptide levels are low Type 2 diabetes- c-peptide levels are high Diabetes specific antibodies point towards type 1

Question 109

Anticoagulation and head injury?

Answer 109

CT head within 8 hours

Question 110

Exam question fungal nail?

Answer 110

If more than 2 nails affected- oral terbinafine If less than that amorolfine nail lacquer Trichophyton rubrum is one of the most common dermatophyte nail infections

Question 111

Which echocardiogram investigation for dissection if too unstable for a CT?

Answer 111

Transoesophageal

Question 112

Causes of Horner's syndrome?

Answer 112

Symptoms- miosis, ptosis, usually anhidrosis Look on passmed for causes Some can cause no anhidrosis

Question 113

Mononeuritis multiplex?

Answer 113

RFs for it- diabetes, RA, amyloidosis, sarcoidosis Distribution of weakness/sensory loss that doesnt make sense >=2 single nerve lesion

Question 114

Intrahepatic cholestasis of pregnancy?

Answer 114

Pruritis Clinically detectable jaundice Raised bilirubin seen in >90% of cases Management Induction of labour at 37-38 weeks Ursodeoxycholic acid Vitamin K supplementation

Question 115

Gingival hyperplasia?

Answer 115

CCBs, Phenytoin, Tacrolimus/cyclosporin

Question 116

Thiazide diuretics electrolytes?

Answer 116

Hypokalaemia Hyponatremia Hypercalcaemia

Question 117

Recurrent episodes of otitis externa despite antibiotic treatment?

Answer 117

?Candida infection- especially if severe itching/ white, curd-like discharge Bacterial causes are staphylococcus aureus, pseuomonas aeruginosa Seborrhoeic dermatitis or recent swimming

Question 118

Tachycardia peri arrest?

Answer 118

Shock/hypotension/instability- Synchronised DC cardioversion Broad complex- amiodarone infusion Narrow complex- vagal manouvres then adenosine If narrow an irregular- follow A-Fib protocol If broad and irregular- specialist help

Question 119

Subclinical hypothyroidism?

Answer 119

TSH raised- T3, T4 normal TSH >10 and free thyroxine in normal range- consider offering levothyroxine if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart TSH between 5.5-10 and free thyroxine in normal range- if <65 considering offering 6 months levothyrooxine trial if the TSH level is 5.5 - 10mU/L on 2 separate occasions 3 months apart,and there are symptoms of hypothyroidism In older people watch and wait is often use If asymptomatic observe and repeat thyroid function in 6 months

Question 120

First line anticoagulant in reducing stroke risk?

Answer 120

DOACs

Question 121

Should tricyclic antidespressants be stopped in dementia?

Answer 121

Yes

Question 122

When would you start antihypertensives straight away if BP 180/120 or higher?

Answer 122

If evidence of target organ damage is identified- do not wait for ABPM or HBPM Such as blood in urine, vision changes

Question 123

First line drugs for spasticity in MS?

Answer 123

Baclofen Gabapentin

Question 124

Reducing the risk of relapses in MS?

Answer 124

Natalizumab

Question 125

Birth defects drug timing?

Answer 125

Lungs mature last, heart matures first For fluoxetine- First trimester- congenital heart defects Last trimester- persistent pulmonary HTN

Question 126

Broad vs narrow tachycardia?

Answer 126

Generally speaking- Broad is ventricular- treat with amiodarone Narrow is SVT- adenosine

Question 127

Conservative care for pneumothorax?

Answer 127

Primary spontaneous PTX- review every 2-4 days as an outpatient Secondary spontaneous PTX- monitor as inpatient

Question 128

MI secondary prevention drugs?

Answer 128

DABS Dual antiplatelet therapy ACEi Beta blocker Statin Ticagrelor and prausgrel more widely used- Post ACS medically managed- ticagrelor to aspirin- stop ticagrelor after 12 months Post PCI- add prausgrel or ticagrelor to aspirin- stop second antiplatelet after 12 months 12 month period can be altered for people at high risk of bleeding or those at high risk of further ischaemic events

Question 129

Stages of labour?

Answer 129

1st stage- onset of labour to full dilation Latent phase 0-3cm dilation Active phase 3-7cm dilation Transition 7-10cm dilation 2nd stage- from full dilation to delivery 3rd stage- from delivery to when the placenta and membranes have been completely delivered

Question 130

Post menopausal bleeding?

Answer 130

Endometrial cancer until proven otherwise All women over 55 who present with PMB should be referred using the suspected cancer pathway First investigation is a transvaginal ultrasound Hysteroscopy with endometrial biopsy Treated with surgery

Question 131

Punched out lesions?

Answer 131

Eczema herpeticum- severe primary infection of the skin by HSV 1 or 2 Most commonly seen in children with atopic eczema and presents with a rapidly progressing painful rash Potentially life-threatening- admit for IV aciclovir

Question 132

Gastric cancer investigations?

Answer 132

Diagnosis- oesophago-gastro-dudenoscopy with biopsy Signet ring cells may be seen in gastric cancer Staging- CT scan of chest, abdomen and pelvis Management- Surgical- gastrectomy Chemotherapy

Question 133

DMD Kawasaki heart problems?

Answer 133

Duchenne- dilated cardiomyopathy Kawasaki- coronary artery spasm

Question 134

DMD?

Answer 134

Progressive muscle weakness from 5, calf pseudohypertrophy, Gower's sign- child uses arms to stand from squatted position Investigation- raised CK and genetic testing Management- supportive

Question 135

Management of essential tremor?

Answer 135

Propanolol

Question 136

What are the heart sounds made by?

Answer 136

The valves closing S1- Mitral and tricuspid closing S2- aortic and pulmonary closing (S3 is sometimes normal in athletes, sometimes pathological)- rapid filling of ventricles during diastole (S4 always pathological- atrial contraction against stiff/non-compliant ventricle)

Question 137

Which drug is contraindicated in VT?

Answer 137

Verapamil- important

Question 138

Score for prediciting the severity of pancreatitis?

Answer 138

Modified Glasgow score PANCREAS Pa02 <8kPa Age >55 years Neutrophilia WBC >15x10^9 Calcium <2mmol/L Renal function Urea >16mmol/L Enzymes LDH >600 ; AST >200 Albumin <32g/L Sugar Blood glucose >10mmol/L

Question 139

GET SMASHED?

Answer 139

Passmed

Question 140

Asthma new guidelines

Answer 140

Diagnosis and treatment

Question 141

Which antibiotics can cause torsades de pointes?

Answer 141

Macrolides (azithromycin)

Question 142

Sexual history and knee pain?

Answer 142

Septic arthritis from Neisseria gonorrhoeae Gram negative diplococci

Question 143

Refractory anaphylaxis?

Answer 143

Ongoing anaphylactic reaction that persists despite being given 2 doses of IM adrenaline

Question 144

How to remember homonymous quadrantanopias?

Answer 144

PITS (Parietal-Inferior, Temporal-Superior)

Question 145

Craniopharyngioma vs pituitary tumour visual field defect?

Answer 145

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

Question 146

Surgery prep if a long fasting period of more than one missed meal or whose diabetes is poorly controlled?

Answer 146

Variable rate intravenous insulin infusion- (sliding scale)

Question 147

Difference between posterior MI and NSTEMI?

Answer 147

Tall R waves Posterior MIs cause: reciprocal changes in V1-3 horizontal ST depression tall, broad R waves upright T waves dominant R wave in V2

Question 148

Acanthosis nigricans is associated with which type of cancer?

Answer 148

Gastrointestinal cancer

Question 149

What causes acanthosis nigricans?

Answer 149

T2DM GI cancer Obesity PCOS Acromegaly Cushing's disease Hypothyroidism

Question 150

Management of tension PTX?

Answer 150

Decompression of the pleural space Needle thoracostomy (decompression) second intercostal space mid clavicular line on affected side first as quicker in emergency Place a chest drain in the triangle of safety Tension PTX should be diagnosed clinically

Question 151

Head CT within 1 hour?

Answer 151

GCS < 13 on initial assessment GCS < 15 at 2 hours post-injury suspected open or depressed skull fracture any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign). post-traumatic seizure. focal neurological deficit. more than 1 episode of vomiting

Question 152

CT head within 8 hours?

Answer 152

CT head scan within 8 hours of the head injury - for adults with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury: age 65 years or older any history of bleeding or clotting disorders including anticogulants dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs) more than 30 minutes' retrograde amnesia of events immediately before the head injury

Question 153

Bloody diarrhoea, abdominal pain and fever after dodgy food?

Answer 153

Campylobacter Crampylobacter Usually self limiting First line antibiotic would be clarithromycin

Question 154

Most common cause IE?

Answer 154

S.aureus- especially in IVDUs Staph epidermis is common after surgery due to indwelling lines

Question 155

In which MI complication is ESR elevated?

Answer 155

Dressler's syndrome

Question 156

RIPE ONGO?

Answer 156

RIPE ONGO Rifampicin: Orange secretions Isoniazid: Neuropathy- prevent with pyridoxine (Vit B6) Pyrazinamide: Gout Ethambutol: Optic Neuritis

Question 157

Gonorrhoea management?

Answer 157

Gram negative diplococcus 1st- Ceftriaxone If sensitive to ciprofloxacin- give that instead If refuse needle- cefixime oral and azithromycin oral

Question 158

What causes Lyme disease?

Answer 158

Borrelia burgdorferi Early features- Erythema migrans- bullseye rash- develops on 1-4 weeks Systemic- headache, lethargy, fever, arthralgia Later features- Cardio- heart block, myocarditis Neuro- meningitis, facial nerve palsy

Question 159

Lyme disease investigation?

Answer 159

If erythema migrans is present- start antibiotics Enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi is first line If negative but still suspected or positive and immunoblot test should be done It is a spirochaete (like syphilis)

Question 160

Management of lyme disease?

Answer 160

Doxycycline Ceftriaxone if disseminated disease Jarisch-Herxheimer may be seen (also seen in syphilis)- fever, rash, tachycardia after first dose of antibiotic

Question 161

Only two BBs with evidence in heart failure?

Answer 161

Bisoprolol, carvedilol, nebivolol

Question 162

Rare but important side effect of DPP4-inhibitors such as sitagliptin?

Answer 162

Pancreatitis

Question 163

What should patients with MI secondary to cocaine be given?

Answer 163

Benzodiazepine first line If chest pain- benzo + glyceryl trinitrate BB poor evidence but arguements for/against

Question 164

Adverse effects of cocaine?

Answer 164

Cardiovascular- coronary artery spasm, hypertension Neurological- seizures

Question 165

Impetigo return to school?

Answer 165

48 hours after treatment

Question 166

Impetigo treatment?

Answer 166

Hydrogen peroxide 1% cream if systemically well Topical fusidic acid Extensive disease- oral flucloxacillin

Question 167

Legionella treatment?

Answer 167

Macrolides such as clarithromycin

Question 168

Diagnostic investigation for Legionella?

Answer 168

Urinary antigen

Question 169

Legionella symptoms?

Answer 169

Flu-like symptoms including fever Dry cough Relative bradycardia Confusion Mid-lower zone patchy consolidation

Question 169

Epilepsy treatment?

Answer 169

Generalised- M- Sod Val F- Lam/leve Focal- Both- Lam/leve 2nd- Carbamazepine Absence-Both- Ethosuximide 2nd- F- Lam/leve M- Sod Val Atonic- F- Lam M- Sod Val Myclonic- F- Leve M- Sod Val

Question 169

In acute mitral regurgitation (rupture of the papillary muscle) what else can occur?

Answer 169

Acute hypotension and pulmonary oedema

Question 169

Status epilepticus definition?

Answer 169

Single seizure lasting >5 mins or >=2 seizures within a 5-minute period without the person returning to normal between them

Question 169

Which drug reduces the risk of calcium oxalate stones recurring?

Answer 169

Bendroflumethiazide

Question 169

Status epilepticus treatment pathway?

Answer 169

ABC- airway adjunct, oxygen, check blood glucose First-line- benzodiazepines Pre-hospital- PR diazepam or buccal midazolam In hospital- IV lorazepam, repeated once after 5-10 mins If ongoing status epilepticus appropriate to start a second-line agent such as levetiracetam, phenytoin or sodium valproate If no response within 45 minutes- refractory status- best way to achieve rapid control of seizure activity is induction of general anaesthesia or phenobarbital

Question 170

COCP cancer risks?

Answer 170

Increased risk of breast and cervical Protective against ovarian and endometrial

Question 171

What can cause ascites?

Answer 171

History of alcohol excess, cardiac failure can

Question 172

Women with breast cancer and no palpable lymphadenopathy, if pre-operative axillary ultrasound negative, management?

Answer 172

Sentinel node biopsy to assess nodal burden

Question 173

Which infection can cause lactose intolerance and foul smelling floating stool?

Answer 173

Giardia lamblia- giardiasis RFs- foreign travel Features: often asymptomatic non-bloody diarrhoea with steatorrhoea Bloating, abdo pain Lethargy Malabsorption and lactose intolerance Stool microscopy for trophozoite and cysts Treatment is with metronidazole

Question 174

Can myocarditis have ST elevation?

Answer 174

Yes, myocarditis can have ST elevation and it can be in a specific area of the heart- in contrast to pericarditis where the ST elevation is usually more widespread (affects the pericardial sack which is around the whole heart) Myocarditis can also caused raised troponin/cardiac enzymes Suspect it as more likely than MI in younger patients Preceding flulike illness is characteristic and most common cause is viral

Question 175

Myocarditis?

Answer 175

Inflammation of the myocardium- paticularly consider it in younger patients with chest pain Causes- viral- cocksakie (bacterial, spirochaetes (lyme disease) Presentation- young patient with chest pain, SOB, arrythmias Raised inflammatory markers, raised cardiac enzymes, ST elevation on ECG Tx cause- supportive or antibiotics if bacterial

Question 176

Rough/sandpaper/course rash?

Answer 176

Scarlet fever Caused by streptococcus pyogenes ORal penicllin V for 10 days

Question 177

MDMA (ecstasy) poisoning?

Answer 177

Hyponatremia Neuro- agitation, anxiety, confusion, ataxia Cardio- tachycardia, hypertension Hyperthermia Rhabdomyolysis Supportive Dantrolene for hyperthermia if simple measures fail

Question 178

PSC positive finding?

Answer 178

p-ANCA (also found in UC and autoimmune hepatitis) Some others Anti-dsDNA- SLE Anti-CCP- RA

Question 179

What do all cases of pneumonia get?

Answer 179

Repeat chest x-ray at 6 weeks after clinical resolution- ensure consolidation resolved and no underlying pathologies (such as a lung tumour)

Question 180

Breast cancer screening age?

Answer 180

50-70 years (mammogram every 3 years)

Question 181

What should be co prescribed when starting allopurinol for gout prevention?

Answer 181

Colchicine

Question 182

Aplastic crisis in sickle cell?

Answer 182

Pancytopenia- severe drop in haemoglobin Decreased reticulocyte count

Question 183

Haemolytic crisis in sickle cell?

Answer 183

Rare- severe anaemia and jaundice

Question 184

Acute chest syndrome in sickle cell?

Answer 184

Chest pain, cough, wheeze, SOB, tachypnoea Pulmonary infiltrates Vaso-occlusive crisis of the lungs

Question 185

Sequestration crisis?

Answer 185

This would present with abdominal pain, signs of haemodynamic compromise and hepatomegaly/splenomegaly. Pooling of blood in the spleen occurs, leading to severe anaemia and haemodynamic collapse Increased reticulocyte count

Question 186

Vaso-occlusive crisis?

Answer 186

These could affect different organs, but would typically present with the development of acute pain due to microvascular occlusion. Other presentations include dactylitis, cerebral infarction, mesenteric ischaemia, avascular necrosis of the femoral head or priapism

Question 187

Is doxycycline contraindicated in pregnancy?

Answer 187

Yes

Question 188

What is considered early menarche?

Answer 188

Before age 12

Question 189

Does HRT increase cancer risk?

Answer 189

If progestogen is added- it increases the risk of breast cancer Increased risk of endometrial cancer if oestrogen given without progestogen- adding progestogen lowers the risk but not completely Increased risk of VTE Transdermal HRT does not increase the risk of VTE Increased risk of stroke Increased risk of ischaemic heart disease

Question 190

Polycythemia vera associated with which mutation?

Answer 190

JAK2

Question 191

Anticoaglation to prevent stroke in AF?

Answer 191

DOACs Warfarin 2nd line

Question 192

Actinic keratoses management?

Answer 192

Avoid sun Fluorouracil cream Topical diclofenac

Question 193

Autoimmune haemolytic anaemia?

Answer 193

Anaemia Reticulocytosis Raised LDH Low haptoglobin Blood film- spherocytes and reticulocytes Specific to autoimmune haemolytic anaemia- positive direct antiglobulin test (Coomb's test) Most common type of AIHA- warm AIHA- idiopathic, SLE, neoplasia Management Treat underlying disorder Steroids (+/- rituximab) used 1st line In cold AIHA usually IgM

Question 194

PULSELESS ELECTRICAL ACTIVITY?

Answer 194

NOT A SHOCKABLE RHYTHM

Question 195

Investigations for pericarditis?

Answer 195

ECG- Saddle shaped ST elevation, PR depression- most specific ECG marker for pericarditis All patients with suspected acute pericarditis should have TRANSTHORACIC ECHOCARDIOGRAPHY Elevated inflammatory markets and possibly troponin

Question 196

Treatment of pericarditis?

Answer 196

Combination of NSAIDs and colchicine

Question 197

Sites for venous and arterial ulcer?

Answer 197

Venous- above medial malleolus- painless Compression bandaging Arterial- occurs on the toes and heel Punched out appearance Painful

Question 198

Difference between somatisation disorder and illness anxiety disorder (hypochondriasis)?

Answer 198

Somatisation- worrying about symptoms present for at least 2 year Illness anxiety disorder- persistent belief in the presence of an underlying serious disease

Question 199

SSRI and NSAID?

Answer 199

GI bleeding risk give a PPI

Question 200

Rickets vs osteomalacia?

Answer 200

Rickets is vitamin D deficiency in children, osteomalacia is vitamin D deficiency in adults

Question 201

Osteomalacia?

Answer 201

Features- Bone pain Bone/muscle tenderness Fractures- especially femoral neck Proximal myopathy- may lead to waddling gait Ix- Low vitamin D levels Low calcium/phosphate Raised ALP X-ray- translucent bands Vit D supplementation Calcium supplementation

Question 202

Retinal detachment?

Answer 202

Presence of darkening or shadows in peripheral vision New flashes and floaters No pain Straight lines appear curved

Question 203

Key features of frontotemporal dementia?

Answer 203

Disinhibition- socially inappropriate behaviour Apathy/inertia Loss of sympathy/empathy Perseverative/compulsive behaviours Hyperorality Executive dysfunction with relative sparing of memory and visuospatial functions Onset before 65 Insidious onset Relatively preserved memory/ visuospatial skills Personality change and social conduct problems Not recommended to use AChE inhibitors or memantine in people with frontotemporal dementia

Question 204

T score interpretation?

Answer 204

-1 to -2.5 indicates osteopenia -2.5 or lower indicates osteoporosis T score compares to mass of young reference population- Z score is adjusted for age, gender and ethnic factors

Question 205

Chicken pox complications?

Answer 205

Secondary bacterial infections: NSAIDs may increase the risk Small area of cellulitis- some patients may have invasive group A streptococcal soft tissue infections resulting in nec fasc Rare: Pneumonia Encephalitis Disseminated haemorrhagic chickenpox Arthritis, nephritis and pancreatitis

Question 206

Can you get anosmia in Parkinson's?

Answer 206

Yes often an early sign

Question 207

Do you have to have protein urea for pre-eclampsia?

Answer 207

No, The current formal definition is as follows new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following: proteinuria other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction

Question 208

Upper GI bleed/ ulcer with peritonitis?

Answer 208

? Perforated peptic ulcer Epigastric pain later becoming more generalised Diagnosis largely clinical Upright CXR is required with acute upper abdo pain Many with perforated ulcer will have free air under diaphragm

Question 209

Insulin sick day rules?

Answer 209

Carry it on as normal Make sure to maintain good fluid intake

Question 210

Sick day rules for oral hypoglycaemics?

Answer 210

Temporarily stop most of them Metformin Sulfonylureas SGLT-2 inhibitors GLP-1

Question 211

Impulse control disorders are linked with which type of Parkinson's medication?

Answer 211

Dopamine receptor agonists

Question 212

Cervical screening?

Answer 212

25-49- 3 yearly 50-64- 5 yearly

Question 213

Chronic alcohol electrolyte disturbance?

Answer 213

Hypomagnesaemia

Question 214

Patient on warfarin/DOAC/bleeding disorder with suspected TIA?

Answer 214

Imaging immediately to exclude a haemorrhage

Question 215

TIA further investigation?

Answer 215

Carotid duplex ultrasound if elegible for carotid intervention

Question 216

CTPA vs V/Q scan?

Answer 216

CTPA is preferred V/Q scan is investigation of choice in renal impairment

Question 217

Food poisoning organisms?

Answer 217

Staph Aureus- Short incubation Bacillus cereus- rice

Question 218

Traveller's diarrhoea cause?

Answer 218

E.Coli- watery stools, abdo cramps and nausea

Question 219

Prolonged bloody diarrhoa?

Answer 219

Incubation period > 7 days Giardiasis- prolonged and NON-bloody Amoebiasis- gradual onset bloody diarrhoea, abdo pain and tenderness which may last for several weeks

Question 220

Carbon monoxide poisoning?

