1
Q
What is the first line treatment for syphilis?
A
- Penicillin (benzathine / procaine IM if early)
- Benzathine IM or amoxicillin + probenecid PO if late
- 2nd line: doxy
Treatment varies based on the stage of syphilis.
2
Q
Which antibiotic is used for cat scratch disease?
A
Azithromycin
This is the recommended treatment for this condition.
3
Q
What is the treatment for Shigella infection?
A
Azithromycin
This antibiotic is effective against Shigella.
4
Q
For a human bite, what is the first line treatment?
A
- Co-amoxiclav
- If pen allergic: metronidazole + doxy/clari
Co-amoxiclav is preferred due to its broad spectrum.
5
Q
What is the first line treatment for Giardia?
A
- Metronidazole
- Tinidazole
- 2nd line: azithromycin
These medications are effective against Giardia infections.
6
Q
Which antibiotics are used for Mycoplasma infections?
A
- Macrolides
- Tetracyclines
- Fluoroquinolones
These classes of antibiotics are effective against Mycoplasma.
7
Q
What is the treatment for Legionnaires’ disease?
A
- Macrolides
- Fluoroquinolones
These antibiotics are commonly used for this type of pneumonia.
8
Q
What is the first line treatment for leptospirosis?
A
- Benzylpenicillin
- IV cephalosporin
- Doxy if pen allergic
Treatment may vary based on the patient’s allergy history.
9
Q
What is the treatment for Nocardia infections?
A
Sulphonamides
Nocardia can cause pneumonia and cerebral abscess.
10
Q
What is the treatment regimen for Pelvic Inflammatory Disease (PID)?
A
- IM ceftriaxone
- PO doxy + metro
This combination targets the common pathogens involved in PID.
11
Q
What are the options for meningococcal prophylaxis?
A
- Cipro
- Rifampicin
- Ceftriaxone
These antibiotics are used for prophylaxis in close contacts of meningococcal disease.
12
Q
What does Linezolid cover?
A
MRSA and has good brain penetration
Linezolid is effective against resistant strains of Staphylococcus aureus.
13
Q
What is the treatment for latent TB?
A
- Isoniazid for 6 months
- RI for 3 months
RI refers to rifampicin and isoniazid.
14
Q
What is the treatment for non-CNS TB?
A
- RI for 6 months
- PE for 2 months
PE refers to pyrazinamide.
15
Q
What is the treatment duration for CNS TB?
A
9 months
CNS TB requires a longer treatment duration due to its severity.
16
Q
What are the common pathogens after neurosurgery that can cause meningitis?
A
- Staph epidermidis
- E. coli
These organisms are common in post-surgical infections.
17
Q
What is the first line treatment for Listeria meningitis?
A
- Amoxicillin and gentamicin
- Just amoxicillin in pregnancy
- Erythromycin if pen allergic
Listeria is a common cause of meningitis in pregnant women and the elderly.
18
Q
What is the incubation period for Salmonella gastroenteritis?
A
6-72 hours
Symptoms typically appear within this time frame after exposure.
19
Q
What is the incubation period for Campylobacter gastroenteritis?
A
24 hours - 1 week
Symptoms can vary based on the individual’s immune response.
20
Q
What is the incubation period for Norovirus?
A
12-48 hours post exposure
Norovirus is highly contagious and spreads rapidly.
21
Q
What is the incubation period for Rotavirus?
A
1-5 days
This virus primarily affects children under 5 years old.
22
Q
What are the symptoms of Shigella infection?
A
Dysentery, bloody/mucus diarrhoea
Shigella is known for causing severe gastrointestinal symptoms.
23
Q
What are the symptoms of Cholera?
A
Profuse watery diarrhoea, dehydration
Treatment includes IV fluids, doxy, and cipro.
24
Q
What are the symptoms of amoebic dysentery?
A
Fever, abdominal pain, blood/mucus
This condition is caused by Entamoeba histolytica.
25
What is the treatment for **Lyme disease**?
Doxycycline
## Footnote
Lyme disease is transmitted by ticks and can cause various systemic symptoms.
26
What is the treatment for **Babesiosis**?
* Azithromycin
* Atovaquone
## Footnote
Babesiosis is a tick-borne illness that can cause hemolysis.
27
What is the treatment for **Rickettsia infections**?
Doxycycline
## Footnote
Rickettsial infections are often associated with tick bites.
28
What are the symptoms of **Giardia infection**?
Explosive diarrhoea, flatulence, malabsorption
## Footnote
Giardia is often contracted through contaminated water.
29
What are the symptoms of **Schistosomiasis**?
Fever, hepatosplenomegaly, bloody diarrhoea
## Footnote
This condition is caused by parasitic worms.
30
What are the features of **Leishmaniasis**?
sand flies. East africa, india.
fever, night sweats, heptosplenomegaly.
Visceral and cutaneous (enlarging ulcer) forms.
## Footnote
Leishmaniasis can present as visceral or cutaneous forms.
31
What is the treatment for **Chagas disease**?
* Bed rest
* Benznidazole
## Footnote
This disease is caused by the Trypanosoma cruzi parasite.
32
What is the treatment for **Onchocerciasis**?
Ivermectin
## Footnote
This condition is also known as river blindness.
33
What are the symptoms of **Dengue fever**?
Fever, headache, rash, arthralgia
## Footnote
Dengue is transmitted by mosquitoes.
34
What is the treatment for **Trypanosomiasis**?
* Suramin (early)
* Melarsoprol (late)
## Footnote
This disease is transmitted by the tsetse fly.
35
What is the treatment for **Strongyloidiasis**?
* Ivermectin
* Albendazole (2nd line)
## Footnote
Strongyloidiasis can cause gastrointestinal symptoms.
36
What is the treatment for **Filariasis**?
* Diethylcarbamazine (DEC)
* Ivermectin (second-line)
## Footnote
Filariasis can cause significant lymphatic issues.
37
What are the features of **Brucellosis**?
Bone pain, neuropsych, fever
Low blood counts, mildly deranged lfts,
bone marrow biopsy/culture to diagnose
## Footnote
This disease is often associated with cattle.
38
What is the treatment for **Q fever**?
* Hydroxychloroquine
* Doxycycline
## Footnote
Q fever is caused by Coxiella burnetii.
39
What are the symptoms of **leptospirosis**?
Fever, jaundice, renal impairment
## Footnote
This condition is often associated with exposure to contaminated water.
40
What are the characteristics of **bacterial vaginosis (BV)**?
Thin white, fishy discharge
## Footnote
Treatment involves metronidazole.
41
What are the characteristics of **Candida infection**?
Itchy, white, lumpy discharge
## Footnote
This is a common fungal infection.
