Wrong Flashcards
1
Q
Triad of Felty’s syndrome
A
RA, low WCC, splenomegaly
2
Q
Adhesive capsulitis RFs (4)
A
Diabetes mellitus, MI, lung disease, neck disease
3
Q
Treatment of first presentation RA
A
Methotrexate with 2-3mos bridging corticosteroids
4
Q
Skin condition associated with reactive arthritis
A
Keratoderma blennorrhagica
5
Q
Treatment of herpes zoster ophthalmicus
A
Urgent ophthalmological review and 7-10 days oral antivirals
6
Q
How can recurrent PE affect the physiology of the lungs on pulmonary function testing?
A
Reduced TLCO - areas of the lung are poorly perfused leading to VQ mismatch, causing reduced gas exchange, hence reduced TLCO
7
Q
COPD staging
A
Stage 1: FEV1 >80% predicted (mild)
Stage 2: FEV1 50-79% predicted (mod)
Stage 3: FEV1 30-49% predicted (severe)
Stage 4: FEV1 <30% predicted (v severe)
ALL have FEV1/FVC <0.7
8
Q
What does lichen planus look like and how to treat
A
Well-demarcated purple papules with thin white lines running across them
Treat with topical steroids, or benzydamine mouthwash if oral lesions
9
Q
Treatment for anterior uveitis
A
Steroid and cycloplegic (mydriatic, e.g. atropine) eye drops
10
Q
Causes of carpal tunnel (5)
A
Idiopathic, pregnancy, oedema, lunate fracture, RA
11
Q
Investigation for mesothelioma
A
Thoracoscopy
12
Q
Asthma uncontrolled on mod-dose MART - next step
A
Bloods for eosinophils or FeNO.
If either raised - refer to resp.
If neither raised - trial or LRTA or LAMA.
13
Q
Which protein is affected in Marfan’s syndrome
A
Fibrillin-1
14
Q
Which conditions cause erythema nodosum
A
TB, sarcoidosis, IBD, pregnancy, malignancy/lymphoma, drugs (penicillins, COCP, sulphonamides), streptococci.
15
Q
How does polymorphic eruption of pregnancy present?
A
Usually in the 3rd trimester, pruritic papule over striae that evolve into larger erythematous plaques and may spread to buttocks and thighs
16
Q
Ank spond: 1st and 2nd line treatment?
A
1: Oral NSAID
2: TNF-α blockers e.g. infliximab and etanercept.
17
Q
What are markers of poor prognosis for SCC
A
Poorly differentiated tumours, >20mm diameter, >4mm deep, immunosupression
18
Q
SCC treatment
A
Surgical excision with 4mm margins if lesion <20mm or 6mm if >20mm.
Mohs micrographic surgery considered if high-risk or cosmetically important site.
19
Q
RA XR changes
A
Loss of joint space
Erosions
Soft tissue swelling
Soft bones (osteoporosis)
20
Q
L3 nerve root compression sx
A
Sensory loss - anterior thigh
Weak hip flexion, knee extension, hip adduction
Reduced knee reflex
Positive femoral stretch test
21
Q
L4 neve root compression sx
A
Sensory loss - anterior aspect of the knee and medial malleolus
Weakness - knee extension, hip adduction
Reduced knee reflex
Positive femoral stretch test
22
Q
L5 nerve root compression sx
A
Sensory loss - dorsum of foot
Weakness - foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
23
Q
S1 nerve root compression sx
A
Sensory loss - posterolateral aspect of leg and lateral aspect of foot
Weakness - plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
24
Q
What is an acral lentiginous melanoma?
A
Pigmentation of the nail bed affecting the proximal nail fold (Hutchinson’s sign)
Rare
25
Treatment for Hep C?
Ribavirin and interferon-α.
Interferon can cause flu-like symptoms.
