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Question 1

how does post obstructive jaundice present?

Answer 1

pale stools and dark urine

Question 2

which clotting factors are the only ones not made in the liver?

Answer 2

vWF

Factor 8

Question 3

why is vancomycin not used in meningitis?

Answer 3

Poor penetration through the BBB

Question 4

What antibiotics are used for cholecystitis?

Answer 4

• Co-amoxiclav or Metronidazole+Ciprofloxacin or Meropenem

Also give IV fluids, analgesia and arrange for cholecystectomy

Question 5

How long dose patients need to take antibiotics for acute cholecystitis?

Answer 5

If no surgery due to being too frail then 4-6 weeks
If cholecystectomy and no perforation none needed after surgery
If perforation then 5 days post operatively
IV fluids, analgesia, antibiotics

Question 6

is meropenem safe in penicillin allergies?

Answer 6

Has a beta lactam ring so can still cause some reactions

Check if patient has true penicillin allergy

Question 7

When do you refer to secondary care for suspected heart failure?

Answer 7

Refer for echo within 2/52 if NT-proBNP >236
Refer straight for echo if previous MI

Question 8

what can you include in your management apart from treatment?

Answer 8

Self help advice e.g monitor BM, stop smoking
Escalate to senior
Analgesia and antiemetic

Question 9

what is dalteparin?

Answer 9

LMWH

Works by binding to factor Xa and inactivating it and binding to ATIII to potentiate it’s action

Question 10

What malignancy and non-malignant diseases are related to obesity?

Answer 10

OBESITY IS A RISK FACTOR FOR

• Cancer: bowel, ovarian, breast, endometrial
• Non-malignant: stroke, OA, T2DM, MI

Question 11

what is the role of aspirin?

Answer 11

Irreversible COX inhibitor and TXA2 inhibitor

Question 12

how is BPPV managed?

Answer 12

Avoid sudden change in position
Adequate hydration
Advise not to drive whilst symptomatic

Question 13

What do you need to tell someone that is starting on the pill?

Answer 13

Does not protect against STI
What to do with missed pill
Vomiting and diarrhoea
Interaction with antibiotics

Question 14

What is the treatment for LRTI in a bronchiectasis patient?
What is the likeliest organisms in a diabetic leg ulcer?
What should you check before startin azathioprine?

Answer 14

Amoxicillin for 14 days
E.Coli
TPMT levels

Question 15

What are some questions you should ask if a patient has ascites?

Answer 15

Alcohol history
Risks for viral hepatitis e.g IVDU, blood transfusions
Obesity

Question 16

how is falciparum malaria treated?

Answer 16

IV artesunate

Question 17

what is a side effect of bisphosphonates

Answer 17

GORD

Question 18

How do the LP parameters vary for bacterial, viral and fungal meningitis?

Answer 18

Appearance: cloudy and turbid in bacterial, clear in viral, clear or cloudy in fungal

Opening pressure: rasied in bacterial, normal or raised in viral, raised in fungal

WBC: raised in all, mostly in viral

Glucose: low in bacterial and fungal, normal in viral

Protein: elevated in all

Question 19

What are some investigations and management you should do for a patient in post op with a suspected PE?

Answer 19

Ix:

Bedside: ECG
Bloods: Trop, D-dimer,
Imaging: CTPA
Mx

Start rivaroxaban
Oxygen
IV fluids
Analgesia
Stop any precipitating medications

Question 20

what are some differentials for tiredness?

Answer 20

Hypothyroidism
Anaemia
Coealics
Cushings
Diabetes
OSA

Question 21

what are some sign and symptoms in ILD?

Answer 21

Symptoms: dry cough, SOB on exercise that is progressive

Signs: clubbing, fine inspiratory crackles, reduced chst expansion

Question 22

what are some causes of pulmonary artery hypertension?

Answer 22

PE
Hypoxia
LVH
Idiopathic

Question 23

How do you work out the causes of hyponatraemia?

Answer 23

Pseudo: check serum osmolality, if normal then due to hyperlipidaemia, mannitol, TURP or high BM

Hypervolemic: CCF, Nephrotic syndrome, Cirrhosis

Euvolemic: SIADH (ADH stops RAAS and aldosterone production so Na goes into urine)

Hypovolemic: Diuretics, vomiting, addisons, sweat, diarrhoea

Question 24

What are some reversible causes of a dementia like presentation?

Answer 24

Polypharmacy with anticholinergics
Thiamine deficiency
Normal pressure hydrocephalus
Syphilis

Question 25

what do you see in diabetic retinopathy?

Answer 25

1. Background retinopathy: microaneurysms and hard exudates
2. Pre-proliferative retinopathy: cotton wool spots, haemorraghe
3. Proliferative: new vessels form, urgent referral
4. Maculopathy: decreased visual acuity

Question 26

What is seen on fundoscopy with hypertensive retinopathy?

Answer 26

I = silver wiring

II = AV nipping

III = flame haemorraghes and cotton wool spots

IV = papilloedema

Question 27

can you cardiovert someone who has hyperthyroidism with AF

Answer 27

No they need to be euthyroid for 8-10 weeks

Question 28

who do people with CKD get hyperkalaemia?

Answer 28

Impaired GFR plus a frequently high dietary potassium intake
Extracellular shift of potassium caused by the metabolic
acidosis

Treatment with K+sparing drugs e.g. ACEi/ARBs