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1
Q

Budd-chiari syndrome

A

Hepatic venous outflow obstruction
Hepatomegaly, ascites, abdominal pain
Caudate lobe hypertrophy
Associated with thrombotic conditions

May require liver decompression - transjugular intrahepatic portosystemic shunt

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2
Q

Gilbert’s Syndrome

A

Mildy symptomatic/asymtomatic unconjugated hyperbilirubinaemia
Mild jaundice, malaise
LFTs largely normal except raised bilirubin
Normal reticulocyte, normal urobilinogen

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3
Q

Associations with adult polycystic kidney disease

A

Intracranial berry aneurysms - subarach
Miltral valve prolapse
Colonic diverticula
Renal cell carcinoma

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4
Q

Caplan’s syndrome

A

Coal miners pulmonary fibrosis
Multiple round nodules on CXR

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5
Q

Pytiriasis rosea

A

Herald patch followed by rash
Self limiting

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6
Q

PSA test conditions

A

No heavy exercise 48h
No ejaculation 48h
No prostate biopsy 6w
No acitve UTI

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7
Q

Labyrinthitis vs vestibular neuronitis

A

In labyrinthitis there is sensorineural hearing loss/tinnitus.

Just dizziness in neuronitis

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8
Q

ECG abnormality in lithium toxicity

A

Flattened / inverted T waves

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9
Q

Tamoxifen
Side effects

A

Oestrogen receptor antagonist in breast tissue
In other tissues it is an agonist
- bone protection

S/E
Endometrial carcinoma/hyperplasia
Thromboembolism
Fatty liver

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10
Q

Digoxin toxicity ECG

A

yellow green vision
ST depression T wave inversion V5/V6
Reverse tick

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11
Q

Diabetes diagnosis

A

Symptomatic + Fasting > 7, Random > 11.1, HbA1c > 6.5% 48

Asymptomatic 2 of:
Fasting>7, Random>11.1, HbA1c >6.5% 48

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12
Q

Impaired glucose tolerance

A

Fasting>7 and 2h GTT 7.8-11

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13
Q

Prediabetes

A

Hba1c 6.1-6.4
42-47

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14
Q

Impaired fasting glucose

A

6.1-6.9

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15
Q

Metoformin SE

A

GI upset
Lactic acidosis
Vit B12 deficiency

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15
Q

Metoformin SE

A

GI upset
Lactic acidosis
Vit B12 deficiency

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16
Q

Goodpasture’s syndrome triad

A

diffuse pulmonary haemorrhage
Glomerulonephritis
Anti-GBM antibodies

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17
Q

TB treatment

A

RI for 6 months
PE for the first 2 moths

2 months RIPE
4 months RI
RI for 10 months if CNS TB

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18
Q

Fungal nail infection treatment

A

topical: amorolfine nail lacquer
Systemic: terbinafine
Itraconazole

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19
Q

Hear lice

A

Dimeticone 4% lotion Applied twice 7d between applications, left on for 8h.

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20
Q

Vitamin B2

A

Ribofalvin - angular stomatitis

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21
Q

IgA nephropathy vs post-strep glomerulonephritis

A

IgA is 24-48h after URTI
Post-strep glomeulonephritis occurs 1-2 weeks after infection

Nephritic syndorme -visible haematuria.
High dose prednisolone in IgA nephropathy
Post-strep is self limiting

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22
Q

Bells Pasy Treatment

A

Oral prednisolone for 10d if presenting within 72h

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23
Q

Encapsulated bacuteris

A

Streptococcus
Haemophilus influenzae
Neisseria meningitidis (meningococcus)
Klebsiella
Salmonella typhi

