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#passmed 2022 > yhhhh > Flashcards

yhhhh Flashcards

1
Q

What is Beta-thalassaemia major caused by? (2 things)

A
  1. Absence of Beta chains
  2. On Chromosome 11
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2
Q

What are the CF of Beta-thalassaemia major? (2 things)

What age does it present at?

A
  1. Failure to thrive
  2. Hepatosplenomegaly

Presents in 1st year of life

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3
Q

What will the bloods of Beta-thalassaemia major say? (3 things)

A
  1. Microcytic anaemia
  2. Raised: HbA2 + HbF
  3. Absent: HbA
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4
Q

How do you manage Beta-thalassaemia major?

A

Blood transfusion

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5
Q

What is a complication of repeated transfusions in Beta-thalassaemia major management?

How do you overcome this?

A

Iron overload

Overcome by: Iron chelation agent = Deferiprone

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6
Q

What is Wilson’s disease?

A
  1. Rare inherited disorder
  2. Copper accumulates in liver + brain
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7
Q

What is the treatment of Wilson’s Disease?

A

Copper chelator: Trientine

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8
Q

What is Azathioprine?

What conditions is it used to treat? (3 things)

A

Immunosuppresant

Treats:

  1. RA
  2. UC
  3. Crohn’s
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9
Q

What are the side fx of Azathioprine? (2 things)

A
  1. Pancreatitis
  2. Bone marrow depression
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10
Q

What are the side fx of Amiodarone? (3 things)

A
  1. Thyroid dysfunction
  2. Pulmonary fibrosis
  3. Hepatic fibrosis
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11
Q

What are the ECG signs of HypERkalaemia? (3 things)

A
  1. Small / absent P waves
  2. Wide QRS complex
  3. Tall tented T wave
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12
Q

What are the ECG signs of HypOkalaemia? (4 things)

A
  1. Prolonged PR interval
  2. Long QT interval
  3. ST depression
  4. Small / inverted T wave

some nigga on passmed comments:

in HYPOkalaemia …
U have not Pot and no T but a long PR and a long QT

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13
Q

What nerve is clarted when pt can’t keep a piece of paper from slipping from between THUMB and INDEX?

What will they do to compensate for this nerve clartation? What is this called?

A

Ulnar nerve (deep branch)

Extra flexing da thumb: Froment’s sign

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14
Q

What is the Cavernous sinus?

A

Paired venous sinus in Sphenoid bone

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15
Q

Where does the Cavernous sinus run FROM and TO?

A

From: Superior Orbital Fissure (SOF)

To: Petrous Temporal Bone

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16
Q

What is Medial and Lateral to the Cavernous sinus? (2+1 things)

A

Medial:

  1. Pituitary Fossa
  2. Sphenoid sinus

Lateral: Temporal lobe

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17
Q

What are the components of the Lateral wall of the Cavernous sinus from top to bottom? (4 things)

A
  1. Oculmotor nerve (3)
  2. Trochlear nerve (4)
  3. Ophthalmic nerve (V1)
  4. Maxillary nerve (V2)
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18
Q

What are the contents of the Cavernous Sinus?

A
  1. Internal carotid artery
  2. Abducens nerve (6)
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19
Q

What is the blood supply of the Cavernous Sinus? (2 things)

A
  1. Ophthalmic vein
  2. Superficial cortical veins
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20
Q

Where does the Cavernous Sinus drain into?

Via what? (2 things)

A

IJV

via: Sup + Inf Petrosal sinuses

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21
Q

What are the 4 stages of sleep in order and their associated EEG waves?

A

N1, N2, N3, REM

Theta, Sleep spindles, Delta, Beta (The Sleep Doctor’s Brain)

* N = non-RM stage

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22
Q

If you have a spinal injury, what is the loss of pain distribution?

What phenomena explains this?

A

Loss of pain sensation on OPPOSITE side from anywhere BELOW injury site

Spinothalamic tract DECUSATES in spinal cord 1 level above where stimulus enters, and da tract travels UPWARDS

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23
Q

What is da most common cause of sudden cardiac death in the yutesdem?

A

Hypertrophic Obstructive CardioMyopathy (HOCM)

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24
Q

What is the inheritence pattern of Hypertrophic Obstructive CardioMyopathy (HOCM)?

What is it’s prevalence?

A

Autosomal dominant

1 in 500

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25
Q

What is the pathophysiology of Hypertrophic Obstructive CardioMyopathy (HOCM)? (3 steps)

A
  1. LV Hypertrophy
  2. Decreased compliance
  3. Decreased CO
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26
Q

What are the CF of Hypertrophic Obstructive CardioMyopathy (HOCM)? (5 things)

A
  1. Often asymptomatic
  2. Sudden death (bc ventricular arrythmias)
  3. Syncope (usually after exercise)
  4. SOB (worse on exertion)
  5. Angina
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27
Q

What tract would get clarted in an ANTERIOR spinal cord lesion?

What CF would you get?

A

Spinothalamic tract clarted

Loss of Pain + Temp + Crude Touch BELOW lesion

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28
Q

What tract would get clarted in an CENTRAL spinal cord lesion? (2 things)

What CF would you get? (2 things)

A
  1. Spinothalamic tracts
  2. Cervical cord
  3. Loss of Pain + Temp + Crude Touch CONTRALAT BELOW lesion
  4. Sensory + Motor deficits (more in upper limb tho)
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29
Q

What tract would get clarted in a DORSAL spinal cord lesion?

What CF would you get?

A

Posterior columns (aka Medial Leminiscal Pathway)

Loss of Fine touch, vibration, proprioception

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30
Q

What tract would get clarted in a TRANSVERSE spinal cord lesion?

What CF would you get?

A

All tracts clarted

AKA All motor + sensory pathways clarted

Bilateral sensory + motor clartation below lesion

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31
Q

What tract would get clarted in a HEMISECTION spinal cord lesion?

What CF would you get? (3 things)

A

Whole side clarted on one half

  1. IPSILAT Paralysis
  2. IPSILAT Loss of Vibration & Propriecpetion
  3. CONTRALAT Loss of Pain & Temp (bc decusating spinothalamic)
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32
Q

What vit deficiency can cause a spinal cord lesion?

A

B12 deficiency

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33
Q

What column is clarted first in vit 12 deficiency?

A

Dorsal columns

Then lateral columns

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34
Q

What channel does Digoxin inhibit?

A

Na+/K+ ATPase

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35
Q

What is Digoxin used to treat? (3 things)

A
  1. AF
  2. Atrial Flutter
  3. HF
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36
Q

How does Digoxin work when it inhibits da channel dat it inhibits? (5 steps)

A
  1. Inhibits Na+/K+ ATPase
  2. Increases IC Na
  3. Ca Influx in heart
  4. Increased contractility
  5. Increased CO
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37
Q

Apart from the Na+/K+ ATPase channel, what else does Digoxin inhibit?

A

AV Node (has vagomimetic fx on AV Node)

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38
Q

What are the vit K dependant clotting factors?

Which is first to drop in concentration when you have low vit K?

(aka in Coeliac disease –> vit K malabsorption)

A

2, 7, 9, 10

First to drop: 7

(ronaldo)

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39
Q

What are Type 1, 2, 3, 4 Hypersensitivity reactions?

A

Anaphylactic

Cell Bound

Immune Complex

Delayed hypersensitivity

(ACID)

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40
Q

What is the mechanism of a Type 1 Hypersensitivity (Anaphylactic) reaction?

What is an example?

A

Antigen reacts w IgE bound to Mast Cells

EE is top (1st) broadband lol, MASTer is number 1

e.g. Anaphylaxis / Asthma / Eczema / Hayfever

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41
Q

What is the mechanism of a Type 2 Hypersensitivity (Cell bound) reaction?

What is an example?

A

IgM / IgG binds to antigen on Cell surface

MG coz i am top 2 lol

e.g AI Haemolytic Anaemia / Pernicious Anaemia

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42
Q

What is the mechanism of a Type 3 Hypersensitivity (Immune complex) reaction?

What is an example?

A

Free antigen + antibody (IgG, IgA) combine

IgA like in GN immune complexes n dat

e.g Post-Strep GN

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43
Q

What is the mechanism of a Type 4 Hypersensitivity (Delayed Hypersensitivity) reaction?

What is an example?

A

T-cell mediated

T cells are always Delayed bc dey were having Tea

e.g TB

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44
Q

What artery is most likely to be damaged in a Submandibular removal surgery?

A

Facial Artery

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45
Q

What is Total Lung Capacity a measurement of?

A

Vital Capacity + Residual volume

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46
Q

What is Vital Capacity?

A

Max vol that can be expired after Max inspiration

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47
Q

What is the Residual volume?

A

Vol of air in lungs after Max Expiration

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48
Q

What happens to RBC in Sideroblastic anaemia? (2 steps)

A
  1. RBC can’t completely form Haem
  2. Leads to Iron deposition forming a ring around nucleus (Ring Sideroblast)
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49
Q

What are the causes of Sideroblastic anaemia? (3 things)

A
  1. TB meds: Isoniazid
  2. Lead poisoning
  3. Myelodysplasia (bone marrow cancer)
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50
Q

What are the Lab results for Sideroblastic anaemia? (3 things)

A
  1. Hypochromic Microcytic Anaemia (Pale + Low MCV)
  2. High Ferritin
  3. High Transferrin saturation
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51
Q

What happens to RBC in Haemolytic Anemia?

A

AI destruction

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52
Q

What are the Lab results for Haemolytic anaemia? (3 things)

A
  1. Normochromic + Normocytic Anaemia (Normal Colour + MCV)

Haemolysis products:

  1. High bilirubin
  2. High LDH
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53
Q

Who commonly has Iron deficiency anaemia?

A

Young menstruating women

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54
Q

What are the lab results in Iron deficiency anaemia? (3 things)

A
  1. Microcytic anaemia (Low MCV)
  2. Low Ferritin
  3. Low Transferrin saturation
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55
Q

Why is Megaloblastic anaemia called that?

A

Bone marrow produces large, immature RBCs (Megaloblasts)

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56
Q

What causes Megaloblastic anemia? (2 things)

A
  1. Vitamin B12 deficiency
  2. Folate deficiency
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57
Q

What are the Lab results in Megaloblastic anaemia? (2 things)

A
  1. Macrocytic anamia (High MCV)
  2. Low B12 / Folate
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58
Q

What is Pernicious anaemia?

A

AI condition causing low Intrinsic Factor

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59
Q

Where is Intrinsic Factor made?

What is it needed for?

A

Made in gastric Parietal cells

Needed for vit B12 absorption to help w EPO prod

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60
Q

Since Pernicious anaemia is an AI condition, who is more likely to have it?

A

Women

Esp if already have other AI condition (e.g T1DM)

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61
Q

What are the Lab findings for Pernicious anaemia? (3 things)

A
  1. Low Vit B12
  2. Raised MMA
  3. Parietal cell / Intrinsic Factor antibodies
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62
Q

What is a Common Cold caused by?

A

Rhinovirus

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63
Q

What is a Bronchiolitis caused by?

A

RSV

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64
Q

What is a Flu caused by?

A

Influenza

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65
Q

What is a Community-acquired Pneumonia caused by?

A

Strep pneumonia

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66
Q

What is Croup caused by?

A

Parainfluenza virus

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67
Q

What Microbiology techniques should you do for the following?

DNA

RNA

Protein

A

DNA: South blotting

RNA: Northern blotting

Protein: Wester blotting

S-NO-W

D-Ro-P

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68
Q

Which Abx inhibit Cell Wall synthesis? (3 things)

A
  1. Cephalosporins
  2. Glyocpeptides (e.g Vancomycin)
  3. Penicillins

CGP books stop from making a brain Wall to knowledge lol

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69
Q

Which Abx inhibit Protein synthesis, by acting on the 50S ribosome subunit? (2 things)

A
  1. Macrolides
  2. Clindamycin

50cent j hus came wid da MAC

j hus loves linda

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70
Q

Which Abx inhibit Protein synthesis, by acting on the 30S ribosome subunit? (2 things)

A
  1. Aminoglycosides (e.g Gentamicin) (uk dis one)
  2. Tetracyclines (e.g Doxycycline) (remember greg simons gave it to dat nigga)
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71
Q

Which Abx inhibit DNA synthesis? (2 things)

A

Quinolones (e.g. Ciprofloxacin)

Quiche n Crypto in my DNA

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72
Q

Which Abx damages DNA?

A

Metronidazole

Metro train runs over da DNA

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73
Q

Which Abx inhibits Folic acid synthesis? (2 things)

A
  1. Sulphonamides
  2. Trimethoprim

sulphur cah sulfuric ACID, n get an acidic trimothy

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74
Q

Which Abx inhibits RNA synthesis?

A

Rifampicin

R n R

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75
Q

What does the Musculocutaneous nerve innervate? (3 things)

A
  1. Biceps brachii
  2. Coracobrachialis
  3. Brachialis
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76
Q

What is Troponin?

A

Compex of 3 proteins involved in Skeletal + Cardiac muscle contraction

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77
Q

What do the 3 proteins of Troponin bind to?

A

Troponin C: Calcium ions

Troponin T: Tropomyosin –> Troponin-Tropomyosin complex

Troponin I: ActIn –> Holds Troponin-Tropomyosin complex in place

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78
Q

Which cells in the Duodenum release CCK?

A

I cells

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79
Q

What does CCK do? (4 things)

A
  1. Gallbladder: Contraction
  2. Pancreas: Stimulates Exocrine Pancreas
  3. Stomach: Delays gastric emptying (relaxes stomach)
  4. Satiety: Induces satiety (vagal stimulation)

GPSS

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80
Q

What medication can you give to reduce inflamm in RA?

What is its MOA?

A

Rituximab

Anti-CD20 Monoclonal Antibody

-mab = Monoclonal AntiBody

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81
Q

Where is Bilirubin turned from Unconjugated to Conjugated?

A

Liver

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82
Q

What arrythmia is Atrial Flutter a subtype of?

A

SVT

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83
Q

What is a risk factor for Atrial Flutter?

A

Valvular HD

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84
Q

How is Atrial Flutter treated?

A

Like AF:

  • Anticoag + Amiodarone
  • Beta blocker
  • Calcium channel blocker
  • Digoxin
  • Electrocardioversion

ABCDE

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85
Q

How would a LBBB present in a ECG?

A

W pattern in V1

M pattern in V6

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86
Q

What would a LBBB lead to?

A

Delayed contraction of L ventricle

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87
Q

What will you see in Colonoscopy if there is severe mucosal ulceration in UC?

A

Pseudopolyps

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88
Q

What is the drainage of the Ovarian vessels + Uterine fundus?

What is the significance of this?

A

Para-aortic lymph nodes

Endometrial cancer in uterine fundus will spread to these lymph nodes

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89
Q

What is the drainage of the Uterus body?

