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Clinical Medicine > Revision > Flashcards

Revision Flashcards

1
Q

What is the incubation period of hepatitis C?

A

6-9 weeks

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2
Q

What 3 clinical symptoms can sometimes be seen in patients post exposure to hepatitis C

A
  1. Transient rise in serum aminotransferases/ jaundice
  2. Fatigue
  3. Arthralgia
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3
Q

How can chronic hepatitis C be defined?

A

Persistence of HCV RNA in the bloodstream for 6 months

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4
Q

Give 2 side effects associated with ribavirin

A
  1. Haemolytic anemia

2. Cough

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5
Q

Give 5 side effects associated with interferon alpha

A
  1. Flu like symptoms
  2. Depression
  3. Fatigue
  4. Leukopenia
  5. Thrombocytopenia
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6
Q

Suggest 6 potential causes of hypoadrenalism

A
  1. Addison’s disease
  2. TB
  3. Metastases (e.g. bronchial carcinoma)
  4. Meningococcal septicaemia (Waterhouse-Friderichsen syndrome)
  5. HIV
  6. Antiphospholipid syndrome
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7
Q

Identify 2 at risk groups for the development of a subdural haematoma

A
  1. Elderly

2. Alcoholics

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8
Q

Why could an infant have a subdural haematoma?

A

Rupture of the small fragile bridging veins within the subdural space in shaken baby syndrome.

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9
Q

What is the main difference in pathology between Crohn’s disease and ulcerative colitis?

A

In Crohn’s disease lesions can found anywhere along the length of the GI tract from mouth to anus while in ulcerative colitis lesions are never found proximal to the iliocaecal valve.

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10
Q

Recall the causes of acute pancreatitis using the mnemonic ‘GET SMASHED’

A

G - Gallstones
E- Ethanol
T - Trauma

S - Steriods
M - Mumps
A - Autoimmune (polyarteritis nodosa)
S - Scorpion Venom
H - Hypertriglyceridemia, Hyperchylomicronemia, Hypercalcemia, Hypothermia
E - ERCP
D - Drugs e.g. Azathioprine, Furosemide, steroids and sodium valproate

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11
Q

Aortic regurgitation is associated with what type of murmur?

A

Early diastolic murmur that is high pitched and blowing in character.

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12
Q

Anti TPO antibodies are present in ~ 90% patients with what form of thyroid disease?

A

Hashimoto’s thyroiditis

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13
Q

TSH receptor antibodies are seen in 90-100% of patients with what form of thyroid disease?

A

Grave’s disease

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14
Q

What adverse affect is linked with the use of carbimazole?

A

Agranulocytosis

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15
Q

Uvula deviation is caused by a lesion to which cranial nerve? (2)

A
  1. Deviation towards the side of the lesion - CNXII

2. Deviation away from the side of the lesion - CNX

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16
Q

Recall the 3 components of CNIII palsy

A
  1. Ptosis
  2. Eye down and out
  3. Dilated fixed pupil
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17
Q

What type of diplopia is seen with a CNIV palsy?

A

Vertical diplopia

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18
Q

What type of diplopia is seen with a CNVI palsy?

A

Horizontal diplopia

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19
Q

Name the eye muscles that are inhibited with a CNIV and CNVI nerve palsy respectively

A

CNIV - Superior Oblique

CNVI - Lateral rectus

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20
Q

What are the afferent and efferent components of the corneal reflex?

A

Afferent - CNV (Ophthalmic division)

Efferent - VII

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21
Q

What are the afferent and efferent components of the jaw jerk reflex?

A

Afferent - CNV (Mandibular division)

Efferent - CNV (Mandibular division)

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22
Q

What are the afferent and efferent components of the Gag reflex?

A

Afferent - CN IX

Efferent - CN X

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23
Q

What are the afferent and efferent supplies to the carotid sinus?

A

Afferent - CN IX

Efferent - CN X

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24
Q

What are the afferent and efferent components of the pupillary light reflex?

A

Afferent - CN II

Efferent - CN III

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25
Q

What are the afferent and efferent components of the lacrimation reflex?

A

Afferent - CN V (Ophthalmic division)

Efferent - CN VII

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26
Q

Suggest 3 vascular causes of an acute abdomen

A
  1. Ruptured abdominal aortic aneurysm
  2. Mesenteric ischaemia
  3. MI
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27
Q

Suggest 2 inflammatory causes of an acute abdomen

A
  1. Pancreatitis

2. Peptic ulcer disease

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28
Q

Recall 9 potential infective causes of acute abdominal pain

A
  1. Gastroenteritis
  2. Appendicitis
  3. Diverticulitis
  4. Pyelonephritis
  5. Cholecystitis
  6. Cholangitis
  7. Pelvic inflammatory disease
  8. Hepatitis
  9. Pneumonia
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29
Q

Give 6 possible complications of hepatitis B infection

A
  1. Chronic hepatitis
  2. Fulminant liver failure
  3. Hepatocellular carcinoma
  4. Glomerulonephritis
  5. Polyarteritis Nodosa
  6. Cryoglobulinemia
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30
Q

Suggest 6 causes of a respiratory acidosis

A
  1. COPD
  2. Opiod Overdose
  3. Decompensated life threatening asthma
  4. Neuromuscular disease
  5. Obesity hypoventilation syndrome
  6. Benzodiazapine overdose
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31
Q

Suggest 6 causes of respiratory alkalosis

A
  1. PE
  2. Anxiety leading to hyperventilation
  3. CNS disorders e.g. stroke, sub arach or encephalitis
  4. Altitude
  5. Pregnancy
  6. Salicylate poisoning
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32
Q

Name 3 conditions that have been associated with primary sclerosing cholangitis

A
  1. Ulcerative Colitis
  2. Crohn’s disease
  3. HIV
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33
Q

What is primary sclerosing cholangitis?

A

Biliary disease of unknown aetiology characterised by inflammation and fibrosis of both intra and extra hepatic bile ducts

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34
Q

Give 2 complications associated with primary sclerosing cholangitis

A
  1. Cholangiocarcinoma

2. Increased risk of colorectal cancer

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35
Q

Name the organism most likely to cause pneumonia following an infection of influenza

A

Staphylococcus aureus

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36
Q

Name the condition associated with respiratory syncytial virus

A

Bronchiolitis

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37
Q

Name the condition associated with Parainfluenza virus

A

Croup

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38
Q

What is the most common causative organism of community acquired pneumonia?

A

Strep Pneumonia

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39
Q

What is the most common causative organism of an exacerbation of bronchiectasis

A

Haemophilus Influenza

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40
Q

Name an organism that commonly causes pneumonia in patients with HIV

A

Pneumocystis Jiroveci

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41
Q

Recall 2 complications associated with infection by the organism: Mycoplasma Pneumonia

A
  1. Haemolytic anemia

2. Erythema multiforme

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42
Q

What are the 4 main clinical symptoms seen in patients presenting with ulcerative colitis?

A
  1. Bloody diarrhoea
  2. Urgency
  3. Tenesmus
  4. Abdominal pain
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43
Q

What are the characteristic features of a history of myoclonic seizure?

A

Loss of consciousness followed by rapids jerks of facial muscles and limbs.

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44
Q

What are the 5 components of life threatening asthma?

A
  1. PEFR < 33% of best or predicted
  2. O2 saturations < 92%
  3. Silent chest, cyanosis or feeble respiratory effort
  4. Bradycardia, dysrthmia or hypotension
  5. Exhaustion, confusion or coma
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45
Q

What is the key diagnostic result in the investigation of toxic multi nodular goitre?

A

Nuclear scintigraphy shows an enlarged thyroid gland with ‘patchy’ uptake.

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46
Q

What is the most common cause of an infective exacerbation of COPD?