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24
Physiological changes in pregnancy
Everything rises except Hb (dilution) and BP in 2nd trimester Prolactin rises Plasma volume rises WBC, plt, ESR rise CO rises Ventilation and tidal volume and resp rate rises Urinary frequency increases Rised GFR Pigmented skin chloasma, hair loss from scalp Compensated respiratory alkalosis
25
Autosomal dominant vs autosomal recessive
Dominant = structural Von willebrand HNPCC Achondroplasia Ehlers Danlos Osteogenesis impperfecta Tuberous sclerosis Recessive = metabolic (except inhertied ataxias)
26
association of H pylori
Peptic ulcer Gastric MALT Gastric adenocarcinoma IDA Coronartisi Menetriers disease
27
Low voltage QRS complexes
Increased distance from heart - pericardial effusion - obesity - COPD Hypothyroidism
28
Treatment of impeitgo
Hydrogen peroxide cream Fuscidic acid Mupiroscin Oral fluclox or clari
29
How long to observe following anaphylaxis
6 hours
30
Section 2 Section 3 Section 4
2 - assessment for 28 days 3 - treatment for 6 months 4 - 72 hour assessment as emergency GP and approved social worker or relative
31
Section 5(2) Section 5(4) Section 135 Section 136
5(2) - doctor on inpatient for 72h 5(4) - nurse on inpateint for 6h 135 - home to place of safety by police 136 - public to place of safety by police
32
Plasma osmolarity
2Na + urea + glucose
33
Congenital adrenal hyperplasia
Autosomal recessive Defective adrenal hormones resulting in deficient aldosterone and cortisol. This leads to increased ACTH secretion resulting in adrenal hyperplasia. Hyperpigmetation Females virilised at birth Adrenal crisis. Hypoglycaemia Life-long hydrocortisone and fludrocortisone replacement required
34
Antiplatelets following: Angina ACS medical management PCI for ACS PCR for stable coronary artery disease CABG Stroke or TIA PAD
Angina: Aspirin ACS medical - aspiring + ticagrelor for 12m PCI for aCS : Aspirin for life, + prasugrel or ticagrelor for12m PCI in stable CAD: aspirin + clopidogrel CABG DAPT Stroke/TIA - clopidogrel PAD - clopidogrel
35
Pneumonia in alcoholics
Klebsiella Redcurrant jelly sputum
36
Obstructive spirometry pattern
FEV1 < 80% FVC reduced but less than FEV1 FEV1/FVC < 0.7 Obstructive reaches FVC eventually Restrictive does not COPD Asthma Emphysema Bronchiectasis Cystic Fibrosi
37
Restrictive spirtometry
FEV1< 80% FVC < 80% FEV1/FVC > 0.7 Pulmonary fibrosis Pneumoconiosis Pulmonary oedema Obesity PRegnancy Neuromsucular CTD
38
Drugs that trigger psoraisis
Beta blockers Lithium NSAIDs ACE i Alcohol Trauma
39
causes of erythema nodosum
Infection - strep, TB Systemic - sarcoidosis, IBD, BEhcet's Drugs - pencillins, sulphonamides, COCP Pregnancy
40
Guttate psoriasis
Preceded by streptococcal sore throat 2-4 weeks Tear drop scaly papules
41
Orange peel shin lesions
Pretibial myxoedema
42
TReatment for chronic heart failure
ACE inhibitor Beta blocker 2nd line: Aldosterone antagonist - spironolactone, eplenerone If AF - digoxin Ivabradine Hydralazine + nitrate Annual influenza vaccine One off pneumococcal vaccine
43
Angina treatment
Sublingual GRN for attacks Beta blocker and CCB first line If CCB monotherapy - verapamil or diltiazem NO BETA BLOCKER WITH VERAPAMIL = bradycardia and heart failure Long acting nitrate Ivabradine Nicorandil
44
Cardioversion in AF
<48h - electrical DV cardioversion Onset > 48h Anticoagulation for 3 weeks prior to cardioversion Electrical cardioversion Anticoagulate for 4 weeks
45
Non-shockable rhythm management
PEA, asystole Chest compressions 30:2 Give 1 mg 1:10000 adrenaline IV as soon as possible Repeat every 3-5 minutes
46
Shockable rhythm management
Pulseless ventricular tachycardia, ventricular fibrillation Single shock followed by 2 minutes of CPR If witnessed in monitored patient, 3 successive shocks Adrenaline 1mg once chest compressions restarted after third shock Repeat every 3-5 minutes Amiodarone 300mg IV after 3 shocks Futher dose of amiodarone 150mg after 5 shocks IV or IO
47
4H 4T
Hypoxia Hypokalaemia/Hyperkalaemia Hypothermia Hypovolaemia Tension pneumothorax Tamponade Toxins Thrombosis
48
HTN treatment if ABPM/HBPM >= 150/95 or if >=135/85
>= 150/95 - offer drug treatmetn regardless of age >=135/85 Treat if <80 and any of target organ damage, established CVS disease, renal disease, DM, 10 year QRISK >10%
49
Torsades de pointes rx
IV magnesium sulphate
50
Mx of STEMI
Aspirin 300mg If PCI posible within 120minutes (12h of symptoms onset) - PCI - prasugrel, unfractionated heparin, drug eluting stent If PCI not possible within 120 minutes and 12h of symtpom onset Fibrinolysis with alteplase Ticargreolor following procedure If fails to resolved 90min after fibrinolysis - PCI transfer Clopidogrel if pt is high pleeding risk or on oral anticoagulants
51
