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Phase 2a > Shit I don't know > Flashcards

Shit I don't know Flashcards

1
Q

What are the hypertension stages (clinical/ambulatory)?

A

Stage 1 = 140/90 or 145/90
Stage 2 = 160/100 or 165/105
Severe = 180/110

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2
Q

What are 6 causes of peptic ulcers?

A
  1. H. Pylori
  2. Increased acid production
  3. NSAIDs
  4. Mucosal Ischaemia
  5. Smoking/alcohol
  6. Stress
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3
Q

What are 4 complications of untreated GORD?

A
  1. Oesophageal ulcers
  2. Oesophagitis
  3. Barrett’s oesophagus
  4. Oesophageal cancer
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4
Q

What is achalasia?

A

Impaired oesophageal peristalsis due to LOS not opening

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5
Q

Where is colon cancer most common?

A

Rectum and sigmoid colon (distal colon)

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6
Q

What are 4 causes of diverticula formation?

A
  1. Low fibre diet
  2. Obesity
  3. Smoking
  4. NSAIDs
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7
Q

How does crohn’s commonly cause anaemia?

A

Iron and folate deficiency

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8
Q

What are 4 symptoms of prostatitis?

A
  1. Pelvic pain
  2. LUTS
  3. Sexual dysfunction (post ejac. pain)
  4. Pain on defecation
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9
Q

What is reactive arthritis also known as?

A

Reiter’s syndrome

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10
Q

What is a common complication of PKD?

A

Berry aneurysms –> subarachnoid haemorrhage

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11
Q

What is a thunderclap headache indicative of?

A

Subarachnoid haemorrhage

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12
Q

How does nephrotic syndrome present?

A
  • Proteinuria
  • HYPOalbuminaemia
  • Oedema
  • HYPERlipidaemia
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13
Q

How does nephritic syndrome present?

A
  • Proteinuria
  • Haeamaturia
  • Oliguria
  • HTN
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14
Q

What are 5 risk factors of DVT?

A
  1. Pregnancy
  2. Recent surgery
  3. Recent leg fracture
  4. Combined oral contraceptive (not POC)
  5. History of cancer
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15
Q

What criteria is used for DVT?

A

Well’s score

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16
Q

What is the prophylaxis treatment for VTE?

A

LMWH (dalteparin) and DOAC (apixaban)

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17
Q

What does rituximab do?

A

Acts on B cells (CD20) to reduce antibody production

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18
Q

What does infliximab do?

A

Tumour necrosis factor inhibitor

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19
Q

What is the treatment for complicated/severe malaria?

A
  • IV artesunate (first line)
  • IV quinine and doxycycline
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20
Q

What is the treatment for uncomplicated malaria?

A

Oral chloroquine

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21
Q

What does an atherosclerotic plaque contain?

A
  • Connective tissue
  • Foam cells (lipid laden macrophages)
  • T lymphocytes
  • Smooth muscle cells
  • Cholesterol
  • Lipid deposits
  • Fragments of destroyed internal elastic lamina
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22
Q

What is Budd Chiari syndrome?

A

Thrombus in hepatic vein (can cause liver failure)

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23
Q

How does pseudogout present?

A
  • Knee pain
  • Red and swollen
  • Fever
  • Patient may feel fine
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24
Q

What is the first line investigation for stroke?

A

CT head to figure out what type of stroke it is

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25
Q

Unprovoked epileptic seizures require preventative treatment such as…

A

Sodium valproate

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26
Q

What are 4 common causes of peripheral neuropathy?

A
  1. Diabetes (loss of sensation in ‘glove and stocking’ distribution)
  2. Immunocompromised state (Hep C, diphtheria, leprosy, HIV, lyme disease)
  3. Connective tissue disorders (e.g. SLE, Sjogren’s)
  4. Alcohol –> vitamin B1 (thiamine) deficiency
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27
Q

What are the 3 most common bacterial causes of IECOPD?

A
  1. Haemophilus influenza
  2. Strep. pneumonia
  3. Moraxella catarrhalis
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28
Q

What is the most common viral cause of IECOPD?

A

Rhinovirus

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29
Q

What investigation is done first for IECOPD?

A

Arterial blood gas sampling to assess severity

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30
Q

How does acute severe asthma present?

A
  • Inability to complete sentences in one breath
  • RR >25/min
  • HR >110/min
  • PEF 33-50%
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31
Q

How does life threatening asthma present?

A
  • Altered consciousness
  • Silent chest
  • Hypotension
  • SpO2 <92%
  • PaO2 <8kPa (normal PaCO2)
  • PEF <33%
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32
Q

Which receptors do SABAs act on and what does this cause?

A
  1. Beta 2 adrenergic receptors = bronchodilation
  2. Sympathetic receptors in heart = tachycardia
  3. Sympathetic receptors in skeletal muscle = tremor
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33
Q

What electrolyte imbalance can asthma cause?

A

Hyperkalaemia

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34
Q

What are 2 side effects of ICS?

A
  • Oral candida
  • Stunted growth in children
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35
Q

Which types of lung cancer are least/most associated with smoking?

