Revision Flashcards
1
Q
What is the incubation period of hepatitis C?
A
6-9 weeks
2
Q
What 3 clinical symptoms can sometimes be seen in patients post exposure to hepatitis C
A
- Transient rise in serum aminotransferases/ jaundice
- Fatigue
- Arthralgia
3
Q
How can chronic hepatitis C be defined?
A
Persistence of HCV RNA in the bloodstream for 6 months
4
Q
Give 2 side effects associated with ribavirin
A
- Haemolytic anemia
2. Cough
5
Q
Give 5 side effects associated with interferon alpha
A
- Flu like symptoms
- Depression
- Fatigue
- Leukopenia
- Thrombocytopenia
6
Q
Suggest 6 potential causes of hypoadrenalism
A
- Addison’s disease
- TB
- Metastases (e.g. bronchial carcinoma)
- Meningococcal septicaemia (Waterhouse-Friderichsen syndrome)
- HIV
- Antiphospholipid syndrome
7
Q
Identify 2 at risk groups for the development of a subdural haematoma
A
- Elderly
2. Alcoholics
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.
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.
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
11
Q
Aortic regurgitation is associated with what type of murmur?
A
Early diastolic murmur that is high pitched and blowing in character.
12
Q
Anti TPO antibodies are present in ~ 90% patients with what form of thyroid disease?
A
Hashimoto’s thyroiditis
13
Q
TSH receptor antibodies are seen in 90-100% of patients with what form of thyroid disease?
A
Grave’s disease
14
Q
What adverse affect is linked with the use of carbimazole?
A
Agranulocytosis
15
Q
Uvula deviation is caused by a lesion to which cranial nerve? (2)
A
- Deviation towards the side of the lesion - CNXII
2. Deviation away from the side of the lesion - CNX
16
Q
Recall the 3 components of CNIII palsy
A
- Ptosis
- Eye down and out
- Dilated fixed pupil
17
Q
What type of diplopia is seen with a CNIV palsy?
A
Vertical diplopia
18
Q
What type of diplopia is seen with a CNVI palsy?
A
Horizontal diplopia
19
Q
Name the eye muscles that are inhibited with a CNIV and CNVI nerve palsy respectively
A
CNIV - Superior Oblique
CNVI - Lateral rectus
20
Q
What are the afferent and efferent components of the corneal reflex?
A
Afferent - CNV (Ophthalmic division)
Efferent - VII
21
Q
What are the afferent and efferent components of the jaw jerk reflex?
A
Afferent - CNV (Mandibular division)
Efferent - CNV (Mandibular division)
22
Q
What are the afferent and efferent components of the Gag reflex?
A
Afferent - CN IX
Efferent - CN X
23
Q
What are the afferent and efferent supplies to the carotid sinus?
A
Afferent - CN IX
Efferent - CN X
24
Q
What are the afferent and efferent components of the pupillary light reflex?
A
Afferent - CN II
Efferent - CN III
25
What are the afferent and efferent components of the lacrimation reflex?
Afferent - CN V (Ophthalmic division)
| Efferent - CN VII
26
Suggest 3 vascular causes of an acute abdomen
1. Ruptured abdominal aortic aneurysm
2. Mesenteric ischaemia
3. MI
27
Suggest 2 inflammatory causes of an acute abdomen
1. Pancreatitis
| 2. Peptic ulcer disease
28
Recall 9 potential infective causes of acute abdominal pain
1. Gastroenteritis
2. Appendicitis
3. Diverticulitis
4. Pyelonephritis
5. Cholecystitis
6. Cholangitis
7. Pelvic inflammatory disease
8. Hepatitis
9. Pneumonia
29
Give 6 possible complications of hepatitis B infection
1. Chronic hepatitis
2. Fulminant liver failure
3. Hepatocellular carcinoma
4. Glomerulonephritis
5. Polyarteritis Nodosa
6. Cryoglobulinemia
30
Suggest 6 causes of a respiratory acidosis
1. COPD
2. Opiod Overdose
3. Decompensated life threatening asthma
4. Neuromuscular disease
5. Obesity hypoventilation syndrome
6. Benzodiazapine overdose
31
Suggest 6 causes of respiratory alkalosis
1. PE
2. Anxiety leading to hyperventilation
3. CNS disorders e.g. stroke, sub arach or encephalitis
4. Altitude
5. Pregnancy
6. Salicylate poisoning
32
Name 3 conditions that have been associated with primary sclerosing cholangitis
1. Ulcerative Colitis
2. Crohn's disease
3. HIV
33
What is primary sclerosing cholangitis?
Biliary disease of unknown aetiology characterised by inflammation and fibrosis of both intra and extra hepatic bile ducts
34
Give 2 complications associated with primary sclerosing cholangitis
1. Cholangiocarcinoma
| 2. Increased risk of colorectal cancer
35
Name the organism most likely to cause pneumonia following an infection of influenza
Staphylococcus aureus
36
Name the condition associated with respiratory syncytial virus
Bronchiolitis
37
Name the condition associated with Parainfluenza virus
Croup
38
What is the most common causative organism of community acquired pneumonia?
Strep Pneumonia
39
What is the most common causative organism of an exacerbation of bronchiectasis
Haemophilus Influenza
40
Name an organism that commonly causes pneumonia in patients with HIV
Pneumocystis Jiroveci
41
Recall 2 complications associated with infection by the organism: Mycoplasma Pneumonia
1. Haemolytic anemia
| 2. Erythema multiforme
42
What are the 4 main clinical symptoms seen in patients presenting with ulcerative colitis?
1. Bloody diarrhoea
2. Urgency
3. Tenesmus
4. Abdominal pain
43
What are the characteristic features of a history of myoclonic seizure?
Loss of consciousness followed by rapids jerks of facial muscles and limbs.
44
What are the 5 components of life threatening asthma?
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
45
What is the key diagnostic result in the investigation of toxic multi nodular goitre?
Nuclear scintigraphy shows an enlarged thyroid gland with 'patchy' uptake.
46
What is the most common cause of an infective exacerbation of COPD?
Haemophilus Influenza
47
'Cobble stone appearance' on endoscopy is associated with which form of inflammatory bowel disease?
Crohn's disease
48
What is the first line treatment for a new diagnosis of COPD?
SABA or SAMA
49
Suggest 3 interventions which may improve survival in patients with stable COPD
1. Smoking cessation
2. Long term oxygen therapy in patient who fit the criteria
3. Lung volume reduction surgery in selected patients
50
What is the normal pressure range for the pulmonary circulation?
