1
Q
what drug does azothioprine interact with to cause a pancytopenia
A
allopurinol
2
Q
interaction between azothioprine and allopurinol
A
pancytopenia
3
Q
interaction between statin and clarithromycin
A
clarithromycin increases effect of station - rhabdomyolysis
4
Q
interaction between methotrexate and trimethoprim
A
both folate antagonists - synergistic antifolate effects - pancytopenia
5
Q
can u inform DVLA about pt if they refuse to do so
A
yes - only if you have persuaded them to stop driving and made efforts. If they continue to drive u can inform DVLA
6
Q
conversion of oramorph to syringe driver morphine
A
divide by 2
7
Q
antiemetic for drug induced n+v
A
- dopamine antagonist (metoclopramide) or haloperidol
8
Q
antiemetic for motility disorders
A
- metoclopramide (its a prokinetic)
or - domperidone (if at high risk of EPSEs)
9
Q
antiemetic for raised ICP/movement related nausea
A
cyclizine
10
Q
antiemetic for multifactorial n+v
A
levomopromazine
11
Q
conversion of oral morphine to oral oxycodone
A
divide by 2
12
Q
oral morphine to SC oxycodone
A
divide by 4
13
Q
oral codeine to oral morphine conversion
A
divide by 10
14
Q
breakthrough dose
A
1/6th of total daily dose of morphine
15
Q
conversion oral tramadol to oral morphine
A
divide by 10
16
Q
oral morphine to SC diamorphine
A
divide by 3
17
Q
acute heart failure Tx
A
‘PODMAN’
position oxygen diuretic (furosemide 40mg stat) morphine anti-emetic nitrate
18
Q
chronic heart failure Mx
A
- ACEi + Beta-Blocker
- Spironolactone
- Ivabradine
- Digoxin or Hydralazine/Isosorbide mononitrate
(Loop Diuretic - furosemide for symptom relief)
19
Q
HTN Mx in preg
A
- labetalol
- methydopa
- nifedipine
20
Q
Mx of recently healed venous ulceration
A
graduated compression stocking
21
Q
Mx of enlarging ulcer in elderly pt with normal pulse and no venous problems
A
biopsy - suspected marjolin’s ulcer or SCC
22
Q
Mx of a multifactorial ulcer with ABPI of 2.1
A
toe brachial index (more accurate ABPI as diabetic pts have calcification of the crural vessels)
23
Q
Dx of a leg ulcer with brown patches
A
venous leg ulcer (haemosiderin staining)
24
Q
J waves on ECG
A
hypothermia
25
U waves ECG
hyperkalaemia
26
hypocalcaemia presentation
tetany
27
effect of autonomic neuropathy on ECG
sinus arrhythmia
28
aortic dissection causing inferior MI, 1st line tx?
CT
29
what is used to monitor response to pneumonia Tx
CURB65 score
30
CXR appearance of atypical pneumonia
patchy consolidation, often bilateral
31
emphysema with hyper expanded chest - apex beaT?
loss of apex beat
32
reversal of warfarin if major bleed
prothrombin complex and vit K
33
reversal of warfarin if minor bleed
vit K
34
reversal of warfarin if INR > 8 and no bleeding
stop warfarin and give Vit K
35
reversal of warfarin if INR 6-8 and no bleeding
withold warfarin and restart when INR <5.0
36
INR therapeutic range
between 2 and 3 (ideal 2.5)
37
initial Ix for ?pancreatic ca
abdo US
| gold standard diagnostic = CT
38
causes of oesophageal candidiasis
steroid inhalers
| immunosuppression
39
Ix for IBS
clinical diagnosis
do bloods to rule out other causes - FBC/ESR/CRP/coeliac screen
40
Ix for IBD
1. stool study - faecal calprotectin
2. ?UC - flexible sigmoidoscopy
?Crohn's - colonoscopy
41
Dx altered bowel habit - mass in elderly man with wt loss
colorectal ca
42
Dx altered bowel habit - constipation and bleeding with fleshy lumps palpable
haemorrhoids
43
Dx altered bowel habit - loose stools after ciprofloxacin
c. diff
44
Dx altered bowel habit - pain with passing stool and exquisitely tender PR
anal fissure
45
Ix for addisons diagnosis
short synacthen test
46
cause of proteinuria with Hx of recurrent UTI
reflux nephropathy
47
Ix of reflux nephropathy
MCUG
48
Mx complicated UTI
amox + gent
49
stepdown Tx complicated UTI
co-trimoxazole
50
Mx mild/mod CAP
amoxicillin PO
51
Mx severe CAP
co-amoxiclav + doxycycline
52
Mx CAP in HDU/ICU or NBM
co-amoxiclav + clarithromycin
53
Mx non severe HAP
amoxicillin PO
54
Mx severe HAP
amox + gent
55
Mx non-severe aspiration pneumonia
amox + met
56
Mx severe aspiration pneumonia
amox + met + gent
57
Mx giardiasis
metronidazole
58
Mx amoebiasis
metronidazole
59
Mx campylobacter
mild - no Tx
| severe - erythromycin
60
Mx E.coli 0157
no abx!
