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Deepa's MSRA > Topics I'm not good at > Flashcards

Topics I'm not good at Flashcards

1
Q

T12-L1 give rise to which nerve?

A

T12-L1 give rise to iliohypogastric nerve.

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2
Q

L1-2 give rise to which nerve?

A

L1-2 give rise to genitofemoral nerve.

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3
Q

L2-4 give rise to which nerve?

A

L2-4 give rise to femoral nerve.

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4
Q

S2-4 give rise to which nerve?

A

S2-4 give rise to pudendal nerve.

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5
Q

L4-5, S1-3 give rise to which nerve

A

Sciatic nerve

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6
Q

Hypertensive retinopathy stages

A

I: Arteriolar narrowing and tortuosity. Silver wiring
II: AV nipping
III: Cotton-wool exudates
Flame and blot haemorrhages - ‘macular star’
IV: Papilloedema

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7
Q

Patau syndrome

A

Triosomy 13
P - Palate (cleft)
A - A-lot-of-fingers (polydactyly)
T - Tiny mouth (micrognathia)
A - Angry scalp lesions
U - Uveas are small (small eyes)

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8
Q

Edward’s syndrome

A

Trisomy 18
E - ears (low)
D - Dinky mouth
D - Dodgy feet (rockers)
Y - Fingers overlap (make a y shape)

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9
Q

Fragile X

A

X linked

Learning difficulties & ADHD & Autism
Macrocephaly
Long face
Large ears
Macro-orchidism
Seizures

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10
Q

Noonan syndrome

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

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11
Q

Pierre-Robin syndrome*

A

Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

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12
Q

Prader Willi Syndrome

A

Hypotonia
Hypogonadism
Obesity

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13
Q

William’s syndrome

A

Deletion on Chromosome 7

Short stature
Learning difficulties & ADHD
Friendly, extrovert personality
Starbrust iris
Wide mouth and big smile

Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

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14
Q

Cri du chat syndrome

A

Chromosome 5p
Characteristic cry due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism

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15
Q

Meniscal tear

A

Gives way & locks
Worse on straightening leg
Tender on joint line

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16
Q

Episcleritis

A

Diffuse redness
NO Pain
Blanches with eye drops

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17
Q

Scleritis

A

Redness, painful ++, pain worse on eye movement, reduced visual acuity
Rheumatoid

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18
Q

GET SMASHED

A

Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs: azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, sodium valproate

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19
Q

cephalohaematoma

A

Does not crosses suture lines
bleeding between the periosteum and the skull
2-3 days after delivery
Resolves

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20
Q

Caput succedaneum

A

Crosses suture lines
Few hours after delivery
Takes months to improve
Oedema of presenting part

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21
Q

Erythema infectiosum

A

5th disease or slapped cheek
Parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
No school exclusion
pancytopaenia, aplastic crisis, hydrops fetalis

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22
Q

Measles

A

Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

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23
Q

Mumps

A

Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

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24
Q

Rubella

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

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25
Q

Scarlet fever

A

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

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26
Q

Hand, foot and mouth disease

A

coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet

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27
Q

Angina management

A
  1. Beta blocker/ CCB
    - CCB monotherapy: verapamil/ diltizaem
    - if combo with B-b: amlodipine, modified-release nifedipine
  2. Add other of step 1
  3. a long-acting nitrate/ ivabradine/ nicorandil/ ranolazine
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28
Q

Erythema nodosum causes - SORE SHINS

A

SORE SHINS
Streptococci
OCP
Rickettsia
Eponymous (Bechets)

Sulfonamides
Hansen’s disease (leprosy)
IBD
NHL
Sarcoidosis

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29
Q

Ankylosing spondylitis features - the ‘A’s

A

Anterior uveitis
Apical fibrosis
Aortic regurgitation
AV node block
Achilles tendonitis
Amyloidosis

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30
Q

Erythema multiforme

A

Target lesions
HSV (commonest cause)
Idiopathic
Mycoplasma
Streptococcus
Drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, OCP, nevirapine
SLE
Sarcoidosis
Malignancy

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31
Q

Anion gap

A

NA + K - bicarb - Cl
Normal is between 12-17

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32
Q

Plasma osmolality

A

2Na + Urea + Glucose
Normal between 285-295

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33
Q

Bloody diarrhoea causes

A

SEECSY
Salmonella
E coli
Entamoeba
Campylobacter
Shigella
Yersinia

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34
Q

Side effect of Methotrexate

A

Myelosuppression
Liver cirrhosis
Pneumonitis

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35
Q

Side effect of Sulfasalazine

A

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

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36
Q

Side effect of Leflunomide

A

Liver impairment
Interstitial lung disease
Hypertension

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37
Q

Side effect of Hydroxychloroquine

A

Retinopathy
Corneal deposits

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38
Q

Side effect of Prednisolone

A

Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts

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39
Q

Side effect of Gold

A

Proteinuria

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40
Q

Side effect of Penicillamine

A

Proteinuria
Exacerbation of myasthenia gravis

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41
Q

Side effect of Etanercept

A

Demyelination
Reactivation of tuberculosis

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42
Q

Side effect of Infliximab

A

Reactivation of tuberculosis

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43
Q

Side effect of Adalimumab

A

Reactivation of tuberculosis

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44
Q

Side effect of Rituximab

A

Infusion reactions are common

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45
Q

Side effect of NSAIDs (e.g. naproxen, ibuprofen)

