Specialities high yield qs Flashcards
How long should benzos be prescribed for?
2-4 weeks
What is a normal MMSE score
24 or more
What is a severe impairment on MMSE
<10
What is a normal MoCA score?
26 or more out of 30
Scoring questionnaires for depression
PHQ-9, hospital anxiety and depression scale
Scalings for PHQ-9?
5-9 = mild
10-14=moderate
15-19 = moderately severe
20-27 = severe
Screening tools for alcohol?
CAGE, AUDIT, clinical institute withdrawal assessment for alcohol (CIWA-Ar)
Post initial treatment this strain of malaria requires primarquine to eradicate liver parasites?
Plasmodium vivax
This test is done to determine species of malarial parasite
Thin blood film
- 45 year old with itchy skin and AMA positive and high ALP levels
PBC
Raised alt levels indicate what?
Viral hepatitis
45 admitted post fall leucocytosis with elevated bilirubin, alumbin folate and vit B12 low , prolonged PT - cause?
Alcoholic liver disease
Wide spread organ damage in malaria due to impaired microcirculation - what type?
Plasmodium falciparum
Effect of Ace inhibitors on renal disease?
Prevent end stage renal failure, drops albuminuria.
Gfr drops and creatinine goes up
When are ACEi contraindicated?
Renal artery stenosis
- ACE inhibitors in diabetes
o Worsens creatinine within days of starting.
Hypertension and hypokalaemia
Low renin high aldo
Conn’s syndrome
Hypertension and hypokalaemia
High renin high aldo
Renal artery stenosis
Sodium level in psychogenic polydipsia?
Low
Sodium level in diabetes insipidus?
High
What is the full name of a “rodent ulcer?
Basal cell carcinoma
Jaundice and conjunctival haemorrhages
Leptospirosis
Found in rat urine
Lakes/canoeing etc.
Polyuria and polydipsia very high sodium, nothing else
Diabetes insipidus
- Which of these occur in patients with osetomalacia?
Secondary hyperparathyroidism
- What occurs in patients with Lesch-Nyhan spyndrome?
Gout
o Low sodium, high potassium, high calcium, normal PTH and phosphate
Addisons disease
Carpal tunnel, tingling spasm
o Low calcium, highish phosphate
o Very high PTH
Secondary hypertparahyroidism
Polyuria, polydipsia
High calcium, normal PTH, low phosphate
Primary hyperparathyroidism
(inappropriately normal)
Which one is a good marker of glucose control over last 3 weeks?
Fructosamine
Which one rises most in chronic renal failure caused by a fall in GFR?
Creatinine
Which one rises most in acute renal failure where the cause dehydration?
Urea
Most increased in prostatic carcinoma?
o Acid phosphatase – prostate specific antigen
Most raised in chronic alcoholic liver cirrhosis?
Aspartate aminotransferase
Which one is most raised in jaundice from viral hepatitis?
Alanine aminotransferase
Which one of these is most increased in a patient with jaundice caused by a gallstone?
Alkaline phosphatase (goes up in obstruction)
What is increased in osteomalacia?
ALP
Hearing problems associated with Paget’s?
Both conductive or nerve (sensorineural)
Conductive of bones inside ear
Compression on 8th cranial nerve
- Post op thyroidectomy + tingling
What should you check?
Calcium level
Due to parathyroid gland removal/damage
Investigations for Paget’s?
Technetium bisphosphonate bone scan tracer
Plain xray
A 26 year old known I.V. drug user presents with fever, weakness, lassitude and night sweats. On examination you discover a heart murmur.
What is the diagnosis?
Infective endocarditis
Duke’s criteria
What type of neutrophil is shown in the middle of this blood film, in this patient known to have pernicious anaemia?
Hypersegmented
A liver biopsy histology is reported as showing “A “nutmeg” appearance”. What is the most likely diagnosis?