A

Haemophilus Influenza

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47
Q

‘Cobble stone appearance’ on endoscopy is associated with which form of inflammatory bowel disease?

A

Crohn’s disease

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48
Q

What is the first line treatment for a new diagnosis of COPD?

A

SABA or SAMA

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49
Q

Suggest 3 interventions which may improve survival in patients with stable COPD

A
  1. Smoking cessation
  2. Long term oxygen therapy in patient who fit the criteria
  3. Lung volume reduction surgery in selected patients
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50
Q

What is the normal pressure range for the pulmonary circulation?

A

10-14 mmHg

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51
Q

Loss of haustrations seen on a barium enema is indicative of which condition?

A

Ulcerative colitis

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52
Q

Which arteries are involved in a total anterior circulation infarct?

A

Anterior and middle cerebellar arteries

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53
Q

Which arteries are involved in a lacunar infarct?

A

Perforating arteries around the internal capsule, thalamus and basal ganglia

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54
Q

Which arteries are involved in a posterior circulation infarct?

A

Vertebrobasilar arteries

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55
Q

What are the 3 possible presentations of a lacunar infarct?

A
  1. Unilateral weakness (and/or sensory deficit)
  2. Pure sensory stroke
  3. Ataxic hemiparesis
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56
Q

What are the 3 possible presentation of a posterior circulation infarct?

A
  1. Cerebellar or brainstem syndromes
  2. Loss of consciousness
  3. Isolated homonymous hemianopia
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57
Q

Name the 3 most common organisms implicated in acute food poisoning

A
  1. Staph Aureus
  2. Bacillus cereus
  3. Clostridium Perfringens
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58
Q

Name 3 drugs that have an adverse effect of increasing the incidence of Gout

A
  1. Loop diuretics
  2. Thiazides
    3 Pyrazinamide
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59
Q

Name 2 drugs that can cause depression as an adverse effect

A
  1. Steroids

2. Isotretinoin

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60
Q

Name 3 drugs that can cause photosensitivity as an adverse effect

A
  1. Tetracyclines
  2. Amiodarone
  3. Isotretinoin
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61
Q

Name 3 drugs that can result in lengthening of the QT interval

A
  1. Ciprofloxacin
  2. Antipsychotics
  3. Amiodarone
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62
Q

Recall 4 indications for the use of tetracylines

A
  1. Acne vulgaris
  2. Lyme disease
  3. Chlamydia
  4. Mycoplasma pneumonia
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63
Q

Recall the classical triad of symptoms seen in patients with infective mononucleosis

A
  1. Sore throat
  2. Lymphadenopathy
  3. Pyrexia
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64
Q

List 5 side effects associated with beta-blockers

A
  1. Bronchospasm
  2. Cold peripheries
  3. Fatigue
  4. Sleep disturbance
  5. Erectile dysfunction
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65
Q

Give 4 contra-indication for the use of beta blockers

A
  1. Uncontrolled heart failure
  2. Asthma
  3. Sick sinus syndrome
  4. Concurrent Verapamil use
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66
Q

Name 4 drugs that can cause pulmonary fibrosis

A
  1. Methotrexate
  2. Nitrofurantoin
  3. Amiodarone
  4. Sulphasalazine
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67
Q

Classify amiodarone as an anti arrhythmic agent

A

Class III

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68
Q

Why should amiodarone only be given into a central vein?

A

Risk of thrombophlebitis

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69
Q

What are the 3 main characteristics of subacute combined degeneration of the spinal cord?

A
  1. Bilateral spastic paresis
  2. Loss of proprioception and vibration sense
  3. Limb ataxia
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70
Q

Give 6 potential differentials for stridor and inspiratory wheeze

A
  1. Epiglottitis
  2. Croup
  3. Inhaled foreign body
  4. Rapidly progressing laryngomalacia
  5. Laryngeal papillomas
  6. Anaphylaxis causing laryngeal oedema
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71
Q

Metabolic differentials for vomiting and abdominal pain in the absence of food poisoning or fever (6)

A
  1. Drug overdose e.g. digoxin
  2. DKA
  3. Hypercalcemia
  4. Addison’s disease
  5. Acute intermittent porphyria
  6. Phaemochromocytoma
  7. Lead poising
  8. Vitamin A intoxication
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72
Q

Give 4 potential causes of prehepatic jaundice as a result of haemolysis

A
  1. Hereditary haemolytic anemia
  2. Acquired haemolytic anemia
  3. Septicaemic haemolysis
  4. Malaria
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73
Q

Name 2 congenital enzyme defects that can lead to hepatic jaundice

A
  1. Gilbert’s syndrome

2. Crigler - Najjar syndrome

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74
Q

What are the 4 main differentials for acute central abdominal pain?

A
  1. Small bowel obstruction
  2. Abdominal aortic dissection
  3. Crohn’s disease
  4. Mesenteric artery occlusion
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75
Q

What are the 4 differentials to consider in patients presenting with tenesmus?

A
  1. Rectal inflammation
  2. Rectal tumour
  3. Tumour of descending colon
  4. Pelvic inflammatory disease
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76
Q

Name 2 connective tissue disorders linked with an increased incidence of aortic dissection

A
  1. Marfan syndrome

2. Ehler’s- Danlos syndrome

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77
Q

Name a vascular disorder that is associated with aortic dissection

A

Bicuspid aortic valve (congenital abnormality)

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78
Q

What is the definition of ‘massive haemoptysis’?

A

> 400 ml over 3 hours or > 600 mms over 24 hours

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79
Q

Suggest 6 potential causes of massive haemoptysis

A
  1. Bronchiectasis
  2. Bronchial carcinoma
  3. TB
  4. Lung abscess
  5. Aspergilloma
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80
Q

Suggest 4 types of systemic vasculitis which may cause haemoptysis

A
  1. SLE
  2. Wegner’s
  3. Goodpasture’s
  4. Microscopic polyangiitis
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81
Q

Outline the main complications associated with DKA (6)

A
  1. Hypokalaemia
  2. Hypophosphatemia
  3. Hypercholeraemic acidosis
  4. Hypoglycaemia
  5. Cerebral oedema in children
  6. Thromboembolism
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82
Q

Name a neurological complication severe vitamin B12 deficiency

A

Subacute combined degeneration of the spinal cord

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83
Q

Give 3 cardiac causes of ascites

A
  1. Cardiac failure
  2. Constrictive pericarditis
  3. Tricuspid incompetence
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84
Q

Suggest 4 potential causes of acute onset ascites

A
  1. Acute decompensation of liver cirrhosis
  2. Malignancy
  3. Portal or splenic vein thrombosis
  4. Budd - Chiari syndrome
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85
Q

What is the classic triad of symptoms associated with Budd-Chiari syndrome?

A
  1. Abdominal pain
  2. Ascites
  3. Liver enlargement
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86
Q

What is Kussmaul’s sign + suggest 2 conditions that may cause this sign.

A

Elevation of the JVP on inspiration. Can be seen in cases of pericardial effusion or restrictive pericarditis as they limit right ventricular filling during diastole

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87
Q

What is the mechanism of action of dipyramidole?

A

Phosphodiesterase inhibitor

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88
Q

Classify the drug dipyramidole

A

Anti-platelet

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89
Q

Give 2 congenital causes of prolonged QTC interval

A
  1. Jervell- Lange- Nielsen syndrome

2. Romano-Ward syndrome

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90
Q

Suggest 3 drugs that can cause a prolonged QTC interval

A
  1. Amiodarone
  2. Sotalol
  3. Tricyclic antidepressants
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91
Q

Name 2 conditions that can be linked with coeliac disease

A
  1. Dermatitis herpetiformis

2. Autoimmune conditions (e.g. DMT1 or autoimmune hepatitis)

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92
Q

Name 3 conditions that can cause hypernatremia

A
  1. Diabetes insipidus
  2. Dehydration
  3. Hyperosmolar non- ketotic diabetic coma
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93
Q

Name 6 drug types that can lead to impaired glucose tolerance

A
  1. Thiazide diuretics
  2. Steroids
  3. Tacrolimus, ciclosporin
  4. Interferon alpha
  5. Nicotinic acid
  6. Antipsychotics
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94
Q

What is the most common electrolyte imbalance caused by the use of ACE inhibitors?