Answer 220

May be a discrpancy between peripheral oxygen saturations but they may have low oxygen on a blood gas Aim for sats of 100% Questions hint at badly maintained houses

Question 221

Sepsis catagorisation score?

Answer 221

Sequential (Sepsis-Related) Organ Failure Assessment Score (SOFA)

Question 222

When is the lactational amenorrhoea method effective?

Answer 222

<6 months post-partum, the women is fully breastfeeding and amenorrhoeic

Question 223

Screening tool for malnutrition?

Answer 223

Malnutrition Universal Screening Tool (MUST)

Question 224

Positive D-dimer, negative ultrasound in DVT?

Answer 224

Stop antigcoagulation, US again in a week

Question 225

SLE investigations?

Answer 225

ANA positive Anti-dsDNA ESR to monitor, CRP usually normal unless inefection Complement levels (C3, C4) are low during active disease

Question 226

eGFR and opioids in palliative care?

Answer 226

<10 = fentanyl/buprenorphine 10-50 = oxycodone >50 = morphine

Question 227

Risk factors for developmental dysplasia of the hip?

Answer 227

Female sex Breech presentation Positive family history First born Oligohydraminos Birth weight >5kg

Question 228

DDH screening?

Answer 228

Following require routine ultrasound examination: First-degree family hip problems in early life Breech presentation at or after 36 weeks, irrespective of presentation at birth or mode of delivery All infants also screened at newborn and six week check using barlow and ortolani If infant over 4.5 months then x-ray if first line to look for DDH

Question 229

Barlow/Ortolani?

Answer 229

Balow- attempts to dislocate an articulated femoral head Ortolani- attempts to relocate a dislocated femoral head

Question 230

DDH management?

Answer 230

Most unstable hips spontaneously resolve by 3-6 weeks If not a Pavlik harness in children younger than 4-5 months Older children may require surgery

Question 231

Amiodarone in advanced life support?

Answer 231

300mg give after 3 shocks Further dose of 150mg given after 5 shocks For those who are in VF/pulseless VT

Question 232

Is there raised calcium in Paget's?

Answer 232

No ALP is raised

Question 233

Reasons for raised calcium in malignancy?

Answer 233

PTHrP (PTH related protein) from the tumour Bone metastases Myeloma

Question 234

Two main causes of hypercalcaemia?

Answer 234

Primary hyperparathyroidism Malignancy

Question 235

What cancer is associated with an unresolving left sided varicocele?

Answer 235

Renal tract cancer Triad of- haematuria, loin pain and abdominal mass

Question 236

Management renal cell carcinoma?

Answer 236

Nephrectomy- maybe partial if T1 tumour

Question 237

Migraine prophylaxis?

Answer 237

Topiramte or propanolol Propanolol CI in asthmatics

Question 238

Absent ankle jerks but brisk knee jerks?

Answer 238

Subacute combined degeneration of the spinal cord Also has a positive Romberg's sign

Question 239

Monitoring in HSP?

Answer 239

BP and urinalysis to detect progressive renal involvement

Question 240

Nephritic syndrome triad?

Answer 240

Oedema, hypertension and haematuria

Question 241

Meniscal tear key features?

Answer 241

Twisting, knee instability, giving way and locking due to displaced meniscal fragments Thessaly's test- weigh bearing at 20 degrees of knee fexion, positive if pain on twisting knee

Question 242

Difference between episcleritis and scleritis?

Answer 242

Scleritis is painful wheras episcleritis is not Scleritis is associated with RA and SLE Red eye, watering and photophobia are common, gradual decrease in vision Same day assessment by opthalmologist NSAIDs may be used first line

Question 243

Animal bite antibiotic?

Answer 243

Co-amoxiclav If penicillin allergic- doxycycline and metronidazole Co-amoxiclav also for human bites

Question 244

Kawasaki disease?

Answer 244

High grade fever > 5 days Conjunctival infection Bright red, cracked lips Strawberry tongue Cervical lymphadenopathy Red palms on the hands/soles of feet Clinical diagnosis Management: High-dose aspirin IV immunoglobulin Echocardiogram Complications- Coronary artery syndrome

Question 245

Raised ICP and LP in meningitis?

Answer 245

Contraindicated

Question 246

Exacerbating factors for myasthenia gravis?

Answer 246

Beta blockers Penicillamine Lithium Quinidine Phenytoin Antibiotics- gentamicin, macrolides, quinolones, tetracyclines

Question 247

Meningitis LP?

Answer 247

From a comment on another question: 1) Is CSF glucose < half of serum glucose? Yes = bacteria, no = viral 2) Are lymphocytes or polymorphs predominant? Lymphocytes = TB (if bacterial), viral, or fungal. Polymorphs = non-TB bacteria

Question 248

Most likely cause of irregular broad complex tachycardia in an unstable patient?

Answer 248

Atrial fibrillation with bundle branch block

Question 249

What is penicillamine used for?

Answer 249

Wilson's Chelates copper Alternatively- trientine hydrochloride

Question 250

Causes of erythema nodosum?

Answer 250

NO - idiopathic D - drugs (penicillin sulphonamides) O - oral contraceptive/pregnancy S - sarcoidosis/TB U - ulcerative colitis/Crohn's disease/Behçet's disease M - microbiology (streptococcus, mycoplasma, EBV and more)

Question 251

RA initial investigations?

Answer 251

Antibodies- Rheumatoid factor Anti-cyclic citrullinated peptide antibody (Anti-CCP)- may be detectable up to 10 years before the development of arthritis, much more specific than rheumatoid factor X-ray of the hands and feet

Question 252

ANA positive condition?

Answer 252

SLE Also Anti-dsDNA

Question 253

When do you have to stop drinking clear fluids before surgery?

Answer 253

You are allowed to drink up until 2 hours before the operation Non-clear liquids/fluids is 6 hours before the operation

Question 254

UTI in the third trimester?

Answer 254

Use amoxicillin or cefalexin Nitrofurantoin CI in the third trimester

Question 255

Presenting features of biliary atresia?

Answer 255

Presents in the first few weeks of life with: Jaudice- extending beyond the physiological two weeks Dark urine, pale stools Appetite and growth disturbance, although may be normal in some cases Signs- Jaundice Hepatomegaly with splenomegaly Abnormal growth Conjugated bilirubin is abnormally high Surgical intervention is the only definitive treatment

Question 256

Massive painless bleed in infant?

Answer 256

Meckel's diverticulum Congenital diverticulum Usually asymptomatic- can have abdo pain mimicking appendicitis, rectal bleeding, intestinal obstruction

Question 257

Urine osmolality after fluid deprivation: Low Urine osmolality after desmopressin: Low ?

Answer 257

Nephrogenic diabetes insupidus

Question 258

Anticoagulation even after a single episode of resolved AF?

Answer 258

Yes- calculate CHADSVASC

Question 259

A key investigation for acute mesenteric ischaemia?

Answer 259

Venous blood gas- would show raised lactate Also a CT angiogram abdo and pelvis with contrast is needed

Question 260

Drugs that cause gynaecomastia?

Answer 260

DISCO Digoxin Isoniazid Spironolactone Cimetidie Oestrogen

Question 261

COPD not controlled with SABA, LABA and ICS?

Answer 261

Triple therapy- LAMA, LABA and ICS Keep on SABA, switch to SABA if it is a SAMA Basically add tiotropium- LAMA

Question 262

What to do before starting azithromycin prophylactically in COPD?

Answer 262

ECG to exclude QT prolongation as azithromycin can prolong thw QT interval Also- CT thorax and sputum culture

Question 263

Third nerve palsy pupil dilated?

Answer 263

Surgical cause- CT head/refer to neurosurgery

Question 264

What causes Hand, Foot and Mouth disease?

Answer 264

Coxsackie, enterovirus Features: Mild systemic upset- sore throat, fever Oral ulcers Followed by vesicles on the palms and soles of feet Symptomatic treatment only- no school exclusion

Question 265

What does fetal fibronectin (fFN) detect?

Answer 265

Labour Highly sensitive, not very specific

Question 266

Why give steroids if looking like premature labour?

Answer 266

To mature the foetal lungs

Question 267

Marker for neuropaenic sepsis?

Answer 267

Known cause of neutropenia and a temperature of >38 degrees

Question 268

Triad for reactive arthritis?

Answer 268

Urethritis, conjunctivitis and arthritis Post-STI, post-dysenteric

Question 269

Breast eczema starting at the nipple?

Answer 269

If it starts at the nipple- it is Paget's disease of the breat If it doesn't start at the nipple just areola- it is eczema

Question 270

Differentiate between ductal or lobular carcinoma in situ?

Answer 270

Calcification is seen more in ductal than lobular- means it is visible on a mammorgram Invasive ductal carcinoma are the most common type of breast cancer

Question 271

Severe hepatitis in pregnany women?

Answer 271

Think hepatitis E

Question 272

Seizure by location?

Answer 272

Temporal- rising epigastric sensation, deja vu, jamais vu, (less common auditory, olfactory hallucinations), automatisms are common- lip plucking/smacking/grabbing Frontal- head/leg movements, posturing, post-ictal weakness, Jacksonian march Parietal lobe- parasthesia Occipial lobe- floaters/flashes

Question 273

When to give baby vaccines in hospital environment?

Answer 273

If born before 28 weeks

Question 274

Characteristic biochemistry for tumour lysis syndrome?

Answer 274

Hyperphosphatemia, hypocalcaemia and elevated renal markers- (AKI) Symptoms- Nausea, vomiting, weakness, muscle cramps

Question 275

LP findings in Guillain-Barre?

Answer 275

Rise in protein with a normal WCC Also, nerve conduction studies, decresed motor nerve conduction velocity due to demyelination

Question 276

Women between 16-32 weeks pregnant vaccine?

Answer 276

Whooping cough

Question 277

Cyanaotic heart diseases and what to give before surgery?

Answer 277

Prostoglandin E1- maintains the ductus arteriosus It is useful to remember the 5 T's for cyanotic congenital heart diseases (CHD): Tetralogy of fallot Transposition of great vessels (TGA) Tricuspid atresia Total anomalous pulmonary venous return Truncus arteriosus

Question 278

What closes the ductus arteriosis?

Answer 278

NSAIDs- indomethacin

Question 279

Test to differentiate normal neonatal cyanosis from cardiac causes?

Answer 279

The nitrogen washout test

Question 280

Chlamydia key symptoms?

Answer 280

Discharge, bleeding, dysuria Investigation- vulvovaginal swab for NAAT Men- urine first void sample

Question 281

Perthe's under 5?

Answer 281

No treatment usually resolves If over 5- surgery Hip pain over a few weeks, limp, stiffness and reduced range of movement X-ray- early changes

Question 282

Most common neurological infection seen in HIV?

Answer 282

Cerebral toxoplasmosis 2nd is CNS lymphoma

Question 283

Cerebral toxoplasmosis symptoms?

Answer 283

Constitutional symptoms, headache, confusion, drowsiness CT usually shows single or multiple ring enhancing lesions, mass effect may be seen Management: sulfadiazine and pyrimethamine

Question 284

CNS lymphoma (related to HIV and EBV)?

Answer 284

Single lesion, solid (homogenous) enhancement Thallium SPECT positive (cerebral toxoplasmosis is negative) Treat with dexamethasone, chemotherapy with or without whole brain irradiation

Question 285

Other neuro diseases in HIV?

Answer 285

Encephalitis Cryptococcus- most common fungal infection of CNS Progressive multifocal leukoencephalopathy (PML) AIDS dementia complex

Question 286

X-ray for osteoarthritis?

Answer 286

LOSS- Loss of joint space (joint space narrowing) Osteophyte formation Sclerosis Subchondral cysts

Question 287

What is the SAAG calculation to get the SAAG number?

Answer 287

Serum albumin- ascites albumin

Question 288

Different types of shock?

Answer 288

Septic Haemorrhagic Neurogenic Cardiogenic Anaphylactic

Question 289

EVAR or Open surgery for AAA?

Answer 289

Seems to be Open surgery- emergency or if no other major risk factors EVAR- if have risk factors for surgery

Question 290

Treatment of methotrexate toxicity?

Answer 290

Folinic acid

Question 291

Cremaster reflex absent on affected side, pain worsens on elevation?

Answer 291

Testicular torsion

Question 292

Elevation of testes relieves the pain + urinary symptoms?

Answer 292

Epididymyitis

Question 293

How to remember the effects of changing sodium rapidly?

Answer 293

Sodium high to low- the brain will blow- cerebral oedema Sodium low to high- the pons will die- central pontine myelinosis/osmotic demyelination syndrome

Question 294

Raised bilirubin, raised reticulocytes, anaemia with low MCV

Answer 294

Beta-thalassaemia

Question 295

Orbital cellulitis?

Answer 295

Unilateral swelling of the eye accompanied by proptosis and reduced eye movements May also be pain and other visual changes Medical emergency- admission to hospital, senior review and IV antibiotics CT with contrast sometimes used FBC Clinical examination mainy Swab for culture

Question 296

Treatment for otitis media with effusion (Glue ear)?

Answer 296

First presentation- active observation for 3 months Grommets Adenoidectomy

Question 297

Organic corneal foreign body?

Answer 297

If an organic thing is stuck in the eye- refer to opthalmology

Question 298

When does HIV seroconversion occur?

Answer 298

3-12 weeks

Question 299

Pneumonia causative organisms?

Answer 299

Klepsiella (KlepSTELLA) - alcoholics Streptococcus pneumoniae - most common cause for CAP. Mycoplasma pneumoniae - atypical, associated with erythema multiforme, haemolytic anaemia, ITP, diagnose with serology. Legionella pneumophila - another atypical, lymphopenia and hyponatraemia, recent holiday (air conditioning units), diagnose with urinary antigen. Staphylococcus aureus - most common in people after recent influenza infection

Question 300

Can essential tremor affect your voice?

Answer 300

Yes it can, soft and shaky with rhythmic changes

Question 301

Things that SLE causes?

Answer 301

SOAP BRAIN MD Serositis - Pleurisy, pericarditis Oral ulcers Arthritis Photosensitivity Blood disorders Renal involvement Antinuclear antibodies Immunologic phenomena Neurologic disorder Malar rash Discoid rash

Question 302

Rapid plasma reagin (RPR) test in syphilis?

Answer 302

How many times a solution has to be diluted so that the syphillis is undetectable 1 in 2 1 in 8 etc If it goes up on the repeat test- more dilutions needed- syphilis not treated successfully

Question 303

Anion gap calculation?

Answer 303

(Sodium + Potassium - (Chloride + Bicarbonate) Normal anion gap is 8-14

Question 304

Normal anion gap metabolic acidosis?

Answer 304

GI bicarb loss- diarrhoea Renal tubular acidosis Drugs- acetazolamide Addison's

Question 305

Raised anion gap metabolic acidosis?

Answer 305

Lactate- shock, hypoxia Ketones- DKA, alcohol Urate- renal failure Acid poisoning- salicylates, methanol

Question 306

Way to tell if NG tube positioned correctly on a CXR?

Answer 306

If below diaphragm- if where lung is not positioned correctly probably

Question 307

Are children with minimal change disease likely to have another episode?

Answer 307

2/3 do

Question 308

First line analgesia for shingles?

Answer 308

Paracetamol and NSAIDs Amitriptyline if not responding Oral corticosteroids may be considered in first 2 weeks if pain is severe and not responding to other treatments

Question 309

Guillain-Barre LP?

Answer 309

High protein with a normal WCC Other investigations: Nerve conduction studies- decreased motor nerve conduction velocity (due to demyelination)

Question 310

What needs to be done in patients starting long term steroids (over 3 months)?

Answer 310

First- correct any hypocalcaemia/ vitamin D deficiency Then give a bisphospohonate when the above has been done if needed Hypocalcaemia/vitamin D deficiency needs to be corrected before starting a bisphosphonate

Question 311

First line for campylobacter treatment?

Answer 311

Usually self limiting Treatment if severe symptoms (high fever, bloody diarrhoea, or more than eight stools per day), symptoms have lasted more than 1 week or immunocompromised First line is clarithromycin

Question 312

Placenta praevia what is CI?

Answer 312

If it is a possible diagnosis (previous scan shows low placenta, high presenting part on abdominal examination or the bleed had been painless) Digital vaginal examination should not be performed until an ultrasound has excluded placenta praevia You can however do a speculum however this is not diagnostic for placenta praevia

Question 313

Placenta praevia management?

Answer 313

If low-lying at 20-week scan: Rescan at 32 weeks No need to limit activity/intercourse unless they bleed If still presentat 32 weeks then scan every 2 weeks Final ultrasound at 36-37 weeks to determine the method of delivery Elective caesarean for grades III/IV between 37-38 weeks, if grade I then can trial vaginal I know PP goes into labour prior to elective caesarean do an emergency caesarean PP with bleeding Admit ABC Not stable- emergency caesarean In labour/term reached- emergency caesarean

Question 314

Do they screen for Hep B in pregnancy?

Answer 314

Yes

Question 315

Vaginal candidiasis treatment?

Answer 315

Oral fluconazole for single dose Clotrimazole intravaginal pessary single dose if oral therapy contraindicated If pregnant only local treatments

Question 316

Infantile colic vs spasms?

Answer 316

Colic- child distressed during spasms Spasms- distressed between spasms- EED- hypsarrhythmia commonly found in West's syndrome

Question 317

X-ray findings in ankylosing spondylitis?

Answer 317

Subchondral erosions, sclerosis and squaring of vertebrae

Question 318

Leukaemias?

Answer 318

ALL- most common in children AML- mostly adults, auer rods, ATRA CLL- Most common leukaemia overall, can transform to Non-hodgkin lymphoma (Richter transformation), smudge cells CML- Philadelphia chromosome, Imatinib

Question 319

Drugs exacerbating psoriasis?

Answer 319

Beta blcokers Lithium Alcohol NSAIDs ACEi Antimalarials (Quines)

Question 320

Which drugs can cause hypomagnesaemia?

Answer 320

Diuretics Proton pump inhibitors

Question 321

Most common organism generally in UK and in IVDUs in infective endocarditis?

Answer 321

Staph aureus

Question 322

Tricyclic vs SSRI overdose ECG?

Answer 322

Tricyclic- widening of the QRS SSRIs- prolongation of the QT

Question 323

Opening snap?

Answer 323

Mitral stenosis Operating System is MicroSoft

Question 324

Fragility fracture in those over 75 years old?

Answer 324

Start bisphosphonate without the need for a DEXA scan Wait until fracture healed to start bisphosphonate and check vit D/ calcium levels/correct them before starting

Question 325

Chronic insomnia?

Answer 325

Trouble falling or staying asleep at least three nights per week for 3 months or longer

Question 326

What is fostair and trimbow?

Answer 326

Fostair- inhaler with LABA and ICS Trimbow- inhaler with LABA + LAMA + ICS

Question 327

Alcohol withdrawl with liver cirrhosis?

Answer 327

Lorazepam not chlordiazepoxide

Question 328

Why does an alcohol binge lead to polyuria?

Answer 328

ADH suppression in the posterior pituitary gland

Question 329

Conducive hearing loss?

Answer 329

Anything stopping the sound getting to the ear- could be earwax

Question 330

Allopurinol and ACEi?

Answer 330

Contraindicated

Question 331

Oesophageal cancers?

Answer 331

Upper 2 thirds- squamous cell carcinoma (smoking, achalasia, alcohol) Lower third- adenocarcinoma- Barrett'sn GORD

Question 332

Open angle glaucoma management?

Answer 332

360 selective laser trabeculoplasty 1st line to people with IOP 24 or more Prostaglandin analogue eyedrops should be used next-line Next: Bet-blocker eyedrops Carbonic anhydrase inhibitor eye drops Sympathomimetic eye drops Surgery- trabeculectomy in refractory cases

Question 333

Prostoglandin analogues?

Answer 333

Latanoprost Increases uveoscleral outflow Adverse effects- brown pigmentation of the iris, increased eyelash length

Question 334

Beta-blockers- eye drops?

Answer 334

Timolol, betaxolol Reduces aqueous production Avoided in asthmatics or heart block

Question 335

Sympathomimetics- eye drops?

Answer 335

Brimonidine Reduces aqueous production and increases outflow Avoid if taking MAOI or tricyclic

Question 336

Haematuria malignancies?

Answer 336

Renal cell carincoma- painful or painless Urothelial malignancies- 90% are transitional cell carcinoma- can occur anywhere along the urinary tract- painless haematuria

Question 337

Symptoms of serotonin syndrome?

Answer 337

Hypertension, tachycardia, flushing and sweating, hyperflexia, clonus and muscle rigidity, fever, change in mental status- agitation

Question 338

Drugs causing serotonin syndrome?

Answer 338

Tramadol, SSRIs, MAOIs, triptans and St Johns wort Discontinue drugs and can give a benzodiazapine for agitation 5-HT antagonists- cyproheptadine and chlorpromazine are sometimes administered

Question 339

Can tramadol cause serotonin syndrome?

Answer 339

Yes

Question 340

What is PCP related to HIV?

Answer 340

Pneumocyctic jiroveci pneumonioa All patients with CD4 count under 200 should recieve PCP prophylaxis

Question 340

PCP features?

Answer 340

Dyspnoea Dry cough Fever Very few chest signs Pneumothorax common CXR typically bilateral interstitial pulmonary infliltrates Exercise-induced desaturation Management- co-trimoxazole

Question 341

C-peptide?

Answer 341

Made with insulin in the pancreas C-peptide levels low in T1DM High/normal in T2DM

Question 342

Investigation for T2DM for over 40 who respond well to oral hypoglycaemic agents?

