Random knowledge to review 3 Flashcards
1
Q
Over what age do you give amxoicillin with ceftriaxone?
A
50
2
Q
Schizophrenia first rank symptoms (Schneider’s)?
A
Auditory hallucinations
Thought disorders
Passivity phenomena
Delusional perceptions
3
Q
COPD acute management?
A
O
Shit
I
Hate
The
BiPaP
Oxygen
Salbutamol
Ipratropium
Hydrocortisone (steroids)
Theophylline
BiPaP(resp acidosis use BiPaP)
4
Q
Lung cancer paraneoplastic features?
A
Small cell- ADH, ACTH, Lambert-Eaton
Squamous cell-
Parathyroid hormone-related protein (PTH-rp)
Clubbing
Hypertrophic pulmonary oesteoarthropathy (HPOA)
Ectopic TSH
Adenocarcinoma
Gynaecomastia
Hypertrophic pulmonary osteoarthropathy (HPOA)
5
Q
What do statins inhibit?
A
HMG-CoA reductase
Rate-limiting enzyme in choelsterol synthesis
6
Q
PPH how much blood?
A
> 500ml after a vagnial delivery
7
Q
Serum osmolality equation?
A
2x Na + Glucose + Urea
8
Q
Most common cause of viral meningitis?
A
Enterovirus in adults- coxsackie B virus, echovirus
In encephalitis it is HSV that is most common
9
Q
VIRAL MENINGITIS?
A
ENTEROVIRUSES- COCKSACKIE B
10
Q
Digoxin in A-Fib?
A
Give as second line rate control
After BBs/ rate limiting CCBs
11
Q
VEAL CHOP?
A
Variable decelerations- cord compression
Early decelerations- head compression
Accelerations- Okay
Late decelerations- placental insufficiency
12
Q
In anterior resection for a rectal tumour what do they do for anastomosis?
A
Loop ileostomy
Not loop colostomy- this is to let the astomosis in the colon heal, contents are diverted proximally at the small bowel
13
Q
Is Crohn’s disease a risk factor for gallstones?
A
Yes
Stones for Crohn’s
14
Q
Acute stress disorder inital management?
A
Refer for trauma-focused cognitive-behavioural therapy (CBT)
15
Q
DKA criteria?
A
pH <7.3 or bicarb <15
Glucose over 11
Ketones over 3
16
Q
Most common cause of vomiting in infancy?
A
GORD
17
Q
Does a subarachnoid haemorrhage cause torsades de pointes?
A
Yes
18
Q
The beta blocker causing heart failure/pulmonary oedema?
A
Verapamil
19
Q
Pneumocytis jirovecci investigaitons and managemnet?
A
Silver staining
Some signs on x-ray
Treat with co-trimoxazole
Oxygen saturations characteristically decline on exertion
20
Q
Investigation for peripheral arterial disease?
A
ABPI more like a screening
Duplex ultrasound
21
Q
Fibroadenoma size for surgical excision?
A
> 3cm
22
Q
Ongoing jaundice after cholecystectomy?
A
Gallstone in the common bile duct
23
Q
Pregnancy and BPs?
A
> 140/90- secondary care assessment by specialist
> 160/110- admit and immediate obstetric assessment
24
Q
Different between loop and end stomas?
A
Loop stomas- 2 openings
End stomas- 1 opening
25
PAD antiplatelet?
Clopidogrel used first line
26
PAD treatment if critical?
(Clopidogrel and statin)
Exercise
Endovascular revascularisation- typically for short segment <10cm, high risk or aortic iliac
Surgical revascularisation- long segment lesions >10cm, multifocal lesions
Amputation
27
Full name for LSD?
Lysergic acid diethylamide
28
Cyclical mastalgia?
Breast pain that varies in intensity related to the menstrual cycle
Wear a supportive bra, conservative treatments include standard oral and topical analgesia
29
COPD stable management?
1st- SABA or SAMA
2nd- no asthma features- SABA, LAMA, LABA (no SAMA and LAMA together)
Asthma features- LABA + ICS
If remain breathless- LAMA, LABA and ICS
30
High pitched blowing murmur with breathlessness?
Mitral regurgitation if left sided
31
RA imaging pre surgery?
X-rays to assess for atlantoaxial subluxation
32
Nasopharyngeal cancer?
Associated with Asian people- can present as painless lymphadenopathy due to tendancy for early spread
33
Tachyphylaxis?
Rapid tolerance to a drug- can happen with nasal decongestants
34
When to start anticoagulation after a stroke when AF is found?
If it is a TIA- anticoagulation for AF should start immediadley
In acute stroke patients, in the absence of haemorrhage, anticoagulation therapy should be commenced after 2 weeks, antiplatelet given during the intervening period
35
TIA when on an anticoagulant?
Don't give aspirin
Immediate referral to ED for a non-contrast CT head
36
Is adenosine CI in asthmatics?
Yes- use verapamil instead
37
Bechet's disease?
Oral ulcers, genital ulcers and uveitis, VTE also seen
38
Giardiasis?
RFs- foreign travel, drinking/swimming river or lake, MSM
Non-bloody diarrhoea, steatorrhoea
Bloating, abdo pain
Lethargy
Flatulance
Weight loss
Malabsorption and lactose intolerance
Metronidazole
39
Lithium toxicity?
CHAPS
Coarse tremor
Hyperreflexia
Acute confusion
Polyuria
Seizures
40
Bell's palsy + forehead?
CANNOT move forehead
41
Loss of taste in anterior 2/3 of tongue in Bell's palsy?
Yes- facial nerve weakness
It is facial nerve paralysis
42
Adenosine CI?
CI in asthma
Use verapamil for tachycardias
43
Digoxin toxicity?
Unwell, nausea and vomiting, confusion, yellow-green vision
Arrythmias- AV block, bradycardia
Gynae
Classically precipitated by hyokalaemia
Management is with Digibind
44
Heart failure chest x-ray?
ABCDEF
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Effusions
Fluid in horizontal fissure
45
After 2 DMARDs starting what and doing what investigation?
Biologics- TNF inhibitors- etanerecpt/infliximab
Can cause reactivation of TB so need to do a CXR before
46
RR below 8?
Ventilate- either bag and mask or ?intubate
GCS below 8 inutbate
If gave oxygen not breathing enough to bring sats up
47
Learn table with eye drugs on open angle glaucoma page
/
48
Acute bronchitis?
Think when looks like pneumonia but not enough symptoms/ clear chest x-ray
Treated with doxycycline
Often viral but use antibiotic when-
systemically unwell
Other co morbidities
CRP >100
49
First line investigation for stable angina?
Contrast-enhanced CT coronary angiogram
50
PITS?
Remember it
Parietal inferior, temporal superior
And effects the contalateral side
51
Can temporal arteritis also cause central retinal artery occulsion?
Yes- classically would cause anterior ischaemic optic neuropathy- this presents with a blurred optic disc
Central retinal artery occlusion would present with painless visual loss, cherry red spot on the retina and a relative afferent pupillary defect
Central retinal artery occlusion is either from a thromboembolism or arteritis
52
Amlodipine side effects?
Headache, flushing, ankle oedema
53
Location and types of lung cancer?
Squamous and small cell and central and associated with smoking
LA is on the coast (large cell and adenocarcinoma are peripheral)
54
How do you classify the severity of COPD?
Based on the FEV1
50-70%- moderate
30-49%- severe
<30%- very severe
55
When can you restart hormonal contraception after taking ulipristal?
5 days
56
More folic acid?
Give MORE Folic acid (5mg OD) to:
M- Metabolism problem (diabetes and coeliac)
O- Obesity (BMI >30)
R- Relative with NTD history
E- Epilepsy (taking antiepileptic meds)
+ sickle cell and thalassemia
57
Does subacute thyroiditis (De Quervain's) occur following a viral infection?
Yes
Goitre is only there during the hyperthyroid stage and is painful, with raised ESR
58
Fever on alternating days?