A

External iliac lymph nodes

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90
Q

What is the drainage of the Cervix? (3 things)

A
  1. External + Internal Iliac nodes
  2. Presacral nodes
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91
Q

What stimulates satiety?

What stimulates hunger?

A

Leptin

Ghrelin

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92
Q

What is Pramipexole and what is it used for?

A

Dopamine agonist, used in Parkinsons to reduce L Dopa dose

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93
Q

What is a side fx of Pramipexole?

A

Addictive behaviours (gambling / hypersexuality)

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94
Q

What is the most important drug to give in Anaphylaxis?

A

IM Adrenaline

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95
Q

What are the CF of Clostridium difficile? (2 things)

A
  1. Abd pain
  2. Diarrhoea
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96
Q

What causes Clostridium difficile?

A

Clartation of normal gut flora by Abx

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97
Q

What Abx causes Clostridium difficile?

A

Cephalosporins (e.g Ceftriaxone)

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98
Q

Other than abx, what can also cause Clostridium difficile?

A

PPI

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99
Q

What Abx is FIRST line for Clostridium difficile?

A

Vancomycin

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100
Q

What is Niacin (aka Nicotinic acid) used for?

A

Hyperlipidaemia (aka high cholesterol) patients

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101
Q

How does Niacin (aka Nicotinic acid) work? (3 things)

A
  1. Lowers cholesterol levels
  2. Lowers triglyceride levels
  3. Raised HDL levels
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102
Q

What are the side fx of Niacin (aka Nictonic acid)?

A
  1. Flushing (bc prostaglandins)
  2. Impaired glucose tolerance (insulin resistance)
  3. Myositis (painful muscles)
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103
Q

When are Lymphocytes raised? (2 things)

A
  1. Chronic inflamm
  2. Acute viral inf
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104
Q

When are Eosinophils raised? (2 things)

A
  1. Allergy
  2. Parasitic infection
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105
Q

What is the most common cause of Cellulilitis (aka Soft tissue infection) in IV drug users?

A

Staph aureus

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106
Q

What is the most common cause of Cellulilitis (aka Soft tissue infection) in NON IV drug users?

A

Streptococcus pyogenes

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107
Q

What are the features of Staph aureus?

A
  1. Gram POSITIVE
  2. Catalase POSITIVE
  3. Oxidase NEGATIVE
  4. Beta haemolytic
  5. Bacilli
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108
Q

What are the CF of Cellulitis? (3 things)

A
  1. Erythema + pain + swelling
  2. Commonly on shins
  3. Fever
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109
Q

What is the treatment for Mild / moderate Cellulitis?

A

Flucloxacillin (type of penicillin)

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110
Q

What is the treatment for Mild / moderate Cellulitis if the pt has a penicillin allergy? (2 things)

A
  1. Clarithromycin
  2. Doxycline
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111
Q

What is the treatment for Mild / moderate Cellulitis if the pt has a penicillin allergy and is pregnant?

A

Erythromycin

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112
Q

What is the treatment for Severe Cellulitis?

A

Co-amoxiclav

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113
Q

What are the causes of Hypercalcaemia?

A

CHIMPANZEES

C alcium supplementation
H yperparathyroidism
I atrogentic (Drugs: Thiazides)
M ilk Alkali syndrome
P aget disease of the bone
A cromegaly + Addison’s Disease
N eoplasia
Z olinger-Ellison Syndrome (MEN Type I)
E xcessive Vitamin D
E xcessive Vitamin A
S arcoidosis

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114
Q

How would a Posterior Cerebral Stroke present in the eyes?

A

Contralateral homonymous hemianopia w Macular sparing

(8 on pic)

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115
Q

What is Lidocaine?

What is it used for? (3 things)

A

Local anesthetic (main function) + Antiarrhythmic drug

  1. Haematoma block (to allow painless # reduction)
  2. Ventricular arrhythmias
  3. Premature ejac
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116
Q

What are the side fx of Lidocaine? (4 things)

A
  1. Change in mental status
  2. Low seizure threshold
  3. HTN
  4. Constipation
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117
Q

What is the fractions of blood supply to the liver?

A

Hepatic Portal Vein: 2/3

Hepatic artery: 1/3

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118
Q

What is the Hepatic Portal Vein supplied by? (3 things)

A
  1. Sup + Inf Mesenteric veins
  2. Splenic Vein
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119
Q

What is the function of Gluteus Medius n Minimus?

A

ABducts

3abs cah der not da Max lol

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120
Q

What is the function of Gluteus Maximus?

A

External rotation

Extension

mAximum EXtension EXternal XXX

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121
Q

What causes Macrocytic Anaemia?

A

Macro aka FAT rbc’s so its:

F - Folate (b9) n b12 deficiency

A - Alcohol

T - hypoThyroidism

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122
Q

How does Phenytoin (anti-epileptic) cause Macrocytic anaemia?

A

Phenytoin = AntiFolate (aka b9)

Macrocytic anaemia (FAT rbc’s)

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123
Q

What does Epstein-Barr Virus cause?

A

Glandular fever (sore throat + fever)

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124
Q

What does Human papillomavirus (HPV) cause?

A

Gynaecological malignancy

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125
Q

What is Ramsey Hunt syndrome?

A

Reactivation of Varcella Zoster virus @ geniculate ganglion of CN 7

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126
Q

What are the CF of Ramsey Hunt syndrome? (4 things)

A
  1. Ear pain (1st feature)
  2. Facial nerve palsy
  3. Ear rash
  4. Vertigo + Tinnitus
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127
Q

How do you manage Ramsey Hunt syndrome? (2 things)

A
  1. Aciclovir
  2. Corticosteroids
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128
Q

What are the post-MI complications? (11 things)

A
  1. Cardiac arrest
  2. Cardiogenic shock
  3. Chronic HF
  4. Tachyarrhythmias
  5. Bradyarrhythmias
  6. Pericarditis
  7. Dresslers Syndrome
  8. LV aneursym
  9. LV free wall rupture
  10. Ventricular septal defect
  11. Acute Mitral regurg

Carl Couldn’t Connect The Bt Password,

David Loves Lying Verbally Always

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129
Q

What’s the most common cause of death Post-MI?

A

Cardiac arrest, pt develops VF

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130
Q

How does MI cause Cardiogenic shock? (4 steps)

A
  1. Infarcation
  2. Damages Ventricular Myocardium
  3. Reduced EF
  4. Cardiogenic shock
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131
Q

What’s the treatment for Cardiogenic shock? (2 things)

A
  1. Inotropic support
  2. Intra-aortic balloon pump
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132
Q

How does MI cause Chronic HF? (3 steps)

A
  1. Infarction
  2. Damages Ventricular Mycoardium
  3. Chronic HF
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133
Q

What is the treatment for Chronic HF? (3 things)

A
  1. ACEi
  2. Beta blockers
  3. Spironolactone (reduce fluid overload)

ABS for HF

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134
Q

What Tachyarrhythmias can you develop post-MI? (2 things)

A
  1. VF
  2. VT
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135
Q

What is the most common Bradyarrhythmias post-MI?

Which MI in particular?

A

Atrioventricular block

Common after INFERIOR MI

(makes sense bc bottom of heart, atrioventricular kinda bottom or middle wtever)

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136
Q

What’s the time frame for Pericarditis occuring post-MI?

A

48 hours after a Transmural MI (in 10% of pt)

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137
Q

When is the pain in Pericarditis worse?

A

@ lying flat

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138
Q

What can you hear in Pericarditis?

A

Pericardial rub

(scratching / rubbing sound like leather on leather sound)

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139
Q

What will you see on an Echo of Perciarditis?

A

Perciardial effusion

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140
Q

What is Dresslers Syndrome? (2 things)

A
  1. Type of pericarditis
  2. Post-MI complication
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141
Q

What is the time frame for Dresslers syndrome to happen post-MI?

A

2-6 weeks after

(compared to Pericarditis which is 48 hours)

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142
Q

What is the pathophysiology of Dresslers syndrome?

A

AI reaction vs antigenic proteins forming as Myocardium recovers after an MI

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143
Q

What are the CF of Dresslers Syndrome? (4 things)

A
  1. Fever
  2. Pleuritic chest pain
  3. Pericardial Effusion
  4. Raised ESR
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144
Q

What is the treatment for Dresslers Syndrome?

A

NSAIDs

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145
Q

How does an MI cause LV aneursym? (3 steps)

A
  1. Ischaemic damage
  2. Weakened myocardium
  3. Aneursym
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146
Q

How do you see a LV aneursym on a ECG?

A

Persistent ST elevation (2+ weeks after MI)

Mainly seen in precordial leads (V leads)

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147
Q

What does LV aneursym increase the risk of and how?

How do you prevent this?

A

Stroke bc thrombus can form in aneursym

Prevent by taking anticoag.

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148
Q

What is the time frame for a LV free wall rupture happening post-MI?

A

1-2 weeks post-MI

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149
Q

How does a LV free wall rupture present?

A

Acute HF secondary to Cardiac Tamponade

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150
Q

What are the CF of cardiac tamponade? (3 things)

A
  1. Raised JVP
  2. Pulsus paradoxus (drop in systolic BP by 10+ @ inspiration)
  3. Diminished heart sounds
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151
Q

What is the treatment for LV free wall rupture? (2 things)

A
  1. Pericardiocentesis (drain fluid in pericardium)
  2. Thoracotomy (access to thoracic organs)
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152
Q

What is the time frame for a Ventricular Septal Defect to happen post-MI?

A

1st week after MI

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153
Q

What are the CF of a Ventricular Septal Defect? (2 things)

A
  1. Acute HF
  2. Pansystolic murmur
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154
Q

What investigation should you do for Ventricular Septal Defect and why?

A

Echo, to exclude Mitral regurg

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155
Q

What is the treatment for Ventricular Septal Defect?

A

Surgical correction

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156
Q

What MI is Acute Mitral regurg most common to occur after?

A

Infero-post MI

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157
Q

How can a MI cause an acute Mitral Regurg?

A

Ischaemia / papilllary muscle rupture

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158
Q

What are the CF of acute Mitral regurg? (2 things)

A
  1. Pulm oedema
  2. Early-mid systolic murmur

Remember widad said ASMR is systolic murmurs

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159
Q

What is the treatment for Acute Mitral Regurg? (2 things)

A
  1. Vasodilator therapy
  2. Surgical repair
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160
Q

What are the CF of Cystic Fibrosis? (4 things)

A
  1. Newborn: Meconium ileus (bowel obst)
  2. Recurrent chest infections
  3. Failure to thrive (bc malabs)
  4. Steatorrhoea (bc malabs)
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161
Q

What are the complications of Cystic Fibrosis? (4 things)

A
  1. DM
  2. Short stature
  3. Delayed puberty
  4. Infertility (total in male, subfertility in female)
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162
Q

How do you calculate CO?

A

CO = stroke volume x HR

Stroke volume = end diastolic volume - end systolic volume

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163
Q

What is the MOA of Heparin?

A

Activates antithrombin 3

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164
Q

What is the MOA of Dabigatran?

A

Direct Thrombin inhibitor

dabigaTran

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165
Q

What is the MOA of Rivaroxaban?

A

Direct factor X inhibitor

rivaroXaban

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166
Q

What CN mediate the cough reflex?

A

9 + 10

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167
Q

What CN are afferent and efferent in gag reflex?

A

Afferent: 9

Efferent: 10

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168
Q

In the Circle of Willis, what anatomical locaiton do the Vertebral arteries unite at to form the Basilar arteries?

A

Base of pons

(pontine arteries from basilar artery is literally da pons area lol)

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169
Q

What valve disease is a S4 sound associated with?

A

Aortic stenosis

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170
Q

We said both AS and MR are systolic murmurs, but how do you differentiate between them?

A

AS = EJECTION systolic murmur

MR = Pan-systolic murmur

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171
Q

How does a PE present on a ECG? (2 things)

A
  1. Sinus tachycardia
  2. T wave inversion in ant leads
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172
Q

What is the preventative measure for PE if everything else fails?

A

Inf Vena Cava filter

(IVC is retroperitoneal btw)

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173
Q

What is Pernicious anaemia pathophys?

A
  1. AI clartation of Intrinsic factor + Parietal cells
  2. Intrinsic factor needed for B12 from intestines

Pernicious cells n Parietal

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174
Q

What can a kidney infection UTI (aka pyelonephritis) lead to an infection in as well?

A

Psoas muscle

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175
Q

What is Gilberts Syndrome? (2 things)

A
  1. Autosomal recessive conditin
  2. Defective bilirubin conjugation
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176
Q

What are the CF of Gilberts Syndrome?

A
  1. Unconjugated hyperbilirubinaemia
  2. Jaundice (in times of stress)
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177
Q

What investigations can you do for Gilberts Syndrome?

A

Rise in bilirubin @: prolonged fasting / IV nicotinic acid

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178
Q

What is the treatment for Gilberts Syndrome?

A

No treatment required

Widad said its a dumb disease, its so mild

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179
Q

What artery supplies the prostate gland?

A

Inferior vesical artery

(branch of internal iliac artery)

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180
Q

What is the Epiploic foramen, and what are its borders?

A

Passage between Greater + Lesser Sac

Borders:

  • Ant: R: Common bile duct / Behind: Portal vein / L: Hepatic artery
  • Post: IVC
  • Superior: Liver (caudate process)
  • Inf: Duodenum
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181
Q

What is the clinical (surgical) significance of the Epiploic foramen?

A

Pringles manoeuvre: clamping Anterior aspect of epiploic foramen

Therefore occluding:

  1. Common bile duct
  2. Portal vein
  3. Hepatic artery

Done in Liver surgery bleeding

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182
Q

What level of Bilirubin do you need to start experiencing Jaundice?

A

35+

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183
Q

What is the sentinel (aka first) lymph node of the gall bladder?

A

Lund’s node (aka cystic lymph node)

cah remember choloCYSTitis n dat lol

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184
Q

What lymph nodes drain the large intestine?

A

Mesenteric lymph nodes

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185
Q

What are the lymphoid follicles around the ileum?

A

Peyers patches

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186
Q

What is Sarcoidosis?

A

Growth of inflamm cells (granulomas) anywer in body but mainly:

  • Lungs
  • Lymph nodes (bilateral hilar enlargement)
  • Eyes (red eye)
  • Skin (erythema nodosum = painful shin nodules)
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187
Q

Who gets Sarcoidosis more?

A

woman niggas

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188
Q

What things would be elevated in bloods in Sarcoidosis?

A
  1. ACE levels
  2. Calcium
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189
Q

What is the treatment for Sarcoidosis?

A

Steroids (prednisolone)

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190
Q

Where in the brain is the respiratory centre located?