26
What paraneoplastic features does small cell lung cancer cause
ADH, ACTH, LEMS
27
What paraneoplastic features does squamous cell lung cancer cause
PTH-rp, clubbing, hyperthyroidism and hypertrophic pulmonary osteoarthropathy.
28
What paraneoplastic features does adenocarcinoma of the lung cancer cause
gynaecomastia and
29
Features of empyema on analysis
pH <7.2, low glucose, high LDH.
- Low glucose as bacteria use for respiration.
- Low pH as bacteria produce CO2.
- High LDH as this is used to convert glucose to energy by bacteria.
30
What is the pleural effusion fluid protein/serum protein ratio in an exudate?
>0.5 = exudate.
<0.5 = transudate
31
What are the signs of Meig's syndrome? (3)
Benign ovarian tumour, ascites and pleural effusion
32
Indications for corticosteroid treatment in sarcoidosis?
Parenchymal lung disease, uveitis, hypercalcaemia and neurological/cardiac involvement
33
Symptoms of dengue fever
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia
34
Classic feature of Chagas disease
Swollen eyelids
Cause of fever in returning traveller, typically latin America
35
Management of genital warts?
Multiple, non-keratinised: topical podophyllum
Solitary, keratinised warts: cryotherapy
36
Cryptococcal meningitis px?
HIV, neurological sx, headache, CSF india ink positive
37
Symptoms of typhoid fever
Fever, abdo pain, diarrhoea (yellow-green) and 'rose' spots on abdomen
38
Which vaccines are live attentuated? (5)
BCG, MMR, oral polio, yellow fever and oral typhoid
39
Carcinoid tumours: sx and ix
Sx: flushing, diarrhoea, abode pain, LoW, systolic murmur and hepatomegaly.
Ix: urinaru 5-HIAA
40
What visual defects does posterior cerebral artery infarction cause?
Contralateral homonymous hemianopia with macular sparing and visual agnosia.
41
Acute graft failure px
Within months, asymptomatic, rising creatinine, pyuria and proteinuria.
42
2 key features of Kartagener's syndome/primary ciliary dyskinesia?
Recurrent chest infections and sub fertility.
43
Which antibodies are involved in limited systemic sclerosis?
Anti-centromere antibodies
44
Which antibodies are involved in diffuse scleroderma
Anti-Scl-70 antibodies
45
What are the 3 patterns of systemic sclerosis?
1. Limited cutaneous systemic sclerosis: raynauds may be the first sign, affects face and distal limbs. Subtype is CREST syndrome
2. Diffuse cutaneous systemic sclerosis: affects trunk and proximal limbs predominantly. CREST plus internal organs.
3. Scleroderma: no internal organ involvement, tightening and fibrosis of the skin.
46
What is CREST syndrome
Calcinosis, Raynauds, esophageal dysmotility, sclerodactyly, telangiactasia.
47
Blood findings in Kleinfelter's syndrome
High LH, low testosterone
48
Which area of vision is most affected in glaucoma
Peripheral
Also decreased acuity and optic disc cupping
49
How to identify familial hypercholesterolaemia
Markedly elevated LDL (>5)
Presence of tendon xanthomata
FHx of premature CVD
50
What organism causes pneumonia following influenza
Staph. aureus
51
TFTs in sick euthyroid syndrome
low T3/T4, normal TSH with acute illness
52
Management of tumour lysis syndrome
IV fluids and IV rasburicase
53
How does bacterial meningitis CSF appear?
Cloudy, low glucose, high protein, neutrophil predominance
54
How does viral meningitis CSF appear?
Clear/cloudy, lymphocytes predominance, normal/raised protein, glucose 60-80% of plasma value
55
56
How does TB meningitis CSF appear?