A

Least = adenocarcinoma
Most = small cell/squamous cell (squamous more common)

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36
Q

How does a PE present?

A
  • Pleuritic chest pain that is worse on deep breaths
  • SOB
  • Haemoptysis
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37
Q

How does COPD present on an xray?

A
  • Barrel chest
  • Hyperinflated lungs
  • Bullae
  • Flat hemidiaphragm
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38
Q

How does TB present on an xray?

A
  • Consolidation
  • Bilateral hilar lymphadenopathy
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39
Q

How does pneumonia present on an xray?

A
  • Consolidation
  • Fluid filled alveoli
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40
Q

How does sarcoidosis present on an xray?

A

Bilateral hilar lymphadenopathy

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41
Q

How does bronchiectasis present on an xray?

A
  • Signet ring
  • Dilated thickened bronchi
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42
Q

How does pleural effusion present on an xray?

A
  • Blunting of costophrenic angles
  • Consolidation (excess fluid)
  • Tracheal deviation
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43
Q

How does a pneumothorax present on an xray?

A
  • Tracheal deviation
  • Area between lung and chest wall (no lung markings)
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44
Q

What is a life threatening complication of rheumatoid arthritis?

A

Felty’s syndrome - repeated infections due to RA, splenomegaly and neutropenia

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45
Q

What are extra articular manifestations of rheumatoid arthritis?

A

Skin = nodules, vasculitis (ulcers, splinter haemorrhages)
Ocular/oral = Sjogren’s
Pulmonary = pleuritis, effusions
Renal = glomerulonephritis
Neuro = peripheral neuropathy
Haematology = deranged bloods
Cardiac = atherosclerosis, pericarditis, MI

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46
Q

What condition is the result of a hemisection of the spinal cord?

A

Brown sequard syndrome

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47
Q

In brown-sequard syndrome, loss of pain and temperature sensation is due to which tract?

A

Spinothalamic tract (contralateral side 1-2 levels below lesion)

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48
Q

In brown-sequard syndrome, loss of motor function, vibration, fine touch and proprioception is due to which tract?

A

Dorsal column medial lemniscus pathway (ipsilateral)

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49
Q

Where does the DCML pathway decussate?

A

Medulla oblongata

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50
Q

What are 5 causes of cauda equina syndrome?

A
  1. Tumour
  2. Spinal metastases
  3. Spondylolisthesis (displacement of vertebra)
  4. Abscess
  5. Trauma
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51
Q

What is seen in patients with infective endocarditis?

A
  • Splinter haemorrhages (hands)
  • Janeway lesions (hands)
  • Osler nodes (hands)
  • Roth spots (eyes)
  • Petechiae (skin)
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52
Q

Which valves are most affected in infective endocarditis?

A

Mitral valve
Tricuspid in IVDU

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53
Q

What criteria is used for infective endocarditis?

A

Duke’s criteria = 2 major/1 major and 3 minor/5 minor

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54
Q

What are Duke’s major criteria?

A
  1. Pathogen grown from blood cultures
  2. Evidence of endocarditis on echo or new valve leak
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55
Q

What are Duke’s minor criteria?

A
  1. Risk factors e.g. IVDUs, poor dental hygeine
  2. Fever
  3. Vascular phenomena (e.g. roth spots, janeway lesions etc.)
  4. Immune phenomena (glomerulonephritis, painful nodes)
  5. Equivocal blood cultures
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56
Q

What are 6 complications of infective endocarditis?

A
  1. Sepsis
  2. Death
  3. Pulmonary embolism
  4. Kidney damage
  5. Spleen damage
  6. Heart failure
    Lots more
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57
Q

What commonly occurs due to excess alcohol consumption and presents with vomiting and retching?

A

Mallory Weiss tear (or oespphageal variceal rupture)

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58
Q

What is used to risk stratify patients with upper GI bleeds (consider factors indicating a more severe bleed)?

A

Glasgow Blatchford Score

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59
Q

Name 5 factors that are part of the Glasgow Blatchford Score

A
  1. Gender
  2. Systolic blood pressure
  3. Heart rate (tachycardia)
  4. Melaena
  5. Urea
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60
Q

What are 2 tests used to examine for meningitis/meningococcal septicaemia?

A
  1. Kernig’s test (hip flexed, straighten knee = pain)
  2. Brudzinski test (flex chin to chest, hip and knee flex)
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61
Q

What type of bacteria is neisseria menigitidis?

A

Gram negative diplococci

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62
Q

Strep pneumoniae is a common cause of meningitis, what type of bacteria is it?

A

Gram positive cocci

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63
Q

How is bacterial meningitis/meningococcal septicaemia treated?

A

Community = IM benzylpenicillin + hospital referral
Hospital aged 1-3 months = IM cefotaxime and amoxicillin
Hospital = Ceftriaxone
Risk of MRSA = vancomycin
Supportive = dexamethasone

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64
Q

How does aortic stenosis present on an xray?

A
  • Cardiomegaly (specifically LVH)
  • Dilated ascending aorta
  • Pulmonary oedema
  • Calcification of aortic valve
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65
Q

What are 5 causes of finger clubbing?

