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1
Q

What are the triad of symptoms for cardiac tamponade?

A
  1. Hypotension
  2. Muffled heart sound
  3. Jugular vein distension
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2
Q

What are the 4 classifications that can be used for peripheral artery disease?

A
  1. Asymptomatic
  2. Claudication
  3. Critical limb ischaemia
  4. Acute limb ischaemia
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3
Q

Name 6 signs of acute limb ischaemia?

A
  1. Pain
  2. Pallor
  3. Pulselessness
  4. Paraesthesia
  5. Perishing cold
  6. Paralysis
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4
Q

What are some differentials for peripheral artery disease?

A
  1. Arthritis
  2. Venous claudication
  3. Spinal stenosis
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5
Q

What are the 4 types of shock?

A
  1. Distributive
  2. Cardiogenic
  3. Hypovolaemic
  4. Obstructive
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6
Q

What is shock?

A

A condition that occurs when the body is not receiving enough bloodflow

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7
Q

What is distributive shock?

A

Extreme vasodilation leads to a sharp drop in blood pressure and insufficient organ perfusion

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8
Q

Give 3 examples of distributive shock

A
  1. Septic
  2. Anaphylactic
  3. Neurogenic
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9
Q

What is cardiogenic shock?

A

The heart is unable to meet the body’s demand for oxygen rich blood resulting in insufficient perfusion -> organ failure

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10
Q

Give 3 examples of cardiogenic shock

A

Myocardial infarct

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11
Q

What is hypovolaemic shock?

A

Loss of a large amount of blood volume causes lack of oxygen in organs

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12
Q

Give 3 examples of hypovolaemic shock

A
  1. Burns
  2. Trauma
  3. Heavy GI bleed
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13
Q

What is obstructive shock?

A

Where blood flow to/from the heart is obstructed, causing a large drop in blood pressure and widespread oxygen shortage

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14
Q

Give 3 examples of obstructive shock

A
  1. Tension pneumothorax
  2. Cardiac Tamponade
  3. Tumours
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15
Q

What investigations would you order for suspected infective endocarditis?

A
  1. Blood culture
  2. Echocardiogram
  3. Full blood count
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16
Q

What are some complications of Infective Endocarditis?

A
  1. Pericarditis
  2. Myocardial infarction
  3. Pulmonary embolism
  4. Systemic infection
  5. Acute renal failure
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17
Q

What investigation can be used to diagnose stable angina?

A

Stress ECG

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18
Q

What drugs are used for TB treatment?

A
  1. Rifampicin
  2. Isoniazid
  3. Pyrazinimide
  4. Ethambutol
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19
Q

What drug is used to treat Myasthenia Gravis?

A

Pyridostigmine

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20
Q

What is the mechanism of Pyridostigmine?

A

It is a cholinesterase inhibitor, reduces the breakdown of ACh

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21
Q

What is the treatment for Parkinson’s

A

Co-careldopa

Levodopa + Carbidopa that prevents its breakdown

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22
Q

What is Ramsay-Hunt syndrome?

A

A form of shingles that affects the facial nerve, causing Bell’s palsy and a rash on the outer ears

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23
Q

What is Charcot’s triad?

A
  1. Fever
  2. RUQ Pain
  3. Jaundice
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24
Q

What does painless jaundice point to?

A
  1. Pancreatic cancer
  2. Cholangiocarcinoma
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25
Q

What pathogens tend to cause reactive arthritis?

A

GI - Salmonella, Shigella

GU - Chlamydia

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26
Q

What is the gold standard diagnosis for bronchiectasis?

A

High resolution CT chest

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27
Q

What is the inheritance pattern of alpha-1-antitrypsin deficiency?

A

Autosomal co-dominant

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28
Q

Which lung cancer has the main paraneoplastic involvement?

A

Small cell lung cancer

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29
Q

What lung cancer has PTHnrP?

A

Squamous cell cancer

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30
Q

What is the gold standard test for kidney stones?

A

Non contrast CT kidney ureter bladder (NCCTKUB)

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31
Q

What are the common causes of UTI?

A

Klebsiella
E. coli
Enterococcus
Proteus/Pseudomonas
Staphylococcus saprophyticus

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32
Q

What pathogens can trigger reactive arthritis?

A

Salmonella, shigella

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33
Q

What is minimal change disease?

A

A type of nephrotic syndrome where minimal changes are seen on light microscopy

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34
Q

What is the difference between nephrotic and nephritic disease?

A

In nephritic disease there is haematuria

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35
Q

Where in the kidneys does furosemide act?

A

The ascending limb of the loop of Henle
NKCC channels

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36
Q

Where in the kidneys do thiazide diuretics act?

A

Distal convoluted tubule

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37
Q

Where is iron absorbed?

A

Duodenum and proximal jejunum

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38
Q

What chromosome is linked to chronic myeloid leukaemia?

A

Philadelphia chromosome

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39
Q

In what cancer could platelets be raised?

A

CML

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40
Q

What are some signs of iron deficiency anaemia?

A
  1. Brittle hair and nails
  2. Koilonychia
  3. Pale conjunctivae and skin
  4. Systolic flow murmur
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41
Q

What causes a macrocytic megaloblastic anaemia?

A

Vitamin B12 or folate deficiency

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42
Q

How can you tell between B12 and folate deficiency?

A

Folate deficiency will not present with neurological symptoms

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43
Q

What is pharmacokinetics?

A

The action of the body on the drug
1. Absorption
2. Distribution
3. Metabolism
4. Excretion

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44
Q

What is pharmacodynamics?

A

The action of the drug on the body

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45
Q

What are some causes of iron deficiency anaemia?

A
  1. Malabsorption
  2. NSAIDS
  3. Chronic kidney disease
  4. Pregnancy
  5. Heavy periods
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46
Q

What are some side effects of amitriptyline?

