1
Q
What is an X-ray finding of transfusion associated lung injury?
A
Bilateral diffuse lung infiltrates
2
Q
What are some contraindications for pioglitazone (2)?
A
- Heart failure
- Bladder cancer/ macroscopic haematuria (uninvestigated)
3
Q
Which opioids ate safe in renal failure (2)?
A
- Buprenorphine
- Fentanyl
4
Q
How can cellulitis and erysipelas be differentiated?
A
Erysipelas has well defined borders, cellulitis does not
5
Q
How does behcets disease present (3)?
A
- Genital ulcers
- Oral ulcers
- Anterior uveitis
6
Q
How does leriche syndrome present (3)?
A
- Claudication of buttocks/ thighs
- Atrophy of musculature of legs
- Impotence
7
Q
What wells score suggests a DVT is likely?
A
2 points or more
8
Q
What wells score suggests a PE is likely?
A
5 points or more
9
Q
What is case control study vs retrospective cohort study?
A
- Case control = look at disease and see what risk factors people have for it vs those without the disease
- Retrospective cohort = look at one risk factor/ exposure and look at the outcomes of people with this risk factor
10
Q
What are the criteria for starting steroids in sarcoidosis (3)?
A
- CXR stage 2/3 disease + symptomatic
- Hypercalcaemia
- Eye/ heart/ neuro involvement
otherwise just watch and wait
11
Q
What medication should be given to patients with plasmodium ovale or vivax to destroy the liver hypnozoites?
A
Primaquine
12
Q
What findings indicate a severe pancreatitis (6)?
A
- Hypoxia
- Age > 55
- Hypocalcaemia
- Hyperglycaemia
- Neutrophilia
- Elevated LDH/ AST
13
Q
How is H. pylori treated (2)?
A
- PPI + amox + (clary or metronidazole)
- Try the other of clary/ metro
pen allergy = PPI + clary + metro
14
Q
How can COPD be managed after referral to a specialist + on maximal standard treatment (2)?
A
- Prophylactic antibiotics (azithromycin)
- PDE-4 inhibitors - if persistent severe symptoms
15
Q
What are some criteria for a CT head < 8 hours after a head injury in adults (8)?
A
- GCS < 13 initially
- GCS < 15 at 2 hours
- Open/ depressed skull fracture
- Basal skull features (panda eyes, battle sign)
- Seizure
- Focal neuro deficit
- More than 1 episode vomiting
- Coagulopathy + amnesia/ LOC
16
Q
What is a common side effect of panretinal laser photocoagulation?
A
Visual field reduction
17
Q
How does peripheral neuropathy present (2)?
A
- Predominant motor loss
- Predominant sensory loss
18
Q
What is a complication of draining a pleural effusion too quickly?
A
Re-expansion pulmonary oedema
19
Q
When would low anterior resection vs abdominoperineal resection be done (2)?
A
- Low anterior resection = cancer > 5cm from anal verge
- Abdominoperineal resection = cancer < 5cm from anal verge
20
Q
What is specificity calculated?
A
TN/(TN+FP)
21
Q
Other than colon cancer what cancer does hereditary non-polyposis colorectal carcinoma increase the risk of?
A
Endometrial
22
Q
What are two risk factors for placenta accreta?
A
- Previous c-section
- Placenta praevia
23
Q
What medication must be avoided in bowel obstruction?
A
Metoclopramide
24
Q
How should a woman with bleeding in pregnancy < 6 weeks be managed (provided there is no pain)?
A
Expectant management + repeat pregnancy test in 7-10 days
25
What is the medical management of BPH (3)?
1. Alpha blocker (e.g. tamsulosin)
2. Antimuscarinic (e.g. tolterodine)
* Finasteride (5 alpha reductase inhibitor) - if patient has significantly enlarged prostate/ high risk of progression
26
What are some common findings on blood film in those with coeliacs (2)?
* Howell jolley bodies
* Target cells
*due to hyposplenism*
27
When should an ABG be done in those with pneumonia?
Sats < 92%
28
What are the different locations of a hip fracture?
* Intracapsular (subcapital)
* Extracapsular (trochanteric or subtrochanteric)
29
How are intracapsular hip fractures managed (2)?