A
  1. Bronchiectasis
  2. Mesothelioma
  3. Idiopathic pulmonary fibrosis
  4. Lung abscess
  5. Sepsis
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66
Q

AFLD is associated with raised LFTs but which one specifically?

A

Gamma-glutamyl transferase (GGT) particularly associated with alcohol

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67
Q

What are used to manage the effects of alcohol and drug withdrawal?

A

Alcohol = chlordiazepoxide
Drugs = methadone

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68
Q

Which pneumonia causing organism is most associated with patients with HIV?

A

Pneumocystis jirovecii - PCP

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69
Q

Which tumour markers are raised in which cancers?

A

HCC = alpha fetoprotein
Pancreatic = CA 19-9
Ovarian = CA 125
Breast = CA 15-3
Testicular = lactate dehydrogenase (seminoma - hCG)

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70
Q

How does mitral stenosis often present?

A

Malar flush and atrial fibrillation

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71
Q

What are the stages of change transtheoretical model of change?

A

Precontemplation = no intention of changing
Contemplation = aware a problem exists but not commitment to action
Preparation = intent upon taking action
Action = active modification
Maintenance = sustained change
Relapse = fall back into old patterns of behaviour

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72
Q

What is added to beta lactam antibiotics in order to inhibit beta lactamase?

A

Clavulanic acid

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73
Q

Which antibiotics inhibit cell wall synthesis?

A
  • Glycopeptides (vancomycin)
  • Beta lactams (penicillins, carbapenems, cephalosporins)
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74
Q

Which antibiotics inhibit protein synthesis by targeting 50s ribosome subunits?

A
  • Chloramphenicol
  • Macrolides (clarithromycin)
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75
Q

Which antibiotics inhibit protein synthesis by targeting 30s ribosome subunits?

A
  • Tetracyclines (doxycycline)
  • Aminoglycosides (gentamicin)
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76
Q

Which antibiotics inhibit folate synthesis?

A
  • Trimethoprim
  • Sulphamethoxazole
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77
Q

Which antibiotics inhibit DNA gyrase?

A

Fluroquinolones (ciprofloxacin)

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78
Q

Which antibiotics bind to RNA polymerase?

A

Rifampicin

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79
Q

Which antibiotics break DNA strands?

A

Metronidazole

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80
Q

What are the severity stages of COPD?

A

Early = FEV1 >80% predicted
Moderate = FEV1 <80% predicted
Severe = FEV1 <50% predicted
Very severe = FEV1 <30% predicted

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81
Q

Compare all viral hepatitis infections

A

A - RNA, faeco-oral. 100% immunity,
B - DNA, blood-borne. 10% fulminant liver failure.
C - RNA, blood-borne. 75% fulminant liver failure.
D - RNA, blood-borne. Binds to HBVsAg to survive.
E - RNA, faeco-oral. 100% immunity.

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82
Q

What is the treatment for haemachromatosis?

A

Therapeutic phlebotomy (a.k.a venesection)

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83
Q

Which organism is associated with a history of recent antibiotic use and how is it treated?

A

Clostridium difficile (spores spread via faeco-oral route) - treated with vancomycin

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84
Q

What autoantibody is most specific to dermatomyositis/polymyositis?

A

Dermatomyositis - Anti Mi-2
Polymyositis - Anti Jo1
(ANA is most common but non specific)

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85
Q

What autoantibody is most specific to SLE?

A

Anti dsDNA

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86
Q

What autoantibody is most specific to Sjogren’s disease?

A

Anti La

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87
Q

What autoantibody is most specific to scleroderma?

A

Scl70

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88
Q

How do the antibodies present?

A

IgG = monomer (most specific and abundant)
IgM = pentamer
IgA = dimer (mucosal antibody)
IgE = monomer (bound to mast cells)
IgD = monomer (B cell development)

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89
Q

What are the most common causes of Guillain Barre syndrome?

A
  1. Campylobacter jejuni (MOST COMMON)
  2. CMV
  3. EBV
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90
Q

Describe the characteristic presentation of anal fissures

A

Fresh red blood and tearing sensation

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91
Q

Describe copper results for Wilson’s disease

A
  • High urine copper assay
  • Low serum copper
  • Low blood ceruloplasmin
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92
Q

Describe turner syndrome’s karyotype

A

45 OX

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93
Q

Describe klinefelter syndrome’s karyotype

A

47 XXY

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94
Q

What is given to prevent tumour lysis syndrome?

A

Allopurinol

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95
Q

What do prothrombin time and activated partial thromboplastin time give estimates of?

A

PT = extrinsic and common
APTT = intrinsic (factors VIII and IX)

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96
Q

What is a never event?

A

Serious, largely avoidable patient safety event which should not occur if the available preventative measures have been implemented

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97
Q

What is the normal range for ejection fraction?

A

50-75%

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98
Q

What is coeliac disease?

A

Type IV hypersensitivity reaction

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99
Q

What is first line treatment for HTN?

A

> 55 or African/Caribbean = CCB
<55 = ACE-i

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100
Q

How does pericarditis present?