A
  1. Dry mouth
  2. Confusion
  3. Blurred vision
  4. Urinary retention
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47
Q

What is used to treat heroin addiction?

A

Methadone

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48
Q

What is a complication of C. diff infection?

A

Pseudomembranous colitis

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49
Q

What is the 1st line treatment for osteoporosis?

A

Oral bisphosphonate and AdCal (Vit D and calcium supplement)

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50
Q

What is the 2nd line treatment for osteoporosis?

A

Denosumab - a monoclonal antibody to RANK ligand

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51
Q

What is the mechanism of action of bisphosphonates?

A

Inhibit bone resorption by inhibiting osteoclast activity

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52
Q

What is the 1st line treatment for migraine?

A

NSAIDS

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53
Q

What is the 2nd line treatment for migraine?

A

Triptans

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54
Q

What is the mechanism of action of Triptans?

A

Serotonin (5-HT1) receptor agonists - reduces inflammation and causes vasoconstriction

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55
Q

What are some causes of meningitis?

A
  1. Neisseria meningitidis
  2. Listeria monocytogenes (pregnant)
  3. Streptococcus agalacticae (neonates)
  4. Streptococcus pneumoniae (common)
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56
Q

What are the signs of a UMN lesion?

A

In UMN everything goes UP!
1. Increased muscle tone
2. Hyperreflexia
3. Spasticity
4. Muscle weakness
5. Positive Babinski sign

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57
Q

What are the signs of a LMN lesion?

A
  1. Muscle atrophy
  2. Fasciculations
  3. Hyporeflexia
  4. Decreased tone
  5. Negative Babinski sign
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58
Q

What can be used to treat psychosis in Huntington’s?

A

Haloperidol

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59
Q

What can be used to treat chorea in Huntington’s?

A

Risperidone

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60
Q

Name some SSRIs

A
  1. Sertraline
  2. Fluvoxamine
  3. Citalopram
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61
Q

What is the pharmacological treatment for Idiopathic Pulmonary Fibrosis?

A

Nintedanib and Pirfenidone

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62
Q

What is the treatment for motor neurone disease?

A

Riluzole

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63
Q

What is the treatment for Alzheimer’s?

A

Rivastigmine - cholinesterase inhibitor

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64
Q

What is the treatment for Myasthenia Gravis?

A

Pyridostigmine

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65
Q

What are some causes of tension headaches?

A
  1. Stress
  2. Lack of sleep
  3. Missed meals
  4. Depression
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66
Q

What is the treatment pathway for a PE?

A
  1. DOAC
  2. LMWH such as Dalteparin
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67
Q

Is HIV a notifiable disease?

A

No

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68
Q

What is included in the 6 in 1 vaccine?

A
  1. Diptheria
  2. Polio
  3. Tetanus
  4. Hepatitis B
  5. Whooping cough
  6. Haemophilus Influenzae B
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69
Q

What is sarcoidosis?

A

An inflammatory disease characterised by the presence of non-caseating granulomas. It is a type of interstitial lung disease

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70
Q

What are the symptoms of sarcoidosis?

A
  1. Malaise
  2. Dry cough
  3. Shortness of breath
  4. Red nodules on shins
  5. Low grade fever
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71
Q

What is the 1st line treatment for sarcoidosis?

A

Oral steroids 6-24 months + bisphosphonates

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72
Q

What is the treatment for a pneumothorax with no SOB and < 2cm rim on CXR?

A

No treatment required - follow up in 2-4 weeks

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73
Q

What is the treatment for a pneumothorax with SOB and/or a > 2cm rim on CXR?

A

Aspiration (Intercostal drain) and reassessment

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74
Q

What does CLL show on blood film?

A

Smudge cells

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75
Q

What does Philadelphia chromosome lead to?

A

CLL

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76
Q

What ages is ALL common in?

A

Children

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77
Q

What shows Auer rods on blood film?

A

AML

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78
Q

What are risk factors for thrombotic thrombocytopenia purpura?

A
  1. Black
  2. Female
  3. Obesity
  4. Pregnancy
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79
Q

What is the pathophysiology of thrombotic thrombocytopenia purpura?

A

A deficiency or inhibitor of the ADAMTS-13 enzyme leads to micro clots forming in the vasculature

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80
Q

In combined B12 and folate deficiency, what must you deal with first?

A

The B12!!! Due to neurological complications

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81
Q

What is the fluid / sodium profile for SIADH?

A

Euvolaemia + Hyponatraemia

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82
Q

How does insulin affected potassium?

A

Drives it into cells (treats hyperkalaemia)

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83
Q

What must patients with Addison’s do if they feel unwell?

A

Double their steroid dose

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84
Q

What are the symptoms of Coeliac disease

A
  1. Diarrhoea
  2. Weight loss
  3. Erythematous lesions
  4. Bloating
  5. Abdominal pain
  6. Steatorrhea
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85
Q

What drugs are used in someone with stable ulcerative colitis?

A

Azathioprine & Infliximab

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86
Q

What is azothioprine?

A

DMARD

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87
Q

What is Mesalazine?

A

An amino salicylate (DMARD) used to treat IBD

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88
Q

What is the gold standard test for C.Diff infection?

A

Stool sample

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89
Q

What is a complcation of Crohn’s disease?

A

Gallstones - Terminal ileitis leads to impairment of bile salt reabsorbtion - gallstones

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90
Q

What is the 1st line test for duodenal ulcers?

A

Urea breath test / Stool antigen test for H. pylori

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91
Q

What is the most common cause of ascending cholangitis?

A

E. Coli

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92
Q

What are the symptoms of pancreatic cancer?

A
  1. PAINLESS JAUNDICE
  2. Weight loss
  3. Fatigue
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93
Q

What is the diagnostic test for pancreatitis?

