UCL 2017 Paper 2 Flashcards
Fundus photograph of someone with deterioration of vision, pic show yellow exudates ringed around macula.
Diabetic maculopathy
Young chap 72 hour hx of sore throat but for last 24hr can’t eat/drink. o/e, has an erythematous soft palate and uvula deviated other way. He cant open his mouth fully.
quinsy
Woman 30yo who has been in UK 8 years , originally from brazil. Has pain, tingling, sensory loss all limbs v weird no obvious pattern. Has thickened ulnar and peroneal nerves. Answer likely Leprosy therefore rx is
Dapsone
Primary options
rifampicin: 600 mg orally once monthly
and
clofazimine: 50 mg orally once daily plus an additional 300 mg once monthly
and
dapsone: 100 mg orally once daily
A patient with CKD is given a drug and K rises to 7.2.
Trimethoprim Trimethoprim (an organic cation) acts like amiloride and blocks apical membrane sodium channels in the mammalian distal nephron. As a consequence, the transepithelial voltage is reduced and potassium secretion is inhibited. Decreased renal potassium excretion secondary to these direct effects on kidney tubules leads to hyperkalemia in a substantial number of patients being treated with trimethoprim-containing drugs.
Description of diabetic gastroparesis young T1DM ha dyspepsia and nausea after meals what is best rx -
domperidone or metoclopramide
Middle lobe collapse
Remember CXR looks like wedge wipe out
25yo from Bangladesh 2 week ago gram negative rods were grown in aerobic and anaerobic bottles, had rash buttocks thighs. which organism?
salmonella typhi/paratyphi
^These are rose spots or ‘enteric fever’ – also look for a relative bradycardia
Brain with fucked temp lobe. This patient had prolonged seizure then died -
hsv enceph
. Guy has transjugular shunt, and next day noted to be solmnent. Why?
TIPS predisposes to hepatic encephalopathy because ammonia can reach brain and cause osmotic change, damaging astrocytes
Wasted small muscles hand, abduction adduction and thumb adduction all weak. Loss of sensation of medial aspect of forearm (? Classic c8 dermatome). Triceps biceps reflexes and finger flex normal. L arm normal. T1 or c8 lesion, or median nerve palsy?
C8 or T1
Guy who plays golf with pain at lateral epicondyle what muscles weak?
extensors wrist (ie muscles on ventral aspect of forearm)
Ecg shows pr depression and curved st elevation but only get some leads, dX?
PR depression MOST sensitive sign of pericarditis
Gram positive diplococi
strep pneumo for example
Person has 2 episodes of hemoptysis and upper lobe consolidation on XR. What is best Ix -
AFBs
Description of asthma lady who has exacerbations despite SABA LABA and ICS at maximum dose, what next?
LTRA
Lady with UC, has been well controlled for 3 years with mesalazine, now admitted with severe 8 bloody stools/d ,
IV hydrocort
Girl 30 pr fresh red blood on tissue and described an episode where blood was dripping into bowl. Pr normal no masses next Ix?
protoscopy
Long description of breast cancer an how many kids shes had. What is her greatest risk factor for breast ca?
, ?obesity
Msm with painless ulcer, causative organism?
treponema palidum
Guy dysuria for 4 days and 4 raised painful lesions on corona of penis
herpes simplex
Guy decreased maximal urine flow post gonorehoa which was like 2 years ago, which complication has occurred?
stricture
Woman has dry eyes and mouth enlarged parotids what it? May also have said her schirmer test was 7mm (should be >5, gives you reference range).
sjogren
young person normally moistens 15 mm of each paper strip. Because hypolacrimation occurs with aging, 33% of normal elderly persons may wet only 10 mm in 5 minutes. Persons with Sjögren’s syndrome moisten less than 5 mm in 5 minutes.
Woman with obvious ra but RhF factor negative. Discussed she been tired, metacarpophalangeal swelling and pain
answer still RA
Guy with metatarsophalangeal pain exquisitely tender. This is podagra. What is best rx?
Naproxen. NB its NSAID 1st line acutely and colchicine in NSAID CI like asthma/renal failure. If already on allopurinol, continue dose. If not, start AFTER event if predisposed.
Guy has huge trauma and bleeds out, how does body combat this?