61
does everyone with salmonella get Abx?
no - only if:
> 50 y
immunocompromised
have cardiac valve disease
62
Abx Mx of salmonella
ciprofloxacin
63
cause of croup
parainfluenza
64
cause of bronchiolitis
RSV
65
GCS motor scoring
6. obeys commands
5. localises to pain
4. withdraws from pain
3. abnormal flexion to pain (decorticate)
2. extension to pain (decerebrate)
1. none
66
GCS verbal scoring
5. orientated
4. confused
3. words
2. sounds
1. none
67
GCS eye scoring
4. spontaneous
3. to voice
2. to pain
1. none
68
biceps reflex
C5
69
triceps reflex
C7
70
brachioradialis reflex
C6
71
knee jerk reflex
L4
72
ankle reflex
S1
73
visual defect - pituitary tumour
bitemporal hemianopia
74
visual defect - optic neuritis
ipsilateral central scotoma
75
visual defect - occipital cortex strok
contralateral homonymous hemianopia with macular sparing
76
CSF results - idiopathic intracranial HTN
normal
77
CSF bacterial meningitis
cloudy appearance
low glucose
high protein
polymorphs
78
CSF viral meningitis
clear appearance
60-80% of plasma glucose
normal protein
lymphocytes
79
CSF TB meningitis
slightly cloudy - 'fibrin web'
low glucose
high protein
lymphocytes
80
sudden shooting back pain while performing heavy lifting - Dx?
prolapsed disc
81
low-grade fever, local tenderness at L3 - Dx?
discitis
82
lorry drive, stiff and tender back pain - Dx?
mechanical back pain
83
hemiparesis with homonymous hemianopia with macular sparing - artery affected?
posterior cerebral artery
84
ataxia, decreased conscious level, facial muscle weakness, facial sensory loss - area affected?
pontine
85
nystagmus of right eye looking to right and failure of left eye to cross midline on looking to right - Dx?
internuclear ophthalmoplegia
86
internuclear ophthalmoplegia - sign of?
MS
87
Mx of DVT/PE in preg
LMWH - stop at onset of labour, continue for 3m postnatal
88
Dx of Downs at 16w gestation
amniocentesis
89
timing of amniocentesis
>15w
90
timing of chorionic villus biopsy
11.5-15w
91
who performs amniocentesis
obstetrician
92
who review pt at 6/52 post-natal
GP
93
who repairs 2nd degree perineal tear
midwife
94
who repairs 3rd degree perineal tear
obstetrician
95
who performs any labour other than just a nroaml vag delivery
obstetrician
96
who performs normal vaginal deliveries
midwives
97
who performs epidurals and pudendal nerve blocks
anaesthetists
98
arcuate scotoma
glaucoma
99
pt with SNHL after being in intensive care for severe sepsis - cause?
aminoglycoside toxicity (gentamicin)
100
SNHL with notch at 4000Hz - Dx?
noise induced HL
101
how long must symptoms be present for Dx of PTSD
3m
102
how long must symptoms be present for Dx of depressive ep
2w
103
adjustment disorder
'situational depression'
unable to cope with particular stress or life event
resolves once person is able to adapt
104
presentation of measles
rash in mouth - koplick spot's
| then rash starts behind ears and spread to whole body
105
presentation of scarlet fever
"strawberry tongue"
| sandpaper texture rash - torso first, spares palms and soles
106
Mx scarlet fever
penicillin V for 10d, can go back to school after 24h
107
presentation of rubella
maculopapular rash starts on face and spread to whole of body
108
child has an itchy, red rash and has a brother with asthma - Dx?