A

Hyperkalemia

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95
Q

What are the 3 classical features of a hepatitis B infection?

A
  1. Fever
  2. Jaundice
  3. Raised liver transaminases
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96
Q

Name 6 complications associated with a hepatitis B infection

A
  1. Chronic hepatitis
  2. Fulminant liver failure
  3. Hepatocellular carcinoma
  4. Glomerulonephritis
  5. polyarteritis nodosa
  6. Cryoglobulinaemia
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97
Q

What is Courvoisier Sign?

A

A palpable mass in the right upper quadrant

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98
Q

Define Sister Mary Joseph Nodes

A

Periumbilical lymphadenopathy

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99
Q

What is the most common electrolyte imbalance associated with acute renal failure?

A

Hyperkalemia

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100
Q

What is the first line acute treatment for migraine?

A

Triptan + NSAID or Triptan + Paracetamol

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101
Q

Name a patient subgroup for which Topiramate is contra-indicated

A

Women of child bearing age - potentially teratogenic and can reduce the effectiveness of the oral contraceptive pill.

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102
Q

The monoclonal antibody CA 125 is associated with which type of tumour?

A

Ovarian cancer

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103
Q

The monoclonal antibody CA 19-9 is associated with which type of tumour?

A

Pancreatic cancer

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104
Q

The monoclonal antibody CA15-3 is associated with which type of tumour?

A

Breast cancer

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105
Q

The tumour antigen AFP (alpha-feto protein) is associated with which type of tumour?

A

Hepatocellular carcinoma

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106
Q

The tumour antigen CEA (carcinoembryonic antigen) is associated with which type of tumour?

A

Colorectal cancer

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107
Q

The tumour antigen S-100 is associated with which type of tumour?

A

Melanoma or Schwannomas

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108
Q

The tumour antigen Bombesin is associated with which type of tumour?

A
  1. Small cell lung carcinoma
  2. Gastric cancer
  3. Neuroblastoma
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109
Q

Name the most common type of cardiomyopathy

A

Dilated cardiomyopathy

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110
Q

Name an inherited syndrome that will increased an individuals risk of developing dilated cardiomyopathy

A

Duchenne muscular dystrophy

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111
Q

Recall the classical triad of symptoms seen in patients with normal pressure hydrocephalus

A
  1. Urinary incontinence
  2. Dementia and bradyphrenia
  3. Gait abnormalities (may be similar to Parkinson’s disease)
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112
Q

What is the most common causative agent of an exacerbation of bronchiectasis?

A

Haemophilus Influenza

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113
Q

Severe hypokalaemia can lead to what form of acid base disturbance?

A

Metabolic alkalosis

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114
Q

What is the mechanism of action of Warfarin?

A

Inhibits carboxylation of clotting factors II, VII, IX and X

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115
Q

Outline the nerves that supply taste sensation to the tongue.

A
  1. Anterior 2/3 innervated by CN VII

2. Posterior 1/3 innervated by CN IX

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116
Q

What is the most common cause of primary hyperaldosteronism?

A

Bilateral idiopathic adrenal hyperplasia

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117
Q

What are the 3 classical features of primary hyperaldosteronism?

A
  1. Hypotension
  2. Hypokalaemia (often seen clinically as muscle weakness)
  3. Alkalosis
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118
Q

What is the first line investigation for primary hyperaldosteronism?

A

Plasma renin/aldosterone ratio

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119
Q

Outline 4 complications associated with chronic lymphocytic leukaemia

A
  1. Anemia
  2. Hypogammaglobulinaemia (leading to recurrent infections)
  3. Warm autoimmune haemolytic anemia
  4. Richter’s transformation
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120
Q

Name 4 drugs that can cause pancreatitis as an adverse drug effect

A
  1. Corticosteroids
  2. Thiazides
  3. Sodium valproate
  4. Azathioprine
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121
Q

What is the first line treatment for focal seizures?

A

Carbamazepine

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122
Q

Name 4 drugs that can cause pulmonary fibrosis

A
  1. Amiodarone
  2. Methotrexate
  3. Sulphalazine
  4. Nitrofurantoin
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123
Q

Suggest 3 potential causes of a third heart sound

A
  1. Dilated cardiomyopathy
  2. Constrictive pericarditis
  3. Mitral regurgitation
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124
Q

Suggest 2 potential causes of peaked T waves

A
  1. Hyperkalemia

2. Myocardial ischaemia

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125
Q

Recall the 6 potential causes of inverted T waves

A
  1. Myocardial ischaemia
  2. Digoxin toxicity
  3. Subarachnoid haemorrhage
  4. Arrythmogenic right ventricular cardiomyopathy
  5. Pulmonary embolism
  6. Brugada syndrome
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126
Q

If a patient has a superior homonymous quadrantanopia, where is the lesion most likely to be?

A

Temporal lobe

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127
Q

If a patient has an inferior homonymous quadrantanopia, where is the lesion most likely to be?

A

Parietal lobe

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128
Q

Suggest 2 conditions in which pulses paradoxus may occur

A
  1. Severe asthma

2. Cardiac tamponade

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129
Q

Name 5 drugs that can cause peripheral neuropathy as an adverse side effect

A
  1. Amiodarone
  2. Metronidazole
  3. Nitrofurantoin
  4. Isoniazid
  5. Phenytoin
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130
Q

What is Berger’s disease?

A

IgA nephropathy - the most common cause of glomerulonephritis worldwide

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131
Q

What is the classical presentation of IgA nephropathy?

A

Macroscopic haematuria in a young person following an upper respiratory tract infection

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132
Q

Name 3 conditions associated with IgA nephropathy

A
  1. Alcoholic cirrhosis
  2. Coeliac disease
  3. Henoch- Schonlein Purpura
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133
Q

What is the most common causative organism of acute epiglottitis?

A

Haemophilus Influenza

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134
Q

What is the first line treatment for trigeminal neuralgia?

A

Carbamazepine

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135
Q

What is the typical location of pain associated with renal colic?

A

Loin pain radiating to the groin

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136
Q

Name 4 causes of target cells seen on blood cell microscopy

A
  1. Sickle cell or thalassemia
  2. Iron-Deficiency anemia
  3. Hyposplenism
  4. Liver disease
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137
Q

What is the first line treatment for absence seizures?

A

Sodium Valproate or Ethosuximide

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138
Q

What are the 3 predominant causes of hypernatraemia?

A
  1. Diabetes insipidus
  2. Dehydration
  3. Hyperosmolar non-ketotic diabetic coma
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139
Q

Outline 4 characteristics of Gerstmann’s syndrome

A
  1. Alexia
  2. Acalculia
  3. Finger agnosia
  4. Right-left disorientation
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140
Q

Name 4 clinical features of parietal lobe lesions

A
  1. Sensory inattention
  2. Apraxia
  3. Astereognosis
  4. Inferior Homonymous quadrantanopia
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141
Q

Give 3 clinical characteristics of an occipital lobe lesion

A
  1. Homonymous hemianopia with macula sparing
  2. Cortical blindness
  3. Visual agnosia
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142
Q

Broca’s aphasia is associated with a lesion in what area of the brain?

A

Frontal lobe

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143
Q

Wernicke’s aphasia is associated with a lesion in what area of the brain?

A

Temporal lobe

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144
Q

Which brain areas are implicated in Wernicke-Korsakoff syndrome?