A

Severe sharp pleuritic chest pain with referral to left shoulder tip that is relieved by sitting forward and worse when lying flat
- Widespread saddle shaped ST elevation
- PR depression

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101
Q

Describe key findings in each of the leukaemias?

A

AML = auer rods in blast cells
ALL = blast cells
CML = philadelphia chromosome (treat with tyrosine kinase inhibitors)
CLL = smear/smudge cells (Richter’s transformation to non Hodgkin’s lymphoma)

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102
Q

Describe the CHA2DS2VASc score

A
  • Congestive heart failure
  • HTN
  • Age >75
  • Diabetes
  • Stroke/TIA/VTE
  • Vascular disease
  • Age 65-74
  • Sex = female
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103
Q

What is given to reduce the risk of sickle-cell crises?

A

Hydroxycarbamide

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104
Q

What is the first line investigation for renal cell carcinoma?

A

CT urogram (CT KUB with IV contrast)

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105
Q

What is phenoxybenzamine and when is it given?

A

Alpha blocker - given peri-operatively to control BP to avoid HTN spikes during operations or given to people with pheochromocytomas

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106
Q

What is cut to release pressure on the median nerve in carpal tunnel syndrome?

A

Transverse carpal ligament

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107
Q

What are 4 endocrine causes of HTN?

A
  1. Cushing’s
  2. Hyperthyroidism
  3. Conn’s
  4. Pheochromocytoma
108
Q

What is the first line management of an Addisonian crisis?

A

Hydrocortisone 100mg stat dose

109
Q

What is the sepsis 6?

A

BUFALO
- Blood cultures
- Urine sample
- Fluids
- Antibiotics
- Lactate (blood)
- Oxygen

110
Q

What can spironolactone cause?

A

Potassium sparing diuretics - hyperkalaemia (impaired excretion of potassium via kidneys)

111
Q

What can furosemide and bendroflumethiazide cause?

A

Loop and thiazide diuretics - hypokalaemia

112
Q

How do beta lactam antibiotics work?

A

Inhibit cell wall synthesis by inhibiting transpeptidation reactions needed to cross link peptidoglycan in the cell wall

113
Q

What are the most common causes of UTIs?

A

KEEPS
- Klebsiella
- E. Coli
- Enterococcus
- Proteus/psedomonas
- Staph. aureus/saprophyticus

114
Q

What is the first line treatment for uncomplicated UTIs?

A

Trimethoprim or nitrofurantoin PO for 3 days

115
Q

What is Conn’s syndrome?

A

Primary hyperaldosteronism - too much aldosterone

116
Q

What does Conn’s cause and how does this present?

A

Hypokalaemia - flat T waves, prolonged QT interval and ST depression (and U waves)

117
Q

What does aldosterone do?

A

Stimulates Na+/K+ pump - increases sodium/water retention and increases potassium excretion

118
Q

What is the treatment for chlamydia?

A

First line = doxycycline 100mg twice daily for 7 days
If contraindicated (pregnant/breastfeeding) = azithromycin 1g PO single dose + 500mg PO OD for 2 days

119
Q

What is the treatment for acute cluster headaches?

A
  • Analgesics unhelpful
  • 15L 100% O2 for 15 mins via non-rebreather mask
  • Triptans e.g. sumatriptan
120
Q

What is the prophylactic treatment for cluster headaches?

A
  • 1st line = verapamil (CCB)
  • Prednisolone
  • Lithium
  • Reduced alcohol consumption and stop smoking
121
Q

What is the management of acute migraines?

A
  • Paracetamol, aspirin, NSAIDs, triptans
  • Triptans (5HT agonists) abort migraines when they start.
  • If N+V - Use anti-emetics such as metoclopramide
122
Q

What is the prophylactic treatment for migraines?

A
  • Propranolol
  • Topiramate
  • Amitriptyline
  • Acupuncture
123
Q

What chromosome is affected in hereditary haemochromatosis?

A

Chromosome 6

124
Q

What chromosome is affected in cystic fibrosis?

A

Chromosome 7

125
Q

What chromosome is affected in Wilson’s disease?

A

Chromosome 13

126
Q

What chromosome is affected in alpha 1 antitrypsin deficiency?

A

Chromosome 14

127
Q

What chromosome is affected in Down’s syndrome?

A

Chromosome 21

128
Q

What is the first line investigation for large bowel obstructions?

A

CT abdomen (gaseous distension of large bowel)

129
Q

What do SGL2 inhibitors do?

A

Block the reabsorption of glucose in the kidneys

130
Q

What is a positive predictive value?

A

Proportion of positive results that are true positives

131
Q

What is sensitivity?

A

Ability of a test to correctly identify those with the disease

132
Q

What is specificity?

A

Ability of a test to correctly exclude those who don’t have the disease

133
Q

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

A

Osteosarcoma
(Ewing sarcoma is less common and typically affects bones more proximally)

134
Q

What is the best test for figuring out which diabetes insipidus a patient has?

A

IM desmopressin injection
- Cranial = concentrated urine
- Nephrogenic = diluted urine

135
Q

What are the triggers for reactive arthritis?

