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SAQs Flashcards

1
Q

What meds are people put on post-STEMI?

A
  • Atorvastatin
  • Aspirin
  • Another antiplatelet-> clopidogrel or ticagrelor for 12 months
  • ACE-i-> ramipril
  • Atenolol or other beta-blocker
  • GTN spray
  • Aldosterone antagonist-> if clinical HF
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2
Q

STEMI management?

A
  • PCI-> present within 12 hours + available within 2 hours of presentation
  • Thrombolysis-> if within 12 hours but PCI not available within 2 hours
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3
Q

What cardiac enzymes can rise during damage?

A
  • Tropinin
  • LDH
  • CK
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4
Q

Pathway for asthma management?

A
  • SABA
  • SABA + ICS
  • SABA + ICS + LABA
  • SABA + ICS + LRTA
  • Consider MART regimes
  • May add LAMA or theophylline later
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5
Q

Physiological measurement of COPD control/severity?

A

FEV1

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6
Q

Stages of CKD?

A 
1-> >90
2-> 60-89
3a-> 45-59
3b-> 30-44
4-> 15-29
5-> <15
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7
Q

Causes of CKD?

A
  • Hypertension
  • Glomerulonephritis
  • Renovascular disease
  • Pyelonephritis
  • Polycystic kidney disease
  • Obstructive uropathy
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8
Q

Why do renal USS in CKD?

A
  • Exclude obstruction
  • Assess renal size
  • Exclude PCKD
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9
Q

Blood tests in CKD?

A
  • U+Es
  • Calcium
  • Phosphate
  • ALP
  • PTH
  • FBC
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10
Q

Signs of CKD on examination?

A
  • Pallor
  • Uraemic tinge
  • Purpura
  • Bruising
  • Brown nail discolouration
  • Excoriation
  • Peripheral oedema
  • HTN
  • Pericardial rub
  • Pleural effusions
  • Proximal myopathy
  • AV fistula
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11
Q

Complications of peritoneal dialysis?

A
  • Bacterial peritonitis
  • Local infection at catheter site
  • Constipation
  • Failure
  • Sclerosing peritonitis
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12
Q

Why do people on immunosuppression need dermatology input?

A

Increased risk of SCC

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13
Q

X-ray findings in rheumatoid arthritis?

A
  • Loss of joint space
  • Soft tissue swelling
  • Juxta-articular osteopaenia
  • Bony erosions
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14
Q

Extra-articular complications of RA?

A
  • Scleritis
  • Episcleritis
  • Scleromalacia
  • Lymphadenopathy
  • Pleural effusion
  • Pulmonary fibrosis
  • Pericardial effusion
  • Rheumatoid nodules-> elbow, pleura
  • Amyloidosis
  • Vasculitis
  • Anaemia
  • Felty’s syndrome-> splenomegaly
  • Peripheral neuropathy
  • Raynaud’s phenomenon
  • Carpal tunnel
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15
Q

What is Felty’s syndrome?

A

RA + splenomegaly

+ neutropenia

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16
Q

How do NSAIDs work?

A

COX2 inhibitors-> reduce prostaglandin synthesis + reduce inflammation

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17
Q

What are some signs of acromegaly?

A
  • Bitemporal hemianopia
  • Excess sweating
  • Enlarged facial features
  • HTN
  • Headache
  • Prognathism
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18
Q

Role of OGTT in acromegaly?

A
  • Normal-> rapid blood glucose increase should suppress GH secretion
  • In acromegaly-> doesn’t
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19
Q

Tests of choice in acromegaly?

A
  • Serum IGF-1

- OGTT

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20
Q

What else needs to be screened for in acromegaly?

A

Diabetes-> GH is anti-insulin so can cause insulin resistance + DM

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21
Q

What might FBC in hypothyroidism show?

A

Macrocytic anaemia

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22
Q

Causes of hypothyroidism?

A
  • Autoimmune
  • Iodine deficiency
  • Cancer
  • Infection
  • Hypopituitarism
  • Amiodarone
  • Radiotherapy
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23
Q

Signs of hypothyroidism?

A
  • Goitre
  • Dry/thinning hair
  • Bradycardia
  • Dry skin
  • Loss of lateral third of eyebrows
  • Ataxia
  • Mental slowness
  • Carpal tunnel
  • Oedema
  • Peaches and cream complexion
  • Slow relaxing relfexes
  • Peripheral neuropathy
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24
Q

Where does the thyroid originate from?

A

Foramen caecum

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25
Q

What might white patches on the hands in hypothyroidism indicate?

A

Vitiligo

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26
Q

What are some signs of lymphoma?

A
  • Lump-> painless, rubbery, pain induced by alcohol
  • Enlarged nodes at other side
  • Splenomegaly
  • Hepatomegaly
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27
Q

Why might SVC obstruction occur in lymphoma?

A

Mediastinal lymph node enlargement

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28
Q

What are some signs of iron deficiency anaemia?

A
  • Tachypnoea
  • Tachycardia
  • Pale conjunctiva
  • Ejection systolic murmur
  • Angular chelosis
  • Koilionychia
  • Atrophic glossitis
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29
Q

Chronic diarrhoea differentials in younger people?

A
  • IBD
  • IBS
  • Infective-> protozoa/parasites
  • Coeliac
  • Cancer
  • Medications
  • Chronic pancreatitis
  • Thyrotoxicosis
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30
Q

Tests for IBD?

A
  • FBC-> anaemia, raised WCC
  • CRP
  • Albumin
  • Vitamin B12
  • Stool MC&S
  • Coeliac screen
  • Amylase
  • TFTs
  • Sigmoidoscopy + biopsy
  • Colonoscopy
  • Barium enema
  • Capsule endoscopy
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31
Q

Histological features of Crohn’s?

A
  • Granulomas
  • Transmural inflammation
  • Lymphocytic infiltration
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32
Q

Endoscopic appearance and distribution of Crohn’s?

A
  • Skip lesions-> not continuous
  • Mouth to anus
  • Commonly terminal ileum
  • Cobblestone appearance
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33
Q

Endoscopic appearance and distribution of ulcerative colitis?

A
  • Only large bowel-> mostly rectum
  • Uniform inflammation
  • Thin walls + vascular pattern
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34
Q

Extraintestinal features of Crohn’s?

A
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Iritis
  • Conjunctivitis
  • Episcleritis
  • Large-joint arthritis
  • Ankylosing spondylitis
  • Aphthous ulcers
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35
Q

Complications of Crohn’s?

A
  • Perianal fistulae
  • Perianal abscess
  • Enteric fistulae
  • Perforated bowel
  • Small bowel obstruction
  • Colon carcinoma
  • Malnutrition
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36
Q

How does infliximab help in Crohn’s?

A

Monoclonal antibody against TNF-> used to establish inflammation + granuloma formation

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37
Q

Why might Hb be unaffected in upper GI bleed?

A

No haemodilution-> fall might not happen till later after bleed

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38
Q

What blood test abnormality might be apparent in upper GI bleed?

A

Urea raised out of proportion to creatinine

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39
Q

Where might portosystemic anastamoses occur in liver cirrhosis?

A
  • Superior rectal vein-> haemorrhoids

- Paraumbilical vein-> caput medusae

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40
Q

Treatment of oesophageal varices?

A
  • Banding
  • Adrenaline
  • Sclerotherapy
  • Argon plasma coagulation
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41
Q

What conditions are associated with berry aneurysms?

A
  • PCKD
  • Ehler-Danlos
  • Coarctation of aorta
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42
Q

Symptoms and signs of SAH?

A
  • Thunderclap headache
  • Vomiting
  • Collapse
  • Seizures
  • Coma
  • Visual disturbance
  • Photophobia
  • Focal neurology due to haematoma
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43
Q

What is Kernig’s sign?

A
  • Hip and knee bent to 90 degrees
  • Pain when straighten knee-> positive
  • Suggests meningeal irritation
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44
Q

What is Brudzinski’s test?

A
  • Lie flat on back
  • Lift head and neck off bed
  • Positive-> involuntary hip and knee flexion
  • Suggests meningitis
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45
Q

Appearance of extradural haematoma on CT?

A
  • Lens-shaped or biconvex (eat the lemon)

- Can’t cross sutures

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46
Q

Appearance of subdural haematoma on CT?

A
  • Crescent shaped

- Not limited by suture lines ie can cross

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47
Q

Pathophysiology of pain in appendicitis?

A
  • Visceral peritoneum supplied by T10 dermatome-> generalised pain
  • Parietal supply-> somatic + specific (RIF)
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48
Q

Complications of appendicitis?

A
  • Appendix mass
  • Abscess
  • Perforation and peritonitis
  • Sepsis
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49
Q

What is a diverticulum?

A

Outpouching of colonic mucosa through the muscle wall

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50
Q

Complications of diverticulitis?

A

Perforation, bleeding, abscess, strictures, fistulas

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51
Q

Causes of urinary retention?

A
  • UTI
  • BPH
  • Constipation
  • Meds-> anticholinergics, opiates, antidepressants
  • Pelvic nerve damage
  • Post-anaesthesia
  • Alcohol
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52
Q

What is important to assess in urinary retention?

A

Lower limb neuro + PR-> cauda equina symptoms

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53
Q

What does post-catheterisation care involve?

A
  • Residual volume measurement
  • Take specimen for CSU
  • Retract foreskin over glans
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54
Q

What is the difference in symptoms between acute and chronic urinary retention?

A
  • Acute-> painful

- Chronic-> painless and higher volume (1.5L+)

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55
Q

How does tamsulosin work?

A

Alpha-1 receptor antagonist-> relax prostatic smooth muscle

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56
Q

How does finasteride work?

A

Anti-androgen 5-alpha reductase inhibitor-> inhibits conversion of testosterone to dihydrotestosterone (more potent androgen in prostatic tissue)

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57
Q

Risk factors for bladder cancer?

A
  • Smoking
  • Aromatic amines-> paint and dye workers
  • Chronic cystitis
  • Schistosomiasis-> SCC
  • Pelvic radiotherapy
  • Cyclophosphamide
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58
Q

How is T1 TCC of the bladder treated?

A
  • TURBT

- Intravesical agents-> BCG, mitomycin C

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59
Q

Where do bladder tumours metastasise to?

A
  • Local-> uterus, rectum, pelvic side wall
  • Lymphatics-> iliac, para-aortic
  • Other-> liver, lungs, bone
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60
Q

What are some risk factors for developing septic arthritis?

A
  • Intra-articular injections
  • RA
  • DM
  • Immunosuppression
  • Penetrating injury
  • Infection elsewhere eg gonococcal
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61
Q

Common organism in septic arthritis in a metal prosthesis?

A

Staphylococcus epidermis

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62
Q

Where does the supraspinatus attach to the humerus?

A

Greater tuberosity

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63
Q

What most commonly causes epistaxis?

A

Trauma

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64
Q

Why should FBC be done in epistaxis?

A
  • Hb drop

- Low platelets-> may be cause of epistaxis

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65
Q

Blood tests in epistaxis?

A
  • FBC
  • LFTs-> clotting factors etc
  • Group and save-> may need transfusion
  • INR if on warfarin
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66
Q

Management of epistaxis?

A
  • Cauterisation
  • Packing
  • Balloon/foley catheter
  • Ligation or embolisation of artery
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67
Q

Medical term for painful swallowing?

A

Odynophagia

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68
Q

Symptoms of tonsillitis?

A
  • Odynophagia
  • Fever
  • Anorexia
  • Headache
  • Ear pain
  • Change to voice
  • Abdominal pain
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69
Q

What lymph node is often affected in tonsillitis?

A

Jugulodigastric

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70
Q

Why is amoxicillin contraindicated in tonsillitis?

