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
2
Q
What are 6 causes of peptic ulcers?
A
- H. Pylori
- Increased acid production
- NSAIDs
- Mucosal Ischaemia
- Smoking/alcohol
- Stress
3
Q
What are 4 complications of untreated GORD?
A
- Oesophageal ulcers
- Oesophagitis
- Barrett’s oesophagus
- Oesophageal cancer
4
Q
What is achalasia?
A
Impaired oesophageal peristalsis due to LOS not opening
5
Q
Where is colon cancer most common?
A
Rectum and sigmoid colon (distal colon)
6
Q
What are 4 causes of diverticula formation?
A
- Low fibre diet
- Obesity
- Smoking
- NSAIDs
7
Q
How does crohn’s commonly cause anaemia?
A
Iron and folate deficiency
8
Q
What are 4 symptoms of prostatitis?
A
- Pelvic pain
- LUTS
- Sexual dysfunction (post ejac. pain)
- Pain on defecation
9
Q
What is reactive arthritis also known as?
A
Reiter’s syndrome
10
Q
What is a common complication of PKD?
A
Berry aneurysms –> subarachnoid haemorrhage
11
Q
What is a thunderclap headache indicative of?
A
Subarachnoid haemorrhage
12
Q
How does nephrotic syndrome present?
A
- Proteinuria
- HYPOalbuminaemia
- Oedema
- HYPERlipidaemia
13
Q
How does nephritic syndrome present?
A
- Proteinuria
- Haeamaturia
- Oliguria
- HTN
14
Q
What are 5 risk factors of DVT?
A
- Pregnancy
- Recent surgery
- Recent leg fracture
- Combined oral contraceptive (not POC)
- History of cancer
15
Q
What criteria is used for DVT?
A
Well’s score
16
Q
What is the prophylaxis treatment for VTE?
A
LMWH (dalteparin) and DOAC (apixaban)
17
Q
What does rituximab do?
A
Acts on B cells (CD20) to reduce antibody production
18
Q
What does infliximab do?
A
Tumour necrosis factor inhibitor
19
Q
What is the treatment for complicated/severe malaria?
A
- IV artesunate (first line)
- IV quinine and doxycycline
20
Q
What is the treatment for uncomplicated malaria?
A
Oral chloroquine
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
22
Q
What is Budd Chiari syndrome?
A
Thrombus in hepatic vein (can cause liver failure)
23
Q
How does pseudogout present?
A
- Knee pain
- Red and swollen
- Fever
- Patient may feel fine
24
Q
What is the first line investigation for stroke?
A
CT head to figure out what type of stroke it is
25
Unprovoked epileptic seizures require preventative treatment such as...
Sodium valproate
26
What are 4 common causes of peripheral neuropathy?
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
27
What are the 3 most common bacterial causes of IECOPD?
1. Haemophilus influenza
2. Strep. pneumonia
3. Moraxella catarrhalis
28
What is the most common viral cause of IECOPD?
Rhinovirus
29
What investigation is done first for IECOPD?
Arterial blood gas sampling to assess severity
30
How does acute severe asthma present?
- Inability to complete sentences in one breath
- RR >25/min
- HR >110/min
- PEF 33-50%
31
How does life threatening asthma present?
- Altered consciousness
- Silent chest
- Hypotension
- SpO2 <92%
- PaO2 <8kPa (normal PaCO2)
- PEF <33%
32
Which receptors do SABAs act on and what does this cause?
1. Beta 2 adrenergic receptors = bronchodilation
2. Sympathetic receptors in heart = tachycardia
3. Sympathetic receptors in skeletal muscle = tremor
33
What electrolyte imbalance can asthma cause?
Hyperkalaemia
34
What are 2 side effects of ICS?
- Oral candida
- Stunted growth in children
35
Which types of lung cancer are least/most associated with smoking?
Least = adenocarcinoma
Most = small cell/squamous cell (squamous more common)
36
How does a PE present?
- Pleuritic chest pain that is worse on deep breaths
- SOB
- Haemoptysis
37
How does COPD present on an xray?