A

Gastroenteritis or chlamydia

136
Q

When is it appropriate to break confidentiality?

A
  • Risk to public safety (crime/abuse)
  • Given consent
  • Required by law (notifiable disease)
137
Q

What is a common side effect of calcium channel blockers?

A

Ankle swelling

138
Q

What is a common side effect of ACE inhibitors?

139
Q

What is the most appropriate diagnostic investigation for DVT?

A

Ultrasound scan (D Dimer can only exclude DVT)

140
Q

What is used to treat chronic myeloid leukaemia?

A

Tyrosine kinase inhibitor e.g. imatinib

141
Q

What are 6 symptoms of right sided heart failure?

A
  1. Ascites
  2. Peripheral oedema
  3. Anorexia
  4. Nausea
  5. Big face
  6. Nosebleeds
142
Q

What are 5 symptoms of left sided heart failure?

A
  1. Poor exercise tolerance
  2. Nocturia
  3. Cold fingers
  4. SOB
  5. Pulmonary oedema
143
Q

What does compensation mean in metabolic acidosis/alkalosis?

A
  • pH affected
  • HCO3 affected
  • PaCO2 levels change to compensate
144
Q

What 4 things can cause upper lobe fibrosis?

A
  1. Sarcoidosis
  2. Hypersensitivity
  3. Silicosis
  4. Ankylosing spondylitis
145
Q

What can cause lower zone fibrosis?

A

Idiopathic pulmonary fibrosis

146
Q

What is the gold standard investigation and first line treatment for a pulmonary embolism?

A

CTPA - computed tomography pulmonary angiogram
DOAC e.g. rivaroxaban

147
Q

What is the CD4 definition of AIDS?

A

CD4+ cell count <200 cells/mm3

148
Q

How do emphysema and chronic bronchitis differ on presentation?

A

Emphysema = small amounts of sputum (pink puffer)
Chronic bronchitis = large amounts of sputum (blue bloater)

149
Q

Which marker is most specific for highlighting acute liver damage?

A

ALT = alanine transaminase

150
Q

What do the results of hepatitis B screening tests mean?

A
  • HBsAg = active infection (acute/chronic)
  • HBeAg = active infection (acute/chronic)
  • Anti-HBs/HBsAb = vaccination/resolved past infection
  • Anti-HBc/HBcAb = active/past infection (IgM = acute, IgG = chronic)
151
Q

What is the biggest risk factor for aortic dissection?

A

Hypertension

152
Q

What are patients suffering from pernicious anaemia given?

A

IM hydroxocobalamin injections (man made B12)

153
Q

How do external haemorrhoids present?

A

Itching and irritation in anal region

154
Q

How do internal haemorrhoids present?

A

Painless bleeding

155
Q

How does a rectal prolapse present?

A

Dragging sensation in anal region

156
Q

Where is a pilonidal sinus located?

A

Cleft of the buttocks (just above the separation of the cheeks)

157
Q

Define margination

A

Slowing of blood velocity to allow neutrophils to line up along endothelium

158
Q

What is a benign tumour of non-glandular, non-secretory epithelium?

159
Q

What is a benign tumour of glandular or secretory epithelium?

160
Q

What is a malignant tumour of non-glandular, non-secretory epithelium?

161
Q

What is a malignant tumour of glandular or secretory epithelium?

A

Adenocarcinoma

162
Q

What is a malignant tumour of connective tissue?

A

Sarcoma e.g. liposarcoma, rhabdomyosarcoma

163
Q

What is the ligand for TLR2?

A

Lipoteichoic acid (part of peptidoglycan on gram positive bacteria)

164
Q

What is the ligand for TLR5?

A

Flagellin (component of flagellated bacteria)

165
Q

What is the ligand for TLR3?

A

Viral double-stranded DNA

166
Q

What is the ligand for TLR4?

A

Lipopolysaccharide (part of bacterial cell wall)

167
Q

Where is MHC-1 found?

A

It is an antigen found on all nucleated cells in the body

168
Q

What are 5 properties of mycobacteria?

A
  1. Slow growing
  2. Predominantly immobile
  3. Rod shaped
  4. Intracellular
  5. Gram positive
169
Q

What is the most specific antibody for Grave’s disease?

A

TSH-receptor antibody

170
Q

What is the treatment for SIADH?

A

1st line = fluid restriction and hypertonic saline (and treat cause)
Chronic SIADH = tolvaptan

171
Q

What is tolvaptan?

A

ADH antagonist - reduces water reabsorption at the collecting ducts

172
Q

What is the treatment for pheochromocytoma?

A

Alpha blockers (phenoxybenzamine/doxazosin)
Beta blockers

173
Q

What is the first line and diagnostic investigations for acromegaly?

A

1st line = Serum IGF-1
Diagnostic = oral glucose tolerance test/growth hormone suppression test

174
Q

What is the treatment for AF if the patient is haemodynamically stable?

A
  • Rate control (BBs/CCBs) + anticoagulation
    OR
  • Rhythm control (cardioversion) –> BBs + anticoagulation
175
Q

What is the treatment for AF if the patient is haemodynamically unstable?