A

Medial thalamus and mammillary bodies of the hypothalamus

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145
Q

Which brain areas are implicated in Hemiballismus?

A

Subthalamic nucleus of the basal ganglia

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146
Q

Which brain areas are implicated in Huntington’s chorea?

A

Striatum (caudate nucleus) of the basal ganglia

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147
Q

Which brain areas are implicated in Parkinson’s disease?

A

Substantia nigra of the basal ganglia

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148
Q

Which brain areas are implicated in Kluver-Bucy syndrome?

A

Amygdala

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149
Q

What type of cancer is most closely associated with EBV?

A

Hodgkin’s lymphoma

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150
Q

What is ciclosporin?

A

Immunosuppresant which decreases clonal proliferation of T cells by reducing IL-2 release

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151
Q

What is the most characteristic electrolyte imbalance associated with dehydration?

A

Hypercalcaemia

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152
Q

What area of the brain is most common affected by herpes simplex encephalitis?

A

Temporal lobes

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153
Q

Name 2 drugs that can cause gynaecomastia in men

A
  1. Digoxin

2. Spironolactone

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154
Q

Give 2 characteristic features of a lesion in CNVIII

A
  1. Nystagmus

2. Vertigo

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155
Q

What is the treatment for a heparin overdose?

A

Protamine sulphate

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156
Q

Name 2 lipophilic statins

A
  1. Simvastatin

2. Atorvostatin

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157
Q

Name 3 hydrophilic statins

A
  1. Rosuvastatin
  2. Pravastatin
  3. Fluvastatin
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158
Q

What is the mechanism of action of adenosine?

A

Agonist of the A1 receptor in the AV node

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159
Q

What organism causes rubella?

A

Togavirus

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160
Q

Outline the characteristic lymphadenopathy seen with a rubella infection

A

Suboccipital and post-auricular

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161
Q

Give 4 complications associated with Rubella Infection

A
  1. Arthritis
  2. Thrombocytopenia
  3. Encephalitis
  4. Myocarditis
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162
Q

What is the mechanism of action of allopurinol?

A

Xanthine oxidase inhibitor

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163
Q

Name the 3 main drugs that are known to interact with allopurinol

A
  1. Azathioprine
  2. Cyclophosphamide
  3. Theophylline
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164
Q

Mutations of which gene are associated with haemochromatosis?

A

HFE gene on chromosome 6

165
Q

Recall all gram positive rod bacteria using the mnemonic ABCD L

A

A - Actinomyces
B - Bacillus anthrax
C - Clostridium
D - Diphtheria

L - Listeria Monocytogenes

166
Q

Name the 3 gram negative cocci

A
  1. Neisseria Meningitidis
  2. Neisseria gonorrhea
  3. Moraxella Catarrhalis
167
Q

What are the 4 main causes of LBBB?

A
  1. Ischaemic heart disease
  2. Hypertension
  3. Aortic stenosis
  4. Cardiomyopathy
168
Q

List 5 causes of a normocytic anemia

A
  1. Anemia of chronic disease
  2. Chronic kidney disease
  3. Aplastic anemia
  4. Haemolytic anemia
  5. Acute blood loss
169
Q

Name the antibody most closely associated with coeliac disease

A

Anti-tissue transglutaminase antibody

170
Q

What are the 2 main clinical components of Goodpastures syndrome?

A
  1. Pulmonary haemorrhage

2. Rapidly progressive glomerulonephritis

171
Q

What are the 4 main differentials for hypertension with a low potassium level?

A
  1. Conn’s syndrome
  2. Cushing’s syndrome
  3. Renal artery stenosis
  4. Liddle’s syndrome
172
Q

Suggest 4 causes of an transudate pleural effusion

A
  1. Congestive cardiac failure
  2. Liver Cirrhosis
  3. Nephrotic syndrome
  4. SVC obstruction
173
Q

What is the mechanism of action of ciclosporin?

A

Immunosuppressant which decreases clonal proliferation of T cells by reducing IL-2 release

174
Q

Recall the components of a bifascicular block seen on ECG

A
  1. RBBB

2. Left axis deviation

175
Q

What is the age range with peak incidence of myeloma?

A

Between 60-70 years

176
Q

Suggest 3 potential complications of pelvic inflammatory disease

A
  1. Infertility
  2. Chronic pelvic pain
  3. Ectopic pregnancy
177
Q

What is the causative organism of hand, foot and mouth disease?

A

Coxsackie A16 virus

178
Q

Give 3 risk factors for subdural haematoma

A
  1. Alcoholism
  2. Old age
  3. Antocoagulation
179
Q

Name 2 NSAIDS that have been linked to an increased incidence of cardiovascular events

A
  1. Ibuprofen

2. Diclofenac

180
Q

Name an Xray finding that is associated with osteoarthritis

A

Subchondral Cysts

181
Q

Outline 5 ‘medical’ (non-abdominal) causes of abdominal pain

A
  1. MI
  2. DKA
  3. Pneumonia
  4. Acute intermittent porphyria
  5. Lead poisoning
182
Q

What is the most common causative agent of bronchiolitis?

A

Respiratory syncytial virus

183
Q

Suggest 5 medications which may trigger anxiety

A
  1. Salbutamol
  2. Theophylline
  3. Corticosteriods
  4. Antidepressants
  5. Caffeine
184
Q

Briefly outline the mechanism of action of benzodiazepines

A

They enhance the effect of GABA signalling by up regulating the expression of chlorine ion channels.

185
Q

Give 4 examples of extra-pyramidal side effects that can be caused by anti-psychotic medications

A
  1. Parkinsonisms
  2. Acute dystonia
  3. Akathisia (severe restlessness)
  4. Tardive dyskinesia
186
Q

Name a drug that can be used to managed extra-pyramidal side effects of drugs

A

Procyclidine

187
Q

Define vital capacity

A

Maximum volume of air that can be expired following a maximal inspiration

188
Q

Give 3 predisposing factors for acute angel glaucoma

A
  1. Hypermetropia
  2. Pupillary dilatation
  3. Lens growth associated with age
189
Q

Burns must cover what % of total body surface area before IV fluids must be administered for resuscitation (values for adults and children)

A

Adults - greater than 15% of total body surface area

Children - greater than 10%

190
Q

Recall the Parkland formula used to calculate volume of IV fluid given for resuscitation following a burn injury

A

Volume of fluid = total body surface area percentage * weight (kg) * 4

191
Q

Define a fistula

A

An abnormal connection between two epithelial surfaces

192
Q

Name a strong topical steroid medication

A

Clobetasol propionate

193
Q

What is the identified long term risk with Lichen sclerosus?

A

Increased risk of vulval cancer

194
Q

What is Lichen Sclerosus?

A

Inflammatory condition that usually affects the genitalia - leads to atrophy of the epidermis and white plaque formation

195
Q

What are the 3 characteristic symptoms of diverticular disease?

A
  1. Altered bowel habits
  2. Bleeding
  3. Abdominal Pain
196
Q

What are the 4 characteristic features of pneumococcal pneumonia?

A
  1. Rapid onset
  2. High Fever
  3. Pleuritic chest pain
  4. Herpes Labialis
197
Q

What are the 4 adverse signs with regards to peri-arrest arrhythmias?

A
  1. Shock (systolic BP <90)
  2. Syncope
  3. Myocardial ischaemia
  4. Heart failure
198
Q

When would IV amiodarone be the indicated treatment for VT?

A

Only if the patient shows no peri-arrest adverse signs

199
Q

What is the most common presentation of IgA nephropathy?

A

Macroscopic haematuria in young people following an upper respiratory tract infection

200
Q

What is the key difference in presentation between IgA nephropathy and post-streptococcal glomerulonephritis?

A

Post- streptococcal glomerulonephritis presents with proteinuria, which is rare in IgA nephropathy

201
Q

What is the inheritance pattern of MODY?