- Barrel chest
- Hyperinflated lungs
- Bullae
- Flat hemidiaphragm
38
How does TB present on an xray?
- Consolidation
- Bilateral hilar lymphadenopathy
39
How does pneumonia present on an xray?
- Consolidation
- Fluid filled alveoli
40
How does sarcoidosis present on an xray?
Bilateral hilar lymphadenopathy
41
How does bronchiectasis present on an xray?
- Signet ring
- Dilated thickened bronchi
42
How does pleural effusion present on an xray?
- Blunting of costophrenic angles
- Consolidation (excess fluid)
- Tracheal deviation
43
How does a pneumothorax present on an xray?
- Tracheal deviation
- Area between lung and chest wall (no lung markings)
44
What is a life threatening complication of rheumatoid arthritis?
Felty's syndrome - repeated infections due to RA, splenomegaly and neutropenia
45
What are extra articular manifestations of rheumatoid arthritis?
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
46
What condition is the result of a hemisection of the spinal cord?
Brown sequard syndrome
47
In brown-sequard syndrome, loss of pain and temperature sensation is due to which tract?
Spinothalamic tract (contralateral side 1-2 levels below lesion)
48
In brown-sequard syndrome, loss of motor function, vibration, fine touch and proprioception is due to which tract?
Dorsal column medial lemniscus pathway (ipsilateral)
49
Where does the DCML pathway decussate?
Medulla oblongata
50
What are 5 causes of cauda equina syndrome?
1. Tumour
2. Spinal metastases
3. Spondylolisthesis (displacement of vertebra)
4. Abscess
5. Trauma
51
What is seen in patients with infective endocarditis?
- Splinter haemorrhages (hands)
- Janeway lesions (hands)
- Osler nodes (hands)
- Roth spots (eyes)
- Petechiae (skin)
52
Which valves are most affected in infective endocarditis?
Mitral valve
Tricuspid in IVDU
53
What criteria is used for infective endocarditis?
Duke's criteria = 2 major/1 major and 3 minor/5 minor
54
What are Duke's major criteria?
1. Pathogen grown from blood cultures
2. Evidence of endocarditis on echo or new valve leak
55
What are Duke's minor criteria?
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
56
What are 6 complications of infective endocarditis?
1. Sepsis
2. Death
3. Pulmonary embolism
4. Kidney damage
5. Spleen damage
6. Heart failure
Lots more
57
What commonly occurs due to excess alcohol consumption and presents with vomiting and retching?
Mallory Weiss tear (or oespphageal variceal rupture)
58
What is used to risk stratify patients with upper GI bleeds (consider factors indicating a more severe bleed)?
Glasgow Blatchford Score
59
Name 5 factors that are part of the Glasgow Blatchford Score
1. Gender
2. Systolic blood pressure
3. Heart rate (tachycardia)
4. Melaena
5. Urea
60
What are 2 tests used to examine for meningitis/meningococcal septicaemia?
1. Kernig's test (hip flexed, straighten knee = pain)
2. Brudzinski test (flex chin to chest, hip and knee flex)
61
What type of bacteria is neisseria menigitidis?
Gram negative diplococci
62
Strep pneumoniae is a common cause of meningitis, what type of bacteria is it?
Gram positive cocci
63
How is bacterial meningitis/meningococcal septicaemia treated?
Community = IM benzylpenicillin + hospital referral
Hospital aged 1-3 months = IM cefotaxime and amoxicillin
Hospital = Ceftriaxone
Risk of MRSA = vancomycin
Supportive = dexamethasone
64
How does aortic stenosis present on an xray?
- Cardiomegaly (specifically LVH)
- Dilated ascending aorta
- Pulmonary oedema
- Calcification of aortic valve
65
What are 5 causes of finger clubbing?
1. Bronchiectasis
2. Mesothelioma
3. Idiopathic pulmonary fibrosis
4. Lung abscess
5. Sepsis
66
AFLD is associated with raised LFTs but which one specifically?
Gamma-glutamyl transferase (GGT) particularly associated with alcohol
67
What are used to manage the effects of alcohol and drug withdrawal?
