1
Q
Which cancers metastasize to the bone
A
Breast
Prostatę
Lung
Thyroid
Kidney
2
Q
Most common site Of bony metastasis?
A
Spine
3
Q
Otolani test
A
tests for developmental dysplasia of the hip, for posterior dislocation
4
Q
Mc Murray test
A
evaluates tear in meniscus - bent knee, foot everted, then invert the knee and straigthen it -> if click, then meniscus tear
5
Q
Fikelstein sign
A
For de Quervians tenosynovitis
- ulner deviation of the fist
6
Q
thomas test
A
for hip extension contracture - one leg is bent to the chest, if the other one flexes, there is a contracture
7
Q
lachmans test
A
for ACL tear, anterior ‘drawer’, tibia rolls on the femur anteriorly
8
Q
indications for DEXA scan
A
> 50yo with low trauma fx
xray with osteopenia or vertebral collapse
BMI <19
postmenopausal + fhx of Hip fracture
long term steroid
oestrogen deficiency
9
Q
Z deformity
A
thumbs
metacarpophalangeal flexion, extension of interphalangeal
10
Q
Maisonneuve fracture
A
proximal fibula fx and associated fracture of medial malleolus
11
Q
HLA in RA
A
HLA DR1 & DR 4
12
Q
conus medullaris
A
similar to cauda equina but both LMN and UMN signs
13
Q
Central cord syndrome
A
pain and temp sensation and motor loss, worse in Upper limbs than Lower
14
Q
anterior cord
A
loss of motor and temp+pain sensation BELOW the level of injury
15
Q
systemic scleroderma antibodies
A
anti SCL70
16
Q
sjorgen syndrome
A
anti SSA/Ro, anti SSB/La
17
Q
Limited cutaneous systemic sclerosis
A
ANA and anti-centromere
18
Q
juvenile idiopathic arthritis
A
ANA and RF and CCP
19
Q
Kocher criteria
A
ESR>40
WCC >12
temp >38.5
non weight bearing
20
Q
osteomalacia
A
deficiency in vit D - rickets
21
Q
osteopetrosis
A
marble bone, increased bone density
22
Q
Barton fracture
A
distal radius fracture with associated dislocation of the radiocarpal joint
23
Q
mallet / baseball finger
A
DIP in constant flexion, extensor tendon ruptured
24
Q
Jersey / rugby finger
A
DIP in constant extension, flexor tendon ruptured
25
Boxer fracture
5th metacarpal head fracture
26
Bennet and Ronaldo fractures
base of 1st metacarpal, Ronaldo comminuted
27
OA
joint space narrowing
osteophytes
subchondral sclerosis
subchondral cysts
28
RA
marginal erosions
periatricular osteopenia
joint deformities and joint space narrowing
soft tissue swelling
29
Spondylolisthesis
slippage of vertebrae and the spine above it, relative to the vertebrae below
30
Bhecet disease
chronic multisystem vasculitis: oral ulcers, genital ulcers, skin lesions, eye inflammation,
31
systemic sclerosis ab
anti centromere and anti scl70
32
polimyositis/dermatomyositis ab
anti Jo 1
33
Lupus ab
anti dsDNA and anti smith
34
orthopnea
SOB when lying down
35
Pulmonary oedema x ray
kerley B lines, batwinging,
36
AAA screening
<3cm - no screening
3-4.4 cm - annual
4.5-5.4 - 3 monthly
>5.5 - 2 ww referral to Vascular Surgery
37
HTN Tx: without diabetes in >55 and black
1st CCB
2nd add ACE/ARB or Thiazide
3rd all 3
38
HTN Tx: T2DM or <55 non black
1st ACE/ARB
2nd add CCB or Thiazide
3rd all 3
39
4th line tx HTN
add
spironolactone if K <4.5
or A/B blocker if K >4.5
40
HTN stages
stage 1 140/90
stage 2 160/100
stage 3 180/120
41
anterior/septal infarct leads
V1-V4 - LAD
42
Inferior leads
II, III, aVF - Right coronary
43
Lateral leads
I, aVL, V5-V6 - Circumflex
44
hypertrophic cardiomyopathy
-P mitrale
-systolic ejection murmur
-lateral displacement of pulse
45
brugada syndrome
AD
'coved' ST elevation and inverted T wave
tx with ICD
46
x ray water bottle sign
cardiac tamponade
47
pulsus paradoxus
drop in systolic BP >10mmHg on inspiration
48
thiazide SE
hypokalemia and hyperuricaemia
49
QTc prolongation
TCA, SSRI, erythromycin, fluconazole
low Ca, low K, low Mg
50
Hypothermia ECG features
AF
PR prolongation
Widened QRS and QT
J waves
51
Diastolic murmur at apex
mitral stenosis
52
thiazide like diuretics
eg indapamide, bendroflumethiazide
acts on DCT, inhibits sodium reabsorption
SE postural hypotension, hyperglycaemia, hypokalemia
53
Spironolactone SE
hyperkalemia
54
Calcium channel blockers SE
eg amlodipine
ankle oedema
55
Mitral regurg
systolic murmur
56
atrial septal defect
midsystolic murmur at left upper sternal border with splitting of S2
57
Ventricular septal defect
harsh holosystolic murmur at lower left sternal border
58
PDA
continuous machine like murmur at upper left sternal border
59
tetralogy of fallot
-VSD
-R ventricular hypertrophy
-overriding aorta
- pulmonary valve stenosis
60
aortic regurg
diastolic, collapsing pulse
at LEFT sternal border
61
ECG wolff-parkison-white
delta wave (at beginning of QRS)
62
U wave ECG
hypokalemia
63
paroxysmal AF
last less than 7 days
64
Persistent AF
episodes lasting longer than 7 days
65
permanent AF
AF that fails to resolve using cardioversion
66
HAS BLED / ORBIT
scoring of risk of major bleeding in pts on anticoagulation for AF
67
chadvasc
risk of stroke in AF
68
QRISK
risk of developing cardiovascular disease in 10 years
69
stable angina first line ix
exercise treadmill test
70
Bornholm disease
/pleurodynia/
viral condition, coxackie B virus, stabbing pain in chest/abdomen, episodes last 15-30mins,
71
Morbitz 1
progressive prolongation of P-R with eventual drop of QRS
72
Mobitz 2
eg 2:1 or 3:1 block, so per 2 P waves, there is 1 QRS. No P-R prolongation.