10-14 mmHg
51
Loss of haustrations seen on a barium enema is indicative of which condition?
Ulcerative colitis
52
Which arteries are involved in a total anterior circulation infarct?
Anterior and middle cerebellar arteries
53
Which arteries are involved in a lacunar infarct?
Perforating arteries around the internal capsule, thalamus and basal ganglia
54
Which arteries are involved in a posterior circulation infarct?
Vertebrobasilar arteries
55
What are the 3 possible presentations of a lacunar infarct?
1. Unilateral weakness (and/or sensory deficit)
2. Pure sensory stroke
3. Ataxic hemiparesis
56
What are the 3 possible presentation of a posterior circulation infarct?
1. Cerebellar or brainstem syndromes
2. Loss of consciousness
3. Isolated homonymous hemianopia
57
Name the 3 most common organisms implicated in acute food poisoning
1. Staph Aureus
2. Bacillus cereus
3. Clostridium Perfringens
58
Name 3 drugs that have an adverse effect of increasing the incidence of Gout
1. Loop diuretics
2. Thiazides
3 Pyrazinamide
59
Name 2 drugs that can cause depression as an adverse effect
1. Steroids
| 2. Isotretinoin
60
Name 3 drugs that can cause photosensitivity as an adverse effect
1. Tetracyclines
2. Amiodarone
3. Isotretinoin
61
Name 3 drugs that can result in lengthening of the QT interval
1. Ciprofloxacin
2. Antipsychotics
3. Amiodarone
62
Recall 4 indications for the use of tetracylines
1. Acne vulgaris
2. Lyme disease
3. Chlamydia
4. Mycoplasma pneumonia
63
Recall the classical triad of symptoms seen in patients with infective mononucleosis
1. Sore throat
2. Lymphadenopathy
3. Pyrexia
64
List 5 side effects associated with beta-blockers
1. Bronchospasm
2. Cold peripheries
3. Fatigue
4. Sleep disturbance
5. Erectile dysfunction
65
Give 4 contra-indication for the use of beta blockers
1. Uncontrolled heart failure
2. Asthma
3. Sick sinus syndrome
4. Concurrent Verapamil use
66
Name 4 drugs that can cause pulmonary fibrosis
1. Methotrexate
2. Nitrofurantoin
3. Amiodarone
4. Sulphasalazine
67
Classify amiodarone as an anti arrhythmic agent
Class III
68
Why should amiodarone only be given into a central vein?
Risk of thrombophlebitis
69
What are the 3 main characteristics of subacute combined degeneration of the spinal cord?
1. Bilateral spastic paresis
2. Loss of proprioception and vibration sense
3. Limb ataxia
70
Give 6 potential differentials for stridor and inspiratory wheeze
1. Epiglottitis
2. Croup
3. Inhaled foreign body
4. Rapidly progressing laryngomalacia
5. Laryngeal papillomas
6. Anaphylaxis causing laryngeal oedema
71
Metabolic differentials for vomiting and abdominal pain in the absence of food poisoning or fever (6)
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
72
Give 4 potential causes of prehepatic jaundice as a result of haemolysis
1. Hereditary haemolytic anemia
2. Acquired haemolytic anemia
3. Septicaemic haemolysis
4. Malaria
73
Name 2 congenital enzyme defects that can lead to hepatic jaundice
1. Gilbert's syndrome
| 2. Crigler - Najjar syndrome
74
What are the 4 main differentials for acute central abdominal pain?
1. Small bowel obstruction
2. Abdominal aortic dissection
3. Crohn's disease
4. Mesenteric artery occlusion
75
What are the 4 differentials to consider in patients presenting with tenesmus?
1. Rectal inflammation
2. Rectal tumour
3. Tumour of descending colon
4. Pelvic inflammatory disease
76
Name 2 connective tissue disorders linked with an increased incidence of aortic dissection
1. Marfan syndrome
| 2. Ehler's- Danlos syndrome
77
Name a vascular disorder that is associated with aortic dissection
Bicuspid aortic valve (congenital abnormality)
78
What is the definition of 'massive haemoptysis'?
> 400 ml over 3 hours or > 600 mms over 24 hours
79
Suggest 6 potential causes of massive haemoptysis
1. Bronchiectasis
2. Bronchial carcinoma
3. TB
4. Lung abscess
5. Aspergilloma
80
Suggest 4 types of systemic vasculitis which may cause haemoptysis
1. SLE
2. Wegner's
3. Goodpasture's
4. Microscopic polyangiitis
81
Outline the main complications associated with DKA (6)
1. Hypokalaemia
2. Hypophosphatemia
3. Hypercholeraemic acidosis
4. Hypoglycaemia
5. Cerebral oedema in children
6. Thromboembolism
82
Name a neurological complication severe vitamin B12 deficiency
Subacute combined degeneration of the spinal cord
83
Give 3 cardiac causes of ascites
1. Cardiac failure
2. Constrictive pericarditis
3. Tricuspid incompetence
84
Suggest 4 potential causes of acute onset ascites
1. Acute decompensation of liver cirrhosis
2. Malignancy
3. Portal or splenic vein thrombosis
4. Budd - Chiari syndrome
85
What is the classic triad of symptoms associated with Budd-Chiari syndrome?
1. Abdominal pain
2. Ascites
3. Liver enlargement
86
What is Kussmaul's sign + suggest 2 conditions that may cause this sign.
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
87
What is the mechanism of action of dipyramidole?
Phosphodiesterase inhibitor
88
Classify the drug dipyramidole
Anti-platelet
89
Give 2 congenital causes of prolonged QTC interval
1. Jervell- Lange- Nielsen syndrome
| 2. Romano-Ward syndrome
90
Suggest 3 drugs that can cause a prolonged QTC interval
1. Amiodarone
2. Sotalol
3. Tricyclic antidepressants
91
Name 2 conditions that can be linked with coeliac disease
1. Dermatitis herpetiformis
| 2. Autoimmune conditions (e.g. DMT1 or autoimmune hepatitis)
92
Name 3 conditions that can cause hypernatremia
1. Diabetes insipidus
2. Dehydration
3. Hyperosmolar non- ketotic diabetic coma
93
Name 6 drug types that can lead to impaired glucose tolerance
1. Thiazide diuretics
2. Steroids
3. Tacrolimus, ciclosporin
4. Interferon alpha
5. Nicotinic acid
6. Antipsychotics
94
What is the most common electrolyte imbalance caused by the use of ACE inhibitors?
Hyperkalemia
95
What are the 3 classical features of a hepatitis B infection?