A

Brainstem

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191
Q

What are the contents of the Superior Mediastinum? (11 things)

A
  1. Longus choli muscles
  2. Esophagus
  3. Trachea
  4. Vagus nerve
  5. Phrenic nerve
  6. Left recurrent laryngeal nerve
  7. SVC = Right + Left Brachiocephalic Veins, L = Thoracic Duct
  8. Arch of Aorta = Left Subclavian Artery + Left Common Carotid Artery + Brachiocephalic Trunk
  9. Thymus
  10. Sternohyoid muscle
  11. Sternothyroid muscle

LET VPL …

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192
Q

What are the contents of the Posterior Mediastinum? (8 things)

A
  1. Thoracic duct
  2. Esophagus
  3. Descending Aorta
  4. Splanchnic nerves
  5. Azygous vein
  6. Hemiazygous vein
  7. Accessory hemiazygous veini
  8. Vagus nerve

TED SAHAV

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193
Q

What are the contents of the Middle Mediastinum? (6 things)

A
  1. Heart
  2. Aortic Root
  3. Main bronchi
  4. Pericardium
  5. Arch of azygous vein

HAMPA

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194
Q

What are the contents of the Anterior Mediastinum? (3 things)

A
  1. Thymic remnants
  2. Lymph nodes
  3. Fat

TLF

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195
Q

What are all the instrinsic muscles of larynx innervated by?

What is the exception?

A

Recurrent laryngeal nerve

CricoThyroid - innervated by Superior External Laryngeal Nerve

remember dis from ur pharyngeal arches table innit

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196
Q

At what level does the Inf Vena Cava cross the diaphragm?

A

T8

(8 letters in Vena Cava)

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197
Q

At what level does the Oesophagus cross the diaphragm?

A

T10

10 letters in Oesophagus

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198
Q

At what level does the Vagus Nerve cross the diaphragm?

A

T10

Vagus nerve is CN 10

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199
Q

At what level does the Thoracic Duct + Abdominal Aorta cross the diaphragm?

A

T12

12 letters in Thoracid Duct

n Abdominal Aorta is only one left over wid it

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200
Q

What Paraneoplastic syndrome is most associated with Squamous cell carcinoma?

A

PTH related protein

da calcium one innit

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201
Q

What is Ankylosing spondylitis?

A

A Spondyloarthropathy

aka arthritis that also affects spine

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202
Q

What antigen is associated with Ankylosing spondylitis?

A

HLA-B27

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203
Q

Who is your common Ankylosing spondylitis pt?

A

Males aged 20-30 yrs old

aka footballers

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204
Q

What are the CF of Ankylosing spondylitis? (3 + 4)

A

Spinal:

  1. Back stiffness (worse in morning, better @ excercise)
  2. Reduced forward flexion
  3. Reduced chest expansion (bc fused spine) (late)

Extra atricular: 4 A’s

  1. Anterior uveitis
  2. Aortic regurg
  3. Apical fibrosis
  4. Achilles tendonitis
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205
Q

Why is Ankylosing spondylitis also called Bamboo spine?

A

Cah Ankylosing means fusing, n da spine fuses together into one long bamboo stick

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206
Q

What are the management options for Ankylosing spondylitis? (3 things)

A
  1. NSAIDs (pain)
  2. Steroids (inflamm)
  3. Anti-TNF meds (immunosuppresant cah isa AI condition)
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207
Q

Where in the kidney does most water absorption happen?

A

PCT (70%)

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208
Q

What are the side fx (aka contraindications) of Thiazide diuretics? (6 things)

A
  1. Hyponatraemia + Hypokalaemia + Hypercalcaemia
  2. Impaired glucose tolerance (–> DM)
  3. Dehydration
  4. Postural hypotension
  5. Impotence
  6. Gout

HID PIG

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209
Q

What are the nerve roots of the Musculocutaneous nerve?

A

C: 5,6,7

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210
Q

What are the nerve roots of the Axillary nerve?

A

C: 5,6

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211
Q

What are the nerve roots of the Radial nerve?

A

C: 5,6,7,8

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212
Q

What are the nerve roots of the Median nerve?

A

C: 6, 8 + T1

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213
Q

What are the nerve roots of the Ulnar nerve?

A

C8, T1

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214
Q

What is the tumour marker for Ovarian cancer?

A

CA125

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215
Q

What medication is given to reduce the size of the Prostate in prostate cancer?

What is its MOA?

A

Finasteride

MOA: 5-alpha reductase inhibitor: Converts testosterone into DHT –> reduces prostate size

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216
Q

What pneumonia organism should be suspected when multiple people contract pneumonia in an air conditioned space?

A

Legionella pneumophila

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217
Q

What is commonly seen in Legionella pneumophilia? (2 things)

A
  1. Hyponatraemia
  2. Lymphopenia (low lymphocytes)
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218
Q

What pneumonia organism should be suspected in acoholics?

A

Klebsiella pneumoniae

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219
Q

What pneumonia organism should be suspected in patients w COPD?

A

H influenzae

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220
Q

What pneumonia organism should be suspected in patients after an influenza infection?

A

Staph aureus

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221
Q

What pneumonia organism should be suspected in patients with a DRY cough and atypical chest signs / CXR?

A

Mycoplasma pneumoniae

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222
Q

What is sometimes seen with Mycoplasma pneumoniae? (2 things)

A
  1. AI haemolytic anaemia
  2. Erythema (skin redness)
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223
Q

What pneumonia organism should be suspected in patients with a DRY cough and atypical chest signs and CXR?

A
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224
Q

What pneumonia organism should be suspected in patients with HIV?

A

Pneumocystis jiroveci

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225
Q

What is sometimes seen with Pneumocystis jiroveci pneumonia? (3 things)

A
  1. Dry cough
  2. Exercise induced desaturations
  3. X chest signs
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226
Q

What are some complications of Diverticulitis? (2 things)

A
  1. Perforation + Faecal peritonitis (Hinchey 4)
  2. Colovesical Fistula
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227
Q

How would a patient with a Colovesical fistula as a result of Diverticulitis present? (2 things)

A
  1. Urinary sepsis
  2. Pneumaturia (bubbles in urine)
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228
Q

What is the CF of Vit A deficiency? (seen in Coeliac disease)

A

Night blindness

vit A is also called Retinol, n is converted into Retinal, aka eye involvement lol

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229
Q

What is the medication for Anaphylaxis?

What is its MOA?

A

Adrenaline

Causes vasoconstriction (by acting on Alpha-adrenergic receptors)

Bc Anaphylactic shock causes: Vasodilation + Increased vasc perm

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230
Q

What are the 2 most common Valve dysfunctions 2ndary to HF?

A

MR + TR

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231
Q

How would a leg present in an ANT vs POST hip dislocation?

A

ANT: Ext rot

POST: Int rot

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232
Q

What are the borders of the Femoral Triangle?

A
  1. Sartorius
  2. Adductor longus
  3. Inguinal ligament
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233
Q

What anticoag medication is a Direct factor Xa inhibitor?

A

Rivaroxaban

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234
Q

What anticoag medication directly inhibits Thrombin?

A

Dabigatran

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235
Q

What are the Afferent n Efferent nerves for the Lacrimation reflex?

A

Aff: Ophthalmic nerve (V1)

Eff: CN 7

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236
Q

What are the Afferent n Efferent nerves for the Corneal reflex?

A

Aff: Nasociliary branch of Opthalmic N (CN V1)

Eff: CN 7

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237
Q

What are the Afferent n Efferent nerves for the Gag reflex?

A

Aff: CN 9

Eff: CN 10

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238
Q

What are the Afferent n Efferent nerves for the Carotid sinus reflex?

A

Aff: CN 9

Eff: CN 10

(same as gag reflex)

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239
Q

What is the most abundant antibody in blood?

A

IgG

hes a G

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240
Q

What does NICE guidelines say about ppl on Warfarin with INR 5-8 but NO bleeding? (2 things)

A
  1. Withhold 1 or 2 Warfarin doses
  2. Reduce Maintenance Dose
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241
Q

What does NICE guidelines say about ppl on Warfarin with INR 5-8 with Minor bleeding? (2 things)

A
  1. Stop Warfarin + IV Vit K
  2. Restart Warfarin @ INR 5
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242
Q

What does NICE guidelines say about ppl on Warfarin with INR 8+ with NO bleeding? (3 things)

A
  1. Stop Warfarin
  2. Oral Vit K
  3. Restart Warfarin @ INR 5
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243
Q

What does NICE guidelines say about ppl on Warfarin with INR 8+ with Minor bleeding? (3 things)

A
  1. Stop Warfarin
  2. IV Vit K
  3. Restart Warfarin @ INR 5
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244
Q

What does NICE guidelines say about ppl on Warfarin with MAJOR bleeding, regardless of INR? (4 things)

A
  1. Stop Warfarin
  2. IV Vit K
  3. IV Prothrombin Complex Concentrate / FFP
  4. Restart Warfarin @ INR 5
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245
Q

Can Warfarin be used in breast feeding?

A

Yes

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246
Q

What are the causes of Hyperkalaemia? (7 things)

A
  1. Meds (SAN: Spironolactone / ACEi / NSAIDs)
  2. Acidosis (Met + Resp)
  3. Cellular destruction (Burns)
  4. Hypoaldosteronism (Addisons) / Haemolysis
  5. Intake (Excessive)
  6. Nephrons aka AKI
  7. Excretion impaired

MACHINE

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247
Q

Name 3 Enzyme inducers?

A
  1. Rifampicin
  2. Phenytoin (anti epileptic)
  3. Carbamazepine (anti epileptic)
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248
Q

Name 3 Enzyme inhibitors? (6 things)

A
  1. Isoniazid
  2. Omeprazole
  3. Abx: Ciprofloxacin / Erythromycin
  4. Amiodarone (anti-arrhytmhic chemical cardioversion)
  5. SSRIs (fluoxetine / Sertraline) (dey depress da enzyme lol)
  6. Sodium valproate (anti-epileptic)

IOAASS

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249
Q

What are the cardiac complications of Hyperthyroidism? (2 things)

A
  1. High Output Cardiac Failure
  2. AF
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250
Q

What are RED flags in back pain?

A
  1. Thoracic back pain (T1 - T12 levels)
  2. Keeps up at night

Most likely MSCC (Metastatic Spinal Cord Compression)

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251
Q

What NSAID is CI in CVS disease?

A

Diclofenac

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252
Q

What are the differentials for someone w Erythema nodosum? (3 things)

A
  1. Crohn’s
  2. TB
  3. Sarcoidosis
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253
Q

What is a neuro complication of DM?

What are its CF?

A

Autonomic neuropathy

Triad:

  1. Postural hypotension
  2. Loss of resp arrhytmias (aka breathing doesnt control HR)
  3. Erectile dysfunction
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254
Q

In cardiac arrest, what is a “non shockable” rhythm?

A

Pulseless-electrical activity (PEA)

aka ECG shows stuff but u cant feel pulse or hear breath sounds

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255
Q

What should you do in a “non-shockable” cardiac arrest?

A

Chest compressions 30:2 rescue breaths

Then adrenaline

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256
Q

What is the criteria for Severe asthma attack? (4 things)

A
  1. PEFR 33-50%
  2. Cant complete sentences
  3. RR 25+
  4. HR 110+
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257
Q

What is the criteria for a Life threatening asthma attack? (8 things)

A
  1. 33: PEFR below 33%
  2. 92: Sats below 92
  3. Cyanosis
  4. Hypotension
  5. Exhaustion / confusion
  6. Silent chest
  7. Tachycardia
  8. NORMAL PCO2

maryam said 33-92-CHEST

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258
Q

Why is normal PCO2 a sign of life threatening asthma attack?

A

Bc High RR in asthma attack should lower pCO2 but its not working

If pCO2 is high… near-fatal asthma attack

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259
Q

What are the NICE guidelines for COPD management?

A
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260
Q

Who should be given a rescue pack in COPD?

What is in this rescue pack?

A

Frequent exacerbations

Prednisolone + Abx (amoxicillin)

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261
Q

When should a COPD pt with a rescue pack take the Abx in their rescue pack?

A

If they coughing up purulent sputum

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262
Q

What organism causes Acute epididymo-orchitis?

A

Chlamydia trachomatis

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263
Q

Bronchial + Hypopharyngeal Secretions is common in last few days of life.

What palliative treatment can you give to treat this?

A

Hyoscine hydrobromide (antimuscarinic)

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264
Q

What are Alpha blockers mainly used for? (2 things)

A
  1. HTN
  2. BPH
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265
Q

What are the side fx of Alpha blockers? (4 things)

A
  1. Postural hypotension
  2. Drowsiness
  3. SOB
  4. Cough
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266
Q

What are the ECG findings for a PE? (4 things)

A
  1. Sinus tachycardia
  2. RBBB
  3. Right axis deviation
  4. S1Q3T3 (aka large S in lead 1, large Q in lead 3, inverted T wave in lead 3) (only in 20%)
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267
Q

What should you give to a Crohns pt w a Perianal fistula?

A

Oral metronidazole (abx)

to stop it from getting infected

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268
Q

What is the 1st line for Abx for tonsilittis nigga?

A

Phenoxymethylpenicillin for 10 days

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269
Q

If a stroke pt is already on warfarin, wts your next step?

A

Urgent CT head scan

Bc Stroke can be either: Haemorrhagic or Thrombotic, so you need to see which one it is b4 giving Aspirin 300mg, cah der already on blood thinners

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270
Q

What is the treatment for Restless Leg Syndrome?

(uncontrollable urge to move legs esp at night)

A

Ropinirole (dopamine agonist)

R n R

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271
Q

Why is Digoxin dangerous in AKI?

A

Can build up bc not cleared by kidney so is toxic in large amounts

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272
Q

What is a marker of POOR prognosis in RA?

A

Anti-CCP antibodies

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273
Q

What HTN meds should be stopped in AKI?

A

ACEi

Bc dey worsen renal function

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274
Q

What meds are CI in AKI? (3 things)

A
  1. Diuretics
  2. ACEi
  3. NSAIDs

DAN

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275
Q

What is the 1st line SSRI for children and adoloscents?

A

Fluoxetine

FluoxeTEENS lol

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276
Q

What is the 1st line investigation for Angina (stable chest pain of sus CAD aetiology)?

A

Contrast-enhanced CT coronary angiogram

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277
Q

Before doing a PCI in a STEMI pt, what should you give a pt?

How does this change if they are already on an anticoag?

A

Aspirin + Prasugrel

(dual antiplatelet therapy)

If already on anticaog: Aspirin + Clopidogrel

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278
Q

What is a shoulder complication in 20% of Diabetics?

A

Frozen shoulder aka Adhesive Capsulitis

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279
Q

What movement is clarted in Frozen shoulder aka Adhesive Capsulitis?

How long does this episode last?