infantile eczema
109
purplish lesions on elbows in elderly man - Dx?
lichen planus
110
++ itch with ongoing Ix for GI problems - Dx?
dermatitis herpetiformis
111
T2DM with urinalysis of 2+ protein - what Ix to do next?
urinary albumin:creatine ratio
normal: <3.5 female, <2.5 male
112
Ix for addisons
short synacthen test
113
pt with HbA1c of 66 - what do u start them on
metformin
114
pt started on new diabetic drug, developed diarrhoea - what caused it
metformin
115
old man, acute exacerbation (breathless), is already on inhalers for asthma, CXR shows hyperinflation, ECG - sinus tachy, bilateral wheeze - next Ix?
peak flow
116
Mx primary spontaneous pneumothorax <2cm or asymptomatic
discharge
117
Mx primary spontaneous pneumothorax >2cm or symptomatic
needle thoracocentesis (aspiration)
if this fails - chest drain
118
Mx secondary spontaneous pneumothorax 0-1cm and aysymptomatic
give O2 and admit for 24h
119
Mx secondary spontaneous pneumothorax 1-2cm and asymptomatic
needle thoracocentesis (aspiration)
if this fails - chest drain
120
Mx secondary spontaneous pneumothorax if >2cm or symptomatic
chest drain
121
pt with bilateral LMN symptoms & loss of proprioception & vibration sense up to ankle. What tract
DCML
122
hemiparesis & hemisensory loss - what artery
anterior cerebral artery
123
presentation of CN III palsy
eye located down and out (they cannot adduct and elevate eye)
124
artery affected inferior MI
right coronary artery
125
artery affected anterior MI
left anterior descending
126
artery affected lateral MI
left circumflex
127
CXR appearance pulmonary oedema
ABCDE
```
Alveolar oedema (bats wings)
B kerley B lines
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion
```
128
critical limb ischaemia definition
advanced chronic limb ischaemia:
| chronic >2w ischaemic rest pain, necrosis or ulceration as a result of proven arterial disease
129
patient had anterior MI - they have congestive heart fialure symptoms, low Na and normal potassium - what sort of renal injury do they have?
renal hypoperfusion (pre renal aki)
130
sharp central chest pain worse on lying flat, relieved by leaning forward, had an infection - Dx?
pericarditis
131
pt with drooling and uvular deviation - Dx?
quinsy (peritonsillar abscess)
132
pt with all centor criteria present - Mx ?
penicillin 500mg
133
post-thyroidectomy, pt has hoarseness, what nerve has been affected?
recurrent laryngeal nerve (branch of vagus)
134
1st line Mx urge incontinence
1. bladder training
2. anti-muscarinics e.g. oxybutinin, tolteridine
3. b3 agonists e.g. mirabegron
135
1st line Mx stress incontinence
pelvic floor exercises
136
what is the active 1st stage of labour
from 4cm - full dilation
137
GDM - lifestyle advice has been given (lost 3kg) but finger prick is still 8-14 - what do you start?
metformin
138
eclampsia 1st line Mx
magnesium sulphate 4g IV over 5-10mins
then infusion of 1g/hr.
continue Tx for 24h after last seizure
139
fishy smelling discharge, pH 5.5 - Dx?
bacterial vaginosis - give metronidazole
140
Mx for kid with facial non-infective eczema
hydrocortisone 1%
141
Mx oesophageal candidiasis
nyastatin suspension
142
Ix for HSP
U&Es (renal involvement)
143
kid who is overwght, snores, daytime somnolence and only breathes through their mouth - Dx?
adenoidal hypertrophy
144
rptd unilateral rhinorrhoea - Dx?
foreign body
145
Fhx of asthma, single crease on nose - Dx?
allergic rhinitis
146
achilles tendon rupture - Ix?
ultrasound
147
s/e of risedronate that means you need to discontinue the drug
oesophagitis or oesophageal ulcer
148
pt had painful red eye with nausea and headache - Ix?
check IOP (AACG?)