A

Bronchospasm in asthmatics
Dyspepsia/peptic ulceration

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46
Q

-

A

=i

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47
Q

Splenectomy vaccines/ Abx

A

Pneumococcal
HIB
Meningococcal
Influenza (annual)
Oral phenoxymethylpenicillin prophylaxis

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48
Q

Complications post MI

A

DARTHVADER
Death
Arrtyhymia
Rupture
Tamponade
Heart failure
Valvular disease
Aneurysm
Dressler’s syndrome
Recurrence
Cardiogenic shock

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49
Q

Acute mitral regurgitation

A

More common with infero-posterior infarction
ischaemia or papillary muscle rupture.
Acute hypotension andpulmonary oedemamay occur.
early-to-mid systolic murmur.
Vasodilator therapy but often require emergency surgical repair.

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50
Q

Bradyarrhythmias

A

AV block post inferior MI

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51
Q

Cardiogenic shock

A

If EF reduces too much due to ischaemia -> cardiogenic shock. Or after left ventricular free wall rupture as listed below. Inotropic support and/or an intra-aortic balloon pump.

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52
Q

Left ventricular aneurysm

A

Persistent ST elevationand left ventricular failure

Thrombus within the aneurysm increasing the risk of stroke- therefore anticoagulated

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53
Q

Left ventricular free wall rupture

A

in 3% of MIs and occurs around 1-2 weeks after. acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds). Urgent pericardiocentesis and thoracotomy

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54
Q

Pericarditis

A

Pericarditis in the first 48 hours following a transmural MI is common(c. 10% of patients). The pain is typical for pericarditis (worse on lying flat etc), a pericardial rub may be heard and a pericardial effusion may be demonstrated with an echocardiogram.

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55
Q

Dressler’s syndrome

A

2-6 weeksfollowing a MI
autoimmune reaction against antigenic proteins formed as the myocardium recovers
fever,pleuritic pain, pericardial effusion and a raised ESR
NSAIDs

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56
Q

Tachyarrhythmias

A

VF and VT. VF -> Death

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57
Q

Ventricular septal defect

post MI

A

first week
around 1-2% of patients.
acute heart failure
pan-systolic murmur.
An echocardiogram excludes acute MR which presents in a similar fashion.
Urgent surgical correction needed.

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58
Q

C diff treatment

A
  1. PO Vancomycin 10 days
  2. Retreatment: fidaxomicin
  3. PO Vanc +- IV Met
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59
Q

PID

A

Cef 1g IM
PO Doxy 10mg BD 14 days
PO Metro 400mg BD 14 days

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60
Q

Most common cause septic arthritis

A

Staph Aureus

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61
Q

Serotonin syndrome

A

Alternated mental status
NM hyperactivity - profound shivering, tremor, teeth grinding, hyperreflexia
Autonomic instability: Tachy, fever, high BP, D&V

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62
Q

Neuroleptic malignant syndrome

A

Treating with dopamine antagonists or withdrawal of dopamine agoinsts
Hyperthermia, muscle rigidity, altered mental status, sympathetic nervous system lability, hypermetabolism, high CK

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63
Q

Reed Sternberg cells

A

Hogkin’s Lymphoma

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64
Q

Philadelphia chromosome

A

CML

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65
Q

Corneal abrasion

A

Chloramphenicol

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66
Q

Herpes Simplex Keratitis

A

topical aciclovir

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67
Q

Conjunctivitis

A

Clean with cooled boiled water
Chloramphenicol drops

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68
Q

Chlamydia

A
  1. PO Doxy 7 days
  2. if doxycycline contraindicated : azithromycin (1g stat, then 500mg OD for 2 days)
  3. if pregnant then azithromycin, erythromycin or amoxicillin
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69
Q

–

A

–

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70
Q

Trichomonas

A

PO metronidazole 5-7 days
or one-off dose of 2g metronidazole

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71
Q

Gonorrhoea

A
  1. single dose of IM ceftriaxone 1g
  2. PO stat dose of cefixime 400mg + azithromycin 2g
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72
Q

Bacterial vaginosis

A

PO metronidazole 5-7 days or single oral dose of metronidazole 2g
Topical clindamycin can also be used

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73
Q

Scleroderma

A

Systemic: anti scl-70anti-topoisomerase
Limited (CREST): Anti-nuclear and anti-centromere

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74
Q

Cushing’s syndrome: Investigations

A
  1. overnight (low-dose) dexamethasone suppression/
    24 hr urinary free cortisol/ bedtime salivary cortisol
  2. High-dose dexamethasone suppression test
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75
Q

steeple sign x ray

A

croup

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76
Q

thumbprint sign xray

A

epiglottis

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77
Q

When to use ondansetron?