Think malaria
59
When to start ACEi in CKD?
If they have an ACR over 30
60
Lupus pernio?
Rash that comes in sarcoidosis
Affects the nose, cheeks, lips, ears and digits. Not normaly itchy or painful. Is purple.
61
Normal pressure hydrocephalus triad?
Urinary incontinence
Dementia and bradyphrenia
Gait abnormality (may be siilar to parkinsons
Imaging shows ventriculomegaly
Management- ventriculoperitoneal shunting
62
Fluctuating confusion/consciousness in which brain bleed?
Subdural haematoma
63
READ THE QUESTION
BOTH AORTIC STENOSIS AND PULMONARY STENOSIS PRESENT IN SIMILAR WAYS
RILE
64
What is the infective agent in eczema herpeticum?
Herpes simplex virus 1 or 2
65
Acute pyelonephritis presentation?
Fever, chills, nausea, vomiting, severe loin pain and a history of dysuria and frequency
Typically caused by E.coli
66
Can ECV be performed at 36 weeks/ in early labour?
Yes can be performed in early labour as long as the membranes have not yet ruptured
67
Twin-to-twin transfusion syndrome?
Monochorionic twins- sharing the same placenta- one gets more than the other
One gets fluid overloaded and the other get anaemia
68
MRSA treatment?
Vancomycin
69
How to work out the cause of AKI?
Can use Urea to Creatinine ratio:
(Urea/Creatinine) x 1000- if it is over 100 it is a pre renal cause of AKI
70
When to prescribe steroids in sarcoidosis?
P- Parenchymal lung disease
U- Uveitis
N- Neurological involvement
C- Cardiac involvement
H- Hypercalcaemia
71
Thiazide like diuretics and ED?
Yes
72
DIAGNOSTIC CRITERIA FOR HYPEREMESIS GRAVIDARUM vs VOMITING IN PREGNANCY?
5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance
73
Nerve block for labour?
Pudendal
74
Epidural with anticoagulation and spinal cord compression?
?Haematoma
75
Complications of opioid misuse?
Viral infection
Bacterial infection
VTE risk
Overdose
Pshychological problems
Social problems
76
All patients with peripheral arterial disease should take what?
Clopidogrel and statin
Should also be encouraged to stop smoking
77
Can you diagnose AKI from a raised potassium or raised urea?
NO- YOU CAN ONLY DIAGNOSE AKI FROM
Creatinine > 26 in 48 hours
Creatinine 50% rise in 7 days
Urine output less than 0.5ml/kg/hour for more than 6 hours
78
Oesophageal ulcers?
Bisphosphonates
79
Diastolic murmur and AF?
?Mitral stenosis
Can be felt over apex beat- apex beat is over the left ventricle
80
Mirtazapine side effects?
Sleepiness and increased appetite
81
Orthostatic hypotension?
Iatrogenic causes- alpha blockers
Drop of BP >20/10 within 3 minutes of standing
Presyncope/syncope
Management- midorine or fludrocortisone
ECG for all patients
82
Pigmented gallstones causes?
Anything causing red cell haemolysis
83
Main side effect of colchicine?
Diarrhoea
84
Eosinophilia in which renal disease?
Acute interstitial nephritis
Most commonly caused by drugs- paticularly antibiotics
Features-
Fever, rash, arthralgia
Eosinophilia
Mild renal impairment
Hypertension
Investigations-
Sterile pyuria
White cell casts
85
Most common site for metatarsal stress fracture?
2nd metatarsal
86
Urgent assessment for what age child with limp?
Any child less than 3 years presenting with an acute limp- refer urgently for paediatric assessment
87
Do you treat asymptomatic BV?
No
88
Vaccine offered to patients with chronic hepatitis?
One-off pneumococcal vaccine
89
Treatment of choice for toxic multinodular goitre?
Radioactive iodine therapy
90
TB meningitis unique LP?
Has lymphocytes not neutrophils (polymorphs) despite being a bacteria
91
Milestones speaking?
Combine 2 words- 2 yeards
What/who questions- 3 years
Why/when/how- 4 years
2-6 words is 12-15 months (refer at 18 months)
92
Acute limb threatening ischaemia first investigation?
Dopper ultrasound
Not in other PAD just acute as quick- ABPI in those
93
Legionella type of virus?
Gram-negative bacilli
94
Furosemide in heart failure?
Use if significant overload/ acute features
95
Signs for renal replacement therapy in AKI?
Hyperkalaemia
Pulmonary oedema
Uraemia (pericarditis, encephalopathy)
AEIOU for haemodialysis- acidosis, electrolytes (high K+), intoxication, oedema, uraemia BOI
96
HIV fungal neuro infection?
Cryptococcus
Headache, fever, malaise, N+V, seizures, focal neurological defecit
CSF- high opening pressure, elevated protein, reduced glucose, usually lymphocyte predominance
Key investigation- India ink test positive
97
Which TB drugs and for how long?
Give 4 for 2 and 2 for 4
Give all four RIPE for 2 months, then give the first two for a further 4 months
98
HIV drugs that end in navir?
All protease inhibitors
If end in gravir they are integrase inhibitors
Zidovudine, abacavir- nucleoside analogue reverse transcriptase inhibitors (NRTI)
99
Thrombectomy/Thrombolysis?
Thrombectomy- give if under 6 hours, give if salvagable tissue on CT/MRI up to 24 hours
Thrombolysis- give if less than 4.5 hours, give if salvagable tissue on CT/MRI up to 9 hours
100
Most common type of intracapsular fracture?
A subcapital fracture
Try not to confuse with extra capsular which are either trochanteric or subtrochanteric
101
Who should recieve PCP prophylaxis (pneumocytic jiroveci)?
CD4 count <200/mm3
Treat with co-trimoxazole
Silver stain
102
How to confirm a posterior infarction?
There would be reciprocal changes in V1-3-
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2
Put on posterior leads (V7-9)
Would see ST elevation and Q waves
103
Thoracic outlet syndrome?
Compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet- can be neurogenic or vascular- former is 90% of cases
Cervical rib is associated
Neurogenic- painless muscle wasting of the hand muscles, sensory symptoms- numbness and tingling
Vascular- subclavian vein compression painful diffuse arm swelling with distended veins.
Artery leads to painful arm claudication, ulceration and gangrene
104
Is nexplanon affected by enzyme inducers?
Yes, potentially can use depot
IUD, IUS probably ok
COCP/POP will not work
105
Alternative opioid replacement therapy to methadone?
Buprenorphine- given as a siblingual tablet
106
BP over 180/120 with no worrying signs on examination?
Urgent investigations for end organ damage
Urine dipstick, urinary albumin:creatinine ration, blood tests and an ECG
If target organ damage identified- consider starting antihypertensive drug treatment immediatley
If no target organ damage identified, repeat clinic blood pressure measurement within 7 days
107
Otitis externa managment?
Topical antibiotic or topical antibiotic and steroid
Refer to ENT if fail to respond to topical antibiotic
108
Hypokalaemia ECG?
Absent T waves, U waves (after T waves)
109
Even if ST elevation in I, aVF and V6 showing lateral MI, check V1-3 for ST depression as could suggest a posterolateral MI which would show if put V7-9 leads on
Yes
110
Why is nephrotic syndrome a hypercoagulable state?
Loss of antithrombin III via the kidneys
111
Behcet's?
Classic triad of oral ulcers, genital ulcers and anterior uveitis
More common in Mediterranean (Turkey)
Oral/genital ulcers are relapsing/remitting
112
Gold standard investigation for coeliac dissease?
Endoscopic intestinal biopsy
113
Medication causing lip swelling?
ACEi cause angiodema
Discontinue
114
True epileptic vs psychogenic non-epileptic seizures?
Factors favouring pseudoseizures:
Pelvic thrusting
Family member with epilepsy
Female
Crying after seizure
Don't occur when alone
Gradual onset
Factors favouring true epileptic seizure:
Tongue biting
Raised serum prolactin
115
Blunt ocular trauma with associated hyphema?