A

Cardioversion with synchronised DC shock + anticoagulation

176
Q

What are 2 characteristic findings in patients with multiple myeloma?

A
  • Blood film = rouleaux formation
  • Urinalysis = Bence Jones proteins
177
Q

What electrolyte abnormalities does tumour lysis syndrome cause?

A
  • Hypocalcaemia
  • Hyperphosphatemia
  • Hyperuricaemia
  • Hyperkalaemia
178
Q

Where is the remnant of the vitelline duct located and what pathology is it most associated with?

A

Distal ileum - Meckel’s diverticulum

179
Q

Which portion of the GI tract is most likely to perforate when there is an obstruction?

A

Caecum - thinnest wall

180
Q

What are the most/least common type of hernias?

A

Most = inguinal (above pubic tubercule)
Least = femoral (below pubic tubercule)

181
Q

Describe the difference between an indirect and direct inguinal hernia?

A

Direct = protrudes through inguinal ring
Indirect = protrudes through anterior abdominal wall

182
Q

What is terlipressin?

A

ADH analogue (for hypovolaemia) - constricts splanchnic arteries to reduce bleeding - used in ruptured oesophageal varices

183
Q

What blood tests best reflects synthetic function of the liver?

A

Prothrombin time and serum albumin

184
Q

What is naproxen?

185
Q

How do you differentiate osteomalacia and osteopenia/osteoporosis on bloods?

A
  • Osteopenia/osteoporosis = normal blood results
  • Osteomalacia = low vit D, low calcium, low phosphate and high PTH (raised ALP)
186
Q

What are the most important blood tests to conduct in suspected rhabdomyolysis?

A

Raised myoglobin and creatine kinase

187
Q

What is Marfan’s syndrome?

A

Autosomal dominant FB1 mutation resulting in decreased connective tissue strength

188
Q

What is Ehlers-Danlos syndrome?

A

Autosomal dominant mutations affecting collagen proteins (type II collagen)

189
Q

Which presentation is most confident in differentiating osteoarthritis and rheumatoid arthritis?

A

Rheumatoid arthritis = morning joint stiffness lasting 2 hours

190
Q

How does alcohol cause polyuria?

A

Ethanol suppresses ADH secretion from posterior pituitary gland

191
Q

How do you differentiate between IgA nephropathy and post-streptococcal glomerulonephritis?

A

IgA = ill recently
Post-strep = ill 2-3 weeks ago

192
Q

Give 5 causes of nephritic syndrome

A
  1. IgA nephropathy (mesangial hyperplasia and IgA deposits)
  2. SLE
  3. Post-streptococcal glomerulonephritis
  4. Small vessel vasculitis (HSP)
  5. Goodpasture’s (anti-GBM - IgG deposits along basement membrane)
193
Q

Give 3 primary causes of nephrotic syndrome?

A
  1. Minimal change disease (fusion of podocytes and foot-process effacement)
  2. Membranous nephropathy (thickened GBM)
  3. Focal segmental glomerulosclerosis (scarring of glomeruli - focal sclerosis)
194
Q

Give 5 secondary causes of nephrotic syndrome

A

DDANI
- Diabetes
- Drugs
- Autoimmune
- Neoplasia
- Infection

195
Q

What is Cushing’s reflex?

A

Nervous system response to elevated ICP:
- HTN
- Bradycardia
- Irregular breathing
- Wide pulse pressure

196
Q

Why is levodopa given over dopamine?

A

Levodopa can cross the blood brain barrier whereas dopamine cannot (too polar)

197
Q

How does cor pulmonale present?

A
  • SOB and fatigue
  • Chronic cause of hypoxia (e.g. COPD)
  • Raised JVP
  • Hyperinflated chest
  • Bilateral coarse crackles
198
Q

What are 4 features of tension pneumothorax?

A
  1. Decreased breath sounds
  2. Tracheal deviation away
  3. Hyper-resonant percussion (more air inside chest)
  4. Decreased tactile and vocal fremitus
199
Q

What is the most common valvular heart disease?

A

Aortic stenosis due to idiopathic age related calcification

200
Q

How does sarcoidosis present and what is the first line treatment?

A
  • Dry cough
  • SOB
  • Low grade fever
  • Uveitis
  • Erythema nodosum (tender red nodules on shins)
  • Prednisolone + bisphosphonates
201
Q

Which antibody is seen in patients with granulomatosis with polyangiitis

202
Q

What would a peripheral blood smear show in patients with thrombotic thrombocytopenic purpura?

A

Schistocytes (fragmented RBCs)

203
Q

What is the key management for glucose-6-phosphate dehydrogenase deficiency?

A

Avoid triggers e.g. fava beans, henna, certain medications

204
Q

In what order do you correct a folate, B12 and vitamin D deficiency?

A

B12, folate, vitamin D

205
Q

What are the first line and gold standard investigations for achalasia?

A

1st line = upper GI endoscopy
Gold standard = oesophageal manometry

206
Q

What condition is associated with gallstone development?