A

Ext rot clarted

Lasts 6 months - 2 yrs

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280
Q

What is the Tx for Frozen shoulder aka Adhesive Capsulitis? (3 things)

A
  1. NSAIDs
  2. Physio
  3. Oral / intra-articular corticosteroids
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281
Q

What are the side fx of Phenytoin? (3 things)

A
  1. Gingival hyperplasia (fat gums)
  2. Hirsutism
  3. Coarsening of facial features
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282
Q

What meds cause gingival hyperplasia (fat gums)? (3 things)

A
  1. Phenytoin
  2. Ca channel blockers (esp nifedipine)
  3. Ciclosporin (immunosupressant)
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283
Q

What are the CF of Digoxin toxicity? (5 things)

A
  1. Confusion
  2. Yellow green vision
  3. N+V
  4. Gynaecomastia
  5. Arrhythmias (AV Block / Bradycardia)
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284
Q

What can cause Digoxin toxicity? (2 things)

A
  1. Thiazides aka (Bendroflumethiazide) (interact w digoxin directly)
  2. Hypokalaemia (so any diuretics)
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285
Q

What are the complications of Blood transfusions? (9 things)

A
  1. Acute Haemolytic
  2. Non-Haemolytic febrile
  3. Allergic / Anaphylaxis
  4. Infective
  5. Transfusion-related acute lung injury (TRALI)
  6. Transfusion-associated circulatory overload (TACO)
  7. Hyperkalaemia
  8. Iron overload
  9. Clotting

ANA ITT-HIC

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286
Q

When do you get a Acute Haemolytic Reaction in blood transfusion?

A

Incomplatible blood (human error)

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287
Q

What are the CF of an Acute Haemolytic Reaction in blood transfusion? (3 things)

A
  1. Fever
  2. Hypotension
  3. Abdominal pain
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288
Q

What is the management for an Acute Haemolytic Reaction in blood transfusion? (2 things)

A
  1. Coombs test (confirms haemolytic anaemia Dx)
  2. Fluid resus

Widad said coombs test is wen u think u given da wrong blood type

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289
Q

When do you get a Non-haemolytic febrile reaction in blood transfusion?

A

Antibodies reacting w WBC + Cytokines in blood product @ storage

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290
Q

What are the CF of a Non-haemolytic febrile reaction in blood transfusion?

A

Fever + chills

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291
Q

What is the management of a Non-haemolytic febrile reaction in blood transfusion?

A

Paracetamol

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292
Q

When do you get a Anaphylaxis reaction in blood transfusion?

A

IgA deficiency

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293
Q

What are the CF of an Anaphylaxis reaction in blood transfusion? (4 things)

A
  1. SOB
  2. Wheezing
  3. Hypotension
  4. Angioedema
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5
Perfectly
294
Q

What is the management of an Anaphylaxis reaction in blood transfusion?

A

Adrenaline

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295
Q

When do you get a Transfusion-related acute lung injury (TRALI) in blood transfusion? (3 steps)

A
  1. Host Neuts activated by donated blood
  2. Increases vasc permeability
  3. Pulm Oedema
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296
Q

What are the CF of a Transfusion-related acute lung injury (TRALI) in blood transfusion? (4 things)

A
  1. Fever
  2. Pulm infiltrates @ CXR
  3. Hypotension
  4. Hypoxia (low sats)
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297
Q

What is the management of a Transfusion-related acute lung injury (TRALI) in blood transfusion?

A

Oxygen

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298
Q

When do you get a Transfusion-associated circulatory overload (TACO) in blood transfusion? (2 things)

A
  1. Transfusion too fast
  2. Pre-existing HF
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299
Q

What are the CF of Transfusion-associated circulatory overload (TACO) in blood transfusion? (2 things)

A
  1. Pulm oedema
  2. HypERtension
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300
Q

What are the management for Transfusion-associated circulatory overload (TACO) in blood transfusion?

A

Loop diuretics (furosemide)

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301
Q

What happens to the pH in a paracetemol overdose?

Why is this important?

A

Low PH (acidosis)

Acidosis means poor prognosis

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302
Q

If RIF pain is worse after eating, what should you suspect?

Why?

A

Meckels diverticulum

Ectopic gastric mucosa secrete acid –> bleeding + ulceration

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303
Q

If RIF pain + fever + WL + diarrhoea, what should you suspect?

A

Crohn’s

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304
Q

What is the 1st line med for HTN pt who are diabetics, REGARDLESS of age?

A

ACEi / ARBs

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305
Q

What is the Toxicity Bear for Toxic meds? (7 meds)

A
  1. Aspargine = Neurotoxic
  2. Cisplastin = ototoxic + nephrotoxic
  3. Vincristine / Vinblastin = Peripheral neuropathy (christ my nerves) + Myelosuppression (blast my bones)
  4. Bleomycin = Lung fibrosis
  5. Doxorubicin = Cardiotoxic
  6. Ψ Cyclophosphamide = Nephrotoxic + Bladder toxic + SIADH
  7. Methotrexate = Nephrotoxic + Myelosuppression
306
Q

Why can you have Plethoric red facies (red face) in COPD? (3 steps)

A

Polycythaemia (COPD complication)

  1. COPD
  2. Chronic Type 2 Resp failure
  3. Polycthaemia (high RBC aka raised Hb in bloods) (to compensate for long term hypoxaemia)
307
Q

What are the findings of Type 1 Resp failure?

A
  • PaO2: LOW
  • PaCO2: Normal / low
  • Bicarbonate: Normal

Type 1 aka Hypoxaemia resp failure

308
Q

What are the findings of Type 2 Resp failure?

A
  • PaO2: Low
  • PaCO2: HIGH
  • Bicarbonate: Normal / Rising (defo raised in chronic Type 2)

Type 2 aka Hypercapnic resp failure

309
Q

What are the pathopneumonic features of Pagets disease of the nipple?

A

Starts as a erythematous rash in nipple

THEN spreads to areolar tissue in late disease

310
Q

How do you differentiate between Pagets disease and eczema in the breast?

A

Pagets: starts in nipple –> spreads to areola later

Eczema: starts in areola –> spreads to nipple

311
Q

Whats the difference between a Lipoma and Fibroadenoma of breast?

A

Lipoma - FIXED, non-painful, highly mobile, smooth, discrete

Fibroadenoma - MOBILE, non-painful, mobile, smooth, discrete

312
Q

Whats the difference between Fibroadenoma and Fibroadenosis of the breast? (4 things)

A

Fibroadenoma

  • Under 30yrs
  • Discrete
  • Painless
  • Mobile

Fibroadenosis

  • Middle-aged
  • “Lumpy” breasts
  • Painful (sometimes)
  • Symptoms worse in pre-menstrual period
313
Q

What should be arranged for pt with sus ruptured AAA?

A

Crossmatch 6 units blood

314
Q

If angina is not controlled with a Beta blocker, what should be added?

A

Nifedipine (calcium channel blocker)

315
Q

What are the 2 causes of pan-systolic murmurs?

How do you differentiate between them? (4 things)

A

MR

TR

TR

  • Louder on inspiration
  • Heard better @ L lower sternal border

MR

  • Heard better @ apex
316
Q

What are the types of Aortic dissection?

A

Type A - Ascending aorta (2/3 of cases)

Type B - Descending aorta (distal to left Subclavian origin)

317
Q

How are the different types of Aortic dissection managed?

A

Type A: Surgery + Control BP (IV labetalol)

Type B: Only Control BP (IV labetalol)

318
Q

What are the CF of Pericarditis? (6 things)

A
  1. Non prod cough
  2. SOB
  3. Pleuritic chest pain (worse @ leaning back)
  4. Pericardial rub
  5. Tachycardia
  6. Tachypnoea
319
Q

What investigations should you do for sus acute pericarditis?

A

ALL patients with sus acute pericarditis should have:

Transthoracic ECHOcardiography (TTE)

320
Q

What are the ECG findings in pericarditis? (3 things)

A
  1. PR depression (most specific ECG marker for pericarditis)
  2. “Saddle shaped” ST elevation
  3. GLOBAL / WIDESPREAD changes, not in specific territories of ECG
321
Q

What should you know about a Pregnant woman with High cholesterol?

A

Statins are contraindicated in pregnancy

322
Q

What BP meds affect glucose and insulin?

A

Thiazides: will cause hyperglycaemia

Esp after meals

323
Q

What are the treatments for Orthostatic hypotension? (2 things)

A
  1. Fludrocortisone (increases Na reabs)
  2. Midodrine
324
Q

What’s the most common cause of Congenital Heart Disease?

A

Ventricular septal defects (VSD)

325
Q

Apart from Congenital, what can cause Ventricular septal defects (VSD)?

A

Post MI

326
Q

What does VSD cause after a few weeks?

A

R HF

327
Q

What are the complications of VSD? (4 things)

A
  1. R HF
  2. Aortic regurg
  3. Asymptomatic + Pansystolic murmur @ L lower sternal edge
  4. Louder P2
328
Q

If a HTN who is on ACEi has a drop in eGFR, what should you do?

A

If it drops more than 20% –> half ACEi dose

329
Q

What is the rescue pack for asthma n COPD have? (2 things)

A
  1. Prednisolone
  2. Abx
330
Q

What are the side fx of Beta blockers? (2 things)

A
  1. Cold feet + hands
  2. Insomnia / Nightmares
331
Q

What are the side fx of Calcium channel blockers? (2 things)

A
  1. Ankle oedema
  2. Headaches
332
Q

What is the abx for Staph aureus?

A

Flucloxacillin

333
Q

What is the abx for Strep pneumoniae?

A

Penicillin

334
Q

What happens if you give Na too fast in SIADH?

What is the prognosis?

A

Central Pontine Myelinolysis (CPM)

50% death

335
Q

What is Clomifene?

A

Treatment for PCOS induced infertility

336
Q

What are the side fx of Clomifene? (3 things)

A
  1. Flushing
  2. Vaginal bleeding
  3. Ovarian hyperstimulation syndrome (OHSS) –> resp distress (SOB, pleural effusion)
337
Q

What should you give HF pt w Hypotension? (1st n 2nd line)

A
  1. FIRST LINE: Dobutamine (inotrope)
  2. SECOND LINE: Adrenaline
338
Q

What should you give HF pt w Resp Failure?

A

CPAP

339
Q

We said ABS for HF, but what is the most important medication for ACUTE HF?

A

Furosemide (loop diuretic)

340
Q

What are the medication causes of QT prolongation? (3 things)

A
  1. Amiodarone
  2. SSRI
  3. Haloperidol
341
Q

What are the electrolyte causes of QT prolongation? (3 things)

A
  1. Hypokalaemia
  2. Hypocalcaemia
  3. Hypomagnesaemia
342
Q

What are the ECG findings of Ant, Post, and Inf MI?

A

Ant: ST elevation @ V1-4

Inf: ST elevation @ II, III, aVF

Post: tall R waves in V1-2

343
Q

If JVP rises on inspiration, what sign is this, and what is the condition

A

Kussmauls sign

Constrictive pericarditis

344
Q

What type of stoma is done in an emergency setting of Colonic tumour w risk of perforation?

A

End colostomy

345
Q

What are the cancers of the colon vs anus?

A

Colon: Adenocarcinoma

Anus: Squamous cell carcinoma

346
Q

What can constipation cause in the rectum?

A

Haemorrhoids (painless)

347
Q

What do you see in the toilet with haemorrhoids?

A

Blood in the toilet pan

348
Q

What should you sus when dey have a midline Sentinal skin tag @ external inspection of der bum?

A

Fissure in ano

349
Q

Are Fissure in ano painful?

A

Yes

350
Q

What stomas are flush to the skin, and which are Spouted, and why?

A

Colostomy: flush to skin

Ileostomy: Spouted (aka away from skin bc small bowel contents are acidic n will clart da skin)

351
Q

When are haemorrhoids painful?

A

If they are thrombosed

352
Q

What is the grading system for internal haemorrhoids?

A

Grade 1: DO NOT prolapse out of anal canal

Grade 2: Prolapse @ pooing but reduce by demselves

Grade 3: Can be manually reduced

Grade 4: CAN NOT be reduced

353
Q

What is mesenterich ischeamia?

A

Heart attack of da colon

354
Q

What should you give in chronic anal fissures? (3 things)

A
  1. Laxatives
  2. Local anaesthetic
  3. Topical GTN (aaah thats the stuff)
355
Q

What are the options for ACUTE Anal fissure? (4 things)

A
  1. Soften stool (aka high fibre + fluid diet) (laxatives)
  2. Lubricants (before pooing)
  3. Topical anaesthetics
  4. Analgesia
356
Q

What are the management options for Chronic anal fissures? (3 things)

A
  1. Continue ACUTE management options
  2. Topic GTN
  3. Sphincterectomy (if GTN not working)
357
Q

What is the treatment for Torsade de pointes?

A

IV magnesium sulfate

358
Q

How do you get Cardiac tamponade?

A

Fluid in pericardium

(like getting stabbed)

359
Q

What are the CF of cardiac tamponade? (3 things)

A

Becks triad:

  1. Raised JVP
  2. Hypotension
  3. Muffled heart sounds @ ausc
360
Q

What are the 1st line Abx of choice for an infective exacerbation of COPD? (3 things)

A
  1. Amoxicillin
  2. Clarithromycin
  3. Doxycycline

1 of dem not all 3 lol

361
Q

What Abx is given for prohylaxis of a COPD pt with freqeuent infective exacerbations?

A

Azithromycin

362
Q

What can reduce the risk of sudden death in HOCM?

A

Implantable cardioverter defibrillator (ICD)

363
Q

What abx can cause Torsade de pointes?

A

Azithromycin / Clarithromycin (Macrolide)

364
Q

What is the treatment for pulmonary oedema?

A

IV furosemide

365
Q

What are the ECG findings of Digoxin toxicity? (3 things)

A
  1. Short QT interval
  2. ST depression (downsloping)
  3. T wave inversion
366
Q

What are the CF of Digoxin toxicity? (2 things)

A
  1. Anorexia
  2. Confusion
367
Q

What is S1 caused by?

A

T + M closure

(tricuspid + mitral)

368
Q

What is S2 caused by?

A

A + P closure

(aortic + pulmonary)

369
Q

When is S1 soft? (2 things)

A
  1. Long PR
  2. MR
370
Q

When is S1 loud?

A

MS

371
Q

When is S2 loud?

A

Pulmonary HTN (bc loud P2)

372
Q

When is S2 soft?

A

AS

373
Q

What is S3 caused by?

A

Diastolic filling of ventricle

374
Q

When is S3 considered normal?

A

If under 30 yrs old

375
Q

When is a S3 heard? (3 things)

A
  1. MR
  2. LV failure (e.g dilated cardiomyopathy)
  3. Constrictive pericarditis
376
Q

What is S4 caused by?

A

Atrial contraction against stiff ventricle

377
Q

What does S4 coincide with on a ECG?