42
What are the characteristics of **Trichomonas infection**?
Green, itchy, offensive discharge
## Footnote
This is a sexually transmitted infection.
43
What is the treatment for **genital herpes**?
* Oral aciclovir
* 1 year prophylaxis if recurrent (>6x/year)
## Footnote
Genital herpes is caused by the herpes simplex virus.
44
What is the treatment for **Chancroid**?
* IM ceftriaxone
* PO azithromycin
## Footnote
Chancroid is caused by Haemophilus ducreyi.
45
What is the treatment for **genital warts**?
* Podophyllotoxin ointment
* 2nd line: cryotherapy
## Footnote
Genital warts are caused by human papillomavirus (HPV).
46
What is the causative organism of **swimmer's ear**?
Pseudomonas
## Footnote
This condition is an outer ear canal infection.
47
How is **leprosy** diagnosed?
Skin biopsy
## Footnote
Leprosy is caused by Mycobacterium leprae.
48
What are the symptoms of **measles**?
Coryza, maculopapular rash, conjunctivitis
## Footnote
Diagnosis is better with NPA/throat swab than PCR in immunocompromised patients.
49
What is the treatment for **molluscum contagiosum**?
Cryotherapy
Do HIV test as part of work up
## Footnote
An HIV test is part of the work-up for this condition.
50
What virus is associated with **Kaposi sarcoma**?
HHV8
also AIDs
## Footnote
This condition is commonly seen in AIDS patients.
51
Which vaccines are considered safe in **pregnancy**?
* Tetanus
* Whooping cough
* Hep B
* Influenza
## Footnote
These vaccines are recommended to protect both mother and child.
52
What is a side effect of **Ethambutol**?
Optic neuropathy
## Footnote
Ethambutol is used in the treatment of tuberculosis.
53
What is a side effect of **Rifampicin**?
Orange secretions, enzyme inducer
## Footnote
Rifampicin is also used in tuberculosis treatment.
54
What are the complications of **diphtheria**?
* Myocarditis
* Peripheral neuropathy
* Renal impairment
## Footnote
Diphtheria can lead to serious systemic complications.
55
What are the complications of **typhoid fever**?
* Endocarditis
* Cholecystitis
* Pneumonia
* OM
* Haemolytic anaemia
## Footnote
Typhoid fever can lead to various severe complications.
56
What is **HUS** associated with?
E. coli O157:H7
## Footnote
HUS is characterized by thrombocytopenia, haemolysis, and renal impairment.
57
What are the **gram-positive rods** categorized as ABCD L?
* Actinomyces
* Bacillus anthracis
* Clostridium
* Diphtheria
* Listeria
## Footnote
These organisms are significant in clinical microbiology.
58
What is the causative organism of **impetigo**?
Staph aureus
Tx topical abx. PO fluclox / macrolide if systemically unwell
## Footnote
Treatment involves topical antibiotics or PO flucloxacillin/macrolide if systemically unwell.
59
What infections are caused by **flavivirus**?
* Dengue
* Yellow fever
* Zika
* West Nile
* Japanese encephalitis
## Footnote
These viruses are transmitted by mosquitoes.
60
What are the characteristics of **inguinal lymphadenopathy** in sexually transmitted infections?
* Painless IL + Painless ulcer: Syphilis
* Painful IL + Painless ulcer: LGV
* Painful IL + Painful ulcer: Chancroid
## Footnote
These presentations help in the differential diagnosis.
61
What can cause **false positive VDRL/RPR** results?
SLE, TB, malaria, HIV
## Footnote
These conditions can mimic syphilis serology.
62
What does a **modified ZN stain** show?
Red = cryptosporidium, mycobacterium
## Footnote
This staining technique is used in microbiology.
63
What are the signs of **severe malaria falciparum infection**?
* Anaemia
* Thrombocytopenia
* Acute kidney injury
* Raised parasite level (>2%)
## Footnote
Severe malaria requires prompt treatment.
64
What is the treatment for **severe malaria**?
IV artesunate until parasite level drops <1%, then step down to PO
## Footnote
After stabilization, the patient can be switched to oral treatment.
65
How do you treat cholera?
IV fluids, doxy, cipro
66
What are the features of lyme disease?
Connecticut. rash, neuro, cardiac, joint problems.
67
What are the features of babesiosis?
haemolysis, long island, haemboglobinuria
68
What are the features of rickettsia?
south africa. eschar, lymphadenopathy, vasculitic rash, flu symptoms
69
How do you treat Schistosomiasis?
praziquantel
70
What are the features of chagas disease?
triatomine bugs, latin america.
lymphadenopathy, conjunctivitis, periorbital cellulitis, chagoma.
Later - megaoesophagus, megacolon, CCF
71
What are the features of Onchocerciasis?
African river blindness
blackfly
72
What are the features of Trypanosomiasis?
tsetse fly. Chancre, then meningoencephalitis
73
What are the features of Q fever?
coxiella burnetti
farms
carditis, hepatitis
74
What are the features of Leptospirosis?
fever, jaundice, renal impairment
75
what are the different types of liver cysts?
Hydatid = echinococcus granulosus, rural/farms, daughter cysts. Tx albendazole + surgery
Amoebic = entamoeba histolytica, tropical areas, homogenous lesion, anchovy paste fluid. Tx metronidazole
Pyogenic = e.coli (usually), complex/multi-loculated, purulent fluid, +ve culture. Tx antibiotics + drainage
76
What are the symptoms of **acute anterior uveitis**?
* Painful
* Reduced acuity
* Perilimbal injection
* Associated with systemic conditions
## Footnote
Treatment includes topical steroids and mydriatic drops.
77
What are the features of **episcleritis**?
Gritty sensation, Associated with UC. Self limiting
## Footnote
It is self-limiting and associated with ulcerative colitis (UC).
78
What are the symptoms of **scleritis**?
* Very painful
* Worse with eye movements
* Reduced vision
## Footnote
Associated with rheumatoid arthritis (RA). Treatment includes NSAIDs and steroids if no improvement.
79
What are the symptoms of **acute angle closure glaucoma**?
* Headaches
* Eye pain
* Halos
* Fixed dilated pupil
* Reduced acuity
## Footnote
This condition requires urgent treatment.
80
What condition is associated with **optic neuritis**?
Multiple sclerosis (MS)
## Footnote
Neuromyelitis optica is also associated, particularly in Asian and Afro-Caribbean populations.
81
What are the symptoms of **carotid artery dissection**?
* Ipsilateral amaurosis fugax
* Horner's syndrome
## Footnote
These symptoms indicate a serious vascular condition.
82
What is the treatment for **diabetic retinopathy**?