A

Crohn’s - inflamed terminal ileum prevents bile salts from being absorbed

207
Q

What are the preferred diagnostic investigations for acute pancreaittis?

A
  • Serum lipase >3 times the upper limit of normal (stay elevated for longer)
  • Serum amylase >3 times the upper limit of normal
208
Q

What is the name of a dormant malaria spore?

A

Hypnozoite

209
Q

What is dose-response?

A

The higher the exposure, the higher the risk of disease

210
Q

What is Lambert-Eaton Myasthenic syndrome and what is it commonly associated with?

A

Progressive muscle weakness (similar to myasthenia gravis) - associated with small cell lung cancer - antibodies against calcium channels

211
Q

Describe Neisseria meningitidis

A

Gram negative diplococci

212
Q

Describe the histopathological findings of Parkinson’s disease

A
  • Loss of dopaminergic neurones in substantia nigra pars compacta
  • Presence of Lewy bodies/eosinophilic cytoplasmic inclusions
213
Q

Which two inherited conditions increase the risk of bowel cancer?

A
  • Familial adenomatous polyposis (FAP)
  • Lynch syndrome
214
Q

What is familial adenomatous polyposis?

A
  • An autosomal dominant mutation of the tumour suppressor gene APC which leads to 1000s of polyps developing in the bowel
  • This leads to inevitable bowel cancer usually before age 40.
215
Q

What is Lynch syndrome?

A
  • Hereditary non polyposis colorectal cancer
  • Autosomal dominant mutation of DNA mismatch repair gene
  • Increases risk of all cancers, but especially colorectal cancer
  • Doesn’t cause polyps, but tumours in isolation
216
Q

What is the difference between venous and arterial ulcers?

A

Venous = most common occur above the medial/lateral malleoli
Arterial = often affect toes/shins

217
Q

What is the most common dermatological manifestation of Crohn’s disease?

A

Erythema nodosum (swollen fat under skin causing bumps/patches that look red/dark)

218
Q

How is disseminated intravascular coagulation treated?

A
  • Cryoprecipitate (if low fibrinogen)
  • Platelet transfusion
  • Treat underlying cause
219
Q

What is ipratropium bromide?

A

Short acting muscarinic receptor antagonist (SAMA) - muscarinic acetylcholine receptor antagonist that acts as a bronchodilator

220
Q

Describe the blood results of a patient with systemic lupus erythematosus

A
  • Anaemia
  • Low serum complement 3 and 4
  • Raised ESR and CRP
221
Q

Patients with Sjogren’s syndrome have an increased risk of getting what?

A

Non Hodgkin Lymphoma

222
Q

Describe the pathophysiology of cholera

A

Toxin deregulates ion transport in epithelial cells

223
Q

What are the complications following an MI?

A

DREAD
Death
Rupture of septum/papillary muscle
oEdema (HF)
Aneurysm/arrhythmia
Dressler’s syndrome

224
Q

What is Wenckebach phenomenon also known as?

A

Mobitz Type I heart block (second degree heart block) - PR becomes progressively more prolonged until QRS complex missed (then pattern resets)

225
Q

What is the marker of Addison’s?

A

Anti 21 hydroxylase - autoimmune destruction of adrenal cortex

226
Q

What is a side effect of SGLT2 inhibitors (e.g. empagliflozin)?

A

Glycosuria –> increases chances of UTIs and thrush

227
Q

Describe the AKI stages

A

Stage 1 = SCr increases >1.5-2 from baseline and low urine for 6 hours
Stage 2 = SCr increases >2-3 from baseline and low urine for 12 hours
Stage 3 = SCr increases >3 from baseline and low urine/anuria for 24/12 hours

228
Q

What are the causes of subdural, extradural, intracerebral and subarachnoid haemorrhages?

A

Subdural = rupture of bridging veins
Extradural = rupture of middle meningeal artery
Intracerebral = rupture of aneurysm
Subarachnoid = rupture of cerebral aneurysm

229
Q

How do subdural and extradural haemorrhages present on CT scans?

A

Subdural = crescent shape, not limited by cranial sutures
Extradural = bi-convex shape, limited by cranial sutures

230
Q

What is found on an XRAY/skeletal survey for multiple myeloma?

A
  • Punched out lesions
  • Osteolytic lesions
  • Raindrop skull
231
Q

Is cytomegalovirus an AIDS-defining illness?

A

Yes, unless of the liver, spleen or glands

232
Q

How does neurogenic shock present?

A
  • Altered consciousness
  • Flushed appearance
  • Hypotension
  • Bradycardia
233
Q

What are causes of pulmonary fibrosis?

A
  • Idiopathic
  • Lung damage (pneumonia, TB)
  • Irritants (coal, dust, silica)
  • Connective tissue disease (SLE, RA, Sjogren’s)
  • Drugs (amiodarone, nitrofurantoin)
234
Q

What is seen in the hands of someone with idiopathic pulmonary fibrosis?

A
  • Finger clubbing
  • Acrocyanosis
235
Q

What are the medications for idiopathic pulmonary fibrosis?