A

Serum amylase / lipase elevated (>3x upper limit of normal)

Lipase is more sensitive than amylase

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94
Q

What do seminomas secrete?

A

Just b-hCG

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95
Q

In non seminomas (teratoma, choriocarcinoma) what is elevated?

A

AFP or b-hCG

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96
Q

What are risk factors for pseudogout?

A
  1. Hypercalcaemia
  2. Hypophosphataemia
  3. Hypomagnesaemia
  4. Hypothyroid
  5. Haemachromatosis
  6. Hyperparathyroidism
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97
Q

What is Felty syndrome?

A

Triad of rheumatoid arthritis, neutropenia and splenomegaly

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98
Q

What is the most common pathogen responsible for septic arthritis?

A

Staphylococcus Aureus

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99
Q

What is the most common pathogen responsible for septic arthritis in patients that have just had joint surgery?

A

Staphylococcus Epididermis

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100
Q

What is the most common pathogen responsible for septic arthritis in patients in young sexually active adults?

A

Neisseria Gonorrhoea

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101
Q

What is the 1st line management for reactive arthritis?

A

NSAIDs

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102
Q

What is a raised ALP indicative of?

A

Increased bone turnover or Cholestasis

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103
Q

What is given as prophylaxis for cluster headaches?

A

Verapamil

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104
Q

What are the symptoms of cluster headaches?

A
  1. Unilateral pain around orbit
  2. Rhinorrhoea
  3. Lid swelling
  4. Ipsilateral lacrimation
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105
Q

What is Uhthoff phenomenon?

A

A transient worsening of neurological symptoms related to MS when the body becomes overheated

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106
Q

What is primary prevention?

A

Aiming to prevent disease before it occurs, eg education

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107
Q

What is secondary prevention?

A

Aiming to reduce the impact of disease that has already occured, eg screening

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108
Q

What is tertiary prevention?

A

Aiming to reduce the impact of complications / permanent impairments of the disease, eg stroke rehabilitation

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109
Q

What is a side effect of Lamotrigine?

A

Large blistering rash throughout the body (Stevens-Johnson syndrome)

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110
Q

What is the difference between vascular Parkinsonism and Parkinson’s disease?

A

Vascular Parkinsonism is more likely to have a bilateral onset with lower limb predominance

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111
Q

What is the pathology of Myasthenia Gravis?

A

Autoantibodies attack the post synaptic ACh receptors at the neuromuscular junction

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112
Q

What are the symptoms of Myasthenia Gravis?

A

Muscle fatigue and weakness, especially ocular, bulbar and proximal limb groups

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113
Q

What is the pathology of Lambert-Eaton Myasthenic Syndrome?

A

Antibodies attack the voltage gated calcium channels in the presynaptic membrane of the neuromuscular junction (this leads to reduced ACh release)

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114
Q

What differentiates Lambert-Eaton from Myasthenia Gravis?

A

LE improves with use / MG gets worse

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115
Q

What are the sepsis 6?

A

GIVE: O2, IV Abx, Fluids
TAKE: Cultures, Lactate, Urine output

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116
Q

What can cause an angina flare up?

A
  1. Exercise
  2. Stress
  3. Cold weather
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117
Q

What is diabetic ketoacidosis?

A

Build up of ketones in the blood due to a lack of insulin restraining free fatty acid formation and oxidation into ketones

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118
Q

What would the blood profile look like in DKA?

A
  1. High ketones
  2. High glucose
  3. Low bicarb
  4. High potassium
  5. Low CO2 (respiratory compensation)
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119
Q

What is the treatment for DKA?

A

IV fluids / electrolytes
IV insulin - watch for hypokalaemia

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120
Q

What are two complications of DKA treatment?

A
  1. Cerebral oedema - fluid too fast
  2. Hypokalaemia
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121
Q

What is peritonitis?

A

Inflammation of the peritoneum

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122
Q

What are some causes of peritonitis?

A
  1. Pancreatitis / Appendicitis / Cholecystitis
  2. Crohn’s / Diverticulitis
  3. Trauma
  4. Perforation of colon
  5. Contamination of peritoneal dialysis equipment
  6. Cirrhosis of liver
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123
Q

What is the treatment for peritonitis?

A
  1. IV fluids with electrolytes
  2. Antibiotics (Cefalexin and Metronidazole)
  3. If due to ascites - IV albumin
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124
Q

What are some risk factors for depression?

A
  1. Recent incident (bereavement, loss of job)
  2. Genetic predisposition
  3. Chronic pain
  4. Other neurological problems
  5. Childhood abuse
  6. Drug/alcohol abuse
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125
Q

What are some symptoms of depression?

A
  1. Low self esteem
  2. Muscle pain
  3. Weight loss / gain
  4. Lack of concentration
  5. Feelings of isolation
  6. Sleep problems
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126
Q

What does the PHQ-9 ask

A
  1. Feeling tired
  2. Poor appetite or overeating
  3. Sleep problems
  4. Feeling you are a failure
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127
Q

What is the treatment for bacterial meningitis before hosptal?

A

IM benzylpenicillin

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128
Q

What is the treatment for bacterial meningitis in hospital?

A

IV Cefotaxime

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129
Q

Why must patients on ACE inhibitors be monitored for renal function?

A

ACE inhibitors decrease GFR which can cause AKI

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130
Q

What joints are commonly affected in OA?

A
  1. DIP / PIP
  2. Hip
  3. Base of thumb (Carpometacarpal joint)
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131
Q

What are some contraindications for using thrombolytic therapy?

A
  1. Clotting disorder
  2. Recent surgery
  3. Active malignancy
  4. Brain aneurysms
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132
Q

What surgical techniques can be used in ischaemic strokes?

A
  1. Clot retrieval
  2. Decompressive craniectomy
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133
Q

What are some risk factors for stroke?