73
Kussmaul sign
rise in JVP on inspiration
74
ABCD2 score
risk of stroke following TIA
75
Digoxin effect
salvador dali sagging - ST depression
76
unprovoked DVT cause
active cancer or thrombophilia
77
infective endocarditis symptoms
splinter haemorrhage
osler node
janeway leison
eyes - roth spots
78
chronic heart failure treatment
quadruple treatment:
ACEi, B Blocker, SGLT/gliptin, Spironolactone/-one
79
acute pericarditis length
4-6w
80
incessant pericarditis
>6w but <3m
81
chronic pericarditis
>3m
82
lipid modifying drugs in pregnancy
only resins (colesevelam) and bile acid sequestrants are allowed with caution
83
hypercalcemia ECG
short QT
J wave
84
acute heart failure treatment
IV diamorphine, IV diuretic, IV GTN
85
indapamide
thiazide-like diuretic, SE hypokalemia
86
sick sinus syndrome
elderly pt with alternating bradycardia and tachycardia
87
GRACE
in hospital and 6 month mortality post MI
88
COPD treatment
1st SABA/SAMA
2nd
- if asthmatic features (atopy, high eosinophil count, diurnal PEF variation), then add LABA + ICS
- if NO asthmatic features add LABA + LAMA
3rd LABA + LAMA + ICS
89
Tietze syndrome
similar to chostochondritis but includes joint swelling
90
91
Can theophylline be administer as nebuliser?
No
Oral or injection only
92
Lung CT: eggshell calcification of lymph nodes
Silicosis
93
transudate
failures (heart, kidney)
94
exudate
inflammation, infection
95
lights criteria for exudative effusion
pleural to serum protein ratio >0.5
pleural to serum LDH ratio >0.6
pleural fluid LDH >2/3 of normal serum LDH
96
Mycobacterium tuberculosis
Aerobic mycobacterium
97
ghon focus
initial granulomatous lesion in TB
98
ghon complex
calcified focus with lymphadenopathy in TB
99
sputum sample in TB - stain
Ziehl-Neelsen for acid-fast bacilli
100
Active TB treatment
RIPE
Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (2 months)
Continuation: R I (4 months)
101
Latent TB
RI (3 months) OR I (6 months)
102
Framingham Risk Score
1- year risk of cardiovascular events
103
asthma severity
moderate >50%
severe 33-50%
life-theatrening PEF <33%
104
asthma diagnosis in >16yo
1) measure eosinophil or FeNO levels (50)
2) bronchodilator reversibility test in spirometry
3) PEF 2/day for 2w
4) bronchodilator challenge test
105
>12 yo assthma management
1) AIR - ICS+ LABA (Regular)
2) MART - ICS+LABA (regular + reliever)
106
HAP organisms
pseudomonas aeruginosa, staphylococcal aureus, enterobacteriacaea + early onset: step pneumonia and h influenza
107
centor criteria
criteria for risk stratification of pharyngitis (group a strep)
- fever
-tonsilar exudate
- ly,phadenopathy
-no cough
108
COPD staging PEF
>80% Mild
50-79% moderate
30-49% severe
<30% very severe
109
Caplan’s syndrome
Pulmonary fibrosis in coal miners with RA
- multiple round nodules on X ray
- tx steroids
110
Left ventricular failure
Prominent upper lobe vessels
Coughing up pink frothy sputum
111
Influenza vaccine
Inactivated IM - adults
Live attenuated Nasal - Children
112
how to diagnose OSA?
polysomnography
113
klebsiella pneumonia
red currant jelly sputum
114
asbestos exposure -what cancer?
1st lung cancer
2nd mesothelioma
3rd asbestosis
4th GI
115
extrinsic allergic alveolitis
hypersensitivity reaction to an inhaled organic dust (eg bird/pigeon fancier's lung - avian, OR fungal - farmer/malt worker/mushroom worker's lung)
116
salicylate poisoning
initially respiratory alkalosis and then metabolic acidosis tx gastric lavage in 1h
117
Haemolytic uraemic syndrome
triad of
1 acute renal failure
2 haemolytic anaemia
3 thrombocytopenia
pc: diarrhoea that turns bloody after 1-3 days
118
torsion of the appendix testes
blue dot sign
119
prehn sign
positive in epididymitis,
-elevation of the testes relieves the pain-
120
most common kidney stones
calcium oxalate
121
normal pressure hydrocephalus triad
urinary incontinence, dementia, abnormal gait
122
Testicular tumours
1. germ cell tumours (95% of all - incl 45% seminomas and 50% non-seminomas)
2. non-germ cell tumours (Leydig cell, Sertoli cell)
123
how do seminomas spread?
to para-aortic nodes, producing back pain
124
how do teratomas spread?
via blood, to liver, lung, bone, brain
125
what type of tumour is teratoma?
nonseminoman
126
nonseminoma hormones
aFP and BhCG (non radio sensitive tumour)
127
seminoma hormones
BhCG (Radiosensitive tumour)
128
which zone does prostate cancer arise in?
peripheral zone
129
which zone does BPH arise in?