* Laser therapy
* Anti-VEGF (bevacizumab)
## Footnote
These treatments aim to manage and prevent vision loss.
83
What are the characteristics of **CRVO**?
Flame haemorrhages
## Footnote
Central Retinal Vein Occlusion (CRVO) can lead to significant vision issues.
84
What is a key sign of **CRAO**?
Cherry red spot
## Footnote
Treatment options include IV acetazolamide, massage, and thrombolysis.
85
What are the types of **macular degeneration**?
* Dry ARMD: gradual central visual loss
* Wet ARMD: neovascularization, rapid loss of vision
## Footnote
Both types affect visual perception significantly.
86
What is the effect of **atropine** on glaucoma risk?
Increases risk
## Footnote
Treatment options include topical beta blockers, acetazolamide, and topical pilocarpine.
87
What is the treatment for **thyroid eye disease**?
* IV steroids
* Surgical decompression
## Footnote
These treatments aim to alleviate symptoms and prevent complications.
88
What are the symptoms of **toxoplasmosis**?
* Painful
* Blurred vision
* Floaters
## Footnote
Risk factors include undercooked meat, dairy, and cat feces.
89
What are the symptoms of **retinitis pigmentosa**?
* Night blindness
* Peripheral vision loss
## Footnote
There is currently no cure for this condition.
90
What is the treatment of glaucoma?
topical beta blockers, acetazolamide, topical pilocarpine
91
How is warfarin reversed?
Vitamin K and PCC (replaces factors II, VII, IX, X; works faster than vitamin K alone)
92
What reverses apixaban and rivaroxaban?
Andexanet alpha.
93
What reverses heparin?
Protamine sulfate.
94
What reverses dabigatran?
Idarucizumab.
95
Features of intravascular haemolysis?
Anaemia, ↑ reticulocytes, jaundice, haemoglobinuria.
96
What are the 4 H’s of extravascular haemolysis?
Haemoglobinopathies (sickle cell, thalassaemia), Hereditary spherocytosis, Haemolytic disease of the newborn, Warm autoimmune haemolytic anaemia.
97
What is MDS?
Myelodysplastic syndrome: faulty immature blood cells causing pancytopaenia; can transform into AML.
98
What defines multiple myeloma on bone marrow biopsy?
>10% plasma cells.
99
What does serum protein electrophoresis show in myeloma?
M band (monoclonal protein).
100
What urinary finding is seen in myeloma?
Bence Jones protein.
101
What defines MGUS?
IgG paraprotein band <20.
102
Key features of Waldenström’s macroglobulinaemia?
Raised IgM, increased serum viscosity, lymphoplasmocytic bone marrow infiltrate.
103
Blood film finding in ALL?
Blast cells.
104
Blood film finding in CLL?
Smudge (smear) cells.
105
Blood film finding in AML?
Auer rods.
106
What translocation occurs in APML?
t(15:17).
107
Treatment for APML?
ATRA (all-trans retinoic acid).
108
Translocation in Burkitt lymphoma?
t(8:14).
109
Philadelphia chromosome is seen in which condition?
CML (t(9:22)).
110
Features of homocystinuria?
Short sightedness, joint laxity, thromboembolism, Marfanoid habitus, psychiatric symptoms, rash.
111
Treatment for homocystinuria?
Pyridoxine and folic acid.
112
What is DIC?
Dysregulated coagulation causing thrombosis + consumption of platelets/clotting factors → bleeding.
113
Blood results in DIC?
↑ D-dimer, prolonged PT/APTT, ↓ fibrinogen, ↓ platelets
114
Treatment of DIC?
Treat cause; FFP if bleeding; LMWH if thrombosis predominant.
115
What does PT assess?
Extrinsic/common pathway (Factor VII).
116
What does APTT assess?
Intrinsic/common pathway (Factors VIII, IX, XI, XII).
117
Common pathway factors?
II, V, X.
118
EPO level in primary polycythaemia (PV)?
Low.
119
EPO level in secondary polycythaemia?
High.
120
Common presentation of IgA deficiency?
Recurrent sinusitis.
121
What causes PNH?
Loss of CD55/CD59 → complement-mediated RBC destruction.
122
Features of PNH?
Haemolytic anaemia, pancytopaenia, thrombosis, dark morning urine
123
Features of hyperviscosity syndrome?
Mucosal bleeding, visual changes, headache
124
Triad of HUS?
Microangiopathic haemolytic anaemia, thrombocytopenia, AKI
125
Features of GvHD?
Rash, liver dysfunction, GI symptoms.
126
Treatment of GvHD?
IV steroids.
127
What happens to APTT in vWD when mixed with normal plasma?
Corrects.
128
What happens to APTT in acquired factor VIII deficiency when mixed?
Remains prolonged.
129
Pentad of TTP?
Haemolysis (schistocytes, ↑ LDH), thrombocytopenia, fluctuating neurology, fever, renal impairment.
130
Acute treatment of TTP?
Plasmapheresis and steroids.
131
Long-term management of TTP?
Aspirin once platelets >50.
132
Treatment of ITP?
Steroids, IV immunoglobulin, splenectomy.
133
Management of type 2 HIT?
Stop LMWH; start DOAC, bivalirudin, or fondaparinux.
134
Cause of Haemophilia A?
Factor VIII deficiency.
135
Cause of Haemophilia B?
Factor IX deficiency.
136
Inheritance pattern of haemophilia?
X-linked recessive (affects males).
137
Why is VTE risk increased in nephrotic syndrome?
Loss of antithrombin III in urine.
138
What is Factor V Leiden?
Activated protein C resistance; most common inherited thrombophilia.
139
Treatment of hairy cell leukaemia?
Cladribine.
140
Features of dysbetalipoproteinaemia?
Palmar xanthomas, raised cholesterol and triglycerides, normal/low HDL and LDL.
141
Features of familial combined hyperlipidaemia?
Raised triglycerides and cholesterol, low HDL, eruptive/tendinous xanthomas; most common inherited lipid disorder.
142
Features of hyperchylomicronaemia?
Triglycerides >10, eruptive xanthomas, lipaemia retinalis, recurrent pancreatitis.
143
What anticoagulant is preferred in NSTEMI with renal impairment?
Unfractionated heparin (instead of fondaparinux).
144
What does a high intensity signal around the heart on ECHO suggest?
Constrictive pericarditis.
145
Drugs used for medical cardioversion in AF?
Flecainide (avoid in ischaemic/structural heart disease) and amiodarone.
146
Why perform angiography before valve replacement in moderate/severe AS?
To assess for coronary disease and perform CABG at the same time if needed.
147
When operate in asymptomatic aortic regurgitation?
EF <50% with severe LV dilatation or LVESD >50mm.