A

5HT3 antagonist
Post op & cytotoxic drug related (chemo)

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78
Q

Domperidone, procholerperazine, haloperidol, metoclopramide

A

Dopamine antagonist
Neoplastic disease, radiation sickness, opioids, cytotoxic and general anaestehtic
Note metoclopramide is prokinetic - so useful in GI disease

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79
Q

Cyclizine, promethazine, meclizine

A

Antihistamines H1
Motion sickness, morning sickness pregnancy, opidoids

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80
Q

Henoch Shloen Purpura HSP presentation

A

Recent illness
Palpable rash
Abdo pain/ bloody diarrhoea
Joint pain
Glomerlunephritis: urine dip for blood/ protein

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81
Q

Niacin deficiency

A

B3
Pellagra:
dermatitis
diarrhoea
dementia

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82
Q

Retinoid deficiency

A

Vitamin A
Night blindness

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83
Q

Thiamine deficiency

A

B1
Beriberi
polyneuropathy, Wernicke-Korsakoff syndrome
heart failure

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84
Q

Pyridoxine deficiency

A

B6
Anaemia, irritability, seizures

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85
Q

Biotin deficiency

A

B7
Dermatitis, seborrhoea

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86
Q

Folic acid deficiency

A

B9 Megaloblastic anaemia, deficiency during pregnancy - neural tube defects

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87
Q

Cyanocobalamin deficiency

A

Megaloblastic anaemia, peripheral neuropathy

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88
Q

Ascorbic acid deficiency

A

Vitamin C
Scurvy
gingivitis
bleeding

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89
Q

Tocopherol, tocotrienol deficiency

A

Vitamin E
Mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy

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90
Q

Naphthoquinone deficiency

A

Vitamin K
Haemorrhagic disease of the newborn, bleeding diathesis

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91
Q

Lachman test

A

ACL rupture

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92
Q

ACL rupture

A

high twisting force applied to a bent knee
loud crack, pain and RAPID joint swelling (haemoarthrosis)

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93
Q

PCL rupture

A

hyperextension injuries
Tibia lies back on the femur
Paradoxical anterior draw test

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94
Q

Rupture of medial collateral ligament

A

leg forced into valgus via force outside the leg
Knee unstable when put into valgus position

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95
Q

Menisceal tear

A

Rotational sporting injuries
Delayed knee swelling
Joint locking (Patient may develop skills to ‘unlock’ the knee
Recurrent episodes of pain and effusions are common, often following minor trauma

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96
Q

Chondromalacia patellae

A

Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy

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97
Q

Osgood-Schlatter disease
(tibial apophysitis)

A

Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle

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98
Q

Osteochondritis dissecans

A

Pain after exercise
Intermittent swelling and locking

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99
Q

Patellar subluxation

A

Medial knee pain due to lateral subluxation of the patella
Knee may give way

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100
Q

Patellar tendonitis

A

athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

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101
Q

Drug causes constriction of pupils

A

Miosis

Pilocarpine (muscarinc agonist)
Prostaglandin
Opioids
Organophosphate insecticide

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102
Q

Drug causes dilation of pupils

A

Mydriasis

Anticholinergics: atropine, tropicamide, cyclopentikate
Sympathomimetics: adrenaline, phenylephrine

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5
Perfectly
103
Q

Rotavirus

A

Most common diarrhoeal in children
Watery with vomiting +- fever, abdo pain

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104
Q

Causes of bleeding in 1st trimester

A

Miscarriage
Ectopic
Hydatidiform mole

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105
Q

Causes of bleeding in 2nd trimester

A

Miscarriage
Placental abruption
Hydatidiform mole

106
Q

Causes of bleeding in 3rd trimester

A

Bloody show
Placental abruption
Placenta praevia
Vasa praevia

107
Q

Anti D indications

A

TOP: surgical or medical
If miscarriage is followed by medical or surgical evac
Spontaneous complete miscarriage >12 weeks
Transplacental haemorrhage risk (CVS, amino, ECV, APH), abdo trauma, intrauterine death
Ectopic pregnnacy
Treatened miscarriage >12 weeks

108
Q

Beck’s triad

A

Cardiac tamponade
Distended neck veins
Hypotension
Muffled heart sounds

109
Q

Haemophillia A

A

Factor 8
APTT

110
Q

Haemophillia B

A

Factor 9
APTT

111
Q

Von Willebrand disease

A

Reduced VWF - important for platelet function and stablising factor 8

112
Q

APTT test

A

Intrinsic and common pathway
Factor 1,2,5,8,9,10,11,12

113
Q

PT

A

Extrinsic and common pathway
Factor 1,2,5,7,10
Vitamin K deficiency
INR

114
Q

Stork mark

A

Pink, flat, irregular, back of neck, not thickened

115
Q

Port wine stain

A

Persist through life
Superficial and deep dilated capillaries
Pulse laser

116
Q

Primary sclerosing cholangitis

A

Chronic inflammation and fibrosis of intra and extraheptic bile duct
IBD - esp UC
Male 30-40 years
ALP +, bilirubin +. ALT and ALP + after some time
MRCP beading of bile ducts