* Total hip replacement (could walk, not cognitively impaired, suitable for anaesthetic)
* Hemiarthroplasty
30
How are extracapsular hip fractures managed (2)?
* Stable intertrochanteric = dynamic hip screw
* Subtrochanteric or unstable = IM device
31
What is a key side effect of prednisolone that you would see on an FBC?
Neutrophilia
32
How should AAA be screened for (4)?
* All 65 year old men have an USS
* 3-4.4 = rescan every 12 months
* 4.5-5.4 = rescan every 3 months
* > 5.5 = 2ww referral to vascular
33
What would be seen on x-ray in acute respiratory distress of the newborn?
Diffuse ground glass pattern
34
How long should patients with tonsillitis be treated for if an antibiotic prescription is indicated?
5-10 days
35
How should RCC be surgically managed (2)?
* < 7cm/ T1 = partial nephrectomy
* > 7cm/ T2 = radical nephrectomy
36
How should acute cholecystitis be managed (2)?
* IV Abx
* Laparoscopic cholecystectomy < 1 week
37
How should a dysphagia/ SVCO due to tumour obstruction be managed medically in palliative care?
8mg dexamethasone orally
38
What are the features of menierres disease (4)?
Attacks of:
* Vertigo (prominent symptom)
* Tinnitus
* Unilateral sensorineural hearing loss
* Fullness in ear
39
How is hypercalcaemia managed (2)?
* IV fluids (up to 3/4 litres)
* IV bisphosphonates (denosumab if renal impairment)
40
What are some causes of erythema multiforme (8)?
* HSV (most common)
* Idiopathic
* Mycoplasma
* Streptococcus
* SLE
* Sarcoidosis
* Malignancy
* Penicillins, NSAIDs, carbamazepines, COCP, sulfonamides
41
How is rosacea managed (2)?
1. Topical ivermectin (also metro, azelaic acid)
2. Topical ivermectin + oral doxy
42
What is the most common cause of erysipelas?
Strep pyogenes
43
How does lichen planus present?
Itchy pink/ purple papule over the palms, soles, genitals, flexor surfaces of arms
44
How does a sebaceous cyst present?
Smooth fluctuant lesions with central epithelial defect
45
How is plaque psoriasis managed (3)?
1. Potent corticosteroid + vit D analogue (both topical) OD
2. Topical vit D analogue BD
3. Topical potent corticosteroid BP or coal tar preparation
46
How is scalp psoriasis managed?
Potent corticosteroid 4 weeks
47
What is the most common malignancy associated with acanthosis nigricans?
GI adenocarcinoma
48
What are the blood findings for those with myelofibrosis (2)?
* Anaemia
* Raised WCC, platelets (in early disease)
49
What medications can cause pancreatitis (4)?
* Bendroflumethiazide
* Furosemide
* Mesalazine
* Azathioprine
50
How long must a patient refrain from driving for after an acute MI?
1 week
51
How is a beta block overdose managed (2)?
1. Atropine
2. Glucagon
52
What are the features of takotsubu cardiomyopathy (4)?
* Chest pain
* Features of heart failure
* ST elevation
* Normal angiogram (can have raised troponin)
53
How does a thyroglossal cyst present?
Fluctuant central neck lump that moves upward with swallowing + when tongue is stuck out
54
How is a thyroglossal cyst managed?
Surgical excision
55
What is the most common cause of conjunctivitis?
Adenovirus
56
Which lung cancer is cavitating on x-ray?
Squamous cell carcinoma
57
What pain relief should be offered to women in the early stages of labour (3)?
1. Paracetamol
2. Entonox
3. Opioids (e.g. diamorphine)
*epidural not usually used in early stages*
58
How does chancroid present?
* Painful genital ulcers (ragged, sharply defined borders)
* Unilateral painful inguinal lymphadenopathy
59
How is chancroid treated?
Ceftriaxone or azithromycin
60
What is the most common cause of myocarditis and pericarditis?
Coxsackie B virus
61
What antibody is raised in dermatomyositis (2)?
* Anti Mi-2 (more commonly)
* Anti-Jo1
62
What is a finding in the blood of those with post strep glomerulonephritis?