Answer 342

C-peptide levels Diabetes-specific autoantibodies

Question 343

Neoplastic spinal cord compression?

Answer 343

(Cancer symptoms) Back pain- progressive, not relieved when lying down, worse when straining Reduced lower limb power and diminshed pinprick sensation Give dexamethasone and urgent MRI within 24 hours

Question 344

Child with hip pain and fever?

Answer 344

Refer for same-day assessment- potential for septic arthritis

Question 345

Dementia diagnosis?

Answer 345

Blood screen Neuroimaging- MRI Both before a diagnosis can be made

Question 346

If hypomagnesemia and hypokalaemia?

Answer 346

Treat/replace the magnesium first before the potassium Hypomagnesemia prevents potassium absorption

Question 347

Primary hyperparathyroidism most common cause?

Answer 347

Solitary adenoma

Question 348

Can statins cause rhabdomyolysis?

Answer 348

Yes

Question 349

Rhabdomyolysis treatment?

Answer 349

IV fluids

Question 350

Symptoms of oesophageal candidiasis?

Answer 350

Dysphagia can be a symptom Hisotry of HIV or steroid inhaler use

Question 351

Levodopa adverse effects from dosage?

Answer 351

End-of-dose wearing off- symptoms worsen towards the end of dosage interval On-off phenomenon- large variations in motor performance Dyskinesias at peak dose- dystonia, chorea and athetosis Do not stop levodopa acutely- if you do dopamine agonist patch as rescue medication if cannot take orally

Question 352

DVLA and psych?

Answer 352

Generally cannot drive during acute illness Can drive again if well and table for at least 3 months Adheres adequately to any agreed treatment plan Free from medication that would impair driving Subject to a suitable specialist report being favourable

Question 353

Angiodema medication?

Answer 353

ACEi A- Angiodema C- Cough E- Elevated potassium i- 1st dose hypertension

Question 354

Drugs making psoriasis worse?

Answer 354

BLANQ B- beta-blockers L- Lithium A- ACEi N- NSAIDs Q- Quinines

Question 355

Can smokers have a raised carboxyhaemoglobin without CO poisoning?

Answer 355

Yes- up to 10%

Question 356

Optic neuritis?

Answer 356

CRAP Central scotoma Relative afferent pupillary defect Acuity- unilateral decrease in visual acuity over hours/days Pain worse on eye movement Poor discrimination of colours- red desaturation Ix- MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases Management- high dose steroids

Question 357

Hip fracture management?

Answer 357

Intracapsular hip fracture: Undisplaced- fit- internal fixation, unfit- hemiarthroplasty Displaced- Arthroplasty if fit, hemiparthroplasty if unfit Extracapsular hip fracture Stable interrochanteric fractures- dynamic hip screw If reverse oblique, transverse or subtrochanteric- intramedullary device

Question 358

Croup emergency treatment?

Answer 358

High-flow oxygen Nebulised adrenaline

Question 359

Reed-Sternberg cells?

Answer 359

Hodgkin's lymphoma

Question 360

When do you have to stop eating non-clear liquids/food before surgery?

Answer 360

6 hours before Clear liquids is 2 hours before

Question 361

Unilateral glue ear in adult?

Answer 361

Refer on 2 week wait

Question 362

Correction of sodium pneumonic?

Answer 362

From High to Low your brain will blow = Cerebral oedema From Low to High your brain will die = Central pontine myelinolysis

Question 363

Anti- HBs Anti-HBc In hepatitis B?

Answer 363

Anti-HBs = Safe (Have immunity so either immunised or previously exposed, -ve in chronic disease) Anti -HBc = Caught (acquired infection at some point rather than immunised) HBsAg- Ongoing infection

Question 364

Anion gap?

Answer 364

↑AG → basically when you have added some acid (lactate, ketones, urate, aspirin, methanol) ↔AG → ABCD: Addisons; Bicarb loss (GI, RTA); Chloride (e.g. saline); Drugs (acetazolamide)

Question 365

Bilateral adrenocortical hyperplasia treatment?

Answer 365

Aldosterone antagonist- Spironolactone

Question 366

FeverPAIN?

Answer 366

Fever P- Purulent tonsils A- Adenopathy and comes on quick <3days I- Inflamed tonsils N- No cough or coryza

Question 367

Headaches worst in the morning and when lying down?

Answer 367

Raised ICP

Question 368

Treatment for MRSA positive on surgical screening?

Answer 368

Nasal mupirocin + chlorexidine for the skin

Question 369

Pelvic inflammatory disease treatment?

Answer 369

IM ceftriaxone stat + 14 days of oral doxycycline + oral metronidazole 2nd- Oral ofloxacin and oral metronidazole

Question 370

How do pancoast tumours cause a hoarse voice?

Answer 370

They suppress the recurrent laryngeal nerve

Question 371

Gonorrhoea organism?

Answer 371

Gram-negative diplococci

Question 372

CBT for schizophrenia?

Answer 372

Yes Schizophrenia management- Oral atypical antipsychotics are first -line CBT offered to all patients Close attention to cardiovascular risk-factor modification due to high rates in schizophrenic patients

Question 373

When to send a urine culture in non-pregnant women wit hUTI?

Answer 373

Over 65 Visible or non-visible haematuria

Question 374

Does psoriatic arthritis need to have skin changes?

Answer 374

No Often precedes the development of skin lesions

Question 375

Psoriatic arthritis vs ankylosing spondylitis?

Answer 375

DIP joint involvement + dactylitis + enthesitis = Think Psoriatic Arthritis. Back pain and sacroiliitis without peripheral joint involvement = Think Ankylosing Spondylitis.

Question 376

First line treatment for PAD?

Answer 376

Statin- if established CVD Antiplatelet- clopidogrel is first-line in patients with PAD

Question 377

Stable angina investigations?

Answer 377

1st- contrast-enhanced CT coronary angiography

Question 378

Good way to check whether blurred vision is retractive or not?

Answer 378

Pinhole occluders

Question 379

What suggests a recently passed stone if not one on scan?

Answer 379

Periureteric fat stranding

Question 380

Menorrhagia treatment?

Answer 380

Doesn't need contraception: mefenamic acid or tranexamic acid- both started on first day of period Requires contraception- IUS- mirena first line COCP Long-acting progestogens

Question 381

Hoffman and Hoover tests?

Answer 381

HoFFman- finger flick- to see if reflex of index finger is exaggerated or not hOOver- differentiates between organic and non-organic paresis of the leg

Question 382

LESS vs LOSS- RA and OA?

Answer 382

Radiological features of RA: LESS L: loss of joint space E: erosions (late sign) as eroded something takes a while S: soft tissue swelling S: soft bones (osteopenia) (early sign) Radiological features of OA: LOSS L: loss of joint space O: osteophytes S: subchondral cysts S: subchondral sclerosis

Question 383

When fluid restriction in ascites?

Answer 383

If the sodium is <125mmol/L Spironolactone- especially if liver cirrhosis Drainage if tense ascites- large-volume paracentesis requires albumin cover

Question 384

Drug of choice in palliative care for reducing the discomfort of a painful mouth?

Answer 384

Benzydamine hydrochloride (mouthwash or spray)

Question 385

Post MI- left ventricular aneurysm?

Answer 385

Persistent ST elevating and left ventricular failure Thrombus may form within the aneurysm increase stroke risk- patient must be anticoagulated

Question 386

Features of serotonin syndrome?

Answer 386

Sweating, tremor, confusion and hyperreflexia

Question 387

Blood stained nipple discharge?

Answer 387

Intraductal papilloma Common in younger patients

Question 388

Thick, green nipple discharge, non-bloody?

Answer 388

Mammary duct ectasia Most common in menopausal women Smokers

Question 389

FSH/LH in developmental disorders?

Answer 389

KALLman- FALL (Low FSH & LH) TURNer- TURNed up (High FSH/LH)

Question 390

HIV diagnosis?

Answer 390

HIV antibodies p24 antigen Combination tests- (HIV p24 antigen and HIV antibody) are now standard for HIV diagnosis and screening Testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure After an initial negative result when testing for HIV in an asymptomatic patient, offer a repeat test at 12 weeks

Question 391

Vision colour change after drugs?

Answer 391

Sildenafil- blue tinge to vision called cyanopsia Digoxin- can cause visual disturbances such as blurry vision, halos around lights and yellow-greeen colour perception

Question 392

Treatment for legionella?

Answer 392

Erythromycin/clarithromycin Diagnostic test of choice- urinary antigen May be a hyponatremia present

Question 393

Woman over 30 with unexplained breast lump?

Answer 393

Urgent referral using suspected cancer pathway If under 30 it would be a non urgent referral Refer if over 50 with discharge, retraction or other changes in one nipple

Question 394

Oral or IV aciclovir for chickenpox in pregnancy?

Answer 394

Oral aciclovir

Question 395

PMS managment?

Answer 395

Mild- lifestyle advice Moderate- new generation COCP- Yasminu (drospirenone 3mg and ethinylestradiol) Severe- SSRI- continuously or just during the luteal phase of the menstrual cycle

Question 396

Two key investigations for rheumatoid arthritis?

Answer 396

Rheumatoid factor Anti-CCP

Question 397

First line for muscle spasticity in multiple sclerosis?

Answer 397

Baclofen, Gabapentin

Question 398

First line for reducing risk of relapse in MS?

Answer 398

Natalizumab

Question 399

Specific drugs in MS?

Answer 399

Fatigue- exclude other problems- amantadine Spasticity- baclofen and gabapentin first line Bladder dysfunction- ultrasound first to assess bladder emptying If significant residual volume- intermittent self-catheterisation If no significant resifual volume- anticholinergics may improve frequency Oscillopsia (visual fields appear to oscillate)- gabapentin is first line

Question 400

Amiodarone in ALS?

Answer 400

300mg after 3 shocks Further dose of 150mg for after 5 shocks For patients in VF/pulseless VT Lidocaine is an alternative if amiodarone is not available

Question 401

Drugs causing torsades de points (long QT and polymorphic ventricular tachycardia)?

Answer 401

ABCDE A- AntiArrythmetics B- AntiBiotics C- AntiCychotics D- AntiDepressants E- AntiEmetics Basically Tricyclics Antipsychotics Erythromycin Hypothermia Subarachnoid haemorhage Chloroquine

Question 402

Pre-eclampsia tirad?

Answer 402

New-onset hypertension Proteinuria Oedema

Question 403

How is osteomyelitis diagnosed?

Answer 403

MRI Osteomriitis

Question 404

Remember diabetic foot ulcer can lead to osteomyelitis

Answer 404

/

Question 405

First line antiemetic for nausea and vomiting due to raised ICP?

Answer 405

Cyclizine Dexamethasone can also be used

Question 406

How long c.diff stay in a side room?

Answer 406

Until at least 48 hours after last episode of diarrhoea

Question 407

Developmental dysplasia of the hip?

Answer 407

Ultrasound- unless over 4.5 months and then x-ray Management- Most spontaneously stabilise by 3-6 weeks of age Pavlik harness- children younger than 4-5 months Older children my require surgery

Question 408

Diagnostic investigation for lymphoma?

Answer 408

Excisional node biopsy- Burkitt's starry sky appearance

Question 409

Thiazides side effects?

Answer 409

HyperGLUC High glucose High lipids High uric acid High calcium (but low in urine so can be used for stones)

Question 410

Lung cancers and paraneoplastic syndromes?

Answer 410

SCLC ADH ACTH Lambert-Eaton syndrome SCC Parathyroid hormone-related protein Adenocarcinoma Gynaecomastia

Question 411

Does the malar rash spare nasolabial folds in SLE?

Answer 411

Yes

Question 412

Most important opioid conversions to remember?

Answer 412

PO morphine to SC- divide by 2 PO codeine to PO morphine- divide by 10

Question 413

Heart failure and hypertension?

Answer 413

Cannot give CCBs such as nifedipine Only amlodipine

Question 414

Under 3 with a limp?

Answer 414

Specialist referral

Question 415

When to refer for carotid endarterectomy in TIA/stroke?

Answer 415

Within the distribution of the carotid artery 50-99% stenosis evaluated for possible enarterectomy The endarterectomy should be performed on the side of the brain that had the stroke- so if symptoms on the right hand side do it on the left

Question 416

TIA preferred investigation?

Answer 416

MRI- including diffusion-weighted and blood-sensitive

Question 417

Side effects of lithium?

Answer 417

LITHIUM Lethargy Insipidus (diabetes) Tremor Hypothyroidism Insider (gastrointestinal) Urine (increased) Metallic taste

Question 418

Kaposi's sarcoma?

Answer 418

Purple papules or plaques on the skin or muscosa Caused by HHV-8 Link to HIV

Question 419

Side effects of levothyroxine therapy?

Answer 419

Hyperthyroidism- overtreatment Reduced bone mineral density Worsening of angina AF

Question 420

Levothyroxine interactions?

Answer 420

Iron, calcium carbonate Absorption of levothyroxine is reduced, give at least 4 hours apart

Question 421

Loop and end stoma difference?

Answer 421

Loop has two openings End has one

Question 422

Malnutrition criteria?

Answer 422

BMI less than 18.5 Unintentional weight loss greater than 10% within the last 3-6 months BMI of less than 20 and unintentional weight loss greater than 5% within the last 3-6 months

Question 423

Puerperal pyrexia?

Answer 423

Causes: Endometritis- most common UTI Wound infections- perineal tears + caesarean section Mastitis VTE If endometritis suspected patient should be referred to hospital for IV antibiotics (clindamycin and gentamicin) until afebrile for greater than 24 hours

Question 424

HIV and adrenal insufficiency?

Answer 424

Adrenal insufficiency affects around 10% of HIV patients

Question 425

Hashimoto's thyroiditis other name?

Answer 425

Autoimmune thyroiditis

Question 426

After the menopause breast cancer?

Answer 426

Anastrozole/Letrozole

Question 427

Haemorrhageg after tonsillectomy?

Answer 427

Primary haemorrhage- occurs within the first 6-8 hours folowing surgery- immediate return to theatre Secondary haemorrhage- 5-10 days after surgery- associated with wound infection- admission and antibiotics

Question 428

Lower lobe fibrosis causes? (everything else assume upper zone)

Answer 428

DAIM Drugs- amiodarone + bleomycin + methotrexate Asbestosis Idiopathic Most connective tissue disorders except ankylosing spondylitis

Question 429

Occupational asthma investigation?

Answer 429

Serial measurements of peak expiratory flow at and away from work

Question 430

Is abnormal head impulse test in HiNTs exam vestibular neuronitis or posterior circulation stroke syndrome?

Answer 430

Vestibular neuronitis

Question 431

Impaired fasting glucose/impaired glucose tolerance?

Answer 431

Impaired fasting clucose- 6.1-7 Impaired glucose tolerance- OGTT 2-hour value 7.8-11.1

Question 432

Aspirin or no aspirin in TIA?

Answer 432

Aspirin If on blood thinners get a CT head first to rule out haemorrhage even though symptoms have resolved

Question 433

Malaria symptoms?

Answer 433

Intermittent fevers, myalgia and headaches Thrombocytopenia and presence of trophozoites on a blood film If falciparum malaria give aresunate If not falciparum can also give chloroquine

Question 434

Hypocalcaemia ECG?

Answer 434

Prolonged QT Rememver Trousseau's and Chvostek's sign

Question 435

Different types of Hodgkin's lymphoma?

Answer 435

Most common- nodular sclerosing Best prognosis- lymphocyte predominant Worst prognosis- lymphocyte depleted

Question 436

Hypercalcaemia ECG?

Answer 436

Shortening of the QT interval

Question 437

Haemophillia and factors?

Answer 437

Haemophilia A- VII (8) Haemophilia B- IX (9)

Question 438

PITS and optic radiations?

Answer 438

PITS refers to the visual field- Parietal inferior, temporal superior. Optic radiatons are opposite so it would be a superior optic radiation in the parietal lobe

Question 439

Coarse crackles, haemoptysis, clubbing, persistent productive cough, SOB, wheezing?

Answer 439

Bronchiectasis Permanent dilatation of the airways secondary to chronic infection or inflammation

Question 440

Back pain with bilateral leg neurological symptoms?

Answer 440

Lumbar discitis or abscess On a background of fever/sepsis

Question 441

Gluttae psoriasis?

Answer 441

After an infection 'Tear drop', scaly papules on trunk and limbs Most cases resolve spontaenously within 2-3 months Reassure and topical agents if symptomatic

Question 442

Anticoagulants in STEMI?

Answer 442

Always aspirin If PCI, then prasugrel (the Ps) If thrombolysis, then ticagrelor (the Ts) If on anti-coagulants then clopidogrel (the Cs)

Question 443

Neuropathic pain?

Answer 443

Do not stack drugs Switch from one monotherapy to another (diabetic neuropathy, post-herpatic neuralgia, trigeminal neuralgia, prolapsed intervertebral disc) First line- amitriptyline, duloxetine, gabapentin or pregabalin If first line doesn't work tey one of the other three- switch don't add Tramadol can be used as a rescue therapy for exacerbations of neuropathic pain

Question 444

Most common cancer for tumour lysis ayndrome?

Answer 444

Burkitt's lymphoma Starry sky appearance on microscopy Linked to Epstein-Barr virus

Question 445

Traveller's diarrhoea?

Answer 445

E.coli

Question 446

Antivirals for shingles?

Answer 446

Yes, for the majority of patients within 72 hours unless under 50 with mild pain and rash and no underlying features Antivirals reduce the incidence of post-herpatic neuralgia

Question 447

Bipolar types?

Answer 447

Type I disorder- mania and depression- most common Type II disorder- hypomania and depression

Question 448

Test for squint?

Answer 448

Corneal light reflection test Screening test for squint

Question 449

What is amblyopia?

Answer 449

The brain fails to fully process inputs from one eye and over time favours the other eye

Question 450

Types of squint?

Answer 450

Concomitant- imbalance in extraocular muscles- convergent more common than divergent Paralytic- due to paralysis of extraocular muscles

Question 451

BV treatment?

Answer 451

Oral metronidazole 5-7 days- even throughout pregnancy Topical metronidazole or topical clindamycin are alternatives

Question 452

Eczema herpeticum?

Answer 452

Worsening of eczema that requires IV antivirals Severe primary infection with HSV 1 or 2 Children with history of atopic eczrema and a rapidly progressing painful rash

Question 453

How does myoglobinuria cause renal failure?

Answer 453

Tubular cell necrosis

Question 454

How much to increase morphine by each time?

Answer 454

30-50%

Question 455

Disease with symptoms that mimic peripheral arterial disease but pain gets better/worse when walking uphill/downhill?

Answer 455

Lumbar spinal stenosis Claudication symptoms- sitting bettwe than standing and easier to walk uphill rather than downhill

Question 456

Aspirin overdose?

Answer 456

Ringing in ears Starts as a respiratory alkalosis- simulation of resp centre- turns into a metabolic acidosis- salicylic acid

Question 457

Peptic ulcer disease with perforation?

Answer 457

No OGD Do an erect chest x-ray to look for air under the diaphragm

Question 458

Critical limb ischaemia vs acute limb-threatening ischaemia?

Answer 458

Critical limb ischemia- more chronic comes on over time Acute limb-threatening ischaemia- more sudden onset

Question 459

Raised CRP and white cells after surgery?

Answer 459

Generally to be expected

Question 460

Common pneumonia after influenza infection?

Answer 460

S.Aureus

Question 461

Painful genital ulceration vs painless genital ulceration?

Answer 461

Painful- genital herpes Painless- syhphilis

Question 462

Investigation for genital herpes?

Answer 462

Nucleic acid amplification tests (NAAT) Painful genital ulceration- primary infection more severe than recurrent episodes Management- Saline, analgesia, topical anaesthetic agents Oral aciclovir

Question 463

ROSIER socre?

Answer 463

-1- loss of conciousness/syncope -1 seizure activity +1- asymmetric facial weakness +1- asymmetric arm weakness +1- asymmetric leg weakness +1- speech disturbance +1- visual field defect

Question 464

Bell's palsy where facial paralysis shows no sign of improvement after 3 weeks?

Answer 464

Refer urgently to ENT

Question 465

De Quervain's tenosynovitis?

Answer 465

Sheath containing extensor pollicis brevis and abductor pollicis longus tendons are inflamed Affects females 30-50 years old Pain on radial side of the wrist Tenderness over the radial styloid process Abduction of the thumb against resistance is painful Finkelstein's test- the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. Patient with tenosynovitis pain over radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus Management- Analgesia Steroid injection Immobilisation with thumb splint Surgical treatment

Question 466

Herpes 1 and 2?

Answer 466

HSV 1- most likely oral (cold sores) HSV 2- most likely genital herpes

Question 467

What to screen for when starting rituximab?

Answer 467

Could be for lymphoma treatment Screen for hepatitis B

Question 468

Which drugs do you screen for TB before starting?

Answer 468

Infliximab Etanercept

Question 469

Which cranial nerves are affected by vestibular schwannomas?

Answer 469

Cranial nerves V, VII and VIII Vertigo, sensorineural hearing loss, tinnitus Absent corneal reflex Facial palsy

Question 470

Pott's fracture?

Answer 470

Bimalleolar ankle fracture Forced foot eversion

Question 471

How long to be a depressive episode?

Answer 471

Two weeks

Question 472

Recurrent episode of C.difficile within how long give oral fidaxomicin?

Answer 472

Recurrent episode within 12 weeks- initially treated with oral vancomycin

Question 473

Fitz-Hugh-Curtis syndrome?