A
  1. AF!!!
  2. Smoking
  3. Obesity
  4. Excess alcohol
  5. Hyperlipidaemia
  6. Diabetes Mellitus
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134
Q

What is the treatment for a pulmonary embolism?

A
  1. SC Low molecular weight heparin
  2. Start on DOAC
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135
Q

What investigations may you do in suspected prostate cancer?

A
  1. Urine dipstick
  2. Bloods for PSA
  3. Digital rectal exam

Prostate biopsy is gold standard

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136
Q

What is used as pharmacological treatment in prostate cancer?

A

Goserelin

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137
Q

What is the treatment for Cushing’s disease?

A

Trans-sphenoidal resection of the pituitary gland

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138
Q

What is the treatment for Cushing’s syndrome?

A
  1. Try to treat underlying cause
  2. Adrenal steroid synthesis inhibitor, eg Metyrapone
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139
Q

What is the treatment for Conn’s?

A

Spironolactone

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140
Q

What is the gold standard test for Conn’s syndrome?

A

Selective adrenal vein catheterisation

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141
Q

At what size of abdominal aortic aneurysm does surgery become indicated?

A

5.5cm diameter

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142
Q

What are the symptoms of left sided colon cancer?

A
  1. Rectal bleeding
  2. Change in bowel habit
  3. Change in stool consistency
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143
Q

What are the symptoms of right sided colon cancer?

A
  1. Mass in right iliac fossa
  2. Anaemia
  3. Weight loss
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144
Q

What are the stages in Dukes bowel cancer staging?

A

1 - Only inner lining of bowel affected
2 - Spread through all bowel layers
3 - Lymph node involvement
4 - Metastases

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145
Q

What are some risk factors for prostatitis?

A
  1. STIs
  2. Catheters
  3. Recent investigation (DRE, Biopsy)
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146
Q

What is the pathophysiology of gout?

A

Hyperuricaemia - uric acid precipitates out of solution
Deposits in areas of slowest blood flow eg, joints

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147
Q

What is an epileptic seizure?

A

Transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain

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148
Q

What is the inverse care law?

A

The idea that people who are most at need of care find it the hardest to access it

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149
Q

What is the pathophysiology of Huntington’s?

A

Huntington gene contains triplet repeat of CAG
CAG codes for glutamine - excess levels of glutamine cause cell death

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150
Q

What is a marker for hepatocellular carcinoma?

A

Alpha fetoprotein

151
Q

What is a marker for pancreatic cancer?

152
Q

What is a marker for ovarian cancer?

153
Q

What is a marker for breast cancer?

154
Q

What is the management for a severe case of giant cell arteritis that has started to affect vision?

A

IV methylprednisolone

155
Q

What are some symptoms of mitral stenosis?

A
  1. Haemoptysis
  2. Shortness of breath
  3. Heart racing
156
Q

What is the management for small bowel obstruction?

A

Nil by mouth, IV fluids, NG tube aspiration

157
Q

What are the stages of change in the transtheoretical model?

A
  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse
158
Q

What is precontemplation?

A

No intention of changing behaviour

159
Q

What is contemplation?

A

Aware a problem exists but no commitment to action

160
Q

What is preparation?

A

Intent upon taking action

161
Q

What is action?

A

Active modification of behaviour

162
Q

What is maintenance?

A

Sustained change - new behaviour replaces old

163
Q

What is relapse?

A

Fall back into old patterns of behaviour

164
Q

What is the role of clavulonic acid in Co-Amoxiclav?

A

Inhibits beta lactamase which bacteria use to break down beta lactams

165
Q

What is stage 1 - early COPD?

A
  1. FEV1 > 80%
  2. FEV1/FVC < 0.7
166
Q

What is stage 2 - moderate COPD?

A
  1. FEV1 < 80%
  2. FEV1/FVC < 0.7
167
Q

What is stage 3 - severe COPD?

A
  1. FEV1 < 0.5
  2. FEV1/FVC < 0.7
168
Q

What is stage 4 - very severe COPD?

A
  1. FEV1 < 0.3
  2. FEV1/FVC < 0.7
169
Q

What is the 1st line treatment for suspected testicular torsion?

A

Surgical exploration and untwisting if required

170
Q

What is defined as early menopause?

171
Q

What antibody is commonest in dermatomyositis?

172
Q

What is the most specific antibody in dermatomyositis?

173
Q

What are some causes of gallstones?

A
  1. Supersaturation of bile
  2. Gallbladder stasis
  3. Gallbladder infection
  4. Not enough bile salts
174
Q

What is the gold standard investigation for portal hypertension?

A

Hepatic venous pressure gradient

175
Q

What is Senna?

A

A stimulant laxative

176
Q

What would the serum copper be in Wilson’s disease?

177
Q

What can be given to prevent tumour lysis syndrome?

A

Allopurinol

178
Q

What gives the best estimate of the activity of the intrinsic pathway of the coagulation cascade?

A

Activated partial thromboplastin time

179
Q

What gives the best estimate for both extrinsic and common pathways?

A

Promthrombin time

180
Q

What is a normal range for ejection fraction?

181
Q

Where is the most common place for adenocarcinomas to arise in the pancreas?

182
Q

When are NSAIDSs contraindicated?

A
  1. GORD
  2. Kidney disease
  3. Heart failure
183
Q

What is the treatment for Goodpasture’s syndrome?

A

Prednisolone and cyclophosphamide for induction

Then continue oral prednisolone

184
Q

When are epsilon waves fiund?

A

Arrythmogenic right ventricular cardiomyopathy

185
Q

If clinic BP is over 140/90, what is the diagnostic investigation for hypertension?

A

24 hour ambulatory blood pressure monitoring

186
Q

What can be given to reduce risk of sickle cell crisis?

A

Hydroxycarbamide

187
Q

What are symptoms of renal cell carcinoma?