A

Causes maculopapular rash if diagnosis is actually glandular fever

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71
Q

Definition of an arterial aneurysm?

A

Swelling of more than 150% of original diameter due to weakness in wall

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72
Q

What is the number needed to screen?

A

Number of patients needed to be screened to prevent one access death/morbidity

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73
Q

What can cause AAA?

A
  • Connective tissue disease-> Ehler Danlos, Marfans
  • Atheromatous degeneration
  • Mycotic aneurysms from infection
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74
Q

Surgery complications in AAA repair?

A
  • Bleeding
  • Infection
  • DVT/PE
  • MI
  • Spinal ischaemia
  • Renal failure
  • Mesenteric ischaemia
  • Distal thrombus-> limb ischaemia
  • Death
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75
Q

Disadvantages of EVAR?

A
  • Long term follow up needed
  • Not suitable for every type of aneurysm
  • High reintervention rate
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76
Q

Investigations for AAA?

A
  • FBC
  • Cross match
  • Amylase
  • U+E
  • ECG
  • Abdominal CT with contrast if stable
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77
Q

What is trash foot?

A
  • Cholesterol embolism
  • From vascular surgery-> atheromatous debris shed during surgery + lodges in distal vessels
  • Local ischaemia-> mottled skin + darkened segments
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78
Q

What are the four layers of an arterial vessel?

A
  • Intima
  • Tunica media
  • Tunica externa
  • Adventitia
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79
Q

What serum immunoglobulin is often raised in severe eczema?

A

IgE

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80
Q

What are some of the different types of psoriasis?

A
  • Plaque
  • Flexural
  • Guttate
  • Pustular
  • Erythrodermic
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81
Q

Treatment options for psoriasis?

A
  • Emollients
  • Topical steroids
  • Vitamin D analogues
  • Coal tar
  • Topical calcineurin inhibitors eg tacrolimis
  • Phototherapy
  • Ciclosporin
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82
Q

What causes conjunctivitis?

A

Allergy or infection

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83
Q

What causes neonatal conjunctivitis?

A

Gonorrhoea or chlamydia

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84
Q

What are the signs of diabetic retinopathy (proliferative)?

A
  • Microaneurysms
  • Flame haemorrhages
  • Hard exudates
  • Engorged tortuous veins
  • Cotton wool spots-> ischaemic nerve fibres
  • Neovascularisation
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85
Q

How is proliferative diabetic retinopathy treated?

A

Panretinal photocoagulation

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86
Q

What eye conditions are diabetics at risk of getting?

A
  • Diabetic retinopathy
  • Cataracts
  • Glaucoma
  • Vitreous haemorrhage
  • Retinal detachment
  • Ocular motor nerve palsies
  • Infections
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87
Q

Risk factors for placenta praevia?

A
  • Previous C section
  • Twin/multiple pregnancy
  • High parity
  • Older women
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88
Q

Causes of antepartum haemorrhage?

A
  • Placenta previa
  • Placental abruption
  • Uterine rupture
  • Vasa previa
  • Cervical polyp
  • Cervical cancer
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89
Q

What foetal lie and presentation is usually present in placental abruption?

A

Normal-> longitudinal + cephalic

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90
Q

What are some risk factors for placental abruption?

A
  • IUGR
  • Previous abruption
  • Maternal smoking
  • Pre-eclampsia
  • HTN
  • Multiple pregnancy
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91
Q

What would clotting studies after major abruption show?

A
  • Afibrinogenaemia-> placental damage causes thromboplastin release into circulation
  • Causes DIC-> clotting factors used up
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92
Q

Symptoms of ectopic pregnancy?

A
  • Severe unilateral abdominal pain
  • Amenorrhoea
  • Adenexal mass
  • PV bleed
  • Shoulder tip pain
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93
Q

Risk factors for ectopic pregnancy?

A
  • Previous ectopic
  • IUD
  • Previous PID
  • Tubal surgery
  • Endometriosis
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94
Q

Medical management of ectopic?

A

Methotrexate

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95
Q

Risk factors for hyperemesis gravidarum?

A
  • 1st pregnancy
  • Young age
  • Multiple pregnancy
  • Molar pregnancy
  • Hyperthyroidism
  • Previous motion sickness
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96
Q

Definition of orthostatic hypotension?

A

Drop in systolic by >20mmHg or drop in diastolic by >10mmHg within 1st 10 minutes of standing

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97
Q

Causes of postural hypotension?

A
  • Hypertensive meds-> ACE-is, diuretics
  • Excess alcohol
  • Hypovolaemia-> dehydration, diarrhoea, haemorrhage, Addison’s
  • Primary autonomic failure-> Parkinson’s, multiple system atrophy
  • Secondary autonomic failure-> diabetic neuropathy
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98
Q

Management options for postural hypotension?

A
  • Education on symptoms and taking action
  • High salt diet
  • Bed tilt
  • Full length compression hosiery
  • Fludrocortisone
  • Midodrine
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99
Q

Definition of delirium?

A

Syndrome of clouded consciousness, disorientation, perceptual impairment and changes in affect and behaviour

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100
Q

What tool can be used to differentiate dementia from delirium?

A

Confusion Assessment Method (CAM)

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101
Q

How do penicillins work?

A

Inhibit cell wall synthesis

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102
Q

How do bacteria develop resistance against penicillin-based antibiotics?

A

Beta-lactamase production-> break down beta-lactam ring

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103
Q

Why are other antibiotics often added to penicillin-based ones in treatment regimes?

A

These are beta-lactamase inhibitors-> reduce resistance

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104
Q

What should be done before starting lithium?

A
  • U+Es
  • TFTs
  • ECG
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105
Q

Symptoms of lithium toxicity?

A
  • Coarse tremor
  • N+V
  • Diarrhoea
  • Confusion
  • Lethargy
  • Polyuria
  • Seizures
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106
Q

What are the key features of depression?

A

Low mood + anhedonia + lack of energy-> for 2+ weeks

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107
Q

What are some limitations to the Hospital Anxiety and Depression Score (HADS)?

A
  • Variation of scores between different populations and cultures
  • Only validated in hospitals not general population
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108
Q

What are the features of atypical depression?

A
  • Weight increase
  • Increased appetite
  • Hypersomnolence-> daytime sleepiness
  • Mood improves with positive events
  • Catanonia-> leaden limbs
  • Social impairment
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109
Q

What might CXR show in bronchiolitis?

A

Hyperinflation

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110
Q

Differentials for stridor in children?

A
  • Croup
  • Epiglottitis
  • Anaphylaxis
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111
Q

What organisms cause croup?

A
  • Parainfluenza
  • RSV
  • Influenza
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112
Q

What can be used in severe croup?

A

Nebulised adrenaline

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113
Q

What can trigger an angina attack?

A
  • Cold/windy weather
  • Emotion-> anxiety, excitement
  • Lying down
  • Vivid dreams-> nocturnal
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114
Q

Blood tests in angina?

A
  • FBC-> anaemia
  • TFTs-> thyrotoxicosis
  • Lipid profile
  • Glucose-> random, fasting etc
  • U+Es-> if considering ACEi
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115
Q

How does aspirin work?

A
  • Irreversibly inhibits COX-> prevents thromboxane production
  • Shifts balance of PGI2:TxA2 towards inhibiting platelet aggregation
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116
Q

How to raise someone’s K+?

A

K+ replacement-> oral or add to fluids

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117
Q

3 most likely organisms to cause CAP?

A
  • Strep pneumoniae
  • H.influenzae
  • Mycoplasma pneumoniae
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118
Q

At what CURB65 score should someone be admitted to hospital with CAP?

A

Score of two or more

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119
Q

Why should statins be stopped when clarithromycin is started?

A

Interacts-> risk of myositis increased

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120
Q

Where does hydroxylation of vitamin D occur?

A

Liver + kidney

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121
Q

What is bone disease in renal failure called?

A

Renal osteodystrophy

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122
Q

What blood results would you expect in tertiary hyperparathyroidism?

A
  • Calcium-> high
  • PTH-> high
  • Prolonged secondary-> PT glands act autonomously
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123
Q

Pre-renal causes of AKI?

A
  • Hypovolaemia
  • Sepsis
  • Renal artery stenosis
  • ACE-is
  • NSAIDs
  • Congestive cardiac failure
  • Cirrhosis
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124
Q

Renal causes of AKI?

A
  • Acute tubular necrosis
  • Nephrotoxins-> drugs, contrast
  • Myeloma
  • Rhabdomyolysis
  • Vasculitis
  • Glomerulonephritis
  • Haemolytic uraemia syndrome
  • Malignant hypertension
  • TTP
  • Cholesterol emboli
  • Acute tubulointerstitial nephritis
  • Pre-eclampsia
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125
Q

Complications of AKI?

A
  • Pulmonary oedema
  • Hyperkalaemia
  • Haemorrhage
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126
Q

Indications for dialysis in AKI?

A
  • Acidaemia
  • Electrolytes-> refractory hyperkalaemia
  • Intoxication/ingestions
  • Overload-> CCF
  • Uraemia-> encephalopathy, pericarditis
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127
Q

Causes of gout attacks?

A
  • Alcohol
  • High purine diet-> meat and shellfish
  • Trauma
  • Infection
  • Surgery
  • Dehydration
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128
Q

Signs of gout on X-ray?

A
  • Normal joint space
  • Soft tissue swelling
  • Periarticular joint erosions
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129
Q

Sign of pseudogout on X-ray?

A

Chondrocalcinosis-> calcification within joints

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130
Q

What joints are usually affected in pseudogout?

A
  • Knee
  • Hips
  • Wrist
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131
Q

What drugs can be used in hyperthyroidism?

A
  • Carbimazole

- Propythiouracil

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132
Q

What are the symptoms of diabetes insipidus?

A
  • Weight loss
  • Polyuria
  • Polydipsia
  • Hypernatraemia
  • Absence of glucosuria
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133
Q

What causes diabetes insipidus?

A

Lack of (cranial) or lack of response to (nephrogenic) ADH

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134
Q

How does the water deprivation test for diabetes insipidus work?

A
  • Starve of fluid
  • Normal-> concentrated urine + reduced UO
  • DI-> still low osmolality + increased UO
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135
Q

What is Sheehan’s syndrome?

A

Pituitary infarction-> happens after PPH

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136
Q

Drugs used in sickle cell disease?

A
  • Hydroxyurea (hydroxycarbamide)
  • Penicillin
  • Folic acid
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137
Q

What can bring on sickle cell crisis?

A
  • Infection
  • Dehydration
  • Cold weather
  • Hypoxia
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138
Q

Commonest immunoglobulin expressed in myeloma?

A

IgG

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139
Q

Symptoms of multiple myeloma?

A
  • Abdominal pain
  • Confusion
  • Renal stone symptoms
  • Weight loss
  • Recurrent infections
  • Tiredness
  • Bruising easily
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140
Q

Why are patients with myeloma prone to infections?

A

Bone marrow infiltration-> immunoparesis secondary to overexpression of 1 Ig and underexpression of others

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141
Q

Acute complications of myeloma?

A
  • Hypercalcaemia
  • AKI
  • SCC
  • Hyperviscosity
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142
Q

Risk factors for peptic ulcer disease?

A
  • Smoking
  • Physiological stress
  • H.pylori
  • SSRIs
  • NSAIDs
  • Hypercalcaemia
  • Chronic renal failure
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143
Q

How does the urease breath test work?

A
  • H.pylori produces urease-> breaks down urea into ammonia + CO2
  • Radio isotope of carbon (C13 or C14) in form of urea ingested
  • If urease present-> breaks down urea + radioisotope measured
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144
Q

What is Zollinger-Ellison syndrome?