1. Fever
2. Jaundice
3. Raised liver transaminases
96
Name 6 complications associated with a hepatitis B infection
1. Chronic hepatitis
2. Fulminant liver failure
3. Hepatocellular carcinoma
4. Glomerulonephritis
5. polyarteritis nodosa
6. Cryoglobulinaemia
97
What is Courvoisier Sign?
A palpable mass in the right upper quadrant
98
Define Sister Mary Joseph Nodes
Periumbilical lymphadenopathy
99
What is the most common electrolyte imbalance associated with acute renal failure?
Hyperkalemia
100
What is the first line acute treatment for migraine?
Triptan + NSAID or Triptan + Paracetamol
101
Name a patient subgroup for which Topiramate is contra-indicated
Women of child bearing age - potentially teratogenic and can reduce the effectiveness of the oral contraceptive pill.
102
The monoclonal antibody CA 125 is associated with which type of tumour?
Ovarian cancer
103
The monoclonal antibody CA 19-9 is associated with which type of tumour?
Pancreatic cancer
104
The monoclonal antibody CA15-3 is associated with which type of tumour?
Breast cancer
105
The tumour antigen AFP (alpha-feto protein) is associated with which type of tumour?
Hepatocellular carcinoma
106
The tumour antigen CEA (carcinoembryonic antigen) is associated with which type of tumour?
Colorectal cancer
107
The tumour antigen S-100 is associated with which type of tumour?
Melanoma or Schwannomas
108
The tumour antigen Bombesin is associated with which type of tumour?
1. Small cell lung carcinoma
2. Gastric cancer
3. Neuroblastoma
109
Name the most common type of cardiomyopathy
Dilated cardiomyopathy
110
Name an inherited syndrome that will increased an individuals risk of developing dilated cardiomyopathy
Duchenne muscular dystrophy
111
Recall the classical triad of symptoms seen in patients with normal pressure hydrocephalus
1. Urinary incontinence
2. Dementia and bradyphrenia
3. Gait abnormalities (may be similar to Parkinson's disease)
112
What is the most common causative agent of an exacerbation of bronchiectasis?
Haemophilus Influenza
113
Severe hypokalaemia can lead to what form of acid base disturbance?
Metabolic alkalosis
114
What is the mechanism of action of Warfarin?
Inhibits carboxylation of clotting factors II, VII, IX and X
115
Outline the nerves that supply taste sensation to the tongue.
1. Anterior 2/3 innervated by CN VII
| 2. Posterior 1/3 innervated by CN IX
116
What is the most common cause of primary hyperaldosteronism?
Bilateral idiopathic adrenal hyperplasia
117
What are the 3 classical features of primary hyperaldosteronism?
1. Hypotension
2. Hypokalaemia (often seen clinically as muscle weakness)
3. Alkalosis
118
What is the first line investigation for primary hyperaldosteronism?
Plasma renin/aldosterone ratio
119
Outline 4 complications associated with chronic lymphocytic leukaemia
1. Anemia
2. Hypogammaglobulinaemia (leading to recurrent infections)
3. Warm autoimmune haemolytic anemia
4. Richter's transformation
120
Name 4 drugs that can cause pancreatitis as an adverse drug effect
1. Corticosteroids
2. Thiazides
3. Sodium valproate
4. Azathioprine
121
What is the first line treatment for focal seizures?
Carbamazepine
122
Name 4 drugs that can cause pulmonary fibrosis
1. Amiodarone
2. Methotrexate
3. Sulphalazine
4. Nitrofurantoin
123
Suggest 3 potential causes of a third heart sound
1. Dilated cardiomyopathy
2. Constrictive pericarditis
3. Mitral regurgitation
124
Suggest 2 potential causes of peaked T waves
1. Hyperkalemia
| 2. Myocardial ischaemia
125
Recall the 6 potential causes of inverted T waves
1. Myocardial ischaemia
2. Digoxin toxicity
3. Subarachnoid haemorrhage
4. Arrythmogenic right ventricular cardiomyopathy
5. Pulmonary embolism
6. Brugada syndrome
126
If a patient has a superior homonymous quadrantanopia, where is the lesion most likely to be?
Temporal lobe
127
If a patient has an inferior homonymous quadrantanopia, where is the lesion most likely to be?
Parietal lobe
128
Suggest 2 conditions in which pulses paradoxus may occur
1. Severe asthma
| 2. Cardiac tamponade
129
Name 5 drugs that can cause peripheral neuropathy as an adverse side effect
1. Amiodarone
2. Metronidazole
3. Nitrofurantoin
4. Isoniazid
5. Phenytoin
130
What is Berger's disease?
IgA nephropathy - the most common cause of glomerulonephritis worldwide
131
What is the classical presentation of IgA nephropathy?
Macroscopic haematuria in a young person following an upper respiratory tract infection
132
Name 3 conditions associated with IgA nephropathy
1. Alcoholic cirrhosis
2. Coeliac disease
3. Henoch- Schonlein Purpura
133
What is the most common causative organism of acute epiglottitis?
Haemophilus Influenza
134
What is the first line treatment for trigeminal neuralgia?
Carbamazepine
135
What is the typical location of pain associated with renal colic?
Loin pain radiating to the groin
136
Name 4 causes of target cells seen on blood cell microscopy
1. Sickle cell or thalassemia
2. Iron-Deficiency anemia
3. Hyposplenism
4. Liver disease
137
What is the first line treatment for absence seizures?
Sodium Valproate or Ethosuximide
138
What are the 3 predominant causes of hypernatraemia?
1. Diabetes insipidus
2. Dehydration
3. Hyperosmolar non-ketotic diabetic coma
139
Outline 4 characteristics of Gerstmann's syndrome
1. Alexia
2. Acalculia
3. Finger agnosia
4. Right-left disorientation
140
Name 4 clinical features of parietal lobe lesions
1. Sensory inattention
2. Apraxia
3. Astereognosis
4. Inferior Homonymous quadrantanopia
141
Give 3 clinical characteristics of an occipital lobe lesion
1. Homonymous hemianopia with macula sparing
2. Cortical blindness
3. Visual agnosia
142
Broca's aphasia is associated with a lesion in what area of the brain?
Frontal lobe
143
Wernicke's aphasia is associated with a lesion in what area of the brain?
Temporal lobe
144
Which brain areas are implicated in Wernicke-Korsakoff syndrome?
Medial thalamus and mammillary bodies of the hypothalamus
145
Which brain areas are implicated in Hemiballismus?