A

P wave

(bc atrial contraction against stiff ventricle)

378
Q

When will you get a S4? (3 things)

A
  1. AS
  2. HTN
  3. HOCM
379
Q

What is the treatment for syptomatic relief of Angina pt with HR 70+ ?

A

Ivabradine

(HCN aka funny channel blocker)

380
Q

What are the side fx of Ivabradine?

A

Visual disturbances

eyevabradine

381
Q

What is narrow vs broad complex tachycardia?

A

QRS less than 120ms = narrow (SVT)

QRS more than 120ms = broad (VT)

382
Q

What are the adenosine DOSES for management of SVT after valsava manouvre and carotid sinus massage have failed?

A

6mg –> 12mg –> 18mg

383
Q

Who is adenosine CI in for SVT management?

What do you give instead?

A

Asthmatics

Give verapamil

384
Q

What do you do if ur 3 doses of Adenosine fail in SVT management?

A

DC cardioversion

385
Q

What are the 1st line management options for Pericarditis? (2 things)

A

NSAID (ibuprofen)

+

Colchicine

386
Q

Are bilateral pleural effusions transudate or exudate?

A

Transudate

(source: comment on passmed)

387
Q

How is a Posterior MI confirmed?

A

ST elevation and Q waves in POSTERIOR lead placement (V7-9)

388
Q

How do you confirm a diagnosis of cardiac tamponade?

A

Echo

389
Q

What is a skin side fx of amiodarone?

A

Grey skin appearance

390
Q

What are the CF of Aortic dissection? (5 things)

A
  1. Tearing Chest / Back pain
  2. HTN
  3. AR
  4. Pulse deficit (no pulse in carotid / brachial / femoral)
  5. Pulse difference (difference in 20+ systolic between arms)

THAPP

391
Q

What is CURB65 score for pneumonia?

A

Confusion

Urea 7+

Resp Rate 30+

BP 90/60 -

65+ age

0-1 fine

2 = hospital care

3+ = ICU

392
Q

Which lung cancer is gynaecomastia most commonly assoc with?

A

Adenocarinoma

393
Q

What are the causes of Upper zone pulmonary fibrosis? (5 things)

What will you hear?

A

TEARS fall from the sky

  1. TB
  2. Extrinsic Alveolitis
  3. Ankylosing Spondylitis
  4. Radiotherapy
  5. Sarcoid

APICAL crackles (upper zone crackles)

394
Q

What are the causes of Lower zone pulmonary fibrosis? (5 things)

What will you hear?

A

CRABS are on the ground

  1. Cryptogenic (aka Idiopathic)
  2. RA
  3. Asbestosis
  4. Bleomycin
  5. Systemic slerosis / scleroderma

Basal crackles

395
Q

What is Quincke’s sign?

A

Nailbed pulsation

Sign of AR

(therefore assoc w early-mid diastolic murmur)

396
Q

When is S3 normal?

A

Under 30 yrs old

3 n 3

397
Q

When is S4 normal?

A

Over 40

4 n 4

398
Q

What causes S3?

A

LVF n MR –> Pulm oedema

S threee hard to breeeath

399
Q

What causes S4?

A

HOCM n AS –> sudden death

S4 hit da floor

400
Q

Which COPD pt should be ASSESSED for Long Term Oxygen Therapy (LTOT)? (4 things)

A
  1. Blue: Cyanosis / sats 92-%
  2. Breathing: Airway obst / FEV1: 30-%
  3. Blood: Secondary polycthaemia (high Hb)
  4. Ballooning: Peripheral oedema / Hepatomegaly / Raised JVP
401
Q

How do you assess a COPD pt to see if they need LTOT?

A

2 ABG’s, 3 weeks apart

402
Q

After you assesses a COPD pt, who should you give LTOT for?

A

If PaO2: LESS than 7.3 kPa

OR

7.3 - 8 kPa PLUS one of:

  1. Peripheral oedema
  2. Pulmonary hypertension
  3. Secondary polycythaemia
403
Q

Who should you NOT offer LTOT for in COPD pt?

A

ppl still smoking

404
Q

Who should you refer for 2ww for sus lung cancer? (2 things)

A
  1. Sus CXR
  2. 40yr + w unexplained haemoptysis
405
Q

What criteria determines if a sore throat is BAC or viral?

A

Centor criteria

406
Q

What are the Centor Criteria?

A
  1. Tender anterior cervical lymphadenopathy
  2. Fever Hx
  3. Absence of cough
  4. Presence of tonsillar exudate

3+ = BAC (aka GAS)

T-FAP

407
Q

What are the ECG findings of Hypercalcaemia?

A

Shortening of QT interval

408
Q

What is CI in VT?

A

Verapamil (ca channel blocker)

409
Q

What is the most common organism causing infective exacerbation of COPD?

A

H influenza

410
Q

What is the long term medications post-MI? (4 things)

A
  1. Dual antiplatelet therapy
  2. ACEi
  3. Beta blocker
  4. Statin

DABS

411
Q

What will you hear in a Atrial septal defect? (3 things)

A
  1. Ejection systolic murmur
  2. Louder on inspiration
  3. Fixed split S2
412
Q

Who are Atrial septal defects common in?

A

Downs syndrome

413
Q

What is a contraindication for Chest drain insertion?

A

INR 1.3+

414
Q

What should be sus in YOUNG pt with chest pain?

A

Myocarditis

415
Q

What are the causes of the Myocarditis? (4 things)

A
  1. Viral (coxsckie B / HIV)
  2. BAC
  3. AI
  4. Drugs: Doxorubicin
416
Q

What are the CF of myocarditis? (4 things)

A
  1. YOUNG pt, acute hx
  2. Chest pain (doesnt change with breathing / position)
  3. SOB
  4. Arrhytmias
417
Q

What investigations should you do for Myocarditis? (2 things)

A
  1. Bloods
  2. ECG
418
Q

What will bloods show you in Myocarditis? (3 things)

A
  1. Raised inflamm markers
  2. Raised cardiac enzymes
  3. Raised BNP
419
Q

What will ECG show you in Myocarditis? (3 things)

A
  1. Tachycardia
  2. Arrhytmias
  3. ST elevation / T wave inversion
420
Q

What are the management options for Myocarditis? (2 things)

A
  1. TUC (abx if BAC)
  2. Supportive (for HF / arrhythmias)
421
Q

What are the complications of Myocarditis? (3 things)

A
  1. HF
  2. Arrhytmias –> sudden death
  3. Dilated cardiomyopathy (late)
422
Q

What bloods will Total Parenteral Nutrition (TPN) clart?

A

LFT’s

high everything

423
Q

What is the tumour marker for breast cancer?

A

CA15-3

424
Q

What is the analgesia of choice for Renal colic?

A

IM Diclofenac

(its voltarol lol)

425
Q

When do you use Neuromuscular blocking drugs?

A

To paralyse muscles to allow for Intubation

426
Q

What are the 2 types of Neuromuscular blocking drugs?

A

Depolarizing n Non-depolarizing

427
Q

What is the MOA of Depolarizing Neuromuscular blocking drugs?

A

Binds to nAChR’s –> persistent depolarization of Motor end plate

428
Q

What is the MOA of Non depolarizing Neuromuscular blocking drugs?

A

Competitive antagonist vs nAChR’s

429
Q

What is an example of a Depolarizing Neuromuscular blocking drug?

A

Succinylcholine

aka Suxamethonium

430
Q

What is an example of a Non depolarizing Neuromuscular blocking drug?

A

Pancuronium

like pancreas lol

431
Q

What are the side fx of Depolarizing Neuromuscular blocking drugs like Suxamethonium? (3 things)

A
  1. Fasiculations (muscle twitches)
  2. Malignant hyperthermia
  3. Hyperkalaemia
432
Q

What are the side fx of Non depolarizing Neuromuscular blocking drugs like Pancuronium?

A

Hypotension

433
Q

How do you reverse Depolarizing Neuromuscular blocking drugs like Suxamethonium?

A

You can’t

434
Q

How do you reverse Non depolarizing Neuromuscular blocking drugs like Pancuronium?

A

Acetylcholinesterase inhibitors (neostigmine)

435
Q

Which Neuromuscular blocking drugs is the one of choice for intubation?

A

Depolarizing (Suxamethonium)

436
Q

What are the CI for Suxamethonium (Depolarizing Neuromuscular blocking drug)? (2 things)

Why?

A
  1. Acute angle glaucoma
  2. Penetrating eye injuries

Bc Suxamethonium increased inra-ocular pressure

437
Q

What surgical complication is more likely to occur with Open surgery than in Laparoscopic?

A

Adhesions

438
Q

How do you manage an obstructed Urinary stone with signs of infection? (2 things)

A
  1. IV abx
  2. Urgent renal decompression
439
Q

What is a Extradural (epidural) haematoma?

A

Bleeding into space between Dura mater + Skull

440
Q

What are the most common causes of Extradural (epidural) haematomas? (2 things)

A
  1. Car crash (acceleration-deceleration injury)
  2. Blow to side of head
441
Q

Which part of the head do most Epidural haematomas occur?

A

Temporal region

442
Q

What artery is clarted by the skull # in Epidural haemotomas?

A

Middle meningeal artery

443
Q

What is the shape of the Epidural haematoma bleeding on a scan?

A

Lemon shape

Lemon pie = e-PIE-dural lol

444
Q

What is a Subdural haematoma?

A

Bleeding into Outermost Meningeal layer

445
Q

What lobes of the brain do Subdural haematomas most commonly occur? (2 things)

A
  1. Frontal lobe
  2. Parietal lobe
446
Q

What are the RF for Subdural haematomas? (3 things)

A
  1. Age
  2. Alcohol
  3. Anticoag

3 A’s for Subdural

447
Q

Which has a slower onset of symptoms, Epidural or Subdural?

A

Subdural

SSSlow SSSubdural

448
Q

What symptoms might you get in Subdural haematomas?

A

Fluctuating confusion / consciousness

449
Q

What shape are Subdural haematomas on a scan?

A

Banana shape

suB = Banana

450
Q

What symptoms does a Subarachnoid haemorrhage (SAH) classically cause?

A

Sudden occipital headache

SAH at da back in da occipital area

cah SAiHdev played back in midfield not upfront lol

i can feel it in my brem lol

451
Q

When do you get Subarachnoid haemorrhage? (2 things)

A
  1. Spontaneously after Cerebral aneurysm
  2. Traumatic brain injury
452
Q

What is seen in a Subarachnoid haemorrhage in a scan?

A

Bleeding in the back of the brain

i can feel it in my brem

453
Q

What is a Intracerebral (intraparenchymal) haemorrhage (IPH)?

A

Collection of blood within brain substance

454
Q

What are the causes / RF for Intracerebral (intraparenchymal) haemorrhages (IPH)? (5 things)

A
  1. Brain tumour
  2. HTN
  3. Aneurysms
  4. Trauma
  5. Infarct (esp stroke pt undergoing thrombolysis)

BHATI

455
Q

What pt will Intracerebral (intraparenchymal) haemorrhage (IPH) patients present similarly to?

A

Stroke patients

This is why u gotta do a CT head for all stroke pt b4 thrombolysis to rule dis out

456
Q

What will you see in a scan of (Intracerebral (intraparenchymal) haemorrhage (IPH)?

A

Hyperdense lesion in brain substance

457
Q

What is the treatment for Intracerebral (intraparenchymal) haemorrhage (IPH)?

A

Small: Conservative

Large: Surgery

458
Q

How should Diabetes meds (metformin n co) be managed on DAY BEFORE surgery?

A

Take as normal

459
Q

How should Metformin be managed on DAY OF surgery operation?

A

If once / twice daily: take as normal

If 3 times daily: miss lunchtime dose

morning / afternoon operation doesnt matter

460
Q

How should Sulfonylurea (gliclazide) be managed on DAY OF surgery operation?

A

If once daily: miss dose (morning or afternoon op)

If twice daily: miss morning dose / miss both doses if afternoon op

461
Q

How should DDP4i (Sitagliptin) be managed on DAY OF surgery operation?

A

Take as normal

462
Q

How should SGLT2i (canaglifozin) be managed on DAY OF surgery operation?

A

Miss on day (morning or afternoon pm)

463
Q

How should ONCE DAILY INSULIN be managed on DAY BEFORE / DAY OF surgery operation?

A

Reduce dose by 20% on day before + day of surgery (morning or afternoon op)

464
Q

How should Twice daily insulin be managed on DAY BEFORE / DAY OF surgery operation?

A

Day before: Take as normal

Day of: Half morning dose, evening dose as normal (morning or afternoon pm)

465
Q

What tests should you do in your Pre-op assessment of an Elective surgery pt? (7 things)

mnemonic

A
  1. DVT / PE assessment + thromboprophylaxis plan
  2. Blood tests (FBC / UnE / LFTs / Clotting / Group n Save)
  3. Sickle cell test
  4. Pregnancy test
  5. Urinalysis
  6. CXR
  7. ECG

Dan Brings Silly People Uncooked Cookies Everyday

466
Q

How long should patients fast from non clear liquids n food for b4 surgery?

A

6 hours

467
Q

How long should patients fast from clear liquids for b4 surgery?

Examples of clear liquids?

A

2 hours

water / coffee or tea without milk

468
Q

What are the bloods of someone in DIC? (3 + 2 things)

A

RAISED:

  1. PT
  2. APTT
  3. D-dimer

LOW:

  1. Fibrinogen
  2. Platelets
469
Q

How is Total Parenteral Nutrition (TPN) done?

A

Thru Subclavian vein

470
Q

What elec imbalance is a common complication of Subarachnoid Haemorrhages (SAH)?

A

Hyponatraemia (N+V + loss of consciousness)

SAH –> SIADH

471
Q

How do you manage a life threatening rise in Intra-cranial pressure, e.g in epidural haematoma?

What should you do in meantime?

A

Surgery

Meantime give: IV mannitol / furosemide

472
Q

How do you manage diffuse Cerebral oedema?

A

Decompressive craniotomy

473
Q

How do you manage OPEN depressed skull #s? (2 things)

A
  1. Surgical reduction
  2. Debridement
474
Q

How do you manage CLOSED depressed skull #s?

A

Non-operatively if minimal displacement

475
Q

Who is it appropriate to monitor Intra-Cranial Pressure (ICP) and who is it mandatory to monitor it?

A

GCS 3-8 w normal CT scan = appropriate

GCS 3-8 w abnormal CT scan = must

476
Q

What is the pupil presentation of a CN3 compression secondary to tentorial herniation? (2 things)

A
  1. Unilat dilation
  2. No / slow light reponse
477
Q

What is the pupil presentation of a Bilat CN3 palsy or Poor CNS perfusion? (2 things)

A
  1. Bilat dilation
  2. No / slow light reponse
478
Q

Which pt are MORE sensitive to Non-depolarizing anaesthetic agents (aka Pancuronium)?