Alcohol = chlordiazepoxide
Drugs = methadone
68
Which pneumonia causing organism is most associated with patients with HIV?
Pneumocystis jirovecii - PCP
69
Which tumour markers are raised in which cancers?
HCC = alpha fetoprotein
Pancreatic = CA 19-9
Ovarian = CA 125
Breast = CA 15-3
Testicular = lactate dehydrogenase (seminoma - hCG)
70
How does mitral stenosis often present?
Malar flush and atrial fibrillation
71
What are the stages of change transtheoretical model of change?
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
72
What is added to beta lactam antibiotics in order to inhibit beta lactamase?
Clavulanic acid
73
Which antibiotics inhibit cell wall synthesis?
- Glycopeptides (vancomycin)
- Beta lactams (penicillins, carbapenems, cephalosporins)
74
Which antibiotics inhibit protein synthesis by targeting 50s ribosome subunits?
- Chloramphenicol
- Macrolides (clarithromycin)
75
Which antibiotics inhibit protein synthesis by targeting 30s ribosome subunits?
- Tetracyclines (doxycycline)
- Aminoglycosides (gentamicin)
76
Which antibiotics inhibit folate synthesis?
- Trimethoprim
- Sulphamethoxazole
77
Which antibiotics inhibit DNA gyrase?
Fluroquinolones (ciprofloxacin)
78
Which antibiotics bind to RNA polymerase?
Rifampicin
79
Which antibiotics break DNA strands?
Metronidazole
80
What are the severity stages of COPD?
Early = FEV1 >80% predicted
Moderate = FEV1 <80% predicted
Severe = FEV1 <50% predicted
Very severe = FEV1 <30% predicted
81
Compare all viral hepatitis infections
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.
82
What is the treatment for haemachromatosis?
Therapeutic phlebotomy (a.k.a venesection)
83
Which organism is associated with a history of recent antibiotic use and how is it treated?
Clostridium difficile (spores spread via faeco-oral route) - treated with vancomycin
84
What autoantibody is most specific to dermatomyositis/polymyositis?
Dermatomyositis - Anti Mi-2
Polymyositis - Anti Jo1
(ANA is most common but non specific)
85
What autoantibody is most specific to SLE?
Anti dsDNA
86
What autoantibody is most specific to Sjogren's disease?
Anti La
87
What autoantibody is most specific to scleroderma?
Scl70
88
How do the antibodies present?
IgG = monomer (most specific and abundant)
IgM = pentamer
IgA = dimer (mucosal antibody)
IgE = monomer (bound to mast cells)
IgD = monomer (B cell development)
89
What are the most common causes of Guillain Barre syndrome?
1. Campylobacter jejuni (MOST COMMON)
2. CMV
3. EBV
90
Describe the characteristic presentation of anal fissures
Fresh red blood and tearing sensation
91
Describe copper results for Wilson's disease
- High urine copper assay
- Low serum copper
- Low blood ceruloplasmin
92
Describe turner syndrome's karyotype
45 OX
93
Describe klinefelter syndrome's karyotype
47 XXY
94
What is given to prevent tumour lysis syndrome?
Allopurinol
95
What do prothrombin time and activated partial thromboplastin time give estimates of?
PT = extrinsic and common
APTT = intrinsic (factors VIII and IX)
96
What is a never event?
Serious, largely avoidable patient safety event which should not occur if the available preventative measures have been implemented
97
What is the normal range for ejection fraction?
50-75%
98
What is coeliac disease?
Type IV hypersensitivity reaction
99
What is first line treatment for HTN?
>55 or African/Caribbean = CCB
<55 = ACE-i
100
How does pericarditis present?
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
101
Describe key findings in each of the leukaemias?
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)
102
Describe the CHA2DS2VASc score
- Congestive heart failure
- HTN
- Age >75
- Diabetes
- Stroke/TIA/VTE
- Vascular disease
- Age 65-74
- Sex = female
103
What is given to reduce the risk of sickle-cell crises?
Hydroxycarbamide
104
What is the first line investigation for renal cell carcinoma?
CT urogram (CT KUB with IV contrast)
105
What is phenoxybenzamine and when is it given?