A
  • Abnormally high gastrin levels-> atypical ulcers

- Usually from pancreatic gastrinoma

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145
Q

How long are antibiotics given in H.pylori?

A

2 weeks

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146
Q

What is the gold standard test for proving reflux?

A

Oesophageal pH manometry

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147
Q

How does Nissen fundoplication help in GORD?

A

Augments high pressure zone-> gives strength to gastrooesophageal junction

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148
Q

Side effects of Nissen fundoplication?

A
  • Dysphagia from compression of GOJ
  • Dumping syndrome
  • Achalasia
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149
Q

Commonest cause of cerebral infarct?

A

Carotid artery embolism-> endarterectomy

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150
Q

What is Todd’s palsy?

A

Temporary weakness after a seizure-> usually in affected limbs and after focal seizures

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151
Q

What airway adjunct can be used in seizures?

A

Nasopharyngeal airway

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152
Q

What is a hernia?

A

Protrusion of a structure through the wall of a cavity in which it’s usually contained

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153
Q

How are femoral and inguinal hernias differentiated in relation to the pubic tubercle?

A
  • Femoral-> inferior + lateral

- Inguinal-> superior + medial

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154
Q

How are indirect and direct hernias differentiated (in relation to the inferior epigastric vessels)?

A
  • Indirect-> lateral to vessels

- Direct-> medial to vessels

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155
Q

Risk factors for inguinal hernias?

A
  • Premature
  • Male
  • Chronic cough
  • Constipation
  • Obesity
  • Heavy lifting
  • Physical activity-> sports
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156
Q

What is the difference between an obstructed and a strangulated hernia?

A
  • Obstructed-> GI contents can’t pass through

- Strangulated-> ischaemia of portion of bowel affected

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157
Q

Complications of inguinal herniotomy surgery?

A
  • Infection of wound site
  • Recurrence
  • Mesh infection
  • Hydrocele
  • Intestinal damage
  • Bladder damage
  • Spermatic cord damage
  • Testicular infarction (secondary to blood vessel damage)
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158
Q

What line divides internal and external haemorrhoids?

A

Dentate line

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159
Q

What is sensitivity (of a test)?

A
  • Number of people with the disease who test positive

- True +ves / true positives + false negatives

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160
Q

What is specificity (of a test)?

A
  • Ability of a test to rule out a diagnosis/condition
  • Number of people without the disease who test negative
  • True negatives / true negatives and false positives
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161
Q

What should be done if testicular torsion is suspected?

A

Surgical exploration-> very limited time before necrosis of testicle

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162
Q

What does whirlpool sign on US/CT indicate?

A

Ovarian torsion

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163
Q

What are the layers of the testicle?

A
  • Skin
  • Dartos fascia
  • External spermatic fascia
  • Cremaster muscle
  • Internal spermatic fascia-> tunica vaginalis
  • Tunica albuginea
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164
Q

When is nasopharyngeal airway contraindicated?

A

Suspected basal skull fracture

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165
Q

What would dull percussion of lung after stab wound indicate?

A

Massive haemothorax

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166
Q

How is massive haemothorax managed?

A

Wide bore chest drain

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167
Q

What is the definition of Barrett’s oesophagus?

A

Metaplasia of squamous to columnar epithelium in the lower oesophagus

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168
Q

What does difficulty swallowing solids but not liquids indicate?

A

More likely a stricture (benign or malignant)-> if fluids difficult, would likely be motility disorder

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169
Q

Risk factors for oesophageal cancer?

A
  • Smoking
  • Alcohol
  • Obesity
  • Achalasia
  • Barrett’s oesophagus
  • Coeliac
  • Older age
  • Male
  • Family history
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170
Q

Why is left recurrent laryngeal palsy more common than on the right?

A

Longer course-> more risk of damage

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171
Q

Which laryngeal muscle isn’t supplied by the recurrent laryngeal nerve?

A

Cricothyroid

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172
Q

What nerve supplies the cricothyroid muscle?

A

Superior laryngeal nerve

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173
Q

What can cause recurrent laryngeal nerve palsy?

A
  • Tumour-> thyroid, larynx
  • Surgery
  • Idiopathic
  • Bulbar or pseudobulbar palsy
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174
Q

Symptoms of vocal cord palsy?

A
  • Hoarse voice
  • Cough
  • SOB
  • Vocal fatigue
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175
Q

6P’s of critical limb ischaemia?

A
  • Pulseless
  • Paraesthesia
  • Pallor
  • Pain
  • Perishing cold
  • Paralysis
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176
Q

What causes critical limb ischaemia?

A
  • Thrombosis
  • Embolism
  • Aortic dissection
  • Trauma
  • Iatrogenic
  • Intra-arterial drugs
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177
Q

When should limb salvage surgery be done in critical limb ischaemia and why?

A
  • Within 6 hours

- Irreversible tissue ischaemia can occur within this time

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178
Q

How does heparin prevent blood clots?

A

Activates anti-thrombin III-> inactivates thrombin + factor Xa-> prevents clotting cascade from activating-> anticoagulant

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179
Q

Side effects/complications of heparin infusion?

A
  • Frequent APTT monitoring + dose adjustment
  • Increased haemorrhage risk
  • Heparin-induced thrombocytopaenia
  • Long term-> osteoporosis
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180
Q

What is intermittent claudication a sign of?

A

Peripheral vascular disease

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181
Q

What could intermittent claudication + impotence + buttock pain be a sign of?

A

Internal iliac artery stenosis

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182
Q

Diagnostic investigations for intermittent claudication?

A
  • US doppler
  • ABPI
  • CT/MRI angiogram
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183
Q

What is the pathway between the common femoral artery and the aorta?

A

Common femoral-> external iliac-> common iliac-> aorta

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184
Q

What is the diagnosis- Ashkenazi Jewish man, blisters erupting all over body (especially mouth), easily burst?

A

Pemphigus vulgaris

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185
Q

Tests in pemphigus vulgaris?

A
  • Biopsy

- Autoantibodies screen

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186
Q

What causes pemphigus vulgaris?

A

Drug-induced or autoimmune

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187
Q

What is Nikolsky’s sign?

A

Rub skin-> skin layers separate

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188
Q

How is pemphigus vulgaris treated?

A

Immunosuppression or high dose steroids

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189
Q

What are the types of melanoma?

A
  • Superficial spreading
  • Nodular
  • Acral lentiginous
  • Letingo maligna
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190
Q

What is used to assess severity/prognosis of a melanoma?

A

Breslow thickness-> superficial to deep

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191
Q

Where can malignant melanoma occur?

A
  • Skin
  • Choroid of eye
  • CNS
  • GI tract
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192
Q

How is hypertensive retinopathy classified?

A

Grade 1-4

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193
Q

What are some signs of severe hypertensive retinopathy?

A
  • Silver wiring-> arteriolar constriction
  • AV nipping
  • Cotton wool spots
  • Exudates
  • Flame haemorrhages
  • Papilloedema
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194
Q

What are the findings in grade 2 hypertensive retinopathy?

A
  • Silver wiring

- AV nipping

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195
Q

Differentials for loss of vision?

A
  • Cataracts
  • Maculopathy
  • Retinal disease
  • Presbyopia
  • Optic neuritis
  • Vitreous haemorrhage
  • GCA
  • TIA
  • Retinal vein occlusion
  • Central retinal artery occlusion
  • Optic atrophy
  • Macular degeneration
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196
Q

Risk factors for cataracts?

A
  • Older age
  • Diabetes
  • Eye trauma
  • Uveitis
  • Long term steroids
  • Smoking
  • Alcohol
  • Congenital
  • Myotonic dystrophy
  • Radiotherapy
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197
Q

Surgical treatment for cataracts?

A

Phacoemulsification

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198
Q

Complications of cataracts surgery?

A
  • Early-> posterior capsule rupture

- Late-> posterior capsule opacification

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199
Q

What blood tests are routinely offered in pregnancy?

A
  • FBC + Hb
  • Blood group + rhesus status
  • Rubella
  • Syphilis serology
  • Blood glucose
  • HIV
  • Hep B
  • Hb electrophoresis-> sickle cell
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200
Q

Why are sexual infections screened for in some pregnancies?

A
  • Risk of prematurity
  • Vertical transmission
  • Neonatal conjunctivitis
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201
Q

What will a triple test for Down’s syndrome show if positive?

A
  • hCG-> increased
  • AFP-> decreased
  • Unconjugated oestriol-> decreased
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202
Q

Risk factors for gestational diabetes?

A
  • Previous GDM
  • Previous macrosomia
  • Previous stillbirth
  • 1st degree relative with diagetes
  • Obesity
  • Race-> Asian, black Caribbean
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203
Q

Risks of diabetes in pregnancy?

A
  • Congenital abnormalities
  • Premature labour
  • Foetal lung immaturity
  • Increased birth weight
  • Polyhydramnios
  • Shoulder dystocia
  • Birth trauma
  • Sudden foetal death
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204
Q

How is miscarriage managed medically?

A

Mifepristone + misoprostol

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205
Q

What are some complications of surgical evacuation of miscarriage?

A
  • Cervix injury
  • Uterus perforation
  • Asherman’s syndrome-> scarring of endometrium
  • Anaesthetic risks
  • Bleeding
  • Infection
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206
Q

What can cause recurrent miscarriage?

A
  • Antiphospholipid syndrome
  • Infection
  • Cervical incompetence
  • Parental chromosome abnormality
  • Uterine abnormality-> large fibroids, bicornuate
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207
Q

What can be offered before hysterectomy in dysfunctional bleeding?

A
  • Mirena coil

- Endometrial ablation

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208
Q

What can be used in Alzheimer’s and how do they work?

A
  • Anticholinergics-> donepezil or rivastigmine

- Inhibit acetylcholinesterase-> less ach broken down-> more available at synapse

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209
Q

What drugs might precipitate urinary incontinence?

A
  • Diuretics

- Sedatives-> opiates, antipsychotics

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210
Q

Risk factors for stress incontinence?

A
  • Childbirth
  • Multiparity
  • Pregnancy
  • Obesity
  • Chronic cough-> may be exacerbated by drugs (eg ACEis)
  • Chronic constipation
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211
Q

How does duloxetine help in stress incontinence?

A
  • SNRI-> inhibits reuptake of noradrenaline at synapse
  • Increased NA available
  • Increases urethral sphincter tone
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212
Q

Complications of chronic alcohol abuse?

A
  • Fatty liver
  • Hepatitis
  • Cirrhosis
  • Cognitive dysfunction
  • Seizures
  • Ataxia
  • Peripheral neuropathy
  • Hypertension
  • Strokes
  • Cardiomyopathy
  • Peptic ulcers
  • Pancreatitis
  • Oesophageal varices
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213
Q

How does disulfiram work?

A
  • Blocks acetaldehyde dehydrogenase-> acetaldehyde not broken down
  • Builds up when ingest alcohol-> vomiting, tachycardia, headache, SOB
  • Aversion
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214
Q

Is bile present in vomit in pyloric stenosis?

A

No-> stenosis causes obstruction too high for bile to be present

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215
Q

Where is pylorus palpated during feeds in pyloric stenosis?

A

Lateral border or rectus in RUQ

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216
Q

What are the four sections of the stomach?

A
  • Cardia
  • Fundus
  • Body
  • Pylorus
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217
Q

What are the risk factors for SUFE?

A
  • Male
  • Age 10-15
  • Obesity
  • Trauma
  • Chemo/radiotherapy
  • Hormone deficiency (eg GH)
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218
Q

What cartilage makes up the epiphyseal plate?

A

Hyaline cartilage

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219
Q

What is the normal length of a QRS complex?

