UCL 2017 Flashcards by Chris E

Farmer has 24 hour symptoms. Vital signs very bad hypotensive tachycardic and high resps, painful lymphadenopathy up right arm and paronchia of right thumb.

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Orf, staphylococcal toxic shock syndrome, brucellosis

Orf is a zoonotic disease, meaning humans can contract this disorder through direct contact with infected sheep and goats or with fomites carrying the orf virus.[2] It causes a purulent-appearing papule locally and generally no systemic symptoms. Infected locations can include the finger, hand, arm, face and even the penis (caused by infection either from contact with the hand during urination or from bestiality). Consequently, it is important to observe good personal hygiene and to wear gloves when treating infected animals.[1] The papule may persist for seven to ten weeks and resolves spontaneously. It is an uncommon condition and may be difficult to diagnose.

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Man has 4 month sx of pain in heel which has stopped him walking. An XR demonstrates a Calcaneal spur

Plantar fasciitis

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According to NICE guidelines, a patient has a Qrisk of 20%. What Rx?

Statin

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ECG with ST depression in v2-4. Which part of heart has been damaged?

posterior left wall

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Patient has sudden onset L facial weakness and R arm weakness. They have diplopia on L lateral gaze.

L brainstem (lateral medullary syndrome)

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Long chat about a guy with bradycardia. His ECG shows broad QRS complexes 40bpm regular and p waves at a rate of 75bpm. Is this 1st degree, 2nd or complete heart block

complete heart block

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Pancreatitis guy gets v unwell with bibasal crackles his CXR is shown. What is dx

ARDS

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CSF Glucose was 4.4 (2-4.4), opening pressure 80cm H20 (normal), lots of white cells.

viral

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HIV guy has brain MRI shows multiple ring enhancing lesions

Toxoplasma

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Guy 22 with AIDS has disseminated infection with chest, abdominal pain, diarheoa, vomiting etc. He is then treated with multiple drug treatment, which is most likely organism.

Mycobacterium avium-intracellulare infection (MAI) is an atypical mycobacterial infection, i.e. one with nontuberculous mycobacteria or NTM, caused by Mycobacterium avium complex (“MAC”), which is made of two mycobacteria species, M. avium and M. intracellulare.[1] This infection causes respiratory illness in birds, pigs, and humans, especially in immunocompromised people. In the later stages of AIDS it can be very severe. It usually first presents as a persistent cough. It is typically treated with a series of three antibiotics for a period of at least six months.

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Guy has Hep C 10 year ago infection. What is best test to do now?

RNA

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Guy post rta shortened r leg internally rotated and slightly flexed.

Posterior dislocation

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Patient with hypokalemia and hypernatremia. What is best Ix

Aldosterone and Plasma Renin Activity

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Cluster headache acute rx:

Management

acute: 100% oxygen (80% response rate within 15 minutes), subcutaneous triptan (75% response rate within 15 minutes)
prophylaxis: verapamil is the drug of choice. There is also some evidence to support a tapering dose of prednisolone
NICE recommend seeking specialist advice from a neurologist if a patient develops cluster headaches with respect to neuroimaging

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Guy come back from walking trip in woods in Europe, has rash

Lyme disease

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Description woman with dry eyes (Sjogen) what is rx?

hypromellose artificial tears

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Menieres despriction ie dizzy deaf and vertigo with ear fullness next Ix?

Audiometry

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Weber lateralises to L ear, Rinne’s negative on the R (Air conduction>bone)

Acoustic neuroma,

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Hearing loss, has FHx, worsen in preg

Otosclerosis

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. Ghanian girl 20yo collapses during badminton. O/E has pansystolic murmur mitral region (MR) and ejection systolic murmur (AS) and father had sudden death

HOCM

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Patient post MI has crackles and HF and a MDM at the apex.

papillary rupture -> MR,

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Patient with HF has found hypokalameia 2, what is cause?

Metolazone (thiazide-like diuretic)

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Patient has coarse crackles lower lobe. Describes CAP Whats commonest

Strep pneumo

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Classic patient has pink urine. He had a URTI 3 days ago.

IgA nephropathy

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Heavy smoker has cavitating lesion at L hilum. Bronchoscopy reveals a lesion with Keratin pearl.

Squamous Cell Carcinoma

Squamous cell whats next rx?