148
Indications for mitral valve intervention?
Symptoms, LV dysfunction, pulmonary hypertension, new AF with dilated LV, valve area <1cm².
149
When consider surgery in asymptomatic AS?
Valve gradient >40mmHg with LV systolic dysfunction.
150
Features of pulmonary oedema?
Dyspnoea, tachycardia, raised JVP, gallop rhythm, inspiratory crackles.
151
Why avoid digoxin in amyloidosis?
Increased risk of toxicity.
152
Radiofemoral delay suggests what?
Coarctation of the aorta; investigate with TTE.
153
How is aortic root dilatation managed in Marfan syndrome?
Bisoprolol, annual echos, consider surgery at 4.5cm.
154
Treatment of VT in digoxin overdose?
IV lignocaine (avoid amiodarone).
155
What is pulsus paradoxus associated with?
Constrictive pericarditis and pericardial effusion.
156
Features of atrial myxoma?
Clubbing, normocytic anaemia, positional murmur, cardiac calcification on CXR.
157
ECG features of HOCM?
Axis deviation, BBB, T wave changes, prolonged PR, inferolateral Q waves.
158
What is P mitrale?
Left atrial enlargement (mitral stenosis, MR, HTN).
159
What is P pulmonale?
Right atrial enlargement (pulmonary stenosis, pulmonary HTN).
160
What is bifascicular block?
RBBB + LAD or RAD.
161
What is trifascicular block?
Bifascicular block + prolonged PR.
162
ECG finding in amyloidosis?
Low voltage QRS with poor R wave progression in chest leads.
163
ECG criteria for LVH?
S in V1 + R in V5 or V6 >40mm.
164
ECG features of left atrial enlargement?
Bifid P wave in II >120ms and negative terminal portion in V1.
165
ECG features of right atrial enlargement?
Tall P waves in II and V1 >0.25mV.
166
ECG features of Brugada syndrome?
Incomplete RBBB + convex ST elevation >2mm in V1–V3 followed by negative T wave.
167
ECG features of ARVD?
T wave inversion V1–V3, RBBB, epsilon wave.
168
ECG features of Wellens syndrome?
Biphasic or deeply inverted T waves in V2–V3.
169
ECG changes in digoxin toxicity?
Downsloping ST depression, flat/inverted T waves, short QT, AV block, bradycardia.
170
When does MR occur post-MI?
7–10 days (earlier with papillary muscle rupture); pansystolic murmur + hypotension.
171
When does ventricular septal rupture occur post-MI?
Few hours to weeks (often after anterior MI).
172
What causes sudden death post-MI due to rupture?
Ruptured ventricular free wall.
173
Features of pericardial tamponade?
Low BP, raised JVP, muffled heart sounds.
174
First-line management of chronic heart failure?
ACE inhibitor + beta blocker (start one at a time).
175
Second-line heart failure therapy?
Aldosterone antagonist.
176
Role of SGLT2 inhibitors in CCF?
Reduce morbidity and mortality in HFrEF.
177
When use ivabradine in heart failure?
Sinus rhythm >75bpm and LVEF <35%.
178
When use digoxin in heart failure?
Coexistent atrial fibrillation.
179
When use sacubitril/valsartan (Entresto)?
LVEF <35%.
180
When consider CRT?
Wide QRS complex.
181
What does the JVP a wave represent?
Atrial contraction.
182
What does the JVP c wave represent?
Closed tricuspid valve.
183
What does the JVP x descent represent?
Atrial relaxation.
184
What does the JVP v wave represent?
Venous filling.
185
What does the JVP y descent represent?
Atrial emptying into ventricle.
186
What causes a loud S1?
Mitral stenosis, L→R shunts, short PR, atrial premature beats, hyperdynamic states.
187
What causes a quiet S1?
Mitral regurgitation.
188
What causes a loud S2?
Hypertension, hyperdynamic states, ASD without pulmonary HTN.
189
What causes a soft S2?
Aortic stenosis.
190
What causes fixed split S2?
ASD.
191
What causes wide split S2?
Deep inspiration, RBBB, pulmonary stenosis, severe MR.
192
What causes reversed split S2?
LBBB, severe AS, RV pacing, WPW type B, PDA.
193
Contraindications to beta blockers?
Asthma, bradycardia, WPW.
194
Contraindications to adenosine?
Asthma, allergy, WPW.
195
Contraindications to verapamil?
Bradycardia, VT, WPW.
196
Contraindications to diltiazem?
WPW.
197
Contraindication before giving amiodarone?
Ensure QT not prolonged.
198
Contraindication to digoxin?
WPW.
199
What is cardiac index?
Cardiac output divided by body surface area (CO/BSA).
200
Normal cardiac index range?
Approximately 2.5–4.0 L/min/m².
201
Diagnostic criteria for HHS?
plasma osmolality >320
Gluc >30
202
Formula for plasma osmolality?
2(Na) + urea + glucose.
203
Thyrotoxicosis treatment in 1st trimester pregnancy?
Propylthiouracil (PTU).
204
Thyrotoxicosis treatment in 2nd/3rd trimester pregnancy?
Carbimazole.
205
TSH target in pregnancy?
0.2–3.
206
Which antithyroid drug is safer in breastfeeding?
PTU (though neither recommended).
207
Risk factors for thyroid cancer?
FAP, Hashimoto’s, thyroid adenoma, endemic goitre, female sex.
208
Features of Kallmann syndrome?
Anosmia with low FSH, LH, testosterone and GnRH.
209
What is special about insulin glargine?
Peakless insulin; reduces risk of hypoglycaemia.
210
Which diabetes drugs cause hypoglycaemia?
Sulphonylureas and meglitinides.
211
Which diabetes drugs cause weight gain?
Thiazolidinediones, meglitinides, sulphonylureas
212
Features of thiazide abuse?
Normal/low BP, low potassium, high bicarbonate
213
What organs are involved in MEN 1?
Pancreas, parathyroid, pituitary
214
What syndrome is associated with MEN 1?
Zollinger-Ellison syndrome.
215
What is included in MEN II?
Phaeochromocytoma +/- parathyroid disease.
216
Treatment of acromegaly?
Surgery and somatostatin analogue.
217
Treatment of prolactinoma?
Cabergoline or bromocriptine; surgery if resistant.
218
Why give ketoconazole before Cushing’s surgery?
To control cortisol, BP and glucose pre-operatively.
219
Treatment of myxoedema coma?
IV hydrocortisone (until Addison’s excluded), IV T3, slow rewarming.
220
Surgery criteria in asymptomatic hyperparathyroidism?
Creatinine clearance ↓ ≥30%, T score <-2.5, age <50, Ca >0.25 above ULN, urinary Ca >10mmol/day.