A

<0.12s ie 2 small squares

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220
Q

What is a capture beat?

A

Normal QRS between VT complexes

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221
Q

What drugs may be used during cardiac arrest?

A
  • Amiodarone
  • Adrenaline
  • Oxygen
  • Lidocaine
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222
Q

What ECG pattern might be seen due to digoxin use?

A
  • Reverse tick pattern
  • ST depression
  • T wave inversion in V5-V6
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223
Q

What drugs are used to treat TB and how long for?

A
  • Rifampicin (6 months)
  • Isoniazid (6 months)
  • Pyrazinamide (2 months)
  • Ethambutol (2 months)
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224
Q

Why are 4 different drugs used to treat TB?

A

To combat multi-drug resistance

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225
Q

What can cause erythema nodosum?

A
  • Idiopathic
  • Crohn’s
  • UC
  • Sarcoidosis
  • TB
  • Drugs-> OCP, sulphonamides
  • Streptococcal infection
  • Chlamydia
  • Leprosy
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226
Q

What organisms commonly colonise the lungs of people with CF?

A
  • Pseudomonas aeruiginosa
  • Strep pneumoniae
  • H. influenzae
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227
Q

What can cause bronchiectasis?

A
  • Idiopathic
  • CF
  • TB
  • Post-infective
  • Post-obstruction-> tumour, foreign body
  • Allergic aspergillosis
  • RA
  • UC
  • A1 antitrypsin deficiency
  • Congenital
  • Immunodeficiency
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228
Q

What is the diagnosis- elderly man, confused, fallen, raised U+Es, blood in urine, AKI?

A

Rhabdomyolysis due to prolonged immobility-> acute tubular necrosis

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229
Q

What blood test will be raised in rhabdomyolysis?

A

Creatinine kinase

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230
Q

What might be seen on urine microscopy in rhabdomyolysis?

A

Urinary myoglobin-> muddy brown/granular casts

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231
Q

What can cause rhabdomyolysis?

A
  • Statins
  • Prolonged immobility
  • XS exercise
  • Crush injury
  • Burns
  • Seizures
  • Neuroleptic malignant syndrome
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232
Q

ECG changes in hyperkalaemia?

A
  • Tall tented T waves
  • Flattened P waves
  • Prolonged PR interval
  • Widened QRS
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233
Q

What blood tests should be done in rapidly progressive glomerulonephritis?

A
  • ANCA

- Anti-GBM

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234
Q

How might a diagnosis of Wegener’s granulomatosis be confirmed?

A

Renal biopsy

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235
Q

What immunological blood tests might be positive in SLE?

A
  • Anti-DsDNA
  • ANA
  • Antiphospholipid antibodies
  • Anti-Sm
  • RF
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236
Q

What skin changes might be present in SLE?

A
  • Malar rash on face
  • Discoid rash
  • Photosensitive rash
  • Vasculitis rash
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237
Q

What are some features of SLE?

A
  • CVD
  • Increased infections
  • Thrombocytopaenia
  • Pericarditis
  • Lupus nephritis
  • Arthralgia
  • Myalgia
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238
Q

How is SLE managed?

A
  • NSAIDs
  • Steroids
  • Hydroxychloroquine
  • MTX
  • Azathioprine
  • Monoclonal antibodies
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239
Q

What can repeated episodes of hypoglycaemia lead to?

A

Lack of hypoglycaemia awareness

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240
Q

How can hypoglycaemia be prevented?

A
  • Regular finger prick monitoring
  • Never miss a meal
  • Emergency supply of glucose in pocket
  • Adjust insulin appropriately in response to change in diet/activity/illness
241
Q

What can cause hypoglycaemia in non-diabetic patients?

A
  • Liver failure
  • Addison’s
  • Insulin secreting tumours
  • Pituitary insufficiency
242
Q

How does the oral glucose tolerance test work?

A
  • Fast overnight
  • Give drink with 75g glucose
  • BMs before + 120 mins after
  • Diagnosis-> if >11.1mmol/L
  • Fasting blood glucose-> >7mmol/L
  • Don’t drink coffee or smoke during fast
243
Q

What can cause splenomegaly?

A
  • Lymphoma
  • Malaria
  • Mononucleosis
  • Haemolytic anaemia
  • Myelofibrosis
  • Liver cirrhosis with portal HTN
  • Amyloidosis
244
Q

How can acute and chronic leukaemia be differentiated on a blood film?

A
  • Acute-> white cells in blast stage (immature)

- Chronic-> white cells mature + full spectrum of lineage

245
Q

Main information for ALL?

A
  • Most common in kids

- Associated with Down’s

246
Q

Main information for CLL?

A
  • Most common leukaemia in adults overall
  • Associated with warm haemolytic anaemia
  • Ritcher’s transformation into lymphoma
  • Smudge/smear cells
247
Q

Main information for CML?

A
  • 3 phases including asymptomatic chronic phase

- Philadelphia chromosome

248
Q

Main information for AML?

A
  • Most common acute adult leukaemia
  • Can be result of transformation from myeloproliferative disorder
  • Auer rods
249
Q

What causes bone pain in haematological malignancy?

A

Bone marrow infiltration

250
Q

What supportive treatment is needed pre-stem cell transplant?

A
  • Blood transfusions-> anaemia symptoms
  • Platelet transfusions-> prevent haemorrhage
  • Prophylactic antibiotics
  • Counselling about treatment
251
Q

What is the tumour marker sometimes present in pancreatic cancer?

A

CA19-9

252
Q

What does having antibodies to hepatitis B core antigen (anti-HBC) signify?

A

Past infection

253
Q

What does HBsAg (surface antigen) signify?

A

Active infection

254
Q

What does HBeAg (E antigen) signify?

A

Viral replication-> high infectivity

255
Q

What does HBcAb (core antibodies) signify?

A

Past or current infection

256
Q

What does HBsAb (surface antibody) signify?

A

Vaccination or past or current infection

257
Q

What does HBV DNA signify?

A

Direct count of viral load

258
Q

What does bitemporal hemianopia with no endocrine symptoms signify?

A

Non-functional pituitary adenoma

259
Q

Damage to what can lead to homonymous hemianopia?

A
  • Optic radiations

- Occipital lobe

260
Q

What sensations are conveyed by the spinothalamic tracts?

A

Pain, temperature, light touch

261
Q

What sensations are conveyed by the dorsal columns?

A

Proprioception, vibration, deep touch

262
Q

Where does the dorsal column decussate?

A

Medulla

263
Q

How does Brown Sequard present?

A
  • Ipsilateral spastic paralysis + loss of vibration and proprioception
  • Contralateral loss of pain and temperature
264
Q

What modalities are conveyed by the corticospinal tracts?

A

Motor neurones

265
Q

What is the gold standard for imaging in acute mesenteric ischaemia?

A

Angiography

266
Q

What is the function of the red pulp of the spleen?

A

Filter and destroy faulty RBCs

267
Q

What is the function of the white pulp of the spleen?

A

Lymphoid tissue + part of immune system

268
Q

Indications for splenectomy?

A
  • Splenic rupture
  • Neoplasia
  • Cysts
  • Abscess
269
Q

What are patients at risk of post-splenectomy?

A

Encapsulated bacteria infection

270
Q

What do patients require post-splenectomy?

A
  • Antibiotic prophylaxis

- Vaccinations-> PCV, meningococcal, influenza

271
Q

What are Howell-Jolly bodies?

A
  • RBCs present post-splenectomy

- Nuclear remnant still seen

272
Q

How does small bowel obstruction present differently to large bowel?

A
  • Less abdominal distention

- Pain higher up in abdomen

273
Q

What is in bile?

A
  • Cholesterol
  • Bile salts
  • Bile pigment
  • Phospholipids
  • Water
274
Q

What are the different types of gallstone?

A
  • Cholesterol
  • Bile pigments
  • Mixed
275
Q

What are the four lobes of the liver?

A
  • Right
  • Left
  • Caudate
  • Quadrate
276
Q

What ligament divides the anterior of the liver into the two anterior lobes?

A

Falciform ligament

277
Q

Where do secondary liver cancers typically originate from?

A
  • GI tract
  • Uterus
  • Lung
  • Breast
278
Q

Tumour marker for HC cancer?

A

AFP

279
Q

How do renal masses present?

A
  • Moves up and down with respiration
  • Mass palpable on bimanual palpation
  • Can get above it
280
Q

Risk factors for renal cell cancer?

A
  • Increased age
  • Male
  • Smoking
  • Obesity
  • Hypertension
  • Long term dialysis
  • Hereditary papillary RCC
  • Von Hippel-Lindau syndrome
281
Q

What is the gold standard investigation for renal colic?

A

CT-KUB

282
Q

Where is the ureter narrowed and more prone to obstruction with stone?

A
  • Pelvic-ureteric junction
  • Vesico-ureteric junction
  • Renal pelvis
283
Q

Emergency intervention in pyelonephritis?

A

Percutaneous nephrostomy-> relief of obstruction

284
Q

What is ‘triple diagnosis’?

A

Physical, psychological and social

285
Q

What management is indicated in kids <1 year with hydrocele?

A

Conservatively-> spontaneously resolves

286
Q

What causes hydrocele?

A

Fluid in tunica vaginalis as derived from processus vaginalis (connected to embryonic peritoneum)

287
Q

Risks associated with TURP?

A
  • Retrograde ejaculation
  • Bladder neck stenosis
  • Haematospermia
  • TURP syndrome
288
Q

What is TURP syndrome?

A
  • Irrigation fluid from op enters IV space via prostatic bed
  • Expands IV space
  • Fluid overload and hyponatraemia
289
Q

How does oxybutynin work?

A

Anticholinergic-> reduces spasmodic activity of detrusor

290
Q

What can cause recurrent UTI in men?

A
  • Urethral stricture
  • Prostatic enlargement
  • Indwelling catheter
  • Neuropathic bladder
  • Urinary tract surgery
  • Colovesical fistula
  • Immunosuppression
291
Q

What organisms frequently cause UTI?

A
  • E.coli
  • Klebsiella
  • Enterococcus
  • Staph saprophyticus
292
Q

What can cause urethral stricture?

A
  • Pelvic trauma
  • Perineal trauma
  • Urethral instrumentation
  • Foreign body
  • Gonorrhoea
  • Chlamydia
  • Long term catheter
  • Lichen sclerosis
293
Q

How does urethral stricture present?

A
  • LUTS
  • Divergent stream
  • Chronic retention
  • Overflow incontinence
294
Q

Investigations for urethral stricture?

A
  • Cystoscopy
  • Urinalysis
  • U+Es
  • Urodynamic testing
  • Endoluminal US
295
Q

Complications of urethral stricture?

A
  • Calculus formation
  • Chronic infection + prostatitis
  • Epididymitis
  • Renal impairment
  • Bladder diverticula
296
Q

How does bladder diverticulum occur?

A
  • Chronic increase in intravesical pressure
  • Bladder mucosa pushes through muscle layer
  • Chronic colonisation pseudomonas or E.coli
297
Q

What is the unhappy triad?

A

Tear in ACL + medial collateral ligament + medial meniscus-> tight adherence

298
Q

What imaging can be used to visualise meniscal tears?

A

Knee MRI

299
Q

Where is an autograft taken from for ACL reconstruction?

A

Patella, hamstring or quadriceps tendon

300
Q

What is the arterial supply to the head of the femur?

A
  • Intramedullary vessels
  • Artery of ligamentum teres
  • Cervical vessels in joint capsule retinaculum
301
Q

What is fractured in a Colle’s fracture?

A

Distal radius (metaphysis)-> dorsal displacement + angulation

302
Q

What is a Smith’s fracture?