A

Autosomal dominant

202
Q

What are the gene defects found in MODY 2,3 and 5 respectively?

A

MODY 2 - Defect in glucokinase gene
MODY 3 - Defect in HNF-1 alpha gene
MODY 5 - Defect in HNF-1 beta gene

203
Q

What is the most common cause of secondary hypertension?

A

Conns syndrome

204
Q

Name 4 types of renal disease which may cause secondary hypertension

A
  1. Glomerulonephritis
  2. Pylonephritis
  3. Adult polycystic kidney disease
  4. Renal artery stenosis
205
Q

Suggest 5 potential drug causes of secondary hypertension

A
  1. Steroids
  2. Monoamine oxidase inhibitors
  3. The combined oral contraceptive pill
  4. NSAIDS
  5. Leflunomide
206
Q

What is Leflunomide?

A

An immune-suppresive disease modifying anti-rheumatic drug

207
Q

What is the mechanism of action of Leflunomide?

A

Pyrimidine synthesis inhibitor

208
Q

What are the typical abnormal blood results seen in patients with neuroleptic malignant syndrome?

A

Raised creatine kinase and white cell count often accompanied by hyperkalemia as a result of muscle damage

209
Q

What is the mechanism of action of sulphonylureas drugs?

A

Increase pancreatic insulin secretion

210
Q

What is the mode of inheritance of haemophilia A and B?

A

X- linked recessive

211
Q

What is the most common congenital infection seen in the UK?

A

Cytomegalovirus

212
Q

What are the 3 major congenital infections encountered on examinations?

A
  1. Rubella
  2. Toxoplasmosis
  3. Cytomegalovirus
213
Q

What are the 4 characteristic features of congenital rubella syndrome?

A
  1. Sensorineural deafness
  2. Congenital cataracts
  3. Congenital heart disease (e.g. patent ductus arteriosus)
  4. Glaucoma
214
Q

What are the 3 main characteristic features of congenital toxoplasmosis infection?

A
  1. Cerebral calcification
  2. Chorioretinitis
  3. Hydrocephalus
215
Q

What are the 2 characteristic features of congenital cytomegalovirus infection?

A
  1. Growth retardation

2. Purpuric skin lesions

216
Q

Recall the organisms of the HACEK mneuomonic that make up the possible culture negative infective organisms

A 
H - Haemophilus 
A - Actionbacillus 
C - Cardiobacterium 
E - Eikenella 
K - Kingella
217
Q

What is the most common causative organism of infective endocarditis in the UK?

A

Staph. Aureus

218
Q

Suggest 7 potential causes of hypocalcaemia

A
  1. Vitamin D deficiency (osteomalacia)
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Pseudohypoparathyroidism
  5. Rhabdomyolysis
  6. Magnesium deficiency
  7. Massive blood transfusion
219
Q

Which nerve is most commonly damaged with an anterior hip dislocation?

A

Obturator nerve

220
Q

What is the motor supply of the femoral nerve?

A

Knee extension and thigh flexion

221
Q

What is the motor supply of the Obturator nerve?

A

Thigh adduction

222
Q

Foot drop is caused by injury to which nerve?

A

Common perineal nerve

223
Q

Injury to which nerve will result in a positive Trendelenburg sign?

A

Superior gluteal nerve

224
Q

What is Amaurosis fugax?

A

Painless temporary loss of vision in one or both eyes as a result of vascular ischaemia

225
Q

Give 3 potential causes of central retinal vein occlusion

A
  1. Glaucoma
  2. Polycythemia
  3. Hypertension
226
Q

Recall the classical triad of symptoms seen in patients with normal pressure hydrocephalus

A
  1. Urinary incontinence
  2. Dementia and bradyphrenia
  3. Gait abnormalities (similar to those seen in Parkinson’s disease)
227
Q

Why is Aspirin normally contra-indicated in children?

A

Risk of Reye’s syndrome - Can cause liver and brain damage

228
Q

What is an associated complication of Kawasaki disease?

A

Coronary artery aneurysm

229
Q

Give 5 risk factors for the development of pseudo-gout

A
  1. Haemochromotosis
  2. Hyperparathyroidism
  3. Acromegaly
  4. Low magnesium or low phosphate
  5. Wilson’s disease
230
Q

What is the most common causative organism of gastroenteritis in children?

A

Rotavirus

231
Q

Lung fibrosis caused by asbestos usually affects what area of the lungs?

A

Lower Zones

232
Q

Recall the acronym CHARTS for the causes of upper zone pulmonary fibrosis

A 
C - Coal worker's pneumoconiosis 
H - Histiocytosis/ Hypersensitivty pneuomonitis 
A - Ankylosing spondylitis 
R - Radiation 
T - Tuberculosis 
S - Sillicosis/ Sarcoidosis
233
Q

What is the pathophysiology of Perthe’s disease in children?

A

Avascular necrosis of the femoral head

234
Q

In what patient subgroup is pioglitazone contra-indicated in for the treatment of type 2 diabetes?

A

Those with heart failure

235
Q

Define Paget’s disease of the breast

A

Intraductal carcinoma associated with a reddening/ thickening of the aerola/ nipple

236
Q

Schistosomiasis infection is a risk factor for what type of bladder cancer?

A

Squamous cell carcinoma of the bladder

237
Q

Which form of the hepatitis virus may cause polyarteritis nodosa?

A

Hepatitis B

238
Q

Give 4 clinical uses of bisphosphonates?

A
  1. Prevention and treatment of osteoporosis
  2. Hypercalaemia
  3. Paget’s disease
  4. Pain from bony metastases
239
Q

Loss of vibration sense and proprioception with no motor deficits is characteristic of what form of spinal cord lesion?

A

Neurosyphilis

240
Q

Give 5 adverse effects associated with methotrexate

A
  1. Mucositis
  2. Myelosuppresion
  3. Pneumonitis
  4. Pulmonary fibrosis
  5. Liver fibrosis
241
Q

What is the most common form of leukaemia seen in adults?

A

CLL - Chronic lymphocytic leukaemia

242
Q

What are the 5 cardinal features of a myxeodemic coma?

A
  1. Hypothermia
  2. Hyporeflexia
  3. Bradycardia
  4. Peri-orbital oedema
  5. Seizures
243
Q

What is the gene defect associated with Wilson’s disease?

A

Defect in the ATP7B gene located on chromosome 13

244
Q

Name the copper chelator used in the treatment of Wilson’s disease

A

D - Penicillamine

245
Q

What is the most common autosomal recessive condition?

A

Haemochromatosis

246
Q

What are the 3 diagnostic components of a history of irritable bowel syndrome?

A
  1. Abdominal pain
  2. Bloating
  3. Change in bowel habits
247
Q

Outline the ROME criteria for the diagnosis of IBS

A

Recurrent abdominal pain/ discomfort at least 3 days per month in the last 3 months that is associated with 2 or more of the following:

  1. Improvement with defecation
  2. Onset associated with a change in stool frequency
  3. Onset associated with a change in form of stool
248
Q

A coeliac disease screen involves testing for levels of which biomarker?

A

Tissue transglutaminase antibodies

249
Q

Name 2 patient subgroups who exhibit an increased incidence of Whipple’s disease

A
  1. HLA-B27 positive patients

2. Middle aged men

250
Q

What is the causative organism of Whipple’s disease?