Urgent referral- hyphema in trauma
Main risk to sight is the raised intraocular pressure- blockage of angle and trabecular meshwork with erythrocytes
Assess for orbital compartment syndrome
Urgent lateral canthotomy to decompress the orbit
116
Giardia lamblia?
Can cause fat malabsorption and therefore greasy stool, is resistant to chlorine so can transfer within swimming pools
117
How to give magnesium?
<0.4mmol/L or tetany, arrythmias or seizures
IV magnesium
>0.4 mmol/L
Oral magnesium salts
Diarrhoea can occur with oral magnesium salts
118
Exertional dizziness?
Could be aortic stenosis
119
Post-streptococcal glomerulonephritis organism?
Streptococcus pyogenes
120
When to add vancomycin in meningitis?
Add IV vancomycin if prolonged/multiple antibiotic use or travel to areas with highly resistant pneumococciT
121
Types of drugs in dementia?
Acetylcholinesterase inhibitors- rivastigmine, donepezil, galantamine
NMDA receptor antagonists- memantine
Give one acetylcholinerase inhibitor if need more therapy add NMDA receptor antagonists
122
Sildenafil side effects?
Blue discolouration to vision
Headaches
Nasal congestion
Flushing
GI upset
Priaprism
123
Remember haemochromatosis can present oddly?
Darkened skin, reduced energy, erectile dysfunction, reduced libido
Screening-
General population- transferrin saturation
Family members- genetic testing for HFE mutation
124
PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment
125
Drug causes of pancreatitis?
DIS (diuretics, IBD meds, sodium valproate)
D- furosemide, bendroflumethiazide
I- steroids, azathioprine, mesalazine
S- sodium valproate
126
Bladder urothelial carcinoma (transitional cell carcinoma) vs squamous cell carcinoma RFs?
Transitional cell carcinoma- smoking, dyes, irradiation
Squamous cell- schistosomiasis
127
Assessing for LTOT in COPD- 4 Bs?
Blue (cyanosis, spO2 <92%)
Breathing (severe airway obstruction, FEV1 <30%)
Blood (secondary polycythemia)
Ballooning (peripheral oedema, raised JVP, hepatomegaly)
128
Patients with persistent hyperkalaemia?
Dialysis should be considered- haemofiltration/haemodialysis
Emergency treatment in hyperkalaemia is for those with ECG changes or >6.5mmol
129
Four A's of ankylosing spondylitis?
Arthritis
Anterior uveitis
Apical (upper) lobe fibrosis
Aortic regurgitation
Reduced chest expansion, reduced lateral flexion and reduced forward flexion are seen
Can also get achilles tendonitis
130
What do DPP-4 inhibitors do?
Gliptins- increase levels of increatins (GLP-1 and GIP)
131
Turners murmur?
Ejection systolic- due to bicuspid aortic valve
132
What is now used first line in preference to ethanol for ethylene glycol overdose?
Fomepizole
133
What do you also use fomepizole/ethanol for?
Methanol poisoning
134
Organophosphate insecticide poisoning?
Atropine
135
Digoxin, iron, lead and cyanide overdose treatments?
Digoxin- digoxin-specific antibody fragments
Iron- desferrioxamine- a chelating agent
Lead- dimercaprol, calcium edetate
Cyanide- hydroxocobalamin, also a combination of amyl nitrite, sodium nitrite and sodium thiosulfate
136
Is s.aureus pneumonia associated with cavitating lesions?
Yes
Streptococcus pneumoniae is associated with cold sores
137
Haemolytic uraemic syndrome?
Generally seen in young children- triad of-
AKI
Microangiopathic haemolytic anaemia
Thrombocytopenia
Most cases are secondary
Classically shiga toxin-producing E.Coli 0157
138
Rupture of the membranes followed immediately by vaginal bleeding?
Vasa praevia
Fetal bradycardia may also be seen
139
Ankle fracture management?
Seems to be reduce straight away before further management- x-rays, surgery etc
140
R waves in V1-2?
Posterior MI
141
Concave or convex ST elevation in pericarditis?
Concave (saddle shaped) ST elevation and PR depression is seen
All patients with suspected acute pericarditis should have a transthoracic echocardiography
142
Myasthenia gravis investigation?
Single fibre electromyography
Antibodies to acetylcholine receptors
Long-acting acetylcholinesterase inhibitors- pyridostigmine
143
Most common cause of bacterial otitis media?
Strep pneumoniae, H.influenzae and moraxella catarrhalis
144
Pityriasis rosea treatment?
Conservative- usually self limiting
Recent viral infection- herald patch followed by erythematous, oval, scaly patches
Usually disspears in 6-12 weeks
Caused by herpes hominis virus & (HHV-7)
145
Read the question- do not miss stuff like abdominal pain
Mesenteric ischaemia- raised lactate causing a lactic acidosis- high lactate value and high acidosis
On a background of AFib
146
Horizontal vs vertical nystagmus?
Horizontal nystagmus = peripheral cause (goes in direction of ears)
Vertical nystagmus = central cause (goes in direction of brain)
147
Do sulfonylureas cause weight loss or gain?
Weight gain as increase insulin secretion- gliclazide
148
Diabetic drugs helping you lose weight?
1,2 lost a few- GLP-1 and SGLT2
149
Hypo risk in SGLT-2?
Seems not to be a risk of causing hypos, unless taking sulfonylureas
Does cause normoglycaemic ketoacidosis though
150
Superior vena cava syndrome?
Can be a way lung cancer presents due to intraluminal mass/ extrinsic compression
Face and neck swelling, distended neck and chest veins, SOB, cough
151
Codeine relation to morphine?
Codeine equals 10% the dose of morphine
120mg of codeine equals 12mg of morphine
Add it into calculations for breakthrough doses
Oral to subcut morphine is divide by 2
152
What stage is renal cell carcinoma typically when it presents?
Stage 4
Most common histological subtype is clear cell
153
How to treat proliferative retinopathy?
Panretinal laser photocoagulation
154
IS CURRENT BREAST CANCER A CI FOR INJECTABLE PROGESTERONE CONTRACEPTIVES?
YES IT IS
155
When to add metformin to T1DM?
If the BMI is over 25 metformin should be considered for addition to insulin
Monitor HbA1c every 3-6 months
156
TYPES OF HIP FRACTURE????
INTRACAPSULAR, EXTRACASULAR
INTERTROCHANTERIC IS BETWEEN THE GREATER AND LESS TROCHANTER- DYNAMIC HIP SCREW
157
Avoid performing a PSA within how long of a UTI or prostatitis?
6 weeks
1 week of DRE
6 weeks of urology intervention
6 weeks following UTI
48 hours of vigorous exercise
48 hours of ejaculation
158
What happens on abrupt stop of l-dopa?
Neuroleptic malignant syndrome, antipsychotics also cause a fall in dopamine which is why they can be caused it
159
Side effects of common diabetes drugs?
Sulfonylureas- hypos, increased appetitie and weight gain, SIADH
Glitazones- weight gain, fluid retention, liver dysfunction, fractures
Gliptins- pancreatitis
160
Can beta-blockers precipitate a myasthenic crisis?
Yes drugs making myasthenia worse:
Penicillamine
Quinidine, procainamide
Beta-blockers
Lithium
Phenytoin
Antibiotics- gentamicin, macrolides, quinolones, tetracyclines
161
Bowen's disease?
Precancerous dermatosis that is a precursor to squamous cell carcinoma
Red, scaly patches, slow-growing and in sun-exposed areas- head, neck, lower limbs
Management- topical 5-fluorouracil
162
If Bishops score over or equal to 8?
And not been in labour for ages
Consider observing for a bit because spontaneous delivery might occur
If not do the amniotomy/ IV oxytocin
163
Strange Ca low, phosphate high, parathyroid high?
Could be chronic kidney disease- vitamin D deficiency, increased phosphate as less excretion but still get the raised PTH and low calcium
164
Is HIV test offered to all women at booking?