Transition zone
130
anterior vs posterior urethral injuries
anterior: penile and bulbar
posterior: membranous and prostatic
deep to superficial:
prostatic, membranous, bulbar, penile
131
tx of interstitial cystitis (synonym bladder pain syndrome)
conservative (pelvic floor exercise, avoiding triggers, bladder training, TENS)
+ amitriptyline
132
Pylonephritis abx
cefalexin 7d/ ciprofloxacin 7d / trimethoprim 14d/ co amox 7d- all first line
pregnant women: cefalexin 7d
133
Nephritic syndrome
low level proteinuria, haematuria, oliguria, HTN
134
Nephrotic syndrome
high-level proteinuria, oedema
135
Poststreptococcal glomerulonephritis
group A strep tonsillopharyngitis, followed by nephritic syndrome, visible haematuria,
Antistreptolysin O titres (ASO)
in CHILDREN
136
Wegener granulomatosis / Granulomatosis with polyangitis
Triad: upper and lower Resp tract infection and glomerulonephritis +MSK symptoms
137
IgA nephropathy - Berger disease
most common primary glomerulonephritis
Nephritis post URTI or GI infection
138
Eosinophilic granulomatosis with polyangitis - Churg Strauss
pANCA, asthma, eosinophilia
139
Alport syndrome
hereditary nephritis
genetic disorder
eye abnormalities and sensorineural hearing loss +ESRD
140
Minimal change disease
most common nephrotic (high proteinuria and oedema) syndrome in children, idiopathic
141
Focal segmental glomerulosclerosis
most common cause of nephrotic syndrome in adults
142
Hypokalemia causes
decreased osmolality
insulin
B blockers
alkalosis
143
eggplant penis
penile fracture, rupture of corpus cavernosum
144
BPH tx
a1 blockers - tamsuloSIN - relax smooth muscle
5a reductase inhibitors - Finasteride - inhibits enlargement of prostate
145
UTI tx
nitrofurantoin - avoid if eGFR <45
trimethoprim -avoid in pregnancy
3d in general
7d pregnant and male
146
varicocele
dilatation of testicular veins in pampiniform plexus
147
sulfasalazine vs sperm
reduces sperm counts
148
drugs causing infertility in women
NSAID, spironolactone, COX inhibitors
149
oligozoospermia
decreased number of spermatozoa
150
asthenozoospermia
decreased sperm motility
151
teratozoospermia
many abnormal sperm on morphological examination
152
tx of nephrogenic DI
, thiazide diuretics, NSAIDs, sodium restriction
153
urine osmolality of <200
hallmark of diabetes insipidus
154
how to differentiate between polydipsia and DI?
water deprivation test (urine will concentrate in polydipsia with >800 osmolality)
155
what differentiates between cranial and neprhogenic DI?
ADH administration - Cranial DI osmolality will be >800, and in nephrogenic DI will be <300. - so osmolality doesn't rise in nephrogenic DI post ADH as kidneys doesn't respond
156
Fanconi syndrome
polyuria, polydipsia, dehydration, and low vit D - rickets
157
functional incontinence
incintinence due to external factors such as dementia or depression
158
overflow incontinence
continuous urine leaking - sometime due to constipation - as a complication of chronic retention
159
stress incontinence tx
1st pelvic floor muscle training
2nd duloxetine
160
continuous incontinence
constant passive leaking such as in fistula
161
urge incontinence tx
1st bladder retraining
2nd anticholinergic (eg oxybutynin)
mirabegron in elderly
162
cannon balls in lungs
RCC metastatic spread
163
hypertrophy
cell enlargementh
164
hyperplasia
increased cell number
165
bacteria causing epididymo-orchitis in <35 yo
chlamydia
166
bacteria causing epididymo-orchitis in >35yo
e coli
pseudomonas
167
chronic renal failure blood gas
metabolic acidosis
168
bloody diarrhoea causes
SEECSY
Salmonella
E. Coli
Entamoeba
Campylobacter
Shigella
Yersinia enterocolitica
169
acute vs persistent vs chronic diarrhoea
<14 days vs >14 days vs >4 weeks
170
H pylori eradication if no penicillin allergy
1 w
PPI + Amoxicillin + Clarithromycin/Metronidazole
171
H Pylori eradication in Penicillin Allergy
1 week
PPI + Clarithromycin + Metro
172
bulk forming laxatives
isphagula husk - works as dietary fibre
173
posthepatic causes of portal hypertension
IVC, constrictive pericarditis/ heart problems, hepatic vein problems.
174
osmotic laxatives
lactlulose, macrogol, - increased amount of water in bowels
avoid in diabetics
175
acute cholangitis vs cholecystitis
cholangitis has jaundice
176
acute cholangitis triad
RUQ pain, fever, jaundice
177
anterior resection
low sigmoid or high rectum tumour, anastomosis
178
abdomino perineal resection
tumours low in the rectum, with removal of rectum and anus
179
pre hepatic causes of portal hypertension
AV fistula, thrombosis - problem in portal vein
180
intrahepatic causes of portal hypertension
cirrhosis, hepatitis, cytotoxic drugs, schistosomiasis, PBC
181
cholecystolithiasis
gallstones in the gallbladder
182
choledocholithiasis
gallstones in the CBD
183
cholesterol stones
green, most common
184
pigmented stones
dark stones - bilirubin and calcium
185
faecal calprotectin
for IBD
186
anal fissure tx
for pain - topical anaesthetic, and for pain and healing - rectal GTN (if symptoms >1w)
187
CA 15-3 marker
breast cancer
188
colorectal ca marker
carcinoembryonic antigen
189
1 u of alcohol
10 ml of pure alcohol
190
ileus
hypomotility of GI tract in absence of mechanical obstruction
191
UC and biliary disease
PSC primary sclerosing cholangitis
192
screening for Wilsons disease
ceruloplasmin levels
193
Pharyngeal pouch
also called Zenker Diverticulum - first swallow is fine, worse with eating
confirmed by barium swallow, tx excision
194
Rockall score
identified risk of adverse outcomes post uper GI bleed
