Stop being a silly billy Y1 Flashcards
First-line treatment for hypertension in diabetics:
ACE inhibitors/A2RBs (regardless of age)
What is oesophageal adenocarcinoma associated with?
GORD or Barrett’s
First-line treatment to maintain remission in patients with Crohn’s:
Azathioprine or mercaptopurine
Abdominal pain with blood and leucocytes on dipstick should prompt you to look for…
renal tract stones (using a non-contrast CT abdomen and renal tract)
What drugs should all patients be offered following an MI according to NICE guidlines?
dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin
Which investigation would be most useful initially to differentiate between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) in primary care?
Faecal calprotectin (using a stool sample)
What test is test recommended for H. pylori post-eradication therapy?
Urea breath test
What is the first line antibiotic for use in patients with C. difficile infection?
Oral vancomycin
Although the NICE guidelines suggest a CTPA as the main investigation of choice in a patient with a suspected PE, when is it contra-indicated? What would be the next best option in that case?
Contra-indicated in patients who have a renal impairment or are allergic to contrast media (baxkground of chronic kidney disease). V/Q scan would be done instead.
What condition is classically characterised by a triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit? What causes this condition?
intestinal angina.
most common cause = atherosclerotic disease in arteries supplying the GI tract
What condition is classically characterised by a triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit? What causes this condition?
intestinal angina.
most common cause = atherosclerotic disease in arteries supplying the GI tract
Easy bruising can be due to a poor diet deficient in vitamin ___?
C
What is the main criteria for determining whether a patient with chronic obstructive pulmonary disease (COPD) should be offered long-term oxygen therapy?
Two arterial blood gases measurements with pO2 < 7.3 kPa
‘Provoked’ pulmonary embolisms are typically treated for __ months
3
pulmonary embolisms with persistent risk factors are typically treated for __ months
trick question - life-long/indefinite anticoagulation is recommended
Unprovoked pulmonary embolisms are typically treated for __ months
6 months
An ECG shows the following:
broad QRS > 120 ms
rSR’ pattern in V1-3 (‘M’ shaped QRS complex)
wide, slurred S wave in the lateral leads (aVL, V5-6)
What is shown here?
Right bundle branch block
How do you remember the difference between LBBB and RBBB?
WiLLiaM MaRRoW
in LBBB there is a ‘W’ in V1 and a ‘M’ in V6
in RBBB there is a ‘M’ in V1 and a ‘W’ in V6
What is melanosis coli associated with?
laxative abuse
The patient presents with painless jaundice and dilatation of the pancreatic duct and common bile ducts. What is the most likely diagnosis?
Pancreatic cancer (could also be cholangiocarcinoma)
a common presenting complaint in Peutz-Jegher’s syndrome:
Small bowel obstruction (often due to intussusception)
indicated by hyperpigmented mucosal macules (most commonly seen on the vermillion border of the lips)
Wilson’s disease - increased/reduced total serum copper
reduced
When is ulcerative colitis classified as ‘severe’ according to The Truelove and Witts’ severity index?
when the patient has blood in their stool, or is passing more than 6 stools per day plus at least one of the following features:
Temperature greater than 37.8°C
Heart rate greater than 90 beats per minute
Anaemia (Hb less than 105g/ L)
Erythrocyte sedimentation rate greater than 30 mm/hour
Diarrhoea, fatigue, osteomalacia → ?
coeliac disease
What is the normal duration of the P-R interval on an ECG?
0.12 to 0.20 seconds
progressive confusion, lethargy, personality changes and in later stages, coma. Diagnosis?
Hepatic encephalopathy
‘quick fix’ for encephalopathy
Lactulose
All patients diagnosed with haemochromatosis undergoing venesection should have monitoring of their…
transferrin saturation and serum ferritin
When is Metoclopramide contraindicated?
If the patient has Parkinson’s
How are liver abscesses generally managed?
antibiotics + image-guided percutaneous drainage
Treatment for acute pulmonary oedema?
IV loop diuretic (e.g. furosemide)
What is contraindicated in aortic stenosis
nitrates
NSTEMI management: what should be given in addition to aspirin to all patients unless high bleeding risk?
fondaparinux
True or False: Pleural plaques are benign and do not undergo malignant change.
True
first-line management for non-alcoholic fatty liver disease:
weight loss
Name a condition associated with gallstones:
Crohn’s disease
the most likely area to be affected by ischaemic colitis;
splenic flexure
first-line recommended treatment for severe autoimmune hepatitis:
Steroids
What is Charcot’s triad? What does it indicate?
jaundice, fever and right upper quadrant pain. Indicates ascending cholangitis
Where should an epipen be injected?