Yes
165
Is treatment for head lice only indicated if live lice are found?
Yes
166
Cholangiocarcinoma associated with which tumour marker?
CA 19-9
This is also elevated in pancreatic and gastric cancer
167
How long should school exclusion be for impetigo?
48 hours
168
Genital wart treatment?
SINGLE KERATINISED WART- cryotherapy
MULTIPLE, NON-KERATINISED WART- topical podophyllum
Imiquimod is second line topical, podophyllum is preferred
169
Stop metformin at what eGFR?
<30ml/min
170
Medication for management of LSD overdose?
Benzodiazepines
Should be used if supportive reassurance hasn't worked
171
Pain in RIF when pressing LIF?
Rovsing's sign
172
Neutrophil predominant leucocytosis in appendicitis?
Yes
173
Weight gain on POP?
NO
Only on injectable
174
COVER AIN vs ATN
/
175
Flying in pregnancy?
>37 weeks no flying for normal pregnancy
Uncomplicated, multiple pregnancy avoid once >32 weeks
176
Blasts vs bands on bloods?
Blasts are acute
Bands are chronic
Raised blasts- AML, ALL
Raised bands- CLL, CML
177
Way to work through blood results in haematology?
1- look at lymphocutes
2- look at WBC
3- others
1- low lymphocytes- AML or CML
2- WBC- if high then more likely to be chronic >100 etc
3. bands/blasts- confirms acute or chronic
Lymphomas would be high lymphocytes, normal or slightly altered WCC with B symptoms and lymphadenopathy
178
Management of patella fractures?
Undisplaced- paticularly vertical fractures with an intact extensor mechanism- can be managed non-operatively in a hinged knee brace for 6 weeks and patietns allowed to fully weight bear
Displaced fractures and those with loss of extensor mechanisms should be considered for operative management- tension band wire, inter-fragmentary screws or cerclage wires
179
Smudge cells in which disease?
CLL
180
Key factor in determining the severity of C.difficile?
WCC
181
Is HbA2 raised in beta thalassaemia?
Yes
Alpha thalassaemia major- not compatible with life
Alpha thalassaemia minor- usually asymptomatic
Beta major- presents at young age (6 months), 2 alpha, 2 beta chains cannot be produced- causes increase in HbA2 (2 alpha, 2 delta) and HbF (2 alpha, 2 gamma)
Beta minor- presents later, anaemia only milld
182
Inguinal hernia surgery types?
Bilateral (and recurrent)- laparoscopic repair
Unilateral- open repair
Hernia truss for patients not fit for surgery
Both surgeries use a mesh
183
Do you treat latent TB?
YES
It is different to treating normal TB
Either-
3 months isoniazid (with pyridoxine) and rifampicin
or 6 months of isoniazid (with pyridoxine)
Diagnose latent TB with positive tuberculin skin test or interferon-gamma release assay combined with a normal chest x-ray
Patients with latent TB cannot pass disease on to others
Latent TB is asymptomatic
184
Is Rosacea associated with blepharitis?
Yes
Also rhinophyma
Sunlight makes symptoms worse
185
VIRUS CAUSING CROUP?
PARAINFLUENZA VIRUS
186
VIRUS CAUSING BRONCHIOLITIS?
RESPIRATORY SYNCYTIAL VIRUS (RSV)
187
Acute heart failure management?
Treatments for all patients:
IV loop diuretics
Possibly-
Oxygen
Vasodilators- nitrates not routinely given to all patients- however may have a role if concomitant myocardial ischaemia, severe hypertension or reguritatnt aortic or mitral valve disease
CI is hypotension
If resp failure CPAP
Dobutamine if cardiogenic shock, also vasopressor agents if hypotension
188
Medication that can reduce the risk of COPD exacerbations?
Phosphodiesterase-4 (PDE-4) inhibitors- roflumilast
189
CKD bone problems?
Can cause high phosphate
Can be high calcium, maybe also low calcoum from lack of Vit D
Reduce dietary intake of phosphate is the first line, phosphate binders, supplement vit D, potential parathyroidectomy
Phosphate binders- calcium based binders and sevelamer (non-calcium based)
190
Denosumab instead of bisphosphonates at what eGFR?
<30
191
If gynae with spironolactone what can you do?
Change to eplerenone
192
Can goserelin cause gynaecomastia?
Yes
193
What is measured in haemochromatosis?
Transferrin saturation
Ferritin
Can test for the HFE mutation
194
Can patients who have had a gastric sleeve have oral contraception?
No- lack of evidence of efficacy
This includes emergency contraception
195
Cut off for mastectomy vs wide local excision?
Generally- above 4cm is a mastectomy, less than 4cm is a wide local excision
Take into account the size on the breasts and if the lesion is solitary or peripheral/central
196
Upper GI bleeding and endoscopy?
Yes- within 24 hours of admission
197
Rheumatic fever?
Preceding sore throat
Migratory joint pain
Pink ring-shaped lesions on the trunk- erythema marginatum
Jerking movements of the face and hands (Sydenham chorea)
Can occur as a complication of inadequatley treated group A streptococcal pharyngitis
Immunological reaction to Streptococcus pyogenes
198
Growth failure, tachycardia and tachypnoea in the context of weak femoral pulses?
Coarctation of the aorta should be considered
Give IV prostaglandin to keep the patent ductus arteriosus open
199
Preserved ejection fraction vs reduced ejection fraction heart failure?
Preserved- diastolic dysfunction- filling problem with the LV
Reduced- systolic problem- impaired myocardial contraction during systole
200
Endometrial cancer treatment?
Pre-menopausal- hysterectomy- leave the ovaries in for oestrogen production
Post-menopausal- hysterectomy and bilateral salpingectomy
201
What tuning fork is used for hearing tests?
512Hz- 512 I hear you
202
Sudden onset sensorineural hearing loss?
Urgent referral to ENT
Majority of cases idiopathic, MRI scan to exclude vestibular schwannoma
High-dose oral corticosteroids used by ENT for all cases of sudden-onset sensorineural hearing loss
203
Diet to help epilepsy?
Ketogenic diet
204
SSRIs of choice in breastfeeding?
Sertraline or paroxetine
205
First line for infertility in PCOS?
Typically clomifene
Weight reduction if appropriate
Ongoing debate over clomifene or metformin
206
General management of PCOS?
Weight reduction if appropriate
If woman required contraception COCP
Third generation COCP may help with hirsutism and acne
207
What causes and is an alternative name for head lice?
Pediculus capitis
208
Diagnosis and signs/symptoms of malignant hypertension?
Papilloedema (must be present for a diagnosis of malignant hypertension)
Retinal bleeding
Raised ICP
Chest pain
Haematuria
Nosebleeds
Diagnosis-
Systolic > = 180, diastolic >=120
Evidence of acute organ damage
209
Which anaesthetic drugs can cause malignant hyperpyrexia?
All potent inhaled general anaesthetics- halothane, thiopental
All depolarising muscle relaxants- suxamethonium
210
RR over what needs A&E referral in children?
60
211
Should ipratropium bromide be given to all patients with severe or life-threatening asthma?
Yes, straight away with nebulised salbutamol
Give to patients with less severe symptoms but not responding to nebulised salbutamol after the nebulised salbutamol
212
Which organism causes acne?
The anaerobic organism Propionibacterium acnes
213
Cutaneous warts?
Caused by HPV
First line management topical treatments- salicylic acid
Cryotherapy potentially
214
Normal pressure hydrocephalus
Triad of-
Urinary incontinence
Dementia and bradyphrenia
Gait abnormality (may be similar to Parkinson's disease)
215
Oligohydraminos?
Reduced amniotic fluid- less than 500ml at 32-36 weeks
Causes
Premature rupture of the membranes
Potter sequence- bilateral renal agenesis + pulmonary hypoplasia
Post-term gestation
Pre-eclampsia
Intrauterine growth restriction
216
Screening for ADPKD?