A

Distal radius-> volar displacement + angulation

303
Q

What is a Bier’s block?

A

Tourniquet applied + LA injected IV

304
Q

How long does it take for a Colle’s fracture to heal?

A

6-8 weeks

305
Q

What classification system is used for open fractures?

A

Gustilo and Anderson classification

306
Q

Complications of open fracture?

A
  • Wound infection
  • Tetanus
  • Osteomyelitis
  • Nerve damage
  • Vascular damage
  • Malunion
  • Non-union
  • Compartment syndrome
  • Sepsis
  • DVT
  • Death
307
Q

Where does the spinal cord terminate in adults?

A

L2/L3

308
Q

Where does the spinal cord terminate in newborns?

A

L4/L5

309
Q

What can cause cauda equina syndrome?

A
  • Slipped intervertebral disc
  • Malignancy
  • Fracture
  • Haematoma
310
Q

Who is more likely to develop OA?

A

Females

311
Q

What can cause unilateral facial weakness?

A
  • Bell’s palsy
  • Ramsey Hunt syndrome
  • TIA
  • Hemiplegic migraine
  • Tumours
  • MS
  • Parotid tumour
  • Acoustic neuroma
  • Cerebellopontine angle lesions
  • GBS
312
Q

What are the branches of the facial nerve?

A
  • Temporal
  • Zygomatic
  • Buccal
  • Marginal mandibular
  • Cervical
313
Q

Causes of vertigo?

A
  • BPPV
  • Meniere’s
  • Vestibular neuronitis
  • Acoustic neuroma
  • MS
  • Cholesteatoma
  • Trauma
  • Drugs-> gentamicin, diuretics, metronidazole
314
Q

What bacteria causes otitis media?

A
  • Strep pneumoniae
  • H.influenzae
  • Moraxella catarrhalis
315
Q

What are the two portions of the eardrum called?

A

Pars flaccida + pars tensa

316
Q

Main differential for vestibular schwannoma (acoustic neuroma)?

A

Meningioma

317
Q

What are paranasal sinuses?

A

Air filled cavities in facial bones with connection to nasal cavity

318
Q

What are the four paranasal sinuses?

A
  • Sphenoid
  • Maxillary
  • Frontal
  • Ethmoidal
319
Q

What epithelium lines the paranasal sinuses?

A

Ciliated and pseudostratified columnar epithelium

320
Q

What causes maxillary sinusitis?

A
  • Mostly bacterial infection (post-viral)
  • Dental rool infection
  • Diving/swimming in infected water
  • Trauma
  • Cancer
321
Q

What percentage of salivary gland tumours are in the parotids?

A

80%

322
Q

What is the commonest tumour of the parotid gland?

A

Pleomorphic adenoma

323
Q

What criteria make up the ABCD2 score?

A
  • Age
  • Blood pressure
  • Character of symptoms-> weakness (2) or speech without weakness (1)
  • Diabetes
  • Duration of symptoms-> >60 mins (2), 10-59 mins (1)
324
Q

What are the risks of carotid endarterectomy?

A
  • Can cause stroke/TIA
  • MI
  • Wound haematoma
  • Death
325
Q

What structures are at risk of damage during carotid endarterectomy?

A
  • Hypoglossal nerve
  • Vagus nerve
  • Ansa cervicalis
  • Internal jugular vein
  • Superficial cervical lymph nodes
326
Q

What is an ulcer?

A

Abnormal break in epithelial surface

327
Q

What is primary intention healing?

A

Wound edges approximated + healing of epidermis + dermis occur without penetration + epithelialisation of entire dermis-> small scars

328
Q

What is secondary intention healing?

A

Wound open + allowed to granulate from bottom up-> scar large + takes longer to heal

329
Q

What can be done for someone with recurrent DVTs?

A

IVC filter-> via femoral/jugular vein + traps clots (before gets to chest)

330
Q

What are some indications for limb amputation?

A
  • Major trauma
  • Venous disease
  • Gangrene
  • Lower limb primary malignant tumour
  • Gas gangrene
  • Uncontrolled sepsis
  • Necrotising fasciitis
  • Severely deformed joints (neuropathy)
  • Failed orthopaedic surgery
331
Q

What should be considered during amputation surgery?

A
  • Adequate blood supply to stump (healing)
  • Retain as many working joints as possible
  • Site between large joints-> prosthesis fitting
332
Q

Muscles in lower leg?

A
  • Gastrocnemius
  • Tibialis anterior
  • Peronei longus
  • Soleus
333
Q

Complications of amputation?

A
  • Wound infection
  • Stump ischaemia + non-healing
  • Failure to mobilise
  • Pressure sores
  • Cardiac events or CVAs
334
Q

Stages of wound healing?

A
  • Haemostasis-> platelets migrate + form platelet plugs
  • Inflammation-> release inflammatory cytokines, recruit macrophages + fibroblasts, extracellular matrix
  • Proliferation-> angiogenesis from endothelial cells + collagen production from fibroblasts
  • Remodelling-> collagen synthesis + destruction levels, scarring (myofibroblasts + surface re-epithelialises)
335
Q

What conditions can cause varicose veins?

A
  • DVT
  • Pregnancy
  • Pelvic tumours
  • Ovarian mass
  • AV malformation
336
Q

Risk factors for varicose veins?

A
  • Obesity
  • Prolonged standing
  • Pregnancy
  • COCP
  • Family history
337
Q

Skin changes in venous disease/varicose veins?

A
  • Eczema
  • Ulcers-> medial malleolus
  • Oedema
  • Haemosiderin staining
  • Lipodermatosclerosis
338
Q

Where is the saphenovenous junction?

A

5cm below + medial to femoral pulse

339
Q

Complications of varicose veins?

A
  • Bleeding
  • Pain
  • Ulcers
  • Superficial phlebitis
  • Psychological
340
Q

What should be done for a life threatening wound?

A
  • Direct pressure
  • Elevation
  • Surgical advice
341
Q

What is the femoral triangle?

A
  • Inguinal ligament (superior)
  • Medial border to adductor longus (medial)
  • Medial border of sartorius (lateral)
342
Q

What is in the femoral triangle?

A

Femoral artery, vein, nerve and lymphatics

343
Q

Signs of vascular injury on exam?

A
  • Profuse bleed
  • Absent/reduced distal pulses
  • Expanding/pulsatile mass
  • Audible thrill over mass
344
Q

Investigation for major artery laceration repair?

A

On table arteriogram

345
Q

What is Bowen’s disease?

A

SCC in situ

346
Q

Differentials for SCC?

A
  • BCC
  • Malignant melanoma
  • Keratoacanthoma
  • Pyogenic granuloma
  • Solar keratosis
  • Warts
347
Q

What sites of SCC have the worst prognosis?

A

Ear and lip

348
Q

Appearance of shingles?

A
  • Vesicular
  • Crusting
  • Erythematous
  • Swollen plaques
  • Dermatomal
349
Q

Common chronic complication of shingles?

A

Post-herpatic neuralgia

350
Q

Grades of pressure sores?

A

I-> non blanching erythema over intact skin
II-> partial thickness skin loss
III-> full thickness skin loss + into SC fat
IV-> destruction including muscle, bone or supporting tissue

351
Q

Differentials for white atrophic area around anogenital area?

A
  • Lichen sclerosus
  • Scleroderma
  • Vitiligo
  • SCC
  • Bowen’s disease
  • Lichen planus
  • Vulval intraepithelial neoplasia
352
Q

How is lichen sclerosus managed?

A
  • Topical steroids
  • Topical emollients
  • Lubricants
353
Q

Complications of lichen sclerosus?

A
  • SCC
  • Constipation
  • Dyspareunia
  • Vulvodynia
  • Uropathy
  • Scarring
354
Q

How is BCC managed?

A

Moh’s micrographic surgery-> removed in layers + histologically analyse

355
Q

Advice to give to people with acne?

A
  • Will likely grow out of it around age 20
  • Wash face with soap and water twice daily
  • Not to do with health
356
Q

Side effects of isotretinoin?

A
  • Depression
  • Teratogenicity
  • Dry skin + lips
  • Migraine
357
Q

Upper limit of normal for intraocular pressure?

A

21mmHg

358
Q

What is gonioscopy?

A
  • Measured iridocorneal angle

- Helps distinguish between open + closed angle glaucoma

359
Q

What’s important to check in open angle glaucoma?

A

Optic disk-> check for cupping

360
Q

Risk factors for open-angle glaucoma?

A
  • Older age
  • Family history
  • Myopia
  • Race-> black
  • Intraocular HTN
361
Q

How is open-angle glaucoma managed?

A
  • Latanoprost (prostaglandin analogue)
  • Timolol (beta-blocker)
  • Pilocarpine (sympathomimetics)
  • Azetazolamide (carbonic anhydrase inhibitor)
  • Trabeculotomy
362
Q

How does latanoprost work?

A
  • Prostaglandin analogue

- Increase uveoscleral outflow

363
Q

How does timolol work?

A
  • Beta blocker

- Reduces aqueous humour production

364
Q

How does azetazolomide work?

A
  • Carbonic anhydrase inhibitor

- Reduce aqueous humour production

365
Q

How does pilocarpine work?

A
  • Sympathomimetic
  • Reduce aqueous fluid production
  • Increase uveoscleral outflow
366
Q

Symptoms of macular degeneration?

A
  • Central visual field loss
  • Reduced acuity
  • Crooked/wavy appearance to straight lines
  • Wet-> acute
367
Q

Features on fundoscopy of macular degeneration?

A
  • Reduced acuity
  • Scotoma (central vision loss)
  • Drusen on fundoscopy
  • Wet-> choroidal neovascularisation, leaky vessels
368
Q

Treatment for wet macular degeneration?

A
  • Anti-VEGF (intravitreal)
  • Photodynamic therapy
  • Laser photocoagulation
369
Q

General advice for patients with macular degeneration?

A
  • Inform DVLA
  • Stop smoking
  • Green veg
  • Won’t cause complete blindness
370
Q

Causes of painless loss of vision?

A
  • Retinal detachment
  • Vitreous haemorrhage
  • Central retinal artery occlusion
  • Retinal vein occlusion
  • CVA
371
Q

Symptoms of retinal detachment?

A
  • Visual field loss
  • Flashes
  • Floaters
  • Acuity loss
372
Q

Is hypermetropia or myopia a risk factor for retinal detachment?

A

Myopia-> retina thinned as stretched over large area

373
Q

How is retinal detachment managed?

A
  • Vitrectomy + replacement
  • Cryotherapy
  • Laser therapy
  • Scleral buckle
374
Q

Risk factors for acute closed angle glaucoma?

A
  • Family history
  • Female
  • Hypermetropia
  • Older age
375
Q

Examination findings in acute closed-angle glaucoma?

A
  • Decreased acuity
  • Hazy cornea
  • Large fixed dilated pupil
  • Increased intraocular pressure
  • Circumcorneal injection (red)
376
Q

Why is acuity decreased in acute closed angle glaucoma?

A

Corneal oedema

377
Q

Why are the symptoms of acute closed-angle glaucoma improved during sleep?

A

Pupil constricts-> pulls peripheral iris out of angle

378
Q

What should you examine when central retinal artery occlusion is suspected?

A
  • BP
  • Carotids for bruit
  • Murmurs
  • Pulse for AF
379
Q

Classical finding on fundoscopy for central retinal artery occlusion?

A
  • Pale retina

- Cherry red spot

380
Q

What is Hutchinson’s sign in shingles?

A
  • Shingles on end of nose
  • Nasocillary nerve affected
  • Likely corneal involvement-> loss of sensation means vulnerable to abrasion
381
Q

What should be tested in ophthalmic shingles?

