1
Q
How should mastitis in breastfeeding women be managed (2)?
A
- Continue breastfeeding for 24 hours
- Fluclox (or if systemically unwell/ nipple fissure present)
2
Q
If a semen sample is abnormal (when investigating infertility) when should a repeat be requested?
A
3 months time
3
Q
What is the best measure for acute liver failure?
A
Prothrombin time (shorter half life than albumin)
4
Q
How does a PET scan work?
A
Radioactive glucose injected into body (this is uptaken by metabolically active cancer cells
5
Q
What results suggest downs on combined test (3)?
A
- Raised HCG
- Decreased PAPP-A
- Thickened nuchal translucency
6
Q
When should NIV be considered for those with a COPD exacerbation?
A
Resp acidosis persists despite maximum treatment
7
Q
What are the causes of normal anion gap metabolic acidosis (3)?
A
- Prolonged diarrhoea
- Renal tubular acidosis
- Addisons disease
8
Q
What are the causes of raised anion gap metabolic acidosis (3)?
A
- Lactate (e.g. sepsis)
- Ketones (DKA/ alcohol)
- Renal failure
9
Q
How is angina managed prophylacticaly (3)?
A
- BB/ CCB (verapamil/ diltiazem)
- BB + CCB (not verapamil/ diltiazem)
- Nicorandil/ ivabridine/ ranolazine - if BB or CCB not tolerated (refer if already on dual therapy)
10
Q
How should erectile dysfunction be investigated in men (2)?
A
- Lipid/ fasting glucose levels
- Morning testosterone
11
Q
What key drug should be avoided in people with myasthenia gravis?
A
Beta blockers
12
Q
How long does finasteride typically take to start working for BPH?
A
6 months
13
Q
What should be offered to pregnant women who smoke?
A
Nicotine replacement therapy
Varenicline + bupronion are contraindicated
14
Q
How do parietal vs temporal lesions to the optic radiations affect vision?
A
- Parietal = contralateral inferior homonomous hemianopia
- Temporal = contralateral superior homonomous hemianopia
PITS
15
Q
What should all patients with COPD be given to keep at home?
A
Short course of steroids + antibiotics
16
Q
What drug is useful for treating an overactive bladder?
A
Oxybutynin
17
Q
What FBC abnormality can steroids cause?
A
Neutrophilia
18
Q
How should an AKI often be managed initially?
A
Fluid challenge
19
Q
How long should you wait between inhaler doses?
A
30 seconds
20
Q
What drugs commonly cause acute interstitial nephritis (3)?
A
- Penicillins
- NSAIDs
- Allopurinol
21
Q
What is boas sign?
A
Hyperpaesthesia (below right scapula) due to acute cholecystitis
22
Q
How is a groin hernia (inguinal or femoral) in a child managed?
A
Urgent surgical repair < 2 weeks
23
Q
What is almost always the most important electrolyte to correct first?
A
Hypomagnesaemia
24
Q
How does WHO classify performance status (5)?
A
- 0 = normal
- 1 = restricted by strenuous work
- 2 = more than 50% day active
- 3 = in chair for 50% of day
- 4 = completely disabled
- 5 = dead
25
What causes a vaginal pH less than 4.5?
Thrush
26
What causes a vaginal pH over 4.5?
* Trichomonas
* BV
27
How should acute pancreatitis be managed?
IV fluids + IV opioids
*NO ANTIBIOTICS*
28
What is the most common upper limb injury in children under 6?
Subluxation of the radial head (e.g. from being pulled back from the road)
29
How is subluxation of the radial head treated?
Passive supination of the elbow joint whilst elbow flex at 90 degrees
30
How is strep agalactiae/ GBS treated if found on vaginal swabs in pregnancy?
Intrapartum IV benzylpenicillin
31
How should remission in UC be maintained (2)?
1. Mesalazine (oral/ topical)
2. Oral azathioprine/ mercaptopurine (or if severe/ 2 or more relapses in 1 year)
32
What are some drug causes of photosensitivity (5)?
* Thiazides
* Abx (e.g. doxy)
* Amiodarone
* NSAIDs
* Sulphonylureas
33
What are the features of diabetic retinopathy?
* Microaneurysms
* Blot haemorrhages
* Hard exudates
* Cotton wool spots
* Proliferative = neovascularisation
34
What causes cupping of the optic disc on fundoscopy?
Primary open angle glaucoma
35
What is the presentation of benign rolandic epilepsy?