Radiotherapy!!! (only 20% for surgery)

Old person has post prandial pain and pr clear:

mesenteric ischemia

Classic stable angina but asthma

Calcium Channel Blocker

Prolong survival HF

Spironolactone

Calcified heart on CXR kussmaul sign

TB pericarditis

Woman has had headache and been at home a week. Is found unresponsive by neighbour. Her pulse 56, BP 166/86 and fast followed by slow breathing. Cause?

raised ICP. (need to identify this is Kussmaul respiration and Cushing reflex seen when there is raised ICP).

Which of these supports a diagnosis of shy dragger? (type of MSA)

orthostatic hypotension

Pt has nonspecific sx nausea malaise etc and yellow tinge on white objects (Xanthochromia)

digoxin

long description of obvious pancreatic cancer first ix

Abdominal US

Unclear XR with what sounded like heart failure. What sign is shown?

septal interstitial lines

Woman with clear venous sinus thrombosis hx. MR venogram demonstrates filling defect in transverse sinus with a small area of associated haemorrhage – best rx? (which can be reversed/titrated)

LMWH -> warfarin

CT scan demonstrated huge renal cancer on R side. Biopsy shows which most likely histology?

Clear cell. -> Most common type of renal cell carcinoma

Patient has huge ortho op and medullary nail for hip fracture. Next day comes in hugely unwell

fat embolism

GCS c. 5 What do you do?

Cuffed tracheal tube (secure

Pt has fit and you as doctor are told by patient he adamant will not tell DVLA. Professional duty not legal to breach confidentiality.

Doctors have to tell DVLA is patient is unfit for driving

One of kid with epiglottitis. After rx with nebulised steroid, RR 80 and kids gets unwell and breathing shallow. Rx?

call anesthetics

Pt in anaphylaxis most important rx?

IM adrenaline,

Hypercalcaemia of malignancy 2 qns one in each paper. First was whats most important initial IV rx?

9% saline

Second qn was what drug to use?

IV zoledronate (bisphosphonates),

Neutropenic sepsis whats most likely org

E coli

Unknown Overdose during argument in a guy recently prescribed antidepressants- which drug. PT was 48, ast 64 (would expect in 1000s and think was an OD after 24 hours). no info pupils

flumazenil, tricyclic, fluoxetine, paracetamol, Aspirin

2 years ago displaced fracture talus in accident. Now 2 yr later pain - xr shows sclerotic area middle of bone

AVN

Asthmatic had rx a+e yday and responded well. now tension clear description of hyperresonant r chest with no air entry with contralaterally displaced trachea. rx?

Needle thoracocentesis.

50 year old with diplopia. R droopy eyelid and 4mm pupil vs 2 on L

Surgical 3rd

Diabetic with ascending weakness. Weird power of how 4/5 and 3/5 mostly in arms and legs. can't close eyelids properly, reflexes gone planters absent but sensation fine –

GBS

Dad and son have diarhoa had chicken at bbq on weekend which most likely org

C jejuni

Pt has diplopia on R gaze answer

R abducent palsy

Post MI ms EDM description and bare failure

IV dilatation?

Guy has lots lesions with rough skin on bald forehead. This lesion predisposes to what?

SCC

Pt with 2 pics: oral severe ulceration looks buttaz and rash affecting palms and arthralgia

SJS

Disseminated renal cell. Progressive pitting oedema legs and distended abdo veins

inginal lymph nodes blocked

Guy on clozapine for schizophrenia and ivdu comes in. o/e neck stiffness, moving all limbs, t39.8 13/15 gcs.

NMS. Management stop antipsychotic IV fluids to prevent renal failure dantrolene* may be useful in selected cases bromocriptine, dopamine agonist, may also be used

Diabetic with bad kidney function gfr low, creatinine>150. What drug to start after diet?

gliclazide, +ACEi Metformin contraindications chronic kidney disease: NICE recommend that the dose should be reviewed if the creatinine is > 130 µmol/l (or eGFR < 45 ml/min) and stopped if the creatinine is > 150 µmol/l (or eGFR < 30 ml/min) metformin may cause lactic acidosis if taken during a period where there is tissue hypoxia. Examples include a recent myocardial infarction, sepsis, acute kidney injury and severe dehydration

Guy painful retention and u+e off - USs shows vv distended bladder

catheter

Single marker prognosis in Hodgkin?

albumin

Hoarse voice weak cough post thyroidectomy

neurpraxia of recurrent largyneal

Patient with papules pustules, telangiectasia, red flushing on face

Rosacea

IN a new trial, why does orally drug have lower area under curve than iv?

First pass hep metabolism

In RCT, if there is a large nocebo effect, what does this mean?

unblinding has occurred

Woman has breast lump removed for which the pathologist provides their standard report. For which of these in further investigation needed?

stage - done by imaging?

