1
Q
What is the recommended target rate of fall of plasma osmolarity per hour in a patient with hyperosmolar hyperglycaemic state?
A
3–8 mosmol/kg per hour
This rate is crucial for safe management of the condition.
2
Q
Name two autoantibodies that may be measured to help confirm type 1 diabetes.
A
- Anti GAD antibodies
- Islet cell antibodies (ICA)
Anti GAD antibodies are the most common.
3
Q
Name one second line antibiotic used as an adjunct to lactulose in hepatic encephalopathy.
A
Rifaximin
Rifaximin helps reduce ammonia-producing bacteria.
4
Q
In SBP, what investigation is required to confirm the diagnosis, and what cell count in the fluid is diagnostic?
A
- Diagnostic ascitic tap
- Neutrophils ≥ 250 cells/mm³
This cell count indicates infection in the ascitic fluid.
5
Q
What two laboratory tests are used in combination to confirm C. difficile infection?
A
- GDH antigen test
- C. difficile toxin assay
These tests help in accurate diagnosis of the infection.
6
Q
Name one severity scoring system used in the first 48 hours to predict prognosis in acute pancreatitis, and list three of its criteria.
A
Glasgow (Imrie) score
* PaO₂ < 8 kPa
* Age > 55 years
* WCC > 15 × 10⁹/L
The Glasgow score helps assess the severity and prognosis of acute pancreatitis.
7
Q
Why does rapid glucose improvement worsen retinopathy in pregnancy?
A
Causes retinal hypoxia + elevated VEGF → paradoxically worsens retinopathy
8
Q
Bacterium causing inflammatory acne lesions?
A
Cutibacterium acnes
9
Q
Non-pharmacological acne advice?
A
pH-neutral cleanser twice daily / avoid oil-based products / don’t pick
10
Q
Why do duodenal ulcers bleed more than gastric?
A
Erodes gastroduodenal artery
11
Q
Endoscopic treatments for bleeding peptic ulcer?
A
Adrenaline injection / clipping / thermal coagulation / fibrin
12
Q
Post-endoscopy rebleeding score?
A
Rockall score
13
Q
TCA overdose → dilated pupils mechanism?
A
Anticholinergic (blocks parasympathetic ACh)
14
Q
TCA overdose → seizure treatment?
A
IV lorazepam / rectal diazepam / buccal midazolam
15
Q
TCA overdose → ventricular dysrhythmia treatment?
A
IV sodium bicarbonate
16
Q
Xanthochromia — what causes it?
A
Bilirubin from RBC breakdown
17
Q
Where is CSF located?
A
Subarachnoid space (between pia mater and arachnoid)
18
Q
SAH risk factors?
A
Smoking / alcohol / Black ethnicity / family history / cocaine / connective tissue disorder / AVM
19
Q
Who sections a patient under the MHA?
A
Section 12 doctor + AMHP
20
Q
Olanzapine side effects?
A
Weight gain / hyperglycaemia / prolonged QT / movement disorders / gynaecomastia
21
Q
Key blood test in NMS?
A
Raised CK (+ leukocytosis)
22
Q
GCS — eyes to pain, confused speech, withdraws from pain?
A
E2 + V4 + M4 = 10
23
Q
Examination signs of raised ICP?
A
Cushing’s triad (bradycardia / widened pulse pressure / irregular breathing) / fixed dilated pupils / papilloedema
24
Q
3 approaches to health needs assessment?
A
Epidemiological / corporate / comparative
25
First-line test for gonorrhoea in men?
NAAT on first catch urine (NOT mid-stream)
26
Follow-up after gonorrhoea treatment?
Test of cure
27
Transtheoretical model — specific plan to change within 2 weeks?
Preparation stage
28
Maintenance fluid rate?
1L over 6–8 hours
29
Furosemide — raises or lowers potassium?
Lowers
30
DKA diagnostic criteria?
Glucose >11 / ketones >3 (or 2+ urine) / pH <7.3 or HCO3 <15
31
DKA symptoms (not nausea/vomiting/pain/hyperventilation/confusion)?
Polyuria / polydipsia / pear drop breath / fatigue / blurry vision / diarrhoea
32
Large volume saline complication on blood gas?
Hyperchloraemic metabolic acidosis
33
PE imaging delayed — what to do?
Treatment dose DOAC
34
Thrombus at pulmonary artery bifurcation?
Saddle PE
35
How to write the PE scan investigation?
CT pulmonary angiogram (not CTPA)
36
2 causes of mediastinal widening?
Aortic aneurysm / lung mass / thymoma / lymphadenopathy / pneumomediastinum
37
Murmur in aortic dissection?
Early diastolic decrescendo — left sternal edge (aortic regurgitation)
38
AAA screening — type of prevention?
Secondary prevention
39
Criteria to evaluate a screening programme?
Wilson and Jungner criteria
40
What monoclonal antibody is used for RSV prophylaxis in high‑risk infants?
Palivizumab
41
If oral steroids cannot be given in croup, which routes are accepted?
✅ Intramuscular dexamethasone
✅ Inhaled (nebulised) budesonide
🚫 Not accepted: “IV steroids” (unless specifically listed)
42
After what age of onset is neonatal jaundice considered physiological?
After 24 hours of life
43
Name causes of neonatal jaundice presenting in the first 24 hours.
✅ Rhesus incompatibility
✅ ABO incompatibility
✅ G6PD deficiency
✅ Hereditary spherocytosis
🚫 Not accepted: Hepatitis
44
What are the four anatomical components of Tetralogy of Fallot?