Nightime seizures
*good prognosis, outgrow around puberty*
36
What is the most common type of thyroid cancer?
Papillary
37
What are the new york heart association classification?
* 1 = no symptoms
* 2 = slight limitation
* 3 = marked limitation, comfortable at rest
* 4 = symptoms at rest
38
What is the intubation period of salmonella vs c. jejuni?
* Salmonella < 2 days
* C. jejuni = 2-5 days
39
How does neurofibromatosis (1) and tuberous sclerosis differ in presentation?
* Neurofibromatosis = cafe au lait spots (hyperpigmented)
* Tuberous sclerosis = ash leaf spots (hypopigmented)
40
What are some blood findings in those with PBC (3)?
* Anti mitochondrial antibodies
* Smooth muscle antibodies
* Raised IgM
41
What is the most common CXR finding in boerhaave syndrome?
Pleural effusion
42
Why should TMPT levels be checked before starting azathioprine?
Can result in severe myelosuppression if insufficient levels
43
How is intrahepatic cholestasis of pregnancy managed (4)?
* Bilirubin < 40 = normal
* Bilirubin 40-100 = deliver at 38-39 weeks
* Bilirubin >100 = deliver 35-36 weeks
* Symptomatic = emollients
44
What features suggest hypocalcaemia is severe (4)?
* Tetany
* Seizures
* ECG changes
* Carpopedal spasm
45
Who should be screened for coeliacs disease (3)?
* Autoimmune thyroiditis
* T1 diabetes
* 1st degree relatives
46
What is there a deficiency of in gilberts syndrome?
UDP glucuronosyltransferase
47
What can cause endphthalmos after trauma to the eye?
Fracture of the ethmoid bone
48
How is fat necrosis of the breast treated?
Conservatively
49
How should breast cysts be managed?
Aspiration of symptomatic cysts
50
How can acute cholecystitis be managed if unfit for surgery?
Percutaneous cholecystostomy
51
What blood should be checked before starting isotretinoin?
LFTs
(as hepatotoxic)
52
What is decerebrate vs decorticate?
* Decorticate = flexion
* Decerebrate = extension
53
What skin change does leprosy usually present with?
Hypopigmented patches of skin
54
What does anti-HBs imply?
Exposure/ immunisation
*immune system wins (does not suggest chronic infection)
55
How should migraine be managed?
Ibuprofen/ aspirin 900mg/ triptans = any first line
56
What is seen on an ECG in hypothermia?
J waves (slurred upsection in ST segment)
57
What does india ink stain detect?
Cryptococcus fungi
58
What are the symptoms of retinal detachment (3)?
* New floaters/ flashers
* Curtain coming down over vision
* RAPD may be present
59
How is dresslers syndrome treated?
NSAIDs
60
How is thyroid eye disease managed if severe?
Surgical decompression
61
When should antibiotics be given for otitis media (5)?
* > 4 days
* Systemic Sx
* Immunocompromised
* < 2 + bilateral
* Perforation/ discharge
62
When should anti-d be given in pregnancy (7)?
* 28 + 34 weeks (in Rh -ve mothers)
* Deliver of Rh +ve infant
* Miscarriage > 12 weeks
* Ectopic (if managed surgically)
* ECV
* Abdo trauma
* Antepartum haemorrhage
63
What is the most specific test for intrahepatic cholestasis of pregnancy?
Bile acids
64
How can G6PD be investigated at the time of an attack?
Direct coombs test
*G6PD enzyme assay only done 3 months after attack*
65
How is BPH treated in those who have postural hypotension?
Finasteride
66
How should a pregnant woman after 28 weeks with reduced foetal movement and no foetal heartbeat on doppler be investigated?
Immediate USS
67
How does chlamydia show on microscopy?
Obligate intracellular bacterium
68
What drugs are given for thrombolysis (2)?
* Alteplase
* Fondaparinux
69
What has likely happened if a patient with dry macular degeneration has vision that quickly deteriorates over months?
Progression to wet macular degeneration (choroidal neovascularisation)
70
How does kallmans affect LH/ FSH levels?
Low
71
How does a pancreatic pseudocyst present?
Bloating, indigestion, abdo pain 4 weeks after pancreatitis
72
What age should the moro reflex have disappeared?
6 months
73
What is the most important prognostic indicator in bladder cancer?
Stage of the tumour
74
What conditions can a thiamine deficiency cause (3)?