- age, co-morbidity, shock, BP + diagnosis and any bleeding on endoscopy
195
Gilbert syndrome
isolated raised unconjugated bilirubin
196
PBC antibodies and symptoms
Fatigue, priuritis, jaundice, steathorhoea
AMA
197
What causes angular chelitis/stomatitis
B2 deficiency
198
Pellagra
Deficiency of B3 - niacin
199
Types of hiatus hernia
Sliding (pull through) vs rolling (bulge)
200
Osteomalacia bloods
Low ca, phos
High ALP
201
Electrolyte cause of ventricular tachycardia
Hypokalemia
202
Ca channel blockers side effects
Headache
Flushing
Ankle oedema
203
Tachycardia tx
If unstable (hypotension, MI, HF, sweating, cold, pallor, confusion): DC cardioversion
If stable:
Broad QRS: amiodarone
Narrow QRS: adenosine
204
INR 5-8 and no bleeding
Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose
205
Which diuretic is contraindicated in renal artery stenosis
Ace inhibitors - eg lisinopril
206
Antiphospholipid syndrome bloods
Prolonged APTT
low platelets
207
INR 5.0-8.0
Minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR <5
208
INR > 8.0
No bleeding
Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0
209
INR > 8.0
Minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0
210
Major bleeding and warfarin
Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*
211
Hydroxychloroquine side effect
Retinopathy
212
Unfractioned heparin monitoring
APTT
213
Liver disease related to sjorgen + tx
Primary biliary cholangitis
Tx ursodeoxycholic acid
214
Haemochromatosis
Diabetes, arthralgia, skin pigmentation
Textbook (cirrhosis, diabetes, skin pigmentation)
215
216
Addisons vs Conns vs Cushings
Addisons primary adrenocortical deficiency
Conn primary aldosteronism (adenoma)
Cushing ACTH-producing primary tumour with excess aldosterone and androgen
217
218
Electrolyte feature of hyperparathyroidism
Hypercalcemia - bones groans moans stones
219
Nephrogenic DI tx
Thiazide diuretics
Eg chlorothiazide
220
Sickle cell anaemia and osteoarthritis
Salmonella
221
High TSH and high T4
TSH secreting pituitary adenoma
222
Hypopituitarism TSH levels
Low TSH low T4
223
Fluid resus in children
Bolus 10mg/kg
224
Osmolarity formula
2 Na + 2 K + Glucose + urea
OR
2 Na + Glucose + Urea
225
DM diagnosis
HbA1c >48
Fasting glucose >7
Random glucose >11.1
226
Endogenous production of insulin
Raised C peptide
227
Carbimazole SE
Agranulocytosis
228
Prophylthiouracil SE
Hepatic reactions
229
first line tx for topical hyperhidosis
aluminium chloride hexahydrate
230
Graves disease antibodies
TSH receptor stimulating antibodies and Thyroid stimulating immunoglobulin
231
chvostek sign
hypocalcemia
twitching of face when tapping on facial nerve in front of ear
232
trousseau sign
hand spasm after compression of upper arm with blood pressure cuff
233
acromegaly
excess growth hormone
check insulin like growth factor 1
234
primary aldosteronism test
aldosterone to renin ratio
235
phaeochromocytoma test
24h urinary metanephrines
236
ACTH test
addisons disease
237
cushings syndrome test
low dose dexamethasone supression test
238
cushings syndrome
purple stria, central obesity, moon face, buffalo hump
239
addisons disease
hyperpigmentation, fatigue, weight loss
240
ACTH low and not supressed by cortisol at all
adrenal adenoma - cushing syndrome
241
ACTH normal and cortisol supressed by high dose
cushing disease- pituitary adenoma
242
alk phos in hyparathyroidism
normal in primary
raised in secondary and tertiary
243
milk alkali syndrome
excess consumption calcium and absorbable alkali (eg PPI)
244
loop diuretics and corticosteroids electrolite abnormality
hypokalaemiaL
245
Kallman syndrome
delayed puberty and ansomnia
246
Nelsons syndrome
condition post bilateral adrenalectomy, excess ACTH production
247
diagnostic test for cushing
overnight dexamethasone supression test
248
papillary Ca of thyroid
spreads to cervical ly,ph nodes, most common type of Ca of thyroud
249
Medullary Ca of thyroid
malignancy of parafollicular C cells
symptoms of diarrhoea and facial flushing,
Calcitonin levels elevated
250
Anaplastic thyroud Ca
large hard tumour with symptoms tdue to local invasion (such as hoarseness or dyspnoea)
251
Hashimoto thyroiditis antibodies
Antithyroid perioxidase antibodies - TPO
252
what diseases have anticardioliptin antibodies
-Antiphospholipid syndrome
-Systemic lupus erythematosus (SLE)
-Immune thrombocytopenia
-Rheumatoid arthritis
-Psoriatic arthritis
-Sjögren’s syndrome
253
B symptoms lymphoma
non hodgkin lymphoma
254
lymphoma with pain post alcohol
hodgkin lymphoma
255
microcytosis
iron deficiency, thalasaemia, anaemia of chronic disease
256
macrocytosis
alcohol, b12 or folate deficiency
257
Adrenaline dose in anaphylaxis
up until 6yo 150 mcg
6-12yo 300 mcg
>12yo 500 mcg
258
primary polycythaemia vera
raised Hb, WCC, platelet (secondary is only raised Hb)
259
cryptococcosis
fungal infection in pts with HIV
tx amphotericin and fluconazole
260
influenza virus
Orthomyxovirus
261
turner syndrome
45 XO
262
Down syndrome risk
20 yo 1:1500
30 1:800
35 1:270
40 1:100
263
Glasgow criteria
>=3 is severe pancreatitis
PaO₂: less than 8 kPa
Age: greater than 55 years
Neutrophils: WBC count over 15 × 10⁹/L
Calcium: less than 2 mmol/L
Renal function: urea greater than 16 mmol/L
Enzymes: LDH above 600 IU/L or AST above 200 IU/L
Albumin: less than 32 g/L
Sugar: greater than 10 mmol/L
264
Barrets oesophagus and Ca
Increased risk of oesophageal adenocarcinoma
265
Achalasia and ca
Increased risk of SCC
266
Reynolds Pentad
Charcots triad + hypotension and mental confusion
267
What’s the trigger of haemolysis in G6DP deficiency?
