Things I got Wrong in Mocks Flashcards
1
Q
Mechanism of action of Neostigmine and Pyridostigmine
(BONUS : what are they used to treat?)
A
Blocks active site of acetylcholinesterase
∴ ↑ amount of Ach available to post-synaptic membrane
Myasthenia Gravis
2
Q
Mechanism of action of Levodopa
A
Crosses the blood-brain barrier and is converted into dopamine which acts to reduce neurological symptoms
3
Q
Mechanism of action of COX-i e.g. ibuprofen
A
Inhibits conversion of arachidonic acid to prostaglandins by inhibiting COX1 and COX2
4
Q
Mechanism of action of Mannitol
A
↓ Intracranial pressure by setting up osmotic gradient between CSF and subarachnoid space
5
Q
Define hyperplasia
A
Increased size of tissue due to increase of number of constituent cells
6
Q
Things you see on blood film for IDA
A
Hypochromic
Microcytic
Poikilocystosis
Anisocytosis
Pencil cells
Thromobocytosis
7
Q
Symptoms for the cause of IDA
A
Meleana
Heavy menstrual bleeding
Change in bowel habits
Nose/Gum bleeding
Haematuria
Pregnancy
Haematemesis
8
Q
What protein carries iron around the body?
A
Transferritin
9
Q
What blood test is used to confirm IDA?
A
Serum Ferritin
Low
10
Q
1 Blood test to confirm Graves’ disease
A
TSH receptor antibodies
11
Q
3 Accepted modalities for hyperthyroidism Tx
A
Thyroidectomy
Anti-thyroid drugs - Carbimazole
Radioactive iodine
12
Q
3 Pathophysiological processes on Osteoporosis
A
Increased bone remodelling
↓ Osteoblast activity
↑ Osteoclast activity
↑ Bone resorption
Micro-architectural distortion
13
Q
MOA Bisphosphonates
A
↓Osteoclast activity
14
Q
Alongside bisphosphonates, what should be prescribed for Osteoporosis?
A
AdCal
(Vit D AND Calcium supplements)
15
Q
Scoring tool to assess risk of developing osteoporosis
A
FRAX
16
Q
Prev Medical history Qs after an epileptic fit!
A
Prev head injury?
Underlying brain disease?
Fever?
Born at full term?
Recently taken drugs or alcohol?
17
Q
2 Ix that should always be taken after someone had an epileptic seizure
A
CT head
MRI Head
EEG
18
Q
Histological features seen in UC
A
↑plasma cells in lamina propria
Ulceration
Crypt distortion
19
Q
2 Major Elements in Pathophysiology of asthma
A
Airway hypersensitivity
Causes airway inflammation
and ∴ bronchoconstriction
20
Q
Carcinoma definition
A
Malignant neoplasm of epithelium
21
Q
Histological features of 1º carcinomas
A
Abundant mitotic figures
Areas of necrosis
Ulceration
Poorly circumscribed margin
Endophytic growth
Variable resemblance of normal tissue
22
Q
How does the Chlamydia Screen Programme aim to control increase of STIs?
A
Control chlamydia through early detection and Tx of asymptomatic infection
23
Q
1ºprevention =
A
Disease prevented from developing
e.g. Vaccinations, counselling, minimising risk factors
24
Q
2º prevention =
A
Disease treated early, usually before symptoms present, to minimise consequences
e.g. screening programmes, contact tracing!