Anterolateral aspect of the middle third of the thigh
A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with…
oral fidaxomicin
Which antibiotic is associated with a high risk of C. difficile?
clindamycin
Fetor hepaticus, sweet and fecal breath, is a sign of what?
liver failure
For patients of black African or African–Caribbean origin taking a calcium channel blocker for hypertension, if they require a second agent consider ____________________
an angiotensin receptor blocker (____sartan)
True or False: overeating is a common feature of appendicitis
False - Anorexia is a common feature of appendicitis
In a mild-moderate flare of distal ulcerative colitis, the first-line treatment is…
topical (rectal) aminosalicylates (e.g. mesalazine)
Dysphagia, aspiration pneumonia, halitosis → ?
pharyngeal pouch
Name the disease…
Common symptoms include:
nausea and vomiting, anorexia
myalgia
lethargy
right upper quadrant (RUQ) pain
Questions may point to risk factors such as foreign travel or intravenous drug use.
Viral hepatitis
Name the disease…
The liver only usually causes pain if stretched. One common way this can occur is as a consequence of congestive heart failure. In severe cases cirrhosis may occur.
Congestive hepatomegaly
Name the disease…
RUQ pain, intermittent, usually begins abruptly and subsides gradually. Attacks often occur after eating. Nausea is common.
It is sometimes taught that patients are female, forties, fat and fair although this is obviously a generalisation.
Biliary colic
Name the disease…
Pain similar to biliary colic but more severe and persistent. The pain may radiate to the back or right shoulder.
The patient may be pyrexial and Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)
acute cholecystitis
Name the disease…
An infection of the bile ducts commonly secondary to gallstones. Classically presents with a triad of:
fever (rigors are common)
RUQ pain
jaundice
Ascending cholangitis
Name the disease…
This describes small bowel obstruction secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.
Abdominal pain, distension and vomiting are seen.
gallstone ileus
Name the disease…
Persistent biliary colic symptoms, associated with anorexia, jaundice and weight loss. A palpable mass in the right upper quadrant (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen
Cholangiocarcinoma
Name the disease…
Usually due to alcohol or gallstones
Severe epigastric pain
Vomiting is common
Examination may reveal tenderness, ileus and low-grade fever
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare
acute pancreatitis
Name the disease…
Painless jaundice is the classical presentation. However pain is actually a relatively common presenting symptom. Anorexia and weight loss are common
pancreatic cancer
Name the disease…
Typical symptoms are malaise, anorexia and weight loss. The associated RUQ pain tends to be mild and jaundice is uncommon.
Amoebic liver abscess
Newly diagnosed patient with hypertension who has a background of type 2 diabetes mellitus - add an _________ or an __________ regardless of age
ACE inhibitor or an angiotensin receptor blocker
The main ECG abnormality seen with hypercalcaemia is…
short QT interval
life-threatening C. difficile infection treatment:
ORAL vancomycin and IV metronidazole
Treatment for torsades de pointes
IV magnesium sulfate
With a background of ulcerative colitis, a patient with mild hepatomegaly, pruritus and fatigue is most likely suffering from what? What investigation should be done?
primary sclerosing cholangitis
investigations = ERCP/MRCP
Most appropriate investigation for a patient with shortness of breath, orthopnoea, bilateral ankle swelling?
echocardiography (as they are showing symptoms of new-onset heart failure
Type A aortic dissection treatment:
control BP (IV labetalol) and surgery
Type B aortic dissection treatment:
control BP (IV labetalol)
Type B aortic dissection treatment:
control BP (IV labetalol)
what do you do if there is dysplasia on biopsy in Barrett’s oesophagus?
endoscopic intervention
What do corticosteroids induce remission of?
Chrohn’s Disease
What does the following indicate?
antinuclear antibodies +ve
anti-smooth muscle antibodies +ve
increased IgG levels
autoimmune hepatitis
What does a combination of liver and neurological symptoms indicate?
Wilson’s disease
What indicates surgery in bronchiectasis?
localised disease
budesonide drug class:
ICS
what is indapamide?
a thiazide-like diuretic
Poorly controlled hypertension, already taking an ACE inhibitor. What do you do?
add a calcium channel blocker or a thiazide-like diuretic
What should be used instead when ACEi not tolerated?
Angiotensin-receptor blockers
The most common ECG finding in patients with pulmonary embolism:
sinus tachycardia
If prescribed erythromycin/clarithromycin, what other medication should be stopped?
statins
What are the boundaries of the ‘safe triangle’ for chest drain insertion?
bounded by latissimus doors, pectoralis major, line superior to the nipple and apex at the axilla
What is Beck’s triad? What is it associated with?
hypotension, a raised JVP (with a negative Kussmaul’s sign as it does not change with breathing) and muffled heart sounds (mentioned as ‘quiet’ in the question)
associated with cardiac tamponade
A thiazide-like diuretic is contraindicated due to the history of…
gout
Most common cause of occupational asthma:
Isocyanates
Unstable angina or NSTEMI?
Elevation in troponin points towards NSTEMI
The AST/ALT ratio in alcoholic hepatitis is…
2:1
Describe Hesselbach’s Triangle:
Superolaterally - Epigastric vessels
Medially - Lateral edge of rectus muscle
Inferiorly - Inguinal ligament
What classically presents with ‘rice water’ diarrhoea?
Cholera
Stroke volumes range:
55-100ml