Cloudy/fibrin web, low glucose, high protein, lymphocyte predominance (same as bacterial but with lymphocytes)
57
Complications of meningitis
Septic shock, hearing loss, seizures, intellectual impairment
58
Features of a malignant breast lump
Non-tender
Orange peel skin
Dimpling of skin
Ulceration
Rash around nipple
New nipple inversion
Bloody discharge
Weight loss
Cervical/axillary lymphadenopathy
59
What is involved in a breast triple assessment
Examination, imaging and biopsy
- Imaging may be mammogram (XR) or USS
60
What is the breast screening programme in the UK
Every 3 years from 50-71
61
What is the breast screening programme for a BRCA1 carrier
Annual MRI screening
62
Biopsy findings of UC
Mucosal inflammation
Depleted goblet cells
Ulceration
Continuous inflammation
Pseudopolyps
63
Biopsy findings of coeliac
Villous atrophy
Crypt hyperplasia
Intraepithelial lymphocytes
64
Biopsy findings of Crohn's
Increased goblet cells
Granulomas
Inflammation from mucosa to serosa
65
Small bowel enema findings for Crohn's
Strictures - Kantor's string sign
Proximal bowel dilatation
Rose-thorn ulcers
Fistulae
66
Findings in IE
Pallor
Clubbing
Roth spots
Splinter haemorrhages
Osler's nodes
Janeway lesions
Petechiae
Hypotension
Tachycardia
Tachypnoea
Splenomegaly
67
How to take blood cultures in IE
Three samples from different sites 6 hours apart
68
RFs for IE
IVDU
Dental surgery
Prosthetic heart valves
Thoracotomy
Rheumatic heart disease
Indwelling cardiac devices
Immunosuppressed
69
Differentials for sudden painless vision loss
CRAO/CRVO
Retinal detachment
Vitreous haemorrhage
70
RFs for age-related macular degeneration
Increasing age
Smoking
FHx
CVD/HTN
Obesity
Poor diet
71
Causes of Parkinsonism
Idiopathic
PSP
MSA
Lewy-body dementia
Drug induced
Wilson's disease
72
Pathological basis of Parkinson's
Progressive degeneration of dopaminergic neurons in the substantia nigra
73
Common side effects of treatment with L-DOPA
Nausea/GI upset
On-Off phenomenon
End-of-dose dyskinesia
Arrhythmia/Palpitations
Syncope
74
Which drugs are used to treat Parkinson's
Levodopa
Ropinirole (dopamine receptor agonist)
Selegiline (MAO-B inhibitor)
Amantadine (anticholinergic)
Entacapone (COMT inhibitor)
75
What would a vertical gaze palsy in Parkinson's suggest
PSP
76
Signs and symptoms of lupus
Fatigue
Weight loss
Arthralgia
Myalgia
Fever
Malar rash
Raynaud's
Shortness of breath
Lymphadenopathy/Splenomegaly
77
Antibodies that are highly specific for SLE
Anti-dsDNA, anti-Sm
78
Antibody most sensitive for SLE
ANA
79
Define sensitivity
A test of the proportion of people who test positive among all those who actually have the disease
80
Define specificity
A test of the proportion of the people who test negative among all those who do not have the disease
81
Which DMARD is used first line in SLE
Hydroxychloroquine
82
Common complications of SLE
Coronary artery disease
HTN
Anaemia
Pericarditis
Pleuritis
Lupus nephritis
Psychosis/seizures/neuropsychiatric SLE
83
Common causes of upper GI bleed
Variceal haemorrhage/portal HTN
Mallory weiss
Gastric ulcer
Malignancy
Gastritis
84
Test for H pylori
Urea breath test
85
Risk factors for refeeding syndrome
BMI<16
Fasting for 5+ days
Rapid weight loss
Excessive exercise
Dehydration
85
86
Brief overview of refeeding syndrome
Caused by sudden introduction of glucose after prolonged starvation
When BM is low, cell metabolism slows down.
When glucose is introduced, insulin is released and glucose is pushed into cells.
This increases the demand for phosphate, potassium and mg.
This results in low phos, K, Mg.
87
What type of aphasia is caused by damage to Brocas and Wernicke's areas
Brocas = expressive
Wenicke's = receptive
88
What classification system is used for intra-articular fractures?