A
  1. Haematuria
  2. Flank pain
  3. Abdominal mass
188
Q

What is the first line investigation for renal cell carcinoma?

A

CT urogram

189
Q

What is an alpha blocker that can be used in phaeochromocytoma?

A

Phenoxybenzamine

190
Q

What is resected to reduce pressure on the median nerve in carpal tunnel syndrome?

A

Transverse carpal ligament

191
Q

What are some symptoms of carpal tunnel syndrome?

A
  1. Pain
  2. Numbness
  3. Parasthesia
  4. Weaker grip
192
Q

What can be diagnostic of pancreatitis?

A
  1. Raised serum amylase / lipase (>3x baseline)
  2. Raised urinary amylase
193
Q

What is the treatment for a URTI in children?

A

Penicillin V (Phenoxymethylpenicillin) for 10 days QDS

194
Q

What are the 5S of adrenal crisis?

A
  1. Salt
  2. Sugar
  3. Steroids
  4. Support
  5. Search for precipitating illness
195
Q

What are some symptoms of Addisonian crisis?

A
  1. Hypotension (+ tachycardia)
  2. Weakness
  3. Confusion
196
Q

What are some risk factors for folate deificiency?

A
  1. Old age
  2. Malabsorption
  3. Alcohol intake
  4. Diet
197
Q

What is indicative of Hodgkin’s lymphoma?

A
  1. Reed Sternberg cells
  2. Owl’s eye appearance on blood film
198
Q

What is the mechanism of beta lactam antibiotics?

A

Inhibit transpeptidation reactions needed to cross-link peptidoglycans in the cell wall

199
Q

What is the management for an uncomplicated UTI?

A

Nitrofurantoin PO for 3 days

200
Q

What are the ECG signs of hypokalaemia?

A
  1. Small T waves
  2. Long QT
  3. ST depression
  4. U waves
201
Q

What are the ECG signs of hyperkalaemia?

A
  1. Tall tented T waves
  2. Prolonged QRS interval
  3. Flattened P waves
  4. Prolonged PR interval
202
Q

What is the treatment for chlamydia?

A

Doxycycline or Azithromycin

203
Q

What can be given as migraine prophylaxis?

A

Propranolol
Topiramate
Amitriptyline

204
Q

What chromosome is affected in Wilson’s?

A

Chromosome 13

205
Q

What chromosome is affected in alpha-1-antitrypsin deficiency?

A

Chromosome 14

206
Q

What are tender sacroiliac joints indicative of?

A

Ankylosing spondylitis

207
Q

What investigation us usually used to confirm a diagnosis of bowel obstruction?

A

Abdomen CT

208
Q

What are the causes of pancreatitis?

A

I - Idiopathic
G - Gallstones
E - ERCP
T - Trauma
S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion sting
H - Hypercalcaemia / Hyperlipidaemia
E - Ethanol
D - Drugs

209
Q

What is the most common primary bone tumour in children and young adults?

A

Osteosarcoma

210
Q

What pathogen is commonly linked to reactive arthritis?

A

Chlamydia pneumoniae

211
Q

What drug class is the 1st line management that is used to induce remission in IBD?

A

Amino salicylate - Mesalazine

212
Q

What parameters are in CHADSVASC

A

C - Heart failure
H - Hypertension
A - Age (1 pt > 65 2 pt > 75)
D - Diabetes
S - Stroke (2)
V - Vascular disease
A - Age again
S - Sex

213
Q

What is the treatment for a pneumothorax?

A

Needle aspiration

214
Q

What is De quervain’s thyroiditis?

A

Inflammation of the thyroid characterised by a triphasic course of transient thyrotoxicosis, hypothyroidism and return to euthyroidism

215
Q

What is the treatment for De Quervain’s thyroiditis?

A

Aspirin and ibuprofen

216
Q

What are the features of Parkinsonian tremor?

A
  1. Worse at rest
  2. Worse on distraction
  3. Reduced on movement
  4. Pill rolling

Usually asymmetrical

217
Q

What does peroneal nerve palsy cause?

A

Inability to dorsiflex the foot

218
Q

Where does idiopathic pulmonary fibrosis cause fibrosis?

A

Lower zone of lungs

219
Q

What is the gold standard investigation for liver cirrhosis?

A

Liver biopsy - regenerative nodules surrounded by connective tissue

220
Q

What is the treatment for low severity community acquired ammonia (CURB65 0 or 1)?

A

Oral amoxicillin at home

221
Q

What is the treatment for moderate severity community acquired ammonia (CURB65 2)?

A

Amoxicillin + Clarithromycin

222
Q

What is the treatment for moderate severity community acquired ammonia (CURB65 3)?

A

Co-amoxiclav + Clarithromycin

223
Q

What is the 1st line investigation for peripheral arterial disease?

A

Ankle-brachial pressure index

224
Q

What can be used to treat prolactinoma?

A

Oral cabergoline - dopamine agonists inhibit the pathway responsible for prolactin

225
Q

What marker is most specific for highlighting acute liver damage?

226
Q

What is the biggest risk factor for aortic dissection?

A

Hypertension

227
Q

What is the treatment for pernicious anaemia?

A

IM hydroxocobalamin

228
Q

What is indicative of anal haemorrhoids?

A

Itching and irritation in the anal region

229
Q

What is given for migraine prophylaxis in pregnancy + asthma?

A

Amitriptyline - Propanolol CI in asthma - Topiramate CI in pregnancy

230
Q

What is Kernig’s sign?

A

Pain in the lower back when knee is extended and hip is held in flexion

231
Q

What is Kernig’s indicative of?

A

Meningitis

232
Q

What features suggest a non epileptic seizure?

A
  1. Crying / talking
  2. Longer length
  3. No post ictal symptoms
233
Q

What is the mechanism of action of Alteplase?

A

Activates plasminogen to form plasmin

Plasmin breaks up the clot

234
Q

What are some signs of COPD on chest xray?