Increased sympathetic tone
What is the single scenario a GP may prescribe sildanefil on nhs?
He depressed and its causing him
How does sildanefil cause postural hypotensive
PDEV inhibitor resulting in vasodilation
Ground glass hepatocytes. aa1 low levels
pathognomnic of hepatitis B
. Guy severe ckd anemia 79, v microcytic. Ferritin 5
Clinical history, presentation, and findings include fatigue, pallor, dyspnoea on exertion, and pica.
Microcytic, hypochromic anaemia; low reticulocyte count.
Characteristics include low serum iron, increased total iron-binding capacity (TIBC), less than 16% transferrin saturation, and low serum ferritin.
The diagnosis of iron deficiency anaemia necessitates investigation of the underlying cause.
There is no single reliable cut-off for red cell transfusion, but patients should be transfused according to clinical need based on co-existing disease (such as anaemia and unstable angina) and haemodynamic stability. Studies suggest that red cell transfusion may be overused. [99] The use of a blood transfusion does not obviate the need for other forms of iron replacement, because one unit of packed red blood cells will provide only approximately 250 mg of elemental iron and would provide only enough iron to raise the haemoglobin by 1 g.
Budd Chriari prv description. A man has polycythaemia which is well treated. He then moves practice area and represents 2 years later with distended abdomen and dilated abdominal veins. Portal vein, splenic vein thrombosis. Answer is PRV which causes Budd Chiari which is
HEPATIC vein thrombosis
Includes hepatic venous outflow obstruction at any level from the small hepatic veins to the junction of the inferior vena cava and the right atrium, regardless of the cause of the obstruction.
Classic triad of symptoms is abdominal pain, ascites, and hepatomegaly.
Seventy-five per cent of patients have at least one underlying hypercoagulable state.
Colour and pulsed Doppler ultrasonography is the first-line investigation for diagnosis. Patients should also undergo testing for hypercoagulable states to identify any predisposition to venous thrombosis.
The aim of therapy and interventional management is to relieve hepatic congestion and prevent necrosis, fibrosis, and ultimately liver failure, cirrhosis, and/or portal hypertension.
The main treatment options are radiological interventional procedures including angioplasty of hepatic vein and/or inferior vena cava, or transjugular intrahepatic portosystemic shunts (TIPS). Further to this, surgical procedures may be used, such as surgical shunts and liver transplantation.
Bre comes with painful knee t 38.5. Start empirical abx or aspirate and ix fluid?
aspirate because will need to confirm dx and need culture and sensitivities to narrow the spectrum.
Guy tired all time normal t4 7, tsh <0.01, testosterone also low 0.02.
Hypopituatrism
Man has painful face and headache with no cause found. He represents a few days later with a few red bumps which extend past the orbit to midline, what is like nerve affected?
Trigeminal opthalmic branch. Good hx of pain before herpes zoster ophthalmicus and as usual, funny way of asking an easy question
Guy with HIV has culture with silver stain which is positive, organism?
Aspergillus
. Ix for pulseless cold R leg?
As already stated, embolectomy is the treatment for an embolic occlusion; whereas more complicated techniques such as arterial angioplasty, thrombolysis and possibly arterial bypass are the treatments for arterial thrombosis.[47] The gold standard to differentiate between these two scenarios is an angiogram,
Another similar question described a R leg which is cold and pulseless and no pulses except femoral pulse, where is pathology?
Superficial femoral
Woman with no mass but bloody discharge. Classic qn from previous years
ductal papiloma
Guy punched someone 3 days ago. Oe cut on 3rd knuckle and exquisitely tender on palmar aspect and can’t move passively.
surgical debridement and iv abx
pain on passive felxion is key word
3 weeks a guy has been off work feeling unwell. O/E has no air movement at R base and dull to percussion and decreased vocal resonance.
I’d say collapse
A lady taxi driver has urticaria but wants non sedating rx due to her job
Remember: cetirizine
Kid has pt aptt etc all normal plt 10. Refers you to a pic petechiae on ankle, dx?
ITP
Bad smoker 50 a day. RUQ pain so has liver bx which demonstrates a random made up marker which suggests lung primary. How’d it get there?
Hematogenous,