Flava beans
268
Scarlet fever causing organism
Group A strep
Streptococcus pyogenes
269
Slapped cheek disease / 5th disease causing organism
Parvovirus B19
270
Schistosomiasis
From swimming in fresh water
(Malaise, muscle and joint ache, rash)
271
Dengue fever
High fever, retro orbital pain, myalgia
272
Typhoid fever
Abdominal symptoms (nausea vomiting diarrhoea constipation), rose spots rash,
Cause: salmonella typhi
273
Chikungunga
Very severe joint pains
Bended over
274
Zika virus
Transmitted by mosquitos
Causes microcephaly in children
Low grade fever, rash, conjunctivitis
275
Campylobacter
Raw meat and bloody diarrhoea + joint pain
276
E coli
Bloody diarrhoea
Travellers diarrhoea + children
277
Haemochromatosis - classic triad
Cirrhosis, DM, skin pigmentation
278
glucagonoma
4Ds
dvt
depression
DM
dermatosis
279
Budd Chiari syndrome
obstruction of hepatic venous outflow
280
Blumberg sign
Rebound tenderness in peritonitis
281
Claybrook sign
heart and breath sounds are transmitted through abdominal wall --> abdominal viscus rupture
282
Sister Mary Joseph nodule
umbilical metastatic nodule
283
schizophrenia
affects perception/thoughts/mood/behaviour
positive symptoms: auditory hallucinations, delusions, disrupted speech
negative symptoms: withdrawal, lack of motivation, flat affect
284
Friedrichs ataxia
autosomal recessive ataxia
affects nervous system and heart
clumsiness, unsteady gait, cardiomyopathy, diabetes
285
HADS
hospital anxiety and depression sca;e
286
MMSE
mini mental state examination - for dementia
287
CAGE questionnaire
screening for alcoholism
288
SAWS
short alcohol withdrawal scale
289
Manchausen/factitious vs Malingering
factitious is for attention gain
malingering is for external gain such as money / military personel or insurance claims
290
hemiparesis
weakness on one side of the body
291
hemiplegia
paralysis of one side of the body
292
De Clerambault syndrome
delusional belief that a celebrity is in love with you
293
Fregoli syndrome
belief that someone is somebody else in disguise (eg strangers are actually my wife)
294
Cotards syndrome
delusion that parts of body have died or rotted away
295
Ekbom's syndrome
delusional parasitosis
belief they are infested with insects/worms/ small organisms + tactile hallucinations
296
Capgras Syndrome
belief that familiar people have been replaced by identical impostors/duplicates
297
Othello syndrome
pathological jealousy, with alleged infidelity
298
Ganser syndrome
giving deliberate incorrect answer despite understanding the question - type of dyssociative disorder or response to trauma
299
Wernickes encephalopathy
confusion, ataxia, horisontal mystagmus
- vit B1 thiamine deficiency
300
Korsakoff's syndrome
severe wernickes + confabulation, memory loss/amnesia, psychosis,
301
When is tranexamic acid contraindicated?
In haematuria as might cause blood clots in kidneys
302
ITP tx
Prednisolone
IVIG
IV anti D immunoglobulin
Presents as isolated low platelets (thrombocytopenia)
303
R
304
Main antibody in secretions (tears, saliva sweat)
IgA
305
Live attenuated vaccines
Rotavirus
MMR
Nasal flu
Shingles
Chickenpox
BCG
306
Live travel vaccines
Yellow fever
Oral typhoid
307
Autoimmune haemolytic anemia
Anaemia
Haemolysis: reticulocytosis, low haptoglobin, high LDH, positive Coombs test
308
Aplastic anaemia
Low Hb
Low platelet
Low Neutrophil
309
Macrocytic anaemia
Alcohol
Liver disease
Folate
B12
310
Edward’s syndrome
18 trisomy
Cleft palate
Clubfoot
Microcephaly
Micrognathia
311
Patau syndrome
Trisomy 13
Congenital heart defects
Brain doesn’t divide into 2 halves, midline defects,
312
Turner syndrome
45XO
313
Kleinefelter syndrome
47 XXY
314
HIV pts with chronic diarrhoea
Cryptosporidosis
315
Fragile X
Recessive
Large testicles, long face, long ears
316
Williams syndrome
Elf / Elfin face
Autosomal dominant with genes deleted on Ch7
317
Williams syndrome
Elf / Elfin face
Autosomal dominant with genes deleted on Ch7
318
PT
Extrinsic and common
1 (fibrinogen), 2, 5, 7, 10
affected vy warfarin, vit K deficiency, liver dysfunction
319
APTT
Intrinsic and common
1, 2, 5, 8, 9, 10, 11, 12
affected by haemophilia
320
ITP
Low platelets
Normal PT / APTT
321
VWD and Haemophilia
Normal platelet
Normal PT
Long APTT
322
DIC
low platelet
Long PT/ APTT
323
Most common cause of epididymitis in children
adenovirus or enterovisur
324
most common cause of epididymitis in sexually active
chlamydia trachomatis, neisseria gonorrhoeae
325
Vaginal candidiasis causing organism
candida albicans
326
bacterial vaginosis causing organism
gardnerella vaginalis
327
trichomoniasis causing organism
trichomonas vaginalis
328
Live vaccines
BCG, MMR, Rotavirus, Polio (oral), Yellow fever, oral typhoid, nasal influenza, varicella
329
Philadelphia chromosome
Translocation of 9 and 22 --> causes CML (tiredness, enlarged spleen, raised WCC)
330
ALL translocation
T 4;11
331
CML drug treatemtn
imatinib
332
what vaccines pre splenectomy?