Subthalamic nucleus of the basal ganglia
146
Which brain areas are implicated in Huntington's chorea?
Striatum (caudate nucleus) of the basal ganglia
147
Which brain areas are implicated in Parkinson's disease?
Substantia nigra of the basal ganglia
148
Which brain areas are implicated in Kluver-Bucy syndrome?
Amygdala
149
What type of cancer is most closely associated with EBV?
Hodgkin's lymphoma
150
What is ciclosporin?
Immunosuppresant which decreases clonal proliferation of T cells by reducing IL-2 release
151
What is the most characteristic electrolyte imbalance associated with dehydration?
Hypercalcaemia
152
What area of the brain is most common affected by herpes simplex encephalitis?
Temporal lobes
153
Name 2 drugs that can cause gynaecomastia in men
1. Digoxin
| 2. Spironolactone
154
Give 2 characteristic features of a lesion in CNVIII
1. Nystagmus
| 2. Vertigo
155
What is the treatment for a heparin overdose?
Protamine sulphate
156
Name 2 lipophilic statins
1. Simvastatin
| 2. Atorvostatin
157
Name 3 hydrophilic statins
1. Rosuvastatin
2. Pravastatin
3. Fluvastatin
158
What is the mechanism of action of adenosine?
Agonist of the A1 receptor in the AV node
159
What organism causes rubella?
Togavirus
160
Outline the characteristic lymphadenopathy seen with a rubella infection
Suboccipital and post-auricular
161
Give 4 complications associated with Rubella Infection
1. Arthritis
2. Thrombocytopenia
3. Encephalitis
4. Myocarditis
162
What is the mechanism of action of allopurinol?
Xanthine oxidase inhibitor
163
Name the 3 main drugs that are known to interact with allopurinol
1. Azathioprine
2. Cyclophosphamide
3. Theophylline
164
Mutations of which gene are associated with haemochromatosis?
HFE gene on chromosome 6
165
Recall all gram positive rod bacteria using the mnemonic ABCD L
A - Actinomyces
B - Bacillus anthrax
C - Clostridium
D - Diphtheria
L - Listeria Monocytogenes
166
Name the 3 gram negative cocci
1. Neisseria Meningitidis
2. Neisseria gonorrhea
3. Moraxella Catarrhalis
167
What are the 4 main causes of LBBB?
1. Ischaemic heart disease
2. Hypertension
3. Aortic stenosis
4. Cardiomyopathy
168
List 5 causes of a normocytic anemia
1. Anemia of chronic disease
2. Chronic kidney disease
3. Aplastic anemia
4. Haemolytic anemia
5. Acute blood loss
169
Name the antibody most closely associated with coeliac disease
Anti-tissue transglutaminase antibody
170
What are the 2 main clinical components of Goodpastures syndrome?
1. Pulmonary haemorrhage
| 2. Rapidly progressive glomerulonephritis
171
What are the 4 main differentials for hypertension with a low potassium level?
1. Conn's syndrome
2. Cushing's syndrome
3. Renal artery stenosis
4. Liddle's syndrome
172
Suggest 4 causes of an transudate pleural effusion
1. Congestive cardiac failure
2. Liver Cirrhosis
3. Nephrotic syndrome
4. SVC obstruction
173
What is the mechanism of action of ciclosporin?
Immunosuppressant which decreases clonal proliferation of T cells by reducing IL-2 release
174
Recall the components of a bifascicular block seen on ECG
1. RBBB
| 2. Left axis deviation
175
What is the age range with peak incidence of myeloma?
Between 60-70 years
176
Suggest 3 potential complications of pelvic inflammatory disease
1. Infertility
2. Chronic pelvic pain
3. Ectopic pregnancy
177
What is the causative organism of hand, foot and mouth disease?
Coxsackie A16 virus
178
Give 3 risk factors for subdural haematoma
1. Alcoholism
2. Old age
3. Antocoagulation
179
Name 2 NSAIDS that have been linked to an increased incidence of cardiovascular events
1. Ibuprofen
| 2. Diclofenac
180
Name an Xray finding that is associated with osteoarthritis
Subchondral Cysts
181
Outline 5 'medical' (non-abdominal) causes of abdominal pain
1. MI
2. DKA
3. Pneumonia
4. Acute intermittent porphyria
5. Lead poisoning
182
What is the most common causative agent of bronchiolitis?
Respiratory syncytial virus
183
Suggest 5 medications which may trigger anxiety
1. Salbutamol
2. Theophylline
3. Corticosteriods
4. Antidepressants
5. Caffeine
184
Briefly outline the mechanism of action of benzodiazepines
They enhance the effect of GABA signalling by up regulating the expression of chlorine ion channels.
185
Give 4 examples of extra-pyramidal side effects that can be caused by anti-psychotic medications
1. Parkinsonisms
2. Acute dystonia
3. Akathisia (severe restlessness)
4. Tardive dyskinesia
186
Name a drug that can be used to managed extra-pyramidal side effects of drugs
Procyclidine
187
Define vital capacity
Maximum volume of air that can be expired following a maximal inspiration
188
Give 3 predisposing factors for acute angel glaucoma
1. Hypermetropia
2. Pupillary dilatation
3. Lens growth associated with age
189
Burns must cover what % of total body surface area before IV fluids must be administered for resuscitation (values for adults and children)
Adults - greater than 15% of total body surface area
| Children - greater than 10%
190
Recall the Parkland formula used to calculate volume of IV fluid given for resuscitation following a burn injury
Volume of fluid = total body surface area percentage * weight (kg) * 4
191
Define a fistula
An abnormal connection between two epithelial surfaces
192
Name a strong topical steroid medication
Clobetasol propionate
193
What is the identified long term risk with Lichen sclerosus?
Increased risk of vulval cancer
194
What is Lichen Sclerosus?
Inflammatory condition that usually affects the genitalia - leads to atrophy of the epidermis and white plaque formation
195
What are the 3 characteristic symptoms of diverticular disease?
1. Altered bowel habits
2. Bleeding
3. Abdominal Pain
196
What are the 4 characteristic features of pneumococcal pneumonia?
1. Rapid onset
2. High Fever
3. Pleuritic chest pain
4. Herpes Labialis
197
What are the 4 adverse signs with regards to peri-arrest arrhythmias?
1. Shock (systolic BP <90)
2. Syncope
3. Myocardial ischaemia
4. Heart failure
198
When would IV amiodarone be the indicated treatment for VT?
Only if the patient shows no peri-arrest adverse signs
199
What is the most common presentation of IgA nephropathy?