Ultrasound examination
217
Treatment for Paget's disease of the bone?
Indications for treatment- bone pain, skull or long bone deformity, fracture, periarticular Paget's
Bisphosphonates (either oral risedronate or IV zoledronate)
Calcitonin less commonly used
218
Surgery complications?
Day 1-2 post surgery - most common complication - Atelectasis
Day 3-7 post surgery - most common complication - Infection
Day 8 + post surgery - most common complication - DVT/PE or intra abdominal abscess
PE can present earlier etc
219
LH/FSH in PCOS?
Ratio 1:1 normally
Women with PCOS- ratio is 2:1 or 3:1
LH disporportionally high when compared to FSH
220
Which type of heart failure do beta blockers and ACEi have no effect on mortality in?
Heart failure with preserved ejection fraction
221
Most common location for bone metastases?
Spine
Common sites
Most common spine
Work way back up- then Pelvis, ribs, skull in that order
222
Most common cancers to cause bone metastases?
PB-KTL
Prostate
Breast
Kidneys
Thyroid
Lung
223
CT head within 1 hour?
GCS less than 13 on initial assessment
GCS less than 15 after 2 hours
Open or depressed skull fracture
Basal skull fracture signs (Battle's sign, panda eyes)
Post-traumatic seizure
Focal neurological defecit
More than 1 episode of vomiting
224
What is a broad QRS complex that would mean giving amiodarone instead of adenosine?
Amiodarone for VT- broad complex tachycardia
Adenosine for narrow complex regular tachycardia
QRS duration exceeding 0.12 seconds- 3 small squares
Also written as 80-120ms
225
Where might gallstones present after cholecystectomy to give ongoing pain and jaundice?
In the common bile duct
226
Mumps?
Caused by RNA paramyxovirus
Fever, malaise, muscular pain, parotitis (earache, pain on eating)- unilateral then becomes bilateral
MMR vaccine efficacy is around 80%
Complications-
Orchitis- uncommon in pre-pubertal but common in post-pubertal males
Hearing loss- usually unilateral and transient
Pancreatitis
227
Sensory loss dorsum of foot, weakness in foot and big toe dorsiflexion, reflexes intact?
L5 nerve root compression
228
PE anticoagulation if high bleeding risk?
Unfractionated heparin as it is more easily reversible
Eg if there has recently been a peptic ulcer bleed etc
DOAC first line in most cases
LMWH for cancer associated PE
Unfractionated heparin IV or SC preferred in high bleeding risk patients
IV gives immediate anticoagulation, unfractionated heparin also requires monitoring
229
Diverticulitis?
Infection of a diverticulum
Intermittent abdominal pain- paticularly in the left lower quadrant
Bloating
Change in bowel habit- constipation or diarrhoea
Severer abdo pain in lower left quadrant
Nausea and vomiting
Change in bowel habit- constipation more common, diarrhoea also reported
Urinary frequency, urgency or dysuria
Colovesical or colovaginal vistula can occur
Mild cases managed with oral antibiotics, liquid diet and analgesia
If symptoms don't settle in 72 hours, patient should be admitted to hospital for IV antibiotics
230
Typical blood picture in DIC?
Think sepsis- also caused by trauma, obstetric complications and malignancy
A typical blood picuture includes:
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
schistocytes due to microangiopathic haemolytic anaemia
231
Difference between warfarin, aspirin, heparin and DIC bloods?
Warfarin
PT- prolonged
APTT- normal
BT- normal
PC- Normal
Aspirin
PT- normal
APTT- normal
BT- prolonged
PC- normal
Heparin
PT- Often normal (may be prolonged)
APTT- prolonged
BT- normal
Platelet count- normal
DIC
PT- prolonged
APTT- prolonged
BT- prolonged
PC- low
232
Increased risk of developing hepatotoxicity after paracetamol overdose?
Enzyme-inducing drugs (rifampicin, phenytoin, carbamazepine, chronic alcohol excess, St John's Wart)
Malnourished patients- anorexia nervosa or patients who have not eaten for a few days
Acute alcohol intake may be protective
233
Most common cause of pruritis vulvae?
Contact dermatitis
Condoms etc
Red and itchy
234
X-ray for osteomalacia?
Translucent bands
235
If clopidogrel is contraindicated or not tolerated after stroke/TIA?
Switch to aspirin for secondary prevention
236
Oral candidiasis from which asthma medication?
Beclometasone
237
Can PPI cause osteoporosis?
Yes
Think in elderly person who has fallen with localised tenderess
For example older woman on PPIs with pain in back, do x-ray of the spine for suspected osteoporotic vertebral fracture
X-ray of the spine is first line for suspected osteoporotic vertebral fractures
238
Asthma guidelines aged 5 to 11?
1st- twice-daily paediatric low-dose inhaled corticosteroid (ICS) + short-acting beta2 agonist (SABA) as needed
MART pathway-
Paediatric low-dose MART + SABA as needed
Paediatric moderate-dose MART + SABA as needed
If less than 5 try the first step and if symptoms resolve stop the treatment
239
Osteomyelitis cause in sick cell patients?
Salmonella
Sickle cell salmonella
S.aureus is the most common cause in general patients
Imagine with MRI
240
HIV, neuro symptoms, single brain lesion with homoggenous enhancement- CNS lymphoma
CNS lymphoma
HIV neuro complications:
Toxoplasmosis- ring-enhancing, SPECT negative, multiple lesions
Lymphoma- uniformly enchancing, SPECT positive, single lesion
TB- single enchancing
241
How long do you take anastrazole/tamoxifen after diagnosis?
At least 5 years
242
Treatment of choice for toxic multinodular goitre?
Radioiodine therapy
243
Isolated, raised GGT in the context of macrocytic anaemia?
Alcohol excess
244
Chest pain referral?
Referral
Current chest pain or chest pain in the last 12 hours with an abnormal ECG: emergency admission
Chest pain 12-72 hours ago: refer to hospital the same-day for assessment
Chest pain > 72 hours ago: perform full assessment with ECG and troponin measurement before deciding upon further action
245
Under what eGFR is metformin contraindicated?
30
246
What can happen in post operative ileus before nausea and vomiting becomes apparent?
Hypovolaemia and electrolyte disturbances
Other signs are abdominal distension and absolute constipation
247
Anaemia and methotrexate?
Methotrexate my result in a megaloblastic, macrocytic anaemia secondary to folate deficiency
248
Erb's palsy vs Klumpke's palsy
Erb's palsy- damage to upper brachial plexus from shoulder dystocia- adduction and internal rotation of the arm with pronation of the forearm
Klumpke's palsy- damage of the lower brachial plexus- affects the nerves innervating the hand muscles
249
NSAID or colchicine first line for gout/pseudogout?
Seems to be NSAID
Then colchicine if that doesn't work or is CI
Then steroids if that doesn't work- intra-articular, intra-muscular or oral steroids
250
Syndesmophytes?
Ankylosing spondylitis
251
Radial tunnel syndrome vs cubital tunnel syndrome?
Radial tunnel syndrome- parasthesia worse on elbow extension
Cubital tunnel syndrome- parasthesia, worse on elbow flexion
252
Streptococcus viridans extra knowledge?
General name- two most notable viridans are streptococcus mitis and streptococcus sanguinis
Associated with poor dental hygiene or following a dental procedure- so dental review if someone gets one of these
253
Nissen fundoplication?
Surgical treatment for GORD- before doing it need oesophageal pH and manometry measurements
254
What is sevelamer?
A phosphate binder
255
Which tablet can interfere with the absorption of levothyroxine and should be taken at least 4 hours apart?
A calcium supplement
256
Hypocalcaemia- long or short QT?
Long QT
>450ms in men
>460ms in women
257
Patients with urinary incontinence universal investigation?
Urinalysis
258
Treatment for bilateral nasal polyps?
All patient referred routinely to ENT for a full examination
Topical corticosteroids shrink polyps in around 80% of patients
(Unilateral polyps is an urgent referral)
259
When titrating up metformin, how long after intital dose to increase dose?