✅ Ventricular septal defect
✅ Pulmonary stenosis (RV outflow obstruction)
✅ Overriding aorta
✅ Right ventricular hypertrophy
🚫 Not a component: Pulmonary hypertension
45
What operation is used to treat duodenal atresia?
Duodenoduodenostomy
46
By what age should an infant be able to sit unsupported?
By 8 months
47
By what age should a child be walking independently?
18 months
48
What is the most common type of atrial septal defect?
Ostium secundum
49
Which drugs are used acutely to treat a Tet spell?
✅ Propranolol
✅ Morphine
🚫 Not accepted: Bisoprolol (too non‑specific)
50
What is the initial surgical procedure for tricuspid atresia?
Blalock–Taussig shunt
51
Anterior Uveitis – Irregular Pupil
Posterior synechiae → adhesions between the iris and lens
52
Anterior Uveitis – Treatment Classes
Topical corticosteroids (e.g. prednisolone drops) Cycloplegics / mydriatics (e.g. cyclopentolate)
53
RAPD – How to Describe It (Not Just Name It)
Using the swinging flashlight test: → When light moves to the affected eye, both pupils dilate instead of constricting
54
Optic Neuritis – Supportive Test
Visual evoked potentials (VEPs)
55
Which hand joints are typically involved in **OA** but spared in **RA**?
* DIP joints
* 1st CMC (base of thumb)
## Footnote
Exam trap: MCP joints = RA, not OA.
56
Is **ulnar deviation** an X‑ray feature or an examination finding?
✅ Examination finding (RA)
❌ Not an X‑ray feature
## Footnote
Rule: X‑ray = bones & joint space; Deformities = examination.
57
Name two **X‑ray features** of RA NOT seen in OA.
* Joint erosions
* Peri‑articular osteoporosis
* (also acceptable: soft‑tissue swelling, uniform joint space narrowing)
## Footnote
These features help differentiate RA from OA.
58
Name TWO **biopsy findings** in giant cell arteritis.
* Granulomatous inflammation
* Multinucleated giant cells
## Footnote
Exam rule: If it says name TWO, always force yourself to give TWO — even if unsure.
59
What are core features of **inflammatory back pain**? (pick any 4)
* Onset < 40 years
* Duration > 3 months
* Morning stiffness >30–60 min
* Improves with exercise
* Does NOT improve with rest
* Night pain (second half of night)
## Footnote
Not accepted: “Responds to analgesia.”
60
Best **biologic class** after NSAID failure in axial spondyloarthritis?
* Anti‑TNF agents (first line)
* IL‑17 inhibitors (alternative)
## Footnote
Default exam answer: ➡️ Anti‑TNF.
61
Which is an **absolute contraindication** to methotrexate?
* Pregnancy
* Severe liver disease
* Severe renal impairment (eGFR <30)
* Active serious infection
## Footnote
NOT absolute: Malignancy.
62
What test screens for **latent TB** before anti‑TNF therapy?
* IGRA / Quantiferon‑TB Gold
* Mantoux
* Chest X‑ray
## Footnote
One‑word exam win: ➡️ IGRA.
63
Name ONE alternative to **bisphosphonates** for osteoporosis.
* Denosumab
* Teriparatide
* Raloxifene
* Romosozumab
## Footnote
Most common exam answer: ➡️ Denosumab.
64
Most common cause of **native joint septic arthritis** in adults?
* Staphylococcus aureus
## Footnote
Exam reflex: Septic arthritis → Staph aureus unless told otherwise.
65
Give TWO **indications for surgical washout** in septic arthritis.
* Failure of aspiration + antibiotics
* Hip joint involvement
* Loculated / multiloculated effusion
* Prosthetic joint infection
## Footnote
Too vague: “Risk of joint damage” (needs specifics).
66
What is a common cause of **iron deficiency anaemia** in adult men and postmenopausal women?
* Chronic gastrointestinal blood loss
* Colorectal cancer
* Peptic ulcer disease
* NSAID-related bleeding
* Coeliac disease
## Footnote
These conditions can lead to significant blood loss, contributing to iron deficiency anaemia.
67
What is the **immunological mechanism** behind an **acute haemolytic transfusion reaction**?
Recipient IgM antibodies bind donor red blood cells → activate complement → intravascular haemolysis
## Footnote
This reaction can lead to serious complications during blood transfusions.
68
What is the mechanism of a **febrile non‑haemolytic transfusion reaction**?
Cytokine release from donor leukocytes or recipient antibodies reacting with donor white cell antigens
## Footnote
This reaction is often less severe than haemolytic reactions.
69
What is the **initial management** for a **febrile non‑haemolytic transfusion reaction**?
* Pause transfusion
* Give paracetamol
* Restart cautiously if symptoms resolve
## Footnote
These steps help to manage symptoms and ensure patient safety.
70
What deficiency is associated with **Haemophilia A**?
Factor VIII deficiency
## Footnote
This type of haemophilia is the most common and affects blood clotting.
71
What deficiency is associated with **Haemophilia B**?
Factor IX deficiency
## Footnote
This type of haemophilia is less common than Haemophilia A.
72
What is the **reversal agent** for **Dabigatran**?
Idarucizumab
## Footnote
This agent is used to reverse the effects of Dabigatran in cases of bleeding or emergency surgery.
73
First‑line **imaging** in suspected acute stroke?
Non‑contrast CT head
## Footnote
This imaging technique is crucial for initial assessment.
74
Which **NIH Stroke Scale** component assesses communication?
Speech / best language
## Footnote
This component evaluates the patient's ability to communicate effectively.
75
Why is **lorazepam** first‑line in status epilepticus?
Rapid GABA‑A–mediated seizure termination
## Footnote
Lorazepam acts quickly to control seizures.