Low C3
63
What is the blood film finding in AML?
Auer rods
64
What is the blood film finding in CML?
Smudge cells
65
Is AST or ALT raised more in alcoholic liver disease?
AST raised more
66
What antibiotics are used for otitis externa?
Ciprofloxacin ear drops
67
What can be used as prophylaxis agains oesophageal variceal bleeding?
BB (e.g. propranolol)
68
What is primary vs secondary hyperparathyroidism?
* Primary = too much PTH --> too much Ca
* Secondary = low Ca --> raised PTH
69
What is low in the blood in those with haemolysis?
Haptoglobin
70
How often is the pneumococcal vaccine given?
Once off vaccine
71
Who is offered the pneumococcal vaccine (5)?
* Aged 65
* Chronic liver disease/ hepatitis
* Diabetes
* Chronic resp diseases
* Asplenia
72
What is the usual outcome in cohort vs case control studies?
* Cohort = relative risk
* Case-control = odds ratio
73
Who should be screened for gestational diabetes in pregnancy (4)?
* BMI > 30
* Previous gestational diabetes
* First degree relative with diabetes
* Unexplained stillbirth
74
When should patients with risk factors be screened for gestational diabetes (2)?
* Booking
* 24-28 weeks
75
What secretes hCG?
Syncytiotrophoblasts
76
What type of lump in the anterior neck will show cholesterol crystals when aspirated?
Branchial cysts
77
What skin change does mycoplasma pneumoniae cause?
Erythema multiforme
78
How is mycoplasma pneumoniae diagnosed?
Serology
79
What are some complications of PSC (2)?
* Cholangiocarcinoma
* Colorectal carcinoma
80
How is lichen planus treated (2)?
* Potent topical steroids
* Benzadamine mouthwash
81
How does acute interstitial nephritis present (4)?
* Fever, rash, arthralgia
* Eosinophilia
* Renal impairment
* Hypertension
*after taking new drug e.g. penicillins*
82
Which antipsychotics are safe during breastfeeding (2)?
* Olanzapine
* Quetiapine
83
What is caplans syndrome?
Shortness of breath + intrapulmonary nodules in people with rheumatoid arthritis
84
How should all tachycardias with life threatening symptoms be managed?
Synchronised DC shock
85
How does staphylococcal scalded skin syndrome present (3)?
* Superficial fluid filled blisters
* Desquamation (positive nikolsky sign)
* Fever + irritability
*due to staph aureus toxins*
86
How is staphylococcus scalded skin syndrome managed?
IV fluclox
87
What are some causes of avascular necrosis of the hip in adults (5)?
* Long term steroids
* Chemo
* Alcohol
* Trauma
* Sickle cell
88
How should a pneumothorax persisting beyond 48 hours with a drain in situ be managed?
Referral to cardiothoracic
89
How should reduced ejection heart failure be managed (4)?
* ACE-i
* BB
* Mineralocorticoid receptor antagonist
* SGLT-2 inhibitor
90
After which shock should amiodarone be given in cardiac arrest?
3rd shock
91
Do varicoceles traniluminate?
NOOOOOOO
92
What is a complication of large volumes of saline administration?
Hyperchloraemic acidosis
93
What are some causes of torsades de pointes (7)?
Long QT causes:
* Congenital
* Macrolides
* Hypo calcaemia, kalaemia, magnesaemia
* Hypothermia
* Antipsychotics
* TCAs
* Subarachnoid
94
What is the gold standard for investigating hypopituitarism?
Insulin tolerance test
95
What two medications are often used post renal transplant and what are their common side effects (2)?
* Tacrolimus = tremor
* Ciclosporin = gingival hyperplasia
96
What time period is an acute graft failure after a renal transplant expected?
< 6 months
97
Where is an AAA most common?
Infra-renal aorta
98
What is the most common cause of meningitis?
Enterovirus
*viral are the most common cause overall*
99
How should FGM be reported in those under 18?
Report to 101 within 1 working day
100
What is the most common mutation in malignant hyperthermia?
Auto dominant mutation in ryanodine receptor 1
101
What is a breast lump that commonly affects women who have recently stopped breastfeeding?