1 week
260
Investigation for varicose veins?
Venous duplex ultrasound- will show retrograde flow
261
Management for varicose veins?
Conservative- leg elevation, weight loss, regular exercise, graduated compression stockings
Secondary care- endothermal ablation, foam sclerotherapy
Surgery- either ligation or stripping
262
Drugs causing cleft lip?
Most likely anti-epileptic drugs
263
Read the question- under what age do you give cefotaxime + amoxicillin for meningitis?
Less than 3 months
Over 50 years old also
264
Elevated prolactin along with secondary hypothyroidism and hypogonadism?
Non-functioning pituitary adenoma
265
Excess fluids given in hospital- hypo or hyper natremia?
Hypernatremia- due to the fluids having sodium in them
266
Is SIADH a complication of SAH?
Yes
267
Low Hb just before surgery due to iron deficiency?
Pre-operative blood transfusion
268
Reactive arthritis management?
Seems to be
Acute- NSAIDs and steroids
Chronic- DMARDs- methotrexate, sulfasalazine
269
Electrolyte disturbances in tumour lysis syndrome?
PUKE Ca
Phosphate, Uric acid, Potassium elevated
Calcium reduced
270
How to diagnose spontaneous bacterial peritonitis?
Paracentesis- neutrophil count >250 cells
Most common organism found on ascitic fluid culture is E.Coli
IV cefotaxime usually given
271
Live attenuated vaccines?
Mi Booty
MMR
Influenza (intranasal)
BCG
Oral polio
Oral rotavius
Typhoid
Yellow fever
Inactivated
Rabied
Hep A
Influenza (intramuscular)
272
Well's score interpretation?
>4- CTPA
4 or less- D-dimer
273
Investigation for aortic dissection (best one for definitive management)?
CT chest, abdo, pelvis
NOT a CT coronary angiogram as that does not show the aorta just the coronary arteries
Other investigations used-
Chest x-ray- widened mediastinum
Transoesophageal echocardiography- for patients too risky for the CT scanner
274
Investigation for chronic pancreatitis?
CT (with contrast)- more sensitive than abdo x-ray at detecting pancreatic calcification
Faecal elastase- may be used to assess exocrine function if imaging inconclusive
Management- pancreatic enzyme supplements, analgesia, antioxidants
275
SBP treatment?
CefoTaxine to treat
CiProfloxacin to prevent
276
Charcot's triad vs Reynold' pentad?
Fever, jaundice, RUQ pain
Hypotension, confusion
277
Condition that RA puts you at increased risk of?
Ischaemic heart disease
Also-
Respiratory- pulmonary fibrosis, pleural effusion, pulmonary nodules
Ocular- keratoconjunctivitis sicca, episcleritis, slceritis
Osteoporosis
Increased risk of infections
Depression
Felty's syndrome (RA + splenomegaly + WCC)
278
Arthritis- better with exercise, worse with rest, dactylitis?
Psoriatic arthritis
279
King's college hospital criteria for liver transplantation in paracetamol liver failure?
Arterial pH <7.3 24 hours after ingestion
Or all of the following:
PT >100s (INR >6.5)
Serum creatinine >300
Grade III or IV hepatic encephalopathy
280
Active vs Latent vs Meningeal TB management?
Active- 4 for 2 and 2 for 4
Latent- 3 months of isoniazid (+pyroxidine) and rifampicin or 6 months of isoniazid (+pyroxidine)
Meningeal- treat for a prolonged period- at least 12 months with the addition of steroids
4 for 2 and 2 for 10
281
CHRONIC PANCREATITIS?
Alcoholic potentially
Features-
Pain typically worse shortly following a meal
Steatorrhoea
Diabetes mellitus develops in majority of patients- typically more than 20 years after symptoms start
Investigation-
X-ray
CT ABDOMEN
Faecal elastase my be used to assess exocrine function if imaging is inconclusive
282
Does isosorbide mononitrate reduce mortality long term after MI?
NO
283
Remember reactive arthritis as a differential for a swollen joint post STI
Will present after a few weeks vs septic arthritis from gonorrhoea which would be quicker
Cloudy yellow colour, culture negative, no crystals- fluid recovered from joint
284
Mastoiditis?
Infection that spreads from the middle ear to the mastoid air spaces of the temporal bone
Otitis media symptoms but swelling over the mastoid
Patient also systemically very unwell
Urgent admission to hospital/ IV antibiotics
Complications-
Facial nerve palsy
Hearing loss
Meningitis
285
Ptosis + dilated pupil, vs ptosis + constricted pupil?
Ptosis + dilated pupil- third nerve palsy
Ptosis + constricted pupil- Horner's syndrome
Ptosis, miosis and anhidrosis
286
Can rectal bleeding happen in acute mesenteric ischemia?
Yes, ischaemia causes mucosal injury and bleeding
Think in questions that have a patient with AF
287
Most common form of lymphoma in the UK?
Diffuse large B cell- a type of non-Hodgkin lymphoma
288
Management primary dysmenorrhoea?
NSAIDs- mefenamic acid and ibuprofen
Second line- COCP
289
What medication cannot be taken with a C.difficile infection?
Opioids
290
Hypothermia ECG?
J waves
291
How you get the different hepatitis?
Hep A & E: Ass and Eating
Hep B & C: Blood and Cum
292
Management of chickenpox exposure?
Remember to check maternal blood for varicella antibodies
293
Scoring system to assess the risk of septic arthritis in children?
Kocher
Fever >38.5
Non-weight bearing
Raised ESR
Raised WCC
294
Causative organism for ascending cholangitis?
E.coli
E.-scending coli-angitis
295
Investigation for post-streptococcal glomerulonephritis?
Bloods- raised anti-streptolysin O titre
Confirms the diagnosis of a recent streptococcal infection
296
Investigation for Meckel's diverticulum?
Embryological remnant that is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2
The investigation is a 99m technetium scan if the child is stable
297
TRALI vs anaphylaxis?
Anaphyalsixs - acute wheeze, hypotension and no fever, presents acutely → expiratory wheeze
TRALI - hypotension, not so acute presentation, non-cardiogenic pulmonary oedema → bilateral coarse crackles
Wheezing key distinguishing feature that points to anaphylaxis
298
What may precipitate lithium toxicity?
Dehydration
Renal failure
Drugs- diuretics, ACEi/ARB, NSAIDs and metronidazole
299
Cranial nerves affected by a vestibular schwannoma?
Cranial nerve VIII- vertigo, unilateral senorineural hearing loss, unilateral tinnitus
Cranial nerve V- absent corneal reflex
Cranial nerve VII- facial palsy
300
LEARN THE WARFARIN REVERSAL TABLE
/
301
Age range osteosarcoma most commonly seen in?
Children and adolescents
302
Can PPIs cause hypomagnesemia?
Yes
303
Post valve replacement infective endocarditis organism?
Staph epidermis if <2months post valve surgery
Staph aureus most common if not
304
How to treat AF post stroke?
Aspirin 300 mg for 2 weeks then lifelong anti-coagulation
If it is a TIA then anticoagulation for AF should start immediately
305
Syphillis testing way to remmeber?
If the test has an A in the name (TPHA), its Always positive
If the test has an R in the name (RPR), its a Recent infection
306
Bloods in a confusion screen?
FBC, U&Es, LFTs, CRP, B12 + folate, bone profile, glucose, TFTs
Key extra ones are TFTs, Bone profile, Folate/B12 and glucose
307
Investigation for genital herpes?
NAAT
308
Minor bleeding vs no bleeding warfarin reversal difference?
If giving vit K
In minor bleeding- IV
In no bleeding- oral
309
Variceal haemorrhage management?
IV terlipressin
If controlled haemorhage- endoscopic variceal band ligation
If uncontrolled haemorrhage- Sengstaken-Blakemore tube
Transjugular Intrahepatic Portosystemic Shunt (TIPSS)
310
Renal stones on X-ray?