Macroscopic haematuria in young people following an upper respiratory tract infection
200
What is the key difference in presentation between IgA nephropathy and post-streptococcal glomerulonephritis?
Post- streptococcal glomerulonephritis presents with proteinuria, which is rare in IgA nephropathy
201
What is the inheritance pattern of MODY?
Autosomal dominant
202
What are the gene defects found in MODY 2,3 and 5 respectively?
MODY 2 - Defect in glucokinase gene
MODY 3 - Defect in HNF-1 alpha gene
MODY 5 - Defect in HNF-1 beta gene
203
What is the most common cause of secondary hypertension?
Conns syndrome
204
Name 4 types of renal disease which may cause secondary hypertension
1. Glomerulonephritis
2. Pylonephritis
3. Adult polycystic kidney disease
4. Renal artery stenosis
205
Suggest 5 potential drug causes of secondary hypertension
1. Steroids
2. Monoamine oxidase inhibitors
3. The combined oral contraceptive pill
4. NSAIDS
5. Leflunomide
206
What is Leflunomide?
An immune-suppresive disease modifying anti-rheumatic drug
207
What is the mechanism of action of Leflunomide?
Pyrimidine synthesis inhibitor
208
What are the typical abnormal blood results seen in patients with neuroleptic malignant syndrome?
Raised creatine kinase and white cell count often accompanied by hyperkalemia as a result of muscle damage
209
What is the mechanism of action of sulphonylureas drugs?
Increase pancreatic insulin secretion
210
What is the mode of inheritance of haemophilia A and B?
X- linked recessive
211
What is the most common congenital infection seen in the UK?
Cytomegalovirus
212
What are the 3 major congenital infections encountered on examinations?
1. Rubella
2. Toxoplasmosis
3. Cytomegalovirus
213
What are the 4 characteristic features of congenital rubella syndrome?
1. Sensorineural deafness
2. Congenital cataracts
3. Congenital heart disease (e.g. patent ductus arteriosus)
4. Glaucoma
214
What are the 3 main characteristic features of congenital toxoplasmosis infection?
1. Cerebral calcification
2. Chorioretinitis
3. Hydrocephalus
215
What are the 2 characteristic features of congenital cytomegalovirus infection?
1. Growth retardation
| 2. Purpuric skin lesions
216
Recall the organisms of the HACEK mneuomonic that make up the possible culture negative infective organisms
```
H - Haemophilus
A - Actionbacillus
C - Cardiobacterium
E - Eikenella
K - Kingella
```
217
What is the most common causative organism of infective endocarditis in the UK?
Staph. Aureus
218
Suggest 7 potential causes of hypocalcaemia
1. Vitamin D deficiency (osteomalacia)
2. Chronic kidney disease
3. Hypoparathyroidism
4. Pseudohypoparathyroidism
5. Rhabdomyolysis
6. Magnesium deficiency
7. Massive blood transfusion
219
Which nerve is most commonly damaged with an anterior hip dislocation?
Obturator nerve
220
What is the motor supply of the femoral nerve?
Knee extension and thigh flexion
221
What is the motor supply of the Obturator nerve?
Thigh adduction
222
Foot drop is caused by injury to which nerve?
Common perineal nerve
223
Injury to which nerve will result in a positive Trendelenburg sign?
Superior gluteal nerve
224
What is Amaurosis fugax?
Painless temporary loss of vision in one or both eyes as a result of vascular ischaemia
225
Give 3 potential causes of central retinal vein occlusion
1. Glaucoma
2. Polycythemia
3. Hypertension
226
Recall the classical triad of symptoms seen in patients with normal pressure hydrocephalus
1. Urinary incontinence
2. Dementia and bradyphrenia
3. Gait abnormalities (similar to those seen in Parkinson's disease)
227
Why is Aspirin normally contra-indicated in children?
Risk of Reye's syndrome - Can cause liver and brain damage
228
What is an associated complication of Kawasaki disease?
Coronary artery aneurysm
229
Give 5 risk factors for the development of pseudo-gout
1. Haemochromotosis
2. Hyperparathyroidism
3. Acromegaly
4. Low magnesium or low phosphate
5. Wilson's disease
230
What is the most common causative organism of gastroenteritis in children?
Rotavirus
231
Lung fibrosis caused by asbestos usually affects what area of the lungs?
Lower Zones
232
Recall the acronym CHARTS for the causes of upper zone pulmonary fibrosis
```
C - Coal worker's pneumoconiosis
H - Histiocytosis/ Hypersensitivty pneuomonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Sillicosis/ Sarcoidosis
```
233
What is the pathophysiology of Perthe's disease in children?
Avascular necrosis of the femoral head
234
In what patient subgroup is pioglitazone contra-indicated in for the treatment of type 2 diabetes?
Those with heart failure
235
Define Paget's disease of the breast
Intraductal carcinoma associated with a reddening/ thickening of the aerola/ nipple
236
Schistosomiasis infection is a risk factor for what type of bladder cancer?
Squamous cell carcinoma of the bladder
237
Which form of the hepatitis virus may cause polyarteritis nodosa?
Hepatitis B
238
Give 4 clinical uses of bisphosphonates?
1. Prevention and treatment of osteoporosis
2. Hypercalaemia
3. Paget's disease
4. Pain from bony metastases
239
Loss of vibration sense and proprioception with no motor deficits is characteristic of what form of spinal cord lesion?
Neurosyphilis
240
Give 5 adverse effects associated with methotrexate
1. Mucositis
2. Myelosuppresion
3. Pneumonitis
4. Pulmonary fibrosis
5. Liver fibrosis
241
What is the most common form of leukaemia seen in adults?
CLL - Chronic lymphocytic leukaemia
242
What are the 5 cardinal features of a myxeodemic coma?
1. Hypothermia
2. Hyporeflexia
3. Bradycardia
4. Peri-orbital oedema
5. Seizures
243
What is the gene defect associated with Wilson's disease?
Defect in the ATP7B gene located on chromosome 13
244
Name the copper chelator used in the treatment of Wilson's disease
D - Penicillamine
245
What is the most common autosomal recessive condition?
Haemochromatosis
246
What are the 3 diagnostic components of a history of irritable bowel syndrome?
1. Abdominal pain
2. Bloating
3. Change in bowel habits
247
Outline the ROME criteria for the diagnosis of IBS
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
A coeliac disease screen involves testing for levels of which biomarker?
Tissue transglutaminase antibodies
249
Name 2 patient subgroups who exhibit an increased incidence of Whipple's disease
1. HLA-B27 positive patients
| 2. Middle aged men
250
What is the causative organism of Whipple's disease?