221
Complications of calcium >3.5 mmol/L?
Arrhythmias, coma, pancreatitis; treat urgently with IV fluids and pamidronate.
222
Cause and features of CAH?
21-hydroxylase deficiency; hirsutism, deep voice, acne.
223
What is necrobiosis lipoidica?
Ulcerated yellow-brown lesions in diabetes; treat with topical steroids.
224
Causes of abdominal bruit (RAMA)?
Renal artery stenosis, Aortic aneurysm, Mesenteric ischaemia, AV fistula.
225
Why does CKD cause hyperprolactinaemia?
Reduced prolactin metabolism + reduced dopamine release due to raised urea.
226
Why does metformin cause diarrhoea?
Bile salt malabsorption.
227
Features of milk-alkali syndrome?
Hypercalcaemia, renal failure, metabolic alkalosis.
228
Cause of AIT type 1?
Iodine excess with increased hormone synthesis.
229
Cause of AIT type 2?
Thyroiditis.
230
Features of APS I?
Chronic mucocutaneous candidiasis, hypothyroidism, adrenal insufficiency.
231
Features of APS II?
Addison’s + thyroid disease or T1DM.
232
Features of APS III?
Autoimmune thyroiditis + DM/pernicious anaemia/vitiligo.
233
Causes of pseudo-Cushing’s?
Alcohol and depression (diurnal cortisol variation preserved).
234
Emergency treatment of severe hyponatraemia?
150mL 3% NaCl over 20 minutes. repeat 2–3 times as needed
235
How do sulphonylureas work?
Stimulate pancreatic beta cells to release insulin.
236
How does pioglitazone work?
Thiazolidinedione that reduces insulin resistance.
237
How do SGLT2 inhibitors work?
Block renal glucose reabsorption (e.g. canagliflozin, dapagliflozin).
238
How do DPP-4 inhibitors (gliptins) work?
Inhibit DPP-4, increasing GLP-1 and insulin release.
239
What is a GLP-1 mimetic example?
Exenatide.
240
Diagnostic findings in diabetes insipidus?
Plasma osmolality >285, urine osmolality <500.
241
Primary hyperparathyroidism labs?
Raised PTH and Ca. Low phosphate.
242
Secondary hyperparathyroidism labs?
Raised PTH. low/normal Ca. phosphate high in renal failure, low in vitamin D deficiency.
243
Tertiary hyperparathyroidism labs?
Raised PTH, Ca and phosphate.
244
Induction therapy for Crohn’s disease?
Steroids, mesalazine
245
Maintenance therapy for Crohn’s disease?
Stop smoking; azathioprine or mercaptopurine; methotrexate.
246
What is Zollinger-Ellison syndrome?
Gastrinoma causing recurrent ulcers and renal stones; associated with MEN 1.
247
Wilson’s disease lab findings?
Low ceruloplasmin and serum copper, raised urinary copper.
248
Key features of ulcerative colitis?
pANCA positive, crypt abscesses, inflammation confined to mucosa and lamina propria.
249
Key features of Crohn’s disease?
ASCA positive, non-caseating granulomas, ileitis, large joint arthritis, ankylosing spondylitis, conjunctivitis, episcleritis, sacroiliitis.
250
OGD findings in eosinophilic oesophagitis?
Oesophageal rings, strictures, white plaques.
251
Management of oesophageal adenocarcinoma?
Neoadjuvant chemoradiotherapy then oesophagectomy; endoscopic resection if T1a; chemoradiotherapy if unfit for surgery; stent + radiotherapy for palliation.
252
Young adult with intermittent melena and normal scopes — diagnosis and test?
Meckel’s diverticulum; wireless capsule endoscopy.
253
Inclusion bodies on colonoscopy suggest what?
CMV colitis; treat with ganciclovir.
254
What is microscopic colitis and treatment?
Collagenous or lymphocytic colitis; treat with budesonide.
255
Acute cellular rejection after liver transplant?
Within 6 months, raised LFTs; higher risk if age >55, hepatitis C, PBC
256
Features of GvHD post liver transplant?
Rash and diarrhoea.
257
Features of ischaemic hepatitis post transplant?
High AST, ALP, GGT with normal bilirubin.
258
What is prolonged intrahepatic cholestasis?
Persistently raised ALP and bilirubin.
259
What does urea breath test diagnose?
Helicobacter pylori.
260
What does hydrogen breath test diagnose?
Small intestinal bacterial overgrowth.
261
Causes of unconjugated hyperbilirubinaemia?
Gilbert’s syndrome, Crigler-Najjar syndrome.
262
Causes of conjugated hyperbilirubinaemia?
Dubin-Johnson syndrome, Rotor syndrome.
263
Features of Whipple’s disease?
Malabsorption, neurological symptoms, cardiac involvement, migratory arthralgia, fever.
264
Autoimmune hepatitis type 1?
Adults; anti-smooth muscle, anti-actin, ANA positive
265
Autoimmune hepatitis type 2?
Children; anti-LKM antibodies.
266
Autoimmune hepatitis type 3?
Soluble liver/liver-kidney antigens.
267
Management of HCC with cirrhosis?
Liver transplant.
268
Management of HCC without cirrhosis?
Hepatic resection.
269
What liver tumour is associated with OCP use?
Hepatic adenoma.
270
Key features of Bartter syndrome?
Presents in childhood (constipation, growth failure, cramps, weakness), raised renin and aldosterone, raised urine calcium.
271
Key features of Gitelman syndrome?
Milder, presents later in life, low or normal urine calcium.
272
Renal biopsy finding in diabetic glomerulosclerosis?
Kimmelstiel-Wilson nodules.
273
When does IgA nephropathy present relative to infection?
2–3 days after URTI.
274
When does post-streptococcal glomerulonephritis present?
Several weeks after streptococcal URT or skin infection.
275
Target ferritin and TSAT in CKD?
Ferritin >100 and transferrin saturation (TSAT) >20%.
276
Target BP in CKD with diabetes or ACR >70 mg/mmol?
130/80 mmHg.
277
Target BP in CKD monitored at home (without diabetes)?
135/85 mmHg.
278
Target BP in CKD monitored in clinic (without diabetes)?
140/90 mmHg.
279
Step 1 management of hyperphosphataemia in CKD?
Dietary restriction plus vitamin D and calcium.
280
Step 2 management of hyperphosphataemia in CKD?
Phosphate binders (sevelamer or lanthanum).
281
Step 3 management of hyperphosphataemia in CKD?
Dialysis.
282
When add cinacalcet in CKD hyperphosphataemia?
If steps 1–3 fail or PTH >85 pmol/L.
283
Common nephrotic syndrome cause in older adults?