Garden
89
Interpretation of DEXA scan results
T score (same sex and race, not age):
-1 to -2.5 = osteopenia
<-2.5 = osteoporosis
Z scores compare bone density to same age, gender, race, height and weight. <-2 is lower than expected for pts age.
90
Mechanism of action of bisphosphonates
Reduced activity of osteoclasts and inhibition of bone resorption
91
Bisphosphonate side effects
Reflux
Atypical fractures
Osteonecrosis of the jaw
Osteonecrosis of the external auditory canal
92
Tumour marker for bowel cancer
Carcinoembryonic antigen (CEA)
93
Signs of HF on CXR
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated prominent upper lobe vessels
Pleural effusions (bilateral)
94
Define stroke
Rapidly developing focal neurological deficit of vascular origin lasting over 24 hours or resulting in death
95
Define TIA
A transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without acute infarction
96
Risk factors for stroke
Increasing age
HTN
AF
DM
Smoking
Prev TIA/stroke
High cholesterol
Cocaine use
97
What kind of anaemia does B12 deficiency cause
Macrocytic, megaloblastic
98
Conditions that cause high MCV
B12 deficiency
Folate deficiency
Hypothyroid
Liver disease
Chronic alcohol excess
Myeloproliferative/myelodysplastic disease
99
Causes of B12 deficiency
Diet - veggie/vegan
Pernicious anaemia
Crohn's/Coeliac
Gastric/bariatric surgery
H pylori
Pregnancy
100
Where is intrinsic factor secreted
Parietal cells of the stomach
101
Where in the gut is B12 absorbed
terminal ileum
102
Where in the gut is iron absorbed
Duodenum/jejunum
103
Where in the gut is folate absorbed
Duodenum/jejunum
104
What is primary and secondary infertility
Primary = couples who have never conceived
Secondary = couples who have conceived at least once before (with each other or with another partner)
105
RFs for infertility in females (modifiable)
Prev/current STI
Obesity
Low BMI
Smoking
Stres
NSAIDs
Chemotherapy
Antidepressant use
106
What are the 3 main structures of the inner ear
Semicircular canals, vestibule, cochlea
107
Pathological basis of Ménière's disease and which hearing loss does it cause
Excessive buildup of endolymph in the labrinth of the inner ear, increasing the pressure and disrupting sensory signals
SN hearing loss
108
What can be used as prophylaxis in Menieres disease
Betahistine
109
When can a combined test for Down's syndrome be done?
11-13+6 wks
110
When can a quadruple test for Down's syndrome be done
15-20wks
111
What is involved in a combined test and what results are suggestive of Downs
Thickened nuchal translucency
Raised B-HCG
Low PAPP-A
Edwards and Patau give similar results, but B-HCG tends to be lower
112
What is involved in a quadruple test and what results are suggestive of Down's
AFP - low
Unconjugated estriol - low
HCG - high
Inhibin A - high
113
When will amniocentesis be done to test for Downs
If testing is highly suggestive and the pregnancy has passed 15wks gestation
114
When can chorionic villous sampling be done for Down's
11-13+6 wks
115
What determines the degree of severity of ToF
Right ventricular outflow obstruction
116
What is the first-line investigation in suspected prostate cancer
Multiparametric MRI
117
Difference between strangulated and incarcerated hernia?
Incarcerated cannot be reduced but is not painful.
Strangulated are painful, can be infected with symptoms of bowel obstruction.
118
What is the first-line medication for BPH
Alpha-1 antagonist, e.g. tamsulosin
5-alpha reductase inhibitors e.g. finasteride take up to 6mos to work
119
What is the triad of vasa praevia
Rupture of membranes, painless vaginal bleeding and foetal bradycardia
120
How to manage known vasa praevia
Corticosteroids from 32wks to mature foetal lungs, planned C-section at 34-36wks
121
How to manage vasa praevia after haemorrhage has started
Emergency C-section
122
What can goserelin use in prostate cancer cause
Transient worsening of sx, called the tumour flare. May have worse LUTS and back pain.