Alpha blocker - given peri-operatively to control BP to avoid HTN spikes during operations or given to people with pheochromocytomas
106
What is cut to release pressure on the median nerve in carpal tunnel syndrome?
Transverse carpal ligament
107
What are 4 endocrine causes of HTN?
1. Cushing's
2. Hyperthyroidism
3. Conn's
4. Pheochromocytoma
108
What is the first line management of an Addisonian crisis?
Hydrocortisone 100mg stat dose
109
What is the sepsis 6?
BUFALO
- Blood cultures
- Urine sample
- Fluids
- Antibiotics
- Lactate (blood)
- Oxygen
110
What can spironolactone cause?
Potassium sparing diuretics - hyperkalaemia (impaired excretion of potassium via kidneys)
111
What can furosemide and bendroflumethiazide cause?
Loop and thiazide diuretics - hypokalaemia
112
How do beta lactam antibiotics work?
Inhibit cell wall synthesis by inhibiting transpeptidation reactions needed to cross link peptidoglycan in the cell wall
113
What are the most common causes of UTIs?
KEEPS
- Klebsiella
- E. Coli
- Enterococcus
- Proteus/psedomonas
- Staph. aureus/saprophyticus
114
What is the first line treatment for uncomplicated UTIs?
Trimethoprim or nitrofurantoin PO for 3 days
115
What is Conn's syndrome?
Primary hyperaldosteronism - too much aldosterone
116
What does Conn's cause and how does this present?
Hypokalaemia - flat T waves, prolonged QT interval and ST depression (and U waves)
117
What does aldosterone do?
Stimulates Na+/K+ pump - increases sodium/water retention and increases potassium excretion
118
What is the treatment for chlamydia?
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
What is the treatment for acute cluster headaches?
- Analgesics unhelpful
- 15L 100% O2 for 15 mins via non-rebreather mask
- Triptans e.g. sumatriptan
120
What is the prophylactic treatment for cluster headaches?
- 1st line = verapamil (CCB)
- Prednisolone
- Lithium
- Reduced alcohol consumption and stop smoking
121
What is the management of acute migraines?
- Paracetamol, aspirin, NSAIDs, triptans
- Triptans (5HT agonists) abort migraines when they start.
- If N+V - Use anti-emetics such as metoclopramide
122
What is the prophylactic treatment for migraines?
- Propranolol
- Topiramate
- Amitriptyline
- Acupuncture
123
What chromosome is affected in hereditary haemochromatosis?
Chromosome 6
124
What chromosome is affected in cystic fibrosis?
Chromosome 7
125
What chromosome is affected in Wilson's disease?
Chromosome 13
126
What chromosome is affected in alpha 1 antitrypsin deficiency?
Chromosome 14
127
What chromosome is affected in Down's syndrome?
Chromosome 21
128
What is the first line investigation for large bowel obstructions?
CT abdomen (gaseous distension of large bowel)
129
What do SGL2 inhibitors do?
Block the reabsorption of glucose in the kidneys
130
What is a positive predictive value?
Proportion of positive results that are true positives
131
What is sensitivity?
Ability of a test to correctly identify those with the disease
132
What is specificity?
Ability of a test to correctly exclude those who don't have the disease
133
What is the most common primary bone tumour in children/young adults?
Osteosarcoma
(Ewing sarcoma is less common and typically affects bones more proximally)
134
What is the best test for figuring out which diabetes insipidus a patient has?
IM desmopressin injection
- Cranial = concentrated urine
- Nephrogenic = diluted urine
135
What are the triggers for reactive arthritis?
Gastroenteritis or chlamydia
136
When is it appropriate to break confidentiality?
- Risk to public safety (crime/abuse)
- Given consent
- Required by law (notifiable disease)
137
What is a common side effect of calcium channel blockers?
Ankle swelling
138
What is a common side effect of ACE inhibitors?
Dry cough
139
What is the most appropriate diagnostic investigation for DVT?
Ultrasound scan (D Dimer can only exclude DVT)
140
What is used to treat chronic myeloid leukaemia?