A

Myasthenia gravis

  • Non-repolarizing agents: Antagonist for nAChR’s –> produces paralysis by their blockade
    • Since MG pt have FEWER nAChR’s –> more sensitive to its blockade
  • Depolarizing agent (aka Suxamethonium) acts ON receptors –> produces paralysis
    • MG pt will be resistant to dis
479
Q

What are the CF of Mesenteric infarction? (3 things)

A
  1. Sudden onset pain
  2. Vomiting
  3. Bloody diarrhoea (sometimes)
480
Q

What is the FIRST LINE investigation for bladder cancer?

A

Cystoscopy

481
Q

How many hours should you wait after these events to do an accurate PSA test? (according to NICE)

A

Prostate biopsy: 6 wks

UTI: 4 wks

DRE: 1 wk

Vigorous exercise / ejaculation: 48 hrs

482
Q

What are “Stag-horn” renal calculi made up of?

What type of urine do they form in?

A

Struvite

dey form in alkaline urine

483
Q

What test tests the Exocrine function in chronic pancreatitis?

A

Faecal elastase

484
Q

Who warrants to have a URGENT CT head scan? (4 things)

A
  1. GCS less than 13
  2. Post-traumatic seizure
  3. Sus open / depressed skull #
  4. 2+ vomiting episodes
485
Q

When do you get Spondylolisthesis? (2 things)

A
  1. Stress #
  2. Spondylolysis
486
Q

How is Minor / Radically Symptomatic Spondylolisthesis managed?

A

Minor: Active monitoring

Radically Symptomatic = Spinal decompression + Stabilisation

487
Q

What GI condition is Ankylosing spondylitis (aka bamboo spine) strongly associated with?

A

UC

488
Q

What should you think about if a pt has an ISOLATED fever in first 24 hrs after surgery?

A

Physiological reaction to op

489
Q

What is the initial management of Acute Limb Ischaemia? (3 things)

A
  1. Analgesia
  2. IV Heparin
  3. Vasc review
490
Q

What is a 3- cm AAA, and how do you manage?

A

Dis is normal, not an AAA

491
Q

What is a 3 - 4.4cm AAA, and how do you manage?

A

Small aneurysm

Rescan every 12 months

492
Q

What is a 4.5 - 5.4cm AAA, and how do you manage?

A

Medium aneursym

Rescan every 3 months

493
Q

What is a 5.5+ cm AAA, and how do you manage?

A

Large aneurysm (rare)

2ww to Vasc surgery

494
Q

What is Hydrocephalus?

When do you commonly get it?

A

Too much CSF in ventricular system

Common complication of Intraventricular haemorrhages

495
Q

What are the CF of Hydrocephalus? (3 things)

A
  1. Headache (worse @ morning / lying down / valsalva) (Coma (if severe)
  2. Papilloedema
  3. N+V
496
Q

What is the FIRST line investigation for sus Hydrocephalus?

A

CT head

497
Q

What is the treatment for Acute Severe Hydrocephalus?

A

External ventricular drain (EVD) (insert in lat ventricle to drain)

498
Q

What are the side fx of Bisphosphonates? (given for osteoporosis innit)

A

Oesophagitis

takhali9 min one O yajeek al tani (osteoporosis –> oesophagitis lol)

499
Q

What is the management for Hypercalcaemia? (4 things)

A
  1. Fluids (1st line)
  2. Bisphosphonates
  3. Calcitonin
  4. Steroids (for sarcoidosis)
500
Q

When is aspirin CI?

A

PUD

501
Q

What is PKD a risk factor for?

A

SAH

502
Q

How much blood do you have to lose in haemorrhagic shock for your BP to drop?

A

30% blood loss

503
Q

What bloods will suggest Renal adenocarcinoma?

A

Polycthaemia (high Hb)

504
Q

What sign in a CT KUB will indicate that someone had a ureteric stone that has passed?

A

Peri-ureteric fat stranding

505
Q

What pre-op management should you do for pt taking prednisolone?

A

Hydrocortisone supplementation

506
Q

What is the biggest risk factor for Testicular cancer?

A

Infertility

3x da risk

507
Q

What monoclonal antibody can you give for RA?

A

Infliximab

508
Q

What monoclonal antibody can you give for Crohns?

A

Infliximab

509
Q

What monoclonal antibody can you give for CRC?

A

Bevacizumab

510
Q

What monoclonal antibody can you give for HER2 breast cancer?

A

Trastuzumab (aka herceptin)

511
Q

What monoclonal antibody can you give for Lung fibrosis?

What other meds can u give?

A

Nintedanib (tyrosine kinase inhibitor)

Pirfenidone (anti-fibrotic n anti-inflamm)

512
Q

What monoclonal antibody can you give for kidney transplants?

A

Basiliximab

basil my cousin wid da kidney bean fool

513
Q

What meds should you give for Overrreactive bladder?

A

Antimuscarinic aka Oxybutynin

514
Q

What can Depolarizing anaesthetics (aka suxamethonium) cause?

A

Malignant hyperthermia

515
Q

What are classical signs of Basilar skull #s?

A

Raccoon eyes: perio-orbital bruising

Battles sign: post auricular bruising

516
Q

After GTN spray and Beta blockers for anginga prophylaxis, what should you give?

A

Nicorandil

Niko omilana for da heart pain

517
Q

What other CT disorder can cause pleural effusion apart from RA?

A

SLE

518
Q

How do you confirm a diagnosis of SLE?

A

Antinuclear Antibody (ANA) titre test

519
Q

What ECG changes warrant urgent PCI / thrombolysis? (3 things)

A
  1. 2+ mm ST elevation in V1-6 (in 2+ consecutive leads)
  2. 1+ mm ST elevation in II, III, aVF (in 2+ consecutive inf leads)
  3. New LBBB
520
Q

What investigationS (plural) r needed to confirm asthma diagnosis? (2 things)

A
  1. FeNO (fractional exhaled nitric oxide) test
  2. Spirometry w bronchodilator reversibility
521
Q

What should you prescribe for a asthma exacerbation?

A
  1. Oral prednisolone (once daily for 5 days + stat dose now)
  2. Step up current routine
522
Q

How do you know in an ABG if resp acidosis is being compensated for?

Is it acute or chronic?

A

If HCO3 is raised, then kidney is trying to compensate

Chronic bc metabolic compensation takes long

523
Q

How does the congenital abn of Coarcation of the aorta present?

A

Weakened femoral pulses

524
Q

What med is CI in VT?

A

Verapamil

525
Q

What meds is CI in moderate-severe Aortic Stenosis?

A

ACEi

526
Q

What is the most common cause of Mitral Stenosis?

A

Rheumatic fever

527
Q

What is the diagnostic test for Obstructive Sleep Apnoea?

A

Polysomnography (PSG)

PSG for finished sleepy players like messi

528
Q

What is the most common causative organism for Inf Endocarditis, esp in IV drug users?

A

Staph aureus

kohli said staph aureus is in skin so obv iv drug users will be putting dat inside der body

529
Q

What will you see on a ECG of hypothermia? (3 things)

A
  1. Bradychardia
  2. J waves
  3. Prolonged PR n QT n QRS intervals

J hus is COLD

530
Q

What should you advise for pt Warfarin due to undergo surgery?

A
531
Q

What will you see ina ECG of LV aneurysm (MI complication)?

A

Persistent ST elevation

532
Q

What is the most common organism of Septic arthritis?

A

Staph aureus

533
Q

What are the CF of septic arthritis? (2 things)

A
  1. Joint pain + swelling
  2. Fever
534
Q

What investigation MUST you do for Septic arthritis?

A

Synovial fluid sampling

preferrably b4 abx

535
Q

What is the tx for septic arthritis? (3 things)

A
  1. Flucloxacillin (Clindamycin if penicillin allerg)
  2. Needle aspiration (to decompress)
  3. Arthroscopic lavage (if needed)
536
Q

How do you investigate a Psoas abscess?

A

CT abdomen

537
Q

What is Hydroxychloroquine used to treat? (2 things)

A
  1. RA
  2. SLE
538
Q

What are the side fx of Hydroxychloroquine?

A

Retinopathy (visual loss)

539
Q

How do you investigate an Achilles tendon rupture?

A

US

540
Q

What is the test for Meniscal tears?

A

McMurrays test (painful click heard)

541
Q

Who is most likely to get Trochanteric bursitis?

A

Women 50-70 yrs

542
Q

What are the CF of Trochanteric bursitis? (2 things)

A
  1. Pain @ lat side of hip / thigh (unilat)
  2. Tenderness @ greater trochanter palpation
543
Q

Where is the most common site of stress #s?

A

2nd metatarsal shaft

544
Q

What is used to manage Acute flare ups of RA?

A

IM Methylprednisolone

545
Q

What is the tx for gout? (2 things)

A
  1. NSAIDs
  2. Colichine (of NSAIDs CI e.g PUD)
546
Q

How do you differentiate between Psoriatic arthritis and RA?

A

Psoriatic arthritis is ASYMMETRICAL polyarthritis

PA: Dactylyitis (global swelling of finger –> sausage finger)

547
Q

Who usually has Lateral epicondylitis (aka tennis elbow)?

A

45-55 yr olds playing tennis / house painting

548
Q

What are the CF of Lateral epicondylitis (aka tennis elbow)? (3 things)

A
  1. Pain + tender @ lateral epicondyle
  2. Pain worse @ wrist ext vs resistance + elbow ext
  3. Lasts 6months - 2yrs
549
Q

What is the tx for Lateral epicondylitis (aka tennis elbow)? (4 things)

A
  1. Avoid muscle overload
  2. Simple analgesia
  3. Physio
  4. Steroid inj
550
Q

What is Raynaud’s phenomenon?

A

Exagg vasoconstrictive response of finger arteries to cold / emotional stress

551
Q

What are the CF of Raynaud’s phenomenon?

A

Bilat fingers turning white –> blue –> red

552
Q

Who is most likely to have Raynaud’s phenomenon?

A

30 yr old women

553
Q

What is Compartment syndrome?

A

Raised pressure within Closed anatomical space

554
Q

What is Compartment syndrome a complication of? (2 things)

A
  1. Supracondylar #s
  2. Tibial shaft injuries
555
Q

What are the CF of Compartment syndrome? (3 things)

A
  1. Pain @ movement (even passive)
  2. Parasthesiae
  3. Paralysis of muscle group (sometimes)
556
Q

How is a dx of Compartment syndrome made? (2 things)

A
  1. Measurement of intracompartmental pressure (20+ = abn, 40+ = diagnostic)
  2. NO XR pathology seen
557
Q

What is the tx for Compartment syndrome? (3 things)

A
  1. Fasciotomy (cut fascia to relieve tension)
  2. IV fluids incase of myoglobinuria complication (bc can result in renal failure)
  3. Amputation
558
Q

What is a stress #, and what is it caused by?

A

Small hairline #

Caused by repetitive activiting + loading of normal bone

559
Q

What is the CF of stress #s? (2 things)

A
  1. Painful but rarely displaced
  2. May present LATE after injury (will see Callus formation around # on XR)
560
Q

What is the tx for stress #?

A

Immobilisation (if early)

561
Q

How do you differentiate between causes of Marfans vs Ehlers Danlos?

A

MarFans = Fibrillin 1 mutation
Ehler Danlos = Collagen 3 mutation

562
Q

What are the CI for Sulfasalazine (DMARD + IBD tx)? (2 things)

A
  1. G6PD deficiency
  2. Allergy to aspirin / sulphonamides
563
Q

What does a +ve femoral nerve stretch test indicate?

A

Hip pain –> Referred lumbar spine pain

564
Q

What are the causes of Osteomalacia? (2 things)

A
  1. Vit D deficiency
  2. CKD (again low vit D activation)
565
Q

What are the CF of Osteomalacia? (3 things)

A
  1. Bone pain
  2. Bone muscle tenderness
  3. Waddling gait
566
Q

What is the tx for Osteomalacia? (2 things)

A
  1. Vit D suppl
  2. Ca suppl (if low dietary intake)
567
Q

What is pain @ longitudinal compression of thumb a sign of?

A

Scaphoid #

568
Q

What are the tx options for Extracapsular hip #s? (2 things)

A
  1. Stable intertrochanteric: DHS
  2. Subtrochanteric: Intramedullary device (IMD)
569
Q

How do you diagnose Ankylosing spondylitis?

A

Pelvic XR: Sacro-ilitis aka Subchondral erosions / Sclerosis (early)

Not bamboo spine bc das LATE

570
Q

What hand fracture is commonly missed in XR?

Why?

A

Scaphoid #

Bc not evident on XR straightaway

line will be present after few days (pt will complain of persistent anatomical snuffbox pain)

571
Q

What are the side fx of Bisphosphonates? (2 things)

A
  1. Oesophageal stuff: Oesophagitis / ulcers
  2. Hypocalcaemia
572
Q

What are the CF of drug induced lupus? (3 things)

A
  1. Face rash
  2. Pleuritis
  3. Athralgia / myalgia
573
Q

What is the age and onset of Polymyalgia Rheumatica (PMR)?

A

60 yrs

Rapid onset

574
Q

What are the CF of Polymyalgia Rheumatica (PMR)? (5 things)

A
  1. Polyarthalgia + Polymyalgia (lol)
  2. Morning stiffness @ prox limb muscles, but NOT weakness (strength no weakness in PMR lol)
  3. Fever (low grade)
  4. Lethargy
  5. Night sweats
575
Q

What will investigations show you in Polymyalgia Rheumatica (PMR)? (2 things)

A
  1. Raised ESR n CRP
  2. NORMAL Creatine kinase n antiCCP
576
Q

What is the tx for Polymyalgia Rheumatica (PMR)?

A

Prednisolone

Should react dramatically, if not –> refer to specialist for alternative dx

577
Q

If you sus Polymyalgia Rheumatica (PMR), but you have raised antiCCP or Creatinine kinase, what should you sus instead?

A

Raised antiCCP: RA

Raised Creatinine kinase: Polymyositis

578
Q

What is long term steroid use (aka for RA) a RF for?

A

AVN

579
Q

What is the tx for Monomorphic VT vs Polymorphic VT?

A

Monomorphic: Amoidarone

Polymorphic: IV magnesium sulfate

580
Q

What organism are Sickle cell ppl more likely to be infected w?

A

Samonella

Sickle cella samonella rhymes lol

581
Q

How do Posterior hip dislocation present?

A

Shortened + Internally rot leg

582
Q

What marker can be used to diagnose SLE?

A

anti-dsDNA

583
Q

How do you differentiate between Greenstick vs Buckle (torus) fractures?

A

Greenstick: widened gap

Buckle (torus): like squeezing 2 cheestrings together –> head parts flatten out bc pressure

584
Q

Apart from colles #, what FOOSH also cause?

A

Acromioclavicular joint injury

585
Q

What is the treatment for the different grades of Acromioclavicular joint injuries?