Answer 473

Complication of pelvic inflammatory disease Liver capsure becomes inflamed causing right upper quadrant pain Occurs in chlamydia or gonorrhoea

Question 474

Gluttate psoriasis?

Answer 474

Can be triggered by streptococcal throat infection

Question 475

CLL and new B-symptoms?

Answer 475

Richter's transformation- change from CLL to large cell lymphoma

Question 476

Way to remember the salter classification?

Answer 476

SALTR S- straight through A- above L- lower T- through all three R- rammed (crush or something)

Question 477

Schistosomiasis is associated with which type of cancer?

Answer 477

Squamous cell carcinoma of the bladder

Question 478

Tests important when starting TB drugs?

Answer 478

Liver funcion test Optic and renal tests for ethambutol Other drugs can all cause hepatitis

Question 479

Ankle fratures management?

Answer 479

Weber A- CAM boot with weight bearing Weber B- radiograph to assess syndesmosis + mortis for ankle stability. If instability- surgery. If not, CAM boot Weber C- fracture will most likely involve syndesmosis and ankle instability- requires surgery- ORIF

Question 480

Ottawa ankle rules?

Answer 480

X-rays only necessary if there is pain in the mallleolar zone and- inability to weight bear for 4 steps Tenderness over the distal tibia Bone tenderness over the distal fibula

Question 481

Hand preference before what age is abnormal?

Answer 481

12 months

Question 482

Milestone referral points?

Answer 482

No smile at 10 weeks Cannot sit unsupported at 12 months Cannot walk at 18 months Hand preference before 12 months abnormal- may indicate cerebral palsy

Question 483

Epididymo-orchitis?

Answer 483

Infection of the epididymis +/- testes resulting in pain and swelling Subacute onset of testicular pain and swelling associated with dysuria Pain relieved by elevating testes (positive Prehn's sign) which would be negative in torsion Unilateral testicular pain swelling Urethral discharge may be present but often urethritis is asymptomatic Investigations- in younger adults assess for STI, in older adults with low-risk sexual history- send a mid-stream urine for microscopy and culture Management- If STI urgent referral to sexual heealth clinic- ceftriaxone and doxcycline If enteric organisms ssend MSU- treat with oral quinolone (ofloxacin) for 2 weeks

Question 484

Pleural effusion- chest drain or aspirate first?

Answer 484

Aspirate first then chest train Resulting management determined by aspirate- If exudate/empyema then drain If transudate then can be medially managed without chest drain Pleural fluid that is purulent or turbid/cloudy or clear with a pH less than 7.2 a chest drain should be placed

Question 485

Campylobacter antibiotic management?

Answer 485

Often self limiting But clarithromycin If you want to get rid of camper, put some mycin their tent Clarithromycin for atypical bacteria

Question 486

6 Ps of acute limb ischaemia?

Answer 486

Pale Pain Pulseless Perishingly cold Paraesthesia Paralysis

Question 487

Management of acute limb-threatening ischaemia?

Answer 487

Initial management- ABC approach Analgesia - IV opioid often used IV unfractionated heparin is usually given to prevent thrombus propagation, paticularly if patient unsuitable for immediate surgery Vascular review Definitive management: Intra-arterial thrombolysis Surgical embolectomy Angioplasty Bypass surgery Amputation- for patients with irreversible ischaemia

Question 488

What would q waves in lead II, III, aVF indicate?

Answer 488

Previous inferior MI (Q waves are a sign of previous myocardial infarction)

Question 489

Wellen syndrome?

Answer 489

Critical stenosis of LAD- chest pain resolves but still need immediate coronary angiography or PCI Deep T wave inversion or biphasic T waves in V2-V3

Question 490

Many characteristic circular target lesions?

Answer 490

Erythema multiform- target lesions initially seen on the back of hands/feet before spreading to the torso Causes- viruses Idiopathic Bacteria- mycoplasma Drugs- penicillin, sulphonamides, carbamazepine, allopurinol CTD Sarcoidosis Malignancy

Question 491

Oral cancer virus association?

Answer 491

Human papillomavirus (HPV)

Question 492

PCOS hormone results?

Answer 492

Raised LH:FSH ratio Testosterone normal or mildly elevated SHBG is normal to low

Question 493

Rotterdam criteria for PCOS?

Answer 493

2 of 3: Infrequent or no ovulation Clinical and/or biochemical signs of hyperandrogenism (hirsutism, acne or elevated levels of total or free testosterone) Polycystic ovaries on ultrasound scan (presence of more than 12 follicles) in one or both ovaries and/or increased ovarian volume

Question 494

3 days fever, then 3 days rash?

Answer 494

6th disease- roseola infantum Caussed by human herpes virus 6 (HHV6)

Question 495

CKD mineral bone disease?

Answer 495

CKD causes low vitamin D and high phosphate High phosphate causes osteomalacia Low calcium due to the lack of vit D, high phosphate Secondary hyperparathyroidism Management: Reduce dietary intake of phosphate is first-line Phosphate binders Vit D Parathyroidectomy in some cases Phosphate binders- sevelamer

Question 496

Osteomalacia presentation?

Answer 496

Lack of bone mineralisation- most common cause is a lack of vitamin D- malabsorption/lack of sunlight/poor diet Diffuse bone pain and tenderness, proximal myopathy and a waddling gait Termed rickets in children, osteoamlacia in adults Bloods- low vit D, low calcium, raised ALP Vit D supplementation

Question 497

Ocular trauma?

Answer 497

Hyphema (blood in the anterior chamber of the eye) warrants urgent referral to an opthalmic specialist Main risk is raised intraocular pressure- blockage of angle and trabecular meshwork with erythrocytes Assessment for orbital compartment syndrome Eye pain/swelling Proptosis Rock hard eyelids Relevant afferent pupillary defect Management- urgent lateral canthotomy to decompress the orbit

Question 498

Drug treatment for stroke?

Answer 498

Aspirin for first 14 days Clopidogrel after that lifelong

Question 499

What blood marker rises after an acute episode of anaphylaxis?

Answer 499

Serum tryptase

Question 500

PTSD drug treatment?

Answer 500

Venlafaxine or SSRI

Question 501

Markers for cancer?

Answer 501

CA-125- Ovarian Carcinoembryonic antigen (CEA)- colorectal Alpha-fetoprotein- Testicular and hepato CA19-9- Pancreas CA15-3- Breast

Question 502

Unilateral polyps in the nose?

Answer 502

Refer to ENT

Question 503

Nasal polyposis associations?

Answer 503

Samter's triad Asthma, aspirin sensitivity and nasal polyposis Unilateral or bleeding refer Topical corticosteroids can shrink polyp in size

Question 504

Which hepatitis strains increase the risk of hepatocellular carcinoma?

Answer 504

Strains B, C, D

Question 505

Management for hepatitis A and E

Answer 505

Supportive- complications rare

Question 506

Limits for orthostatic hypotension to be diagnosed?

Answer 506

A drop in systolic BP of 20mmHg or more (with or without symotoms) A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without symptoms) A drop in diastolic BP of 10mmHg with symptoms

Question 507

Difference between vitamin K and prothrombin complex concentrate (PCC) for warfarin reversal?

Answer 507

PCC for rapid temporary reversal of warfarin's effect- within minutes- use in emergency situations Vitamin K- takes longer to act but is necessary for a longer term warfarin reversal

Question 508

Tetralogy of fallot hand symptoms?

Answer 508

Finger clubbing

Question 509

Type of heart condition that can remain symptomless in childhood but progess to symptoms in adulthood?

Answer 509

Atrial septal defect Causes an ejection systolic murmur

Question 510

Hypokalaemia symptoms?

Answer 510

Muscle weakness, fatigue, ECG findings- reduced t-wave amplitude, PR prolongation and QT prolongation

Question 511

After how many weeks do you need anti-d prophylaxis in women who are resus D negative?

Answer 511

After 10 weeks gestation

Question 512

Glaucoma screening age for those with a positive family history?

Answer 512

From 40 years old

Question 513

ITP?

Answer 513

Immune thrombocytopenia Typically follows an infection or vaccination Features Bruising Petechial or purpuric rash Bleeding less common Bloods- isolated thrombocytopenia Usually no treatment If platelet count very low or significant bleeding- Corticosteroids IV immunoglobulins Platelet transfusions

Question 514

Double duct sign?

Answer 514

Pancreatic cancer

Question 515

Opioids in renal failure?

Answer 515

Mild to moderate- oxycodone More severe- alfentanil, buprenorphine and fentanyl

Question 516

Crohn's and gallstones?

Answer 516

Yes Crohn's gives you stones

Question 517

CRABBI for myeloma?

Answer 517

Calcium Renal- could lead to protein urea? Anaemia Bleeding Bones Infection

Question 518

Open angle glaucoma vs closed angle glaucome definitive management?

Answer 518

Closed angle- laser peripheral iridotomy Open angle- Laser trabeculoplasty

Question 519

Pioglitazone contraindinications?

Answer 519

Bladder cancer Heart failure

Question 520

SGLT-2 and recurrent UTIs?

Answer 520

Contraindication

Question 521

Delirium drug management?

Answer 521

Haloperidol if criteria met Careful in Parkinson's- sometimes atypical antipsychotics quetiapine or clozapine if they require urgent treatment

Question 522

New BP >180/120 and retinal haemorrhage or papilloedema?

Answer 522

Admit for specialist assessment

Question 523

How to cause pain in a scaphoid fracture?

Answer 523

Longitudinal compression of the thumb (telescoping of the thumb) Tenderness over the anatomical snuffbox/ schapoid tubercle and ulnar deviation of the wrist

Question 524

Investigation of choice for an ectopic pregnancy?

Answer 524

Transvaginal ultrasound Generally transvaginal if gynae and early pregnancy Transabdominal ultrasound after 12 weeks pregnancy

Question 525

Can SGLT-2 inhibitors cause foot ulcers?

Answer 525

There is an incrased risk of lower-limb amputation

Question 526

Prevention of thrombotic events in polycythaemia vera?

Answer 526

Aspirin Venesection first line treatent to keep the haemoglobin in the normal range Chemotherapy- hydroxyurea

Question 527

When can you not use IV dexamethasone in meningitis?

Answer 527

Septic shock, meningococcal septicaemia or if immunocompromised or in meningitis following surgery

Question 528

Presentation for Mycoplasma pneumoniae?

Answer 528

Affects younger patients- atypical pneumonia Presents with a dry cough, mild fever, malaise and classically an erythema multiforme rash Diagnosis- mycoplasma serology Treatment- doxycycline or a macrolide Also associated with cold autoimmune haemolytic anaemia

Question 529

Difference between critical limb ischaemia and acute limb-threatening ischaemia?

Answer 529

Acute- sudden and out of nowhere (thrombus) Critical- at the end of a process, slowly getting worse- atherosclerosis etc

Question 530

Unstable braod-complex tachycardia?

Answer 530

Instable ventricular tachycardia- synchronised cardioversion

Question 531

Checking for diabetic foot disease?

Answer 531

Ischaemia- palpate for dorsalis pedis pulse and posterior tibial artery pulse Neuropathy- 10g monofilament used on various pars of the sole of the foot

Question 532

Which tablets can affect levothyroxine absorption?

Answer 532

Iron and calcium carbonate Think of this if newly tired and recently started on these as a new medication

Question 533

Wernicke's encephalopathy/Korsakof's syndrome?

Answer 533

COAT RACK Coat for Wernicke's Rack for Korsakoff's Confusion Opthalmoplegia/nystagmus Ataxia Thiamine deficiency Retrograde amnesia Anterograde amnesia Confabulations Korsakoff's psychosis

Question 534

Fibroadenoma excision?

Answer 534

If >3cm surgical excision is usual

Question 535

Osteoporosis drgus?

Answer 535

Anastrazole and omeprazole can cause it Inhaled corticosteroids less likely than systemic

Question 536

Somatisation vs conversion disorder (functional neurological disorder)?

Answer 536

Somatistaion is multiple symptoms patient refusing to accept reassurance or negative results Conversion disorder- neurological deficit possible in response to a traumatic experience

Question 537

Status epilepticus treatment?

Answer 537

Oh My Lord Phone the Anaesthetist Oxygen Midazolam (PR diazepam or buccal midazolam) Lorazepam Phenytoin Anaesthesia- rapid sequence induction Now generally levetiracetam before phenytoin

Question 538

NSAIDs in AKI?

Answer 538

NSAIDs stopped apart from aspirin at a cardio-protective dose- aspirin 75mg DIANA D- Diuretics I- iodinated contrast A- ACEi/ARB N- NSAIDs A- aminoglycosides

Question 539

Kawasaki disease features?

Answer 539

High-grade fever for >5days + CRASH Conjunctival injection Rash Adenopathy Strawberry tongue Hands and feet swelling/desquamation

Question 540

GnRH and gynae?

Answer 540

Yes- goserelin. buserelin

Question 541

Treatment for venous ulceration?

Answer 541

Compression banding Important to check ABPI for arterial flow

Question 542

Most common cause of very raised ALT/AST in the 10,000s, transaminitis?

Answer 542

Paracetamol overdose

Question 543

Stop metformin if critically ill?

Answer 543

Yes- due to the risk of metformin-associated lactic acidosis

Question 544

Which foods are ok to eat in coeliac?

Answer 544

Corn, potatoes, rice All gluten free

Question 545

Staghorn stone compisition?

Answer 545

Struvite Associated with urinary tract infections caused by Proteus

Question 546

Most common stone composition?

Answer 546

Calcium oxolate

Question 547

Papillary muscle rupture associations?

Answer 547

After posterior MI usually Acute mitral regurgitation- but with a early-to-mid systolic rather than pansystolic Acute hypotension and pulmonary oefema may occur

Question 548

Continue anticoagulation in AF even if have had successful catheter ablation?

Answer 548

Yes- as per CHADS-VASc If 0- 2 month anticoagulation ecommended If over 1- longterm anticoagulation reccomended

Question 549

GnRH agonists for fibroids?

Answer 549

Goserelin etc- same as prostate cancer management Side-effects Menopausal symptoms- hot flushes, vaginal dryness Loss of mineral bone density

Question 550

Investigations for Guillain-Barre?

Answer 550

LP- rise in protein with a normal white cell count Nerve conduction studies- decreased motor nerve conduction velocity (due to demyelination)

Question 551

Hyper or hyponatraemia with MDMA?

Answer 551

HYPOnatraemia Either due to excessive water consumption or SIADH SSRI also causes hyponatraemia

Question 552

Contraindications to LP in meningitis?

Answer 552

Signs of raised ICP Signs of severe sepsis or rapidly evolving Meningiococcal sepsis

Question 553

Lhermitte's sign?

Answer 553

Tingling in hands when flexing neck Associated with MS

Question 554

Paraneoplastic features for renal cell carcinoma?

Answer 554

EPO- polycythaemia ACTH- Cushingoid body habitus and hypertension Renin- hyperaldosteronism (hyperNa, hypoK, HTN) PTHrP- hypercalcaemia Cannonball metastses are characteristic of renal cell carcinoma

Question 555

Management for renal cell carcinoma?

Answer 555

Partial or total nephrectomy depending on tumour size

Question 556

Urea proportionally higher than creatinine?

Answer 556

Dehydration

Question 557

Is Lewy-body dementia fluctuating?

Answer 557

Yes

Question 558

Differentiating brain abscess from meningitis/encephalitis?

Answer 558

Brain abscess- causes more focal neurology whereas meningitis/encephalitis causes more generalised neurological defecit An example of this could be weakness of the left hand

Question 559

Subacute degeneration of the spinal cord?

Answer 559

Progessive unsteadiness, tingling sensation, ataxic gate, distal sensory loss, positive Romberg's, absent ankle jerks Lack of vitamin B12- can result from bariatric surgery etc

Question 560

Drug that causes nephrogenic diabetes insipidus?

Answer 560

Lithium

Question 561

Herpes management in pregnancy?

Answer 561

If over 28 weeks and first episode- caesarean If recurrent episode- low risk of transmission (still give aciclovir in both anyway?)

Question 562

Primary, secondary, tertiary hyperparathyroidism?

Answer 562

Primary- High PTH (or inappropriately normal), high Ca, low phosphate- solitary adenoma Secondary- High PTH, low calcium, elevated phosphate- parathyroid glad hyperplasia due to chronically low calcium (renal disease) Tertiary- High PTH, high calcium, low phosphate- corrected underlying renal problem but still the parathyroid gland hyperplasia

Question 563

ITP treatment?

Answer 563

Children- no treatment self resolving Adults- oral prednisolone Bruising, petechial rash following an infection

Question 564

Is nitrofurantoin contraindicated in breast feeding?

Answer 564

Yes

Question 565

Should you examine throat in croup?

Answer 565

No for same reason as normal epiglotitis Stridor can be a feature of croup

Question 566

Causes of gingival hyperplasia?

Answer 566

PANIC Phenytoin AML Nifedipine/amlodipine- both CCBs Inherited, idiopathic Ciclosporin

Question 567

Does postoperative ileus have bowel sounds?

Answer 567

No

Question 568

Management of BP over 180/120

Answer 568

If signs of end organ damage/ life threatening symptoms- refer for a specialist assessment If none of the above apply- urgent tests for end organ damage

Question 569

Most important prognostic factor in paracetamol overdose?

Answer 569

Arterial pH

Question 570

Weber's test meaning?

Answer 570

Conductive hearing loss- lateralises to the affected ear Sensorineural hearing loss- lateralises to the unaffected ear (Rinnies- air better than bone is normal/sensorinueiral Bone better than air is conductive)

Question 571

Blood gas disturbance caused by aspirin?

Answer 571

Salicylate overdose can cause a mixed primary respiratory alkalosis and metabolic acidosis Causes hyperventilation then as lactate increases causes the metabolic acidosis

Question 572

HNPCC genes involved?

Answer 572

MSH2 MLH1

Question 573

Hand preference before when is abnormal?

Answer 573

12 months

Question 574

COPD LTOT?

Answer 574

O2 of 7.3-8 kPa and one of the following: Secondary polycythaemia Peripheral oedema Pulmonary hypertension

Question 575

Hypercalcaemia treatment?

Answer 575

Rehydration with normal saline Bisphosphonates potentially after rehydration

Question 576

Can you see a false lumen on CXR?

Answer 576

No But you can see a widened mediastinum

Question 577

Aortic dissection investigations?

Answer 577

CXR- widened mediastinum CT angiography- investigation of choice- false lumen Transoesophageal echocardiography (TOE)- More suitable for unstable patients who are too risky to take to CT scanner

Question 578

Acne oral antibiotic?

Answer 578

Try an oral antibiotic before referring if only a topical has previously been used?

Question 579

Even if TSH in normal range still could be secondary hypothyroidism as inappropriately normal for example if cannot produce as much as needd due to a non-functional adenoma?

Answer 579

Generalised hypopituitarism etc think pituitary adenoma

Question 580

Difference between type 1 and type 2 respiratory failure?

Answer 580

Type 1- O2 low, CO2 normal or low Type 2- O2 low, CO2 high

Question 581

Thrombosed haemorrhoids treatment?

Answer 581

Significant pain and tender lump Purplish, oedematous, tender subcutaneous perianal mass If patient presents within 72 hours then referral for consideration for excision Otherwise if over 72 hours then manage with stool softners, ice packs and analgesia

Question 582

Prostate cancer investigation?

Answer 582

Multiparametric MRI is first-line

Question 583

Hypothyroidism electrolyte disturbance?

Answer 583

Euvolaemic hyponatraemia

Question 584

Gestation diabetes treatment?

Answer 584

>7 at diagnosis- start on insulin straight away If not then diet exercise, then metformin then ADD insulin if still not controlled

Question 585

What is included in the combined test for antenatal testing?

Answer 585

Nuchal translucency measurement + serum B-HCG + pregnancy-associated plasma protein A (PAPP-A) Quadruple test- alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin, inhibin A

Question 586

Combined test results?

Answer 586

Down's- HCG up, PAPP-A down, thickened nuchal translucency Patau (13) and Edward's (18) similar result but HCG lower

Question 587

Quadruple test results?

Answer 587

Down's- everything down apart from HI- HCG and Inhibin A raised Edward's- Everything down inhibin A normal NTD- AFP up rest normal

Question 588

Further test if higher chance of Down's on combined or quadruple tests?

Answer 588

Non-invasive prenatal screening test (NIPT)

Question 589

Renal stones management?

Answer 589

Treatment: Stone <5mm- expectant treatment Stone <2cm- lithotripsy Stone <2cm + pregnant- uteroscopy Stone complex- nephrolithotomy (invasive) Hyydronephrosis/infection- nephrostomy Imaging: Non-contrast CTKUB Pain reliever IM Diclofenac

Question 590

Meningitis prophylaxis for household members?

Answer 590

Ciprofloxacin or rifampicin

Question 591

Lamotrigine potential adverse effect?

Answer 591

Stevens-Johnson syndrome

Question 592

Is right heart failure associated with hepatomegaly?

Answer 592

Yes- firm, smooth, tender liver edge that may be pulsatile

Question 593

Common causes of hepatomegaly?

Answer 593

Cirrhosis- if early disease, later liver decreases in size, associated with a non-tender, firm liver Malignancy- metastatic spread or primary hepatoma- hard, irregular liver edge Right heart failure- firm, smooth, tender liver edge that may be pulsatile

Question 594

In which type of lung cancer are cavitating lesions more common in?

Answer 594

Squamous cell carcinoma

Question 595

Kyphoscoliosis?