side effects of ACEi
Cough Angioedema Hyperkalaemia first dose hypotension
52
Investigation for Cushings
Overnight dexamethasone suppression test
53
Ix for Addison's Sick day rules
Short SynACTHen test Plasma cortisol mesaured before and 30min after synthetic ACTH Hyperkalaemia Hyponatraemia Metabolic acidosis Sick day Double hydrocortisone Normal Fludorcortisone
54
Ix for Conns
Aldosterone to renin ratio - high Hypokalaemia Hypernatriaemia
55
Oral to SC morphine Oral codeine to oral morphine Oral tramadol to oral morphine
Oral to SC morphine Divide by 2 Oral cod/tram to morph - divide by 10
56
Mx for Raynaud's
Nifedipine
57
GCS
E4 V5 M6 E 1: Not responsive 2: Eye open to pain 3: Voice 4: Spontaneous V 1: No response 2: Incomprehensible sounds 3: Words 4: Confused speech 5: Orientated M 1: No response 2: Abnormal extension to pain 3: Abnormal flexion to pain 4: Withdrawing from pain 5: Localise to pain 6: Obeys compands
58
Fibroadenoma Mx
<3cm - watchful waiting >3cm surgical exicision
59
Breast - duct ectasia - duct papilloma -fibroadenosis -fat necrosis
Duct papilloma - blood stained discharge Duct ectasia - dilatation of mammary ducts, green discharge Fibroadenosis - lumpy breasts worse on menstruation Fat necrosis - trauma - firm round irregular breast lump - Ix as cancer Breast abscess- more common in lactating women
60
2 week wait criteria colorectal
>= 40 with weight loss and abdo pain >=50 with rectal bleeding >= 60 with IDA OR change in bowel habit Rectal abdominal mass Mass or anal ucleration
61
UC flare treatment
Mild moderate flare - topical aminosalicylate (mesalazine, sulfasalazine) Oral aminosalycilate Oral steroids Severe acute flare Hospital IV steroids IV ciclosporin
62
Pneumothorax Mx
Primary penumothorax >2cm and or breathless - needle aspiration If fails chest drain If <2cm and not SOB - discharge Secondary pneumothorax 1-2cm - needle aspiration <1cm admit for observation give oxygen Observe for 24h Secondary pneumothorax >2cm and/or patient short of breath - chest drain
62
Cervical smear result inadequate
Negative hrHPV (16/18) Return to normal recall Positive hrHPV Abnormal cytology - colposcopy (borderline changes, any dyskaryosis, invasive squam) Cytology normal - repeat in 12m 12m repeat negative for hrHPV - normal recall Repeat test + - cytology normal 12m repat If HPV -ve at 24m - normal recall If HPV +ve at 24m - colposcopy Inadequate sample - repeat in 3m 2 inadequate samples - colposcopy LLETZ for CIN
63
NSTEMI Mx
GRACE score > 3% indicated PCI in 72hours UFH and glucoprotein receptor anatagonist prior to PCI
64
B12 + folate deficiency
B12 B4 folate Replace B12 first to avoid SCDC
65
Acanthosis nigricans
Gastric adenocarcinoma Hyperinsulinaemia PCOS
66
Acanthosis nigricans
Gastric adenocarcinoma Hyperinsulinaemia PCOS
67
Chronic hepatitis B
HBsAg + Anti-Hbc + Anti-Hbs - HbsAg + for 6 months
68
Fragility fracture in pt >75, <75
>75 Start bisphonsphonate alendronate 70mg once weekly <75 DEXA scan and FRAX assesment
69
Raised prolactin causes
P Pregnancy Physiological Prolactinoma MetocloPramide, DomPeridone Primary hypothyroidism PCOS
70
CYP inducers
Carbemazepine Rifampicin Barbiturates Phenytoin St Johns Wort Chronic alcohol
71
Mx for lumbar spinal stenosis
Laminectomy
72
Mx of paracetamol overdose? Staggered?
MEasure paracetamol level at 4 hours post ingestion and compare to normogram - infuse NAC over 1 hour if above treatment line Staggered - paracetamol over more than 1 hour commence IV NAC immediately Kings criteria pH<7.3 24 h after ingestion PT >100s creatinine >300 Grade III/IV encephalopathy
73
Screening
Cervical 25-49 3 yearly cervical smear test 50-64 5 yearly cervical smear test For HPV 16, 18 Breast 3 yearly mammogram 50-70 Colorectal 60-74 2 yearly FIT test - colonsocopy FIT test if not meeting 2 week criteria >=50 with abdo pain or weight loss <60 with bowel habit change or IDA >=60 anaemia no ID
74
Anticoagulation for AF post stroke
TIA - commence immediately if no haemorrhage on scan Stroke - commence after 2 weeks to avoid haemorrhagic transformation (2 weeks of antiplatelets)
75
Breast cancer drugs
Anti-oestrogen Tamoxifen - selective oestrogen receptor modulator Anti-oestrogen in breast but agonist outside so causes hot flushes, VTE, endometrial Ca, vaginal bleeding Aromatase inhibitors anastrazole letrozole Reduce peripheral oestrogen synthesis so cause osteoporosis - DEXA scan
76
Acute flare of RA?
IM methylprednisolone Oral steroid
77
Adrenaline doses
0-6 150 micrograms 6-12 300 micrograms 13+ 500 micrograms 1 dose 5 mins Another dose
77
Adrenaline doses
0-6 150 micrograms 6-12 300 micrograms 13+ 500 micrograms 1 dose 5 mins Another dose Consider IV adrenoaline Observe for 6h minimum

MSRA (7 decks)

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