76
Name a **second‑line drug** for status epilepticus.
* Phenytoin
* Levetiracetam
* Sodium valproate
## Footnote
These medications are used if lorazepam is ineffective.
77
UK **seizure‑free period** before driving (Group 1 licence)?
6 months
## Footnote
This is the required duration for safety regulations.
78
What **lifestyle factor** lowers seizure threshold?
Stress
## Footnote
Stress can trigger seizures in susceptible individuals.
79
Name a **teratogenic risk** of sodium valproate.
Neural tube defects
## Footnote
Sodium valproate poses risks during pregnancy.
80
Characteristic **CSF finding** in Guillain‑Barré syndrome?
Raised protein with normal white cell count
## Footnote
This finding is indicative of the syndrome.
81
**Respiratory measurement** to monitor in Guillain‑Barré syndrome?
Forced vital capacity (FVC)
## Footnote
Monitoring FVC is essential for assessing respiratory function.
82
**Disease‑modifying treatments** for Guillain‑Barré syndrome?
* IV immunoglobulin
* Plasma exchange
## Footnote
These treatments can help reduce the severity and duration of the syndrome.
83
Name an **autonomic complication** of Guillain‑Barré syndrome.
* Urinary retention
* Blood pressure lability
* Arrhythmias
## Footnote
These complications can significantly affect patient management.
84
Drug class that **worsens Parkinson’s disease** motor symptoms.
Dopamine antagonists
## Footnote
These drugs can exacerbate symptoms in Parkinson's patients.
85
Name the phenomenon where **MS symptoms** worsen with heat.
Uhthoff’s phenomenon
## Footnote
This phenomenon is a common experience for many MS patients.
86
What is **dissemination in space** in multiple sclerosis?
Lesions in two or more different CNS areas
## Footnote
This criterion is used for diagnosing MS.
87
What is **dissemination in time** in multiple sclerosis?
Lesions occurring at different time points
## Footnote
This indicates the chronic nature of the disease.
88
Name two **disease‑modifying therapies** for multiple sclerosis.
* Interferon‑beta
* Glatiramer acetate
## Footnote
These therapies help manage MS progression.
89
Name a **non‑visual symptom** of multiple sclerosis.
Limb weakness
## Footnote
MS can present with various neurological symptoms beyond vision.
90
Name a **medical treatment** to reduce raised intracranial pressure.
Mannitol
## Footnote
Mannitol is an osmotic diuretic used in emergency settings.
91
A shocked patient with tearing abdominal pain, hypotension, and a pulsatile abdominal mass — what is the full diagnosis?
Ruptured abdominal aortic aneurysm
92
Which blood tests are included in the Alvarado score?
White cell count and neutrophilia
93
Which types of information does the Alvarado score use?
Symptoms, physical signs, and lab results (WCC/neutrophils)
94
On abdominal X‑ray, which bowel obstruction shows loss of haustra?
Large bowel obstruction
95
What are three classic X‑ray features of small bowel obstruction?
Central dilated loops, valvulae conniventes crossing full width, step‑ladder air–fluid levels
96
Which anatomical landmark distinguishes inguinal from femoral hernia on exam?
Pubic tubercle
97
Inguinal
above and medial
98
Femoral
below and lateral
99
Name two true types of hernia other than inguinal.
Femoral, umbilical (also acceptable: incisional, epigastric, Spigelian, obturator, hiatus)
100
RUQ pain, fever, and inspiratory arrest on palpation — what is the most likely diagnosis?
Acute cholecystitis
101
What is Murphy’s sign and how is it performed?
Pain‑related arrest of inspiration when deep breathing while palpating the right upper quadrant
102
What ultrasound findings support acute cholecystitis?
Gallstones, wall thickening >3 mm, pericholecystic fluid, distended gallbladder, sonographic Murphy’s sign
103
A patient becomes febrile with a rigid abdomen on day 5 after colorectal surgery — what complication is most likely?
Anastomotic leak
104
What is the investigation of choice to diagnose an anastomotic leak?
CT abdomen and pelvis with IV contrast
105
Name two important post‑operative risk factors for DVT in an older male patient.
Major abdominal surgery, malignancy (also valid: immobility, age, obesity, prior DVT)
106
What are standard mechanical methods of post‑operative DVT prophylaxis?
Graduated compression stockings, intermittent pneumatic compression
107
Which pharmacological agents are commonly used for post‑operative DVT prophylaxis?
Low‑molecular‑weight heparin, unfractionated heparin
108
In a patient with colicky pain, vomiting, and prior abdominal surgery, what obstruction should be named precisely?
Small bowel obstruction
109
What is the EF threshold for HFpEF?
≥50% (not >50%)
110
Which diuretic is NOT a standard symptom-relieving drug in heart failure?
Thiazide diuretics — correct answers are loop diuretics, digoxin, or nitrates
111
What are the four 1-point criteria in CHA₂DS₂-VASc?
Congestive heart failure, Hypertension, Age 65–74, Diabetes, Vascular disease, Female sex (any four)
112
What are the two 2-point criteria in CHA₂DS₂-VASc?
Age ≥75 and prior stroke/TIA/thromboembolism
113
What is the penicillin allergy regimen for native valve infective endocarditis?
Vancomycin + gentamicin
114
What are the units for aortic valve area?
cm² (not cm³)
115
What is an absolute contraindication to aortic valve replacement in any form?
Life expectancy less than 12 months / terminal illness / patient refusal
116
Where does the escape pacemaker sit in complete heart block with broad complex escape rhythm?
Below the bundle of His — bundle branches / Purkinje fibres / ventricular myocardium
117
What is the immediate drug treatment for haemodynamically unstable complete heart block?