A

Tropheryma whippelii

251
Q

Define Zollinger- Ellison syndrome

A

Elevated gastrin levels due to a gastrin secreting tumour either of the duedenum or pancreas

252
Q

Name 3 conditions that have an association with Coeliac disease

A
  1. Dermatitis herpetiformis
  2. T1DM
  3. Autoimmune hepatitis
253
Q

Briefly outline the classical presentation of a case of primary billiard cirrhosis

A

Itching in a middle aged women with xanthelasma

254
Q

Name 3 conditions that have an association with primary sclerosing cholangitis

A
  1. Ulcerative colitis
  2. Crohn’s disease (less common)
  3. HIV
255
Q

What are the causes of acute pancreatitis

A
  1. Gallstones
  2. Ethanol
  3. Trauma
  4. Steroids
  5. Mumps
  6. Autoimmune
  7. Scorpion bites
  8. Hypertriglyceridepedemia, hypercalcaemia, hypothermia
  9. ERCP
  10. Drugs (azathioprine, bendroflumethiazide, furosemide, steroids, sodium valproate)
256
Q

Recall 5 clinical signs associated with decompensated liver disease

A
  1. Ascites
  2. Hepatic encephalopathy
  3. Prolonged clotting time
  4. Hypoalbuminaemia (which can manifest as leukonychia peripherally)
  5. Jaundice
257
Q

What are the 10 principle causes of chronic liver disease?

A
  1. Alcoholic liver disease
  2. Fatty liver disease
  3. Drugs (Gold, methotrexate, amiodarone)
  4. Hepatitis B and C
  5. Wilson’s disease
  6. Haemochromotosis
  7. Autoimmune hepatitis
  8. Alpha1 - antitrypsin deficiency
  9. Primary sclerosing cholangitis (associated with increased incidence of cholangiocarcinoma)
  10. Primary biliary cirrhosis (associated with increased incidence of hepatocellular carcinoma)
258
Q

What are the triad of symptoms associated with haemolytic uraemic syndrome?

A
  1. AKI
  2. Microangiopathic haemolytic anaemia
  3. Thrombocytopenia
259
Q

Suggest 4 complications that are associated with the mumps virus

A
  1. Orchitis
  2. Hearing loss
  3. Meningioencephalitis
  4. Pancreatitis
260
Q

What is the electrolyte disturbance that can be caused by a massive blood transfusion?

A

Hyperkalaemia

261
Q

What is the mechanism of action of bisphosphonates?

A

Pyrophosphate analogs which inhibit bone demineralisation by osteoclasts

262
Q

Suggest 4 indications for the prescription of spironolactone

A
  1. Ascites
  2. Heart failure
  3. Nephrotic syndrome
  4. Conn’s syndrome
263
Q

Why would patients with ascites secondary to liver cirrhosis be prescribed spironolactone?

A

Patients with cirrhosis develop a secondary hyperaldosteronism

264
Q

Which antibiotics should be used for the treatment of acute pyelonephritis?

A

Broad spectrum cephalosporin or quinolone

265
Q

Name the organism responsible for travellers diarrhoea

A

E.Coli

266
Q

Classify the organism Klebsiella Pneumoniae

A

Gram negative rod

267
Q

What is a common complication associated with Klebsiella Pneumonia?

A

Lung abscess and empyema

268
Q

Name a potential serious complication of Kawasaki disease

A

Coronary artery aneurysm

269
Q

Name 2 infectious diseases that will result in deranged LFTs

A
  1. Infective mononucleosis

2. Legionella pneumophilia

270
Q

What is the most common causative organism of an exacerbation of bronchiectasis?

A

Haemophilus Influenza

271
Q

Give 3 features which are associated with lithium toxicity

A
  1. Coarse tremor
  2. Hyperreflexia
  3. Confusion
272
Q

Describe the mechanism of action of omeprazole

A

Irreversible blockade of H+/K+ ATPase

273
Q

Give 4 adverse affects associated with the use of proton pump inhibitors

A
  1. Hyponatraemia and hypomagnesaemia
  2. Osteoporosis
  3. Microscopic colitis
  4. Increased risk of C.diff infection
274
Q

Name 4 associated features of appendicitis

A
  1. Fever
  2. Vomiting
  3. Anorexia
  4. Malaise
275
Q

What is Blumberg’s sign?

A

Rebound tenderness caused upon suddenly ceasing deep palpation of the RLQ

276
Q

What is the position of MCBurney’s point?

A

1/3 distance from anterior superior iliac spine to the umbilicus

277
Q

What is the ABCDE criteria for the examination of dermatoligical lesions

A 
A - Asymetry 
B - Border 
C - Colour 
D - Diameter > 6mm
E - Evolving
278
Q

Name two clinical features which can be associated with anorexia nervosa

A
  1. Lanugo body hair

2. Parotid gland swelling

279
Q

Recall the female athlete triad

A
  1. Menstrual dysfunction
  2. Energy deficit (with or without eating disorder)
  3. Reduced bone density
280
Q

Which vessel is most commonly affected in cases of malignant migratory thrombophlebitis?

A

Great saphenous vein

281
Q

What is the most common form of pancreatic carcinoma?

A

Ductal adenocarcinoma, frequently located in the pancreatic head

282
Q

Define Trousseau syndrome

A

Recurring superficial thrombophlebitis that is classically associated with pancreatic cancer

283
Q

Why is Carpel tunnel syndrome more common in pregnancy?

A

Hormone associated weight gain and peripheral oedema causes impingement of the median nerve

284
Q

Name the 3 thenar muscles

A
  1. Opponens Pollicis
  2. Abductor pollicis brevis
  3. Flexor pollicis brevis
285
Q

What is the innervation of the thenar muscles

A

Recurrent branch of the median nerve

286
Q

Name 3 medical syndromes that have an association with carpel tunnel syndrome

A
  1. Hypothyroidism
  2. Rheumatoid arthritis
  3. Acromegaly
287
Q

What is the first line pharmacological treatment for bulimia nervosa?

A

Fluoxetine

288
Q

Outline 3 potential side effects association with the use of Fluoxetine - particularly in young people

A
  1. Sexual dysfunction
  2. Serotonin syndrome
  3. Suicidal ideation
289
Q

What is the most common type of hip dislocation?

A

Posterior hip dislocation

290
Q

What is Dimercaprol?

A

A chelation therapy agent used in the treatment of heavy metal poisoning e.g. arsenic

291
Q

Name the 3 principle causes of palpable kidneys bilaterally

A
  1. Polycystic kidney disease
  2. Renal cell carcinoma
  3. Massive hydronephrosis
292
Q

What is the most common causative organism of bacterial vaginosis?

A

Gardnerella Vaginalis

293
Q

Name the drug used for the treatment of drug induced Parkinsonism

A

Procyclidine

294
Q

What are the 3 principle clinical features associated with Kawazaki disease?

A
  1. High fever lasting > 5 days
  2. Red palms with desquamation
  3. Strawberry tongue
295
Q

What form of malignancy has an association with SIADH?

A

Small cell lung cancer

296
Q

Which section of the bowel is most likely to be affected by ischaemic colitis?

A

Splenic flexure

297
Q

Suboccipital and postauricular lymphadenopathy is characteristic of which viral illness?

A

Rubella

298
Q

Give 2 causes of a late systolic murmur

A
  1. Mitral valve prolapse

2. Coarctation of the aorta

299
Q

Name 3 conditions that have an association with the antibody P-ANCA

A
  1. Ulcerative colitis
  2. Primary sclerosing cholangitis
  3. Churg-Strauss syndrome
300
Q

What is the diagnostic test for infective mononucleosis?

A

Heterophil antibody test (Monospot test)

301
Q

What are the 3 main characteristics of streptococcus pneumonia?

A
  1. High fever
  2. Rapid onset
  3. Herpes labialis
302
Q

Damage to which nerve causes a loss of the ability to plantar flex and invert the foot?

A

Tibial nerve

303
Q

Damage to the inferior gluteal nerve will result in what kind of presentation?