149
pt been to malawi - 2w later has swinging fevers and rigors - what Ix?
thick and thin blood film - ?malaria
150
pt presents with reactive arthritis (cant see, cant pee, cant climb a tree) - what Ix?
chlamydia screen
151
Mx if pt's INR on warfarin is 6.1 and there is no bleed
omit warfarin and review INR
152
Mx if pt's INR is 8.1 on warfarin and they have an active GI bleed with Hb 11.1 and plt 156
FFP
153
Ix for pt with back pain and high calcium
electrophoresis - ?multiple myeloma
154
male, smoker with loin pain, haematuria and abdo mass - Dx?
RCC
155
20y old who moved to UK from afghan recently, has # of pubic ramus.
high PTH, low Ca, high PTH - what next best Ix?
check Vit D level
156
Left side BC>AC
webers lateralises to the left
right side AC>BC
whats the problem?
left conductive deafness§
157
Mx drug induced parkonsonism
procyclidine
158
OD and dont know what - tinnitus, tachy, not hypotensive, sweating - what drug have they probably takne?
aspirin
159
pt with ascites - has fever and generalised abdo tenderness - Dx?
spontaneous bacterial peritonitis
160
35 y/o with 5y Hx of alternating diarrhoea and constipation - Dx?
IBS
161
pt 72h post-ip with generalised abdo tenderness, has not passed stool and no bowel sounds heard - Dx and Ix?
functional ileus
Ix - CT abdo/pelvis
162
CXR provided (squamous cell ca) + hyponatraemia - Dx?
SIADH
163
Most appropriate first Ix for PE
D dimers
164
pt with sinusitis, haemoptysis, urinary problems & cANCA
GPA
165
Mx otitis media
delayed Abx - amoxicillin
166
Ix to diagnose anaphylaxis
serum tryptase
167
pt on triple insulin in the day + lantus in the evening. they are preop. how do you change the lantus dose?
continue on original dose
168
biphasic insulin before lunch is low (BG=2.1), what do you change?
give lucozade and change morning dose
169
SIADH test
urine:serum osmolality
170
pt with symptoms of diabetes, fasting and OGTT done - fasting is normal (<6) and OGTT 8.5 - Dx?
impaired OGTT (pre DM)
171
pt with big jaw and teeth growing apart - what visual deformity is expected?
bitemporal hemianopia
172
34 yo female, never had children, has high LH and FSH, low oestradiol and no menses for 4m - Dx?
premature ovarian failure
173
53 y/o, hot flushes, sweats, amenorrhoea for 7m - what HRT do you give?
cyclical combined HRT
174
symptoms of a perimenopausal lady
hot flushes, has irregular periods
175
lady ovuatory, seems well, tried for 18m, male fit and well - what first Ix do you do for infertility?
semen analysis
176
lady 8w preg, os is open with POC visible, US shows non viable preg, doesnt want to watch and wait - what do you do?
give misoprostol
177
AXR given (dilated loops - small bowel - venae commintantes), Hx of abdo hysterectomy 15y ago, hernia fixation 2y ago - Dx?
obstruction due to adhesions
178
mother on methadone, what would u expect in baby
withdrawn and inactive baby
179
mother took alcohol in preg what symptoms expected in baby
agitated baby
180
pt post-hysterectomy, has numbness over medial thigh - what nerve is affected
obturator nerve
181
binge eating + compensating - Dx?
bulimia
182
pt cant look down and in - what CN
CN IV (eye floats upwards and head tilts)
183
kid with strabismus - if they close their right eye their left eye moves in - what do they have
left exotropia (the eye is out and you see inward movement) - divergent squint
184
pt with SCZ, has been changed from risperidone to olanzapine and has wt gain. Has tried other drugs and they dont work - who to refer to?
dietician
185
pt has vascular dementia and wants independence - who to refer to?
OT
186
old man wants to move into care home - who can help?
care home liason nurse
187
leg ulcer with ABPI of 1.1 - Mx?
compression stockings (ABPI is normal, therefore can do compression as probable venous)
188
diabetic foot ulcer over 1st MT, XR shows bone changes and is dischaging - Mx?
IV Abx - osteomyelitis
189
prostate ca - sudden onset bilateral leg weakness, saddle anaesthesia and urinary incontinence - Dx?
spinal cord compressoin
190
pt lifts up arm and has dimpling present - Dx?
breast ca
191
what do you warn a pt who is about to undergo XRT for prostate ca
rectal bleed? dysuria?