Answer 595

A restrictive lung disease linked to ankylosing spondylitis Ankylosing spondylitis can also cause pulmonary fibrosis

Question 596

What to give for headache caused by raised intracranial pressure due to brain cancer (or metastases)?

Answer 596

Dexamethasone This would be palliative treatment

Question 597

Are hepatitis viruses DNA or RNA?

Answer 597

All RNA apart from Hep B which is DNA

Question 598

VTE 3 or 6 months PE with cancer?

Answer 598

6 months- not an easily reversible cause (unlike stopping COCP or post surgery)

Question 599

Pleural effusion management?

Answer 599

Diagnostic aspiration with 21G needle- send fluid for pH, protein etc to work out the cause Chest drain for symptomatic relief If infection- do a chest tube Might need to treat underlying cause

Question 600

First step in asthma age 11 and under?

Answer 600

Twice- daily paediatric low-dose inhaled corticosteroid (ICS) + short-acting beta2 agonist (SABA) as needed if MART pathway Paediatric low-dose MART + SABA as needed Paediatric moderate-dose MART + SABA as needed

Question 601

Sodium correction?

Answer 601

Sodium low to high the pons will die (osmotic demyelination syndrome which can cause a spastic quadriparesis) Sodium high to low the brain will blow- cerebral oedema

Question 602

What can you use for acute hyponatraemia?

Answer 602

Hypertonic saline (3% NaCl) But be careful can correct sodium too quickly

Question 603

Varices treatment?

Answer 603

To prevent bleeding in varices that are not currently bleeding- propranolol To treat bleeding oesophageal varices- terlipressin

Question 604

Immunosuppression skin cancer?

Answer 604

Squamous cell carcinoma

Question 605

Subacute degeneration of the spinal cord symptoms?

Answer 605

Hyperreflexia, loss of proprioception and loss of vibration sense Distal sensory loss/tingling + absent ankle jerks/extrensor plantars + gait abnormalities/Romberg's positive

Question 606

Anorexia G's and C's?

Answer 606

Most things low, Gs and Cs raised: Growth hormone Glucose Salivary glands Cortisol Cholesterol Carotinaemia

Question 607

Damage to radial nerve?

Answer 607

Wrist drop

Question 608

Horner's syndrome?

Answer 608

Can be due to compression from pancoast tumour of the lung Miosis (small pupil) Ptosis Enopthalmos (sunken eye) Anhidrosis (loss of sweating on one side) Central lesions cause anhidrosis of the face, arm and trunk- stroke, syringomyelia, MS Pre-ganglionic just face- Pancoast's tumour, thyroidectomy, trauma Post-ganglionic lesions- no anhidrosis- carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis, cluster headache

Question 609

How long after COCP to start ulipristal?

Answer 609

5 days

Question 610

Cervical cancer management that best preserves fertility?

Answer 610

Cone biopsy Gold standard generally is a hysterectomy +/- lymph node clearance More advanced tumours might have radiotherapy/chemotherapy

Question 611

PITS pneumonic extra big?

Answer 611

PITS- Parietal inferior, temporal superiors AND PITS- PITuitary Superior Pituitary superior visual loss as tumour is below/ affects lower nerve fibres which recieve from upper visual dield Craniopharyngioma is lower visual field problems

Question 612

Posterior vitreous detatchment vs retinal detatchment?

Answer 612

PVD- floaters RD- curtain over vision

Question 613

Heart failur esymptoms with new AF?

Answer 613

Cardiovert

Question 614

Psoriasis management?

Answer 614

Regular emollients First-line- Potent corticosteroid applied once daily plus a vitamin D analogue once daily Applied seperatley- morning/evening Second line- vitamin D analogue twice daily Third-line- a potent corticosteroid applied twice daily for up to 3 weeks or A coal tar preparation applied once or twice daily

Question 615

Common side effect of nexplanon implantable?

Answer 615

Most effective form of contraception Common side effect is irregular bleeding Can be managed using a co-prescription of the COCP

Question 616

Does positive Rinne's mean healthy or not?

Answer 616

Yes positive Rinne's means normal

Question 617

Raised ICP investigations?

Answer 617

DO NOT do an LP- only can do those for things like IIH when other causes ruled out Non-contrast CT head first to rule out any mass lesions that could cause brain herniation Tip is if asking for most appropriate next step it is rarely something complicated if a first line investigation

Question 618

Pupil dilation in CN3 palsy?

Answer 618

Something compressing the nerve Such as a posterior communicating artery aneurysm

Question 619

Biliary colic vs cholecystitis?

Answer 619

Biliary colic just the RUQ without fever- no LFT/inflammatory marker derangement Cholecystitis- RUQ + fever

Question 620

Moat common complication of thyroid eye disease?

Answer 620

Exposure keratopathy

Question 621

Do you give antibiotics in preterm labour?

Answer 621

Seems to be only if membranes have broken- avoid NEC Tocolytics and steroids to mature lungs if in labour

Question 622

Under what CD4 count in HIV for pneumocytis jiroveci prohylaxis?

Answer 622

200 HAART- highly active anti-retroviral therapy is started on diagnosis Oral co-trimoxazole is the drug of choice for pneumocytis jiroveci pneumonia

Question 623

Lots of problems to do with pituitary?

Answer 623

TSG, LH, FSH- potentially HIGH prolactin Think a non-functioning pituitary adenoma

Question 624

Nephrotic syndrome complication?

Answer 624

Increased risk of thromboembolism related to loss of antithrombin III Can cause a renal vein thrombosis

Question 625

Most common cause of endocarditis following valve surgery?

Answer 625

Staph epidermis

Question 626

CT finding in aortic dissection?

Answer 626

CT ANGIOGRAPHY False lumen X-ray would be a widened mediastinum

Question 627

Rapidly progressive painful rash?

Answer 627

Potentially on a background of atopic dermatitis Eczema herpeticum- IV antivirals

Question 628

Glasgow score for pancreatitis?

Answer 628

Components of Glasgow score for pancreatitis (PANCREAS) PaO2 (<8kPa) Age (>55) Neutrophilia (WCC > 15 x 109/L) Ca2+ (<2mmol/L) Renal function (urea >16mmol/L) Enzymes (LDH >600 iu/L or AST >200 iu/L) Albumin (<32g/L) Sugar (blood glucose >10mmol/L)

Question 629

Management of aortic stenosis for low/medium risk vs high operative risk?

Answer 629

Surgical aortic valve replacement for medium-low risk Transcatheter aortic valve replacement for high operative risk patients

Question 630

Syphilis stages?

Answer 630

Primary- penis, secondary- systemic Primary- localised features Secondary- Systemic symptoms- fevers, lymphadenopathy Rash on trunk, palms, soles, buccal snil track ulcers, condylomata lata (painless, warty lesions on the genitalia) Teriatry features Gummas Ascending aortic aneurysms Congenital syphilis treatment- Blunted upper incisor teeth Keratitis Saber shins Rhagades (linear scars at the angle of mouth) Saddle nose Deafness

Question 631

Propylthiouracil?

Answer 631

Antithyroid drug- second line to carbimazole if that is not tolerated

Question 632

BP targets?

Answer 632

Less than 80- clinic- 140/90, ABPM- 135/85 Over 80- clinic- 150/90, ABPM- 145/85

Question 633

Gold standard investigation for TB?

Answer 633

Sputum culture

Question 634

Hyperdense vs hypodense on CT?

Answer 634

HYPOdense is dark- old on CT HYPERdense is light- new on CT Acute blood is bright (hyper) Dry blood is old (hypo)

Question 635

Can amylase be raised in small bowel obstrution?

Answer 635

Yes

Question 636

If choosing between abscess and cyst?

Answer 636

Remember abscess infective/raised temp etc Acute pancreatitis complications- pseudocysts/pancreatic abscess

Question 637

Tangentiality vs circumstantiality?

Answer 637

Circumstantiality- circle- comes back round to answer just excessive detail Tangentiality- goes on a tangent without returning to the topic or question

Question 638

Is it safe for a mother to breastfeed with hepatitis B?

Answer 638

Yes Hep B for breastfeeding

Question 639

Myeloid leukaemias?

Answer 639

Granulocytes may be seen on blood film

Question 640

CML vs CLL key feature?

Answer 640

CML- massive splenomegaly CLL- lymphadenopathy

Question 641

Acute vs chronic leukaemias on bloods?

Answer 641

If only blasts- immature cells- acute If all stages are present/developed ones- chronic

Question 642

Epilepsy and contraception?

Answer 642

Lots of epilepsy medications are enzyme inducers- carbamazepine, phenytoin etc Lamotrigine CI things like COCP, POP, Nexplanon Use copper IUD, Mirena

Question 643

Is creatine kinase raised in polymyalgia rheumatica?

Answer 643

No it is normal It is ESR that is raised

Question 644

Cancers associated with asbestos exposure?

Answer 644

Mesothelioma Most common is lung cancer, especially is with smoking history as well

Question 645

Where is the caecum?

Answer 645

Start of the large intestine Right hemicolectomy if tumour there

Question 646

Hyponatraemia after SAH most common cause?

Answer 646

SIADH

Question 647

Tocolytics examples?

Answer 647

Terbutaline, nifedipine, Mg2+

Question 648

Psoriatic arthritis?

Answer 648

Symmetric polyarthritis Asymmetrical oligoarthritis DIP joint disease (spared in RA) Psoriatic skin lesions Periarticular disease- tenosynovitis, enthesitis, dactylitis Nail changes- pitting, onycholysis X-ray- pencil in cup Treatment by rheumatologist- mild- NSAID Moderate- methotrexate

Question 649

What are mirror image nuclei?

Answer 649

Reed-Sternberg cells Hodgkin's lymphoma more likely to have systemic B symptoms

Question 650

CKD and anaemia?

Answer 650

Could be reduced EPO- usually normochromic normocytic anameia- eGFR commonly less than 35 Also could be reduced absorption of iron

Question 651

Antibodies in Graves?

Answer 651

IgG antibodies to the TSH receptor causing thyrotoxicosis

Question 652

Corneal abrasion investigation?

Answer 652

Fluorescein staining Topical antibiotic used to prevent secondary bacterial infection Features: Eye pain Lacrimation Photophobia Foreign body sensation and conjunctival injection Decreased visual acuity in the affected eye

Question 653

Get the antibodies the right way round in thyroid issues

Answer 653

/

Question 654

Globus pharyngis/hystericus?

Answer 654

Dysphagia- history of anxiety- intermittent symptoms- painless

Question 655

Courvoisier's law?

Answer 655

In the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones

Question 656

Positively birefringent rhomboid-shaped crystals?

Answer 656

Pseudogout

Question 657

What causes psudogout?

Answer 657

Raised calcium pyrophosphate RFs- Increasing age Hyperparathyroidism Low magnesium, low phosphate Haemochromatosis Wilson's disease Acromegaly

Question 658

Pseudogout x-ray?

Answer 658

Chondrocalcinosis

Question 659

Gold standard investigation for diagnosis of mesothelioma?

Answer 659

Thoracoscopic biopsy Other lung cancers- bronchoscope and biopsy

Question 660

Amaurosis fugax that resolves- is it a stroke or is it a TIA?

Answer 660

If vision loss truly monocular- ipsilateral internal carotid artery or retinal artery pathology- not a TIA If visiion loss affects both eyes or is hemianopic (same side of vision on both eyes)- TIA/stroke affecting the posterior circulation or occipital cortex

Question 661

Most important investigation in venous ulceration?

Answer 661

Ankle-brachial pressure index (ABPI)- assess for poor arterial flow which could impair healing Compression banding is the main management- need a good enough arterial flow for this

Question 662

What type of anal fissure is concerning and needs to be referred?

Answer 662

A lateral one

Question 663

PAD vessels and presentation?

Answer 663

Iliac stenosis- claudication causing buttock pain Femoral stenosis- claudication causing calf pain

Question 664

Stopping medications before OGD?

Answer 664

1 day- gaviscon 2 weeks- PPIs 3 days- ranitidine 4 weeks- antibiotics 1, 2, 3, 4

Question 665

Classification for hip fractures?

Answer 665

Garden classification

Question 666

CK 2-4 times normal?

Answer 666

Less likely to be rhabdomyolysis as massively raised Exercise can induce CK elevation- and cause haematuria too

Question 667

Contrast or no contrast for CT looking for ureteric stone?

Answer 667

No contrast- can't see the stone In urology generally only use contrast if suspecting cancer

Question 668

Diarrhoea within 6 hours- quick onset?

Answer 668

Bacillus cereus, Staphylococcus aureus

Question 669

How long contraceptions take to become effective?

Answer 669

Instant- IUD 2 days- POP 7 days- COCP, injection, implant, IUS

Question 670

Most common reason for hip replacement revision?

Answer 670

Aseptic loosening of the hip replacement

Question 671

Beta thalassemia?

Answer 671

Microcytic anaemia, HbA2 raised Major- first year of life with failure to thrive, severe anaemia Trait- often asymptomatic, diagnosed later potentially- reticulocytosis less common than in major

Question 672

Pneumothorax- no symptoms?

Answer 672

Conservative care regardless of pneumothorax size

Question 673

Felty's syndrome?

Answer 673

Triad of RA, spelenomegaly and neutropenia- patients present with recurrent and severe infections

Question 674

Which lymph nodes does ovarian cancer spread to first?

Answer 674

Para-aortic lymph nodes

Question 675

Be careful with auscletation zones?

Answer 675

A P T M

Question 676

Parvovirus infection causing aplastic crisis reticulocytes?

Answer 676

Causes a reticulocytopenia rather than a reticulocytosis Aplastic crisis in sickle cell sudden fall in haemoglobin and reduced reticulocytes High reticulocyte count suggests sickle cell anaemia- sequestration crises cause increased reticulocytes (precipitated by high altitude eg going on a plane)

Question 677

CKD anaemia?

Answer 677

FIX iron before giving EPO

Question 678

Patient presenting with stroke even if within the 4.5 hour period?

Answer 678

Non-contrast CT head to rule out haemorrhagic stroke Before aspirin Before thrombolysis/thrombectomy

Question 679

Salicylate (aspirin) poisoning metabolic acidosis/alkalosis?

Answer 679

1st- respiratory alkalosis 2nd- metabolic acidosis

Question 680

BV pH?

Answer 680

High vaginal pH >4.5 Clue cells on microscopy Positive whiff test (addition of potassium hydroxide results in fishy odour)

Question 681

What distinguishes scleritis from episcleritis?

Answer 681

Pain in scleritis- associated with RA also SLE/sarcoidosis No pain in episcleritis

Question 682

Short incubation period severe vomiting?

Answer 682

Staphylococcus aureus

Question 683

Before a PSA test people should not have?

Answer 683

Ejaculated in the previous 48 hours Exercised vigorously, for example cycling, in the pervious 48 hours Had a urological intervention such as a prostate biopsy in the previous 6 weeks Had a UTI in the previous 6 weeks

Question 684

Thymomas associated with which condition?

Answer 684

Myasthenia gravis

Question 685

Ix patients with suspected septic arthritis?

Answer 685

Synovial fluid sampling

Question 686

Prostate cancer most common ethnicity?

Answer 686

Afro/caribbean

Question 687

Palivizumab?

Answer 687

Prophylaxis of bronchiolitis in high risk patients

Question 688

Magnesium treatment duration pre-eclampsia?

Answer 688

Until 24 hours after last seizure or 24 hours after delivery

Question 689

Magnesium sulphate respiratory depression treatment?

Answer 689

Calcium gluconate While giving magnesium sulphate measure urine output, reflexes, respiratory rate and oxygen saturations

Question 690

Persistent air leak or insufficient lung reexpansion despite chest drain insertion or recurrent pneumothoraces?

Answer 690

Referral to a thoracic surgeon Video-assisted thoracoscopic surgery (VATS)

Question 691

Mydriasis and sudden eye pain?

Answer 691

Acute glaucoma?

Question 692

RA treatment?

Answer 692

Give DMARD monotherapy straight away +/- a short course of bridging prednisolone Methotrexate (sulfasalazine, lefunomide, hydroxychloroquine) Monitoring response to treatment with CRP and DAS28 RA flares managed with corticosteroids TNF inhibitors if an inadequate response to at least 2 DMARDs- incuding methotrexate- etanercept (reactivation of TB risk) and infliximab are options

Question 693

How much atropine in symptomatic bradycardia before pacing?

Answer 693

6 bolus in total (up to 3mg)- 5 more after initial one External/transcutaneous pacing Adrenaline infusion Transvenous pacing if no response- specialist help

Question 694

Undiagnosed vaginal bleeding?

Answer 694

Contraindication to HRT

Question 695

HRT contraindications?

Answer 695

Current or past nreast cancer Any oestrogen-sensitive cancer Undiagnosed vaginal bleeding Untreated endometrial hyperplasia

Question 696

Vaccines commonly offered to pregnant women in the UK?

Answer 696

Influenza and pertussis

Question 697

When can insert IUD/IUS after pregnancy?

Answer 697

Within 48 hours or after 4 weeks POP anytime post partum Women require contraception after day 21 after giving birth COCP do not use in first 21 days due to the increased risk of VTE UKMEC 4 if breastfeedig <6 weeks post partum

Question 698

Skin condition associated with reactive arthritis?

Answer 698

Keratoderma blennorrhagica Also possible to get circinate balanitis

Question 699

Bishop's score interpretation?

Answer 699

Score of <5 indicates labour is unlikely to start without induction Score of > or equal to 8 indicates a high chance of spontaneous labour If Bishop's score < or equal to 6- vaginal prostaglandins or oral misoprostol If Bishop's score over 6- amniotomy and an intravenous oxytocin infusion Remember membrane sweep can be done first

Question 700

Signet ring cells in which type of cancer?

Answer 700

Gastric cancer

Question 701

Gold standard test/screening for HIV?

Answer 701

HIV p24 antigen HIV antibody

Question 702

Epididymo-orchitis organism if low risk sexual history?

Answer 702

E.coli If STI- chlamydia/gonorrhoeae

Question 703

Patients with type 1 and a BMI over 25 drug in addition to insulin?

Answer 703

Metformin

Question 704

Hypoglycaemia management?

Answer 704

In the community: Initially- oral glucose in liquid, gel or tablet form 10-20g Maybe a HypoKit- injection of glucagon In a hospital setting- Quick acting carbohydrate If patient unconcious or unable to swallow, subcutaneous or intramuscular injection glucagon may be give Or IV glucose 20% through a large vein

Question 705

Does Bell's palsy spare the upper face?

Answer 705

No It is lower motor neurone- BeLL's palsy UMN lesions spare the forehead- a stroke etc IN BELLS FOREHEAD AFFECTED- UNABLE TO RAISE EYEBROWS

Question 706

Symphysis-fundal height?

Answer 706

Measured from the top of the pubic bone to the top of the uterus in centimetres It should match the gestational age in weeks to within 2cm after 20 weeks For example, if 24 weeks then a normal SFH would be 22 to 26 cm

Question 707

Staphylococcal toxic shock syndrome?

Answer 707

Severe systemic reaction to staphylococcal endotoxins related to infected tampon use Diagnostic criteria- Fever- high Hypotension Diffuse erythematous rash Desquamation of rash, especially palms and soles Involvement of three or more organ systems- GI, mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement Management: Removal of infection focus- retained tampon IV fluids IV antibiotics

Question 708

Investigation to do if stroke under the age of 55 with no obvious cause?

Answer 708

Autoimmune and thrombophilia screening

Question 709

Duchenne muscular dystrophy investigation?

Answer 709

Genetic testing now used rather than a muscle biopsy for diagnosis Features: Progressive proximal muscle weakness Calf pseudohypertrophy Gower's sign- child uses arms to stand up from a squatted position There is a raised CK

Question 710

Classification system used to stratify risk post myocardial infarction?

Answer 710

Killip class

Question 711

Reccomended times in a day for diabetics to monitor capillary blood glucose?

Answer 711

Before each meal and before bed

Question 712

Why no insulin first in HHS?

Answer 712

Risk of central pontine myelinolysis due to the rapid increase in sodium concentration as, even though the patient is dehydrated, insulin will send glucose into cells, taking water with it, so sodium will rise quickly as it is now in a more concentrated vasculature

Question 713

What is used to stage COPD?

Answer 713

FEV1 COPD severity (FEV1): 20-30-20-30 Stage 1 (Mild): >80% Stage 2 (Moderate): 50-79% Stage 3 (Severe): 30-49% Stage 4 (Very severe): <30%

Question 714

High risk symptoms in paediatrics?

Answer 714

Pale/mottled/ashen/blue No response to social cues Appears ill to a healthcare professional Does not wake or stay awake if roused Weak, high-pitched or continuous cry Grunting Resp rate over 60 Moderate or severe chest indrawing Reduced skin turgor Age less than 3 months with temp over 38 Non-blanching rash Bulging fontanelle Neck stiffness Status epilepticus Focal neurological signs Focal seizures

Question 715

Itchy, purple, papular rash?

Answer 715

Lichen planus Potent topical steroids

Question 716

Viral meningitis management?

Answer 716

Self limiting If any suspicion of bacterial meningitis or encephalitis- IV antibiotics and antivirals

Question 717

Weight gain on steroids? ESPECIALLY WITH BRUISING ETC

Answer 717

CUSHING'S SYNDROME Hypokalaemia, metabolic alkalosis Same disturbance present in primary hyperaldrostronism Opposite present in addisons Hyperkalaemic, metabolic acidosis

Question 718

How long do symptoms have to be present to diagnose chronic fatigue syndrome

Answer 718

3 months

Question 719

Itchy vagina cream?