Right sided heart failure
.A 70 year old known teetotal patient is noted to have a heart murmur and careful examination reveals splenomegaly with an obvious notch and you can’t get above it. There are no visible veins on the anterior abdominal wall, and there is no ascites, so you conclude that there is no portal hypertension. Dipstick of the urine reveals microscopic haematuria. She is found to have a temperature of between 37.5oC and 38.5oC whenever it is checked.
What is the diagnosis?
Endocarditis
When stained with Congo red stain, an apple green birefringence is seen in a liver biopsy. What is the most likely diagnosis?
Amyloidosis
Non-caseating granulomas?
Sarcoidosis
When stained with a Rhodanine stain a liver biopsy reveals a golden brown colour against the blue counterstain. What is the most likely diagnosis?
Wilson’s disease
An 11 year daughter of an anti-Vaxxer old presents with a fever red eyes, a runny nose and a pink rash that began on the face and then spread downwards to the rest of the body.
What is the most likely diagnosis?
Measles
Name the disorder of calcium handling most commonly seen in patients with end-stage chronic renal failure, in which the plasma calcium is raised?
Tertiary hyperparathyroidism
Name the peptide hormone responsible for increasing plasma calcium in response to reduced calcium levels by stimulating osteoclast activity.
A. Calcitonin
B. Calcitriol
C. Cholecalciferol
D. Ergocalciferol
E. Parathyroid Hormone
Parathyroid hormone
Name for activated vitamin D?
1,25-dihydroxyvitamin D/calcitriol
Name the form of vitamin D produced following the action of 1alpha hydroxylase on 25-OH D3 in the kidney?
Calcitriol
Form of vitamin D supplement for vegans?
Ergocholecalciferol
Which of the options acts to stimulate 1alpha hydroxylase activity in the kidney to increase the production of vitamin D3?
Parathyroid hormone
A patient has a positive Coombes test (positive direct antiglobulin test). Which is the most likely diagnosis?
A. Auto-immune haemolytic anaemia (AIHA)
B. Disseminated intravascular haemolysis (DIC)
C. Hereditary spherocytosis
D. Micro-angiopathic haemolytic anaemia (MAHA)
E. Polycytheamia Rubra Vera
AIHA
Antibodies to phospholipase A2 receptor are associated with what form of glomerulonephritis?
Membranous?
Which of the following cause a polycythaemia?
A. Adrenal cortical carcinoma
B. Colonic carcinoma
C. Prostatic carcinoma
D. Renal cell carcinoma
E. Transitional cell carcinoma of the bladder
Renal cell carcinoma
What cancer can cause polycythaemia?
Renal cell carcinoma
What is the specific auto-antigen that is the target of the immune system in Goodpastures syndrome?
. Type IV Collagen
What is the specific auto-antigen that is the target of the immune system in hereditary spherocytosis?
Spectrin
Which of the following is most diagnostic for Rheumatoid arthritis?
A. Anti-CCP (cyclic citrullinated peptide) Antibody
B. Anti-Centromere Antibody
C. Anti-GAD (glutamic acid decarboxylase) Antibody
D. Anti-Mitochondrial Antibody
E. Rheumatoid Factor
Anti-CCP
Which of these is particularly associated with longstanding bronchiectasis?
A. E-Coli
B. Pseudomonas Aeruginosa
C. Staph aureus
D. Strep pneumoniae
E. Strep pyogenes
Pseudomonas aeruginosa
Which of these is most likely to CAUSE bronchiectasis?
A. E-coli
B. Pseudomonas Aeruginosa
C. Staph aureus
D. Strep pneumoniae
E. Strep pyogenes
Staph aureus
A 40 year old woman has always known cramping pain associated with her periods – which have usually been heavy. Recently this pain has become constant throughout the month, and her periods have become more frequent. She claims never to have used oral contraception and has no children. She is abstaining from sexual intercourse as it is too painful.
What is the likely diagnosis?
A. Cervical Polyps
B. Endometriosis
C. Fibroids
D. Herpes Virus Infection
E. Polycystic Ovary Syndrome
Endometriosis
Which of these is associated with hyperkalaemia?