Focal segmental glomerulosclerosis (FSGS).
284
Common nephrotic syndrome cause in younger adults?
Membranous nephropathy.
285
Most common causes of nephrotic syndrome (MMF)?
Minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis.
286
What are the key features of Friedreich's ataxia?
Progressive limb and gait ataxia before age 25 with absent lower limb deep tendon reflexes
287
Which Parkinsonian disorder is associated with autonomic dysfunction?
Multiple system atrophy
288
Which Parkinsonian disorder is associated with gaze palsy?
Progressive supranuclear palsy (PSP)
289
Which Parkinsonian disorder presents with neuropsychiatric symptoms and raised ALT?
Wilson's disease
290
Which neurodegenerative disorder presents with confusion, hallucinations, and memory impairment?
Dementia with Lewy bodies
291
What infection causes PML and in whom does it occur?
JC virus in immunosuppressed patients
292
What are the clinical features of PML?
Hemiparesis, ataxia, visual field defects, mental status changes
293
What are the key features of CJD?
Myoclonus, cognitive impairment, cortical blindness, cerebellar signs
294
What are the classic features of Guillain-Barré syndrome?
Progressive ascending limb weakness with areflexia
295
How does botulism paralysis typically present?
Descending paralysis
296
What is the classic triad of Miller Fisher syndrome?
Ophthalmoplegia, areflexia, ataxia
297
What serious intracranial complications can sinus or middle ear infections cause?
Cerebral abscess or subdural empyema
298
How does encephalitis present and how is it treated?
Headache, fever, altered consciousness; treat with IV aciclovir
299
How does meningitis present and what is the initial treatment?
Neck stiffness, photophobia; give benzylpenicillin
300
What does the empty delta sign on CT indicate?
Cerebral venous sinus thrombosis (CVST)
301
How are mitochondrial disorders typically inherited?
Maternal inheritance
302
When is carotid endarterectomy indicated in ICA stenosis?
When stenosis is greater than 50%
303
What are causes of ring-enhancing lesions on CT head?
Cerebral toxoplasmosis, lymphoma, TB, cryptococcal disease, PML
304
What is the treatment for cerebral toxoplasmosis?
Sulfadiazine, pyrimethamine, folinic acid
305
Which drugs can trigger or worsen a myasthenic crisis?
Antibiotics (aminoglycosides, fluoroquinolones, macrolides), beta-blockers, calcium channel blockers, corticosteroids (initially), magnesium, neuromuscular blockers, quinidine/procainamide, statins
306
How does vertebral artery dissection present?
Posterior neck/occipital pain with posterior circulation signs (e.g. Wallenberg syndrome)
307
What imaging is used to diagnose vertebral artery dissection?
MRI and MRA brain
308
How does carotid artery dissection present?
Anterior neck pain, ipsilateral headache, Horner's syndrome, visual deficit, anterior circulation signs
309
What are the CSF findings in viral meningitis?
Normal glucose, slightly raised protein
310
What are the CSF findings in TB meningitis?
Low glucose, raised protein
311
What are the CSF findings in Guillain-Barré syndrome?
Raised protein with normal white cell count (albuminocytologic dissociation)
312
What drugs are used to treat absence seizures?
Levetiracetam, lamotrigine, ethosuximide
313
What are features of temporal lobe epilepsy?
Deja vu and automatisms
314
What symptoms suggest a parietal lobe seizure?
Altered or abnormal sensations
315
What is the function of the amygdala?
Emotional response, decision making, memory (part of limbic system)
316
What is the function of the hippocampus?
Converts short-term memory into long-term memory
317
What happens if the corpus callosum is damaged?
Split-brain syndrome with impaired interhemispheric communication
318
What are the features of Weber's syndrome?
Ipsilateral CN III palsy with contralateral limb weakness (midbrain infarct, PCA branches)
319
Which artery is affected in Wallenberg syndrome?
Posterior inferior cerebellar artery (PICA)
320
What are the features of Wallenberg syndrome?
Ipsilateral facial pain/temp loss, Horner’s, ataxia, palatal/vocal cord paralysis; contralateral limb pain/temp loss
321
What are signs of a parietal lobe lesion?
Finger agnosia, left-right disorientation, dysgraphia, acalculia, neglect
322
What are the features of Brown-Sequard syndrome?
Ipsilateral paresis and loss of vibration/proprioception with contralateral loss of pain and temperature
323
What visual defect is caused by posterior cerebral artery infarction?
Macular-sparing homonymous hemianopia
324
What are features of anterior inferior cerebellar artery (AICA) infarction?
Vertigo, vomiting, nystagmus; ipsilateral facial palsy, tinnitus, deafness, ataxia; contralateral pain/temp loss
325
What are features of superior cerebellar artery infarction?
Headache, vomiting, vertigo; ipsilateral ataxia, dysmetria, dysdiadochokinesia, dysarthria, Horner's
326
What causes an extradural haematoma and what is the classic mechanism?
Middle meningeal artery rupture often after temporal bone trauma
327
What are the time-based contraindications to thrombolysis?
1 week: LP; 2 weeks: major surgery; 3 weeks: GI/GU bleed; 4 weeks: stroke/MI/head injury
328
What are absolute contraindications to thrombolysis?
Any prior intracranial haemorrhage, platelets <100, INR >1.7, BP >185/110
329
Upgoing plantars with absent ankle jerks suggests which 5 diagnoses?
Subacute combined degeneration, motor neurone disease, Friedreich's ataxia, tabes dorsalis, dual peripheral and central pathology
330
In CO2 retention, what is the correct NIV response to reduce CO2?
Increase IPAP to 'blow off' CO2
331
What is the effect of increasing EPAP in NIV?
Increases oxygenation by splinting the airways open (effectively PEEP)
332
What are contraindications to NIV?
Recent facial/upper airway surgery or facial injuries; recent upper GI surgery; confusion/agitation; bowel obstruction; upper airway obstruction; excessive upper airway secretions; patient actively vomiting
333
What is the standard TB treatment regimen?
Rifampicin + Isoniazid for 6 months, Pyrazinamide + Ethambutol for 2 months
334
Which TB drug should be avoided in chronic liver disease?
Pyrazinamide (even if stable)
335
Which TB drug should be avoided in decompensated liver disease?
Rifampicin
336
What should be given with isoniazid in renal impairment?
Pyridoxine to prevent peripheral neuropathy
337
What does a sail sign behind the heart indicate on chest X-ray?
Left lower lobe collapse
338
What does a veil sign indicate on chest X-ray?
Upper lobe collapse
339
What preoperative FEV1 indicates suitability for lobectomy?
>1.5 L
340
What preoperative FEV1 indicates suitability for pneumonectomy?