Antibodies are not specific: pANCA, ANA, anti-SMA

Risk of acute cholangitis, cholangiocarcinoma, colorectal cancer,

117
Q

Primary biliary cirrhosis

A

Destruction of intraheptic bile canaliculi -> bile leak
Osteoporosis, sicca
30-65 years
Middle ages woman, fatigue, itching, jaundice, RUQ discomfort
AMA, high ALP
Tc: Ursodeoxycholic acid, cholestyramine
Risk of CVD, ADEK Vitamin deficiency, Hypothyroid, CTD

118
Q

T2DM Dx

A

HbA1c > 48
Fasting glucose > 7
Random glucose or OGGT > 11.1
Twice if asymptomatic, once if symptomatic

119
Q

Autosomal dominant

A

Structural
Exception: Gilbert’s, hyperlipidaemia type II

120
Q

Autosomal recessive

A

Metabolic/ Enzyme defects
Exception: Ataxia telangeiectsia and Friedrich’s ataxia are AR

121
Q

Live vaccines

A

MY BOOTII :

MMR
Yellow fever
BCG
Oral polio,
Oral rotavirus,
Typhoid,
Intranasal influenza

122
Q

azathioprine

A

TMPT
Bone marrow suppression, hepatotoxic
Interacts with:
Allopurinol
Febuxostat
Warfarin
Clozapine
ACEi
Aminosalicylates
Methotrexate

123
Q

Threatened miscarriage

A

Minimal Pain
Less bleeding Compared to peroid
Closed cervix
Uterus for dates
Heart visualised

124
Q

Inevitable miscarriage

A

Pain +
More bleeding Compared to peroid
Open cervix
Uterus for dates
Heart may or may not

125
Q

Complete miscarriage

A

No pain
Less bleeding Compared to peroid
Closing cervix
Uterus for dates
Empty on US

126
Q

Incomplete miscarriage

A

May or may not have pain
Lots of bleeding
Open cervix
Small for dates
Retained products/ no fetal heart

127
Q

Missed miscarriage

A

No pain
Minimal bleeding
Closed cervix
Uterus small for age
No fetal heart

128
Q

RA Xray features

A

SPADES
Soft tissue swelling
Peri-articular osteoporosis
Absent osteophytes
Deformity
Erosions (late feature)
Subluxation (late feature)

129
Q

OA X ray features

A

LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

130
Q

Haemochromatosis

A

DM
Cirrhosis
Skin pigmentation

131
Q

Addison’s disease

A

Hyponatremia and hyperkalemia
Too little aldosterone

132
Q

cyp P450 inhibitors

A

SICKFACES.COM-G
sodium valproate
isoniazid
cimetidine
ketoconzole
fluconazole
acute alcohol+amiodarone
cipro+chloramphenicol
erythromycin
suflonamides
cranberry juice
omeprazole
metronidazole
grapefruit juice

133
Q

cyp P450 inducers

A

BS CRAP GPS
barbiturates
st johns wort
carbamazpine
rifamicin
alcohol(chronic)
phenytoin
grisefulvin
phenobarbital
sulfonylureas.

134
Q

Whirl pool sign

A

ovarian torsion

135
Q

Acromegaly - test

A

IGF1/ OGTT. No suppression of GH in OGTT

136
Q

Addison’s disease - test

A

Short Synacthen test. No production of cortisol

137
Q

Cushing’s - test

A

dexamethasone suppression test. Suppressed cortisol if Cushing’s disease (pituitary adenoma)
Unsuppressed if Cushing’s syndrome/ ectopic

138
Q

Conn’s - test

A

Renin: Aldosterone ratio. Low renin - primary. High renin - secondary cause.

139
Q

SIADH - tests

A

all other tests negative. High urine sodium and osmolality

140
Q

Diabetes insidious - test

A

water deprivation/ desmpressin test. Concentrates after water deprivation - polydipsia. Concentrates after desmopressin - craniogenic. Does not concentrate - neprhogenic DI

141
Q

How to remember Broca/ Wernicke’s

A

Spoken word is heard at the ear. This passes to Wernicke’s area in the temporal lobe (near the ear) to comprehend what was said. Once understood, the signal passes along the arcuate fasciculus, before reaching Broca’s area. The Broca’s area in the frontal lobe (near the mouth) then generates a signal to coordinate the mouth to speak what is thought (fluent speech).

142
Q

Broca’s aphasia

A

difficult to find and say the right words, although they probably know exactly what they want to say.

Severely reduced speech, often limited to short utterances of <4 words.
Limited vocabulary.
Clumsy formation of sounds.
Difficulty writing (but the abilityto read and understand speech).

143
Q

Wernicke’s aphasia

A

Able to speak well & use long sentences, but might not make sense. They may not know that what they’re saying is wrong, so may get frustrated when people don’t understand them.

Impaired reading and writing.
An inability to grasp the meaning of spoken words (producing connected speech is not affected).
An inability to produce sentences that hang together.
The intrusion of irrelevant words in severe cases.