pneumococcal vaccine
HIB vaccine
meningococcal vaccine
influenza vaccine
333
Encapsulates bacteria
SHiN SKiS
Strep pneumoniae
H Influenza
N meningitidis
Group B strep
Klebsiella pneumoniae
Salmonella typhi
334
335
Aplastic anemia
Low neutrophils
Low platelets
Hypocellularity
336
Peutz Jeghers syndrome
Autosomal dominant
Pigmented lesions in buccal mucosa
GI polyps
Presents as bowel obstruction from intusussception
337
Prophylactic drugs against migraine
betablockers and amitriptyline
338
Trigeminal neuralgia tx
Carbamazepine
339
positive symptoms of schizophrenia
auditory hallucinations, delusions, thought disorder
340
negative symptoms of schizophrenia
social withdrawal
poverty of thought and speech
mood disorder
blunting of affect
depression
341
normal pressure hydrocephalus
abnormal gait, urinary incontinence, dementia
342
MMSE score for dementia
23/30
343
AVPU
Alert (GCS 15)
Voice (12-14)
Pain (5-8)
Unresponsive (3)
344
Guillain-Barre syndrome tx
IVIG
345
meningitis examinaiton/test
Kernig's sign - lying down, flexed hip, straightening knee causes pain
Brudzinski sign - lying down, bending neck will cause bending of the knees
346
cluster headache tx
acute: sumatriptan + oxygen
prophylaxis: prednisolone and verapamil
347
Suarachnoid haemorrhage diagnosis steps
1st CT (if positive, angiography)
2nd MRI OR Lumbar puncture (blood stained and xantochromia)
348
temporal bone fracture sign
battle sign - ecchymosis/haematoma behind ears/ in mastoid region
349
Russel sign
knuckle callus from induced vomiting in Bulimia nervosa
350
Lewy body dementia vs Parkinsons disease
Parkinsons: lowy bodies in substrantia nigra
Lewy body: lewy bodies in cortical neurons
351
Pick's disease
frontotemporal dementia
affects personality, bahvaiour, and language function
352
amaurosis fugax
temporary loss of vision in one eye, 'curtain'
353
suspected TIA mx
within <7d of episode, 300mg aspirin and specialist assessment within 24h
If >7d
specialist assessment within 7d
354
Secondary prevention of stroke
clopidogrel 75mg
statin 40mg
anti hypertensives
anticoagulant if ischaemic stroke or AF
355
lithium monitoring
baseline tests (tft, renal fuction, fbc, ue, ecg)
-12h following dose-
5 days after starting/changing dose and then weekly until stable
356
core symptoms of depression
feeling low or down
little interest in doing things
357
tension headache prophylaxis medication
amitriptyline
358
TCA poisoning
causes tachycardia, drowsiness, dry mouth, arrhythmias
tx gastric lavage and then activated charcoal
359
Section 2
Admission for assessment for up to 28 days.
Requires approval from a GP, a psychiatrist, and an approved social worker.
360
Section 3
Admission for treatment for up to 6 months.
Requires involvement of the nearest relative or a social worker, plus two doctors
361
Section 4
A 72-hour assessment order, used in emergencies when Section 2 would cause unacceptable delay.
Requires approval from a GP and an approved social worker or relative.
Often converted to a Section 2 once at the hospital.
362
Section 5(2)
Allows a doctor to detain a voluntary hospital patient for up to 72 hours.
363
Section 5(4)
Similar to Section 5(2), but allows a nurse to detain a voluntary patient for up to 6 hours.
364
Section 135
A court order permitting police to enter a property to remove a person to a Place of Safety.
365
Section 136
Allows police to take someone found in a public place who appears to have a mental disorder to a Place of Safety.
366
Akathisia
SE of starting antipsychotics, lower limb restlessness
- different from restless leg syndrome as this is a subjective experience
367
borderline personality disorder
emotional instability, disturbed patterns of thinking, impulsive behaviour, intense unstable relationships
368
Laboratory finding in self induced hypoglycaemia (injecting insulin)
Normal C peptide
369
Bacterial meningitis lumbar puncture
polymorphonuclear cells (neutrophils, basophils, eosinophils), high protein, LOW glucose
370
viral meningitis lumbar puncture
mononuclear cells (lymphocytes, monocytes), normal protein and normal glucose
371
TB lumbar pucture
mononuclear cells (lymphocytes and monocytes), high protein and low glucose
372
tonic clonic seizure + other seizures tx
lamotrigine, levetiracetam, sodium valproate
373
focal seziures tx
lamotrigine or levetiracetam
374
absence seizures tx
ethosuximide
375
when is the blood spot test taken
day 5 and 8
376
heel prick test
PKU
Hypothyroid
Sickle cell
CF
Maple syrup
Homocystinuria
Medium chain acyl Co A dehydrog. defic.
glutaric and isovaleric acidemias (2 separte things)
377
what vaccines are contraindicates in egg protein allergy?
MMR (can still be given in allergy are not using actual egg), Influenza, Yellow fever (absolutely contraindicated)
378
Uhthoff phenomenon
MS symptoms worsening when body overheated
379
acute angle closure glaucoma
raised intraocular pressure >20mmHg (due to reduced aqueous outflow), blocked canal of Schlemm
pt sees halos around objects, periorbital pain, N&V
380
Tx of acute angle closure glaucoma
IV acetazolamide (Reduces aqueous secretion) or topical pilocarpine (a blocker)
381
first rank symptoms of schizophrenia
auditory hallucinations
thought insertion/broadcasting
delusional perceptions
hallucinations
382
chorea
involuntary random movements flowing from one part of body to another
383
dysdiadochokinesis
incoordination of rapidly alternating movement
384
Hemiballismus
involuntary flinging motions of extremities
385
dermatillomania
urge to pick at own skin
386
which sections detain for 6h?
5.4
387
which sections detain for 72h
4, 5.2
388
which section detains for 28d
2
389
which section detains for 6 months
3
390
neuroleptic malignant syndrome
SE of tx with dopamine antagonist (antipsychotics - haloperidol, clozapine, olanzapine, risperidone).