A

Corneal sensation-> may be affected + vulnerable to ulceration

382
Q

When does puerperal psychosis present?

A

3-5 days (always <2 weeks)

383
Q

How likely is puerperal psychosis to recur?

A

50% chance in next pregnancy

384
Q

Risk factors for post-partum depression?

A
  • Previous history
  • Previous depression or bipolar
  • Lack of social support
  • Marital/partner relationship problems
  • Recent stressful events
385
Q

What medical problem should be considered in people presenting with post-partum depression?

A

Post-partum thyroiditis

386
Q

What causes baby blues?

A
  • Psychosocial

- Hormones

387
Q

Risk factors for pre-eclampsia?

A
  • Nulliparity
  • Multiple gestation
  • Previous history
  • Family history
  • Diabetes
  • Pre-existing HTN
  • Older age
  • Obesity
  • Antiphospholipid syndrome
  • AI disease
388
Q

How is magnesium sulphate toxicity monitored?

A

Reflexes checked

389
Q

Signs of chorioamnionitis?

A
  • Mum-> pyrexia, tachycardia, hypotension, discharge, tenderness
  • Foetus-> tachycardia
390
Q

Components of Bishop score?

A
  • Cervical dilatation
  • Position of cervix
  • Effacement of cervix
  • Consistency of cervix
  • Station of foetal head
391
Q

Why is left DVT more common than right DVT in pregnancy?

A

Gravid uterus puts more pressure on left iliac vein-> slower venous return

392
Q

What blood tests should be done in suspected obstetric cholecystitis?

A
  • LFTs

- Bile acids

393
Q

How should obstetric cholestasis be managed?

A
  • Ursodeoxycholic acid
  • topical emollients
  • antihistamines
  • induction of labour
394
Q

Risk factors for shoulder dystocia?

A
  • Previous dystocia
  • High maternal BMI
  • Large foetus
  • Diabetes
  • Prolonged 1st or 2nd stage of labour
  • Oxytocin augmentation
  • Secondary arrest
395
Q

Manoeuvres in shoulder dystocia?

A
  • McRoberts-> hyperflexion of maternal legs

- Suprapubic pressure

396
Q

Components of APGAR score?

A
  • Appearance
  • Pulse rate
  • Grimace reflex
  • Activity (tone)
  • Respiratory effort
397
Q

Risk factors/causes of cord prolapse?

A
  • Abnormal lie
  • Polyhydramnios
  • Prematurity
  • Foetal abnormalities
  • Abnormal placentation
  • Artificial rupture of membranes
  • Breech
  • Unengaged presenting part
398
Q

What should be done during cord prolapse?

A
  • Pressure off cord by lifting baby’s head

- Emergency C section

399
Q

Why might pregnant people have anaemia?

A

Normal + physiological

400
Q

What can cause ejection systolic murmur in pregnancy?

A

Hyperdynamic circulation-> normal

401
Q

How do pregnant people increase their oxygen intake?

A

Increase tidal volume

402
Q

What are some contraindications to foetal blood sampling?

A
  • Maternal infection
  • Foetal blood disorder
  • Prematurity
  • Abnormal presentation
403
Q

What should happen if someone is shown to have dyskaryosis on smear?

A

Colposcopy referal

404
Q

What is ectropion?

A

Endocervical columnar epithelium (not normal squamous) outside of external os

405
Q

What is CIN?

A

Premalignant-> abnormally dividing cells don’t invade below basement membrane

406
Q

What does LLETZ stand for?

A

Large loop excision of the transition zone

407
Q

What is a dermoid cyst?

A

Derived from primitive germ cells-> can differentiate into any body tissue + low risk of malignancy

408
Q

Where is endometriosis likely to occur?

A
  • Ovary
  • Rectovaginal pouch
  • Uterosacral ligament
  • Pelvic peritoneum
  • Umbilicus
  • Lower abdominal scars
  • Lung
409
Q

Risk factors for endometriosos?

A
  • AGe
  • IUD use long term
  • Smoking
  • Family history
410
Q

Symptoms of endometriosis?

A
  • Dysmenorrhoea
  • Chronic pelvic pain
  • Cyclical + radiate to legs
  • Dyspareunia
  • Dysuria
  • Pain on defecation
  • Rectal bleeding
  • Diarrhoea
  • Haematuria
411
Q

What is adenomyosis?

A

Endometrial tissue in myometrium

412
Q

Treatments for endometriosis?

A
  • Analgesia eg NSAIDs
  • COCP
  • POP
  • Mirena coil
  • GnRH agonists
  • Laparoscopy + excision/ablation of deposits
  • Hysterectomy + bilateral salpingo-oophorectomy
413
Q

Blood tests for ovulatory function?

A
  • LH
  • FSH
  • Oestradiol
  • 21 day progesterone
  • Prolactin
414
Q

Tests for tubal patency?

A

Hysterosalpingogram

415
Q

Symptoms of PCOS?

A
  • Hirsuitism
  • Weight gain
  • Acne
  • Amenorrhoea
  • Infertility
  • Diabetes symptoms
416
Q

treatment for PID?

A

IV ceftriaxone + doxycycline +/- metronidazole

417
Q

Contraindications to IUD?

A
  • Pregnancy
  • STI
  • Cancers-> ovary, endometrium, cervical
418
Q

What can cause post-menopausal bleeding?

A
  • Endometrial cancer
  • Endometrial hyperplasia
  • Polyps
  • Fibroids
  • Cancers-> vagina, cervix, ovary
  • Trauma
  • Infection
419
Q

What is red degeneration of fibroids?

A
  • Ischaemia, infarction and necrosis of fibroid
  • Usually larger + during late pregnancy
  • Severe abdo pain + low grade fever
420
Q

Initial radiological investigation for post-menopausal bleeding?

A

TVUS of pelvis

421
Q

Treatment of endometrial cancers confined to uterus + cervix?

A
  • Chemo
  • Hormone-> medroxyprogesterone acetate
  • Radiotherapy
422
Q

Where do endometrial cancers metastasise to?

A
  • Liver
  • Bone
  • Inguinal LNs
  • Vagina
  • Peritoneum
  • Lung
423
Q

How does warfarin work?

A
  • Inhibits reductase enzyme responsible for regeneration of active vitamin K
  • Inhibits production of vitamin K dependent clotting factors-> 2, 7, 9, 10
  • Vitamin K antagonist
424
Q

Contraindications to thrombolysis?

A
  • Age <18 or >80
  • Haemorrhagic stroke
  • SAH
  • Active bleeding
  • Major surgery within 14 days
  • GI bleed in last 21 days
  • Thrombocytopaenia
  • Pregnancy
  • Systolic BP >185
  • Previous intracranial haemorrhage
  • Neurosurgery in last 3 months
  • Recent LP
  • Hypoglycaemia
425
Q

Myeloma screen components?

A
  • Urine Bence-Jones protein

- Serum electrophoresis

426
Q

Abnormality on X-rays in myeloma?

A

Lytic lesions

427
Q

How is spinal cord compression managed?

A
  • Surgery

- Radiotherapy

428
Q

How is hypercalcaemia managed?

A
  • IV fluids

- IV bisphosphonates

429
Q

Palliative care symptoms and management options?

A
  • Pain-> morphine
  • Agitation-> midazolam
  • Respiratory secretions-> glycopyrronium bromide
  • Nausea-> cyclizine
  • Dyspnoea-> morphine
430
Q

Risk factors for schizophrenia?

A
  • Family history
  • Male
  • Obstetric/prenatal events (eg low birth weight)
  • Perinatal infection
  • Cannabis use
  • Asian or African
  • Poor social situation
431
Q

What is a delusion?

A
  • False held believe with strong conviction despite evidence against it
  • Not in keeping with person’s social + cultural background
432
Q

Negative symptoms of schizophrenia?

A
  • Apathy
  • Reduced speech
  • Blunted affect
  • Social withdrawal
433
Q

What are acute dystonic reactions?

A
  • Secondary to antipsychotics

- Dopamine form substantia nigra blocked-> Parkinsonism occurs

434
Q

What affect does dopamine have on prolactin?

A

Inhibits prolactin release

435
Q

What BMI supports a diagnosis of anorexia?

A

<17.5

436
Q

What can be done if someone presents within 1 hour of paracetamol overdose?

A
  • Activated charcoal-> large surface area to absorb poison + stop absorption
  • Gastric lavage
437
Q

How does NAC work?

A
  • NAPQI metabolite detoxified by conjugation with glutathione
  • Overdose-> glutathione reserves depleted
  • NAC-> gives liver enough glutathione to break NAPQI into form that can be excreted
438
Q

What blood tests should be done after paracetamol OD treatment?

A
  • Clotting studies
  • LFTs
  • U+Es
  • ABG for blood pH
439
Q

Worrying features of self harm that put patient at high likelihood of completed suicide?

A
  • Intention of attempt was death
  • Current psych illness
  • Poor social resources
  • Previous attempts
  • Social isolation
  • Male
  • Unemployed
  • Over 50
440
Q

What detox programmes are available for opioid addiction?

A
  • Methadone
  • Psych-> group therapy etc
  • Rapid detox with naltrexone
441
Q

How does CBT work in anxiety?

A
  • Identifying situations that provoke anxiety
  • Recognition that thoughts are causing panic attacks and aren’t correct
  • Alter negative cognitions
  • Coping mechanisms to deal with situations
442
Q

How does graded exposure therapy work in GAD/OCD?

A
  • Therapist evaluates unpleasant effects of stimuli
  • Exposes patient at increased levels
  • Calms patient down with coping mechanisms
  • Allow patient to function in unpleasant situation
443
Q

What might cause jaundice in first 24 hours of life?

A
  • Always abnormal
  • Rhesus haemolytic disease
  • ABO incompatibility
  • Hereditary sphenocytosis
  • G6PD deficiency
  • Haematomas
  • Toxoplasmosis
  • Syphilis
  • Rubela
  • CMV
  • Herpes
  • Hepatitis
444
Q

Investigations for neonatal jaundice (<24 hours of life)?

A
  • FBC
  • Bilirubin
  • Blood group
  • Direct Coomb’s
  • Blood film
  • TORCH screen
  • Urine-reducing substances
  • Urine dip + microscopy
445
Q

What should be suspected when baby has prolonged jaundice + pale stools + raised conjugated bilirubin?

A

Biliary atresia

446
Q

Causes of acyanotic heart disease?

A
  • ASD
  • VSD
  • PDA
  • Coarctation of aorta
447
Q

Causes of cyanotic heart disease?

A
  • Teralogy of Fallot
  • Transposition of great arteries
  • Tricuspid atresia
  • Pulmonary atresia
448
Q

What is Eisenmenger’s syndrome?

A

Left to right shunt-> pulmonary HTN + shunt reversal-> cyanotic heart defect

449
Q

What are the risk factors of infant respiratory distress syndrome?

A
  • Prematurity
  • Maternal diabetes
  • C-section
  • Male
  • Hypothermia
  • Family history
450
Q

What cells produce surfactant in the lungs?

A

Type II pneumocytes

451
Q

CXR findings in infant respiratory distress syndrome?

A

Diffuse granular or ground glass shadowing

452
Q

What is a complex febrile seizure?

A
  • Lasts 15+ mins
  • Recurrence within 24 hours
  • Incomplete recovery within 1 hour
  • Focal neurology
453
Q

What is cerebral palsy?

A

Chronic disorder of movement and posture due to non-progressive brain abnormalities occurring before the brain is fully developed

454
Q

What are the different types of cerebral palsy?

A
  • Spastic
  • Athetoid
  • Ataxic
  • Mixed
455
Q

Signs and symptoms of cerebral palsy?