Tyrosine kinase inhibitor e.g. imatinib
141
What are 6 symptoms of right sided heart failure?
1. Ascites
2. Peripheral oedema
3. Anorexia
4. Nausea
5. Big face
6. Nosebleeds
142
What are 5 symptoms of left sided heart failure?
1. Poor exercise tolerance
2. Nocturia
3. Cold fingers
4. SOB
5. Pulmonary oedema
143
What does compensation mean in metabolic acidosis/alkalosis?
- pH affected
- HCO3 affected
- PaCO2 levels change to compensate
144
What 4 things can cause upper lobe fibrosis?
1. Sarcoidosis
2. Hypersensitivity
3. Silicosis
4. Ankylosing spondylitis
145
What can cause lower zone fibrosis?
Idiopathic pulmonary fibrosis
146
What is the gold standard investigation and first line treatment for a pulmonary embolism?
CTPA - computed tomography pulmonary angiogram
DOAC e.g. rivaroxaban
147
What is the CD4 definition of AIDS?
CD4+ cell count <200 cells/mm3
148
How do emphysema and chronic bronchitis differ on presentation?
Emphysema = small amounts of sputum (pink puffer)
Chronic bronchitis = large amounts of sputum (blue bloater)
149
Which marker is most specific for highlighting acute liver damage?
ALT = alanine transaminase
150
What do the results of hepatitis B screening tests mean?
- 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
What is the biggest risk factor for aortic dissection?
Hypertension
152
What are patients suffering from pernicious anaemia given?
IM hydroxocobalamin injections (man made B12)
153
How do external haemorrhoids present?
Itching and irritation in anal region
154
How do internal haemorrhoids present?
Painless bleeding
155
How does a rectal prolapse present?
Dragging sensation in anal region
156
Where is a pilonidal sinus located?
Cleft of the buttocks (just above the separation of the cheeks)
157
Define margination
Slowing of blood velocity to allow neutrophils to line up along endothelium
158
What is a benign tumour of non-glandular, non-secretory epithelium?
Papilloma
159
What is a benign tumour of glandular or secretory epithelium?
Adenoma
160
What is a malignant tumour of non-glandular, non-secretory epithelium?
Carcinoma
161
What is a malignant tumour of glandular or secretory epithelium?
Adenocarcinoma
162
What is a malignant tumour of connective tissue?
Sarcoma e.g. liposarcoma, rhabdomyosarcoma
163
What is the ligand for TLR2?
Lipoteichoic acid (part of peptidoglycan on gram positive bacteria)
164
What is the ligand for TLR5?
Flagellin (component of flagellated bacteria)
165
What is the ligand for TLR3?
Viral double-stranded DNA
166
What is the ligand for TLR4?
Lipopolysaccharide (part of bacterial cell wall)
167
Where is MHC-1 found?
It is an antigen found on all nucleated cells in the body
168
What are 5 properties of mycobacteria?
1. Slow growing
2. Predominantly immobile
3. Rod shaped
4. Intracellular
5. Gram positive
169
What is the most specific antibody for Grave's disease?
TSH-receptor antibody
170
What is the treatment for SIADH?
1st line = fluid restriction and hypertonic saline (and treat cause)
Chronic SIADH = tolvaptan
171
What is tolvaptan?
ADH antagonist - reduces water reabsorption at the collecting ducts
172
What is the treatment for pheochromocytoma?
Alpha blockers (phenoxybenzamine/doxazosin)
Beta blockers
173
What is the first line and diagnostic investigations for acromegaly?
1st line = Serum IGF-1
Diagnostic = oral glucose tolerance test/growth hormone suppression test
174
What is the treatment for AF if the patient is haemodynamically stable?
- Rate control (BBs/CCBs) + anticoagulation
OR
- Rhythm control (cardioversion) --> BBs + anticoagulation
175
What is the treatment for AF if the patient is haemodynamically unstable?
Cardioversion with synchronised DC shock + anticoagulation
176
What are 2 characteristic findings in patients with multiple myeloma?
- Blood film = rouleaux formation
- Urinalysis = Bence Jones proteins
177
What electrolyte abnormalities does tumour lysis syndrome cause?