A

Impaired hip extension and lateral rotation. Difficulty rising from a seat and climbing stairs

304
Q

Name an osmotic diuretic

A

Mannitol

305
Q

Give 3 indications for the use of mannitol

A
  1. Cerebral oedema
  2. Rhabdomyolysis
  3. Haemolysis
306
Q

Name 4 clinical signs that are associated with iron deficiency anemia

A
  1. Pallor
  2. Koilonychia
  3. Angular cheilitis
  4. Atrophic glossitis
307
Q

Name 3 bleeding disorders that result in inhibited platelet adhesion and aggregation

A
  1. Glanzman’s thrombasthenia
  2. Von Willebrand disease
  3. Bernard- Soulier syndrome
308
Q

Give 4 risk factors for the development of Hodgkin’s lymphoma

A
  1. Male sex
  2. EBV infection
  3. Immunosuppression e.g. those with HIV
  4. Exotoxin exposure
309
Q

Suggest 5 possible differential diagnoses for osteoporosis

A
  1. Multiple myeloma
  2. Metastatic carcinoma
  3. Osteomalacia
  4. Hyperparathyroidism
  5. Steroid therapy or Cushing’s syndrome
310
Q

Name the most common opportunistic infection affecting the central nervous system in patients with AIDS

A

Toxoplasmosis

311
Q

Recall the classic triad of symptoms associated with Vitamin B12 deficiency

A
  1. Tiredness
  2. Glossitis
  3. Parasthesia
312
Q

Name 2 medical conditions that are associated with renal cell carcinoma

A
  1. Von Hippel-Lindau syndrome

2. Tubular sclerosis

313
Q

What is the most common causative organism of post-streptococcal glomerulonephritis?

A

Streptococcus pyogenes

314
Q

Which autoantibodies are associated with SLE?

A

Anti-dsDNA

315
Q

Which autoantibodies are associated with primary biliary sclerosis?

A

Anti-mitochondrial

316
Q

Which autoantibodies are associated with chronic active hepatitis?

A

ASMA - Anti-smooth muscle antibody

317
Q

Which autantibodies are associated with ulcerative colitis?

A

pANCA

318
Q

Which autoantibodies are associated with Wegener’s granulomatosis?

A

cANCA

319
Q

Which autoantibodies are associated with coeliac disease?

A

Anti endomysial/ gliadin/ transglutamase antibodies

320
Q

Which autoantibodies are associated with scleroderma?

A

Anti-centromere

321
Q

Which autoantibodies are associated with Sjogren syndrome?

A
  1. Anti- Ro

2. Anti- La

322
Q

Which autoantibodies are associated with polymyositis?

A

Anti-Jo

323
Q

Name 3 medical conditions in which rheumatoid factor antibodies may be found

A
  1. Rheumatoid arthritis
  2. Sjorgen’s syndrome
  3. SLE
324
Q

Define polymyositis

A

An inflammatory myopathy that predominantly affects the larger proximal muscle groups and the blood vessels that supply them.

325
Q

What is the treatment of choice for methotrexate toxicity?

A

Folinic acid

326
Q

Name the mutation found in around 50% of patients with essential thrombocytosis

A

JAK2 mutation

327
Q

Outline the 3 potential management options for essential thrombocytosis

A
  1. Hydroxyurea used to reduce the platelet count
  2. Interferon- alpha is also used in younger patients
  3. Low dose aspirin may be used to reduce thrombotic risk
328
Q

Suggest 5 potential infective causes of haemoptysis

A
  1. Pneumonia
  2. Bronchiectasis
  3. Fungal infection
  4. Lung abscess
  5. Tuberculosis
329
Q

Suggest 3 potential neoplastic causes of haemoptysis

A
  1. Primary lung cancer
  2. Lung metastases
  3. Bronchial adenoma
330
Q

Suggest 2 vascular causes of haemoptysis

A
  1. Pulmonary embolism

2. Pulmonary arteriovenous malformation

331
Q

Suggest 4 autoimmune causes of haemoptysis

A
  1. SLE
  2. Goodpasture syndrome
  3. Wegener’s granulomatosis
  4. Diffuse alveolar haemorrhage
332
Q

Define massive haemoptysis

A

Loss of at least 200mls of blood in 24hrs or 50mls per episode

333
Q

Whilst a patient is awaiting referral for symptomatic giant cell arteritis, what medications should be started? (3)

A
  1. 60mg prednisolone
  2. 75mg aspirin
  3. Omeprazole 20 mg (for gastric protection)
334
Q

What is the first line medication for cluster headache prophylaxis?

A

Verapamil

335
Q

What is the first line treatment for trigeminal neuralgia?

A

Carbamazepine 100mg twice daily

336
Q

Name 2 anti emetics

A
  1. Metoclopramide

2. Domperidone

337
Q

Why is a barium enema contraindicated in cases of acute colitis?

A

Risk of precipitating toxic mega colon

338
Q

What are CHRPE eye lesions and what hereditary condition are they associated with?

A

CHRPE = Congenital hypertrophy of the retinal pigment epithelium
Associated with FAP - Familial adenomatous polyposis

339
Q

Name 4 drugs associated with the development of gastric ulcers

A
  1. Alcohol
  2. NSAIDS
  3. Aspirin
  4. Corticosteriods
340
Q

Give 3 ‘high motility’ causes of diarrhoea

A
  1. IBD
  2. Hyperthyroidism
  3. Short gut syndrome
341
Q

What are the 6 main complications associated with coeliac disease?

A
  1. Malignancy (lymphoma or GI cancers)
  2. Stunting and weight loss
  3. Anemia
  4. Osteopenia (due to vitamin D deficiency)
  5. Neurological dysfunction
  6. Hyposplenism
342
Q

Name 3 medications that may irritate the gastric mucosa

A
  1. NSAIDS
  2. Bisphosphonates
  3. SSRIs
343
Q

Name 2 medications that may lead to relaxation of the lower oesophageal sphincter

A
  1. Calcium channel blockers

2. Nitrates

344
Q

Name the possible surgical intervention that may be used for the treatment of reflux oesophagitis

A

Nissen fundoplication

345
Q

Outline the components of H.Pylori eradication therapy

A

1 week:

  1. Omeprazole 20mg BD
  2. Clarithromycin 500mg BD
  3. Amoxicllin 1g BD (if allergic - metronidazole 500mg BD)
346
Q

What is the medication treatment for an uncomplicated peptic ulcer that is H.Pylori negative?

A

2 month course of omeprazole 20mg BD

347
Q

Name 2 acute causes of aortic regurgitation

A
  1. Aortic dissection

2. Infective endocarditis

348
Q

Name 2 conditions that can be associated with autoimmune aortitis

A
  1. Giant cell arteritis

2. Ankylosing spondylitis

349
Q

What is the most serious potential cause of a sinus bradycardia?

A

Cushing’s reflex - as a result of raised ICP

350
Q

Outline the mechanism of action of proton pump inhibitors

A

Irreversible blockade of the H+/K+/ATPase transporter of the gastric parietal cell

351
Q

Name a medication that may be used to control extra-pyramidal side effects of anti-psychotics

A

Procyclidine

352
Q

What are the 4 characteristic features of tetralogy of fallot?

A
  1. Ventricular septal defect
  2. Right ventricular hypertrophy
  3. Right ventricular outflow obstruction i.e. pulmonary stenosis
  4. Overriding aorta
353
Q

Delayed puberty is characteristically seen with which congenital abnormality?

A

Cystic fibrosis

354
Q

Lymphoedema in neonates is most commonly seen with which congenital abnormality?

A

Turner’s syndrome

355
Q

What is the mode of inheritance of Sickel Cell Anemia

A

Autosomal recessive

356
Q

U waves on ECG are a characteristic feature of which electrolyte imbalance?

A

Hypokalaemia

357
Q

Name 4 conditions associated with ANA antibodies

A
  1. SLE
  2. Sjorgen syndrome
  3. Diffuse cutaneous systemic sclerosis
  4. Limited cutaneous systemic sclerosis
358
Q

Which infection has an associated with the development of polyarteritis nodosa?