144
Q

Gout

A

Gout = negatively infringement, monosodium urate, needle shape

145
Q

Pseudogout

A

Pseudogout = positively infringement, rhomboid, calcium pyrophosphate,

146
Q

Bronchiolitis -

A

RSV, 3-6 months, corzyal/ dry cough, SOB, wheeze, fine inspiratory crackles, feeding difficulty. Humidified oxygen

147
Q

Croup -

A

parainfluenza, 6 months to 2 years, barking cough, stridor, dexamethasone, nebulised adrenaline/ budesonide, steeple on X ray

148
Q

Epiglottitis -

A

HIB(haemophilus influenza type B), fever, sore throat, drooling, stridor, muffled voice. Thumb sign. DO not distress child - anaesthetics. Ceftriaxone & steroids.

149
Q

Whooping cough -

A

Bortedella Pertussis, mild cough -> more severe in 2nd week, PCR testing, anti-pertussis toxin immunoglobulin G if longer than 2 weeks. Supportive care. First 21 days azithromycin, erythromycin and clarithromycin. Contacts are given prophylactic antibiotics

150
Q

Laryngomalacia

A
  • inspiratory stridor, 6 months, worse during infection, resolves with age
151
Q

Cystic Fibrosis

A

AR, transmembrane conductance regulatory gene on chromosome 7, sweat test > 60mmol/L chloride,

Colonised by: staph aureus (long term fluxlco for this) and pseudomonas (nebulised tobramycin. PO ciprofloxacin). Vaccinations including pneumococcal, influenza and varicella

152
Q

Drugs that cause gynaecomastia

A

DISCKO
-Digoxin
-Isoniazid
-Spironolactone (most common)
-Cimetidine
-Ketoconazole
-Oestrogen/anti testosterone/hormones Goserelin, Buserelin

153
Q

Cardiac resynchronisation therapy indications

A

left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms.

154
Q

Implantable cardiac defibrillator (ICD) indications

A

previous sustained ventricular tachycardia, ejection fraction <35% and symptoms no worse than class III of of the New York Heart Association functional classification.

155
Q

Genetic causes of long QT syndrome

A

LQT1 / LQT2 (potassium channel mutation); LQT3 (sodium channel mutation)
Jervell and Lange-Nielsen syndrome (associated with deafness)
Romano-Ward syndrome

156
Q

Electrolyte causes of long QT syndrome

A

Hypocalcaemia
Hypomagnesaemia
Hypokalaemia

157
Q

Drug causes of long QT syndrome

A

Antiarrhythmics (e.g. amiodarone, sotalol)
Antibiotics (e.g. erythromycin, clarithromycin, ciprofloxacin)
Psychotropic drugs (e.g. serotonin reuptake inhibitors, tricyclic antidepressants, neuroleptic agents)

158
Q

anterior cerebral artery infarct

A

contralateral hemiparesis and sensory loss (lower extremities affected more than upper).

159
Q

posterior cerebral artery infarct

A

contralateral homonymous hemianopia with macular sparing.

160
Q

posterior inferior cerebellar artery infarct

A

ipsilateral facial pain and temperature loss, and contralateral limb/torso pain and temperature loss
may also be ataxia and nystagmus present.

161
Q

middle cerebral artery infarct

A

contralateral hemiparesis and sensory loss (upper extremity more than lower)
contralateral homonymous hemianopia and aphasia

162
Q

total anterior circulation infarct

A

TACI, c. 15%: involves middle and anterior cerebral arteries
all 3 of:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

163
Q

Partial anterior circulation infarcts

A

PACI, c. 25%
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of :
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

164
Q

Lacunar infarct

A

LACI, c. 25%
involves perforating arteries around the internal capsule, thalamus and basal ganglia
1 of:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

165
Q

Posterior circulation infarcts

A

POCI, c. 25% involves vertebrobasilar arteries
1 of:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

166
Q

Lateral medullary syndrome

A

posterior inferior cerebellar artery aka Wallenberg’s syndrome
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

167
Q

Weber’s syndrome

A

ipsilateral III palsy
contralateral weakness

168
Q

Colles’

A

distal radius dorsal displacement

169
Q

Smith fracture -

A

distal radius volar displacement

170
Q

Bennet fracture -

A

base of metacarpal of thumb. Thenar pain swelling and inability to move thumb

171
Q

Gatekeeper thumb -

A

subluxation of MCP of thumb with abduction

172
Q

Budd Chiari syndrome -

A

occlusion of hepatic vein - severe epigastric pain, ascites, hepatomegaly. VTE

173
Q

Weils disease

A

spirochetes, contaminated water, acute hepatic failure

174
Q

HELLP syndrome

A

haemolysis with elevated LFT, and low platelet. Severe form of pre eclampsia.