A
  • Delayed milestones
  • FTT
  • Epilepsy
  • Urinary incontinence
  • Constipation
  • Drooling
  • Sleep disturbance
  • Contractures
456
Q

What medications can help with muscle spasm in cerebral palsy?

A
  • Baclofen
  • Diazepam
  • Dantrolene
457
Q

X-ray findings in intussussception?

A
  • Target sign
  • RUQ opacity
  • Dilated gas filled proximal bowel
  • Absence of gas in distal bowel
  • Fluid levels
  • Perforation
458
Q

Indications for laparotomy in intissusseption?

A
  • Perforation
  • Peritonitis
  • Prolonged
  • Failed enema
  • High likelihood of pathological cause
459
Q

How do statins work?

A

Inhibits HMG-CoA reductase (rate limiting step in cholesterol synthesis)

460
Q

Signs of hypercholesterolaemia on examination?

A
  • Xanthelasmata
  • Tendon xanthoma
  • Corneal arcus
  • Other xanthomatas
461
Q

What can cause AF?

A
  • Pneumonia
  • MI
  • PE
  • Hyperthyroidism
  • Alcohol XS
  • Heart failure
  • Endocarditis
462
Q

What is cardioversion (for AF)?

A
  • Medical-> amiodarone, flecainide
  • Electrical-> DC cardioversion
  • Ablation
463
Q

Complications of AF?

A
  • Stroke
  • TIA
  • Heart failure
  • Systemic emboli
  • Falls
464
Q

What organism usually causes infective endocarditis?

A

Streptococcus viridans-> 50-80%

465
Q

Why is urine dipstick done in infective endocarditis?

A

Check for microscopic haematuria

466
Q

What are Roth spots?

A
  • Boat shaped retinal haemorrhage with pale centre

- In infective endocarditis

467
Q

What criteria is used to diagnose infective endocarditis?

A

Duke criteria

468
Q

Signs of aortic regurgitation?

A
  • Early diastolic murmur
  • Austin-Flint murmur
  • Collapsing pulse
  • Wide pulse pressure
  • Displaced apex beat
  • Corrigan’s sign-> carotid pulsation
469
Q

How are blood cultures taken in infective endocarditis?

A

Three sets from different sites three different times

470
Q

Risk factors for infective endocarditis?

A
  • IVDU
  • Rheumatic heart disease
  • Prosthetic valves
  • PDA
  • VSD
  • Coarctation
  • MV disease
  • Aortic valve disease
471
Q

How can infective endocarditis be prevented in IVDUs?

A
  • Education on needle use and sterile techniques

- Prophylactic antibiotics before invasive procedures

472
Q

Investigations for PE?

A
  • Well’s score
  • D-dimer
  • CTPA
  • V/Q perfusion scan
473
Q

How does SVC compression present?

A
  • Worsening SOB
  • Severe headache
  • Swelling in arms + legs
  • Dilated neck veins (non-pulsatile)
  • Positive Pemberton’s test
  • Known malignancy or lymphoma
474
Q

What is Pemberton’s test?

A
  • Raise arms above head
  • JVP raises, SOB/stridor, cyanosis in face
  • Indicates SVC compression
475
Q

How does pulmonary fibrosis show on CXR?

A
  • Reduced lung volume
  • Reticulonodular shadowing (worse in lower zones)
  • Honeycomb lung (advanced)
476
Q

What respiratory diseases can cause clubbing?

A
  • Pulmonary fibrosis
  • Bronchiectasis
  • Chronic abscess
  • Chronic empyema
  • Lung cancer
  • Mesothelioma
  • Cryptogenic organising pneumonia
477
Q

What questionnaire can be used to assess obstructive sleep apnoea?

A

Epworth sleepiness scale/score

478
Q

CXR findings in cor pulmonale?

A
  • Dilatation of right atrium
  • Enlarged RV
  • Prominent pulmonary arteries
479
Q

ECG changes in cor pulmonale?

A
  • Right axis deviation
  • P pulmonale
  • Dominant R wave in V1
  • Inverted T waves in chest leads
480
Q

What can cause bilateral hilar lymphadenopathy?

A
  • Lung cancer
  • Lymphoma
  • TB
  • Mycoplasma
  • Extrinsic allergic alveolitis
481
Q

What is seen on biopsy in sarcoidosis?

A

Non-caseating granulomas

482
Q

Extra-pulmonary signs of sarcoidosis?

A
  • Erythema nodosum
  • Ocular-> anterior uveitis, posterior uveitis
  • Arthralgia
  • Neuropathy
  • CN palsy
  • Cardiomyopathy
  • Ventricular dysrythmias
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Hypercalcaemia
483
Q

Why should pleural tap (for effusion) be done above the rib?

A

Avoid neurovascular bundle (immediately beneath ribs)

484
Q

If pleural fluid has high protein content, is it exudate or transudate?

A

Exudate

485
Q

If pleural fluid has high LDH content, is it exudate or transudate?

A

Exudate

486
Q

What lab tests should be performed on pleural fluid?

A
  • Protein
  • LDH
  • MC & S
  • Cytology
  • Glucose
  • Amylase
  • PH
  • Ziehl-Neelsen staining
487
Q

What is pleurodesis?

A
  • Done in malignant pleural effusion
  • Drain effusion then plug gap
  • Can use talc, bleomycin, tetracycline
488
Q

What is nephrotic syndrome?

A
  • Proteinuria (>3g/24 hours)
  • Hypoalbuminaemia (<30g/L)
  • Oedema
489
Q

Most common nephrotic syndrome in kids?

A

Minimal change disease

490
Q

Most common nephrotic syndrome in adults?

A

Membranous nephropathy

491
Q

Complications of nephrotic syndrome and their management?

A
  • Increased infections-> antibiotics when suspected, PCV
  • Thromboembolism risk-> anticoagulation, avoid prolonged bed rest
  • Hyperlipidaemia-> statins
492
Q

Dietary advice in nephrotic syndrome?

A

Normal protein level + low salt diet

493
Q

What is the risk of correcting chronic hyponatraemia too quickly?

A

Central pontine myelinolysis

494
Q

How does ADH work?

A
  • Recruits aquaporin 2 channels to apical membrane of principal cells of collecting duct
  • Makes it water permeable-> reduced secretion and increases water retention
495
Q

What does SIADH cause (in terms of blood and urine osmolality)?

A
  • Euvolaemic hyponatraemia

- Increased urine osmolality-> more concentrated

496
Q

What is used to treat SIADH?

A
  • Strict fluid restriction

- Demeclocycline

497
Q

Risk factors for UTI?

A
  • Female
  • Pregnancy
  • Diabetes
  • Renal calculi
  • Long term catheter
  • Immunosuppression
  • Post-menopause
  • Sexually active
  • Spermicide
  • Incontinence
  • Poor hygiene
498
Q

Contraindications to renal biopsy?

A
  • Abnormal coagulation
  • Single functioning kidney
  • Systolic BP >160
  • Diastolic BP >90
  • CKD with small kidneys
499
Q

Complications of renal biopsy?

A
  • Macroscopic haematuria
  • Haematuria needing blood transfusion, angiography or nephrectomy
  • Pain
  • Haematoma
  • AV aneurysm formation
  • Infection
  • Death
500
Q

What is heliotrope?

A
  • Purple discolouration to eyelids

- In dermatomyositis

501
Q

What are Gottron’s papules?

A
  • Rough, red papules over knuckles

- In dermatomyositis

502
Q

What autoantibodies are associated with dermatomyositis?

A
  • RF
  • ANA
  • Anti-Jo-1
  • Anti-Mi-2
503
Q

What can cause Raynaud’s phenomenon?

A
  • Raynaud’s disease
  • SLE
  • RA
  • Dermatomyositis
  • Polymyositis
  • Ehler Danlos
  • Beta blockers
  • Polycythemia rubra vera
  • Occupation
  • MGUS
  • Hypothyroid
  • Atherosclerosis
  • Buerger’s disease
504
Q

What are the features of CREST syndrome (limited cutaneous systemic sclerosis)?

A
  • Calcinosis
  • Raynaud’s
  • Oeseophageal dysmotility
  • Sclerodactyly
  • Telangiectasia
505
Q

Radiograph findings in ankylosing spondylitis?

A

Bamboo spine->

  • calcification of intervertebral ligaments
  • fusion of spinal facet joints
  • formation of bridging syndesmophytes
506
Q

Eye problem common in ankylosing spondylitis?

A

Anterior uveitis

507
Q

Common lung finding in ankylosing spondylitis?

A

Fine inspiratory creps-> pulmonary fibrosis

508
Q

Common heart sound in ankylosing spondylitis?

A

Aortic regurgitation-> early diastolic murmur

509
Q

What is arthritis mutilans?

A
  • Periarticular osteolysis and shortening of bones

- Severe form of psoriatic arthritis

510
Q

What usually triggers reactive arthritis?

A
  • STI

- Gastroenteritis

511
Q

What is Reiter’s syndrome?

A

Arthritis + urethritis + conjunctivitis

512
Q

What are examples of ANCA +ve small vessel vasculitis?

A
  • Wegener’s granulomatosis
  • Microscopic polyangiitis
  • Churg-Strauss syndrome
513
Q

What are examples of ANCA -ve small vessel vasculitis?

A
  • HSP
  • Goodpasture’s disease
  • Cryoglobulinaemia
514
Q

What are examples of medium vessel vasculitis?

A
  • Kawasaki disease

- Polyarteritis nodosa

515
Q

What are examples of large vessel vasculitis?

A
  • Temporal arteritis (GCA)

- Takayasu’s arteritis

516
Q

What systemic diseases can cause vasculitis?

A

-RA
-SLE
-IBD
-Scleroderma
-Bechet’s
-Hep B+C
Polymyositis
-Dermatomyositis
-Infective endocarditis

517
Q

What can cause mononeuritis multiplex (2+ peripheral nerves)?

A
  • RA
  • Diabetes
  • HIV/AIDS
  • Sarcoidosis
  • Polyarteritis nodosa
  • Leprosy
  • Wegener’s granulomatosis
518
Q

What bedside test can confirm DKA?

A

Urine dipstick-> urinary ketones

519
Q

What are some features of Addison’s disease (primary adrenal insufficiency)?

A
  • Fatigue
  • Nausea
  • Abdominal cramps
  • Reduced libido
  • Bronze hyperpigmentation
  • Hypotension
520
Q

What causes bronze hyperpigmentation in adrenal insufficiency?

A

ACTH stimulates melanocytes to produce melanin

521
Q

What blood results would you expect in Addisonian crisis?

A
  • Hypotensive
  • Hyperkalaemic
  • Hypoglycaemic
  • Hyponatraemia
522
Q

What test is diagnostic for Addison’s disease?

A

Synacthen test
-Give artificial ACTH
-Measure cortisol at 30 + 60 minutes
-Failure to rise less than double the baseline-> Addison’s
-Long test-> no cortisol response as adrenals don’t work (Addison’s)
or eventually rise (adrenal atrophy ie secondary)

523
Q

What U+E test results will be apparent in Addison’s?

A
  • Hyponatraemia

- Hyperkalaemia

524
Q

What is prescribed in Addison’s disease?

A
  • Glucocorticoids-> hydrocortisone

- Mineralocorticoids-> fludrocortisone

525
Q

Imaging for prolactinoma?

A

MRI head

526
Q

What treatments can be used in prolactinoma?

A
  • Dopamine agonists-> cabergoline or bromocriptine
  • Radiotherapy
  • Surgery
527
Q

Blood results for primary hyperparathyroidism?