Tropheryma whippelii
251
Define Zollinger- Ellison syndrome
Elevated gastrin levels due to a gastrin secreting tumour either of the duedenum or pancreas
252
Name 3 conditions that have an association with Coeliac disease
1. Dermatitis herpetiformis
2. T1DM
3. Autoimmune hepatitis
253
Briefly outline the classical presentation of a case of primary billiard cirrhosis
Itching in a middle aged women with xanthelasma
254
Name 3 conditions that have an association with primary sclerosing cholangitis
1. Ulcerative colitis
2. Crohn's disease (less common)
3. HIV
255
What are the causes of acute pancreatitis
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
Recall 5 clinical signs associated with decompensated liver disease
1. Ascites
2. Hepatic encephalopathy
3. Prolonged clotting time
4. Hypoalbuminaemia (which can manifest as leukonychia peripherally)
5. Jaundice
257
What are the 10 principle causes of chronic liver disease?
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
What are the triad of symptoms associated with haemolytic uraemic syndrome?
1. AKI
2. Microangiopathic haemolytic anaemia
3. Thrombocytopenia
259
Suggest 4 complications that are associated with the mumps virus
1. Orchitis
2. Hearing loss
3. Meningioencephalitis
4. Pancreatitis
260
What is the electrolyte disturbance that can be caused by a massive blood transfusion?
Hyperkalaemia
261
What is the mechanism of action of bisphosphonates?
Pyrophosphate analogs which inhibit bone demineralisation by osteoclasts
262
Suggest 4 indications for the prescription of spironolactone
1. Ascites
2. Heart failure
3. Nephrotic syndrome
4. Conn's syndrome
263
Why would patients with ascites secondary to liver cirrhosis be prescribed spironolactone?
Patients with cirrhosis develop a secondary hyperaldosteronism
264
Which antibiotics should be used for the treatment of acute pyelonephritis?
Broad spectrum cephalosporin or quinolone
265
Name the organism responsible for travellers diarrhoea
E.Coli
266
Classify the organism Klebsiella Pneumoniae
Gram negative rod
267
What is a common complication associated with Klebsiella Pneumonia?
Lung abscess and empyema
268
Name a potential serious complication of Kawasaki disease
Coronary artery aneurysm
269
Name 2 infectious diseases that will result in deranged LFTs
1. Infective mononucleosis
| 2. Legionella pneumophilia
270
What is the most common causative organism of an exacerbation of bronchiectasis?
Haemophilus Influenza
271
Give 3 features which are associated with lithium toxicity
1. Coarse tremor
2. Hyperreflexia
3. Confusion
272
Describe the mechanism of action of omeprazole
Irreversible blockade of H+/K+ ATPase
273
Give 4 adverse affects associated with the use of proton pump inhibitors
1. Hyponatraemia and hypomagnesaemia
2. Osteoporosis
3. Microscopic colitis
4. Increased risk of C.diff infection
274
Name 4 associated features of appendicitis
1. Fever
2. Vomiting
3. Anorexia
4. Malaise
275
What is Blumberg's sign?
Rebound tenderness caused upon suddenly ceasing deep palpation of the RLQ
276
What is the position of MCBurney's point?
1/3 distance from anterior superior iliac spine to the umbilicus
277
What is the ABCDE criteria for the examination of dermatoligical lesions
```
A - Asymetry
B - Border
C - Colour
D - Diameter > 6mm
E - Evolving
```
278
Name two clinical features which can be associated with anorexia nervosa
1. Lanugo body hair
| 2. Parotid gland swelling
279
Recall the female athlete triad
1. Menstrual dysfunction
2. Energy deficit (with or without eating disorder)
3. Reduced bone density
280
Which vessel is most commonly affected in cases of malignant migratory thrombophlebitis?
Great saphenous vein
281
What is the most common form of pancreatic carcinoma?
Ductal adenocarcinoma, frequently located in the pancreatic head
282
Define Trousseau syndrome
Recurring superficial thrombophlebitis that is classically associated with pancreatic cancer
283
Why is Carpel tunnel syndrome more common in pregnancy?
Hormone associated weight gain and peripheral oedema causes impingement of the median nerve
284
Name the 3 thenar muscles
1. Opponens Pollicis
2. Abductor pollicis brevis
3. Flexor pollicis brevis
285
What is the innervation of the thenar muscles
Recurrent branch of the median nerve
286
Name 3 medical syndromes that have an association with carpel tunnel syndrome
1. Hypothyroidism
2. Rheumatoid arthritis
3. Acromegaly
287
What is the first line pharmacological treatment for bulimia nervosa?
Fluoxetine
288
Outline 3 potential side effects association with the use of Fluoxetine - particularly in young people
1. Sexual dysfunction
2. Serotonin syndrome
3. Suicidal ideation
289
What is the most common type of hip dislocation?
Posterior hip dislocation
290
What is Dimercaprol?
A chelation therapy agent used in the treatment of heavy metal poisoning e.g. arsenic
291
Name the 3 principle causes of palpable kidneys bilaterally
1. Polycystic kidney disease
2. Renal cell carcinoma
3. Massive hydronephrosis
292
What is the most common causative organism of bacterial vaginosis?
Gardnerella Vaginalis
293
Name the drug used for the treatment of drug induced Parkinsonism
Procyclidine
294
What are the 3 principle clinical features associated with Kawazaki disease?
1. High fever lasting > 5 days
2. Red palms with desquamation
3. Strawberry tongue
295
What form of malignancy has an association with SIADH?
Small cell lung cancer
296
Which section of the bowel is most likely to be affected by ischaemic colitis?
Splenic flexure
297
Suboccipital and postauricular lymphadenopathy is characteristic of which viral illness?
Rubella
298
Give 2 causes of a late systolic murmur
1. Mitral valve prolapse
| 2. Coarctation of the aorta
299
Name 3 conditions that have an association with the antibody P-ANCA
1. Ulcerative colitis
2. Primary sclerosing cholangitis
3. Churg-Strauss syndrome
300
What is the diagnostic test for infective mononucleosis?
Heterophil antibody test (Monospot test)
301
What are the 3 main characteristics of streptococcus pneumonia?
1. High fever
2. Rapid onset
3. Herpes labialis
302
Damage to which nerve causes a loss of the ability to plantar flex and invert the foot?
Tibial nerve
303
Damage to the inferior gluteal nerve will result in what kind of presentation?