- Hypocalcaemia
- Hyperphosphatemia
- Hyperuricaemia
- Hyperkalaemia
178
Where is the remnant of the vitelline duct located and what pathology is it most associated with?
Distal ileum - Meckel's diverticulum
179
Which portion of the GI tract is most likely to perforate when there is an obstruction?
Caecum - thinnest wall
180
What are the most/least common type of hernias?
Most = inguinal (above pubic tubercule)
Least = femoral (below pubic tubercule)
181
Describe the difference between an indirect and direct inguinal hernia?
Direct = protrudes through inguinal ring
Indirect = protrudes through anterior abdominal wall
182
What is terlipressin?
ADH analogue (for hypovolaemia) - constricts splanchnic arteries to reduce bleeding - used in ruptured oesophageal varices
183
What blood tests best reflects synthetic function of the liver?
Prothrombin time and serum albumin
184
What is naproxen?
NSAID
185
How do you differentiate osteomalacia and osteopenia/osteoporosis on bloods?
- Osteopenia/osteoporosis = normal blood results
- Osteomalacia = low vit D, low calcium, low phosphate and high PTH (raised ALP)
186
What are the most important blood tests to conduct in suspected rhabdomyolysis?
Raised myoglobin and creatine kinase
187
What is Marfan's syndrome?
Autosomal dominant FB1 mutation resulting in decreased connective tissue strength
188
What is Ehlers-Danlos syndrome?
Autosomal dominant mutations affecting collagen proteins (type II collagen)
189
Which presentation is most confident in differentiating osteoarthritis and rheumatoid arthritis?
Rheumatoid arthritis = morning joint stiffness lasting 2 hours
190
How does alcohol cause polyuria?
Ethanol suppresses ADH secretion from posterior pituitary gland
191
How do you differentiate between IgA nephropathy and post-streptococcal glomerulonephritis?
IgA = ill recently
Post-strep = ill 2-3 weeks ago
192
Give 5 causes of nephritic syndrome
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
Give 3 primary causes of nephrotic syndrome?
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
Give 5 secondary causes of nephrotic syndrome
DDANI
- Diabetes
- Drugs
- Autoimmune
- Neoplasia
- Infection
195
What is Cushing's reflex?
Nervous system response to elevated ICP:
- HTN
- Bradycardia
- Irregular breathing
- Wide pulse pressure
196
Why is levodopa given over dopamine?
Levodopa can cross the blood brain barrier whereas dopamine cannot (too polar)
197
How does cor pulmonale present?
- SOB and fatigue
- Chronic cause of hypoxia (e.g. COPD)
- Raised JVP
- Hyperinflated chest
- Bilateral coarse crackles
198
What are 4 features of tension pneumothorax?
1. Decreased breath sounds
2. Tracheal deviation away
3. Hyper-resonant percussion (more air inside chest)
4. Decreased tactile and vocal fremitus
199
What is the most common valvular heart disease?
Aortic stenosis due to idiopathic age related calcification
200
How does sarcoidosis present and what is the first line treatment?
- Dry cough
- SOB
- Low grade fever
- Uveitis
- Erythema nodosum (tender red nodules on shins)
- Prednisolone + bisphosphonates
201
Which antibody is seen in patients with granulomatosis with polyangiitis
cANCA
202
What would a peripheral blood smear show in patients with thrombotic thrombocytopenic purpura?
Schistocytes (fragmented RBCs)
203
What is the key management for glucose-6-phosphate dehydrogenase deficiency?
Avoid triggers e.g. fava beans, henna, certain medications
204
In what order do you correct a folate, B12 and vitamin D deficiency?
B12, folate, vitamin D
205
What are the first line and gold standard investigations for achalasia?
1st line = upper GI endoscopy
Gold standard = oesophageal manometry
206
What condition is associated with gallstone development?
Crohn's - inflamed terminal ileum prevents bile salts from being absorbed
207
What are the preferred diagnostic investigations for acute pancreaittis?
- Serum lipase >3 times the upper limit of normal (stay elevated for longer)
- Serum amylase >3 times the upper limit of normal
208
What is the name of a dormant malaria spore?