A
  • PTH high
  • Calcium high
  • Phosphate low
528
Q

Bloods for secondary hyperparathyroidism?

A
  • PTH high
  • Calcium low/normal
  • Phosphate high/normal
529
Q

Bloods for tertiary hyperparathyroidism?

A
  • PTH high
  • Calcium high
  • Phosphate high
530
Q

Complications of parathyroid gland resection?

A
  • Hypoparathyroidism

- Laryngeal nerve palsy

531
Q

What does vitamin D do to calcium?

A

Needed to absorb calcium in the gut

532
Q

What sensory modality is lost first in diabetic neuropathy?

A

Vibration

533
Q

What might be seen on diabetic foot exam?

A
  • Blunted sensation
  • Charcot’s joints (deformity)
  • Painless ulcers
  • High arched foot
  • Toe clawing
  • Diminished reflexes
534
Q

What types of neuropathy occur in diabetics?

A
  • Symmetrical polyneuropathy
  • Autonomic neuropathy
  • Diabetic amyotrophy
  • Mononeuropathy
  • Mononeuritis multiplex
  • Acute painful neuropathy
535
Q

What is the diagnosis- diabetic with neuropathy presenting with intractable vomiting?

A

Autonomic gastroparesis

536
Q

What type of transfusion reaction might be happening- 15 minutes in, temperature of 38.4, BP drop?

A
  • Acute haemolytic reaction

- Bacterial contamination

537
Q

Early complications of blood transfusion?

A
  • Acute haemolytic reaction
  • Bacterial contamination
  • Allergic reaction
  • Anaphylaxis
  • Transfusion related acute lung injury
  • Fluid overload
  • Non-haemolytic febrile transfusion reaction
538
Q

Late complications of blood transfusion?

A
  • Iron overload
  • Graft versus host disease
  • Post transfusion purpura
  • Infection
539
Q

What is a massive blood transfusion?

A

Entire blood volume (or 10 units) transfused within 24 hours

540
Q

What might cause megaloblastic macrocytic anaemia?

A
  • B12 deficiency
  • Folate deficiency
  • Cytotoxic drugs
541
Q

What might cause normoblastic macrocytic anaemia?

A
  • Alcohol
  • Liver disease
  • Hypothyroidism
  • Pregnancy
  • Reticulocytosis
542
Q

How is pernicious anaemia diagnosed?

A
  • FBC
  • Parietal cell antibody serology
  • Intrinsic factor antibody serology
  • Schilling test
543
Q

Signs of thalassaemia?

A
  • Hypochronic microcytic anaemia
  • Hepatosplenomegaly
  • Frontal bossing
  • Jaw enlargement
  • Dental malocclusion
  • Flow murmur
  • Pallor
  • Tachycardia
544
Q

How is beta-thalassaemia major managed?

A
  • Blood transfusions
  • Iron chelation therapy-> desferrioxamine
  • Genetic counselling
545
Q

What can cause acute presentations of limb pain after minor injury in Haemophilia A?

A

Compartment syndrome

546
Q

What causes joint deformity in haemophilia A?

A

Spontaneous bleeds into joints

547
Q

What clotting factor is affected in haemophilia A?

A

Factor VIII

548
Q

What would clotting studies look like in Haemophilia A?

A
  • INR normal

- APTT raised

549
Q

Why might someone be diagnosed with haemophilia A at an older age?

A

Acquired disease

550
Q

Hereditary causes of liver cirrhosis?

A
  • Haemochromatosis
  • Wilson’s disease
  • Alpha-1-antitrypsin deficiency
551
Q

Acquired causes of liver cirrhosis?

A
  • Chronic alcohol abuse
  • Chronic viral hepatitis
  • Autoimmune hepatitis
  • Primary biliary cirrhosis
  • Venous obstruction
  • Idiopathic
552
Q

How is the synthetic function of the liver tested for?

A
  • Albumin

- INT or PT

553
Q

How is ascites managed?

A
  • Fluid restriction
  • Low sodium diet
  • Diuretics
  • Abdominal paracentesis-> drainage
  • Albumin infusion
554
Q

What lab tests should be done for ascitic fluid?

A
  • WCC
  • MC&S
  • Cytology
  • Albumin
  • LDH
  • Glucose
555
Q

Why are laxatives given in hepatic encephalopathy?

A

Increase bowel transit-> reduce number of nitrogen producing bacteria in gut (contributes to encephalopathy)

556
Q

How does coeliac disease present?

A
  • Abdominal pain
  • Weight loss
  • N+V
  • Diarrhoea
  • Steatorrhoea
  • Fatigue
  • Iron deficiency anaemia
  • Osteomalacia
  • FTT
  • Infertility
  • IgA deficiency
  • Dermatitis herpetiformis
557
Q

Why might anti-EMA antibodies be negative in coeliac disease?

A

Severe malabsorption-> IgA deficiency (+other proteins)

558
Q

Histological features of coeliac disease?

A
  • Villous atrophy
  • Increased intraepithelial lymphocytes
  • Hypoplasia of small bowel architecture
  • Proliferation of crypts of Lieberkuhn
559
Q

Cancers associated with coeliac disease?

A
  • GI T-cell lymphoma
  • Enteropathy associated T-cell lymphoma (EATL)
  • NHL
  • Gastric
  • Oesophageal
  • Small bowel
560
Q

Where do colorectal cancers usually metastasise to?

A
  • Lymphatics
  • Local invasion
  • Liver
  • Lung
  • Bone
561
Q

What organisms commonly cause meningitis in young adults?

A
  • Neisseria meningitidis

- Streptococcus pneumoniae

562
Q

Why might CT head be done before LP in meningitis?

A

To rule out raised intracranial pressure

563
Q

Which muscles does the median nerve supply?

A

LLOAF

  • Lateral lumbricals (2)
  • Opponens pollicis
  • Abductor pollicis brevis
  • Flexor pollicis brevis
564
Q

What are some risk factors for carpal tunnel syndrome?

A
  • Pregnancy
  • Repetitive activity
  • Menopause
  • OCP
  • Obesity
  • Trauma
  • Diabetes
  • Hypothyroidism
  • RA
  • Acromegaly
  • Amyloidosis
  • Dialysis
  • Local compression-> lipoma, ganglion
565
Q

Management options for Parkinson’s?

A
  • Levodopa + co-careldopa etc
  • Bromocriptine or cabergoline-> dopamine agnonists
  • Selegiline or rasagiline-> monoamine oxidase-B inhibitors
  • Entacapone-> COMT inhibitors
566
Q

What can be used to medically manage raised intracranial pressure?

A
  • IV mannitol

- Dexamethasone

567
Q

What is Beck’s triad?

A
  • Falling BP + rising JVP + muffled heart sound

- Indicates cardiac tamponade

568
Q

How is tension pneumothorax managed?

A
  • Wide bore cannula

- 2nd IC space, midclavicular line, affected side

569
Q

What can cause pneumothorax?

A
  • Idiopathic
  • Trauma
  • Asthma
  • COPD
  • Lung cancer
  • Pneumonia
  • Lung abscess
  • TB
  • Sarcoidosis
  • Barotrauma
  • CF
  • Connective tissue disorders
  • Iatrogenic-> mechanical ventilation, CVP line insertion
570
Q

How long does it take for PTX to resorb?

A

1.25% of radiographic lung volume per day

571
Q

How long should patients refrain from flying after pneumothorax?

A

1 month after symptoms + PTX resolved

572
Q

Signs on examination in PCKD?

A
  • HTN
  • Palpable kidneys (large + irregular)
  • Hepatomegaly
  • Mitral valve prolapse-> late diastolic murmur
573
Q

Complications of PCKD?

A
  • Berry aneurysms
  • Chronic renal failure
  • HTN
  • Renal calculi
  • Cyst infection
  • Chronic pain
  • Hepatic cysts
  • Haematuria
574
Q

What is Cushing’s disease?

A

Hypersecretion of ACTH from pituitary adenoma

575
Q

What images should be requested in someone with Cushing’s syndrome?

A
  • MRI brain
  • CT abdo
  • CXR
576
Q

How is Cushing’s syndrome investigated?

A
  • Dexamethasone suppression test

- 24 hour urinary cortisol

577
Q

Why might someone with acute epigastric pain need a CXR?

A

Check for pneumoperitoneum

578
Q

What are some components of the Glasgow score for pancreatitis?

A
  • pO2 <8kPa
  • Age 55+
  • Neutrophils (WBCs >15)
  • Corrected calcium <2
  • Urea >16
  • Enzymes (LDH >600 or AST/ALT >200)
  • Albumin <35g/L
  • Glucose >10mmol
579
Q

What is Cullen’s sign?

A

Bruising around umbilicus-> intra-abdominal bleeding in pancreatitis

580
Q

What is Grey Turner’s sign?

A

Bruising along flanks-> intra-abdominal bleeding in pancreatitis

581
Q

What tumour is associated with myasthenia gravis?

A

Thymoma

582
Q

What investigations can aid diagnosis of myasthenia gravis?

A
  • Acetylcholine receptor antibody
  • Anti-MuSK
  • Tensilon test
  • Neurophysiology studies
  • Muscle biopsy
  • CT/MRI for thymoma
583
Q

Treatment options for myasthenia gravis?

A
  • Acetylcholinesterase inhibitors-> neostigmine, pyridostigmine
  • Immunosuppression-> prednisolone, azathioprine, ciclosporin
  • Plasmapheresis
  • IV Igs
  • Thymectomy
584
Q

What can cause a midline neck mass?

A
  • Thyroglossal cyst
  • Dermoid cyst
  • Chondroma
  • Thymus mass
585
Q

How do thyroglossal cysts arise?

A
  • Thyroid develops at foramen caecum
  • Migrate to base of neck
  • Connect to tongue by thyroglossal duct
  • Cysts can arise anywhere on pathway
586
Q

What medical management can be given in PPH?

A
  • Ergometrine
  • Oxytocin
  • Carboprost
  • Haemabate
587
Q

What is a cystocele?

A

A prolapse of the anterior vaginal wall containing bladder

588
Q

What is a rectocele?

A

Prolapse of rectum into the posterior vaginal wall

589
Q

What investigation should be done in incontinence with prolapse?

A

Urodynamic studies

590
Q

What medical treatments can be used in urge incontinence?

A

Antimuscarinics-> oxybutynin, solifenacin, tolterodine

591
Q

What proportion of Caucasians are carriers of cystic fibrosis?

A

1 in 25

592
Q

What are some pulmonary complications of cystic fibrosis?

A
  • Recurrent chest infections
  • PTX
  • Bronchiectasis
  • Pulmonary HTN
  • Aspergillus
  • Nasal polyps
593
Q

What are some GI complications of cystic fibrosis?

A
  • Cirrhosis
  • Pancreatitis
  • Intestinal blockage-> constipation, obstruction, intussusception
  • Reflux
  • Meconium ileus
594
Q

What are the possibly modalities of sustaining burns?

A
  • Thermal injury
  • Electricity
  • Chemicals
  • Radiation
595
Q

How can the extent of burns be assessed?

A
  • Wallace rule of nines

- Lund and Browder chart

596
Q

What are the features of superficial burns?

A
  • Pain
  • Blisters
  • Erythema
  • Brisk capillary refill
597
Q

What are the features of full-thickness burns?

A
  • Painless
  • No blisters
  • White/grey/black
  • Absent cap refill
598
Q

What is the Parkland formula (ie how much IV Hartmann’s to give to someone with burns over 24 hours)?

A

4 x body weight (kg) x body surface area affected (%)

599
Q

How is administration of fluid divided over 24 hours in burns treatment?

A
  • 1/2 given over 8 hours

- 1/2 given over 16 hours

SAQs (1 decks)

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