Galactocele
102
What is the mechanism of action of medication given for noisy secretions at the end of life (e.g. hyoscine)?
Anticholinergics
103
What is the first line investigation for suspected ovarian malignancy?
CA-125
104
What is attrition bias?
Loss of participants in a study (e.g. they dont reply to the study)
105
What is the first line investigation for renal cancer?
USS
106
What would be the changes in calcium and phosphate in those with hyperparathyroidism?
* Calcium raised
* Phosphate low
107
How is adrenaline induced ischemia managed?
Phentolamine
108
When should hormonal contraception be started after taking ulipristal acetate?
5 days after
109
When should HbA1C be monitored in T1DM?
3-6 monthly
110
What medication can be used to shrink the size of fibroids?
GnRH agonists
111
When is slapped cheek no longer infectious?
Once rash appears
112
What antibody is seen in PBC vs autoimmune hepatitis?
* PBC = anti mitochondrial
* Autoimmune = anti smooth muscle
113
What medication should be avoided in raynauds?
Most beta blockers
114
Which bundle branch block can be normal?
RBBB
115
What gene mutations are associated with MEN (2)?
* MEN type 1 = MEN-1 gene
* MEN type 2 (A and B) = RET gene
116
What echo findings indicate severe aortic stenosis (3)?
* Peak gradient > 40 mmHg
* Valve area < 1cm^2
* Aortic jet velocity > 4m/s
117
How can bullous pemphigoid and pemphigus vulgaris be differentiated (2)?
* Bullous pemphigoid = mucous membranes not affected
* Pemphigus vulgaris = mucous membranes affected
118
What antibodies are found in bullous pemphigoid and pemphigus vulgaris (2)?
* Bullous pemphigoid = Abs against desmoglein 3
* Pemphigus vulgaris = Abs against hemidesmosome proteins BP180 and BP230
119
How should severe UC remission be induced (2)?
1. IV steroids
2. IV ciclosporin (after 72 hours) or consider surgery
120
How does spinal muscular atrophy present (4)?
Symptoms usually begin in first 6 months of life
* Hypotonia
* Proximal muscle weakness
* Absent reflexes
* Tongue fasciculations
121
What is the first line imaging for suspected myeloma?
Whole body MRI
122
How can benign vs malignant parotid gland tumours be differentiated (2)?
* Benign = rarely facial nerve involvement
* Malignant = frequent facial nerve involvement
123
How is alzheimers managed (2)?
1. Ach inhibitor (e.g. donepezil, galantamine, rivastigmine)
2. NMDA antagonist (e.g. memantine) - used as add on or if severe disease at diagnosis
124
What is the most common complication of mumps?
Orchitis
125
When should patients with diabetes surrender their driving license?
After 2 episodes of hypoglycaemia
126
How should those on metformin be managed during ramadan?
Take 1/3rd normal dose before sunrise and 2/3rds after sunset
127
What is the most common type of thyroid cancer?
Papillary
*excellent prognosis despite tendency to spread to cervical lymph nodes*
128
What nerve is most at risk from colles fracture?
Median nerve
129
What T4 and TSH measurements could suggest a patient is poorly compliant with levothyroxine?
* TSH high
* T4 normal
*this suggests the patient has started taking the levothyroxine correctly before the blood test, so T4 has normalised, but TSH takes longer to normalise again*
130
What is sick euthyroid syndrome (2)?
* Low/ normal TSH, low T3/4
* Due to acute illness
131
What drugs can cause gynaecomastia (5)?
* Spironolactone = most commonly
* Digoxin
* Finasteride
* GnRH agonists
* Anabolic steroids
132
What can cause a tender goitre in thyrotoxicosis?
De Quervains thyroiditis
133
How can reactive arthritis usually be managed?
NSAIDs
*urgent ophthalmology referral if anterior uveitis suspected, can also just have conjunctivitis*
134
What might cause rising bHCG levels after evacuation of a molar pregnancy?
Choriocarcinoma
135
How is malignant hyperthermia managed?
IV dantrolene
136
How is an insulinoma investigated?
72 hour fast
137
How can keloid scars be managed?
Intra-lesional corticosteroids
138
What is the cause of bilateral retinoblastomas?