Hypnozoite
209
What is dose-response?
The higher the exposure, the higher the risk of disease
210
What is Lambert-Eaton Myasthenic syndrome and what is it commonly associated with?
Progressive muscle weakness (similar to myasthenia gravis) - associated with small cell lung cancer - antibodies against calcium channels
211
Describe Neisseria meningitidis
Gram negative diplococci
212
Describe the histopathological findings of Parkinson's disease
- Loss of dopaminergic neurones in substantia nigra pars compacta
- Presence of Lewy bodies/eosinophilic cytoplasmic inclusions
213
Which two inherited conditions increase the risk of bowel cancer?
- Familial adenomatous polyposis (FAP)
- Lynch syndrome
214
What is familial adenomatous polyposis?
- 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
What is Lynch syndrome?
- 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
What is the difference between venous and arterial ulcers?
Venous = most common occur above the medial/lateral malleoli
Arterial = often affect toes/shins
217
What is the most common dermatological manifestation of Crohn's disease?
Erythema nodosum (swollen fat under skin causing bumps/patches that look red/dark)
218
How is disseminated intravascular coagulation treated?
- Cryoprecipitate (if low fibrinogen)
- Platelet transfusion
- Treat underlying cause
219
What is ipratropium bromide?
Short acting muscarinic receptor antagonist (SAMA) - muscarinic acetylcholine receptor antagonist that acts as a bronchodilator
220
Describe the blood results of a patient with systemic lupus erythematosus
- Anaemia
- Low serum complement 3 and 4
- Raised ESR and CRP
221
Patients with Sjogren's syndrome have an increased risk of getting what?
Non Hodgkin Lymphoma
222
Describe the pathophysiology of cholera
Toxin deregulates ion transport in epithelial cells
223
What are the complications following an MI?
DREAD
Death
Rupture of septum/papillary muscle
oEdema (HF)
Aneurysm/arrhythmia
Dressler's syndrome
224
What is Wenckebach phenomenon also known as?
Mobitz Type I heart block (second degree heart block) - PR becomes progressively more prolonged until QRS complex missed (then pattern resets)
225
What is the marker of Addison's?
Anti 21 hydroxylase - autoimmune destruction of adrenal cortex
226
What is a side effect of SGLT2 inhibitors (e.g. empagliflozin)?
Glycosuria --> increases chances of UTIs and thrush
227
Describe the AKI stages
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
What are the causes of subdural, extradural, intracerebral and subarachnoid haemorrhages?
Subdural = rupture of bridging veins
Extradural = rupture of middle meningeal artery
Intracerebral = rupture of aneurysm
Subarachnoid = rupture of cerebral aneurysm
229
How do subdural and extradural haemorrhages present on CT scans?
Subdural = crescent shape, not limited by cranial sutures
Extradural = bi-convex shape, limited by cranial sutures
230
What is found on an XRAY/skeletal survey for multiple myeloma?
- Punched out lesions
- Osteolytic lesions
- Raindrop skull
231
Is cytomegalovirus an AIDS-defining illness?
Yes, unless of the liver, spleen or glands
232
How does neurogenic shock present?
- Altered consciousness
- Flushed appearance
- Hypotension
- Bradycardia
233
What are causes of pulmonary fibrosis?
- Idiopathic
- Lung damage (pneumonia, TB)
- Irritants (coal, dust, silica)
- Connective tissue disease (SLE, RA, Sjogren's)
- Drugs (amiodarone, nitrofurantoin)
234
What is seen in the hands of someone with idiopathic pulmonary fibrosis?
- Finger clubbing
- Acrocyanosis
235
What are the medications for idiopathic pulmonary fibrosis?
- Pirfenidone (antifibrotic and anti-inflammatory)
- Nintedanib (monoclonal antibody against tyrosine kinase)
236
What is seen in scans of patients with idiopathic pulmonary fibrosis?
- Honeycombing
- Ground glass
- Lower zone fibrosis distribution
237
What are the 2 signs of hypocalcaemia?