Atropine 500 micrograms IV rapid bolus
118
What is the definitive treatment for Mobitz type II and complete heart block?
Permanent pacemaker implantation
119
What is the name of the re-entry circuit responsible for SVT?
AV nodal re-entrant tachycardia (AVNRT)
120
What is the mechanism by which vagal manoeuvres terminate SVT?
Increase parasympathetic tone → slows AV node conduction → increases AV node refractory period → interrupts the re-entry circuit
121
How must adenosine be given?
Rapid IV bolus into a large proximal vein followed by a saline flush
122
Name two absolute contraindications to adenosine
Severe asthma, second or third degree AV block, sick sinus syndrome, WPW with AF (any two)
123
What structure is targeted during ablation for AVNRT?
The slow pathway of the AV node
124
What ECG finding suggests an accessory pathway rather than AVNRT?
Delta waves / slurred upstroke of the QRS on resting ECG (Wolff-Parkinson-White pattern)
125
What is the single most important clinical factor distinguishing VT from SVT with aberrancy?
Structural heart disease / previous MI / impaired ejection fraction
126
Name three ECG features favouring VT over SVT with aberrancy
QRS duration >160ms, AV dissociation, concordance across V1–V6 (also: capture beats, fusion beats, northwest axis)
127
What does synchronised mean in DC cardioversion and why does it matter?
The shock is timed to the QRS complex — unsynchronised shock landing on the T wave can cause VF
128
What investigation confirms adrenal lateralisation in primary hyperaldosteronism?
Adrenal vein sampling (not renal vein sampling)
129
What is the first-line medical treatment for primary hyperaldosteronism?
Mineralocorticoid receptor antagonist (MRA) e.g. spironolactone or eplerenone
130
What investigation confirms fibromuscular dysplasia as a cause of renal artery stenosis?
CT renal angiography / MR renal angiography / duplex renal artery ultrasound
131
What are recognised causes of chronic kidney disease?
Hypertension, diabetes mellitus, glomerulonephritis, polycystic kidney disease, renovascular disease, obstructive uropathy.
132
What is nephrotic syndrome classified as?
A clinical syndrome characterised by proteinuria, hypoalbuminaemia, oedema, and hyperlipidaemia.
133
What treatments are used for CKD–mineral bone disorder?
Phosphate binders, active vitamin D analogues (alfacalcidol or calcitriol), dietary phosphate restriction, cinacalcet, parathyroidectomy in refractory disease.
134
What are life‑threatening complications of acute kidney injury?
Hyperkalaemia, pulmonary oedema, severe metabolic acidosis, uraemic encephalopathy, uraemic pericarditis.
135
What is the diagnosis in prolonged immobility with brown urine and AKI?
Rhabdomyolysis.
136
What blood test is characteristically elevated in rhabdomyolysis?
Creatine kinase (CK).
137
What investigations are urgent in suspected rapidly progressive glomerulonephritis?
ANCA, anti‑GBM antibodies, complement levels (C3/C4), ANA.
138
What are complications of nephrotic syndrome?
Venous thromboembolism, infection, acute kidney injury, hyperlipidaemia.
139
How should pain be described in acute pyelonephritis?
Loin or flank pain with renal angle tenderness.
140
What clinical features distinguish pyelonephritis from lower UTI?
Fever, rigors, flank pain, nausea or vomiting, systemic illness.
141
What level of diagnostic detail is required in exam answers?
A specific diagnosis or complication using precise medical terms.
142
What type of tests are prioritised when glomerulonephritis is suspected?
Immunological blood tests and renal biopsy.
143
What is the FIRST drug to give in an **acute asthma attack**?
Oxygen 15L/min via non-rebreather mask
## Footnote
Not salbutamol. Not steroids. Oxygen first. Always.
144
What are the **3 drugs + doses** in acute asthma?
* Oxygen — 15L/min, non-rebreather mask
* Salbutamol — 2.5–5mg nebulised
* Prednisolone — 40–50mg oral OR hydrocortisone 200mg IV
## Footnote
These are the standard treatments for managing an acute asthma attack.
145
What are the **2 first-line drug classes** that reduce mortality in heart failure?
* ACE inhibitors (or ARBs)
* Beta-blockers
## Footnote
SGLT-2 inhibitors improve outcomes but are asked separately.
146
Name **2 lifestyle modifications** for heart failure.
* Smoking cessation
* Reduce alcohol
* Exercise
* Weight loss
* Reduce salt intake
## Footnote
'Blood pressure control' is not accepted — that is medical management, not lifestyle.
147
What is the definition of a **stroke**? (Learn this word for word)
A rapidly developing focal neurological deficit of vascular origin lasting over 24 hours or resulting in death.
## Footnote
TIA = same definition but resolves within 24 hours.
148
Which artery causes **right-sided weakness + facial droop + aphasia**?
Left middle cerebral artery (MCA)
## Footnote
The internal carotid feeds into the MCA — but the infarcted artery is the MCA itself.
149
MCA infarct vs ACA infarct — which limb is affected more in each?
* MCA = upper limb + face affected more
* ACA = lower limb affected more
## Footnote
This distinction is important for understanding the clinical presentation of strokes.
150
Broca's aphasia — can the patient **speak or understand**?
Can understand. Cannot speak.
## Footnote
Memory tip: Broca's = Babbling is broken.
151
Wernicke's aphasia — can the patient **speak or understand**?
Can speak (fluent nonsense). Cannot understand.
## Footnote
Memory tip: Wernicke's = Words don't make sense to them.
152
Left hemisphere stroke — which **visual field** is lost?
Right homonymous hemianopia
## Footnote
Always state the side. 'Homonymous hemianopia' alone will not get the mark.