Hereditary (auto dom) retinoblastoma
*sporadic would be unilateral*
139
What are the ASA criteria for anaesthetics (5)?
* 1 = healthy patient
* 2 = mild systemic disease (e.g. smoker, pregnancy, obesity, mild lung disease)
* 3 = severe systemic disease (e.g. COPD, distant MI/ CVA)
* 4 = severe systemic disease that is a constant threat to life (e.g. MI < 3m ago, severe valve dysfunction, sepsis/ DIC)
* 5 = moribund patient not expected to survive without surgery (e.g. ruptured AAA)
140
What virus causes genital warts?
HPV 6 and 11
141
How is zollinger ellison syndrome screened for in those suspected of it?
Fasting gastrin levels
142
How is primary biliary cholangitis managed?
Ursodeoxycholic acid
143
What is seen on a blood gas in cushings and hyperaldosteronaemia?
Hypokalaemia metabolic alkalosis
144
How does MEN 1 sometimes present (3)?
* Peptic ulceration
* Galactorrhoea
* Hypercalcaemia
145
What sign can be seen in the eye of those with high lipids in the blood?
Corneal arcus (blue/ white opaque ring around periphery of iris)
146
What is diffuse oesophageal spasm?
Irregular contractions of the oesophagus during swallowing --> severe chest pain
*Dx = barium swallow*
147
What eye drop can cause the eyelashes to thicken/ lengthen?
Travoprost
148
How is shoulder dystocia managed (4)?
1. Mc roberts + suprapubic pressure
* Episiotomy
* Rubins (pressure on posterior aspect anterior shoulder) + woodscrew manoeuvres (pressure on anterior aspect posterior shoulder)
* Zavanelli manoeuvre (push head back in)
149
What are the stages of hypertensive retinopathy (4)?
* 1 = arteriolar narrowing + tortuosity
* 2 = AV nippling
* 3 = cotton wool spots + flame haemorrhages
* 4 = papilloedema
150
A stroke affecting which area might cause a clumsy hand?
Internal capsule
151
When should wound closure after trauma be delayed for 2-5 days (4)?
High risk of infection:
* > 5 cm
* Contaminated with soil
* Stellate in shape
* Co-morbidities
152
What is the appearance of viral warts?
Rough, hyperkeratotic papule with black punctate dots
153
What are the ottawa rules for an ankle x-ray (2)?
Pain in the malleolar area AND:
* Inability to weight bear for 4 steps
* Tenderness at posterior edge of lateral or medial malleolus
154
What is hartmanns procedure?
Sigmoid colon removed and colostomy created
155
What is seen on barium swallow in achalasia?
Bird beak appearance
156
How might a patient with CKD and taking laxatives present (3)?
Laxatives can accumulate in CKD (as they are magnesium salts, this can cause Mg toxicity):
* Reduced reflexes
* Progressive weakness
* Bradycardia + hypotension
157
How is anterior uveitis managed (3)?
* Urgent ophthalmic review
* Steroid eye drops
* Cycloplegics (e.g. atropine or cyclopentolate)
158
How is genital herpes investigated?
NAAT
159
What paraneoplastic syndromes are associated with squamous and small cell lung cancers?
* Squamous = PTHrP
* Squamous = SIADH or cushings
160
What type of kidney stone can be inherited?
Cystine stones
161
What is a complication of miliary TB and how should it be treated?
Adrenal insufficiency
Tx = hydrocortisone
162
What is capgras vs fregoli?
* Capgras = person close to you replaced
* Fregoli = everyone they meet is same person but with different disguises
163
What is the best and safest option for smoking cessation in pregnancy?
Nicotine replacement therapy
164
How does a dermatofibroma appear?
Pink bump (often on legs), skin dimples when squeezed
165
How would a bifascicular block present on ECG?
RBBB + right or left axis deviation
*there is one fascicule on the right and two on the left, therefore it is not complete heart block*
166
How should most cases of clubfoot (talipes equinovarus) be managed?
Ponseti method (progressive casting and manipulation)
*surgery is not usually needed*
167
What are the signs/ symptoms of biliary atresia (5)?