* Wernicke-korsakoff
* Dry beriberi (peripheral neuropathy)
* Wet beriberi (dilated cardiomyopathy)
75
What age is bronchiolitis most common?
3-6 months
76
What age are bow legs normal until?
Up to 4 years
77
How should IDA be managed if patients cannot tolerate oral iron tablets?
IV iron
78
How much should opioids be increased by in palliative patients if pain not controlled?
30-50%
79
When should digoxin levels be measured if toxicity is suspected?
8-12 hours after last dose
80
What condition is H. pylori most strongly associated with?
Duodenal ulcers
81
When ares seizures most common after alcohol withdrawal?
36 hours
82
When should pelvic organ prolapse be referred (3)?
* Grade 3 prolapse (past the introitus)
* Pelvic floor exercises have not helped
* Severe urinary/ rectal incontinence
83
How is labour induced (2)?
* Bishop < 6 = vaginal prostaglandins or oral misoprostol
* Bishop > 6 = amniotomy + oxytocin infusion
84
How is B12 deficiency treated?
* Every other day for 2 weeks
* Then every 3 months
85
How should urethritis be managed?
Doxy +/- IM ceftriaxone (depending on suspicion of gonorrhoea)
86
What are the chromosomes in klinfelters and turners?
* Klinfelters = XXY
* Turners = XO
87
How should patients on insulin be managed prior to surgery (2)?
* Minor surgery = reduce basal insulin to 80% the day before; cut out short insulin on day of surgery
* Major surgery = 80% basal insulin + variable rate insulin + dextrose infusion
88
What is social phobia?
Fear of being judged by others
89
What drug is used to reverse muscle relaxants?
Neostigmine
90
How should VZV be managed in high risk groups (immunocompromised/ pregnant/ neonate) (2)?
* Urgent VZV Ig (in neonates, mothers Ig checked as it is passed on through milk)
* Acyclovir day 7-14 (if Abs low)
91
How can ED be treated in those with contraindications to sildenafil (e.g. already taking nitrates) (2)?
1. Vaccum erection device
2. Intracavernosal prostaglandins
92
How is mycoplasma pneumoniae investigated?
Serology
93
What can be used as prophylaxis for variceal bleeding?
Beta blockers
94
How is endometrial cancer managed?
Bilateral salpingo-oophrectomy +/- post op radio (if high risk)
95
Which hepatitis virus is particularly dangerous during pregnancy?
Hep E
96
How is remission in crohns induced (2)?
1. Glucocorticoids
2. Mesalazine/ 5-ASA drugs
97
How is crohns remission maintained (2)?
1. Azathioprine/ mercaptopurine
2. Methotrexate
98
How is mild/ moderate UC remission induced (3)?
1. Rectal mesalazine (+/- oral mesalazine)
2. Oral mesalazine
3. Oral corticosteroid
99
How is severe UC remission induced (2)?
1. IV steroids
2. IV ciclosporin (after 72 hours)
100
How is remission maintained in UC?
* Mild/ mod = rectal mesalazine (+/- oral)
* Severe = azathioprine/ mercaptopurine
101
What can cause a pseudohyponatraemia on blood results?
Hyperlipidaemia
102
What is the most common cause of aortic valve stenosis in a young patient in the UK?
Bicuspid aortic valve
103
If you suspect neoplastic spinal cord compression, should you do an MRI first or start dexa first?
Dexa started immediately
104
What is trousseau sign of malignancy?
Migratory thrombophlebitis
*often indicates pancreatic cancer*
105
How does haemochromatosis present (4)?
* Bronze tan
* Dilated cardiomyopathy --> oedema
* Arthritis
* Polydipsia/ polyuria
106
How does an osteoporotic vertebral collapse present (2)?
* Sudden back pain
* Local tenderness
*does not usually cause neuro Sx*
107
What investigating polyuria/ dipsia, if you suspect diabetes insipidus, what conditions/ tests should you do before progressing to the water deprivation test (3)?
* Hypercalcaemia
* Hypokalaemia
* Diabetes mellitus
108
How should a cervical spine fracture be investigated?
CT neck
109
How is PSC investigated?
MR cholangiopancreatography
110
What biopsy/ histology findings suggest carcinoma in all sites of body?
* Pleomorphic
* Enlarged nuclei
* Hyperchromatic
111
How should abdominal surgery pain be managed (2)?
* Patient controlled IV analgesia
* Epidural (especially if severe resp disease)
112
Quesmed stuff wrong
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