A
  • Pirfenidone (antifibrotic and anti-inflammatory)
  • Nintedanib (monoclonal antibody against tyrosine kinase)
236
Q

What is seen in scans of patients with idiopathic pulmonary fibrosis?

A
  • Honeycombing
  • Ground glass
  • Lower zone fibrosis distribution
237
Q

What are the 2 signs of hypocalcaemia?

A

Chvostek’s sign = facial muscle spasm
Trousseau’s sign = wrist flexion and finger adduction

238
Q

How do hypercalcaemia/hypocalcaemia present on an ECG?

A

HYPER = short QT interval
HYPO = prolonged QT interval

239
Q

How does hypokalaemia present on an ECG?

A
  • Prolonged PR interval
  • ST depression
  • U waves
  • Flattened, inverted T waves
240
Q

Which enzymes are raised in biliary damage?

A
  • ALP (alkaline phosphate)
  • GGT (gamma-glutamyl transferase)
241
Q

What is the presentation of ascending cholangitis?

A

Charcot’s triad:
- RUQ pain
- Fever
- Jaundice

242
Q

What is a complication of ascending cholangitis and how does it present?

A

Biliary sepsis - Reynauld’s pentad:
- Charcot’s triad (RUQ pain, fever, jaundice)
- Sepsis
- Confusion

243
Q

What are the 2 most common causes of pancreatitis?

A
  1. Gallstones
  2. Alcohol
244
Q

Which parts of the adrenal glands secrete what?

A

Medulla = catecholamines (adrenaline)
Zona reticularis (cortex) = androgens (DHEA)
Zone fasciculata (cortex) = glucocorticoids (cortisol)
Zona glomerulosa (cortex) = mineralocorticoids (aldosterone)

245
Q

Where is a pancoast tumour located and what is it associated with?

A

Apex of lung - Horner’s syndrome (miosis, anhidrosis and ptosis)

246
Q

How do asthma peak flow measurements differ at different times of day?

A

Morning lower, evening higher = diurnal variation

247
Q

What is the action of DOACs?

A

Inhibit factor X in the coagulation cascade

248
Q

Describe the pathophysiology of primary hyperthyroidism (Grave’s)

A
  • IgG autoantibodies (anti-TSHR-Ab) are produced which bind to and activate thyrotropin receptors
  • This results in the increased production of thyroid hormones (T3 and T4)
249
Q

What are some signs of hyperthyroidism?

A
  • Tachycardia
  • Fine tremor
  • Goitre
  • Thin hair
  • Ptosis
250
Q

What are some complications of diabetes?

A
  • Diabetic retinopathy
  • Diabetic neuropathy
  • Increased risk of heart attack/stroke
  • Foot ulcers
  • Recurrent infection
251
Q

Where are alpha adrenoceptors found and what do they do?

A
  • Blood vessels = vasoconstriction
  • Sphincters (e.g. bladder neck) = contracts
252
Q

Where are beta adrenergic receptors found and what do they do?

A
  • Beta 1 = heart = contract heart muscle
  • Beta 2 = bronchioles = bronchodilation of airways
253
Q

What are some symptoms of aortic stenosis?

A

SAD:
- Syncope
- Angina
- Dyspnoea (exertional)
- Fatigue
- Fainting

254
Q

What are the 3 cardinal signs of heart failure?

A
  1. SOB (orthopnoea, paroxysmal nocturnal dyspnoea)
  2. Ankle swelling
  3. Fatigue
255
Q

What are some causes of pericarditis?

A
  • Idiopathic
  • Viral (coxsackie)
  • Bacterial (TB)
  • Autoimmune (SLE, RA)
  • Dressler’s syndrome
  • Cancer (lung/breast)
256
Q

What is the inheritance pattern for haemophilia A and B?

A

X linked recessive

257
Q

What other blood tests are done for patients with suspected iron deficiency anaemia?

A

Iron studies:
- Low serum ferritin
- Low serum iron
- Low transferrin saturation

258
Q

Why are iron studies limited?

A

Ferritin is an acute phase protein - also increases with inflammation

259
Q

What is desmopressin used for?

A

Haemophilia A and B and Von Willebrand Disease - stimulates release of VWF (and therefore factor VIII)

260
Q

What is observed in patients with small bowel obstructions?

A
  • Abdominal distension
  • Hyperresonant bowel
  • Tinkling bowel sounds
261
Q

What is seen on an xray in patients with sigmoid volvulus?

A

Coffee bean sign (volvulus = twisting)

262
Q

What chemotherapy is used for lymphoma?

A

Hodgkin’s = ABVD
Non-Hodgkin’s = RCHOP

263
Q

What is megaloblastic anaemia?

A

Type of macrocytic anaemia e.g. B12 and folate deficiency

264
Q

What is non megaloblastic anaemia?

A

Type of macrocytic anaemia - alcohol, reticulocytosis, liver disease, hypothyroidism

265
Q

Describe the glasgow coma scale

A

Score out of 15
Eye opening = /4
Verbal response = /5
Motor response = /6

266
Q

What is a feature more commonly seen in Crohn’s and Coeliac but not UC?

A

Mouth/aphthous ulcers

Phase 2a (29 decks)

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