A

Hepatitis B

359
Q

Suggest 5 causes of hypocalcaemia

A
  1. Vitamin D deficiency
  2. Chronic kidney diseases
  3. Hypoparathyroidism
  4. Rhabdomyolysis
  5. Magnesium deficiency
360
Q

‘Drainpipe colon’ on AXR is indicative of what condition?

A

Ulcerative colitis

361
Q

Liver Cirrhosis most commonly causes what form of electrolyte imbalance?

A

Hyponatraemia

362
Q

Polycystic ovarian syndrome is a risk factor for what form of cancer?

A

Endometrial cancer

363
Q

What abnormalities are expected in a bone profile of a patient with Paget’s disease?

A

Raised ALP

364
Q

What 4 values make up a full bone profile?

A
  1. Calcium
  2. Phosphate
  3. ALP
  4. PTH
365
Q

What type of cancer is most associated with schistosomiasis?

A

Squamous cell carcinoma of the bladder

366
Q

A non pulsatile raised JVP is seen in which condition?

A

SVC obstruction

367
Q

What is Henoch-Schonlein purpura?

A

IgA mediated small vessel vasculitis

368
Q

What type of hernia is caused by a failure of the processes vaginalis to close?

A

Indirect inguinal hernia

369
Q

Briefly outline the action of metformin

A

Increases insulin sensitivity and decreases hepatic gluconeogenisis

370
Q

Suggest 2 examination findings on palpation that may be indicative of a pneumothorax

A
  1. Tracheal deviation

2. Subcutaneous emphysema

371
Q

Give 3 examination findings that may indicate a tension pneumothorax

A
  1. Hypoxia
  2. Hypotension
  3. Tracheal deviation
372
Q

Conservative management may be appropriate if a pneumothorax is under what size?

A

<2cm (must also be asymptomatic)

373
Q

Outline the 4 main features in a history that point towards interstitial lung disease

A
  1. Chronic dyspnoea
  2. Cough
  3. Haemoptysis
  4. May have a history of connective tissue disease
374
Q

Name 2 conditions that may induce a post renal AKI due to the development of a cast nephropathy

A
  1. Rhabdomyolysis

2. Tumour lysis syndrome

375
Q

Define Uhthoff’s phenomenon - in reference to multiple sclerosis

A

Worsening of vision following a rise in body temperature

376
Q

Name 3 medications that may cause a tremor

A
  1. Lithium
  2. Sodium valproate
  3. Ciclosporin
377
Q

Tonsillitis is associated with what type of lymphadenopathy

A

Upper anterior cervical chain

378
Q

Suggest 5 potential ocular manifestations of rheumatoid arthritis

A
  1. Keratoconjunctivitis Sicca (most common)
  2. Episcleritis
  3. Scleritis
  4. Corneal ulceration
  5. Keratitis
379
Q

Define portal hypertensive gastropathy

A

Visible changes to gastric mucosa as a result of long term portal hypertension

380
Q

Recall the 4 components to the evaluation of hyponatraemia in any patient

A
  1. Identification of onset (acute or chronic)
  2. Presence of symptoms (HA, nausea, confusion or seizures)
  3. Assessment of volume status (oedema, JVP distension, skin turgor and postural BP)
  4. Medical Hx (cardiac, renal and liver disease) as well as drug Hx
381
Q

Give 3 signs/ symptoms associated with a transfusion reaction

A
  1. Fever
  2. Dyspnea
  3. Rash
382
Q

What are the differentials for a transfusion reaction causing a fever?

A
  1. Acute haemolytic transfusion reaction
  2. Sepsis
  3. FNHTR - Febrile non haemolytic transfusion reaction
383
Q

What are the clinical features of TRALI (transfusion related acute lung injury)?

A
  1. Fever
  2. Hypoxia
  3. Infiltration on CXR
  4. Within 6hrs of transfusion
384
Q

What are the 3 components to the initial management of a patient with TRALI?

A
  1. Respiratory support
  2. Fluid resuscitation
  3. Vasopressors
385
Q

Which antibodies should be tested for in patients presenting with TRALI?

A
  1. Anti-neutrophil

2. Anti - HLA

386
Q

Give 3 CNS complications of malignant hypertension

A
  1. Ischaemic stroke
  2. Intracranial haemorrhage
  3. Hypertensive encephalopathy
387
Q

Suggest 4 causes of a low CSF opening pressure

A
  1. Trauma
  2. Instrumentation
  3. Acetazolamide
  4. Furosemide
388
Q

Suggest 2 inflammatory causes of a high CSF opening pressure

A
  1. Meningitis

2. GBS

389
Q

Xanthocromia on CSF sample is indicative of what?

A

SAH

390
Q

Give 2 medical causes of an elevated RBC cell in a CSF sample

A
  1. SAH

2. Herpes encephalitis

391
Q

Name the 3 most common causes of a transudative pleural effusion

A
  1. Congestive heart failure
  2. Cirrhosis
  3. Nephrotic syndrome
392
Q

Name the 4 most common causes of an exudative pleural effusion

A
  1. Pneumonia
  2. Malignancy
  3. Tuberculosis
  4. PE
393
Q

Recall Light’s criteria for the evaluation of pleural fluid

A
  1. Protein Pleural: serum ratio >0.5
  2. LDH Pleural:serum ratio >0.6
  3. Pleural LDH > 2/3 normal serum LDH

If any one of these criteria are met then the fluid is deemed to be exudative

394
Q

Outline the ‘SAAG’ investigation of ascites that is not thought to be of an infective origin

A

Subtract ascites albumin from same day serum albumin in order to narrow differentials.
>1.1 : Cirrhosis, Congestive heart failure, Portal vein thrombosis, Budd-Chiari syndrome, hepatic metastases
< 1.1 : Nephrotic syndrome, serositis

395
Q

Name 3 medications that can lead to drug induced Lupus

A
  1. Procainamide
  2. Hydralazine
  3. Isoniazid
396
Q

Which type of cancer is most associated with H.Pylori infection?

A

B cell lymphoma of MALT tissue

397
Q

Recall 5 potential causes of a normocytic anemia

A
  1. Anemia of chronic disease
  2. Chronic kidney disease
  3. Aplastic anemia
  4. Haemolytic anemia
  5. Acute blood loss
398
Q

Thyrotoxicosis most commonly causes what type of electrolyte abnormality?

A

Hypercalcemia

399
Q

What is the characteristic clinical feature of guttate psoriasis?

A

‘Tear drop’ papules on the trunk and limbs

400
Q

Name the antibody that has the greatest diagnostic accuracy for Sjorgen’s syndrome

A

Rheumatoid factor

401
Q

Which 2 conditions contribute to over 90% of cases of hypercalcaemia?

A
  1. Primary hyperparathyroidism

2. Malignancy

402
Q

Suggest 2 risk factors for squamous cell carcinoma of the bladder

A
  1. Smoking

2. Schistosomiasis

403
Q

Name a medication that is an identified risk factor for the development of transitional cell carcinoma of the bladder

A

Cyclophosphamide

404
Q

What are Triptans?

A

Specific 5-HT1B and 5-HT1D agonists used in the acute treatment of migraine

405
Q

What is the mechanism of action of bisphosphonates?

A

Pyrophosphate analog which inhibits osteoclast activity

406
Q

Recall 4 clinical indications for the prescription of bisphosphonates

A
  1. Prevention and/or treatment of osteoporosis
  2. Hypercalcemia
  3. Paget’s disease of bone
  4. Pain from bone metastases
407
Q

What is endometriosis?

A

Growth of ectopic endometrial tissue outside of the uterine cavity

408
Q

Define dyschezia

A

Painful bowel movements

409
Q

What is the gold standard investigation for endometriosis?

A

Laparoscopy

Clinical Medicine (8 decks)

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