192
Tx for hodgkin's lymphoma
biological chemo
193
pt with peripheral neuropathy - blood Ix show macrocytosis - what do you Tx with?
hydroxcobalamin (b12 deficiency)
194
kardex provided - problems with it?
furosemide @ 10pm
Penicillin allergy - stop co-amoxiclav
has rhabdo - stop statin
195
medication used to induce labour if cervix closed
misoprostal
196
post-coital bleeding in 8w preg lady?
cervical ectropion
197
severe RIF pain, bHCG -ve - Dx?
ovarian torsion
198
lady with Cu coil just inserted, has pain, septic on speculum has red cervix with discharge - Dx?
uterine perforation
199
regular narrow complex tachy. vagal manoeuvres have failed - what is the next step?
IV adenosine
200
ECG after burns. What is the cause for his ECG appearance?
hyperkalaemia
201
rate control of AF
bisoprolol
202
old man with PMR on steroids - cause of hyperlipidaemia?
corticosteroid Tx
203
47y/o male with MI, achilles tendon was thickened cause of hyperlipidaemia?
familial hypercholesterolaemia
204
lady with temporal epilepsy.
Pre-statin she has high cholesterol,
Post 80mg of atorvastatin she has only had a small reduction in lipids - cause?
drug-induced
205
Mx campylobacter diarrhoea
erythromycin
206
50 yo female with RUQ pain. USS showed thickened gallbladder and stones in cystic duct. Comes back for rv, pain free. What to Ix to do?
MRCP
207
AMA +ve - Dx?
PBC
208
16w old baby, fever and irritable lasting for 24h after immunisation which started 3h after immunisation. Precautions for next immunisation?
no precautions required
209
Extensive bowel cancer disease, cannot take PO. He has back pain which was controlled with max codeine before but now in pain (cannot take the meds orally). Normal renal function. What do you change this to?
CSCI morphine
210
pt with multiple stuck on keratotic lesions on her neck - first thing you would do?
reassurance (seborrhoeic keratosis)
211
whole fam have itch, mother has interdigital eczema, grandma has crusty itchy palms and 2y old has itchy palms and soles. Tx?
permethrin (scabies)
212
ECG most common in pulmonary embolism
sinus tachy
213
chronic counterpart of guillain barre syndrome
chronic inflammatory demyelinating polyneuropathy (CIDP) - develop over 6m
214
bells palsy Tx
steroids - oral pred
215
48y/o male with changes in behaviour (aggressive to wife), trouble with moving, disinhibited
picks disease
216
viral infection, hearing loss and vertigo - Dx?
labyrinthitis
217
guy in garden, suddenly dizzy and dropped tools and staggered home. nystagmus. headache started a while later. Dx?
cerebellar stroke
218
boxer, cannot look up nose
nasal septal haematoma
219
RTA, airbag hit face. face oedematous and eye painful. slowly losing vision
orbital haematoma
220
22 y/o post infection, noticed mass at lower 1/3 anteromedial aspect of SCM - Dx?
branchial cyst
221
plummer vinson syndrome
```
difficulty swallowing
iron deficiency anaemia
glossitis
cheilosis
oesophageal webs
```
222
causative agent of dendritic ulcer
herpes simplex
223
Mx dendritic ulcer
topical aciclovir
224
presentation of keratoconjunctivitis sicca
punctate lesion on conjunctiva and cornea
225
antidepressant medications taken in OD. pt is hyper-reflexic, tachycardic and pupils dilated. Tx?
IV sodium bicarb (TCA overdose)
226
pt hyperkalaemic - what HTN drug cant they be on
ACEi
227
teenager with DKA, BM 18 and is hypotensive what is your initial Tx?
IV fluids
228
mnemonic for brachial plexus nerves
my aunty raped my uncle
```
musculocutaneous
axillary
radial
median
ulnar
```
229
nerve roots muculocutaneous nerve
C5,6,7
230
nerve roots axillary nerve
C5,6
231
nerve roots radial nerve
C5-T1
232
nerve roots median nerve
C5-T1
233
nerve roots ulnar nerve
C8-T1
234
what does a ratio concentration of drug mean (e.g. 1:1000)
number of grams in mls of solution
e.g. 1g of adrenaline in every 1000mls of saline
235
what does a % solution of a drug mean
grams of drug per 100mls of solution
236
what does 1g = ? in mls
1 ml
237
what does 1 ml = ? in g
1g
Finals Studying - Condensed
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