Impaired hip extension and lateral rotation. Difficulty rising from a seat and climbing stairs
304
Name an osmotic diuretic
Mannitol
305
Give 3 indications for the use of mannitol
1. Cerebral oedema
2. Rhabdomyolysis
3. Haemolysis
306
Name 4 clinical signs that are associated with iron deficiency anemia
1. Pallor
2. Koilonychia
3. Angular cheilitis
4. Atrophic glossitis
307
Name 3 bleeding disorders that result in inhibited platelet adhesion and aggregation
1. Glanzman's thrombasthenia
2. Von Willebrand disease
3. Bernard- Soulier syndrome
308
Give 4 risk factors for the development of Hodgkin's lymphoma
1. Male sex
2. EBV infection
3. Immunosuppression e.g. those with HIV
4. Exotoxin exposure
309
Suggest 5 possible differential diagnoses for osteoporosis
1. Multiple myeloma
2. Metastatic carcinoma
3. Osteomalacia
4. Hyperparathyroidism
5. Steroid therapy or Cushing's syndrome
310
Name the most common opportunistic infection affecting the central nervous system in patients with AIDS
Toxoplasmosis
311
Recall the classic triad of symptoms associated with Vitamin B12 deficiency
1. Tiredness
2. Glossitis
3. Parasthesia
312
Name 2 medical conditions that are associated with renal cell carcinoma
1. Von Hippel-Lindau syndrome
| 2. Tubular sclerosis
313
What is the most common causative organism of post-streptococcal glomerulonephritis?
Streptococcus pyogenes
314
Which autoantibodies are associated with SLE?
Anti-dsDNA
315
Which autoantibodies are associated with primary biliary sclerosis?
Anti-mitochondrial
316
Which autoantibodies are associated with chronic active hepatitis?
ASMA - Anti-smooth muscle antibody
317
Which autantibodies are associated with ulcerative colitis?
pANCA
318
Which autoantibodies are associated with Wegener's granulomatosis?
cANCA
319
Which autoantibodies are associated with coeliac disease?
Anti endomysial/ gliadin/ transglutamase antibodies
320
Which autoantibodies are associated with scleroderma?
Anti-centromere
321
Which autoantibodies are associated with Sjogren syndrome?
1. Anti- Ro
| 2. Anti- La
322
Which autoantibodies are associated with polymyositis?
Anti-Jo
323
Name 3 medical conditions in which rheumatoid factor antibodies may be found
1. Rheumatoid arthritis
2. Sjorgen's syndrome
3. SLE
324
Define polymyositis
An inflammatory myopathy that predominantly affects the larger proximal muscle groups and the blood vessels that supply them.
325
What is the treatment of choice for methotrexate toxicity?
Folinic acid
326
Name the mutation found in around 50% of patients with essential thrombocytosis
JAK2 mutation
327
Outline the 3 potential management options for essential thrombocytosis
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
Suggest 5 potential infective causes of haemoptysis
1. Pneumonia
2. Bronchiectasis
3. Fungal infection
4. Lung abscess
5. Tuberculosis
329
Suggest 3 potential neoplastic causes of haemoptysis
1. Primary lung cancer
2. Lung metastases
3. Bronchial adenoma
330
Suggest 2 vascular causes of haemoptysis
1. Pulmonary embolism
| 2. Pulmonary arteriovenous malformation
331
Suggest 4 autoimmune causes of haemoptysis
1. SLE
2. Goodpasture syndrome
3. Wegener's granulomatosis
4. Diffuse alveolar haemorrhage
332
Define massive haemoptysis
Loss of at least 200mls of blood in 24hrs or 50mls per episode
333
Whilst a patient is awaiting referral for symptomatic giant cell arteritis, what medications should be started? (3)
1. 60mg prednisolone
2. 75mg aspirin
3. Omeprazole 20 mg (for gastric protection)
334
What is the first line medication for cluster headache prophylaxis?
Verapamil
335
What is the first line treatment for trigeminal neuralgia?
Carbamazepine 100mg twice daily
336
Name 2 anti emetics
1. Metoclopramide
| 2. Domperidone
337
Why is a barium enema contraindicated in cases of acute colitis?
Risk of precipitating toxic mega colon
338
What are CHRPE eye lesions and what hereditary condition are they associated with?
CHRPE = Congenital hypertrophy of the retinal pigment epithelium
Associated with FAP - Familial adenomatous polyposis
339
Name 4 drugs associated with the development of gastric ulcers
1. Alcohol
2. NSAIDS
3. Aspirin
4. Corticosteriods
340
Give 3 'high motility' causes of diarrhoea
1. IBD
2. Hyperthyroidism
3. Short gut syndrome
341
What are the 6 main complications associated with coeliac disease?
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
Name 3 medications that may irritate the gastric mucosa
1. NSAIDS
2. Bisphosphonates
3. SSRIs
343
Name 2 medications that may lead to relaxation of the lower oesophageal sphincter
1. Calcium channel blockers
| 2. Nitrates
344
Name the possible surgical intervention that may be used for the treatment of reflux oesophagitis
Nissen fundoplication
345
Outline the components of H.Pylori eradication therapy
1 week:
1. Omeprazole 20mg BD
2. Clarithromycin 500mg BD
3. Amoxicllin 1g BD (if allergic - metronidazole 500mg BD)
346
What is the medication treatment for an uncomplicated peptic ulcer that is H.Pylori negative?
2 month course of omeprazole 20mg BD
347
Name 2 acute causes of aortic regurgitation
1. Aortic dissection
| 2. Infective endocarditis
348
Name 2 conditions that can be associated with autoimmune aortitis
1. Giant cell arteritis
| 2. Ankylosing spondylitis
349
What is the most serious potential cause of a sinus bradycardia?
Cushing's reflex - as a result of raised ICP
350
Outline the mechanism of action of proton pump inhibitors
Irreversible blockade of the H+/K+/ATPase transporter of the gastric parietal cell
351
Name a medication that may be used to control extra-pyramidal side effects of anti-psychotics
Procyclidine
352
What are the 4 characteristic features of tetralogy of fallot?
1. Ventricular septal defect
2. Right ventricular hypertrophy
3. Right ventricular outflow obstruction i.e. pulmonary stenosis
4. Overriding aorta
353
Delayed puberty is characteristically seen with which congenital abnormality?
Cystic fibrosis
354
Lymphoedema in neonates is most commonly seen with which congenital abnormality?
Turner's syndrome
355
What is the mode of inheritance of Sickel Cell Anemia
Autosomal recessive
356
U waves on ECG are a characteristic feature of which electrolyte imbalance?