25
3º prevention =
Chronic disease managed to prevent further complications or further damage
e.g. control of DM, giving aspirin to someone who has already had a stroke to prevent a second
26
Sensitivity definition
Proportion with the disease that are correctly identified by the test
27
Specificity definition
Proportion of people without the disease that are correctly excluded by the test
28
False negative definition
Incorrectly reports a negative result
29
Population screening programmes in UK
Breast cancer
AAA
Cervical cancer
Diabetic eye
Infectious disease in pregnancy
Sickle cell disease
Thalassaemia
30
3 Diagnostic criteria for nephrotic syndrome
Proteinuria > 3g/L
Hypoalbuminaemia > 25 g/L
Oedema
31
5 Comps of Nephrotic syndrome and why they occur
1. Hyperlipidaemia / Atherosclerosis
↑overproduction in liver
2. Thrombosis
bc renal loss of anti-thrombin III
3. Infection
Renal loss of Igs
4. Renal impairment
bc hypovolaemia
5. Anemia
Loss of iron
32
When is is suitable to send a urine sample for culture?
Pregnant
Male with UTI symptoms
Persistent / Severe Sx
Failed Abx
33
What clinical features might make you think Aortic Stenosis is severe?
Slow rising carotid pulse
Pulsus parvus/Pulsus tardus
Split S2
Ejection-systolic murmur
↓Pulse amplitude
Systolic thrill
34
BEST absolute gold standard Tx for Aortic Stenosis?
Surgical Aortic Valve replacement
35
In elderly, frail patients, what is the best option to treat Aortic Stenosis?
Trans-Aortic Valve Insertion
36
Adrenaline MOA
Alpha and beta adrenergic receptor agonist
37
Other than Adrenaline, what drugs can be given to minimise the severity of Anaphylactic shock?
IV Chlorpheniramine
IV hydrocortisone
38
List 10 Symptoms of a severe anaphylactic reaction
Pruritus
Bronchospasm
Chest tightness
Cough
Faintness
↓ BP
Diarrhoea
Hypovolaemic shock!!!!
Chest pain
Abdo pain
Oedema of lips and tongue
Cyanosis
Periorbital oedema
Erythema
39
How does thrombocytopenia present?
Petechial rash
Easy bruising
Mucosal bleeding - nose bleeds
40
How does Factor 8 & 9 def (Haemophillias) present?
Joint & soft tissue bleeds
41
Tx for Cryptococcal Meningitis
Liposomal Amphotericin B
42
When should you suspect Oesophageal carcinoma?
Progressive dysphagia
Weight loss
IDA
43
When should a thrombophilia screen NOT be done?
if thrombosis suspected or Px on anti-coagulation
44
Severe acute Ischaemia presentation
Loss of sensation
Weakness
Cold
45
Meningococcal meningitis - which serogroup in the MC in UK?
Group B
46
Meningococcal meningitis - which serogroup in the MC worldwise?
Group A
47
What does a Pos Rhomberg sign indicate?
Neuro condition
Cervical myelopath
48
Extra sign's of Cushings
Thin skin
Easy bruising
49
PCS signs / symptoms
| i dont know if this is right idk where i got this from
Hirsutism
Acne
50
Haemoptysis + Haematuria = ?
GOODPASTURE'S
51
Over 55 + IDA,
What do you do?
Refer via 2 week wait pathway
52
PE
If Well's score is above 4, what do you do?
CTPA
53
PE
If Well's score is below or equal to 4, what do you do?
D-Dimer
54
ACh coordinates ___
Both sympathetic and parasympathetic
55
Where can you NOT find noradrenaline?
Skin
56
Known AIDS + Owl eye inclusion bodies =
CMV colitis
57
HSV can cause?
Encephalititis
58
What is the MC cause of LBO?
Malignancy
59
Describe some symptoms of optic neuritis
Blurry vision
Painful when looking sideways
60
Describe the cell type affected in Bladder cancer
Transitional (urothelial) = MC
UNLESS SCHISTOSOMIASIS, then Squamous Cell
61
Haemachromotosis Signs / Symptoms
Slate grey skin
Pituitary insufficiency
Testicular atrophy
Deranged LFTs
62
What would you find in a temporal artery biopsy in GCA?
Granulomatous w skip lesions
63
Tx GCA
Oral prednisolone if no vision change
IV prednisolone if vision change
64
Status Epilepticus Tx
IV Lorazepam 4mg
Then again after 5 mins if not working
Then IV phenytoin
65
What can sideroblastic anaemia be caused by?