hyperthermia, rigidity, confusion
391
MRC muscle power grade
1 slight contraction
2 some active movement
3 movement against gravity
4movement against resistance
5 normal power
392
ovarian failure test
FSH>20 in a women <40yo
393
primary ovarian failure blood test
low oestrogen and high FSH/LH
394
hypothalamic or pituitary problem - sex hormones level
low oestrogen and low FSH/LH
395
Bacterial vaginosis
fishy smelling discharge
clue cells
positive amine test (fishy smell)
Tx Metronidazole
396
Gonorrhoea in female
gram -ve diplococcus
white vaginal discharge
Tx ceftriazone IM single dose /PO
397
Trichomonas vaginalis
yellow/green discharge,
frothy
dyspareunia, dysuria
vulvovaginal irritation
strawberry cervix
sometimes fishy smell
Tx Metronidazole
398
Astheospermia / Asthenozoospermia
reduced sperm mobility
399
azoospermia
no sperm in ejaculate
400
low sperm count
oligospermia
401
reduced ejaculate volume
hypospermia
402
poor sperm morphology
teratospermia
403
how to confirm ovulation
progesterone sample 7d before period
404
vaccinations in pregnancy
non-live
petrussis /whoopping cough 16-32w
influenza
RSV >28w
405
endometriosis tx
cocp / oral or depot progesterone / IUS
last treatment is laparoscopic ablation
406
dysmenorrhoea
period pain
407
placenta previa
placenta is partially or completely covering the cervix
408
vasa previa
fetal vessels cross or are near the cervix
409
breast cyst
breast lump that fluctuates with menstrual cycle
410
painless breast lump
fibroadenoma
411
bilateral breast lumps
fibrous dysplasia
412
adenomyosis
extension of endometrial tissue into the myometrium
413
policystic ovaries diagnosis - follicles
?12 follicles or ovarian volume of >10
414
PCOS investigations
raised LH or raised LH:FSH
415
clomifene
induces ovulation (used in PCOS)
416
how to start COCP
start on D1-5. If started outside this, precautions for 7d
can be started straight after emergency contraception (precautions 7d post levonorgestrel and 14d after ulipristal acetate)
if switching COCPs - start straight after the last active pill of current COCP
417
COCP what if you miss 2 pills
extra precautions for 7d
if missed in 1st 7 tablets -> emergency contraception
if missed in last 7 active tablets, start the next pack straight after, omit the free interval
418
chancroid
painful genital ulcer with tender inguinal lymphadenopathy
cause: haemophilius ducreyi
419
lymphogranuloma venerum
painless ulcer with painful lymphadenopathy
cause: chlamydia
420
Parkinsons symptoms
bradykinesia, hypokinesia, stiffness or rigidity, resting tremorcn
421
dyskinesia
involuntary movements (choreiform-quick,fidgety, OR dystonic - slow and distorted)
422
what antiemetics to avoid in Parkinsonism?
metoclopramide and prochlorperazine as they exacerbate parkinsonism ---> use domperidone instead
423
PHQ9
patient health questionnaire - for depression
424
amts
abreviated mental test score - for cognition assessment
425
HADS
hospital anxiety and depression scale
426
scoff
sick, control, one, fat, food
screens for eating disorders
427
donald duck speech
pseudobulbar palsy
428
syringomyelia
fluid filled cyst within spinal cord
loss of pain and temperature sensation and muscle wasting
429
myotonic dystrophy
autosomal dominant
- anticipation - worse in subsequent generations
frontal balding
muscle weakness
young person tired all the time
cataracts
430
Gravida
Total number of pregnancies started
430
missed miscarriage
non viable pregnancy on USS, but no bleeding
431
Para
X+Y
X pregnancies beyond 24h
Y number of losses before 34w (so if current pregnancy is <24w then doesn't count in either)
432
Mx in pregnancy bleeding/sensitising event in Rhesus Negative mother
If beyond 20 weeks, give 500 IU of anti-D immunoglobulin within 72h of sensitising event
433
commonest type of cervical cancer
squamous cell carcinoma
434
Times for missed progrsteroneonly pills
Levonorgestrel/Norethisterone - 3h
Desogestrel - 12h
Drospirenone - 24h
435
combined test
11-14 weeks of pregnancy
blood test (bHCG) and PAPP-A and USS to measure nuchal translucency
checks for Downs (tris 21), Edwards tris 18, Patau tris 13.
436
quadruple test
14-17 weeks
screens for Downs only
bloods: AFP, hCG, unconjugated oestriol, Inhibin A
437
what are the 2 USS scans in pregnancy?
Dating scan 11-14w
Foetal anomaly scan 18- up to 20+6w
438
pregnancy vaccinations
Influenza
Whooping cough 16-32w
RSV 28w
439
oligomenorrhoea
infrequent menstruation
440
Red degeneration
when fibroid grows rapidly as it feeds on hormones in pregnancy and it outgrows the blood supply
441
HELLP syndrome
Heamolysis, ELevated liver enzymes, LP low platelets
442
PID tx
ceftriaxone 1g stat IM + PO doxycycline 10mg BD for 14d + metronidazole 400mg BD 14D
443
HRT - what cancers are related?
breast cancer if combined HRT,
endometrial cancer if oestrogen-only HRT
444
TB of CNS Tx
RIPE for 2 months, then RI for 10 months
445
446
Haemorrhage straight after artificial rupture of membranes in pregnancy
Vasa praevia
447
Myasthenia gravis dx
testing for serum anti AChR antibodies
repetitive nerve stimulation studies
448
HPV Cancer
HPV 16 AND 18
449
HPV genital warts
HPV 6 and 11
450
UK HPV vaccine
Gardasil quadrivalent, HPV 6, 11, 16, 18
451
How long to use contraception in perimenopause
If <50y then 2y contraception
If >50, 1y
452
Disulfiram
drug to teat alcohol dependence
453
first line test for Coeliac disease
IgA Tissue Trnsglutaminase
454
croup cause
parainfluenza
455
impetigo tx
(Cause: staph aureus)
1. hydrogren peroxide
2. fusidic acid
then abx (topical then oral)
456
henoch scholnein purpura
non blanching
urine dip +ve blood
post infection
GI involvement, joint pains, renal involvement
457
458
Roseola infantum cause
HHV6
459
Hand foot mouth disease cause
Coxsackie virus
460
When to refer with failures of development?