Cystine stones- semi-opaque
Urate + xanthine stones- radio-lucent
Calcium stones are opaque (can see them on x-ray)
Stone near the back of the alphabet are radio-lucent
311
Treatment for hepatitis B?
Pegylated interferon-alpha
312
Contraindicated NSAID for pain relief in renal colic?
Give IV paracetamol
NSAID could be CI due to CKD or upper GI bleed
313
Beta-blocker overdose treatment?
If bradycardic then atropine
In resistant cases glucagon may be used
Bradycardia, hypotension, heart failure, syncope
314
Aromatase inhibitors side effects?
Osteoporosis
Hot flushes, arthralgia, myalgia
Insomnia
315
Thoracic outlet syndrome?
Muscle wasting of the hands, numbness and tingling
Compression of the brachial plexus, subclavian artery or vein at the site of the thoracic outlet
316
Coeliac disease is asasociated with which deficiencies?
Iron, folate and vitamin B12
Mixed anaemia which can be normocytic despite having microcytic and macrocytic cells
317
How do mifepristone and misoprostol work?
Mifepristone is a progesterone receptor antagonist
Misoprostol is a prostaglandin analogue- binds to myometrial cells to create contractions
Mifepristone followed by misoprostol 48 hours later
Pregnancy test performed at 3 weeks
318
Locations of homonymous hemianopias?
Incongruous defects- lesion of the optic tract
Congruous- lesion of occipital radiation or optic cortex
Macular sparing- occipital cortex
319
Children hernia management?
Congenital inguinal hernia- immediate repair to minimise the risk of incarceration
Umbilical hernia- vast majority resolve without intervention before the age of 4-5 years old
320
Avoid NSAIDs for gout if taking warfarin?
Yes, use colchicine instead
Oral steroids can be considered if both are CI
Colchicine CI in severe renal impairment
321
What to give while starting allopurinol?
Colchicine cover
322
CAP vs HAP pneumonia?
Is a HAP if patient develops pneumonia in hospital 48 hours or more after admission
CAP treatment- amoxicillin
HAP treatment- co-amoxiclav
323
Multiple ring-enhancing lesions on CT and negative SPECT?
Toxoplasmosis
HIV neuro complications
324
Biliary atresia presentation?
Typically presents in the first few weeks of life with
Jaundice- extending beyond the physiological two weeks
Dark urine and pale stools
Appetite and growth disturbance
Total bilirubin may be normal, conjugated bilirubin is abnormally high
325
Which factor prolongs APTT?
Factor VIII
Remember as 8PTT
326
What causes an isolated raised APTT and bleeding?
Haemophilia
Haemophilia A due to factor VIII deficiency- more common
Haemophilia B caused by factor IX deficiency- less common
327
Endocrine effects from renal cell carcinoma?
EPO- causes a polycythemia
Parathyroid hormone-related protein (hypercalcaemia)
ACTH
328
Malar flush and atrial fibrillation associated with which murmur?
Mitral stenosis
Asymptomatic- monitor with regular echocardiograms
Symptomatic- percutaneous mitral balloon valvotomy, mitral valve surgery (commissurotomy, or valve replacement)
329
Alfacalcidol?
Vit D that doesn't have to be activated by the kidneys- useful for CKD
330
BB and ED?
Beta blockers can cause reduced libido and erectile dysfunction
Beta blockers are cock blockers
331
Can heart failure cause hyponatraemia?
Yes
332
PE with CKD stage 5?
Unfractioned heparin
If CI use DOAC
333
Heparin-induced thrombocytopenia (HIT)?
Immune mediated antibodies
HIT is prothrombotic
GIve DOAC- agratroban
334
What should all patients with AKI get if there is no obvious cause after initial assessment?
Renal ultrasound
335
Cockroft-Gault?
Formula for estimating eGFR
336
Parkland formula?
Used to calculate the volume of IV fluid required for resuscitation over the first 24 hours after a burn
337
Rapid/ too quick drainage of pneumothorax?
Can result in re-expansion pulmonary oedema
338
Most common location for diverticula?
In the sigmoid colon
339
HIV and HPV positive?
Annual cervical cytology
340
Erythema multiforme major?
Severe form of erythema multiforme associated with mucosal involvement
341
Diarrhoea, fatigue, osteomalacia?
?Coeliac disease
342
What can be used instead of amiodarone in ALS for VT?
Lidocaine
343
CAREFUL ON MRI ETC- goes up from the bottom
SO RIGHT AND LEFTS CAN BE DIFFERENT ETC
344
Gout crystals?
Needle shaped negatively birefringent crystals on microscopy
345
Management of brain abscess?
IV 3rd generation cephalosporin + metronidazole
346
When to restart warfarin after minor bleeding?
When INR is less than 5
347
Most common cardiac manifestation in SLE?
Pericarditis
348
First line for asthma management?
Anti-inflammatory reliever therapy:
Low-dose corticosteroid (ICS)/formoterol combination inhaler
349
MS types differentiators?
Relapsing-remitting- most common- acute attacks followed by remission
Secondary progressive- relapsing-remitting who have developed neurological signs and symptoms between relapses
Primary progressive disease- progressive deterioration from the onset
350
Tear drop papules on the trunk and limbs after a streptococcal infection?
Guttate psoriasis
Most cases resolve within 2-3 months
351
Which antibodies in Grave's disease?
IgG antibodies to the thyroid-stimulating hormone receptor
352
Types of burns?
Superficial epidermal- red and painful, dry, no blisters
Superficial dermal (partial thickness)- pale pink, painful, blistered
Deep dermal (partial thickness)- typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure
Full thickness- white/brown/black, no blisters, no pain
353
Murmur associated with collagen disorders (Marfan's/Ehlers-Danlos)?
Mitral regurgitation
354
WHICH BENZODIAZAPINE IN LIVER CIRRHOSIS FFS
LORAZEPAM
355
How to monitor response to levothyroxine in Hashimoto's?
TSH LEVEL
Avoid giving iron, calcium carbonate at the same time as reduces the absorption of levothyroxine
356
WHICH DRUGS CAN CAUSE A TUMOUR FLARE PROSTATE CANCER?
GnRH AGONISTS
Goserelin
357
What drug class is duloxetine?
SNRI
Use in GAD if SSRI is ineffective
Venlafaxine is also an SNRI
358
Which infarction causes Weber's?
Branches of the POSTERIOR CEREBRAL ARTERY that supply the midbrain
359
Infective endocarditis is associated with which type of spine infection?
Discitis
360
Hemiplegic migraine?
Motor weakness as part of the aura
361
Length of treatment in mastitis- inflammation of the breast tissue associated with breast feeding?
Flucloxacillin for 10 days
362
Are anticholinergic medications contraindicatied in myasthenia gravis?
YES
363
Hepatitis D superinfection?
In a patient with a background of hepatitis B
Bodily fluids
364
Antibiotics for infective exacerbation of COPD?
Amoxicillin or clarithromycin or doxycycline
365
Most common malignancy associated with haematuria and painless haematuria?
Bladder cancer (transitional cell carcinoma of the bladder)
2nd would be renal carcinoma
366
How does herpes simplex keratitis present?
Red, painful eye
Photophobia
Epiphoria
Fluorescein staining may show an epithelial ulcer
Immediate referal to an opthalmologist- topical aciclovir
367
Atelectasis?
Obstructed airways due to bronchial secretions- common postoperative complication due to basal alveolar collapse
Should be suspected in the presentation of dyspnoea and hypocaemia around 72 hours post operatively
Position the patient upright- chest physiotherapy/breathing exercises
368
Dilated cardiomyopathy?
Left ventricle becomes dilated and weakened leading to systolic dysfunction- reduced ejection fraction- heard failure
Symptoms heard failure- dyspnoea, orthopnoea, PND, fatigue, peripheral oedema
Idiopathic- most common
Myocarditis- Coxsackie B
IHD
Peripartum
Hypertension
Iatrogenic- doxorubicin
Alcohol, cocaine
DMD
369
Vitreous haemorrhage management?