175
Q

HOCM

A

Systolic murmur worse on Valsalva and squatting, jerky pulse

176
Q

VSD

A

VSD - biventricular hypertrophy

177
Q

Primary biliary cholangitis -

A

TheMrule
IgM
anti-Mitochondrial antibodies,M2 subtype
Middle aged females

178
Q

Down’s syndrome: Trisomy 21

A

Combined test - 11-14 weeks: >6mm Nuchal thickness, high BHCG, low PAPPA
Triple test - 14-16 weeks: high BHCG, low AFP, low oestriol
Quadruple test - 14-20 weeks: adds in inhibin A high
Aminocentesis if risk is greater than 1:150
CVS can be done before 15 weeks. Aminocenetesis is later, but safer
Hypotonia, small head, short
Reccurent otitis media
Hypothyroid
ASD. AVD. TOF
Hearing - conductive loss, glue ear
Eye problems

179
Q

Meniere’s disease: Acute and chronic treatment

A

Acute: Prochlorperazine or cinnarizine
Chronic/ prevention: betahistine

180
Q

Commonest type of epilepsy in childhood

A

Benign Rolandic

181
Q

Osler Weber Rendu Syndome

A

HHT - Hereditary Hemorrhagic Telangiectasia
1. Telangiectasia
2. Nose bleeds
3. FH

182
Q

acute limb ischaemia

A

Pain
Pallor
Pulseless
Paralysis
Paraesthesia (abnormal sensation or “pins and needles”)
Perishing cold

183
Q

MEN1

A

High calcium and renal stones = hyperparathyroid
Parathyroid adenoma
Pituitary adenoma

Zollinger-Ellison or hyperinsulinaemia - hypos
High prolactin - amenorrhoea
XS Growth hormone - acromegaly
Mass effect from pituary gland tumour

184
Q

MEN2

A

2A:
Medullary thyroid cancer
Phaeochromocytoma - HTN, sweating, diarrhoea
Parathyroid adenoma with hyper parathroidism

2B
MTC, phaeo, Marfanoid, mucosal instetinal ganlioneuromatosis

185
Q
A
186
Q

Bacterial meningitis > 3 months old

A

NHS - most common is strep
Neisseria meningitidis
Haemophilus Type B (HIB)
Streptococcus pneumoniae

187
Q

Bacterial meningitis < 1 months old

A

GBS (Strep agalctiae)
E coli
Streptococcus pneumoniae
Listeria
GESL

188
Q

Hyperkalaemia ECG change

A

Tented T waves
P wave flatenning
PR prolonged
QRS widens
Sine wave

189
Q

Goodpasture’s syndrome

A

Pulmonary haemorrhage
Glomuleonephritis
anti GBM
CXR shows parenchymal consolidation from autoantibody induced inflammatory lesions

190
Q

Wegener’s granulomatosis

A

Granulomatosis with polyangiitis

URTI: nose bleeds, sinusitis
LRTI: Haemopytsis
Glomerulonephritis - pauci immune
Saddle nose
cANCA

191
Q

Churg-Strauss syndrome

A

eosinophilic granulomatosis with polyangiitis (EGPA)
pANCA
Eosinophils
Asthma
Sinusitis

192
Q

Hypocalcaemia ECG change

A

QT long

193
Q

Hypercalcaemia ECG change

A

Short QT
J wave -positive deflection at QRS joint to ST point

194
Q

Hypokalaemia ECG change

A

U waves
small or absent T waves
prolonged PR interval
ST depression

195
Q

Hypothermia ECG changes

A

bradycardia
‘J’ wave (Osborne waves) - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias

196
Q

Smoking cessation drugs

A

Bupropion and varenicline

197
Q

Bupropion

A

Norepinephrine and dopamine reuptake inhibitor and nicotinic antagonist
1-2 weeks before target date
Small seizure risk
Contraindicated in epilepsy, pregnancy & breast feeding
Caution in: eating disorder

198
Q

Varenicline

A

Nicotinic receptor partial agonist
1 week before target date
12 week treatment course
More effective than bupropion
Nausea side effect
Use in caution: depression/ self harm
Contraindicated: pregnancy and breast feeding

199
Q

Brown Sequard Syndrome

A

Ipsilateral loss of proprioception and motor
Contralateral loss of pain and temperature
Due to hemisection of spinal cord - penetrating injury ot lateral compression

200
Q

Central cord syndrome

A

Motor impairment much worse in upper compared to lower
Bladder dysfunction and urinary retnetion
Hyperextension injury in those with underlying cervical disease

201
Q

Anterior cord syndrome

A

Bilateral loss of motor, pain and temp below the injusy
Intact vibrtation and proprioception
Hyperflexion injury/ disrupted anterior spinal arterty

202
Q

neonatal jaundice causes:

A

Increased production of bilirubin or reduced clearance:

203
Q

neonatal jaundice causes:Increased production of bilirubin:

A

Haemolytic disease of the newborn
ABO incompatibility
Haemorrhage
Intraventricular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis and disseminated intravascular coagulation
G6PD deficiency

204
Q

neonatal jaundice causes:Decreased clearance of bilirubin:

A

Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorders (hypothyroid and hypopituitary)
Gilbert syndrome

205
Q

Egg allergy

A

no influenza vaccine
tickbourne encephalitis vaccine
or yellow fever vaccine

206
Q

Wolf Parkinson White

A

Short PR
Prolonged QRS
Delta wave

207
Q

Urge incontinence

A

Overactive muscle
Bladder retraining
Anticholinergic: oxybutynin, tolterdione, darifenacine
B3 agonist: mirabegron (not used in uncontrolled hypertension)
Botox