Which of following most supports dx of delirium vs dementia?

Fluctant course (NOT gradually progressive etc)

Death certificate easy pt has RLL crackles after being admitted. Rx but dies next day whats 1a?

Pneumonia

Anxious banker worried about work palpitations at night. What u do as GP -

24 hour tape to catch the arrthmyia and review it with him

. Person bare proteinuria and oedema. what's most likely cause

membranous GN

Old woman with OA blood film shows target cells what drug to stop?

Stop nsaid ie has IDA

. Blood film bare purple cells old person went aml or all? Think had wcc hb plt all low. No Auer roads obv. Ie all low check

AML

old person pic all lympohocytes all big purple cells huge nuclei. Old person asympto

CLL

Guy hit from behind car accident, immediate pain shoulder neck and spasm muscles. Ix and exam all normal at first, but still pain at 4 weeks despite normal XR and exam , next ix?

Mri or refer neuro

Lool unbelievable Beynon qn. Man has pickled beetroot he made few days ago and some weakness in face

clostridium botulinum

Patient with declining vision she diabetic from India recent immigrant only on amlodipine. Think fundus shows dots and blots, dx is

diabetic retinopathy

Patient has had splenectomy on prophylactic pen. Which organism most at risk of infection?

haemophilus is answer coz proph penicillin will cover

Kid has muscular hypertrophy amd struggling to run with kids 3 years. He has huge calves. Where is the problem?

striated muscle

A young guy has just come back from a 3 month trip in the south of Africa and has had 2 weeks of frank hematuria. A urine dipstick demonstrates 3+ myoglobin. Which is likely cause?

Schistosomiasis

Follow up qn in paper 2: what is the next best investigation?

Terminal urine microscopy

Kid borught in by mum as unwell. V irritable and bulging fontanelle, what most likely dx?

bacterial meningitis.

Patient has treatment for RA and then gets extensive and widespread TB, what is likely cause?

Infliximab

Woman has extensive haematological malignancy, gets treated with emergency chemo and goes into renal failure. What is best test for complication which has occurred? Was getting at tumour lysis syndrome:

urate

Pt has had injury to leg and had morphine but in anguish, what next rx?

answer refer to surgeons for fasciotomy (sounded like compartment syndrome as pain out of proportion)

Patient unwell what is best rx option to administer 02?

Think was 15L via reservoir mask.

Guy with mass in testis, soft and bulges on standing no cough impulse.

varicocele

Woman with tender irreducible lump groin – indirect, direct or femoral strangulated or incarcerated indirect?

Went femoral strangulated because woman and painful

Guy with alcohol hx has ataxia and ophthalmoplegia, what vitamin is deficient?

thiamine (B1)

Guy who's fitting has had 2 lots lorazepam in hospital, what rx next?

phenytoin

L lower lobe dull and bronchial breathing. Try aspirate and nothing come out. Dx?

Effusion

Teratoma tumour marker? -

AFP and beta hcg

Lady with 1 episode of PMB, O/e atrophic vaginitis description of pink raw genital skin, her TV USS shows endometrial thickness 3mm. rx?

Topical cream as no masses

One sided Red eye painful visual loss, not much other hx.

Probably glaucoma so refer opthal

Pancreatitis description, why do his stools not flush?

loss of pancreatic exocrine function

Guy seen a+e for hypoglycaemia, on review which meds to stop?

Do not routinely prescribe antiplatelet treatment for the primary prevention of cardiovascular disease (CVD).” It then states “Consider prescribing aspirin in people with a high risk of stroke or myocardial infarction.” The guidelines remind readers that aspirin is not licensed for the primary prevention of CVD and that people can reduce their CVD risk by other means such as smoking cessation or taking at statin. The guidelines emphasise “if aspirin is being considered, discuss the likely benefits (reduced CVD risk) and risks (such as gastrointestinal bleeding) with the person.” NICE NG17 2015 (updated July 2016) “Do not offer aspirin for the primary prevention of cardiovascular disease to adults with type 1 diabetes.”

Stones description classic, best ix?

Non contrast ct

Pt after RTA 1g IV paractemeol but still in pain, next rx?

Weak opioid

25 yo lady has bp 180/110, normal periods but cliteromegaly

Congenital adrenal hyperplasia

Give clari and coamox. Sensitivities back show resistant to pen fluclox and sensitive teic. What next?

switch to teico

Obv smoker has bad pneumonia which is rx-ed, what's most important fu ix?

CXR

Pt has pulmonary oedema and pitting, acutely sob, what's most important rx? fruse, gtn, morphine?

frusoemide.