1
Q
Describe the ‘double duct’ sign observed on MRCP.
A
The ‘double duct’ sign indicates dilatation of both the common bile duct and pancreatic duct, typically suggestive of pancreatic cancer, particularly in the head of the pancreas, and can also indicate ampullary tumors.
2
Q
Explain the recommended aspirin dosage for diabetic patients during pregnancy.
A
Diabetic patients should take 75mg of aspirin daily from 12 weeks gestation to reduce the risk of pre-eclampsia.
3
Q
Define the preferred antiplatelet therapy following an ischaemic stroke according to NICE guidelines.
A
Clopidogrel 75mg daily is the preferred antiplatelet therapy following an ischaemic stroke.
4
Q
How should patients with vagal manoeuvres and adenosine fail to revert SVT be treated next?
A
The next step is to administer verapamil or a beta-blocker, or consider electrical cardioversion.
5
Q
Identify the most common cause of death following a myocardial infarction.
A
Ventricular fibrillation
6
Q
Explain why ACE inhibitors are contraindicated in hypertrophic obstructive cardiomyopathy (HOCM).
A
ACE inhibitors can reduce afterload, which may worsen the left ventricular outflow tract (LVOT) gradient in patients with HOCM.
7
Q
Describe the cancer risks associated with Barrett’s oesophagus and achalasia.
A
Barrett’s oesophagus increases the risk of oesophageal adenocarcinoma, while achalasia increases the risk of squamous cell carcinoma of the oesophagus.
8
Q
What is the investigation of choice for suspected perianal fistulae in Crohn’s disease?
A
MRI is the investigation of choice for suspected perianal fistulae in patients with Crohn’s disease.
9
Q
How are hypertension and diabetes managed according to guidelines?
A
ACE inhibitors and A2RBs are first-line treatments for hypertension in diabetics, regardless of age.
10
Q
What are the classic triad symptoms of congenital rubella syndrome in neonates?
A
sensorineural deafness, eye abnormalities, and congenital heart disease.
11
Q
Identify the significance of raised beta-human chorionic gonadotropin and alpha-feto protein levels in a male patient.
A
Raised levels indicate the possibility of non-seminomatous testicular cancer.
12
Q
Explain the cause of subdural haemorrhage.
A
Subdural haemorrhage results from bleeding of damaged bridging veins between the cortex and venous sinuses.
13
Q
What does NICE recommend for children older than 3 months with suspected bacterial meningitis?
A
NICE recommends considering adjuvant dexamethasone for children older than 3 months with suspected or confirmed bacterial meningitis.
14
Q
What is the current treatment for Wilson’s disease?
A
The current treatment for Wilson’s disease is penicillamine.
15
Q
Define renal tubular acidosis and its metabolic consequence.
A
Renal tubular acidosis leads to hyperchloraemic, normal anion gap metabolic acidosis.
16
Q
When can carotid artery endarterectomy be considered?
A
Carotid artery endarterectomy can be considered if there is a stroke or TIA in the carotid territory and the patient is not severely disabled.
17
Q
What is the most common cause of reduced blood flow to the calf muscles?
A
Stenosis in the superficial femoral artery (SFA) is the most common cause of reduced blood flow to the calf muscles, leading to ischaemic pain on exertion.
18
Q
List the indications for thoracotomy in cases of haemothorax.
A
Indications for thoracotomy include >1.5L blood initially or losses of >200ml per hour for >2 hours.
19
Q
What type of cancer is penile cancer typically classified as?
A
Penile cancer is usually classified as a squamous cell carcinoma.
20
Q
Explain the Ottawa rules for ankle injuries.
A
The Ottawa rules include pain in the malleolar or midfoot zone, bone tenderness at the posterior edge or tip of either malleolus, and inability to bear weight both immediately and in the emergency department.
21
Q
What is the main neurovascular structure compromised in a scaphoid fracture?
A
The dorsal carpal branch of the radial artery is the main neurovascular structure compromised in a scaphoid fracture.
22
Q
Identify common bacterial causes of otitis media in children.
A
Common bacterial causes of otitis media in children include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.
23
Q
What does chondrocalcinosis indicate on an x-ray?
A
Chondrocalcinosis on an x-ray indicates pseudogout, characterized by linear calcifications of the meniscus and articular cartilage.
24
Q
List some ototoxic medications.
A
Ototoxic medications include gentamicin, quinine, furosemide, aspirin, and some chemotherapy agents.
25
What is the indication for clozapine in schizophrenia treatment?
Clozapine is indicated for patients with schizophrenia who have not responded adequately to at least 2 antipsychotics.
26
What should be done for chickenpox exposure in pregnancy?
Antivirals or VZIG should be given at days 7-14 post-exposure, not immediately.
27
What laboratory findings suggest Down's syndrome?
Down's syndrome is suggested by increased HCG, decreased PAPP-A, and thickened nuchal translucency.
28
How are corticosteroids used in severe alcoholic hepatitis?
Corticosteroids are used in the management of severe alcoholic hepatitis.
29
What does a raised alpha-feto protein level in a 54-year-old woman indicate?
A raised alpha-feto protein level in a 54-year-old woman may indicate liver cancer, specifically hepatocellular carcinoma or teratoma.
30
What can excessive vitamin B6 intake lead to?
Taking more than 200mg a day of vitamin B6 for several months can lead to peripheral neuropathy.