>2.0 L
341
Which drug is a LABA?
Salmeterol
342
Which drug is a LAMA?
Tiotropium
343
Which drug is a SAMA?
Ipratropium
344
What are common causes of drug-induced photosensitivity?
PQRST mnemonic: Phenothiazines, Quinine, retinoids, sulfonamides, tetracyclines
345
What does a pink fluorescence on Wood’s lamp indicate?
Porphyria cutanea tarda
346
What does a yellow-green fluorescence on Wood’s lamp indicate?
Tinea versicolor
347
What does a red fluorescence on Wood’s lamp indicate?
Erythrasma
348
What are the causes of erythema multiforme?
infections (HSV, orf, HBV, HIV, EBV, mumps, mycoplasma, psittacosis, rickettsiae, streptococcus, typhoid, diphtheria),
drug reactions - barbiturates, penicillin, sulphonamides, phenytoin,
SLE
vasculitis - PAN, GPA
Malignancy
Sarcoidosis
RA
UC
349
What is the management of stress incontinence?
Pelvic floor exercises, surgery, duloxetine
350
What is the management of urge incontinence?
Bladder retraining, oxybutynin (not in elderly), solifenacin, botox
351
What does MSA stand for and present with?
Multiple system atrophy: Parkinsonism + autonomic failure
352
What is the first step in psychotic features in Parkinson’s disease?
Review medications; start quetiapine if needed
353
What is the first-line treatment for psychosis in dementia?
Olanzapine
354
What is Felty syndrome?
Rheumatoid arthritis + splenomegaly + neutropenia
355
Which drug is used for Lewy body dementia?
Rivastigmine
356
Which drugs interact with warfarin?
Macrolides, quinolones, statins, ciclosporins
357
How are pressure sores treated?
Calcium alginate dressings, hydrocolloid gel dressings
358
What type of dressings are used for burns?
Silver-based dressings
359
What are major causes of postural hypotension?
Alpha blockers (e.g. doxazosin, tamsulosin)
360
What are the key features of a trichobezoar?
Compressible abdominal mass, malnutrition, alopecia
361
What is the treatment for cataplexy?
Oxybate
362
What are treatments for narcolepsy?
Modafinil, methylphenidate
363
Which treatment is more effective for delusional depression, ECT or medications?
ECT is more effective than medications
364
What is the first-line therapy for body dysmorphic disorder?
Exposure and response prevention (CBT)
365
Which antipsychotic is least associated with weight gain?
Aripiprazole
366
Which antipsychotics can cause diabetes?
Olanzapine and clozapine
367
What are the key features of dermatomyositis?
Gottron's papules (knuckles/elbows), heliotrope rash
368
What proportion of dermatomyositis cases are paraneoplastic and what should be done?
15% of cases; perform a malignancy screen
369
What are the key features of SLE?
Fever, arthralgia, malar rash; normal CRP, raised ESR
370
Which joints are affected in RA?
PIP joints, symmetrical involvement
371
How can you differentiate GPA from relapsing polychondritis?
Relapsing polychondritis has outer ear inflammation and relapsing arthritis
372
What are the features of a joint aspirate in gout?
Monosodium urate crystals, needle-shaped, negatively birefringent
373
What are the features of a joint aspirate in pseudogout?
Calcium pyrophosphate crystals, rhomboid or rod-shaped; chondrocalcinosis
374
What are risk factors for pseudogout?
Haemochromatosis, Wilson's disease, hypothyroidism, hyperparathyroidism, increased age
375
What are risk factors for gout?
Male sex, metabolic syndrome
376
Which markers indicate SLE disease activity?
Falling C3/C4, Hb, WCC, albumin; rising immunoglobulins and platelets
377
What drugs can cause drug-induced lupus?
Mnemonic 3PS HIM: Procainamide, Penicillamine, Phenytoin (+other antiepileptics), Statins, Hydralazine, Isoniazid, Minocycline
378
Which drugs can cause Raynaud’s phenomenon?
Atenolol, Methysergide, Ergotamine, Vinblastine, Bleomycin, OCPs
379
Which diseases are associated with HLA-B27?
Mnemonic PAIR: Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, Reactive arthritis
380
When should amyloidosis be suspected and how is it diagnosed?
In chronic inflammatory conditions with hepatosplenomegaly, cardiac disease, proteinuria, or malabsorption; diagnose with rectal or abdominal fat biopsy (+ Congo red stain)
381
What are the diagnostic criteria for PAN?
≥3 of: Weight loss >5kg, Neuropathy, Testicular pain, Livedo reticularis, Hep B infection, Myalgia, Diastolic BP >90, Raised urea/creatinine
382
Which drugs should be avoided with methotrexate due to risk of bone marrow aplasia?
Trimethoprim and co-trimoxazole
383
Which antibodies are associated with mixed connective tissue disease?
SnRNP (also positive in 40% of SLE patients)
384
Which antibodies are specific for RA?
Anti-CCP; Rheumatoid factor (RhF) also positive
385
Which antibody is associated with drug-induced lupus?
Anti-histone
386
Which antibodies indicate antiphospholipid syndrome (APS)?
Lupus anticoagulant, anticardiolipin
387
Which antibody is associated with systemic sclerosis (scleroderma renal crisis)?
Anti-RNA polymerase III
388
Which antibody is associated with CREST/limited cutaneous systemic sclerosis?
Anti-centromere (associated with pulmonary hypertension)
389
Which antibody is associated with systemic sclerosis and ILD?
Anti-topoisomerase I
390
Which antibodies are associated with polymyositis and dermatomyositis?
Anti-Jo1, anti-synthetase
391
Which antibodies are associated with SLE?
Anti-dsDNA, Ro
392
What conditions are treated with IVIG therapy?
GIMMiCK - GBS, ITP, MS, MG, CIDP, Kawasaki
393
What is acanthosis nigricans associated with?
GI malignancies, especially gastric and pancreatic cancers
394
Which cancers are associated with BRCA1 and BRCA2 mutations?
Breast and ovarian cancers; family members often diagnosed <40 years
395
Which type of oesophageal cancer is most common and where does it occur?
Adenocarcinoma; lower 1/3 of oesophagus; associated with acid reflux and Barrett’s
396
Which type of oesophageal cancer affects the upper 2/3?
Squamous carcinoma
397
What are the key features of Peutz-Jeghers syndrome?
Pigmented lesions on lips and extremities, GI polyps; associated with GI, breast, and ovarian malignancies
398
Which cancers are associated with Lynch syndrome?
Colorectal, ovarian, and endometrial cancers
399
What are risk factors for ovarian cancer?