123
RFs for placental abruption
Abruption previously
Blood pressure (high)
Ruptured membranes (prem or prolonged)
Uterine injury
Polyhydramnios
Twins
Infection of the uterus
Older age (>35)
Narcotic use
124
What is the scoring system used for LUTS and impact on QoL
International prostate symptom score (IPSS)
125
Skin condition associated with Crohn's
Pyoderma gangrenosum
126
Skin condition associated with coeliac disease
Dermatitis herpetiformis
127
Skin condition associated with gastric and pancreatic malignancy
Acanthosis nigricans
128
Which blood tests are used to monitor haemochromatosis
Ferritin and transferrin saturation
129
RFs for neonatal sepsis
Prev baby with GBS disease
Low birth weight
Premature (<37wks)
Intrapartum temperature
Current GBS colonisation in the mother
130
What are axillary freckles indicative of?
NF1
131
What is an important investigation to do in Chagas disease and why?
Echo - cardiomyopathy is the most frequent and severe manifestation of Chagas disease
132
Diverticulitis + pneumaturia = ?
Colovesical fistula (between bladder and bowel), causing air bubbles in the urine.
Usually sigmoid colon
133
What is the first line medical management of Alzheimers
Donepezil - acetylcholinesterase inhibitor
Also galantamine or rivastigmine
134
What is the second line medical management of Alzheimers
Memantine - NMDA receptor antagonist
135
Treatment of severe hypocalcaemia
IV calcium gluconate - 10mls 10% over 10 mins
136
What size of breast lump is indication for mastectomy over WLE?
Over 4cm = mastectomy is preferred
137
What can be seen on joint XR in rickets
Widening of the joint space due to an excess of non-mineralised osteoid at the growth plate
138
IAP choice for GBS
IV Benzylpenicillin
139
Treatment for headlice - patient and family members
Malathion to the patient only - no need to treat asymptomatic household members
140
Investigation for suspected PROM if no fluid seen in posterior vaginal vault?
Test the fluid for IGF binding protein-1 or PAM-G
141
What is 1st and 2nd line for treating impetigo
If localised: 1% hydrogen peroxide, or topical fusidic acid if not responding to hydrogen peroxide.
If extensive disease: oral fluclox or erythromycin if allergic
142
What is included in the HIV test
Viral antibodies and antigen
143
What is the first line imaging in multiple myeloma
Full body MRI
144
What is the treatment for non-falciparum plasmodium
Chloroquine followed by primaquine to destroy the hypnozoites in the liver caused by ovale and vivax sp.
145
What might be seen on a blood film in DIC
Shistocytes due to microangiopathic haemolytic anaemia
146
Amyloidosis Px
Weakness and breathlessness in patients aged 50-65
Most commonly causes reduced renal function and proteinuria, as well as hepatosplenomegaly
147
What organism causes rheumatic fever
S pyogenes
148
Diagnostic criteria for rheumatic fever?