A
  1. Hyperinflation!
  2. Barrel chest
  3. Bullae
235
Q

How is disease progression monitored in Rheumatoid arthritis?

A

ESR and CRP levels

236
Q

Name one life threatening complication of Rheumatoid arthritis

A

Felty’s syndrome - Rheumatoid arthritis, splenomegaly and neutropenia

237
Q

What are some extra articular complications of Rheumatoid arthritis?

A
  1. Sjogrens syndrome
  2. Pericarditis
  3. Pleural effusions
  4. Glomerulonephritis
  5. Skin nodules
  6. Vasculitis
238
Q

What is the sensory loss in the perineum in Cauda Equina called?

A

Saddle anaesthesia

239
Q

What is the treatment for Cauda Equina syndrome?

A
  1. Immediate hospital admission
  2. Emergency MRI
  3. Lumbar decompression surgery
240
Q

What are splinter haemorrhages?

A

Thin red lines on the nails seen in infective endocarditis

241
Q

What sort of blood cultures are taken in infective endocarditis?

A

3s!
3 cultures, 3 different sites, 3 different times

242
Q

What are some major criteria for infective endocarditis from the Duke’s scale?

A
  1. Vegetation on echocardiogram
243
Q

What are some minor criteria for infective endocarditis from the Duke’s scale?

A
  1. Fever
  2. Roth spots
  3. Janeway lesions
  4. Osler nodes
244
Q

What are 2 possible complications from this condition?

A
  1. Sepsis
  2. Permanent valve damage
  3. Pulmonary embolism
  4. Kidney damage
245
Q

What is the gold standard investigation for Mallory Weiss tears?

A

Upper GI endoscopy

246
Q

What other investigations may be done in Mallory Weiss tear?

A
  1. Coagulation profile
  2. FBC
  3. U&E
247
Q

What is the Glasgow Blatchford Score used for?

A

A system to risk stratify patients with upper GI bleeds

248
Q

What are some criteria in the Glasgow Blatchford Score?

A
  1. Tachycardia
  2. Melaena
  3. History of hepatic disease
249
Q

What is the treatment for Mallory Weiss tear?

A

Upper GI endoscopy and clipping + adrenaline
High dose PPI after surgery

250
Q

Where are some common locations for kidney stones?

A
  1. Ureteropelvic junction
  2. Ureterovesical junction
  3. Where the ureter crosses the iliac vessels
251
Q

What radiological intervention can be used to treat renal tract stones?

A

Ultrasound shock wave lithotripsy

252
Q

How should bisphosphonates be taken?

A

Take first thing in the morning on an empty stomach with a full glass of water
Stay upright for 30 minutes after taking them

253
Q

What are 3 side effects of bisphophonates?

A
  1. Oesophagitis
  2. Osteonecrosis of the jaw
  3. Oseophageal ulcers
254
Q

What two signs can be used to test for meningitis on examination?

A

Kernig / Brudzinski sign

255
Q

What would you see on chest X ray in aortic stenosis?

A
  1. Cardiomegaly
  2. Calcification aortic valve
  3. Pulmonary oedema
256
Q

What are some symptoms of septic infection?

A
  1. Fever
  2. Rigors
  3. Sweating
  4. Confusion or disorientation
257
Q

What enzymes may be elevated in acute liver injury?

258
Q

What are some symptoms of delirium tremens?

A
  1. Acute confusion
  2. Tremor
  3. Tachycardia
259
Q

What are some causes of microcytic anaemia?

A
  1. Iron deficiency
  2. Thalassaemia
  3. Lead poisoning
260
Q

What blood tests can be used to diagnose iron deficiency anaemia?

A
  1. Haemoglobin & mean cell volume
  2. Serum ferritin
  3. Blood film
261
Q

What are some signs of iron deficiency anaemia?

A
  1. Pallor
  2. Koilonychias
  3. Angular stomatitis
262
Q

What should be done in older / postmenopausal patients with suspected iron deficiency anaemia?

A

Refer to gastroenterology as can be red flag for colorectal cancer

263
Q

What is the cause of pneumonia people who have been to unhygienic hotels abroad get?

A

Legionella pneumophillia

264
Q

What is the most common subtype of motor neurone disease?

A

Amyotrophic lateral sclerosis

265
Q

What are the three types of motor neurone disease?

A
  1. Amyotrophic lateral sclerosis
  2. Progressive bulbar palsy
  3. Primary lateral sclerosis
266
Q

Which species of plasmodia is the most common cause of malaria?

A

P. falciparum

267
Q

What is atropine?

A

Drug used to treat bradycardias

268
Q

What drugs can be used in acute AF?

A

Pharmacological cardioversion - eg Amiodarone

269
Q

When would you use electrical cardioversion in AF?

A

If the patient is haemodynamically unstable

270
Q

What is the inheritance pattern of G6PD?

A

X linked recessive

271
Q

What can cause a G6PD crisis?

A
  1. Fava beans
  2. Nitrofurantoin
  3. Infection
272
Q

What is Von Willebrand’s disease?

A

A common autosomal dominant disease that makes you bleed more easily than normal because of a low level/ineffective Von Willebrand factor

273
Q

What does Von Willebrand factor do?

A

Helps blood cells clot

274
Q

What is haemophilia A?

A

Deficiency in clotting factor 8

275
Q

What is haemophilia B?

A

Deficiency in clotting factor 9

276
Q

What coagulation profile would be elevated in Haemophilia A and B?

A

Activated partial thromboplastin time - as this measures intrinsic pathway

277
Q

What is the inheritance pattern for haemophilia?

A

X linked recessive

278
Q

What is the gold standard investigation for peripheral artery disease?

A

Contrast angiography

279
Q

What is the 1st line investigation for peripheral artery disease?

A

Ankle brachial pressure index

280
Q

What are some characteristics of venous ulcers?