A

Grade 1-2: Conservative (rest + sling)

Grade 3-6: Surgery

586
Q

What is the treatment for Ankylosing Spondyltitis? (2 things)

A
  1. NSAIDs
  2. Exercise + Physio
587
Q

What is a risk of using Ciprofloxacin?

A

Tendon problems (tendinitis / rupture)

588
Q

What is Pagets disease of the bone?

A

Increased uncontrolled bone turnover

589
Q

What are the CF of Pagets disease of the bone? (3 things)

A
  1. Bone pain (spine / pelvis / femur)
  2. Tibia bowing
  3. Skull bossing
590
Q

What investigation results will prove Pagets disease of the bone?

A

Isolated raised ALP

591
Q

What is the tx for Pagets disease of the bone?

A

Bisphosphonates

592
Q

What do you get after taking antipsychotics for a long time?

A

Tardive dyskinesia

  1. Excessive blinking
  2. Lip smacking
  3. Dysphagia
593
Q

What should you do for Treatment resistant depression?

A

ECT (electroconvulsive therapy)

594
Q

What can you get if you stop taking SSRIs? (4 things)

A
  1. Mood changes
  2. Insomina
  3. Diarrhoea
  4. Sweating

MIDS

595
Q

How long should Lithium levels be checked after the dose is given?

A

12 hours

596
Q

What is PTSD symptoms before 4 weeks called?

A

Acute stress disorder

(ptsd has 4 letters so diagnosed after 4 wks)

597
Q

What meds is given for treatment RESISTANT schizophrenia?

A

Clozapine (atypical antipsychotic)

598
Q

What are the side fx of Atypical antipsychotics (e.g Clozapine)? (6 things)

A
  1. Weight = Obesity (Olanzapine) + Glucose intolerance (-> DM)
  2. Immune = Agranulocytosis (only Clozapine) + Neutropaenia
  3. CVS = Myocarditis + Arrhythmias
599
Q

Can you use SSRIs in pregnancy?

A

No

1st trimester –> Congenital heart defects (esp Paroxetine)

3rd trimester –> Pulmonary HTN for baby

600
Q

What is a side fx of SSRI you will see in bloods?

A

Hyponatraemia

601
Q

What are the side fx of SSRIs? (3 things)

A
  1. GI symptoms (+ GI bleeding)
  2. Hyponatraemia
  3. Anxiety + agitation
602
Q

What SSRIs have beh drug interaction? (2 things)

A
  1. Fluoxetine
  2. Paroxetine
603
Q

What are the side fx of Typical antipsychotics (aka haloperidol n Chlopromazine)? (4 things)

A

Extrapyramidal side fx

  1. Parkinsonism
  2. Acute dystonia (muscle contraction e.g Torticollis / Oculogyric crisis)
  3. Restlessness (akathisia)
  4. Tardive dyskinesia (abn invol movemets e.g chewing n jaw pouting)

Tardive w Typical dat way ull remember is extrapyramidal n remember da rest

*Torticollis = tilting head down

604
Q

What mental health disorder can cause Hypothyroidism?

A

Anorexia

605
Q

What SSRI can cause Torsade de pointes?

A

Citalopram (used for major depressive disorder)

causes long QT syndrome

606
Q

How do you manage Angina?

A

For attacks: GTN spray

Aspirin + Statin (1st line)

Beta / Ca blocker (monotherapy or both) (1st line still)

  • If Ca blocker Monotherapy: Verapamil
  • If Duotherapy: Beta blocker + Nifedipine (safer Ca blocker)

If can’t handle Duotherapy, instead add: Ivabradine / Nicorandil

(ABC IN)

607
Q

What should you monitor when giving SNRI’s (aka Venlaxafine)?

A

BP

Bc SNRI’s can cause HTN

608
Q

What should you monitor when giving Atypical antipsychotics (aka Clozapine)?

A

FBC

Bc can cause Agranulocytosis

609
Q

What should you monitor when giving SSRI’s (aka Sertraline)?

A

UnE’s

Bc can cause Hyponatraemia

610
Q

How do you manage Acute dystonia secondary to Typical Antipsychotics (aka Haloperidol)?

A

Procyclidine

611
Q

What is Serotonin Syndrome? (3 things)

A

Reaction to SSRIs

  1. Rigidity
  2. Hyperreflexia
  3. Autonomic dysfunction
612
Q

How do you treat Serotonin Syndrome?

A

Benzodiazepines (diazepam)

613
Q

What is the treatment for Tardive dyskinesia (side fx of Typical antipsychotic)?

A

Tetrabenazine

T T T

614
Q

What is Hutchinson’s Sign?

A

Involvment of Nasociliary nerve (from V1) in Herpes Zoster Virus

aka Herpes Zoster Opthalmicus (V1 innit) Rash

Affects: Eyelid, Eye, Nose

615
Q

What is clarted in Aniscoria of the Right Eye, aka Right pupil dilated at bright light?

A

Right Ciliary Ganglion

616
Q

What is Dermatomyositis?

A

Multisystem disease characterised by:

  1. Skin changes
  2. MSK weakness
617
Q

What are the skin changes in Dermatomyositis? (5 things)

A
  1. Scaly scalp
  2. Heliotrope: rash around eyes
  3. Shawls sign: rash on back n neck
  4. Gottrons sign / papules: on hands n knees
  5. Raynauds
618
Q

What is the antibody for Dermatomyositis?

A

Anti-Jo1 antibody

Jo has bad skin lol

Widad aid dis one has Dermatomyositis is da only one wid skin in da name

619
Q

What kind of MSK weakness do you see in Dermatomyositis? (2 things)

A

Weakness n fatigue @ everyday activities e.g:

  1. Climbing stairs
  2. Rising from sitting on couch
620
Q

What is Cradles Cap in babies? (2 things)

A
  1. Scaly rash on babys head
  2. Otherwise well
621
Q

How do you treat Cradles Cap in babies?

A

Olive oil den Baby shampoo

622
Q

What is the triad for Spinal (e.g Lumbar) Abscesses?

A
  1. Fever
  2. Back pain
  3. Neurological deficit (aka numbness / weakness)
623
Q

What is Reactive Arthritis? (2 things)

A
  1. Type of Spondylolarhritis
  2. Arthritis happenining after Infection (clue in name Reactive innit)
624
Q

What is special abt culturing joints of Reactive Arthritis? (2 things)

A
  1. You won’t see the pathogens that caused the primary infection
  2. NO WBC
625
Q

What are the CF of Reactive Arthritis? (3 things)

A
  1. Conjuctivitis (see)
  2. Urethritis (pee)
  3. Arthritis (climb a tree)

cant see, pee, or climb a tree

626
Q

What is the antibody associated with Reactive Arthritis?

A

HLA-B27 (like AS)

627
Q

What are the main causative organisms of infections that cause Reactive Arthritis? (3 things)

A
  1. Campylobacter
  2. Salmonella
  3. Shigella

All diarrheal infections

628
Q

What is the tx for Reactive Arthritis?

A

NSAIDs

629
Q

What are the CF of the infections that cause Reactive Arthritis? (4 things)

A
  1. Fever
  2. Nausea
  3. Abd pain (crampy) - (remember cah Campylobacter)
  4. Diarrhoea
630
Q

What is Juvenile idiopathic arthritis (JIA)? (2 things)

A
  1. Arthritis in kids under 16 yrs old
  2. Lasts more than 6 weeks
631
Q

What are the CF of Juvenile idiopathic arthritis (JIA)? (3 things)

A
  1. Fever (intermittent)
  2. Rashes (evanescent, aka disappear quickly)
  3. Arthritis
632
Q

What markers will be positive / negative in Juvenile idiopathic arthritis (JIA)? (2 things)

A
  1. ANA = positive
  2. RF: negative (obv)
633
Q

What conditions have HLA-B27? (2 things)

A
  1. Ankylosing spondylitis
  2. Reactive Arthritis
634
Q

What conditions have HLA-DQ2/DQ8?

A

Coeliac disease

remember we said like d squared lol

635
Q

What conditions have HLA-DR2?

A

Goodpastures

636
Q

What conditions have HLA-DR3? (3 things)

A
  1. Dermatitis herpetiformis
  2. Sjogren’s syndrome
  3. Primary Biliary Cirrhosis
637
Q

What conditions have HLA-DR4? (2 things)

A
  1. T1DM
  2. RA
638
Q

What do you do for Mongolian blue spot in babies?

A

Reassure parents

639
Q

What should you sus in a teenager with no significant PMHx but with palpable lymph nodes?

A

Cancer e.g Hodgkins Lymphoma

640
Q

What is a GI side fx of Bendroflumethiazide?

A

Diarrhoea

641
Q

What does a positive c-ANCA or p-ANCA result mean you have?

A

AI vasculitis

642
Q

What does a positive anti-SS-A (Ro or La) result mean you could have? (3 things)

A
  1. Sjogren syndrome
  2. SLE
  3. RA

anti-SS-A literally is: anti–Sjögren’s-syndrome-related antigen A autoantibodies

La more associated w Sjorgen syndrome

643
Q

What does a positive anti-ss-DNA or anti-ds-DNA result mean you could have? (2 things)

A
  1. SLE
  2. Drug induced lupus
644
Q

What does a positive Anti-Mitochondrial Antibodies (AMA) test mean you could have? (4 things)

A
  1. Primary biliary cirrhosis (mainly)
  2. AI hepatitis
  3. SLE
  4. RA
645
Q

What does a positive Rheumatoid factor (RF) mean you could have/

A
  1. RA
  2. SLE (also positive anti-ds-DNA)
  3. Scleroderma
  4. Sjögren’s syndrome (also positive anti-SS-A (Ro))
  5. Vasculitis (also positive c-ANCA)
646
Q

What are the 2 tumour markers for Testicular cancer?

A
  1. AFP
  2. bHCG
647
Q

What is Sjogren syndrome? (2 things)

A
  1. AI condition
  2. Affects EXOCRINE glands –> dry mucosal surfaces
648
Q

How can you get Sjogren syndrome? (2 things)

A
  1. Primary
  2. Secondary to RA / other CT disorders
649
Q

Which gender gets Sjogrens syndrome more?

A

Women (9:1)

650
Q

What are the CF of Sjogrens syndrome? (4 things)

A
  1. Dry eyes
  2. Dry mouth + Recurrent Parotitis
  3. Athralgia / Myalgia (Raynauds)
  4. Dry vagina
651
Q

What investigations will prove a Dx of Sjogrens syndrome? (4 things)

A
  1. RF: positive
  2. ANA: positive
  3. Anti- Ro/La: positive
  4. Schirmer’s test: positive
652
Q

What is the Tx for Sjogrens syndrome? (2 things)

A
  1. Artificial Saliva + Tears
  2. Pilocarpine (stim saliva prod)
653
Q

What is Systemic Sclerosis (aka Scleroderma)?

A

Condition of hardened sclerotic skin + CT

654
Q

Which gender is more likely to have Systemic Sclerosis (aka Scleroderma)?

A

Females (4:1)

655
Q

What are the CF of LIMITED Systemic Sclerosis (aka Scleroderma)? (5 things)

A
  1. Calcinosis
  2. Raynauds
  3. Esophagus dysmotilty
  4. Sclerodactyly (fingers fusing together)
  5. Telangiectasia (like spider naevi)

CREST

656
Q

What are the CF of DIFFUSE Systemic Sclerosis (aka Scleroderma)? (4 things)

A
  1. Poor prognosis
  2. Resp involvement: ILD, Pulmonary Artery HTN (both –> death)
  3. Renal disease
  4. HTN
657
Q

What antibodies are associated w Systemic Sclerosis (aka Scleroderma)? (4 things)

A
  1. ANA
  2. RF (30%)
  3. LIMITED: anti-centromere antibodies
  4. DIFFUSE: scl-70 antibodies
658
Q

What is some Tx for Systemic Sclerosis (aka Scleroderma)? (5 things)

A
  1. Methotrexate (immunosuppressant)
  2. Bisphosphonates (for Calcinosis)
  3. Emollients (Scleroderma)
  4. ACEi (for Renal complications)
  5. Nifedipine (for Raynauds)

M-BENA

659
Q

What is Temporal Arteritis? (2 things)

A
  1. Inflammation of temporal artery
  2. Pt with PMR get it
660
Q

What are the CF of Temporal Arteritis? (7 things)

A
  1. Headache
  2. Lethargy
  3. Pain at chewing
  4. Visual problems (blurring + diplopia)
  5. Tender + palpable temporal artery
  6. PMR cf: Morning stiffness (no weakness)
  7. Rapid onset (1 month)
661
Q

What will investigations tell you its Temporal Arteritis? (3 things)

A
  1. ESR + CRP raised
  2. Creatine kinase NORMAL (like in PMR)
  3. Temporal artery biopsy (skip lesions)
662
Q

What is the Tx for Temporal arteritis? (2 things)

A
  1. Urgent high dose steroids (even b4 biopsy)
  • Prednisolone (if no visual loss)
  • Methylprednisolone (@ visual loss)
  1. Bisphosphonates (to protect vs long term steroids above)
663
Q

What happens wen you give Trimethoprin (anti-folate) and Methotrexate? (2 things)

A
  1. Fatal Myelosuppression (w inf, anaemia, bleeding)
  2. Fatal Pancytopaenia (low Hb, RBC, platelets)
664
Q

What are the Urate crystals like in the joint aspiration in Gout? (3 features)

A
  1. Needle shaped
  2. Negatively birefringent
  3. Monosodium
665
Q

What are the crystals like in the joint aspiration in PSEUDOGOUT? (2 features)

A
  1. Weakly Positively birefringent
  2. Rhomboid-shaped crystals
666
Q

How do you reduce the risk of side fx with Methotrexate?

A

Take Folic acid with it

(das why taking trimethoprim aka anti-folate with it is bad)

667
Q

How should you manage Antiphospholipid syndrome?

A

If dx by accident w NO VTE (PE/DVT): Daily low dose aspirin

If dx after a VTE: Life long Warfarin

668
Q

What is Interferon-alpha used to treat?

A

Hepatitis B+C

669
Q

What are the side fx of Interferon-alpha?

A

Flu like symptoms

670
Q

If you’re starting someone on long term steroids, what should you also give them? (3 things)

A
  1. Bisphosphenates (alendronic acid)
  2. Vitamin D
  3. Calcium suppl

Bc steroids clart da bones in longterm

671
Q

When are NSAIDs CI in elderly pt?

A

If taking warfarin –> risk of GI bleeds

(so if dey have gout, give colchicine instead of NSAIDs)

672
Q

What are the investigation results for Osteoporosis and Osteogenesis Imperfecta?

A

Calcium, Phosphate, PTH, ALP

ALL NORMAL

673
Q

What does Sjogrens syndrome increase the risk of?

A

Lymphoid cancers aka Lymphoma

674
Q

What is the physical examination test for Ankylosing spondylitis?