Recent streptococcal infection (must have)
Major:
Erythema marginatum (circular rash)
Polyarthritis
Chorea
Carditis and valvulitis
SC nodules
Minor:
Raised ESR/CRP
Pyrexia
Athralgia
Long PR interval
Need 2 major or 1 major and 2 minor criteria for diagnosis
149
Rheumatic fever mx
Oral penV and NSAID
150
What circumstances would make steroid tapering appropriate over immediate cessation
Recent repeated courses
Taking 40mg pred daily or more for more than a week
Over 3 weeks of treatment
151
What medication can be given for the prophylaxis of variceal bleeds in people with varices
Propranolol
152
Which muscles are affected in De Quervains Tenosynovitis
extensor pollicis brevis and abductor pollicis longus tendons
153
What are the 2 main features of CJD
Rapid onset dementia and myoclonus (may not be present at onset)
Caused by infectious, misfolded prion proteins that cause other proteins to become misfolded
154
What accounts for the majority of ocular complications in GCA
Anterior ischaemic optic neuropathy
155
What CSF findings are consistent with SAH
Xanthochromia (bilirubin) and normal or raised opening pressure, done at least 12 hours after onset of sx
156
Mx of perianal abscess in Crohn's disease
I+D followed by abx. If a tract (fistula) is identified, a draining seton might be used
157
What is the inheritance of Charcot Marie Tooth disease
AD
158
What is the most common cause of secondary hypertension
Primary hyperaldosteronism (Conn's)
159
What is the first line investigation for acromegaly
Serum IGF-1
160
What is seen on CT in NPH
Hydrocephalus with ventriculomegaly out of proportion to sulcal enlargement
161
What treatment is used for torsades des pointes
IV Mg Sulfate
162
Brain abscess tx
Broad spec abx, e.g. ceftriaxone and metronidazole
163
What do you give in patients on warfarin having emergency surgery (within 30 mins)? Within the next 6-8 hours?
Within 30mins: four-factor prothrombin complex concentrate
Can wait 6-8hrs: 5mg IV vit K
164
Which parameters are important to monitor is HSP
Urine dip for renal involvement
BP for hypertension
165
How do you diagnose G6PD deficiency? Why?
G6PD enzyme assay at time of presentation and 3 mos later - acute haemolysis means RBCs with least G6PD activity may have haemolysed and young RBCs might be compensating so gives false negative initially, need to retest when not in haemolysis
166
What testing is required prior to starting hydroxychloroquine
Fundoscopy and visual acuity - it can cause severe and permanent retinopathy
167
What can cause exudative pleural effusion (6)
Infection: pneumonia is most common, TB
Malignancy
Connective tissue disease
PE
Pancreatitis
Dressler's syndrome
168
What can cause transudative pleural effusion (4)
Heart failure
Hypoalbuminaemia: liver disease, nephrotic syndrome, malabsorption
Hypothyroidism
Meig's syndrome
169
Toxic multinodular goitre definitive mx?
Radioactive iodine therapy
170
What is the most common organism involved in osteomyelitis?
S. aureus, unless pt has sickle cell then is non-typhi Salmonella (sickle cella salmonella)
171
At what age should patients be investigated for secondary hypertension
Under the age of 40
172
Causes of secondary hypertension
Pheochromocytoma
RAS
Cushing's syndrome
Renal Cell Carcinoma
173
In which region of the adrenal gland is adrenaline/noradrenaline produced?
Medulla
174
In which region of the adrenal gland is aldosterone produced
Zona glomerulosa
175
In which region of the adrenal gland is cortisol produced
Zona fasciculata
176
In which region of the adrenal gland are androgens produced
Zona reticularis
177
Describe the anatomy of the adrenal gland
Medulla (middle)
(outside)
glomerulosa
fasciculata
reticularis
(inside)
GFR enter
178
MS: what is Uthoff phenomenon
Worsening of vision with increases in body temperature
179
MS: what is Lhermitte's sign
Paraesthesia in limbs on neck flexion
180
Which cells are affected in MS
Oligodendrocytes of the myelin sheath in the central nervous system
181
What infections can a charcoal swab detect
BV
TV
Candida
Group B strep
182
What does NAAT test for
Chlamydia and gonorrhoea
183
Causes of a red, painful eye
Acute angle closure glaucoma
Anterior uveitis
Scleritis
foreign body
Keratitis
Corneal abrasion
Chemical injury
184
What is the name of the criteria used to aid diagnosis of MS
McDonald
185
Definitive treatment for AACG
Laser iridotomy
186
Explain the pathophysiology of AACG
- Iris bulges forward and seals off the trabecular meshwork from anterior chamber
- This prevents aqueous humour from draining
- Intra-ocular pressure increases
- This exacerbates the angle closure, and places pressure on the optic nerve