Smile - refer at 10 weeks
Sit without support - Refer at 12 months
Walk unsupported - Refer at 18 months
2-6 words - refer at 18 months
461
Slapped cheek disease
Fifth disease / erythema infectiosum
Human parvovirus B19
462
TORCH
Infections passed from mother to child -before during or after birth-
Toxoplasma
Other (HIV, parvovirus B19, Varicella)
Rubella
CMV
HSV
463
Cholesteatoma
White ear discharge
Conductive hearing loss
Tympanic membrane perforation
464
Glasgow 7
Malignant melanoma
3 major criteria - shape size colour
4 minor >7cm inflammation bleeding itch
465
Meniere disease
Vertigo, tinnitus, hearing loss (sensorineural)
466
Meniere disease treatment
Prochlorperazine in Acute attack
Betahistine for prophylaxis
467
Labyrinthitis
Inner ear inflammation
Vertigo, nausea vomiting, tinnitus, deafness
Nystagmus to opposite site
Prochlorperazine
Cinnarizine/Betahistine
468
Vestibular neuronitis
Vertigo plus nausea and vomiting
469
Vestibular neuronitis vs Labyrinthitis
Vestibular neuronitis has no deafness or tinnitus
470
Indications for tonsillectomy
Haemorrhage
Quinsy
Ca
7x episodes in 1y
5x/y in 2 years
3x/y in 3 years
471
Rosacea
?acne
Tx ivermectin
472
Conjunctivitis causes and organisms
Viral - adenovirus
Bacterial - s pneumonia, s aureus, h influenza
473
Cherry red spot
Central retinal artery occlusion
474
Age related macular degeneration
Drusen - lipid deposition, round
475
Diabetic retinopathy
Cotton wool spots
Microaneurysm
Blot hemmorhage
Hard exudates
476
Optic atrophy
Pale optic disc
477
Retinal vein occlusion
Painless vision loss
Looks like a pizza
478
Eyes: straight lines appearing bent
Age related macular degeneration
479
Age related macular degeneration
Commonest cause of irreversible visual impairment
Drusen
Neovascularisation (wet)
Geographic atrophy (dry)
Metamorphosia- straight lines appearing bent
Central scotoma (black patch)
480
481
Tx of AMD
Wet - anti VEGF into eye
Dry - no tx
482
Chloramphenicol adverse effect
Bone marrow depression
483
Retinal detachment
Curtain across vision
484
Scabies 1st line tx
Permethrin cream
485
herpes simplex keratitis
dendritic ulcer or geographic ulcer
486
uveitis
pain, photophobia, redness, lacrimation, blurred vision
487
otosclerosis
progressive coductive hearing loss
488
presbycusis
sensorineural hearing loss in elderly, (loss of bilateral high frequency hearing loss)
489
glaucoma
raised intraocular pressure - (normal pressure 11-21)
490
pinguecula vs pterygium
both are benign growth of the conjunctiva
pterygia grow over the edge of the cornea and pingueculae don't
491
psoriasis
extensor surfaces with silver scale
492
nasopharyngeal Ca -which virus causes it
Epstein barr virus
493
optic neuritis
loss of red colour vision and pain on movement - diagnosis is MRI
494
polymorphic eruption of pregnancy vs pemphigoid gestationis
pepmhigoid starts around umbilicus and needs topical or oral steroids
495
stat dose in suspected meningitis
benzylpenicillin
496
morphine dose increase
50%
497
morphine dose for breakthrough pain
1/10-1/6 of dose
498
long lasting modified release preparation morphine
same dose as oral morphine
499
drug that causes myopathy
furosemide
500
drug that causes corneal deposits
amiodarone
501
ethambutol se
optic neuritis, red colour blidness, peripheral neuropathy
502
Isoniazid SE
peripheral neuropathy, agranulocytosis, hepatitis
503
streptomycin SE
8th CN - tinnitus, vertigo, ataxia
nephrotoxicity
504
acute sore throat 1st line tx
phenoxymethylpenicillin
505
group A beta haemolytic streptococcus criteria
1. tonsilar exudate 2. anterior cervical lymphadenopathy 3. fever 4. absence of cough
506
gingival hyperplasia causes
phenytoin, ciclosporin, nifedipine
507
tx for fungal nail infection
topical, or oral terbinafine
508
head lice tx
dimeticone
509
functional vs mechanical bowel obstruction, antiemetics
functional - metoclopramide, mechanical - cyclizine
510
which DM drug causes increased risk of UTI?
Dapagliflozin
511
which DM drug should be avoided in heart failure?
pioglitazone
512
Impetigo treatment
Hydrogen peroxide cream
513
Argyl Robinson or Aldie Holmes pupil
Accommodates but doesn’t react - AR is bilateral, HA is unilateral
514
epilepsy medication causing bilateral peripheral visual loss
Vigabatrin
515
epilepsy medicatoin causing weight loss, renal stones, paraesthesia, cognitive impariemtn
Topiramate
516
co-danthramer
combination laxative (stimulant/softener) used in terminally ill
517
what laxatives stain urine red?
co-danthrusate or ca-danthramer
518
tardive dyskinesia
repetitve involuntary purposeless movements, eg lip smacking, due to antipsychotics
519
amiodarone SE
pulmonary fibrosis, skin pigmentation, thyroid disturbance, hepatotoxicity
520
benzodiazepine antidote
flumazenil
521
dermoid cyst
benign, young children, lateral aspect of the eyebrow
522
seborrheic keratosis
brown, proliferation of epidermis
523
trichophyton rubrum tx
fungal nail infection, tx oral terbinafine
524
nighttime blindness
cataract
525
retinal detachment
curtain loss of vision, flashing lights and floaters, reduced visual fields
526
eye down and out
oculomotor
527
MSRA
flashcards
Decks in class (19)
# Cards
-
MSK528
-
MSRA - NICE Guidelines0
-
MSRA - Gastroenterology68
-
MSRA - Musculocutaneous106
-
MSRA - Renal18
-
MSRA - Haematology77
-
MSRA Gen Surg + Urology26
-
MSRA Ophthalmology65
-
MSRA Psychiatry40
-
MSRA Infectious Diseases61
-
MSRA O & G72
-
MSRA Paediatrics92
-
MSRA ENT40
-
MSRA Dermatology52
-
MSRA Respiratory48
-
MSRA Endocrinology80
-
MSRA Neurology101
-
MSRA Cardiology48
-
MSK 260