153
What causes **bitemporal hemianopia**?
Optic chiasm compression e.g. pituitary tumour
## Footnote
This is NOT caused by a stroke.
154
In a fractured neck of femur — which way does the leg **rotate**?
Externally rotated (outward)
## Footnote
NOT internally rotated. The external rotator muscles pull the leg outward.
155
Why is an **intracapsular hip fracture** clinically significant?
The retinacular arteries (not femoral artery) are disrupted → blood supply to femoral head is compromised → risk of avascular necrosis
## Footnote
Understanding the implications of this fracture type is crucial for management.
156
What **classification system** grades intracapsular hip fractures?
Garden classification (Grades 1–4)
## Footnote
Grades 1–2 = undisplaced → fixation; Grades 3–4 = displaced → arthroplasty.
157
What is the **T score range** for osteopaenia?
-1.0 to -2.5
## Footnote
Above -1.0 = normal; -1.0 to -2.5 = osteopaenia; Below -2.5 = osteoporosis.
158
Bisphosphonates — do they inhibit **osteoclasts or osteoblasts**?
Osteoclasts
## Footnote
Osteoclasts = break bone DOWN; Osteoblasts = build bone UP. Bisphosphonates STOP bone breakdown → inhibit osteoclasts.
159
What is the surgical procedure for a **rectal tumour** 6cm from the anal verge?
Anterior resection
## Footnote
5cm from anal verge = anterior resection (sphincter preserved); <5cm from anal verge = abdominoperineal resection (permanent stoma).
160
Ileostomy vs colostomy — which is **spouted** and which is **flush**?
* Ileostomy = spouted (raised/protruding)
* Colostomy = flush with the skin
## Footnote
Ileostomy is spouted to protect skin from liquid contents.
161
Ileostomy vs colostomy — what are the **contents** like?
* Ileostomy = liquid contents
* Colostomy = solid contents
## Footnote
Understanding the differences in output is important for patient management.
162
Where is **intrinsic factor** secreted?
Parietal cells of the stomach
## Footnote
NOT the terminal ileum — that is where B12 is absorbed.
163
Where is **B12 absorbed**?
Terminal ileum
## Footnote
NOT where intrinsic factor is made — that is the stomach.
164
If someone is deficient in both **B12 and folate** — which do you replace first and why?
B12 first
## Footnote
Why: Giving folate first without B12 can cause subacute combined degeneration of the spinal cord — an irreversible neurological complication.
165
Patient found on floor + muscle pain + dark brown urine. What is the **diagnosis**?
Rhabdomyolysis
## Footnote
Recognizing the signs is crucial for timely intervention.
166
In **rhabdomyolysis** — what is the dangerous **electrolyte abnormality** to monitor?
Hyperkalaemia
## Footnote
Why: Muscle breakdown releases potassium → cardiac arrhythmias. NOT hyperuraemia — that is a consequence of AKI, not the dangerous electrolyte.
167
Woman on IVF develops bloating, nausea, vomiting and SOB. What is the **diagnosis**?
Ovarian hyperstimulation syndrome (OHSS)
## Footnote
Know the full name — OHSS.
168
Why does **OHSS** cause shortness of breath? (3 steps)
* Hyperstimulated ovaries release vasoactive mediators
* Increased capillary permeability → fluid shifts from blood vessels into third spaces
* Pleural effusion → shortness of breath
## Footnote
Understanding the pathophysiology is important for management.
169
Labyrinthitis vs vestibular neuronitis — which causes **hearing loss and tinnitus**?
Labyrinthitis causes hearing loss and tinnitus.
## Footnote
Vestibular neuronitis causes vertigo ONLY — no hearing loss. Memory tip: Labyrinthitis affects the whole Labyrinth including the cochlea.
170
What test confirms a **peripheral cause** of vertigo?
HINTS test (Head Impulse, Nystagmus, Test of Skew)
## Footnote
Epley manoeuvre = TREATMENT for BPPV, not a diagnostic test.
171
Peripheral vertigo — what direction is the **nystagmus**?
Unidirectional AND horizontal
## Footnote
Vertical nystagmus = central cause (more serious).
172
What are the **3 main structures** of the inner ear?
* Semicircular canals
* Vestibule
* Cochlea
## Footnote
Memory tip: SVC. The ear drum and ossicles = middle ear, not inner ear.
173
What is the pathological basis of **Ménière's disease**?
Excessive buildup of endolymph in the labyrinth → increased pressure → disrupts sensory signals
## Footnote
Memory tip: Ménière's = flooded inner ear.
174
What drug is used as **prophylaxis** in Ménière's disease?
Betahistine
## Footnote
How it works: Improves inner ear blood flow and reduces endolymph pressure.
175
UK breast cancer screening — what is the **age range**?
50 to 71 years old, every 3 years
## Footnote
NOT 45+. The upper limit of 71 is commonly missed.
176
BRCA1 carrier — what **screening** is offered and how often?
Annual MRI scan
## Footnote
NOT ultrasound. MRI detects lesions better in dense breast tissue.
177
UC biopsy — name **3 findings**.
* Continuous inflammation
* Goblet cell depletion
* Pseudopolyps
## Footnote
Absent granulomas and absent fissuring are also findings. Cobblestoning = Crohn's. Submucosal/transmural inflammation = Crohn's.
178
In **anorexia nervosa** — what causes **hyponatraemia** on U&Es?
Excess water intake (water loading)
## Footnote
NOT poor oral intake — that causes hypernatraemia.