Urgent referral to opthalmology- treat underlying causes (diabetes, proliferative changes), consider vitreoretinal surgery- vitrectomy
370
Mycoplasma pneumonia key bits to remember?
Atypical pneumonia affecting YOUNGER patients typically
Prolonged gradual onset, dry cough, bilateral consolidation on x-ray
Complications
Cold agglutins (IgM)- HAEMOLYTIC ANAEMIA
ERYTHEMA MULTIFORME
Meningoencephalitis/ Guillain-Barre syndrome and other immune-mediated neurological diseases
Diagnosis with serology
Positive cold agglutination test- peripheral blood smear may show red blood cell agglutination
Management- doxycycline or a macrolide (erythromycin/clarithromycin)
HAEMOLYTIC ANAEMIA WOULD MEAN A POSITIVE COOMBS TEST
371
Gold standard investigation for ATN?
Renal biopsy
372
Multiparametric MRI?
Prostate cancer
373
Treatment for toxoplasmosis in immunosuppressed patients?
Pyrimethamine plus sulphadiazine for at least 6 weeks
374
Jaundice during intercurrent illness, exercise or fasting?
Gilbert's syndrome
No treatment required
375
Does haemachromatosis cause decreased androgens?
Yes- hypogonadotrophic hypogonadism
376
UPPER ZONE vs LOWER ZONE FIBROSIS?
LEARN IT
377
Extra heart sounds?
S3 (threee) haed to breeeeaaath (LVF and MR- lead to pulmonary oedema- think DCM)
S4- hit the floor (HOCM and AS- collapse/sudden death)
378
Chronic rhinosinusitis?
Avoid allergen, intranasal corticosteroids, nasal irrigation with saline solution
Red flag symptoms- unilateral, persistent despite 3 months treatment
Epistaxis
379
Investigating PE CTPA negative?
Consider a proximal vein ultrasound scan if DVT is suspected
You don't repeat CTPA- that is for DVT repeat the leg ultrasound after 1 weeks if negative by d-dimer positive
380
How many days before surgery do you stop warfarin?
5 days
381
Mitral valve treatment?
Percutaneous first then open
Monitor patients who are asymptomatic
382
Alports syndrome?
All ports affected- eyes, ears, urinary (renal)
383
Investigation to do before CTPA in PE?
CXR
384
Indirect vs direct hernia?
Indirect goes through the induinal canal so no reappearance when coughing and covering the deep inguinal ring
385
Type of cardiac arrest in tension pneumothroax?
Pulseless electrical activity- conduction system in tact- pressure on the heart means electrical activity cannot make a pulse
386
Oragnophosphate poisoning?
Causes cholinergic effects
Accumulation of acetylcholine- stuff comes out of everywhere
Salivation
Lacrimation
Urination
Defecation/diarrhoea
Hypotension, bradycardia
Small pupils, muscle fasciculation
GI upset
Management- atropine
387
Osteosarcoma x-ray?
Sunburst pattern
388
Drug induced lupus?
ANA positive, dsDNA negative
Anti-histone antibodies found in 80-90%
Can be caused by TB drugs (isoniazid)
389
Treatment for inhaled foreign body in children?
Rigid bronchoscopy
390
WHAT TO REMEMBER ABOUT ADENOSINE?
CI in asthma
Use verapamil instead for narrow complex tachycardia
391
Paracetamol presentation over 24 hours?
Start acetylcysteine if the patient is jaundiced, has hepatic tenderness or an elevated ALT
392
Management fungal nail infection?
Limited involvement- amorolfine 5% nail lacquer
More extensive involvement- oral terbinafine- use in dermatophyte infection
If extensive involvement due to Candida- oral itraconazole
393
ABG in acute mesenteric ischaemia?
Metabolic acidosis- raised lactate
Watch out for respiratory compensation
394
What is levodopa combined with to prevent peripheral metabolism of L-dopa to dopamine?
Decarboxylase inhibitor- carbidopa or benserazide
395
Antibodies in SLE?
ANA- less specific
Anti-dsDNA
Anti-smith
Second two more specific
396
H.Pylori eradication?
PPI + amoxicillin + metronidazole/clarithromycin
397
Inducers CRAP GPs induce headaches?
CRAP GPs induce headaches
C - carbamazepine
R - rifampicin
A - alcohol (chronic)
P - Phenytoin
G -
P - phenobarbital
S - st johns wort, sulfonylureas
Rifampicin is an inducer
Isoniazid is an inhibitor
398
Dangerous electrolyte abnormality in AKI/rhabdomyolyis?
Hyperkalaemia
399
B12 anaemia?
Megaloblastic, macrocytic anaemia
400
HELLP syndrome?
Haemolysis
Elevated liver enzymes
Low platelets
It is a serious manifestation of pre-eclampsia
401
Which type of bladder cancer does schistosomiasis cause?
Squamous cell- 2nd most common, also smoking
Transitional cell carcinoma is the most common- smoking, exposure to aniline dyes, rubber manufacture, cyclophosphamide
402
Causes of polymorphic ventricular tacycardia?
Electrolytes: hypokalaemia, hypomagnesaemia, hypocalcaemia
Also
SAH
Erythromycin
Hypothermia
Treat with IV magnesium sulphate
403
Salter-Harris 1?
Can be slipped when trying to recognise it, not necessarily fractures obviously
404
In primary prevention of CVD what % decrease in non-HDL is aimed for?
>40%
405
Cyclical mastalgia?
Varies in intensity according to the phase of the menstrual cycle
Women advised to wear a supportive bra, conservative treatments include standard oral and topical analgesia
If pain not responded after 3 months and affecting quality of life or sleep-
referral for consideration of bromocriptine or danazol
406
Hypercapnia/hypocapnia?
Watch out for hypercapnia too much CO2- raised ICP
Hypocapnia- lowers ICP
407
Addison's disease?
Hyperkalaemia, metabolic acidosis
408
Live attenuated vaccines?
MMR
BCG
Oral Polio
Yellow fever
Oral typhoid
MI BOOTY
MMR
Influenza (intranasal)
BCG
Oral rotavirus
Oral polio
Typhoid
Yellow fever
409
Atypical lymphocytes?
?Glandular fever
410
Wallace's rules of 9 for burns?
Head + neck- 9
Anterior chest- 9
Posterior chest- 9
Anterior abdo- 9
Posterior abdo- 9
Arm- 9
Anterior leg- 9
Posterior leg- 9
411
When should bulk forming laxatives be avoided?
Opioid induced constipation
Give osmotic and stimulant laxative
412
What is the legally binding version of a DNACPR?
Advance decision to refuse treatment
413
Parkland formula for burns fluids- how much given?
Give 50% in the first 8 hours and then rest over the next 16 hours
414
Why infants more likely to get an indirect inguinal hernia?
Patent processus vaginalis
415
How many joints affected in oligoarthritis vs polyarthritis?
Oligo- 4 or fewer
Poly- more than 4
416
Gout crystal substance?
Monosodium urate
417
Remember VT is either monomorphic or polymorhpic
/
418
Normal QRS length?
0.12/ 120ms
419
Optic neuritis management?
High dose steroids
420
Lhermitte's sign?
Shooting electic pain down legs when flexing neck in MS
421
Triangle of safety?
Pectoralis major, latissimus dorsi, 5th intercostal space
422
Pathological and prolonged jaundice causes?
Pathological (early jaundice)- ABO incompatibility, Rhesus disease, G6PD deficiency, Speherocytosis
Prolonged- Biliary atresia, Hypothyroidism, Breast milk jaundice, Infection
423
Wilson/Junger criteria for screening tests?
Condition important
Disease should have a detectable, latent stage
Screening should be cost-effective and ongoing
Simple, safe, precise and validated screening test
Test acceptable to the population
Agreed policy on the diagnostic investigations of individuals with a positive test