A
  1. Lower calf to medial malleolus
  2. Irregular shape
281
Q

What are some characteristics of arterial ulcers?

A
  1. Distal extremities
  2. Punched out appearance
282
Q

Where do you listen for aortic valve murmurs?

A

2nd intercostal space right sternal border

283
Q

Where you listen for mitral valve murmurs?

A

5th intercostal space left from sternum

284
Q

What blood marker is first line investigation for heart failure?

A

N-Terminal Pro B-Natriuretic Peptide

285
Q

What are some tests used to diagnose cystic fibrosis?

A
  1. Heel prick test for newborns
  2. Sweat electrolyte test (chloride)
  3. Genetic screening
286
Q

What does the heel prick test in babies test for?

A
  1. Cystic fibrosis
  2. Sickle cell disease
  3. Congenital hypothyroid
  4. Inherited metabolic diseases
  5. Severe combined immunodeficiency
287
Q

What are some causes of exudative effusions?

A
  1. Pneumonia (infection)
  2. Cancer
288
Q

What are some causes of transudative effusions?

A
  1. Heart failure
  2. Hypoalbuminaemia
  3. Nephrotic syndrome
  4. Meig’s syndrome (right sided effusion with ovarian malignancy)
289
Q

What investigations can be done to confirm suspected effusions?

A
  1. Sample of pleural aspirate
  2. CXR - blunting of costophrenic angle
290
Q

What is the management for pleural effusions?

A
  1. Diuretics
  2. Therapeutic aspiration
291
Q

What is a complication of pleural effusion?

A

Empyema - Pockets of pus in the lungs

292
Q

What bones are commonly affected in Paget’s?

A
  1. Skull
  2. Vertebrae
  3. Pelvis
  4. Femur
293
Q

What is Beck’s triad?

A

Triad for cardiac tamponade

294
Q

What is in Beck’s triad?

A
  1. Hypotension
  2. Raised JVP
  3. Muffled heart sounds
295
Q

What is Cushing’s reflex?

A

Body’s response to raised intercranial pressure

296
Q

What is in Cushing’s reflex?

A
  1. Widened pulse pressure
  2. Bradycardia
  3. Irregular respirations
297
Q

What investigations could be used to diagnose cardiac tamponade?

A
  1. CXR
  2. Echocardiogram
  3. ECG
298
Q

What is the name of the procedure used to urgently relieve pressure in cardiac tamponade?

A

Pericardiocentesis

299
Q

What antibodies indicate Addison’s disease?

A

Anti 21 hydroxylase

300
Q

What is the management for hypoglycaemia?

A

Intramuscular glucagon injection

301
Q

Which nerves are responsible for shoulder abduction?

A

Suprascapular then axillary

302
Q

What does TLR 3 detect?

A

Double strand RNA

303
Q

What does TLR 4 detect?

304
Q

What does TLR 5 detect?

305
Q

What is absorption?

A

The transportation of the drug from the site of administration to the body circulation system

306
Q

What is distribution?

A

The amount of drug available in circulating volume

307
Q

What is metabolism?

A

The chemical reactions that change drugs into compounds which are easier to eliminate

308
Q

What is excretion?

A

The removal of drugs from the body

309
Q

What are some AIDS defining illnesses?

A
  1. Kaposi sarcoma
  2. Oesophageal candida
  3. Pneumocystis pneumoniae
  4. Toxoplasmosis
  5. Cryptococcal septicaemia
310
Q

What are some causes of nephrotic syndrome?

A
  1. Minimal change disease
  2. Membranous nephropathy
  3. Focal and segmental glomerulosclerosis
311
Q

What are some causes of nephritic syndrome?

A
  1. IgA nephropathy
  2. ANCA vasculitis
  3. Goodpasture’s syndrome
  4. Post streptococcal glomerulonephritis
312
Q

What is the treatment for renal stones <5mm with no signs of obstruction or infection

A

Watch and wait

313
Q

What is the treatment for renal stones >5mm?

A

Ultrasound shock wave lithotripsy

314
Q

What is the treatment for large stones >2cm or complex stones eg. staghorn?

A

Percutaneous nephrolithotomy

315
Q

What can differentiate G6PD and beta thalassaemia major?

A

G6PD presents with jaundice

316
Q

What are some symptoms of beta thalassaemia major?

A
  1. Anaemia
  2. Chipmunk face
317
Q

What are some causes of pulmonary fibrosis?

A
  1. Idiopathic pulmonary fibrosis
  2. SIlicosis
  3. Hypersensitivity pneumonitis
  4. TB / Sarcoidosis
  5. Drugs - Methotrexate
318
Q

What are some signs on the hands of pulmonary fibrosis?

A
  1. Clubbing
  2. Acrocyanosis (Peripheral cyanosis)
319
Q

What signs on CT will indicate pulmonary fibrosis?

A
  1. Ground glass appearance
  2. Honeycombing
320
Q

Where does IPF cause fibrosis?

A

Predominantly lower zone fibrosis

321
Q

What two medicines are used in idiopathic pulmonary fibrosis?

A

Nintedanib - Tyrosine kinase inhibitor
Pirfenidone - Reduces fibroblast actvitiy

322
Q

What are signs of hypocalcaemia?

A
  1. Trousseau’s sign
  2. Chvostek’s sign
323
Q

What are some Xray signs of ankylosing spondylitis?

A
  1. Bamboo spine
  2. Dagger sign
  3. Syndesmophytes
  4. Squaring of the vertebral bodies
324
Q

What test can be used to assess a decrease in lumbar spine flexion?

A

Schober test

325
Q

What are seronegative spondyloarthropathies?

A
  1. Ank spond
  2. Psoriatic arthritis
  3. Enteropathic arthritis
  4. Reactive arthritis
326
Q

What are two signs of haemorrhagic pancreatitis?