208
Q

Stress incontinence

A

Laughing or coughing
Pelvic floor training
Surgery: Tape
Duloxietene SNRI

209
Q

Paroxysmal nocturnal haemoglobinuria

A

Dark urine in AM
Acquired haemolytic anaemia
Thromboses in large vessels
Reduced new blood - pancytopenia/ aplastic anaemia

210
Q

Genital ulcers

A

Painless
- Ulcer: Syhphilis (single) or Klebsiella
- Pustule: Lymphogranuloma venereum (LGV) - Chlamydia trachomati. Tx: Doxy. Lymph nodes & rectal Sx

Painful
- Ulcer: Chancroid (Haemophilus ducreyi, unilateral lymph nodes)
- Vesicles: HSV2 (Herpes)

211
Q

TB drug side effects

A

RIPE
All: Hepatitis
Rifampacin - uRine orange
Isoniazid - peripheral neuropathy. Give B6 (Pyridoxine)
Pyrazinamide - High urea
Ethamutol - Eyes

212
Q

Tx for generalised tonic clonic

A

Sodium valproate
Women that can have children: Lamotrigine or Levetiracetam (Keppra)

213
Q

Tx for partial/ focal

A

Lamotrigine or Keppra
2nd line: carbamazepine

214
Q

Myoclonic

A

Sodium valproate
Women that can have children: Levetiracetam (Keppra)

juvenile myoclonic epilepsy

215
Q

Tonic and atonic

A

Sodium Valproate
Women that can have children: Lamotrigine

Atonic - drop attacks. Lennox-Gastaut syndrome.

216
Q

Abscence

A

Ethosuximide

217
Q

Infantile Spasms

A

West syndrome.
rare (1 in 4000) disorder
starting in infancy at around 6 months of age.
clusters of full body spasms.
poor prognosis: 1/3 die by age 25, however 1/3 are seizure free.

Prednisolone
Vigabatrin

218
Q

Sodium Valproate side effect

A

Increases GABA

Used for most seizures if male - except focal/ absence

Teratogenic, so patients need careful advice about contraception
Liver damage and hepatitis
Hair loss
Tremor
Bone marrow suppression
Weight gain

p450 inhibitor

219
Q

Carbamazepine side effect

A

Agranulocytosis
Aplastic anaemia
Hyponatraemia
Induces the P450 system

220
Q

Phenytonin side effect

A

Folate and vitamin D deficiency
Megaloblastic anaemia (folate deficiency)
Osteomalacia (vitamin D deficiency)
Gingival hyperplasia
P450 inducer

221
Q

Ethosuximide side effect

A

Absence
CCB
Night terrors
Rashes

222
Q

Lamotrigene side effect

A

Stevens-Johnson syndrome or DRESS syndrome. These are life threatening skin rashes.
Leukopenia
OCP can reduce efficacy

223
Q

Levetiracetam side effect

A

Depression
Behavouiral/ Psych issues

224
Q

Which vaccine cannot be given if missed?

A

Rotavirus cannot be given after 24 weeks as risk of intussecuption

225
Q

Trendelenburg Test

A

Hip drop of the unaffected side (the leg you are standing on has weakness in hip abductors: gluteus medius & minimus)

Causes:
Superior Gluteal Nerve Palsy
Weakness of gluteus medius
Hip instability and subluxation
Hip OA
Initially post THR
Lower back pain
Legg-Calvé-Perthes Disease
Congenital hip dislocation

226
Q

Trendelenburg Gait

A

occurs when a patient has paralysis/paresis of the hip abductors.

Hip tilts downwards on non weight bearing side

227
Q

Ottawa Knee Rules

A
  1. > 55
  2. Isolated tenderness of patella
  3. Tenderness at head of fibula
  4. Unable to flex to 90 degree
  5. Unable to weight bear after and in ED for 4 steps
228
Q

Polymorphic eruption of pregnancy PUPP

A

Very itchy
Last trimester
Abdominal straie
Umbilical sparing
Emollients
Resolves with delivery
Does not recurr on next pregnancy

229
Q

Pemphigoid gestionis

A

Uncommon
Itchy, bullous eruption
Gets more severe with other pregnancy
Starts in peri umbilical region
Topical steroids/ oral steroids

230
Q

Absolute contraindications to thrombolysis

A
  • Prev intracranial haemorrhage
  • Seizure at onset of stroke
  • Intracranial neoplasm
  • Suspected SAH
  • Stroke / TBI in preceding 3 months
  • LP in preceding 7 days
  • GI haemorrhage in preceding 3 weeks
  • Active bleeding
  • Oesophageal varices
  • Uncontrolled hypertension >200/120mmHg
231
Q

Relative contraindications to thrombolysis

A
  • Pregnancy
  • Concurrent anticoagulation (INR >1.7)
  • Haemorrhagic diathesis
  • Active diabetic haemorrhagic retinopathy
  • Suspected intracardiac thrombus
  • Major surgery / trauma in the preceding 2 weeks
232
Q

Thrombolysis for acute ischaemic stroke?