Vitamin B6 def
66
H.Pylori increases the risk of which malignancy?
MALT Lymphoma
67
Peptic Ulcer common cause
H PYLORI
68
Describe the aspirate appearance of septic arthritis
Turbid, yellow
69
Crest Antibodies
Anti-Scl-70
70
PE Tx
Apixaban - DOAC
Warfarin
LMWH
71
Pleural effusion XR finding
Bilateral costophrenic blunting
72
DM makes UTI complicatde
73
Goodpasture's antibody?
Anti-GBM
74
GS for Acromegaly
OGTT
75
Tx Syphilis
IM Benzylpenicillin
76
Pathophys Osteoporosis
↓ Bone mass
Normal mineralisation
77
Pathophys Paget's
↑Osteoclastic bone resorption followed by formation of weaker bone
78
Comps of ADPKD
SAH
Renal stones
Liver cysts
HTN
79
Finding on ECG with Hyperparathyroidism
Short QT interval
80
Causes of Hypercalcaemia
Hyperparathyroidism
↑ Diet
Sarcoidosis
CKD
Multiple Myeloma
Squamous cell cancer (PTHrP)
Dehydration
Bone mets
81
Cell type targeted in MS
Oligodendrocytes
82
MS Tx
ACUTE : IV methylprednisolone
CHRONIC : Beta interferon and glatiramer acetate
Infliximab
83
Signs / Symptoms MS
NB LOSS YOU IDIOT
+ Charcot's neuro triad
UMN signs
Uhthoff's
84
Staph Aureus Abx
Flucloxacillin
85
S/E Vancomycin
Nephrotoxicity
86
Pathophysiology Anaphylaxis
Allergen binds to IgE
Stimulates mast cell granulation
∴ Histamine released
Airway bronchoconstriction
Vessel vasodilation (and more permeable)
87
MC cause of Lung Cancer in non-smokers?
Adenocarcinoma
88
Asbestos CXR findings
Pleural plaques
89
Atypical Pneumoniae Causes
**Legions of Psitacci MCQ**
Legionella Pneumophilia - AC
Chlamydia Psittaci - Birds
Mycoplasma Pneumoniae - Erythema Multiforme
Chlamydia Pneumoniae - School aged child
Q fever - farmers
90
S/E SABA
Fine tremor
91
What is Zollinger-Ellison?
Tumour - causes XS gastrin release
∴ lots of ulcers !
Presents with haemorrhage
92
Late sign of pancreatic cancer?
DM Sx
93
High SAAG causes
↑Portal HTN (i think)
Constrictive pericarditis
HF
Liver failure
Cirrhosis
Budd-Chiari syndrome
94
Low SAAG causes
TB
Pancreatitis
Nephrotic syndrome
Peritoneal cancer
95
What is gastroparesis?
Delayed gastric emptying
96
Small/Non-Variceal bleeding Tx
Adrenaline injections
Thermal/Mechanical ligation
+ PPI for 72 hours
97
Oesophageal varices bleeding Tx
Terlipressin - has bad S/E tho so be sure that it's variceal before giving
Prophylactic ABx
Band ligation
98
How to calculate units?
(ml x ABV%) / 1000
99
Von-Hippel-Lindau assoc with?
Renal carcinoma
100
Cell type in most renal carcinomas?
Clear cells
101
Renal cancer assocs?
Von-Hippel Lindau
ADPKD
Tuberous sclerosis
Middle aged men
Smokers
102
When to sus Phaeochromocytoma?
If BP hard to control, episodic or accelerating
103
Diclofencac is a ?
NSAID
104
1st Line IxAppendicitis
US Abdo
105
2nd Degree block
Mobitz type 1
ECG ?
Progressive PR elongation then dropped QRS
106
2nd Degree block
Mobitz type 2
ECG ?