Multiple ovulations: nulliparity, early menarche, late menopause
400
What are protective factors for ovarian cancer?
High parity, oral contraceptive use
401
What are risk factors for bladder cancer?
Aromatic amines, smoking, pelvic radiotherapy, acrolein (from cyclophosphamide)
402
Which cancers commonly cause cannonball metastases?
Renal, endometrial, testicular germ cell tumours
403
Which HPV type is most associated with cervical cancer?
HPV 16
404
What is first-line chemotherapy for ovarian cancer?
Paclitaxel and carboplatin
405
What are the classic features of renal cell carcinoma (RCC)?
Haematuria, costovertebral pain, palpable mass
406
What are the differences between seminomatous and non-seminomatous germ cell tumours (GCT)?
Seminomatous: slow radiosensitive, no AFP, excellent prognosis; NSGCT: fast, aggressive, raised AFP/β-hCG, not radiosensitive
407
Which paraneoplastic syndrome is associated with squamous cell carcinoma of the lung?
PTHrP → hypercalcaemia
408
Which paraneoplastic syndrome is associated with small cell lung carcinoma?
SIADH
409
Which paraneoplastic features are seen in lung adenocarcinoma?
Clubbing, hypertrophic osteoarthropathy
410
What are the features of glucagonoma syndrome?
Pancreatic NET; 4 Ds: dermatitis (NME), diabetes, DVT, depression
411
What type of chemotherapy is cyclophosphamide and its main side effects?
Classic alkylating agent; haemorrhagic cystitis, pulmonary fibrosis
412
What type of chemotherapy is cisplatin and its main side effects?
Non-classic alkylating agent; kidney failure, peripheral neuropathy, ototoxicity
413
What type of chemotherapy is methotrexate and its main side effects?
Antimetabolite; myelosuppression, hepatic failure, pulmonary fibrosis
414
What type of chemotherapy is 5-FU and its main side effects?
Antimetabolite; cardiotoxicity, palmar-plantar syndrome
415
What type of chemotherapy is doxorubicin and its main side effects?
Antibiotic; congestive cardiac failure (CCF)
416
What type of chemotherapy is bleomycin and its main side effects?
Antibiotic; pneumonitis, pulmonary fibrosis, rash
417
What type of chemotherapy is mitomycin C and its main side effects?
Antibiotic; kidney failure, stomatitis, rash, alopecia
418
What type of chemotherapy is vincristine and its main side effects?
Vinca alkaloid; blisters, neuropathy, bronchospasm
419
What type of chemotherapy is paclitaxel and its main side effects?
Taxane; alopecia, peripheral neuropathy, myalgia
420
What type of chemotherapy is irinotecan and its main side effects?
Topoisomerase inhibitor; cholinergic syndrome, diarrhoea
421
What are the features of arsenic poisoning?
Rodenticide exposure; weight loss, GI symptoms
422
What are the features of lead poisoning?
Microcytic anaemia, RTA, motor neuropathy, constipation, raised zinc protoporphyrin; Tx: calcium EDTA
423
What is the treatment for paraquat (herbicide) poisoning?
Activated charcoal
424
What is the treatment for organophosphate poisoning?
Atropine + pralidoxime
425
What is the treatment for aspirin overdose?
Activated charcoal
426
What is the treatment for antifreeze (ethylene glycol) poisoning?
Fomepizole; sodium bicarbonate if pH <7.2
427
What is the treatment for methanol poisoning?
IV ethanol ± haemodialysis; fomepizole can also be given
428
How is TCA overdose with QRS >100 treated?
Sodium bicarbonate
429
How is VT in digoxin overdose treated?
IV phenytoin 250 mg over 5 minutes
430
How is cyanide poisoning treated?
Sodium thiosulfate, dicobalt edetate
431
What are features of local anaesthetic toxicity and treatment?
SAMS: Slurred speech, Altered mental status, Muscle twitching, Seizures; treat with 20% lipid emulsion
432
What is the treatment for CO poisoning?
100% oxygen
433
How is CCB overdose treated?
IV 10% calcium chloride 20 mL (repeat up to 3x)
434
Which DMARDs are safe in pregnancy?
Sulphasalazine, hydroxychloroquine
435
Which drugs are 1st and 2nd line for hypertension in pregnancy?
Labetalol (1st line); nifedipine or methyldopa (2nd line)
436
How is Torsades de Pointes treated?
10 mmol magnesium sulfate over 15 minutes
437
How should gentamicin dosing be adjusted based on pre- and post-dose levels?
If pre-dose high but post-dose ok → reduce to once daily;
if pre-dose high → increase dosing interval;
if post-dose high → reduce dose
438
Which drugs can cause obstructive jaundice?
Co-amoxiclav, ciprofloxacin
439
Which drugs can cause acute pancreatitis?
Mesalazine, azathioprine, furosemide, sodium valproate, steroids, oestrogens, octreotide, metronidazole, thiazides, cimetidine, cisplatin
440
What happens if allopurinol is combined with azathioprine?
Bone marrow suppression
441
What are causes of chronic urticaria?
Lymphoma, autoimmune diseases, drugs (aspirin, NSAIDs, morphine)
442
How is methaemoglobinaemia treated?
Methylene blue
443
Why can oxybutynin cause confusion in older adults?
Anticholinergic effects
444
Which drugs can worsen psoriasis?
Antimalarials, lithium, NSAIDs, beta blockers
445
How is neuroleptic malignant syndrome treated?
IV fluids, cooling, dantrolene; 2nd line: bromocriptine
446
How is serotonin syndrome treated?
Diazepam if needed; 2nd line: cyproheptadine
447
Which drugs should be avoided in myasthenia gravis?
Tetracyclines, macrolides, aminoglycosides, antimalarials (e.g., quinine), beta blockers, antimuscarinics
448
What is the 'BLAST' mnemonic for overdoses that can be dialysed?
Barbiturates, Lithium, Alcohols (e.g., ethylene glycol), Salicylates, Theophyllines
449
What are the classic anticholinergic effects?
Hot as a hare
Dry as a bone
Blind as a bat,
Red as a beet,
Mad as a hatter
450
What are the features of severe iron toxicity?
Liver failure, gastrointestinal caustic damage, coagulopathy with raised APTT, early hyperglycaemia, extensively haemolysed samples
451
Which drugs are P450 enzyme inducers?
CRAP GPS mnemonic: Carbamazepine, Rifampicin, Alcohol (chronic), Phenytoin, Griseofulvin, Phenobarbitone, Sulphonylureas, Smoking, St John's Wort
452
What are possible causes of a high osmolality gap?
Pseudohyponatraemia (extreme hyperproteinaemia or hyperlipidaemia) chronic renal failure or excess toxic alcohols/glycols