A. Addison’s disease
B. Conn’s syndrome
C. Ectopic ACTH
D. Prostate cancer
E. Renal artery stenosis
Addison’s disease
(hyperkalaemia, hyponatraemia)
A 40 year old presents to A&E with severe hypotension and shock. He appears dehydrated and tests reveal the following:
Sodium 123 mmol/L (135–146)
Potassium 6.8 mmol/L (3.5–5.3)
Glucose 2.9mM
Rank the following diagnoses in order of likelihood:
Hypothyroidism
Conn’s syndrome
Primary hyperparathyroidism
Gastroenteritis
Addison’s disease
Addison’s disease (1)
Gastroenteritis (2)
Hypothyroidism (3)
Primary hyperparathyroidism (4)
Conn’s syndrome (5)
What is the correct pathological term for a discontinuation in the epithelial surface?
Ulcer
65 year old male with a long history of epigastric pain. Endoscopy reveals 3.2cm of columnar metaplasia in the lower oesophagus. What does this suggest?
Barrett’s oesophagus
What is the technical term for a connection between two epithelial surfaces, as occurs in Crohns disease where for example there might be a connection between the bladder and the bowel?
Fistula
A 46-year old Japanese female is found to have bilateral ovarian masses on imaging of the abdomen and had both ovaries removed. Histology revealed malignant signet ring cells containing mucin in both ovaries. What is the diagnosis?
Krukenberg tumour
What ovarian tumour is associated with Meig’s syndrome?
Fibroma
50 year-old female was found to have an ovarian mass. On its removal, histology revealed several cell types, including thyroid follicles, hair and teeth. What is the likely diagnosis?
Dermoid cyst
A 37 year-old man presents with a headache, myalgia and a cough. He is also suffering with nausea, diarrhoea and abdominal pain. On examination he is tachypnoeic and has a pyrexia of 39ºC. Blood tests reveal lymphopenia and hyponatraemia. A gram stain from the patient’s sputum is shown here (Gram negative rods). CXR shows lobar consolidation. Cold agglutinins are negative. What is the organism?
Legionella
A 40 year-old woman presents with malaise, muscular pains and diarrhoea with mucus and blood. On examination she has a fever and several distinctive spots on her abdomen (Rose spots). Blood cultures are positive and grow gram negative rods. What is the likely organism?
Salmonella typhi
A genus of spiral flagellated Gram negative bacteria. Found in the stomach within the mucosa layer. It occurs in the majority of middle-aged people and causes progressive gastritis. Invariably present in duodenal ulceration and usually in gastric ulceration. What is the organism?
H. Pylori
The same 28-year old woman with anti-tissue transglutaminase (tTG) and anti-endomyseal (EMA) antibodies wanted to know if she needed any further investigations. What gold standard diagnostic test should be undertaken?
Distal duodenal biopsy
4 year old girl presents to the A&E with a recurrent chest infection that will not clear. On examination, the house officer notices that she has low set ears, a cleft palate and a murmur. Investigations reveal:
Calcium 1.9 mM (NR 2.2 to 2.6); Phosphate 1.4 mM (NR 0.8 to 1.4)
PTH 1.1 pM (NR 1.1 to 6.8)
What is the likely diagnosis?
DiGeorge syndrome
A 40-year old lady complains of tight fingers and dysphagia, and is thought to have a syndrome associated with Raynaud’s phenomenon, and telangiectasia. What antibody should we measure to confirm this possible diagnosis?
Anti-centromere
CREST syndrome
A 32-year old woman is thought to have Graves’ disease. What antibody should you look for?
Anti-TSH receptor antibody
In a patient with Hodgkins Lymphoma, the stage of disease is given by the amount of spread, with stage 1 disease involving only one group of nodes, and stage IV disease involving extra nodal spread. What would stage III Hodgkins disease suggest?
Disease above AND below the diaphragm
Give one feature that would make you add the suffix “B” to the stage of the Hodgkins disease?