A
  1. Cullen’s sign - Periumbilical bruising
  2. Grey Turner sign - Flank bruising
327
Q

What can be given in Graves’ to help treat eye swelling?

A

Corticosteroids

328
Q

How might gallstones cause vitamin K deficiency?

A

Gallstone blocks bile tract - bile can’t be release - fat malabsorption - fat soluble vitamins ADEK not absorbed

329
Q

What shape is a subdural haemorrhage on head CT?

A

Crescent shaped hyperdense

330
Q

What shape is an extradural haemorrhage on head CT?

A

Biconvex shaped hyperdense

331
Q

What shape is subarachnoid haemorrhage on head CT?

A

Hyperdense material in the subarachnoid space

332
Q

What cancers metastasise to bone?

A

Prostate
Breast
Thyroid
Lung
Kidney

333
Q

What cancers metastasise to brain?

A

Lung
Breast
Melanoma

334
Q

Where is PSA produced?

A

Luminal cells of prostate

335
Q

How does the joint damage occur in osteoarthritis?

A

Apoptosis of chondrocytes - loss of cartilage

336
Q

What is the pathophysiology of bronchiectasis from infection?

A

Infection causes release of inflammatory mediators - This impairs cilia function and attracts immune response - tissue damage

337
Q

What does coagulase do?

A

Converts fibrinogen to fibrin

338
Q

What sort of hypersensitivity is IgA nephropathy?

339
Q

What can be seen in the kidneys in IgA nephropathy?

A

IgA deposits and glomerular mesangial proliferation

340
Q

What are two differentials for kidney damage and haemoptysis?

A
  1. Goodpasture’s
  2. Wegener’s granulomatosis
341
Q

What is the treatment for Goodpasture’s and Wegener’s?

A

Corticosteroids + cyclophosphamide

342
Q

What condition is IgA nephropathy linked to?

A

Henloch-Schonlein purpura

343
Q

What is the pathophysiology of IgA nephropathy?

A

IgA immune complexes deposit in the kidney

344
Q

How does histamine cause inflammation?

A

Vasodilation

345
Q

What drugs would you give in thyroid storm?

A
  1. Propranolol
  2. Carbimazole
  3. Potassium iodide
346
Q

What is a monoclonal paraprotein?

A

One immunoglobulin produced excessively

347
Q

What sort of anaemia does myeloma cause?

A

Normocytic normochromic

348
Q

What are some signs of life threatening asthma?

A
  1. Confusion
  2. Silent chest
  3. Cyanosis
349
Q

Signs of left heart failure?

A
  1. Cardiomegaly
  2. Pink frothy sputum
  3. Pulmonary oedema
  4. Tachycardia
350
Q

Signs of right heart failure?

A
  1. Hepatomegaly
  2. Ascites
  3. Tachycardia
  4. ^JVP
351
Q

What colour does Zielhs Neelsen stain with TB?

352
Q

What are the 3 types of IBS?

A
  1. Diarrhoea
  2. Constipation
  3. Mixed
353
Q

What are the symptoms of IBS?

A
  1. Abdominal pain relieved by defecation
  2. Bloating
  3. Change in bowel habit
354
Q

What is lead time bias?

A

When a disease is picked up earlier through screening so it looks like they are “living longer with the disease” but actually they are just being picked up in an earlier stage

355
Q

What is length time bias?

A

When patients with less severe disease are more likely to have those diseases detected through screening

356
Q

What is secondary prevention?

A

Aiming to reduce the impact of a disease or injury that has already occured

357
Q

What is tertiary prevention?

A

Aim to reduce the impact of an illness or injury which has lasting effects

358
Q

What should be done in COPD if a patient is not coping on a SABA alone>

A

Add a LAMA + LABA

359
Q

What is the most common hormone secreted by carcinoid tumours?

360
Q

What are some side effects of excess serotonin secretion?

A

1.Diarrhoea
2. Abdominal pain
3. Flushing
4. Wheeze

361
Q

What is toxic multinodular goitre (Plummer’s disease)?

A

Growth of multiple nodules in the thyroid gland which produce excess thyroid hormone

362
Q

How can you differentiate Graves’ from toxic multinodular goitre?

A
  1. Exopthalmos in Graves’
  2. Rough goitre in TMG
363
Q

What condition has patchy uptake nuclear scintigraphy?

A

Toxic multinodular goitre

364
Q

What are some signs of hydrocephalus?

A
  1. Gait disturbance
  2. Cognitive impairment
  3. Incontinence
365
Q

What’s the best investigation for suspected hydrocephalus?

366
Q

What would you see on head CT in hydrocephalus?

A

Dilated ventricles in the absence of sulcal enlargement

367
Q

What would the blood profile in GIlbert’s syndrome show?

A

Raised unconjugated bilirubin

368
Q

How does calcium gluconate work in treating hyperkalaemia?

A

Stabilisation of cardiomyocyte membrane potentials (prevents life threatening arrythmias)

369
Q

How does insulin work in treating hyperkalaemia?

A

Shifts K+ into cells (give dextrose as well to avoid hypo)!

370
Q

Where is the most common location for an ectopic pregnancy?

371
Q

What is stage 1 AKI?

A
  1. Creatinine 1.5x to baseline
  2. Urine <0.5ml/kg/hr for 6-12 hrs
372
Q

What is stage 2 AKI?

A
  1. Creatinine 2x to baseline
  2. Urine <0.5ml/kg/hr for 12-24 hrs
373
Q

What is stage 3 AKI?

A
  1. Creatinine 3x to baseline
  2. Urine output <0.3ml/kg/hr for 24+ hrs
  3. Anuria for 12 hrs
  4. Creatine > 354
374
Q

What are symptoms of croup?

A
  1. Seal cough
  2. Fever
  3. SOB

2a Mocks (5 decks)

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