Answer 719

Epaderm or diprobase

Question 720

Liver transplant in paracetamol overdose criteria?

Answer 720

Arterial pH <7.3, 24 hours after ingestion Or all of the following Prothrombin time >100 seconds Creatinine >300 Grade III or IV encephalopathy

Question 721

Calculation for serum osmolality?

Answer 721

2xsodium + glucose + urea

Question 722

Carotid investigation after TIA?

Answer 722

Carotid doppler (duplex ultrasound)

Question 723

AMA (anti-mitochondrial antibodies) positive Raised serum IgM?

Answer 723

Primary biliary cholangitis Use ursodeoxycholic acid

Question 724

Pulse oximetry and carbon monoxide poisoning?

Answer 724

Falsely high due to similarlities between oxyhaemoglobin and carboxyhaemoglobin

Question 725

Airway problems with ?c-spine problems?

Answer 725

Jaw thrust If no c-spine concern- head tilt chin lift

Question 726

Drug associated wit a significant increase in mortality in dementia patients?

Answer 726

Antipsychotics

Question 727

When IV isotonic normal saline and when IV 3% sodium chloride in hyponatremia?

Answer 727

Use the 3% if Na less than 120- acute presentation

Question 728

What type of laxative is movicol paediatric plain?

Answer 728

Osmotic

Question 729

Differentiating between osteomalacia and Paget's?

Answer 729

Osteomalacia- decreased Ca, increased PTH, increased ALP Paget's- normal Ca, normal PTH, increased ALP Typically an older male with bone pain and an isolated raised ALP in Paget's

Question 730

COCP cancer risk?

Answer 730

COCP increases the risk of cancers you screen for (cervical and breast) COCP is protective for cancers common in older age (ovarian and endometrial)

Question 731

Tetanus and wounds?

Answer 731

If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago, they don't require a booster vaccine nor immunoglobulins, regardless of how severe the wound is If over 10 years If tetanus prone wound- reinforcing dose of vaccine High-risk wound- reinforcing dose of vaccine + tetanus immunoglobulin If vaccine history unknown- reinforce vaccine all wounds Tetanus prone or high risk- vaccine + immunoglobulin

Question 732

Upper zone fibrosis?

Answer 732

CHARTS C - Coal Worker's Pneumoconiosis H - Histiocytosis A - Ankylosing Spondylitis R - Radiation T - TB S - Sarcoidosis/Silicosis

Question 733

Learn centor and FEVERpain?

Answer 733

/

Question 734

Varicose veins?

Answer 734

Occur due to incompetent venous valves- RFs- increasing age, female gender, pregnancy, obesity May present for cosmetic reasons, aching, throbbing or itching Also- Skin changes- varicose eczema, haemosiderin deposition causing hyperpigmentation, hard/tight skin, hypopigmentation Bleeding Superficial thrombophlebitits Venous ulceration DVT Investigation: Venous duplex ultrasound- will demonstrate retrograde venous flow Management- Majority do not require surgery: Leg elevation Weight loss Regular exercise Graduated compression stockings Reasons for referral: Pain, disco,fort, swelling Skin changes secondary to chronic venous insufficiency (pigmentation and eczema) Superficial thrombophlebitis Active or healed venous ulcer Treatments: Endothermal ablation Foam sclerotherapy Surgery

Question 735

Causes of postpartum haemorrhage?

Answer 735

Tone (uterine atony)- vast majority of cases Trauma (e.g. perineal tear) Tissue (retained placenta) Thrombin (e.g. clotting/bleeding disorder)

Question 736

How much blood is defined as postpartum haemorrhage?

Answer 736

Loss of >500ml of blood after a vaginal delivery

Question 737

Management PPH?

Answer 737

A to E approach- cannulae, lie the woman flat, bloods, warmed crystalloid infusion Mechanical- palpate the uterine fundus and rub it to stumulate contractions Catheter to prevent bladder distension and monitor urine output Medical IV oxytocin Ergometrine (unless history of hypertension) Carboprost IM (unless history of asthma) Misoprostol Potential for tranexamic acid Surgical RCOG state intrauterine balloon tamponade is first line 'surgical' where uterine atony is only or major cause B-lynch suture Ligation of the uterine arteries or internal iliac arteries If severe- hysterectomy sometimes performed as life-saving procedure

Question 738

RA and carpal tunnel?

Answer 738

RA causes it

Question 739

Patients with high blood glucose on bloods but asymptomatic?

Answer 739

Must be high on two seperate occasions to diagnose T2DM so remeasure

Question 740

Mitral stenosis?

Answer 740

Loud S1 as the valve closes Opening snap in diastole as the mitral valve opens

Question 741

Does hyperaldostronism always cause a raised sodium?

Answer 741

Not always But hypokalaemia and hypertension are the one to look for Renin down aldosterone up- check aldosterone:renin ratio

Question 742

Definitive vs first line for obstruction?

Answer 742

X-ray first line CT definitive

Question 743

CKD cutoffs?

Answer 743

CKD clock 120-90- stage 1 if physical signs of CKD 90-60- stage 2- only if physical signs of CKD 60-45- stage 3a 45-30- stage 3b 30-15- stage 4 15-0 stage 5

Question 744

Omeprazole and clopidogrel?

Answer 744

Omeprazole reduces the effectiveness of clopidogrel

Question 745

One, two-- buckle my shoe. Three, four-- kick the door. Five, six-- pick up sticks. Seven, eight-- shut the gate. S1,2 = ankle jerk L3,4 = knee jerk C5,6 = biceps and brachioradialis C7,8 = triceps

Answer 745

Learn innervations L5 does everything Check lower back pain- prolapsed discs

Question 746

Femoral vs inguinal hernia?

Answer 746

Femoral inferolateral to the pubic tubercle Inguinal hernia above and medial to the pubic tubercle MILF Medial- Inguinal Lateral- Femoral

Question 747

Femoral hernia management?

Answer 747

Urgent surgical repair- higher risk of strangualtion

Question 748

Urinary incontinence first line treatment?

Answer 748

Urge incontinece?

Question 749

Schizoid?

Answer 749

Schizoid avoid people

Question 750

When is whole breast radiotherapy offered in breast cancer management?

Answer 750

After wide local excision

Question 751

What are the two surgeries for breast cancer?

Answer 751

Wide local excision- small tumour in large breast, solitary lesion, peripheral tumour, under 4cm Mastectomy- large tumour in small breast, multifocal lesion, peripheral tumour, over 4cm Whole breast radiotherapy reccomended in wide local excision to prevent recurrence

Question 752

When is FEC-D chemotherapy used in breast cancer?

Answer 752

If axilary nodal disease

Question 753

Angina management?

Answer 753

Management of angina: 1. Start everybody on statin + aspirin for 2ndry prevention 2. Also begin monotherapy with B blocker or CCB (verapamil) - depending which one more sensible 3. Dual therapy (B blocker and CCB) - but can't use rate limiting verapamil, have to switch to long acting CCB like amlodipine 4. Get PCI or CABG assessment (can give a 4th drug whilst waiting, eg nicorandil, ivabradine etc)

Question 754

Angina still not controlled on BB and CCB?

Answer 754

Refer for PCI/CABG- add third drug whilst waiting a long-acting nitrate ivabradine nicorandil ranolazine Also add one of those if on monotherapy and cannot tolerate the other drug (for example BB and asthma)

Question 755

Do you give DC shocks in bradycardia?

Answer 755

No even if in shock, syncope, heart failure Try raise heart rate Atropine up to 3mg (500mcg at a time) Transcutaneous pacing Adrenaline/isoprenaline Transvenous pacing

Question 756

Epididymo-orchitis investigation?

Answer 756

Guided by age of the patient (STI likelihood)- Under 35- NAAT- looking for chlamydia/gonorrhoea- if unknown ceftriaxone and doxycycline Over 35- Mid stream urine culture- looking for E.Coli- treat with quinolone (ofloxacin)

Question 757

Sarcoidosis and calcium

Answer 757

Hypercalcaemia

Question 758

Do you do PCI if symptoms present for over 12 hours?

Answer 758

No If the patient presents within 12hrs and PCI can be achieved within 120 mins = management is PCI If the patient presents with sx longer than 12hrs or PCI is not achievable within 120 mins (e.g. PCI centre is 3hrs away) = Fibrinolysis is management PCI still considered if evidence on ongoing ischaemia

Question 759

Mitral regurgitation post MI?

Answer 759

Ventricular septal defect

Question 760

How to cardiovert if AF presenting within 48 hours of symptom onset?

Answer 760

DC cardioversion Unless contraindicated them amiodarone

Question 761

Amiodarone/flecainide contraindications?

Answer 761

Amiodarone- hypothyroidism Flecainide- heart failure

Question 762

Cushing's syndrome vs Cushing's disease

Answer 762

Cushing's syndrome- adrenal adenomas Cushing's disease- pituitary adenoma causing excess ACTH secretion

Question 763

IUS mechanism of action?

Answer 763

Prevents endometrial proliferation

Question 764

Ankylosing spondylitis second line?

Answer 764

First line- oral NSAIDs Second line- Anti-TNF- etanercept

Question 765

Should urine osmolarity mirror urine osmolarity?

Answer 765

Yes, if they are very different there is a problem- could be SIADH or diabetes insipidus Sodium down is SIADH, raised in diabetes insipidus

Question 766

Most common cause of viral meningitis?

Answer 766

Enteroviruses- coxsackie virus

Question 767

Acute limb threatening ischaemia investigation?

Answer 767

Handheld arterial doppler Then ankle-brachial pressure index (ABI) if signs present on doppler

Question 768

Positive head impulse test?

Answer 768

Not a stroke

Question 769

DIC bloods?

Answer 769

Platelets- low Prothrombin time/APTT- raised Bleeding time- raised

Question 770

ITP bloods?

Answer 770

Platelet count decreased PT/APTT- normal

Question 771

CML and leukocyte alkaline phosphotase?

Answer 771

Leukocyte alkaline phosphotase is decreased in CML Also in CML- Fatigue, sweats, weight loss Splenomegaly

Question 772

Do BB make myasthenia gravis worse?

Answer 772

Yes

Question 773

Scar turning into a cancerous lesion?

Answer 773

SCC Non-healing, painless ulcer Rapidly enlarging

Question 774

Bacteria responsible for acne?

Answer 774

Propionibacterium acnes

Question 775

Prophylactic antibiotics before appendicectomy?

Answer 775

Yes- reduces wound infection rates

Question 776

Pseudo-Cushing's causes?

Answer 776

Alcohol excess/ severe depression

Question 777

LArge bowel obstruction most common cause?

Answer 777

Colorectal cancer

Question 778

Egg shell calcification of hilar nodes?

Answer 778

SIlicosis- upper zone fibrosis associated with mining

Question 779

Secondary prevention of CVD in peripheral arterial disease?

Answer 779

Statin 80mg Clopidogrel 75mg

Question 780

IgG vs IgM haemolytic anaemia?

Answer 780

IgG- warm (Greece) IgM- cold (Moscow)

Question 781

Mycoplasma pneumoniae association?

Answer 781

Autoimmune haemolytic anaemia

Question 782

General features of haemolytic anaemia?

Answer 782

Anaemia Reticulocytosis Low haptoglobin Raised lactate dehydrogenase (LDH) Blood film: spherocytes and reticulocytes Specific featres of autoimmune harmolytic anaemia- positive direct antiglobulin test (Coombs test)

Question 783

Warm AIHA treatment?

Answer 783

Treat any underlying disorder Steroids (+/- rituximab)

Question 784

Samter's triad for patients with aspirin sensitivity?

Answer 784

Aspirin sensitivity, asthma and nasal polyps

Question 785

Nail bed melanoma more likely in Afro-Caribbean?

Answer 785

Acral lentiginous melanoma

Question 786

Legionella pneumonia antibiotic and other atypical bacteria?

Answer 786

Atypical bacteria (not strep, steph etc) is treated with clarithromycin/doxycycline Give those if atypical

Question 787

Inactivated vaccines?

Answer 787

HAIR Hep A IM influenza Rabies

Question 788

Pulsus paradoxus?

Answer 788

Abnormally large drop in BP during inspiration Seen in tamponade

Question 789

Hormonal therapy for prostate cancer?

Answer 789

GnRH agonists- Goserelin Cause a testosterone flare initially then reduce to lower levels Need to be covered with an anti-androgen when starting due to a tumour flare Cyproterone acetate, bicalutamide

Question 790

Age when following a fragility fracture a DEXA scan is not required?

Answer 790

Women over 75 Or if postmenopausal/ man over 50 with a vertebral fracture

Question 791

Access site for PCI?

Answer 791

Radial artery preferred over femoral artery

Question 792

Other names for Reed-Sternberg cells?

Answer 792

Large multinucleate cells with eosinophillic nucleoli Mirror image nucleoli

Question 793

Do you get an eosinophilia in Hodgkin's lymphoma?

Answer 793

Yes

Question 794

Hypothermia ECG findings?

Answer 794

Jeez Its Bloody Freezing - J waves (osborne waves) - Irregular rhythms - Bradycardia - First degree heart block

Question 795

Avoid verapamil in which condition?

Answer 795

Heart failure Also don't give with beta-blockers

Question 796

SCLC paraneoplastic syndromes?

Answer 796

ADH- causes SIADH- low sodium ACTH- hypertension, hyperglycaemia, hypokalameia, alkalosis, muscle weakness Lambert-Eaton syndrome

Question 797

Driving and diabetes?

Answer 797

All patients on insulin must inform the DVLA Legal to drive if hypoglycaemic awareness + 12 months no severe hypos

Question 798

HPV testing process remember?

Answer 798

Positive hrHPV- tests for cytology first THEN colposcopy if abnormal If normal- repeat at 12 months

Question 799

Can spinal stenosis present with unilateral leg pain?

Answer 799

Yes- pain improving on sitting down or crouching down Weakness of the leg Lack of smoking history Lack of cardiovascular history

Question 800

Periorbital vs orbital cellulitis?

Answer 800

In periorbital- absence of painful movements, diplopia and visual impairment

Question 801

Middle loss vs peripheral loss in vision?

Answer 801

Middle loss- macular degeneration (can be age related) Peripheral loss- primary glaucoma

Question 802

Can you get hyperlipidaemia in nephrotic syndrome?

Answer 802

Yes Remember to give VTE prophylaxis in nephrotic syndrome

Question 803

Haptoglobin in haemolytic anaemias?

Answer 803

In haemolysis, free haemoglobin is released which then binds to haptoglobin This means that in haemolytic anaemias haptoglobin is reduced

Question 804

Most common cause of vaginal itching?

Answer 804

Pruritus vulvae Irritant contact dermatitis Other dematitits Lichen planus Lichen sclerosis Psoriasis

Question 805

Differentiate between L5/S1 problems?

Answer 805

Big toe- L5 (largest of the 5) Little toe- S1 (smallest 1)

Question 806

Where is the S1 sensory loss?

Answer 806

Posterolateral aspect of the leg, lateral aspect of foot Weakness in plantar flexion of foot Positive sciatic nerve stretch test (also positive L5)

Question 807

Are relfexes in tact in L5 nerve route compression?

Answer 807

Yes L3.4- knee reflex S1, S2- ankle reflex

Question 808

When to send a urine culture in female non-pregnant UTI?

Answer 808

Urine culture if Aged > 65 Visible or non-visible haematuria

Question 809

Rheumatic fever?

Answer 809

Follows an infection with Streptococcus pyogenes Characterised by fever, rash, arthralgia and ejection systolic murmur Rash, arthritis, murmur Management- Oral penicillin V NSAIDs Treatment of complications- HF

Question 810

Major/minor criteria for rheumatic fever?

Answer 810

Major: Erythema marginatum Sydenham's chorea- late feature Polyarthritis Carditis and valvulitis Subcutaneous nodules Minor: Raised ESR/CRP Pyrexia Arthralgia Prolonged PR interval

Question 811

Live attenuated vaccines?

Answer 811

MI BOOTY MMR Intranasal influenza BCG Oral rotavirus Oral polio Typoid Yellow fever

Question 812

Which vaccines can you not give in HIV positive patients?

Answer 812

Live attenuated vaccines- such as BCG, MMR, intranasal influenza

Question 813

How to work out SAAG?

Answer 813

Serum albumin - ascitic albumin

Question 814

Appendicitis bloods?

Answer 814

Neutrophil predominant leucocytosis seen in 80-90% of people

Question 815

Puberty order?

Answer 815

Boys- grapes, drapes, grow , blow Girls- boobs, pubes, grow, flow

Question 816

Only cranial nerve to act contralateral?

Answer 816

Trochlear CN4

Question 817

STI + joint problems?

Answer 817

Could either be septic or reactive arthritis Temperature could be the differentiator (Gonorrhoea classically with septic, chlamydia in reactive)

Question 818

What characteristics are associated with Legionella?

Answer 818

Lymphopenia, hyponatraemia and deranged LFTs

Question 819

Hyperkalaemia ECG?

Answer 819

Tall-tented T waves, small P waves, widened QRS

Question 820

REMEMBER VESTIBULAR NEURONITIS

Answer 820

Vestibular neuronitis and labyrinthitis both present after recent illnesses Differentiated by vestibular neuronitis not being associated with hearing loss and tinnitus whereas labyrinthitis is

Question 821

SLE invstigations?

Answer 821

99% ANA positive Anti-dsDNA Can monitor with ESR Complelent levels (C3,C4) are low during active disease

Question 822

Vomiting in Addison's disease?

Answer 822

Potenitally take the hydrocortisone IM If intercurrent illness hydrocortisone doubled with fludrocortisone staying the same

Question 823

ORBIT?

Answer 823

Assessing bleeding risk in Afib from anticoagulation O- older >75 (1point) R- reduced Hb (2 points) B- bleeding history (2 points) I- insufficient renal function eGFR <60 (1point) T- treatment with a nanti platelet agent (1 point)

Question 824

Women at high risk of pre-eclampsia?

Answer 824

75mg aspirin from 12 weeks until the birth of the baby

Question 825

L5 route compression movement problem?

Answer 825

Weakness in foot and big toe dorsiflexion Reflexes intact

Question 826

When can external cephalic version be performed?

Answer 826

For transverse lie if the amniotic sac has not ruptured After 36 weeks If doesn't work caesarian

Question 827

Nuclear scintigraphy reveals patchy uptake?

Answer 827

Toxic multinodular goitre Thyroid gland that contains a number of autonomously functioning thyroid nodules- causes hyperthyroidism Treatment is radioiodine therapy

Question 828

Rosacea with predominant flushing but limited telangiectasia?

Answer 828

Brimonidine gel can be considered Generally for rosacea: Topical ivermectin first line Combination of topical ivermectin + oral doxycycline for moderate-to-severe papules and/or pustules

Question 829

Difference between drug-induced parkinsonism and Parkinson's disease?

Answer 829

Motor symptoms are generally rapid onset and bilateral Rigidity and rest tremor uncommon

Question 830

Intestinal angina (chronic mesenteric ischaemia) triad?

Answer 830

Severe, colicky post-prandial abdominal pain Weight loss Abdominal bruit

Question 831

Needing blood in acute setting?

Answer 831

Group and save- for if you require blood at later date, saves the blood type as reference- not for an acute setting Crossmatch x(6) units- crossmatch allows for blood now or in the near future- for acute settings Prothrombin complex concentrate- for the reversal of warfarin- not indicated if the patient is not on warfarin

Question 832

If cannot get above a testicular swelling on examination?

Answer 832

Inguinal hernia Cough impulse may be present, may be reducible

Question 833

Difference between sigmoid volvulus and caecal volvulus?

Answer 833

Sigmoid presents with large bowel obstruction, caecal with small bowel obstruction Sigmoid coffee bean sign Sigmoid more common 80% of cases

Question 834

Pontine haemorrhage presentation?

Answer 834

Reduced GCS, paralysis and bilateral pin point pupils Pin point pupils point to pons

Question 835

Investigations for Wilson's disease?

Answer 835

Slit lamp examination- Kayser-Fleischer rings Reduced serum caeruloplasmin Reduced total serum copper Increased 24 hour urinary copper excretion Management: penicillamine

Question 836

Keloid scar treatment?

Answer 836

Intra-lesional steroids KelOID, sterOID

Question 837

Aortic regurgitiation features?

Answer 837

Early diastolic murmur Collapsing pulse Quinkie's sign- nailbed pulsation Wide pulse pressure De Musset's sign- head bobbing

Question 838

TRALI vs TACO?

Answer 838

Can differentiate TRALI from TACO TRALI- hypotension TACO- hypertension

Question 839

Summary transfusion reactions?

Answer 839

Just fever- non-haemolytic febrile reaction- slow infusion and paracetamol Just itch and urticaria- mild allergic- pause transfusion + antihistamine Anaphylaxis- stop + adrenaline Fever + hypotension- either acute haemolytic (abdo pain) or TRALI- stop and fluids Hypertension, fluid overload signs (TACO)- stop infusion + furosemide

Question 840

FIrst step if a patient had a urine output <0.5ml/kg/hour postoperatively?

Answer 840

Consider a fluid challenge- 500ml bolus Hypovolaemia most common cause of post-operative oliguria

Question 841

IgG vs IgM hepatitis serology?

Answer 841

IgG- chronic IgM- acute

Question 842

Can obstructive sleep apnoea cause hypertension?

Answer 842

Yes

Question 843

Iliotibial band syndrome?

Answer 843

Common cause of lateral knee pain in runners Tenderness 2-3cm above the lateral joint line Activity modification and iliotibial band stretches Physiotherapy referral

Question 844

Vaginal candidiasis treatment?