Chvostek's sign = facial muscle spasm
Trousseau's sign = wrist flexion and finger adduction
238
How do hypercalcaemia/hypocalcaemia present on an ECG?
HYPER = short QT interval
HYPO = prolonged QT interval
239
How does hypokalaemia present on an ECG?
- Prolonged PR interval
- ST depression
- U waves
- Flattened, inverted T waves
240
Which enzymes are raised in biliary damage?
- ALP (alkaline phosphate)
- GGT (gamma-glutamyl transferase)
241
What is the presentation of ascending cholangitis?
Charcot's triad:
- RUQ pain
- Fever
- Jaundice
242
What is a complication of ascending cholangitis and how does it present?
Biliary sepsis - Reynauld's pentad:
- Charcot's triad (RUQ pain, fever, jaundice)
- Sepsis
- Confusion
243
What are the 2 most common causes of pancreatitis?
1. Gallstones
2. Alcohol
244
Which parts of the adrenal glands secrete what?
Medulla = catecholamines (adrenaline)
Zona reticularis (cortex) = androgens (DHEA)
Zone fasciculata (cortex) = glucocorticoids (cortisol)
Zona glomerulosa (cortex) = mineralocorticoids (aldosterone)
245
Where is a pancoast tumour located and what is it associated with?
Apex of lung - Horner's syndrome (miosis, anhidrosis and ptosis)
246
How do asthma peak flow measurements differ at different times of day?
Morning lower, evening higher = diurnal variation
247
What is the action of DOACs?
Inhibit factor X in the coagulation cascade
248
Describe the pathophysiology of primary hyperthyroidism (Grave's)
- 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
What are some signs of hyperthyroidism?
- Tachycardia
- Fine tremor
- Goitre
- Thin hair
- Ptosis
250
What are some complications of diabetes?
- Diabetic retinopathy
- Diabetic neuropathy
- Increased risk of heart attack/stroke
- Foot ulcers
- Recurrent infection
251
Where are alpha adrenoceptors found and what do they do?
- Blood vessels = vasoconstriction
- Sphincters (e.g. bladder neck) = contracts
252
Where are beta adrenergic receptors found and what do they do?
- Beta 1 = heart = contract heart muscle
- Beta 2 = bronchioles = bronchodilation of airways
253
What are some symptoms of aortic stenosis?
SAD:
- Syncope
- Angina
- Dyspnoea (exertional)
- Fatigue
- Fainting
254
What are the 3 cardinal signs of heart failure?
1. SOB (orthopnoea, paroxysmal nocturnal dyspnoea)
2. Ankle swelling
3. Fatigue
255
What are some causes of pericarditis?
- Idiopathic
- Viral (coxsackie)
- Bacterial (TB)
- Autoimmune (SLE, RA)
- Dressler’s syndrome
- Cancer (lung/breast)
256
What is the inheritance pattern for haemophilia A and B?
X linked recessive
257
What other blood tests are done for patients with suspected iron deficiency anaemia?
Iron studies:
- Low serum ferritin
- Low serum iron
- Low transferrin saturation
258
Why are iron studies limited?
Ferritin is an acute phase protein - also increases with inflammation
259
What is desmopressin used for?
Haemophilia A and B and Von Willebrand Disease - stimulates release of VWF (and therefore factor VIII)
260
What is observed in patients with small bowel obstructions?
- Abdominal distension
- Hyperresonant bowel
- Tinkling bowel sounds
261
What is seen on an xray in patients with sigmoid volvulus?
Coffee bean sign (volvulus = twisting)
262
What chemotherapy is used for lymphoma?
Hodgkin's = ABVD
Non-Hodgkin's = RCHOP
263
What is megaloblastic anaemia?
Type of macrocytic anaemia e.g. B12 and folate deficiency
264
What is non megaloblastic anaemia?
Type of macrocytic anaemia - alcohol, reticulocytosis, liver disease, hypothyroidism
265
Describe the glasgow coma scale
Score out of 15
Eye opening = /4
Verbal response = /5
Motor response = /6
266
What is a feature more commonly seen in Crohn's and Coeliac but not UC?
Mouth/aphthous ulcers