Fever
A 51-year old man is having investigations for palliative surgery due to gastric adenocarcinoma. He is found to be anaemic, with high a reticulocyte count and fragmented red blood cells on blood smear. What is this anaemia known as? (Remember NOT to use acronyms).
Microagiopathic haemolytic anaemia
A 45 year old woman, presents with increasing pain in her thighs and hips. Blood results : Ca – 2.4 mmol/L (2.2 to 2.6), Phosphate – 0.9 mmol/L (0.8 to 1.4), PTH – 5.0 pmol/L (1.1 to 6.8), ALP 3900 (39-120).What is the likely diagnosis?
Paget’s disease of the bone
Name an example of a drug that inhibits the enzyme dipeptidyl dipeptidase IV (DPP-4).
Sitagliptin
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel
Acarbose
A 25-year-old woman complains of right iliac fossa pain, diarrhoea and weight loss worsening over several weeks. Laparotomy reveals an oedematous, reddened terminal ileum and a biopsy uncovers transmural inflammation with the presence of granulomas - diagnosis?
Crohn’s
A 35-year-old woman presents with diarrhoea and lower abdominal pain. Examination of her stools reveals blood and mucus. A biopsy reveals a continuous superficial ulceration of the colon
UC
A 60-year-old patient presents with chronic left-sided abdominal discomfort and the passage of fresh blood from the rectum. He denies weight loss and on examination has no palpable masses. However a colonoscopy reveals pouches of mucosa extruding through the muscle layer.
Diverticular disease
A 70-year-old man who has been receiving broad-spectrum antibiotic treatment develops profuse diarrhoea and frequent episodes of incontinence. A biopsy of the colon reveals a membrane like material covering the surface composed of mucin, fibrin, polymorphs and what seems to be debris of leukocytes and mucosal epithelial cells. What is the diagnosis?
Pseudomembranous colitis
A 28 year-old junior doctor comes in feeling ‘pretty lousy and aching all over’. She is wearing dark glasses and complains of a stiff neck. CSF examination reveals a normal CSF/blood glucose ratio and slightly raised protein of 0.7 g/L with a lymphocyte count of 150 and no neutrophils. There were no red cells in the CSF which proved that the lumbar puncture was well carried out, and that the SHO undertaking it had not punctured any veins.
What is the likely diagnosis?
Viral meningitis
A 56 year-old male presents with fever, vomiting and seizures. Examination reveals a well- established ear infection and there is a ‘ring-enhancing’ lesion on the MRI of his brain.
Toxoplasmosis???
Gram staining of a blood culture reveals Gram positive diplococci. What is the likely organism?
Streptococcus
27 year old patient has a knee effusion drained. The gram stain reveals Gram negative intracellular diplococci. What is the likely organism?
Neisseria meningitidis
A 28 year old woman presents with malaise, weight loss, an erythematous rash on the face and joint pains. Both antinuclear antibodies (ANA) and double-stranded DNA (dsDNA) antibodies were found in the serum
SLE
A 40 year old man presents with weight loss, muscle aches and abdominal pain. On examination he has high BP and urine dipstick reveals blood + and protein +. The patient is thought to have a vasculitis and is p-ANCA positive
Polymyositis??
A patient is found to have a very high titre of anti-mitochondrial antibody. What is the likely diagnosis?
PBC
. A patient presents with haemoptysis and haematuria. She is thought to have Goodpastures syndrome. What antibody should you look for?
Anti-glomerular basement membrane
A 32yr old woman complains of fatiguability in many muscles and double vision. She is thought to be at risk of other autoimmune diseases as she has a family history of various autoimmune diseases and herself has autoimmune hypothyroidism. Her thyroid function is normal because she is well replaced with thyroxine. What might be causing her muscle weakness?
Myasthenia gravis
A four-year-old boy presents with a purpuric rash across the legs and buttocks. Two weeks previously you had seen the child about a chest infection. Further examination reveals abdominal pain and haematuria. Serum IgA levels are raised. What is the likely diagnosis?