Answer 844

SINGLE dose oral fluconazole

Question 845

Management of alcoholic hepatitis?

Answer 845

Glucocorticoids Maddrey's discriminant function used to determine who would benefit from glucocorticoid therapy- calculated using prothrombin time and bilirubin concentration Pentoxyphylline sometimes used GGT characteristically raised Ratio of AST:ALT is normally >2, a ratio of >3 is strongly suggestive of acute alcoholic hepatitis

Question 846

Newborn positive heel prick for CF?

Answer 846

If they have a raised immunoreactive trypsinogen (IRT) They then get a sweat test which will be high in CF Abnormally high sweat chloride

Question 847

Tear drop poikilocytes?

Answer 847

Myelofibrosis

Question 848

Myelofibrosis?

Answer 848

Myeloproliferative disorder- thought to be caused by hyperplasia of abnormal megakaryocytes

Question 849

Cholesteatoma?

Answer 849

Conductive hearing loss Chronic smelly ear discharge with recurrent glue ear

Question 850

Chronic smelly ear discharge?

Answer 850

Cholesteatoma

Question 851

Kaposi's sarcoma?

Answer 851

Caused by HHV-8 (human herpes virus 8) Presents as purple papules or plaques on the skin or mucosa

Question 852

Organophosphate insecticide poisoning treatment?

Answer 852

Atropine There is features of accumulation of acetylcholine- SLUD Salivation Lacrimation Urination Defecation/diarrhoea

Question 853

Other name for endometrioma?

Answer 853

Chocolate cyst Rupture causes acute abdo pain and free fluid in the pelvis

Question 854

Do you need to recheck for H.pylori after symptoms have resoled?

Answer 854

No need to check for H.pylori eradcation if symptoms have resolved

Question 855

Right sided tenderness on PR exam?

Answer 855

Think appendicitis

Question 856

Mesenteric adenitis?

Answer 856

Inflamed lymph nodes in the mesentery. Similar symptoms to appendicitis. Often follows recent viral infection- needs no treatment. More common in children.

Question 857

When to add metformin in T1DM?

Answer 857

If the BMI is over 25

Question 858

Can you use NSAIDs for gout in stage 4 kidney disease?

Answer 858

No- would have to use oral steroids if both NSAIDs and colchicine are contraindicated

Question 859

Which area of the brain does Alzheimer's disease affect?

Answer 859

Hippocampus in the medial temporal lobe

Question 860

Sudden onset unilateral sensorineural hearing loss?

Answer 860

ENT emergency- same day discussion with the on call ENT specialist, along with the initiation of treatment with high dose corticosteroids- typically prednisolone

Question 861

Is Meniere's constant or episodic?

Answer 861

Recurrent episodes

Question 862

Complication of cataracts surgery?

Answer 862

Endophthalmitis Painful, red eye following cataract surgery- inflammation of the aqueous and/or vitreous humour One of the reasons you don't do bilateral cataract surgeries

Question 863

Rocuronium vs suxamethonium method of action?

Answer 863

Both neuromuscular blocking rugs Act in different ways Rocuronium- non-depolarising, antagonist leaving fewer receptors available for acetylcholine Suzamethonium binds to and activates the receptor first causing muscle contraction then paralysis

Question 864

SALTER?

Answer 864

SALTER Type 1 - S- Straight across/Slipped (growth plate) Type 2 - A- Above (growth plate and methaphysis) Type 3 - L- Lower (growth plate and epiphysis) Type 4 - T- Through (metaphysis, growth plate, and epiphysis) Type 5 - ERasure of growth plate or cRush (compression injury)

Question 865

Nail changes and arthritis?

Answer 865

Psoriatic arthritis

Question 866

Innocent murmurs?

Answer 866

Innocent murmurs heard in systole as blood flows rapidly, diastolic murmurs more indicitive of pathology Venous hums- continuous blowing nous heard just below the clavicles Still's murmur- low-pitched sound at the lower left sternal edge

Question 867

If neutropenic sepsis suspeected (recent chemo + fever)?

Answer 867

IV antibiotics started immediatley- not not wait for WBC count Start Tazocin

Question 868

Normal FEV1/FVC ratio in an adult?

Answer 868

0.7 Restrictive lung disease- normal or increased Obstructive lung disease reduced

Question 869

Osteomalacia low phosphate?

Answer 869

Yes, low phosphate, low calcium, raised ALP Low vit D Give vit D

Question 870

DPP-4?

Answer 870

Sitagliptin Seem to be quite ok to start as have not many side effects

Question 871

In STEMI when going for PCI- Prasugrel?

Answer 871

Yes- give BEFORE the PCI Clopidogrel if already on an anticoagulant Ends up being dual antiplatelet therapy as they will already have been given aspirin

Question 872

Delirium causes?

Answer 872

PINCH ME Pain Infection Nutrition Contipation Hydration Metabolism Environmental changes

Question 873

Primary vs secondary dysmenorrhoea?

Answer 873

Primary- no underlying pathology- pain starts at menarche- pain starts with or within a few hours of the period starting- give NSAIDs such as mefenamic acid, COCP second line Secondary dysmenorrhoea- develops many years after the menarche- result of underlying pathology- pain typically starts 3-4 days before the onset of the period- endometriosis, adenomyosis, PID, IUDs, fibroids Refer all patient with secondary dysmenorrhoea to gynae for investigation

Question 874

Do not miss compartment syndome- tip?

Answer 874

Any neurovascular defecit in trauma cases- refer to an orthopedic surgeon

Question 875

Key dates antenatal care timetable?

Answer 875

Booking visit- 8-12 weeks Down's screening with nuchal scan- 11-13+6 weeks Anomaly scan- 18-20+6 weeks Anti-D given at 28 and 34 weeks

Question 876

HSP symptoms?

Answer 876

Palpable purpuric rash Abdo pain Polyarthritis Features of IgA nephropathy- haematuria, renal failure Treatment- analgesia Monitor BP and urinalysis

Question 877

Unilateral glue ear (otitis media with effusion)?

Answer 877

Refer in adult Glue ear in children Active observation 1st- 3 months Grommit insertion Adenoidectomy Otitits media with effusion is different from acute otitis media

Question 878

URTI symptoms + amoxicillin causing a rash?

Answer 878

?Glandular fever Classic triad of sore throat, pyrexia, lymphadenopathy

Question 879

Over what age for PMB and referral on 2ww?

Answer 879

55

Question 880

For primary prevention of CVD, what should you aim for reduction in non-HDL?

Answer 880

40% reduction- if it does not reduce by 40% or more consider increasing the dose of atorvastatin to 80mg

Question 881

Chronic pancreatitis?

Answer 881

Pain Steatorrhoea DM CT pancreas Faecal elastase can be used to assess exocrine function if imaging inconclusive Management: Pancreatic enzyme supplements Analgesia Antioxidants

Question 882

When to take aspirin during pregnancy to prevent pre-eclampsia?

Answer 882

1 or more high risk factor 2 or more moderate risk factors High risk factors Hypertensive in previous pregnancy CKD Autoimmune: SLE/antiphospholipid DM Chronic HTN Moderate RFs First pregnancy Age 40+ Pregnancy interval of >10 years BMI over 35 FH pre-eclampsia Multiple pregnancy

Question 883

AS valvular gradient to consider valve replacement?

Answer 883

>40mmHg

Question 884

Incomplete miscarrige management if evidence of infection/increased risk of haemorrhage?

Answer 884

Vacuum aspiration

Question 885

Ankle fracture managment?

Answer 885

Prompt reduction- closed reduction quickly Can then do an ORIF- open reduction internal fixation if required ?

Question 886

HINTS test outcomes?

Answer 886

Peripheral- Head impulse test- abnormal Nystagmus- none or unidirectional Test of skew- no vertical skew Central Head impulse test- normal Nystagmus- bidirectional or vertical Test of skew- vertical skew

Question 887

Syphilis is painless ulcers. what would be painful ulcers?

Answer 887

Herpes simplex Lymphogranuloma venereum (LGV) is another cause of painless ulcers caused by Chlamydia, treat wit hdoxycycline

Question 888

Myxoedemic coma?

Answer 888

Treat with thyroxine and hydrocortisone Severe untreated hypothyroidism- obesity, non-pitting oedema, dry skin, hair loss + bradycardia, mild hypotension, hypothermia

Question 889

Dermatitis herpetiformis?

Answer 889

Cutaneous manifestation of coeliac disease

Question 890

Rhabdomyolysis way to tell from bloods?

Answer 890

CK is massively raised- over 10,000

Question 891

Radiotherapy or surgical decompression for spinal metastases?

Answer 891

If fit for surgery- surgical decompression of the spinal cord If not fit for surgery- external bean radiotherapy

Question 892

Opioid in repiratory disease after surgery?

Answer 892

Probably avoid- epidural might be best

Question 893

Increased ratio of LH:FSH?

Answer 893

PCOS

Question 894

Inflammatory back pain vs mechanical back pain?

Answer 894

Inflammatory back pain not improved with rest and is improved with activity Mechanical back pain is worse with activity and relieved by rest

Question 895

Lymphogranuloma venerum?

Answer 895

Another flashcard as well, endemic in MSM- proctitis, ulcer and tender inguinal lymphadenopathy

Question 896

ST elevation vs tall tented t waves?

Answer 896

Seems to be that T waves are seperate entities to the QRS Whereas ST elevation the lot is raised

Question 897

Respiratory acidosis in COPD exacerbation treatment? (type 2 respiratory failure)

Answer 897

Non- invasive ventilation

Question 898

pH for an NG tube to be safe to use?

Answer 898

If the aspirate is less that 5.5

Question 899

Beta-thalassaemia trait?

Answer 899

Mild hypochromic, microcytic anaemia- microcytosis is characteristically disproportionate to the anaemia- e.g. blood cells are much smaller but not that much anaemia HbA2 raised > 3.5%

Question 900

Renal replacement therapy (haemodialysis) indications?

Answer 900

Uraemia (pericarditis, encephalopathy), acidosis, pulmonary oedema, hyperkalaemia

Question 901

What happens if you drain a pneumothorax too quickly?

Answer 901

Reexpansion pneumothorax

Question 902

Anomaly scan dates?

Answer 902

18-20+6 weeks

Question 903

Alcoholic hepatitis treatment?

Answer 903

Prednisolone- can use Maddrey's formula to determine Pentoxyphylline also sometimes used

Question 904

Arterial vs venous ulcer location?

Answer 904

Arterial- lateral malleolus Venous- medial malleolus

Question 905

Tracheo-oesophageal fistula?

Answer 905

Complication of long term ventilation Abnormal connection between the trachea and oesophagus leading to choking episodes during feeding, recurrent aspiration and pneumonia Requires surgical correction

Question 906

Imaging that can be done for acute pancreatitis?

Answer 906

US- looks for gallstones etc Potentially contrast-enhanced CT

Question 907

CHICKENPOX Exposure?

Answer 907

Any doubt about mother previously having chicken pox- check maternal varicella antibodies Give antivirals 7-14 days post exposure If get chickenpox- oral aciclovir within 24 hours

Question 908

Prominent U wave on ECG?

Answer 908

Hypokalaemia Also ST depression and T wave flattening

Question 909

Sildenafil and nitrates?

Answer 909

Contraindicated Another side effect if sildenafil is blue discolouration to vision

Question 910

SBA rules for penile ulcers?

Answer 910

Painful ulcer + Painful lymph nodes in LEDC: Chancroid Painful ulcer(s) + Painful lymph nodes: Genital Herpes Painless ulcer + Painful lymph nodes in LEDC: LGV Painless ulcer + Painless lymph node: Syphilis (Tropenema) Key is multiple painful ulcers in genital herpes

Question 911

Recent sore throat, rash, arthritis, murmur?

Answer 911

? Rheumatic fever Treat with one off dose of IV benzylpenicillin or a course of oral penicillin V

Question 912

Bloods for post-streptococcus glomerulonephritis?

Answer 912

Raised anti-streptolysin O titre

Question 913

Pain on radial side of wrist, tenderness over radial styloid process, abduction of thumb against resistance painful?

Answer 913

De Quervain's tenosynovitis Do Finkelstein's test- pull thumb in ulnar deviation

Question 914

What counts as raised intraocular pressure?

Answer 914

Over 24

Question 915

Which drugs should all patients be offered after MI?

Answer 915

Aspirin Clopidogrel (or another needs dual anti platelet therapy) ACEi BB Statin

Question 916

Heart attack in which territory most likely to cause arrythmias?

Answer 916

Inferior II, III and aVF Right coronary arteries supply blood to the AV node so infarction can cause arrythmias

Question 917

Hypercalcaemia?

Answer 917

Hypercalcaemia- Bones, stones, moans, thrones and groans Hypocalcemia- Muscle twitching (tetany), perioral paraesthesia, prolonged QT Hypernatraemia- *Thirst + dehydration*, weakness, lethargy, irritability, confusion, coma Hyponatraemia- Anorexia, nausea & malaise (followed by) headache, irritability, confusion, weakness, decreased GCS and seizures Hyperkalaemia- ECG changes (Tall tented T waves, small P waves, wide QRS, VF, potentially sinewave like ECG); symptoms are therefore cardiac-like (rapid pulse, chest pain, headache) Hypokalaemia- Muscle weakness, hypotonia, ECG changes(U wave, long PR, long QT, small or absent T waves)

Question 918

Spider naevi vs telangiextasia?

Answer 918

Spider naevi refill from the centre Telangiectasia fill from the edge

Question 919

Chronic hep B with sudden deterioration?

Answer 919

?Hepatocellular carinoma

Question 920

Transudates vs exudates?

Answer 920

Transudates are systemic Exudates are local to the lung

Question 921

Pleural effusion fluid to serum protein ratio?

Answer 921

Pleural effusion fluid/serum protein ratio is >0.5 in an exudate Light's criteria Pleural fluid protein/serum protein >0.5 Pleural fluid LDH/serum LDH >0.6 PPleural fluid LDH more than two-thirds the upper limits of normal serum LDH

Question 922

SNRI monitoring?

Answer 922

BP as they can cause hypertension

Question 923

Electrolyte disturbance with SSRIs?

Answer 923

Hyponatraemia

Question 924

Is HIV a notifiable disease in the UK?

Answer 924

No it is not

Question 925

Hypomagnesaemia?

Answer 925

Presents similar to hypocalcaemia Can be caused by PPIs, alcohol, diarrhoea Features- Paraesthesia Tetany Seizures Arrhythmias Decreased PTH- hypocalcaemia

Question 926

Caesarean and speed?

Answer 926

Cat 1- within 30 minutes Cat 2- within 75 minutes Cat 3- required but mother and baby stable Cat 4- elective carsarean

Question 927

Croup- what is given regardless of the severity?

Answer 927

A single dose of dexamethasone

Question 928

AFP and HCG in seminomas?

Answer 928

Usually normal

Question 929

Optic neuritis?

Answer 929

Optic neuritis = CRAP Central scotoma, RAPD/Red desaturation, Acuity decreased, Painful eye movements

Question 930

Which hepatitis are spread through the faecal oral route?

Answer 930

Hepatitis A and E A and B are vaccinated You can only get D if you have B

Question 931

Ruddy complexion Gout Peptic ulcer disease Pruritus after a warm bath?

Answer 931

Polycythaemia

Question 932

Varicose veins/ chronic venous insufficiency investigation?

Answer 932

Venous duplex ultrasound May demonstrate retrograde flow

Question 933

Calcimimetic for hyperparathyroidism?

Answer 933

Cinacalcet

Question 934

Paediatric constipation?

Answer 934

MSO Movicol Stimulant Osmotic

Question 935

Vestibular neuronitis treatment?

Answer 935

Prochlorperazine If does not resolve symptoms- vestibular rehabilitation exercises

Question 936

Primary biliary cholangitis Ms?

Answer 936

IgM Anti-Mitochondrial antibodies Middle aged females

Question 937

Umbilical vs inguinal hernia in children?

Answer 937

Inguinal- repair ASAP Umbilical- manage conservatively

Question 938

Triad for renal cell carcinoma?

Answer 938

Haematuria, loin pain, abdominal mass

Question 939

Is a CXR recommended for all patients with a PE?

Answer 939

Yes, to exclude other pathology

Question 940

Most common organism in cellulitis?

Answer 940

Streptococcus pyogenes

Question 941

Fibrocystic disease (fibroadenosis)?

Answer 941

Most common in middle-aged women Lumpy breasts which may be painful Symptoms may worsen prior to menstruation

Question 942

Types of burns?

Answer 942

Superficial --> blanching erythema Partial thickness (Superficial dermal) --> blisters Partial thickness (Deep dermal) --> white; and patches of non-blanching erythema Full thickness --> painless

Question 943

Most common cause of neutropenic sepsis?

Answer 943

Staphylococcus epidermis

Question 944

Pityriasis rosea?

Answer 944

Herald patch on trunk that spreads Erythematous, oval, scaly patches Potential recent history of viral infection Self limiting- disappears after 6-12 weeks

Question 945

Magnesium sulfate toxicity (eclampsia)?

Answer 945

Low RR is key Muscle paralysis, absent reflexes Give calcium gluconate

Question 946

SBO vs LBO?

Answer 946

Be careful- if vomiting and no/late constipation- SBO If constipation but no vomiting/very late vomiting- LBO SBO- adhesions from previous surgery, hernias LBO- malignancy, diverticulitis, volvulus

Question 947

White cell casts/sterile pyuria?

Answer 947

Acute interstitial nephritis Will also be an eosinophilia Look for a cause- Most common antibiotics- penicillin Rifampicin NSAIDs Allopurinol Furosemide

Question 948

Muddy brown casts?

Answer 948

Acute tubular necrosis

Question 949

Thumb squaring?

Answer 949

Osteoarthritis Bony enlargements such as Heberden's and Bouchard's Heberden's at DIP, Bouchard's at PIP

Question 950

Does RA spare the DIPJs?

Answer 950

Yes

Question 951

Is adenosine CI in asthmatics?

Answer 951

Yes verapamil is preferable

Question 952

Heparins action?

Answer 952

Activates antithrombin III LMWH- inhibits factor Xa Standard does more

Question 953

Most common meningitis complication?

Answer 953

Sensorineural hearing loss Also: Seizures Focal neurological defecit Sepsis/abscess Raised ICP

Question 954

Are varicoceles associated with infertility?

Answer 954

Yes

Question 955

Reduced fetal movements?

Answer 955

Refer if not developed by 24 weeks Initally handheld doppler If no fetal heartbeat- immediate ultrasound If fetal heartbeat present- CTG

Question 956

Loin pain, haematuria and pyrexia of unknown origin?

Answer 956

?Renal cell carcinoma

Question 957

Systemic onset JIA?

Answer 957

Pyrexia Salmon-pink rash Lymphadenopathy Arthritis Uveitis Anorexia and weight loss Pauciarticuar JIA- Joint and pain swelling- medium sized joints Limp ANA may be positive in JIA 4 or more joints affected

Question 958

Indications for urgent surgical valve replacement in infective endocarditis?

Answer 958

Congestive cardiac failure Severe valvular incompetence

Question 959

Hand muscle innervation?

Answer 959

LOAF muscles- median, all other muscles- ulnar LOAF- Lateral two lumbricles Opponens pollicis Abductor policis brevis Flexor policis brevis

Question 960

Most common type of breast cancer?

Answer 960

Invasive ductal carcinoma in situ

Question 961

COPD LTOT?

Answer 961

>7.3kPa of oxygen or 7.3-8kPa and one of- Secondary polycythaemia Peripheral oedema Pulmonary hypertension

Question 962

How to check for leakage after an anastomosis surgery to join the colon?

Answer 962

Gastrogaffin enema

Question 963

Adrenaline doses?

Answer 963

0.5mg for anaphylaxis- 0.5ml 1:1000 Cardiac arrest 1mg- either 10ml 1:10,000

Question 964

When to consider anaemia of chronic disease?

Answer 964

Hb low Serum iron low TIBC low Ferritin riased Normocytic or maybe microcytic anaemia IDA would be low ferritin high TIBC

Question 965

How many AKI stages?

Answer 965

3 Stage 1- 1.5.1.9- all the 1s 0.5 for 6 Stage 2- 2-2.9- all the 2s 0.5 for 12- another 2 Stage 3- >3x- all the 3s 0.3 for 24 hours- another 3

Question 966

Breech baby investigation?

Answer 966

Ultrasound pelvis in every breech baby at 6 weeks

Question 967

Acute pancreatitis systemic complication?

Answer 967

Acute respiratory distress syndrome

Question 968

Second line for GAD after sertraline?

Answer 968

SNRI- duloxetine or venlafaxine

Question 969

NOF fracture first line analgesia?

Answer 969

Iliofascial nerve block

Question 970

Torsades de pointes ECG?

Answer 970

Like AM cover Arctic Monkeys Administer magnesium

Question 971

Do you give fluids for superficial epidermal burns?

Answer 971

No- equivalent to a sunburn etc Give IV fluids for other burns with greater than 15% total body surface area coverage

Question 972

Rubella symptoms?

Answer 972

Similar to measles but Pink rash from the face Not masses else so put when ruled out other things, some lymphadenopathy present

Question 973

Morphine oral to subcutaneous?

Answer 973

Divide by 2

Question 974

Organisms causing post splenectomy sepsis?

Answer 974

Streptococcus pneumoniae Haemophilius influenzae Meningococci

Question 975

Restarting COCP?