179
Blood ketone level that confirms DKA resolution
< 0.6 mmol/L
180
Physiological reason IV fluids must be given slowly in HHS
Rapid fall in serum osmolarity causes water to move into brain cells
181
C‑peptide finding with endogenous insulin production
Detectable or raised
182
C‑peptide finding with exogenous (pharmaceutical) insulin
Low or undetectable
183
Primary metabolic process causing ketone production in SGLT2‑DKA
Lipolysis due to relative insulin deficiency
184
Retinopathy stage with microaneurysms and hard exudates
Background (non‑proliferative) diabetic retinopathy
185
Correct intramuscular glucagon dose
1 mg IM
186
Portal hypertension
Ascites; splenomegaly; oesophageal varices; caput medusae.
187
Chronic liver disease severity
Child–Pugh score.
188
List Child–Pugh components.
Bilirubin; albumin; INR/prothrombin time; ascites; hepatic encephalopathy.
189
Hepatic encephalopathy (precipitants)
Infection; constipation; dehydration; GI bleeding; opioids/sedatives; electrolyte disturbance; renal failure.
190
Hepatic encephalopathy (treatment mechanism)
Reduces gut ammonia absorption by acidifying colon and increasing excretion.
191
Spontaneous bacterial peritonitis (SBP) – treatment
IV ceftriaxone (or IV cefotaxime).
192
SBP – common organisms
Escherichia coli; Klebsiella pneumoniae; Streptococcus species; Enterococcus species.
193
Variceal bleeding – drug mechanism
Splanchnic vasoconstriction → reduced portal venous inflow.
194
Ulcerative colitis – histology
Mucosal ± submucosal inflammation; crypt abscesses; goblet cell depletion; continuous disease.
195
What are the TWO aims of cervical screening?
Detect high‑risk HPV AND pre‑cancerous cervical cell changes.
196
Up to what age is routine cervical screening offered in the UK?
Up to age 64.
197
Name TWO valid risk factors for placental abruption.
Previous abruption, hypertension, smoking, trauma, cocaine use, multiple pregnancy.
198
Name TWO immediate management steps for suspected placental abruption.
Call senior help AND give high‑flow oxygen.
199
Which nerve causes reduced sensation over the upper anteromedial thigh after inguinal hernia repair?
Ilioinguinal nerve.
200
What is the odds ratio when (40×180) ÷ (160×20)?
2.25.
201
What does Section 4 of the Mental Health Act allow?
Emergency detention for up to 72 hours.
202
Who must be involved in a Section 4 Mental Health Act application?
One doctor AND an AMHP or nearest relative.
203
How often should lithium levels be checked when starting or changing the dose?
Weekly until stable.
204
When should a lithium blood level be taken in relation to the dose?
12 hours after the last dose.
205
Which TWO markers are used for initial hepatitis B screening?
HBsAg and Anti‑HBc.
206
Which hepatitis B marker confirms ACUTE infection?
IgM Anti‑HBc.
207
Which marker measures hepatitis B viral load?
HBV DNA.
208
What shape are calcium pyrophosphate crystals in pseudogout?
Rhomboid‑shaped.
209
What is the most common cause of septic arthritis?
Staphylococcus aureus.
210
What is the NEXT step if atropine 500 mcg does not treat symptomatic bradycardia?
Repeat atropine 500 mcg IV.
211
Name ONE non‑pharmacological treatment for severe bradycardia.
Transcutaneous pacing.
212
What complication of neonatal jaundice causes permanent brain damage?
Kernicterus
213
What is the correct blood gas abnormality in pyloric stenosis?
Hypochloraemic hypokalaemic metabolic alkalosis
214
What is the investigation of choice for pyloric stenosis?
Abdominal ultrasound
215
Which two vaccines are given at 8 weeks alongside the 6‑in‑1?
Rotavirus and MenB
216
At what gestational age is routine screening for gestational diabetes done?
24–28 weeks
217
When should women with previous gestational diabetes be screened in a new pregnancy?
At booking and again at 24–28 weeks
218
What OGTT fasting glucose level diagnoses gestational diabetes?
≥ 5.6 mmol/L
219
What OGTT 2‑hour glucose level diagnoses gestational diabetes?
≥ 7.8 mmol/L
220
What is the classic triad of pyelonephritis?
Loin pain, fever, nausea or vomiting
221
What is the classic name for newborn brain injury caused by bilirubin?
Kernicterus
222
What does “spontaneous pneumothorax” mean in exams?
Occurs without trauma or underlying lung disease
223
What is the correct staging system for Hodgkin lymphoma?
Lugano classification
224
Painful lymph nodes after alcohol ingestion suggest which lymphoma?
Hodgkin lymphoma
225
What biopsy cell is diagnostic of Hodgkin lymphoma?
Reed–Sternberg cell
226
What is the most exam‑safe diagnosis in haemoptysis + nephritic syndrome?
Goodpasture syndrome (anti‑GBM disease)
227
What antibody is diagnostic in pulmonary–renal syndrome SAQs?
Anti‑GBM antibodies
228
What is the correct first treatment for hyperkalaemia without ECG changes?
IV insulin with glucose
229
What is the diagnostic criteria system for PCOS?
Rotterdam criteria
230
What blood tests are recommended by NICE for PCOS investigation?
Testosterone, SHBG, LH, FSH, prolactin, TSH
231
Why does PCOS increase endometrial cancer risk?
Unopposed oestrogen due to low progesterone and infrequent shedding
232
What is the first-line management for a large primary spontaneous pneumothorax?
Needle aspiration
233
Where do you insert the needle for aspiration?
2nd intercostal space, midclavicular line
234
How much air do you aspirate and with what?
Up to 2.5 L using a 50 mL syringe via a three-way tap
235
What is the most important lifestyle advice after pneumothorax?