Randomly dropped QRS
107
Causes of AF
Mrs SMITH
Sepsis
Mitral valve pathology
IHD
Thyrotoxicosis
HTN
108
Abrupt Start and Stop of palpitations =?
AVNRT
109
AVRT and AVNRT ECG?
Narrow QRS
AVRT : short PR
AVNRT : no P waves directly before/after QRS
110
Pancreatitis Comps
Pancreatic abscess
Pancreatitis pseudocyst - can lead to intestinal obstruction
AKI
DIC
Acute resp distress syndrome!
DM
Sepsis
SIRS
Obstructive jaundice
111
Pathophysiology behind MI
Atherosclerotic plaque RUPTURE
112
Indications of atypical pneumonia
Time away from home
↓Na+
Confusion
Renal impairment
↑ Creatinine
↑ Urea
113
Hypothyroidism Sx
**BRADYCARDIC**
**B**radycardic
**R**eflexes relax slowly
**A**taxia
**D**ry thin hair/skin
**Y**awning
**C**old hands
**A**scites
**R**ound puffy face
**D**efeated demeanour
**I**mmobile - ileus
**C**ongestive HF
114
DDx BPH
Age-related detrusor weakness
115
What should you check once a Px has been diagnosed with HIV?
Hep B
Hep C
Syphilis
116
Tx HIV
Aciclovir
Co-trimoxazole (septrin)
117
When is risk of vertical transmission for HIV low?
With ART and undetectable viral load
118
Clinical findings of HF
Peripheral oedema
↑ JVP
Bibasal crackles
Dull percussion at lung bases
Hepatomegaly
S3/S4
Tachycardia, Tachypnoea
Cyanosis
Cold, pale, confusion
Syncope
Narrow pulse pressure
119
Classification system for HF Sx
New York Heart Association Classification
120
Ix HF
1. NT‑proBNP
2. Echo
121
COPD Scale
MRC Dyspnoea Scale
122
CURB-65 ?
**CURB-65**
**C** onfusion
**U**raemia > 7 mmol/L
**R**R > 30
**B**P systolic ≤ 90 mmHg or diastolic ≤ 60 mmHg
**65** years or older
123
MC CAP Cause?
Streptococcus Pneumoniae
124
Stroke 1st line Ix
NON-CONTRAST CT head
125
Other than aspirin, first line acute treatment for ischaemic stroke
Thrombolysis (IV alteplase) within 4.5 hours
OR
Thrombectomy
126
Clopidogrel MOA
P2Y12 Inhibitor
127
Findings on an ECG for AF
Irregularly irregular QRS complexes
No P waves
128
Well's Score ?
What treatment do you give ?
0 = lowe it
1 = consider oral anticoag or aspirin
2+ = oral anticoag (DOAC - apixaban)
| BE AWARE OF CI
129
What findings on a lumbar puncture indicate bacterial meningitis?
Raised neutrophils
Increased protein
Low glucose
Cloudy appearance
130
Iatrogenic Comps of DKA Tx
Hypoglycaemia
Hypokalaemia
Cerebral oedema
131
Blood tests used to monitor/diagnose diabetes
Random plasma glucose > 11.1 mmol/L
HbA1c > 48 mmol/L * check this unit
Fasting plasma glucose > 7 mmol/L
132
RF Hodgkin's
EBV infection
FHx
Male
20 - 40 years
Immunocomp
Smoker
Overweight
133
Acute cholecystitis presentation
RUQ pain radiating to right shoulder
Fever
!!!!
Vomiting
No colour change
134
4 Fs for Gallstones
Female
Fat
Forty
Fertile
135
What is Murphy's sign?
Pain upon palpation of right subcostal area while patient holds breath
136
H. Pylori Tx
CAP !