Answer 975

Breastfeeding- 6 weeks post partum Not breastfeeding- 3 weeks post partum due to VTE risk Women only require contraception after day 21

Question 976

VTE prophylaxis in pregnancy?

Answer 976

DOACs/warfarin contraindicated LMWH is the treatment of choice

Question 977

How to investigate AKI with an unclear cause?

Answer 977

Renal tract ultrasound within 24 hours

Question 978

Acute vs chronic pancreatitis most common causes?

Answer 978

Acute- gallstones Chronic- alcohol excess- important

Question 979

Chronic pancreatitis symptoms?

Answer 979

Pain worse following a meal Steatorrhoea Diabetes mellitus- typically 20 years after symptoms begin CT- pancreatic calcification Functional tests- faecal elastase to assess exocrine function Give pancreatic enzyme supplements + analgesia

Question 980

What is inflammatory back pain?

Answer 980

Ankylosing spondylitis etc Mechanical back pain is hurt back

Question 981

Brain abscess treatment?

Answer 981

Ceftriaxone (3rd generation cephalosporin) and metronidazole Seems metronidazole used in all abscesses Ring enhancing lesions on a CT scan are characteristic of abscesses

Question 982

Causes of false VDRL/RPR (syphilis tests)?

Answer 982

SomeTimes Mistakes Happen SLE, TB, Malaria, HIV Non-treponemal tests- VDRL/RPR- can give false positives Treponemal-specific tests- TP-EIA, TPHA- specific for syphilis Positive non-treponemal test + positive treponemal test consistent with active syphilis infection Positive non-treponemal test + negative treponemal test consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above) Negative non-treponemal test + positive treponemal test : consistent with successfully treated syphilis

Question 983

Adrenaline doses?

Answer 983

Under 6- 150 6-11- 300 12+- 500

Question 984

Broad complex vs narrow complex timings?

Answer 984

Broad >0.12 QRS Narrow <0.12 QRS

Question 985

ARE PROPHYLACTIC ANTIBIOTICS REQUIRED BEFORE AN APPENDICECTOMY?

Answer 985

YES

Question 986

Spontaneous bacterial peritonitis?

Answer 986

Form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis Features - ascites - abdominal pain - fever Diagnosis Paracentesis- neutrophil count over 250 Most common organism is E.coli IV cefotaxime usually given

Question 987

Antibiotic prophylaxis for ascites?

Answer 987

Patients with fluid protein <15 and cirrhosis Previous spontaneous bacterial peritonitis Give ciprofloxacin for prohylacis

Question 988

Subacute thyroiditis (de quervains and ESR?)

Answer 988

ESR Raised in hypoerthyroidism (phase 1) Also a painful goitre

Question 989

Bleeding + haemoarthroses?

Answer 989

Haemophilia

Question 990

KEY THING TO REMEMBER ABOUT REACTIVE ARTHRITIS?

Answer 990

READ ALL THE OPTIONS REMEMBER REACTIVE ARTHRITIS CAN HAPPEN WITH STIs NOT JUST STOMACH RELATED ILLNESSES URETHRITIS, ARTHRITIS AND CONJUNCTIVITIS

Question 991

Disseminated gonococcal diseae?

Answer 991

Tenosynovitis, migratory poly arthritis and dermatitis

Question 992

Haemophilia overview?

Answer 992

Haemophilia A= factor 8 (A=8) Haemophilia B= factor 9 Prolonged APTT, normal PT and bleeding time Bleeding into joints- haemoarthroses Post surgical or post trauma prolonged bleeding X-linked recessive- only affects men

Question 993

Investigation of choice for polycythemia vera?

Answer 993

JAK2 mutation

Question 994

Risk for starting TNF-inhibitors?

Answer 994

Reactivation of TB Do CXR before starting them

Question 995

Severe UC exacerbation investigation?

Answer 995

Sigmoidoscopy not colonoscopy due to risk of perforation

Question 996

Transfuse at what Hb?

Answer 996

<70

Question 997

Choice of antiemetic?

Answer 997

Generally Give cyclizine for everything unless the cause is Gastric motility- metoclopramide Chemically mediated- ondansetron Parkinson's disease- domperidone

Question 998

Sodium valproate causes pancreatitis?

Answer 998

Yes

Question 999

Pseudomembranous colitis?

Answer 999

Severe inflammation of the large intestine caused by C.difficile

Question 1000

Test for diagnosis and screening in HIV?

Answer 1000

HIV p24 antigen and HIV antibody At 4 weeks and 3 months

Question 1001

Genital herpes investigation?

Answer 1001

NAAT- nucleic acid amplification tests

Question 1002

IS IT BIPAP OR CPAP IN COPD EXACERBATION?

Answer 1002

BIPAP REMEMBER IT CPAP is for sleep apnoea 7.25-7.35 BiPaP Less then 7.25 intubate and ventilate

Question 1003

CKD extra medication to take?

Answer 1003

Statin

Question 1004

Ecstasy poisoning electrolyte imbalance?

Answer 1004

Hyponatraemia Can use dantrolene

Question 1005

Alcohol withdrawl symptoms timeline?

Answer 1005

Alcohol withdrawal symptoms: 6-12 hours seizures: 36 hours delirium tremens: 72 hours

Question 1006

Causes of lithium toxicity?

Answer 1006

Dehydration Renal failure Drugs: diuretics (especially thiazides), ACEi/ARB, NSAIDs and metronidazole

Question 1007

Lithium toxicity features?

Answer 1007

Coarse tremor Hyperreflexia Polyuria Acute confusion Seizure Coma

Question 1008

Is WBC raised in ALL?

Answer 1008

Not necessarily because immature blasts

Question 1009

ITP?

Answer 1009

Isolated thrombocytopenia

Question 1010

ALL can present with DIC, what are the signs of DIC?

Answer 1010

Prolonged PT and APTT Reduced fibrinogen Elevated fibrin degradation products (d-dimer) Thrombocytopenia Also- anaemia, leukopenia With systemic symptoms fever, fatigue, pain it raises the suspicion of ALL

Question 1011

ACL vs meniscus?

Answer 1011

ACL swelling very quickly, pop heard at injury, no locking/catching, feels like it will give way Meniscus swelling takes longer >24 hours, locking/catching, no true instability

Question 1012

RA joint aspiration?

Answer 1012

Can be turbid and yellow with a high white cell count- predominatly neutrophils

Question 1013

Glue ear with Down's or cleft palate?

Answer 1013

Refer to ENT

Question 1014

Breast lump in under 30?

Answer 1014

Non-urgent referral

Question 1015

Drug for restless legs syndrome?

Answer 1015

Dopamine agonists- pramipexole, ropinirole Exclude iron deficiency

Question 1016

Guillain-Barre management?

Answer 1016

IV immunoglobulins VTE prophylaxis

Question 1017

Extra heart sounds?

Answer 1017

S3 threee → cannot breeeeeath → LVH or cardiomyopathy (dilated) S4 foooour → drop on flooor → HOCM S3 normal in under 30, S4 normal in over 40 (3 for 30, 4 for 40)

Question 1018

Orbital compartment syndrome?

Answer 1018

Secondary to retrobulbar haemorrhage- true opthalmic emergency Features- history of trauma- Eye pain/swelling Proptosis Rock hard eyelids Relevant afferent pupillary defect Management- Urgent lateral canthotomy to decompress the orbit- before diagnostic imaging

Question 1019

Blood in anterior chamber of the eye (hyphema)?

Answer 1019

If not orbital compartment syndrome which needs immediate treatment Urgent referral to opthalmology

Question 1020

Synchonised or unsynchronised shock?

Answer 1020

Presence of a pulse If pulse- give synchonised If no pulse- unsynchronised Don't shock an unshockable rhythm such as PEA, asystole

Question 1021

Life threatening asthma criteria?

Answer 1021

PEFR <33%, O2 sats <92% + CHEST Cyanosis Hypotension Exhaustion Silent chest, poor respiratory effort Tachy/brady/arrhythmia

Question 1022

SBP causative organism?

Answer 1022

Three C's e.Coli Ciprofloxacin for prophylaxis Cefotaxime IV to treat

Question 1023

Can you get TB after having the TB vaccine?

Answer 1023

Yes it would seem so- it offers limited protection- it is a live attenuated vaccine- no evidence it works over the age of 35 Features of TB- haemoptysis, night sweats, fever and lymphadenopathy Travel to high TB areas SOB, weight loss Hyponatraemia can be seen- TB associated with SIADH

Question 1024

Placental abruption management?

Answer 1024

Fetus alive and < 36 weeks No distress- admit and steroids Distress- Immediate caesarean section Fetus alive > 36 weeks No distress- deliver vaginally Distress- immediate caesarean Fetus dead- vaginal delivery

Question 1025

Ureteric obstruction due to stone stone + infection?

Answer 1025

Urgent decompression

Question 1026

Site of epistaxis?

Answer 1026

Anterior nasal septum bleeds- more common Posterior nasal septum bleeds- more severe Usually an insult to Kiesselbach's plexus

Question 1027

Open angle glaucoma vs closed angle glaucoma treatment?

Answer 1027

Open angle- treat if >24 IOP Laser trabeculoplasty first line Prostoglandin analogue eye drops next- Latanoprost Beta-blocker drops- timolol Carbonic anhydrase drops- dorzolamide

Question 1028

Constrictive pericarditis presentation?

Answer 1028

SOB RHF- elevated JVP, oedema Pericardial knock- loud S3 Kussmaul's sign positive CXR pericardial calcification

Question 1029

How long for conttraceptives to become effective?

Answer 1029

IUD- immediate 2 days- POP 7 days- COCP, injection, implant, IUS

Question 1030

WHEN TO USE PROPHYLACTIC CIPROFLOXACIN FOR SBP?

Answer 1030

IF THE SAAG IS LESS THAN 15

Question 1031

Amitriptyline and BPH?

Answer 1031

Contraindicated

Question 1032

Hyponatremia during TURP? TURP syndrome

Answer 1032

Caused by irrigation with glycine which is hypo-osmolar Presents with CNS, respiratory and systemic symptoms

Question 1033

Latent autoimmune diabetes of adulthood vs maturity onset diabetes of the young

Answer 1033

Latent autoimmune diabetes of adulthood- type 1 diabetes presenting later Maturity onset diabetes of the young- type 2 diabetes presenting in younger people

Question 1034

Hypercalcaemia?

Answer 1034

Painful bones, psychiatric moans, abdo groans

Question 1035

Uric acid levels in gout measurement?

Answer 1035

If uric acid level over 360 it supports the diagnosis If uric acid level <360- repeat the uric acid level measurement at least 2 weeks after the flare has settled

Question 1036

Synovial fluid analysis gout?

Answer 1036

Needle shaped negatively birefringent monosodium urate crystals under polarised light

Question 1037

How long symptoms present to diagnose chronic fatigue syndrome?

Answer 1037

At least 3 months

Question 1038

Other name for chronic fatigue syndrome?

Answer 1038

Myalgic encephalomyelitis

Question 1039

TIA caused by AF?

Answer 1039

Give a DOAC- treat the underlying cause Start it immediately After stroke DOAC is started after 2 weeks aspirin If no AF after stroke use clopidogrel after 2 weeks aspirin Same management for TIA without AF

Question 1040

AST:ALT ratio of 2?

Answer 1040

Alcoholic hepatitis AST is higher for spirits- GGT also characteristically raised ALT is higher for lard- non-alcoholic steatohepatitis (NASH) Glucocorticoids often used during acute episodes of alcoholic hepatitis

Question 1041

Sickle cell- pulmonary infiltrates?

Answer 1041

Acute chest syndrome Pain relief, oxygen, antibiotics, transfusion

Question 1042

Can nitrofurantoin cause pulmonay fibrosis?

Answer 1042

Yes

Question 1043

Most common place for Crohn's?

Answer 1043

Ileum

Question 1044

Optic neuritis?

Answer 1044

CRAP c- central scotoma r- red desaturation/ RAPD a- acuity decreased p- painful eye movement

Question 1045

Insulinoma or?

Answer 1045

Could be sulfonyl urea overdose- causes increased insulin secretion from the pancreas

Question 1046

Type 1 vs type 4 hypersensitivity?

Answer 1046

P4tch test: for type IV sensitivity Pr1ck test: for type I hypersensitivity

Question 1047

TB treatment regime?

Answer 1047

RIPE for first 2 months RI for next 4 months Latent TB is treated with 3 months of RI (with pyridoxine) or 6 months of isoniazid (with pyridoxine)

Question 1048

> 60 with a new onset iron-deficiency anaemia?

Answer 1048

Urgent colorectal cancer pathway referral FIT test and refer on 2ww for colonoscopy FIT test for over 60 with anaemia even without iron deficiency

Question 1049

TIA and referral?

Answer 1049

Within a week- specialist appointment within 24 hours Over a week ago- specialist appointment within a week

Question 1050

Potential complication of panretinal photocoagulation

Answer 1050

A decrease in night vision

Question 1051

Smith fracture?

Answer 1051

Reverse colles fractures Hand goes down

Question 1052

Lupus pernio?

Answer 1052

In sarcoidosis Similar rash to SLE but purple in colour Sarcoidosis has a raised serum calcium

Question 1053

Non-falciparum malariua treatment?

Answer 1053

Plasmodium vivax, plasmodium ovale Artemisinin-based combination therapy (ACT) or chloroquine Patients with ovale or vivax malaria should be given primaquine following acute treatment with chloroquine to destroy live hypnozoites and prevent relapse

Question 1054

Felty's syndrome?

Answer 1054

Splenomegaly and neutropenia in a patient with arthritis Anaemia as well RA + Splenomegaly + low white cell count

Question 1055

Wilson's disease blood results?

Answer 1055

Reduced serum caeruloplasmin (carries copped) Reduced total serum copper (although free copper increased) Increased 24hr urinary copper excretion Management penicillamine (chelates copper)

Question 1056

DDH RFs?

Answer 1056

Fat, female, first born, foot-first, family history

Question 1057

Hand osteoarthritis affected joints?

Answer 1057

CMCs and DIPJs more than the PIPJs Heberden's nodes at the DIP Bouchard's nodes at the PIP

Question 1058

The Levine Scale for murmurs?

Answer 1058

Grade 1 - Very faint murmur, frequently overlooked Grade 2 - Slight murmur Grade 3 - Moderate murmur without palpable thrill Grade 4 - Loud murmur with palpable thrill Grade 5 - Very loud murmur with extremely palpable thrill. Can be heard with stethoscope edge Grade 6 - Extremely loud murmur - can be heard without stethoscope touching the chest wall

Question 1059

Ascending cholangitis causative organism?

Answer 1059

Most commonly E.Coli

Question 1060

When to do a pregnancy test after a medically managed miscarriage?

Answer 1060

3 weeks after

Question 1061

Management of RA flares?

Answer 1061

Corticosteroids- oral or IM

Question 1062

REMEMBER REACTIVE ARTHRITIS!!!!!!!!!!!!!!!! ESPECIALLY POST STI!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Answer 1062

DIFFERENTIATE IT FROM SEPTIC REMEMBER- CAN'T PEE, CAN'T SEE, CAN'T CLIMB A TREE

Question 1063

DOAC length in PE/DVT with active cancer?

Answer 1063

3 to 6 months (could be 6 months as an answer)

Question 1064

Investigation for acute cholecystitis?

Answer 1064

Ultrasound scan

Question 1065

Cause of extradural haematomas?

Answer 1065

Fracture of the pterion which is where the middle meningeal artery is located

Question 1066

When to rescan to see if placenta praevia has resolved?

Answer 1066

At 32 weeks if low lying on the 20 week scan If still present at 32 rescan ever 2 weeks Final ultrasound at 36-37 weeks Grades 3/4 elective caesarean at 37/38 If woman with known placenta praevia goes into labour- emergency caesarean

Question 1067

Brachial plexus injuries?

Answer 1067

Erb-Duchenne paralysis- damage to C5/6 roots- winged scapula, caused by breech presentation Klumpke's paralysis- damage to T1, loss of intrinsic hand muscles Due to traction T1 bring in the thumb

Question 1068

Treatment of otitis externa?

Answer 1068

Topical antibiotic or combined topical antibiotic and steroid are both first line Second line are oral antibiotics (flucloxacillin) if the infection is spreading If patient fails to respond to topical antibiotics then the patient should be referred to ENT

Question 1069

What is a FAST scan?

Answer 1069

Focused assessment eith sonography for trauma Can detect free fluid in the abdomen and chest

Question 1070

Lacunar stroke?

Answer 1070

Involves perforating arteries around the internal capsule, thalamus and basal ganglia Presents with 1 of the following- Unilateral weakness of face, arm, leg or all three Pure sensory stroke Ataxic hemiparesis`

Question 1071

Gential herpes investigation?

Answer 1071

Nucleic acid amplification tests (NAAT)

Question 1072

UC flare that is affecting the whole colon (extensive disease)?

Answer 1072

Both topical and oral aminosalicylate- this is because rectal cannot help the whole of the colon so need an oral agent too

Question 1073

Can alcohol excess cause neuropathy?

Answer 1073

Yes

Question 1074

Chronic pancreatitis and diabetes?

Answer 1074

Can cause it although can take a while

Question 1075

What do patients with CKD (especially those on dialysis) have a significantly higher risk of?

Answer 1075

Cardiovascular diseases- ischaemic heart disease

Question 1076

WHICH IS WORSE CRITICAL LIMB ISCHEMIA OR ACUTE LIMB ISCHEMIA?

Answer 1076

ACUTE- THIS HAS THE 6 P's Pale Pulseless Painful Paralysed Paraesthetic Perishingly cold

Question 1077

How to treat severe cellulitis?

Answer 1077

Co-amoxiclav, clindamycin, cefuroxime, ceftriaxone

Question 1078

B symptoms and Hodgkin's lymphoma?

Answer 1078

Associated with a poorer prognosis Weight loss, fever, night sweats Hodgkin's has Reed-Sternberg cells

Question 1079

Severe hepatitis in a pregnant woman?

Answer 1079

Hepatitis E A and E spread faecally- vowels and bowels B, C, D spread by blood

Question 1080

Ureteric stones vs renal stones?

Answer 1080

Renal stone management is the classic one learnt Ureteric- shockwave lithotripsy +/- alpha blcokers if under 10mm If over 10mm- uretoscopy

Question 1081

Aortic transection?

Answer 1081

Tear through all walls of aorta due to trauma May be ok for a while due to a haematoma but then sudden death

Question 1082

Testicular fixation surgery name?

Answer 1082

Orchidopexy

Question 1083

Genital warts management?

Answer 1083

Caused by HPV 6 & 11 Small fleshy, may bleed or itch Management- Topical podophyllum or cryotherapy- depends of the loaction and type of lesion Multiple, non-keratinised are best treated topically Solitary, keratinised warts respond better to cryotherapy

Question 1084

Starting long term steroid therapy?

Answer 1084

<65 years old- DEXA scan >65 years old- bisphosphonate

Question 1085

Should all pregnanct women take vit D?

Answer 1085

Yes

Question 1086

What should people with heart attack secondary to cocaine be given?

Answer 1086

IV benzodiazapines

Question 1087

Cocaine toxicity treatments?

Answer 1087

Generally benzodiazapines Chest pain- benzos + GTN Hypertension- benos + sodium nitroprusside

Question 1088

Conduction dysphasia affects which part of the brain?

Answer 1088

Arcuate fasciculus

Question 1089

Where is osteomyelitis most likely to affect?

Answer 1089

In children- minors- metaphysis In adults- elders- epiphysis

Question 1090

PSC investigation?

Answer 1090

MRCP/ERCP

Question 1091

Do you shock a bradycardia?

Answer 1091

NO atropine 500 milligrams up to max of 3mg Transcutaneous pacing Isoprenaline/adrenaline infusion Transvenous pacing

Question 1092

De Quervain's?

Answer 1092

Painful goitre and globally reduced uptake of iodine-131, raised ESR Key investigation is the thyroid scintigraphy with the globally reduced uptake of iodine-131 Usually self limiting

Question 1093

Is dialysis ineffective at removing tricyclics?

Answer 1093

Yes

Question 1094

Key investigation for diagnosing CKD?

Answer 1094

Albumin:creatinine ratio (ACR)

Question 1095

Rubella distinguisher from measles?

Answer 1095

Suboccipital and post auricular lymphadenopathy and pink rash

Question 1096

Chalazion vs stye (hordeolum)?

Answer 1096

Stye painful and caused by s.aureus Chalazion painless, sterile lymphogranuloma

Question 1097

Standby medication COPD?

Answer 1097

If had an exacerbation within the last year- keep a short course of oral corticosteroids and oral antibiotics at home

Question 1098

Type 1 vs type 4 hypersensitivity?

Answer 1098

Type 1 rapid- anaphylaxis- IgE Type 4- slower no antibodies (dermatitis, scabies)

Question 1099

Tuberculoid leprosy?

Answer 1099

Whitened skin lesions, nerve damage TB risk factors potentially

Question 1100

Nec fasc

Answer 1100

Type 1- mixed anaerobes and aerobes Type 2- Strep pyogenes SGLT-2 is a RF Perineum most common site (Fournier's gangrene) Rapidly worsening cellulitis- pain out of keeping with physical features Management- urgent surgical referral for debridement IV antibiotics

Question 1101

In pregnancy of unknown location what does a bHCG of over 1500 point to?

Answer 1101

A diagnosis of ectopic pregnancy

Question 1102

Beta thalassemia?

Answer 1102

MCV low In major- Hb very low and MCV very low, symptoms In trait- Hb slightly low, MCV very and disproportionatley low, often asymptomatic