Hypokalaemia
357
Name 4 conditions associated with ANA antibodies
1. SLE
2. Sjorgen syndrome
3. Diffuse cutaneous systemic sclerosis
4. Limited cutaneous systemic sclerosis
358
Which infection has an associated with the development of polyarteritis nodosa?
Hepatitis B
359
Suggest 5 causes of hypocalcaemia
1. Vitamin D deficiency
2. Chronic kidney diseases
3. Hypoparathyroidism
4. Rhabdomyolysis
5. Magnesium deficiency
360
'Drainpipe colon' on AXR is indicative of what condition?
Ulcerative colitis
361
Liver Cirrhosis most commonly causes what form of electrolyte imbalance?
Hyponatraemia
362
Polycystic ovarian syndrome is a risk factor for what form of cancer?
Endometrial cancer
363
What abnormalities are expected in a bone profile of a patient with Paget's disease?
Raised ALP
364
What 4 values make up a full bone profile?
1. Calcium
2. Phosphate
3. ALP
4. PTH
365
What type of cancer is most associated with schistosomiasis?
Squamous cell carcinoma of the bladder
366
A non pulsatile raised JVP is seen in which condition?
SVC obstruction
367
What is Henoch-Schonlein purpura?
IgA mediated small vessel vasculitis
368
What type of hernia is caused by a failure of the processes vaginalis to close?
Indirect inguinal hernia
369
Briefly outline the action of metformin
Increases insulin sensitivity and decreases hepatic gluconeogenisis
370
Suggest 2 examination findings on palpation that may be indicative of a pneumothorax
1. Tracheal deviation
| 2. Subcutaneous emphysema
371
Give 3 examination findings that may indicate a tension pneumothorax
1. Hypoxia
2. Hypotension
3. Tracheal deviation
372
Conservative management may be appropriate if a pneumothorax is under what size?
<2cm (must also be asymptomatic)
373
Outline the 4 main features in a history that point towards interstitial lung disease
1. Chronic dyspnoea
2. Cough
3. Haemoptysis
4. May have a history of connective tissue disease
374
Name 2 conditions that may induce a post renal AKI due to the development of a cast nephropathy
1. Rhabdomyolysis
| 2. Tumour lysis syndrome
375
Define Uhthoff's phenomenon - in reference to multiple sclerosis
Worsening of vision following a rise in body temperature
376
Name 3 medications that may cause a tremor
1. Lithium
2. Sodium valproate
3. Ciclosporin
377
Tonsillitis is associated with what type of lymphadenopathy
Upper anterior cervical chain
378
Suggest 5 potential ocular manifestations of rheumatoid arthritis
1. Keratoconjunctivitis Sicca (most common)
2. Episcleritis
3. Scleritis
4. Corneal ulceration
5. Keratitis
379
Define portal hypertensive gastropathy
Visible changes to gastric mucosa as a result of long term portal hypertension
380
Recall the 4 components to the evaluation of hyponatraemia in any patient
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
Give 3 signs/ symptoms associated with a transfusion reaction
1. Fever
2. Dyspnea
3. Rash
382
What are the differentials for a transfusion reaction causing a fever?
1. Acute haemolytic transfusion reaction
2. Sepsis
3. FNHTR - Febrile non haemolytic transfusion reaction
383
What are the clinical features of TRALI (transfusion related acute lung injury)?
1. Fever
2. Hypoxia
3. Infiltration on CXR
4. Within 6hrs of transfusion
384
What are the 3 components to the initial management of a patient with TRALI?
1. Respiratory support
2. Fluid resuscitation
3. Vasopressors
385
Which antibodies should be tested for in patients presenting with TRALI?
1. Anti-neutrophil
| 2. Anti - HLA
386
Give 3 CNS complications of malignant hypertension
1. Ischaemic stroke
2. Intracranial haemorrhage
3. Hypertensive encephalopathy
387
Suggest 4 causes of a low CSF opening pressure
1. Trauma
2. Instrumentation
3. Acetazolamide
4. Furosemide
388
Suggest 2 inflammatory causes of a high CSF opening pressure
1. Meningitis
| 2. GBS
389
Xanthocromia on CSF sample is indicative of what?
SAH
390
Give 2 medical causes of an elevated RBC cell in a CSF sample
1. SAH
| 2. Herpes encephalitis
391
Name the 3 most common causes of a transudative pleural effusion
1. Congestive heart failure
2. Cirrhosis
3. Nephrotic syndrome
392
Name the 4 most common causes of an exudative pleural effusion
1. Pneumonia
2. Malignancy
3. Tuberculosis
4. PE
393
Recall Light's criteria for the evaluation of pleural fluid
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
Outline the 'SAAG' investigation of ascites that is not thought to be of an infective origin
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
Name 3 medications that can lead to drug induced Lupus
1. Procainamide
2. Hydralazine
3. Isoniazid
396
Which type of cancer is most associated with H.Pylori infection?
B cell lymphoma of MALT tissue
397
Recall 5 potential causes of a normocytic anemia
1. Anemia of chronic disease
2. Chronic kidney disease
3. Aplastic anemia
4. Haemolytic anemia
5. Acute blood loss
398
Thyrotoxicosis most commonly causes what type of electrolyte abnormality?
Hypercalcemia
399
What is the characteristic clinical feature of guttate psoriasis?
'Tear drop' papules on the trunk and limbs
400
Name the antibody that has the greatest diagnostic accuracy for Sjorgen's syndrome
Rheumatoid factor
401
Which 2 conditions contribute to over 90% of cases of hypercalcaemia?
1. Primary hyperparathyroidism
| 2. Malignancy
402
Suggest 2 risk factors for squamous cell carcinoma of the bladder
1. Smoking
| 2. Schistosomiasis
403
Name a medication that is an identified risk factor for the development of transitional cell carcinoma of the bladder
Cyclophosphamide
404
What are Triptans?
Specific 5-HT1B and 5-HT1D agonists used in the acute treatment of migraine
405
What is the mechanism of action of bisphosphonates?
Pyrophosphate analog which inhibits osteoclast activity
406
Recall 4 clinical indications for the prescription of bisphosphonates
1. Prevention and/or treatment of osteoporosis
2. Hypercalcemia
3. Paget's disease of bone
4. Pain from bone metastases
407
What is endometriosis?
Growth of ectopic endometrial tissue outside of the uterine cavity
408
Define dyschezia
Painful bowel movements
409
What is the gold standard investigation for endometriosis?
Laparoscopy