Smoking cessation
236
When can a patient fly after pneumothorax?
Minimum 1 week after confirmed full resolution on imaging
237
What is the diving advice after pneumothorax?
Avoid permanently unless bilateral surgical pleurectomy performed
238
Name one absolute surgical indication other than persistent air leak
Second ipsilateral pneumothorax
239
What imaging confirms aortic dissection?
CT aortogram
240
What is the classification system for aortic dissection called?
Stanford classification
241
What is the target systolic BP in aortic dissection?
100–120 mmHg
242
What causes the early diastolic murmur in aortic dissection?
Dissection flap extending to the aortic root causing aortic regurgitation
243
Name one predisposing condition for aortic dissection other than hypertension
Bicuspid aortic valve / Ehlers-Danlos syndrome / Marfan syndrome / cocaine use
244
What serious vascular complication occurs in nephrotic syndrome?
Venous thromboembolism
245
Why does VTE occur in nephrotic syndrome?
Antithrombin III and anticoagulant proteins are lost in the urine
246
What drug reduces proteinuria in nephrotic syndrome?
ACE inhibitor or ARB
247
Why does oedema worsen beyond oncotic pressure loss in nephrotic syndrome?
RAAS activation causes sodium and water retention
248
What is Rovsing's sign?
Pain in the right iliac fossa on palpation of the left iliac fossa
249
What investigation confirms a post-operative abdominal collection?
CT abdomen and pelvis with IV contrast
250
What further management is needed for an appendix carcinoid less than 2 cm at the tip?
Appendicectomy alone — oncology follow-up, no further surgery
251
What is the preferred iron replacement for Hb 78 g/L pre-operatively?
IV iron infusion
252
From what age are patients invited for bowel cancer screening in England?
Age 50
253
What type of antibiotics are required for severe diabetic foot infection?
IV antibiotics
254
What offloading intervention is used in diabetic foot management?
Non-weight-bearing / total contact cast
255
What classification system grades diabetic foot ulcers?
Wagner classification
256
Name one risk factor for seizures in alcohol withdrawal other than abrupt cessation
Hypomagnesaemia / previous withdrawal seizures / concurrent illness or surgery
257
What three things should have been done at pre-assessment to prevent delirium tremens?
Full alcohol history, AUDIT/CAGE screening, prophylactic reducing-dose benzodiazepine regimen
258
What is the timeframe for surgical decompression in cauda equina syndrome?
Within 24–48 hours
259
What is the concern with NSAIDs in cauda equina syndrome?
May mask worsening pain indicating neurological progression
260
A pansystolic murmur at the apex radiating to the axilla — which valve and what lesion?
Mitral valve — mitral regurgitation
261
What antibodies are associated with GBS?
Anti-ganglioside antibodies e.g. anti-GM1
262
What proportion of GBS patients make a good recovery?
Approximately 80%
263
What residual problems can occur after GBS?
Weakness, fatigue, neuropathic pain
264
What legislation governs adult safeguarding in England?
The Care Act 2014
265
What does Section 42 of the Care Act 2014 require?
Local authorities must make enquiries where an adult with care and support needs is at risk of abuse or neglect
266
What is the first-line drug for mild-to-moderate croup?
Dexamethasone
267
What is the dose of dexamethasone for croup?
0.15 mg/kg orally as a single dose
268
Why must a child be observed for 2 hours after nebulised adrenaline?
Risk of rebound — symptoms return as the vasoconstrictive effect wears off
269
What is the dose of oral prednisolone for acute asthma in a child over 5 years?
30–40 mg
270
What is the duration of oral prednisolone for acute asthma?
3–5 days
271
Name two life-threatening features of acute asthma other than exhaustion
Silent chest / cyanosis / poor respiratory effort / hypotension / PEF <33% predicted
272
Name three red features from the NICE traffic light system for fever in children
Non-blanching rash / mottled or ashen skin / no response to social cues / unable to rouse / weak or high-pitched cry / grunting / CRT ≥3 seconds / neck stiffness / bulging fontanelle / seizure
273
Name three clinical features of bacterial meningitis in an infant under 18 months other than neck stiffness
Bulging fontanelle / high-pitched cry / seizures / irritability / poor feeding / photophobia / vomiting / purpuric rash / opisthotonos
274
What volume of ORS is recommended for rehydration in a child with clinical dehydration?
50 mL/kg over 4 hours plus replacement of ongoing losses
275
Why are anti-diarrhoeal drugs not recommended in children with gastroenteritis?
Risk of paralytic ileus or toxic megacolon — not licensed under 12 years
276
What is the causative organism of scarlet fever?
Group A beta-haemolytic Streptococcus / Streptococcus pyogenes
277
Name two serious complications of measles
Pneumonia / encephalitis / SSPE / otitis media / corneal ulceration or blindness
278
What 2 investigations do you do after CRAO to find the cause?
ECG and carotid Doppler ultrasound (also: echocardiogram, ESR/CRP)
279
Retinal detachment has 3 classic symptoms. What are they?
Floaters / flashes of light / shadow or curtain moving across vision
280
Name 3 operations for retinal detachment
Pars plana vitrectomy / scleral buckling / pneumatic retinopexy
281
Contact lens wearer sleeps in lenses and gets keratitis. What organism?
Pseudomonas aeruginosa
282
What eye drop prevents ciliary spasm and stops the iris sticking to the lens?
Cycloplegic — e.g. cyclopentolate 1%
283
Name one systemic disease linked to uveitis that is not AS, IBD, or reactive arthritis
Sarcoidosis / psoriatic arthritis / Behçet's / TB / syphilis / JIA
284
What is the third treatment for anterior uveitis after steroids and cycloplegics?