A

Schober’s test less than 5cm

remember dat draw 3 X’s on da persons lower spine n get dem to bend forward

675
Q

How should you take Bisphosphonates? (3 things)

A
  1. Take 30 mins b4 breakfast
  2. Beh water pls
  3. Sit upright for 30 mins after
676
Q

What is an early X ray finding of RA?

A

Juxta-articular osteoporosis/osteopenia

677
Q

What conditions can cause Pseudogout? (2 things)

A
  1. HyperPTH (high PTH, high calcium, low phosphate)
  2. Acromegaly
678
Q

What are the Ca, P, PTH, ALP levels in Osteomalacia?

A

Low Ca

Low P

High PTH (bc low Ca)

High ALP (weak bone –> osteoblasts tryna fix it by secreting more ALP)

(remember osteomalacia low Ca n vit D)

679
Q

What are the Ca, P, PTH, ALP levels in Pagets disease of the bone?

A

Normal Ca

Normal P

Normal PTH

High ALP

Pagets disease = isolated rise in ALP

680
Q

What are the Ca, P, PTH, ALP levels in Hypo PTH?

A

Low Ca (bc low PTH)

High P

Low PTH

Normal ALP (bones are fine in hypo PTH)

681
Q

What are the Rotator cuff muscles of the shoulder? (4 things)

A
  1. Supraspinatus
  2. Infraspinatus
  3. Teres minor
  4. Subscapularis

SITS

682
Q

What is the function of the Supraspinatus?

A

Shoulder abduction before Deltoid

  • FIRST 20 degrees = supraspinatus
  • 20-90 degrees = Deltoid
  • Rest = trapezius
683
Q

What is the function of the Infraspinatus?

A

Lat rot

684
Q

What is the function of the Teres minor? (2 things)

A
  1. Adduction
  2. Lat rot (same as infraspinatus one above in SITS list lol)
685
Q

What is the function of the Subscapularis? (2 things)

A
  1. Adduction (same as Teres minor above it in SITS)
  2. Med rot
686
Q

What medications can increase the risk of Stress #s?

A

Bisphosphonates

even tho bisphosphonates r mena protect bone, dey cause stress #s, wow dis is STRESSful to learn

687
Q

What are the side fx of Sulfasalazine (DMARD)? (2 things)

A
  1. Oligospermia (low sperm count) (reversible)
  2. Lung fibrosis / pneumonitis
688
Q

What is the relation between Methotrexate and Pregnancy?

A

Both men AND women must stop Methotrexate 6 months before trying to conceive

689
Q

What is the NAME of the thing you will see on a XR of Ankylosing spondylitis?

A

Syndesmophytes

690
Q

What scoring system is useful for Ehlers Danlos?

A

Beighton score (assesses hypermobility)

691
Q

What is Fibromyalgia? (2 things)

A
  1. Widespread pain around body
  2. Tender points @ specific anatomical sites
692
Q

Who is most likely to have Fibromyalgia?

A

Women 30-50 yrs old

693
Q

What are the CF of Fibromyalgia? (3 things)

A
  1. Chronic pain @ random sites / all over
  2. Lethargy + Headaches + Sleep disturbance
  3. Cognitive impairment (dey call it Fibro fog cah fibroymyalgia)
694
Q

What is the Tx for Fibromyalgia? (4 things)

A
  1. Explanation
  2. CBT
  3. Aerobic exercise
  4. Meds: Pregabalin / Amitriptyline / Duloxetine (PAD)

is all in der head lol

695
Q

What Complement are assoc w SLE?

A

C3 n C4

will be LOW

696
Q

What does RA put you at the risk of?

A

IHD

remember rheumatic fever n all dat

697
Q

What does the Z score on DEXA scan take into account? (3 things)

A
  1. Age
  2. Gender
  3. Ethnicity
698
Q

What is the risk of giving Amoxicillin for sore throats?

What should you give instead?

A

If it’s Glandular fever (EBV), you will cause them Steven-Johnson Syndrome (painful rash + flu-like symptoms)

Penicillin V 500mg QDS 10 days

699
Q

Where is the shoulder pain in PMR?

A

Shoulder GIRDLE

700
Q

What should you suspect if Cancer + Raised CK?

A

Polymyositis

701
Q

What is a variant and antibodies for Polymyositis?

A

Subtype: dermatomyositis

anti-Jo-1 antibodies (Jo has bad skin)

702
Q

What are the complications of RA? (5 things)

A
  1. Eyes: Keratoconjunctivitis sicca / scleritis
  2. Heart: IHD
  3. Reps: Fibrosis / Pleural effusion
  4. Feltys Syndrome (RA + Splenomegaly + Low WBC)
  5. Joints: Osteoporosis
703
Q

What are the side fx of Methotrexate? (4 things)

A
  1. Mouth ulcers
  2. Lung fibrosis / Pneumonitis
  3. Lung fibrosis
  4. Myelosuppresion (esp w Trimethoprin)
704
Q

What should you check for before prescribing Azathioprine?

A

TPMT deficiency

(Thiopurine MethylTransferase Deficiency)

705
Q

What is the tx for Pseudogout? (3 things)

A
  1. NSAIDs
  2. Steroid inj
  3. Aspirate (to exclude septic arthritis)
706
Q

What can you give in bony metastases of cancer to prevent pathological #s? (2 things)

A
  1. Bisphosphonates
  2. Denosumab

Deno lol

707
Q

How do you manage acute RA flare ups?

A

IM methylprednisolone

708
Q

Why do you get Coca cola urine with Compartment syndrome? (6 steps)

A
  1. High pressure in fascial compartment
  2. Muscle breakdown
  3. Myoglobin released into blood stream (rhabomyolysis)
  4. Myoglobin deposits in Renal Tubules
  5. AKI
  6. Myoglobin –> Coca cola urine (+ve for blood)
709
Q

What scan should you do for sus osteomyelitis?

A

MRI

OsteoMRIlitis

710
Q

What is Squaring of thumbs a sign of?

A

OA

thumbs stiff in moring for a few minutes (not 1 hour like in RA)

711
Q

How do you manage subluxation of radial head (aka pulled elbow)

A

Passive supination of elbow joint whilst flexed @ 90 degrees

712
Q

What UTI abx can you use in 1st trimester, 3rd trimester, and breast feeding?

A

1st trimester = Nitrofurantoin

3rd trimester + breast feeding: Trimethoprim

(n before t in alphabet)

713
Q

What is an easy first line management for meningitis (aka raised ICP)?

A

Tilt head of bed to 30 degrees

714
Q

What meds can increase the hepatotoxicity of paracetamol overdose?

A

Carbamazepine (enzyme inducer)

Bc increases breadkdown of parcaetamol into NAPQI (toxic metabolite)

715
Q

What is the most common kidney cancer?

A

Renal adenocarcinoma

ima simple man, i see loin mass, i put renal adenocarcinoma

716
Q

What should you do for adult with sus hydrocele?

A

Refer urgently for US to see if tumour

hydrocele is fine to reassure in newborns only

717
Q

Which cancer is most commonly assoc w acanthosis nigricans (found in neck, groin, and armpit)?

A

Gastric adenocarcinoma

718
Q

How do you treat a SAH? (4 things)

A
  1. Coil (by interv neuroradiologist)
  2. Craniotomy (sometimes)
  3. Nimodipine (prevents Vasospasm) (finding nemo to stop spazzing)
  4. Ext ventricular draining / shunt (if Hydrocephalus)
719
Q

How do you confirm dx of Primary Sclerosing Cholangitis?

A

MRCP

720
Q

How do you differentiate between DI and SIADH?

A

Plasma conc HIGH = DI (rhymes lol)

Plasma conc LOW = SIADH

Also DI causes polyuria + polydypsia (siadh doesnt)

721
Q

What are the NICE guidelines for management of an Acute Stroke? (3 things)

A
  1. Thrombolysis (within 4.5 hours)
  2. Thrombectomy (within 6 hours)
  3. Tx dose Aspirin (if not suitable for thrombectomy)
722
Q

What do you give for Heroin (opioid) detoxification rehab? (2 things)

A
  1. Methadone
  2. Buprenorphine
723
Q

What do you give for Heroin (opioid) overdose?

A

Naloxone

OD means NalOXone

724
Q

What is the tx for Cellulitis?

  1. 1st line Mild moderate:
  2. Allergic to penicillin:
  3. Allergic to penicillin + pregnant:
  4. Severe:
A
  1. 1st line Mild moderate: Flucloxacillin
  2. Allergic to penicillin: Clarithromycin / Doxycline
  3. Allergic to penicillin + pregnant: Eryhtormycin
  4. Severe: Co-amoxiclav
725
Q

What is the tx for Otitis externa?

A

Topical Ciprofloxacin + Dexamethasone

abx + steroid

726
Q

What is the tx for acute Otitis media?

A

Oral amoxicillin

727
Q

What should you do for new onset dysphagia?

A

RED FLAG

URGENT ENDOSCOPY

regardless of age or other symptoms

728
Q

What is a side fx of Clozapine? (3 things)

A
  1. Constipation (clozapine constapine)
  2. Agranulocytosis (fatal low WBC)
  3. Reduced seizure threshold

(cah is a atypical antipsyhotic wid all da metabolic side fx)

729
Q

What is the tx for Acute stress disorder (aka pre PTSD)?

A

Trauma focused CBT

730
Q

What is Torticollis?

A

Stiff neck twisted in random position

Acute dystonia related side fx of Typical antipsychotics

731
Q

What is Somatisation disorder?

A

When patient keeps coming in w Symptoms for 2+ yrs

n refuses to accept reassurance of negative results

732
Q

What is hypoChondriasis?

A

When pt keeps believing they have Cancer

n refuses to accept negative results

733
Q

What should you give an ADULT vs CHILD wid anorexia nervosa? (3 + 1 things)

A

Adult:

  1. Eating disorder focussed CBT (ED-CBT)
  2. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
  3. Specialist Support Clinical Management (SSCM)

Child:

  1. Family based therapy
734
Q

What are the criteria for Anorexia nervosa dx? (3 things)

A

DSM 5 criteria

  1. Restricting dietary intake
  2. Fear of gaining weight
  3. Denying seriousness of low body weight
735
Q

What can be used with CBT in severe PTSD?

A

Eye Movement Desensitisation and Reprocessing (EMDR)

736
Q

What is the first line meds for PTSD if CBT n EMDR hasnt worked?

A

Venlaxafine (SNRI)

Sertraline (SSRI)

737
Q

What are the side fx of SSRI discontinuation? (3 things)

A
  1. Electric shock sensations
  2. Dizziness
  3. Anxiety

EDA, wagaftal fluoxetine?

(an egyptian saying: wts dis, u stopped ur fluoextine?

738
Q

What does the BNF say is the safer SSRI to use in ppl w unstable angina / post MI?

A

Sertraline

safe sertraline

739
Q

What is Imipramine?

A

Tricyclic antidepressant (TCA)

not used much for depression these days, more for neuropathic pain

740
Q

What are the side fx of Tricyclic antidepressants (e.g Amitriptyline / Imipramine)? (4 things)

A

Antimuscarinic side fx

  1. Can’t see = blurred vision
  2. Can’t pee = urinary retention + overflow incontinence
  3. Can’t spit = dry mouth
  4. Can’t sh** = constipation
741
Q

What are the Schneider first rank symptoms for Schizophrenia? (4 things)

A

A = Auditory hallucinations (2nd / 3rd person)

B = Broadcasting / thought withdrawal or insertion

C = Controlled (feel like der being controlled)

D = Delusional perception

742
Q

What is purging? (3 things)

A

Behaviour of bulimia that follows binge behaviour (over eating)

  1. Self induced vomiting
  2. Using laxatives
  3. Over exercisign
743
Q

What are the CF of Anorexia nervosa? (3 things)

A
  1. Low BMI
  2. Enlarged salivary glands
  3. Bradycardia + Hypotension
744
Q

What are the physiological abn that are RAISED in Anorexia Nervosa? (6 things)

A

Gs n Cs raised:

  1. GH (tryna compensate innit)
  2. Glucose (n LOW glucose tolerance)
  3. Salivary Glands
  4. Cortisol
  5. Cholesterol
  6. Carotinaemia (yellow skin)
745
Q

What are the physiological abn that are LOW in Anorexia Nervosa? (4 things)

A
  1. FSH
  2. LH
  3. Oestrogen / Testosterone
  4. Potassium

FLOP

746
Q

What should you give if taking a SSRI + NSAID?

A

Give PPI bc Gi bleed risk

747
Q

What should you think about with a pt on Prednisolone w Psychosis symptoms?

A

Steroid induced phsychosis

748
Q

What is the timeline for side fx stuff of Alcohol Withdrawal? (3 things)

A

Sypmtoms: 6-12 hours

Seizures: 36 hours

Delirium tremens: 72 hours

72-36-18 (half each time, n 6+12 is eighteen lol)

749
Q

What is contraindicated in SSRIs and why?

A

Triptans

can cause Serotonin syndrome

750
Q

What can chronic lithium toxicity cause?

A

Hypothyroidism

751
Q

What is a side fx of Benzodiazepines?

A

Anterograde Amnesia

752
Q

When a pt is abt to start ElectroConvulsive Therapy (ECT) what should you do to the Sertraline?

A

Reduce dose

753
Q

What do SSRIs cause if taken in pregnancy in 1st and 3rd trimester?

A

1st Trimester: Congenital heart defects

3rd Trimester: Persistant pulmonary HTN in baby

754
Q

What can Lithium do to the FBC?

A

Raise WBC

But its fine, dey acc use lithium for pt with chemo for cancer for dis specific reason

755
Q

What is the MOA of benzodiazepines?

A

Enhance effect of GABA (main inhibitory neurotransmitter)

756
Q

What class of antidepressant is Mirtzapine?

A

NaSSA

NASA goes to Mars (mirtzapine)

757
Q

What are some useful side fx of Mirtzapine?

A

Increased appetite (Mmm)

Sleepiness (Zzz)

MmmirtZzzapine

758
Q

What is the best CBT for Borderline?

A

Dialectical behaviour therapy (DBT)

das raacist der tryna say ppl with borderline have weird dialects

759
Q

How do you differentiate between Mania n Hypomania?

A

Mania lasts more than 7 days

Mania has psycho stuff like Auditory hallucinations / Delusions

760
Q

Which atypical antipsychotic is the most Appropriate to give bc least side fx?

A

Aripiprazole

Most Appropriate is Aripiprazole

761
Q

What are the results of scores of a Mini Mental State Examination (MMSE)?

A

Normal: 24 - 30

Mild Impairment: 20 - 23

Moderate: 10 - 19

Severe: 9-

762
Q

How long does ICD-10 say symptoms have to be present for for a Dx of depressive episode to be made?

A

2 weeks

#passmed 2022 (27 decks)

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