137
Unmod RFs for BPH
Increasing Age
Black/Caucasian
FHx
138
Reasons PSA may rise
Recent ejac
Biopsy
Exercise
UTI
Medication
BPH
Prostate cancer
139
Screening programmes in the UK
What ages?
Breast cancer screening (50-71)
AAA (65 men)
Bowel cancer - FIT testing (60-74)
Cervical cancer (25-64)
Diabetic eye screening (12+)
140
Tx Myasthenia Crisis
IV Ig
Plasmapharesis
141
Antibodies for Myasthenia Gravis
Acetylcholine-receptor antibodies
Muscle specific kinase antibodies (MuSK)
142
Define Uhthoff's phenomenon
Neurological features are worsened due to ↑ body temp
143
Findings on a lumbar puncture in a MS patient
Oligoclonal bands in the CSF
↑IgG
↑ WBC
144
Summarise the process of atherosclerosis (6 marks)
1. Endothelial injury - caused by smoking, high cholesterol
2. LDL cholesterol accumulates in sub-endothelial space
3. Macrophages enter and engulf LDL, forming foam cells
4. Inflam response - smooth muscles proliferate and migrate
5. Smooth muscles deposit collagen, form fibrous cap
6. Pressure builds and fibrous cap weakens, leading to plaque rupture.
Thrombus formation causes occlusion of artery
145
Describe the LP findings of viral meningitis
Clear
Increased protein
Normal glucose
Increased lymphocytes
146
Describe the LP findings of TB meningitis
Fibrin web
Increased lymphocytes
HIGH protein
Low glucose
147
Describe the LP findings of Cryptococcal meningitis
Fibrin web
Increased lymphocytes
Increased protein
LOW glucose
HIGH OPENING PRESSURE
148
Trimethoprim MOA
Folate inhibitor
(inhibits 5-dihydrofolate reductase)
149
Shape of TB bacteria
Rod-shaped
150
What would you see in a microscope with TB?
Caseating granuloma
151
Patient presents with a rash that doesn't go when pressed with a glass.
What is this and what is it a sign of?
Purpuric rash
Sign of DIC - bc of meningococcal septicaemia
152
Tx Meningitis
Incl drug class
3rd generation cephalosporin
Cefotaxime or Ceftriaxone
153
Neonate Meningitis bacteria
Group B step
aka S. agalactiae, S. pyogens
E.Coli, S. pneum, Listeria
154
> 3 months Meningitis bacteria
Neisseria Meningitidis
Strep. pneumoniae
H. influenzae (type B)
155
> 65 years Meningitis bacteria
S. pneumoniae
156
What campaign is being used to reduce C.diff spread?
SIGHT campaign
157
3 Meds for COPD
| Have a precious history of Asthma
SABA
LABA
ICS
158
Describe Duke's criteria
Fever > 38
Vascular phenomenon - Roth spots
Immunological - Glomerulonephritis
jeidska
159
What signs might you see on a patient's hand that has IE?
Splinter haemorrhages
Osler nodes
Janeway lesions
160
What might you see on a CXR for AS?
Calcification of aortic valve
Dilated ascending aorta
Cardiomegaly
Pulmonary oedema
161
Septic infection Sx
Fever
Rigors
Night sweats
Weight loss
Anaemia
Clubbing
Splenomegaly
162
XS alcohol abuse can lead to deficiency in what vitamine?
How does this present?
B1
Wernicke-Korsakoff's Encephalopathy
163
Tx delirium tremens
Chlordiazepoxide
164
Delirium tremens presentation
Tachycardia
Confusion
Agitation
Tachypnoea
165
What abx attack 30s?
Tetracyclines
Aminoglycosides
166
VALPROATE S/E
Vomiting
Alopecia
Liver toxicity
Pancreatitis
Retention of fat i.e. weight gain
Oedema
Anorexia
Tremor
Enzyme inhibitor
167
Cause of osteomyelitis
Staph Aureus
Staph epidermidis
Salmonella spp in Sickle cell patient