Same-day ophthalmology referral
285
Background retinopathy has microaneurysms. What features upgrade it to pre-proliferative?
Cotton wool spots / venous beading / IRMA / blot haemorrhages in 4 quadrants
286
New vessels on the disc in diabetic retinopathy — what is the urgent treatment?
Pan-retinal photocoagulation (PRP)
287
What scan detects diabetic macular oedema?
OCT — optical coherence tomography of the macula
288
Name 2 systemic treatments that slow diabetic retinopathy progression
Blood pressure control below 130/80 / optimise HbA1c / statins / ACE inhibitor or ARB / fenofibrate
289
Valvular AF from mitral stenosis — DOAC or warfarin?
Warfarin — DOACs are not recommended in valvular AF
290
Why does mitral stenosis cause AF?
Mitral stenosis causes left atrial dilatation which disrupts atrial electrical conduction
291
Name the interventional procedure for mitral stenosis other than valve replacement
Percutaneous mitral balloon valvotomy
292
BP is 150/50 in aortic regurgitation — why is the diastolic low?
Blood leaks back from aorta into LV during diastole lowering diastolic pressure
293
BP is 150/50 in aortic regurgitation — why is the systolic high?
Compensatory increased stroke volume raises systolic pressure
294
Name 3 eponymous signs of aortic regurgitation
De Musset — head bobbing / Corrigan — visible carotid pulsation / Duroziez — femoral bruit / Quincke — nail pulsation / Austin Flint murmur
295
What imaging do you use to monitor the aorta in Marfan syndrome?
CT aortogram or MRI aorta or echocardiography with aortic root measurement
296
Why does anaemia cause a murmur?
Anaemia causes hyperdynamic circulation with increased blood flow velocity producing turbulent flow across normal valves
297
Name 3 features that make a murmur pathological
Diastolic / pansystolic / grade 3 or above / radiates to carotids or axilla / associated syncope dyspnoea or chest pain / displaced apex or heaves
298
Name 2 drugs used for immediate management of acute mitral regurgitation other than oxygen and diuretics
Vasodilator e.g. GTN infusion / urgent cardiothoracic surgery referral
299
Pansystolic murmur at lower left sternal edge louder on inspiration — which valve?
Tricuspid valve — this is Carvallo's sign indicating a right-sided murmur
300
What is the overall diagnosis when you find a tricuspid murmur in an IVDU with fevers?
Infective endocarditis — not tricuspid regurgitation alone
301
What is the 48-hour rule for serial beta-hCG?
A rise of less than 66% in 48 hours, or a plateau or decline, indicates a non-viable or ectopic pregnancy.
302
What specific abnormality does FBC detect in pre-eclampsia?
Thrombocytopenia.
303
What specific abnormality does U&E detect in pre-eclampsia?
Raised creatinine, indicating renal impairment.
304
What specific abnormality does FBC detect in hyperemesis gravidarum?
Raised haematocrit, from dehydration.
305
What specific abnormality does U&E detect in hyperemesis gravidarum?
Hypokalaemia.
306
What are the 4 Ts of postpartum haemorrhage?
Tone, Trauma, Tissue, Thrombin.
307
What is the third uterotonic drug alongside oxytocin and carboprost?
Ergometrine.
308
In shoulder dystocia, which pressure is correct — fundal or suprapubic?
Suprapubic. Fundal pressure is contraindicated.
309
In cord prolapse, what do you do to the presenting part?
Manually elevate it to relieve cord compression. Do not push the cord back.
310
Name four risk factors for hyperemesis gravidarum.
Nulliparity, multiple pregnancy, hydatidiform mole, previous hyperemesis gravidarum.
311
Name four risk factors for shoulder dystocia.
Macrosomia, maternal obesity, previous shoulder dystocia, gestational diabetes.
312
What is the full first-line antibiotic regimen for PID?
IM ceftriaxone + oral doxycycline + oral metronidazole.
313
Why is thromboprophylaxis needed in hyperemesis gravidarum?
Dehydration, immobility, and the hypercoagulable state of pregnancy combine to increase VTE risk.
314
What is the name of the rash in Lyme disease?
Erythema migrans.
315
What are the BSA thresholds distinguishing SJS from overlap from TEN?
SJS: less than 10%. Overlap: 10–30%. TEN: greater than 30%.
316
What are the two serious complications of untreated scarlet fever?
Acute rheumatic fever and post-streptococcal glomerulonephritis.
317
What two organ systems does late Lyme disease affect?
Neurological and cardiac.
318
How long is the doxycycline course for Lyme disease without neurological involvement?
21 days.
319
What is the specific tick vector for Borrelia burgdorferi?
Ixodes ricinus.
320
What serological test confirms Lyme disease?
Lyme ELISA, confirmed with Western blot if positive.
321
What are the three complications of meningococcal septicaemia?
Septic shock, DIC, limb ischaemia/gangrene/amputation.
322
What is the classic vesicle description in varicella?
Dew drop on a rose petal.
323
Which neonatal group is at high risk of severe varicella?
Neonates born to mothers who develop chickenpox 5 days before to 2 days after delivery.
324
Name two characteristic signs of scarlet fever beyond the rash and tongue.
Circumoral pallor and Pastia's lines.
325
What are Pastia's lines?
Petechiae in skin flexures such as the axillae and antecubital fossae.
326
What scoring system predicts mortality in TEN?
SCORTEN.
327
Name four drug causes of SJS/TEN.
Co-trimoxazole, allopurinol, carbamazepine, lamotrigine.
328
When answering ACR/EULAR criteria, what must you check first?
The vignette. Never list features already given — they score zero.
Finals
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