* Prolonged jaundice
* Hepatosplenomegaly
* Abnormal growth
* Dark urine, pale stools
* Poor growth
168
How is methanol poisoning managed (2)?
1. Fomepizole
2. Haemodialysis if severe
169
What is the hawthorne effect?
Change in behaviour due to the knowledge they are being studies
170
Which artery is most commonly causes complete heart block after an MI?
RCA
171
What are the cutoffs for IDA during pregnancy?
* 1st trimester = 110
* 2nd/ 3rd trimester = 105
* Postpartum = 100
172
When should anti-D prophylaxis be offered for those having a TOP?
After 10 weeks gestation
173
What is the difference between and end and loop stoma?
* End = not usually reversible
* Loop = easily reversible
174
What causes should be ruled out first when dealing with status epilepticus (2)?
* Hypoxia
* Hypoglycaemia
175
What medications are used for urge and stress incontinence (2)?
* Urge = antimuscarinics (oxybutynin, tolteradine or darifenacin) - mirabegron used if frail + old
* Stress = duloxetine
176
What is the most common type of fibroid?
Intramural fibroid
177
What is the preferred chemo regimen in myeloma?
MPT
178
How long should sertraline be continued for in patients with OCD?
12 months after feeling better
*6 months in depression*
179
When must diabetics surrender their drivers licence?
2 or more episodes of hypoglycaemia requiring help from another person
180
How are acute anal fissures managed (< 1 week) (3)?
* Stool softeners
* Topical anaesthetics
* Analgesia
181
How are chronic anal fissures managed (2)?
1. Topical GTN (8 weeks)
2. Refer for sphincterotomy
182
How should a patient with cholecystitis who develops empyema of the gallbladder be managed?
Urgent percutaneous cholecystostomy
*drainage of the empyema*
183
What cancer is associated with acromegaly?
Colon cancer
184
How is endometriosis managed?
1. NSAIDs/ paracetamol
2. COCP
3. Referral for GnRH/ surgery
185
How can acute tubular necrosis and acute interstitial nephritis be differentiated on urine microscopy?
* ATN = granular casts
* AIN = white cell casts
186
What are some factors indicating severe pancreatitis?
* Hypoxia
* Age > 55
* Hypocalcaemia
* Hyperglycaemia
* Neutrophilia
* Elevated LDH/ AST
187
How could iron overload present (2)?
* Hyper pigmented palmar creases
* Swollen joints (metacarpal-phalangeal)
188
What urinary investigation would suggest someone has a carcinoid tumour?
Urinary 5-HIAA
(breakdown product of 5-HT)
189
What is eosinophilic granulomatosis with polyangitis vs granulomatosis with polyangitis?
* EGP = asthma, nasal polyps, mononeuritis multiplex
* GP = saddle nose, haemoptysis, rapidly progressing glomerulonephritis
190
What environment is pseudomonas aeruginosa commonly found?
Inadequately chlorinated water e.g. hot tubs
*this can cause follicle-centred pustular rash*
191
How does hypocalcaemia usually present on examination/ history (3)?
* Tetany
* Perioral paraesthesia
* Chvosteks sign (parotid)
* Trousseas sign (wrist)
192
How does hypercalcaemia usually present on examination?
Normal examination
193
What is NMS vs serotonin syndrome (2)?
* NMS = decreased reflexes, lead pipe rigidity
* Serotonin syndrome = increased reflexes, myoclonus, dilated pupils
194
What meds should all patients with peripheral arterial disease be on?
* Statin
* Clopidogrel (in preference to aspirin)
195
What antibody is often found in membranous nephropathy?
Anti-PLA2R
196
What is the pathophysiology of perthes disease?
Avascular necrosis of the femoral head
197
What is a blood tumour marker for HCC?
AFP (alpha fetoprotein)
198
What is the muscle relaxant of choice for rapid sequence induction?
Suxamethonium
199
Which med causes a blue tinge to vision and which causes a yellow tinge?
* Blue = sildenafil
* Yellow = digoxin
200
When should thrombectomy and thrombolysis be offered for ischemic stokes?
* Thrombolysis < 4.5 hours of Sx
* Thrombectomy < 6 hours (if CTA/ MRA show a proximal anterior circulation occlusion)
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