A

alteplase or tenecteplase
if within 4.5 hours of onset of stroke symptoms &
haemorrhage definitively excluded

regardless of age or stroke severity, who were last known to be well more than 4.5 hours earlier: treatment can be started between 4.5 and 9 hours of known onset, or within 9 hours of the midpoint of sleep when they have woken with symptoms,
AND
evidence from CT/MR perfusion (core-perfusion mismatch) or MRI (DWI-FLAIR mismatch) of potential to salvage brain tissue

BP should be lowered to 185/110 mmHg before thrombolysis.

233
Q

Pre stroke requirement for thrombectomy for acute ischaemic stroke?

A

pre-stroke functional status: <3 modified Rankin scale and >5 NIHSS

234
Q

Who thrombectomy for acute ischaemic stroke?

A

Offer thrombectomy ASAP and within 6 hours of SX, together with intravenous thrombolysis (if within 4.5 hours), to:
- acute ischaemic stroke AND
- confirmed proximal anterior circulation occlusion ON CTA ON MRA

Offer thrombectomy ASAP to between 6 hours and 24 hours previously (including wake-up strokes):
- proximal anterior circulation occulsion on CT or MRA AND
- potential to salvage brain tissue

Consider thrombectomy together with intravenous thrombolysis (if within 4.5 hours) ASAP last known to be well up to 24 hours previously (including wake-up strokes):
acute ischaemic stroke & confirmed proximal posterior circulation occlusion (that is, basilar or posterior cerebral artery) on scan and
- potential to salvage brain tissue

235
Q

Secondary prevention post stroke

A

300mg aspirin for 14 days
Clopi (rather than aspirin)
If clopi not tolerated then aspirin

Carotid artery stenosis
AF
Cholesterol
Smoking
BP control

236
Q

TIA medications

A
  1. 300mg aspirin stat & clopidogrel 300mg
  2. aspirin (75 mg per day for 21 days) & clopidogrel 75 mg once daily 3. clopi after to continue
    OR
  3. 300mg aspirin stat & ticagrelor 180mg
  4. Ticagrelor (90 mg BD plus aspirin (75 mg OD for 30 days)
  5. antiplatelet monotherapy with ticagrelor 90 mg BD or clopidogrel 75 mg OD
237
Q

Antiplatelets: summary of latest guidance

A
238
Q

nbm before surgery

A

food 6 hours
clear liquids 2 hours

239
Q

Bacterial vaginosis

A

overgrowth of anaerobic - gardenlis vaginalis
clue cells
ph >4.5
less lactic acid

240
Q

Post AF ablation do you continue anticoagulation?

A

Patients who’ve had a catheter ablation for atrial fibrillation still require long-term anticoagulation as per their CHA2DS2-VASc score

241
Q

CTG finding Baseline bradycardia

A

< 100
Increased fetal vagal tone, maternal beta-blocker use

242
Q

CTG finding baseline tachycardia

A

> 160
Maternal pyrexia, chorioamnionitis, hypoxia, prematurity

243
Q

CTG finding loss of baseline variability

A

< 5/ min
Prematurity, hypoxia

244
Q

CTG finding
Early deceleration

A

Deceleration of the heart rate which commences with the onset of a contraction and returns to normal on completion of the contraction OK - innocuous feature and indicates head compression

245
Q

CTG finding Late deceleration

A

BAD
Indicates fetal distress e.g. asphyxia or placental insufficiency

Deceleration HR which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction

246
Q

Variable decelerations CTG finding

A

Independent of contractions

Cord compression !

247
Q

What to do with warfarin
Major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage)

A

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*

248
Q

What to do with warfarin
INR > 8.0
Minor bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

249
Q

What to do with warfarin
INR > 8.0
No bleeding

A

Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

250
Q

What to do with warfarin
INR 5.0-8.0
Minor bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

251
Q

What to do with warfarin
INR 5.0-8.0
No bleeding

A

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

252
Q

The most common organism causing infective exacerbations of COPD is…

A

Haemophilus influenzae

253
Q

acromegaly medical management

A

octreotide - somatostatin analogue

2nd line bromocriptine

254
Q

Lower-than-expected levels of HbA1c

A

due to reduced red blood cell lifespan

GP6D deficiency
Hereditary spherocytosis
Haemodialysis

255
Q

Sickle-cell anaemia

A

due to increased red blood cell lifespan

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

256
Q

Breast feeding - what to avoid

A

B- bromocriptine, benzodiazepine
R- Radioactive drugs, rizatriptan
E- ergometrine
A- aspirin, amiodarone, alcohol, atropine
S- sulphinamide, sulphonylurea
T- tetracycline,( iso)tretinoin

M - methotrexate
L - lithium
C - carbimazole
C - ciprofloxacin
C - chloramphenicol

257
Q

Incubation periods of diarrhoeal illnesses

A

Incubation period
1-6 hrs: Staphylococcus aureus, Bacillus cereus
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis

258
Q

targets in T1DM

A

HbA1c: 48
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day

259
Q

targets in t2DM

A

Lifestyle/ Metformin 48
Any drug causing hypo 53
On one drug, but HbA1c increased to 58, aim 53

260
Q

Holmes-Adie pupil

A

ADIE:
Accommodates doesn’t constrict
Dilated pupil
Ipsilateral (unilateral)
Extraocular symptoms- absent reflexes

Deepa's MSRA (4 decks)

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