Post streptococcal glomerulonephritis
A child is found to be anaemic, and molecular studies show a defect in the spectrin molecule. What is the diagnosis?
Hereditary spherocytosis
A 70 year old lady presents with pallor and has the following results:
Hb 90. (NR 120-150) g/dl
MCV 125 fl (NR 76-96).
The film shows hyper-segmented neutrophils. The patient also has type 1 diabetes and hypothyroidism that are both well treated. What is the underlying cause of her low haemoglobin.
Pernicious anaemia
A 70 year old man presents with pallor and has the following results:
Hb 90. (NR 120-150) g/dl
MCV 65 fl (NR 76-96).
What is the likely underlying cause of the low haemoglobin.
Upper GI bleed
A patient presents with tiredness and is found to have a calcium of 3.0mM and a normal PTH at 3.0pM (NR 1.1 to 6.8). What is the likely diagnosis?
Primary hyperparathyroidism
A patient presents with tiredness and is found to have a calcium of 2.0 mM and a raised PTH at 30pM (NR 1.1 to 6.8). What is the likely diagnosis?
Secondary hyperparathyroidism
A patient presents with tiredness and notices that he is more pigmented than usual. His results reveal: Na 129 K 6.2 and his blood pressure is 80/50. What is the likely underlying diagnosis?
Addison’s disease
Which vitamin deficiency is associated with Pellagra?
Niacin deficiency
Dementia, dermatitis, diarrhoea
A patient presents with tiredness and has the following results:
TSH=30 (NR 0.3 to 4.7).
What is the likely diagnosis?
Hypothyroidism
What do cold agglutinins and pneumonia suggest?
Myocplasma pneummoniae
What type of neutrophil is shown in the middle of this blood film, in this patient known to have pernicious anaemia?
Hypersegmented neutrophil
A 67-year-old woman presented with confusion 2 days after a cholecystectomy. She had experienced some pain postoperatively, largely relieved by analgesia. On examination, she was disoriented, her heart rate was 66 beats per minute and her blood pressure was 162/82 mmHg. She only had minor discomfort of the abdomen. The urine sodium was 90mmol/l (NR 20-200mmol/l depending on hydration of patient).
The figure below shows the colours you would see on the dipstick after it has been dipped in the urine, and it was yellow in colour, consistent with an SG of 1.030.
Investigations:
Haemoglobin 130 g/L (115-165)
MCV 92 fL (80-96)
white cell count and platelet count normal
serum sodium 120 mmol/L (137-144)
serum potassium 3.7 mmol/L (3.5-4.9)
serum urea 3 mmol/L (2.5-7.0)
serum creatinine 90 µmol/L (60-110)
serum albumin 36 g/L (37-49)
random plasma glucose 5 mmol/L
What is the most likely cause of the low sodium (avoid acronyms)?
Syndrome of inappropriate ADH
patient presents with weakness and is found to have a potassium of 2.4mM (NR 3.5 to 5.0). What is the likely acid-base abnormality if you check the patients arterial blood gas?
Metabolic alkalosis.
Remember hypokalaemic alkalosis. They go together, hypokalaemia causing alkalosis and alkalosis causing hypokalaemia.
A liver biopsy histology is reported as showing “NON Caseating granulomata”. What is the most likely diagnosis?
Sarcoidosis
A patient has a positive Coombes test (positive direct antiglobulin test). Which is the most likely diagnosis?
Autoimmune haemolytic anaemia
Describe Lesch-Nyhan syndrome
Hyperuricaemia, gout, renal calculi, UTIs, kidney failure, tophi, neurological problems, chorea, dystonia, aggressive behaviour
Xanthine - uric acid enzyme?
Xanthine oxidase
Lesch-Nyhan syndrome inheritance pattern?
X-linked recessive
Lesch-Nyhan syndrome - which gene is affected?
HGRPT
Allopurinol mechanism of action?
Blocks xanthine oxidase