31
Why is buprenorphine considered a safe opioid choice in renal impairment?
Buprenorphine undergoes predominantly hepatic metabolism with minimal renal excretion, making it a safe choice in chronic kidney disease.
32
What does a new left bundle branch block on an ECG indicate in the context of MI?
A new left bundle branch block on an ECG, alongside symptoms consistent with myocardial infarction, is diagnostic of ST-elevation MI.
33
What medications does NICE recommend for migraine prophylaxis?
NICE recommends either propranolol or topiramate for migraine prophylaxis.
34
What medications are associated with gingival hyperplasia?
Gingival hyperplasia can be caused by phenytoin, ciclosporin, calcium channel blockers, and AML.
35
What does a new left bundle branch block suggest in acute coronary syndrome?
A new left bundle branch block may point towards a diagnosis of acute coronary syndrome.
36
How should invasive diarrhoea with bloody diarrhoea and fever be treated?
Invasive diarrhoea caused by Salmonella or Shigella should be treated with ciprofloxacin, while Campylobacter should be treated with clarithromycin.
37
What are the standard tests for diagnosing HIV?
Combination tests for HIV p24 antigen and HIV antibody are now standard for diagnosis and screening.
38
What potential side effect does bleomycin have?
Bleomycin may cause pulmonary fibrosis.
39
What is the increased cancer risk for patients who undergo renal transplant?
Patients who undergo renal transplant are at increased risk of malignancies, particularly squamous cell skin cancer, due to T-cell ablating immunosuppression.
40
What is a common organism causing lower respiratory tract infections in cystic fibrosis patients?
Pseudomonas aeruginosa is an important organism causing lower respiratory tract infections in cystic fibrosis patients.
41
What is the association between nephrotic syndrome and anti-PLA2R antibodies?
Nephrotic syndrome with anti-PLA2R antibodies is indicative of idiopathic membranous nephropathy.
42
What mnemonic helps remember the absolute indications for acute renal replacement therapy?
The mnemonic AEIOU helps remember the absolute indications for acute renal replacement therapy: Acidosis, Electrolyte abnormalities, Intoxication, Overload (fluid), and Uraemic symptoms.
43
What should be avoided in benign prostatic hyperplasia (BPH)?
Amitriptyline should be avoided in benign prostatic hyperplasia (BPH).
44
What is the most specific ECG marker for pericarditis?
PR depression is the most specific ECG marker for pericarditis.
45
How is unfractionated heparin monitored?
Unfractionated heparin requires monitoring by measuring the APTT.
46
What is the follow-up recommendation for patients under 25 years on SSRIs?
Patients aged 25 years or younger who have been started on an SSRI should be reviewed after 1 week.
47
What should be administered after the third shock in VF/pulseless VT during CPR?
After the third shock in VF/pulseless VT, both Adrenaline 1mg IV and amiodarone 300mg IV should be administered during the subsequent CPR cycle.
48
What antibodies are found in drug-induced lupus?
Anti-histone antibodies are found in 80-90% of drug-induced lupus cases.
49
What is the recommended treatment for inguinal hernia in infants?
Inguinal hernia in infants requires urgent surgery.
50
When is digoxin indicated in heart failure?
Digoxin is strongly indicated if there is co-existent atrial fibrillation with chronic heart failure.
51
What is the leading cause of painless massive GI bleeding in children aged 1 to 2 years?
Meckel's diverticulum is the leading cause of painless massive GI bleeding requiring a transfusion in children aged 1 to 2 years.
52
What should be done with existing urate-lowering therapy during an acute gout attack?
During an acute attack of gout, existing urate-lowering therapy (like allopurinol) should not be discontinued or altered in dosage.
53
What should be done for patients on anticoagulants suspected of having a TIA?
Patients on warfarin or a DOAC suspected of having a TIA should be admitted immediately for imaging to exclude a hemorrhage.
54
What is a contraindication for the levonorgestrel-releasing intrauterine system?
Fibroids distorting the uterine cavity is a contraindication for the levonorgestrel-releasing intrauterine system.
55
What laboratory findings suggest gonadal dysgenesis in primary amenorrhoea?
Raised FSH and LH levels in primary amenorrhoea suggest gonadal dysgenesis, such as Turner's syndrome.
56
What is the anticoagulation requirement for patients post-catheter ablation for atrial fibrillation?
Patients who have had a catheter ablation for atrial fibrillation still require long-term anticoagulation based on their CHA2DS2-VASc score.
57
What are Heberden's nodes?
Heberden's nodes are swellings of the distal interphalangeal joints.
58
What are Bouchard's nodes?
Bouchard's nodes are swellings of the proximal interphalangeal joints.
59
How can thiazides affect digoxin toxicity?
Thiazides may precipitate digoxin toxicity due to potassium loss.
60
What is the effect of Bendroflumethiazide on potassium levels?
Bendroflumethiazide is a thiazide diuretic that causes potassium loss, leading to hypokalaemia.
61
Describe the effect of hypokalaemia on digoxin binding.
Hypokalaemia allows digoxin to more easily bind to the ATPase pump, leading to increased inhibitory effects.
62
Explain the interaction between statins and clarithromycin.
Clarithromycin increases systemic exposure to simvastatin, which raises the risk of myopathy.
63
How do kidneys appear on ultrasound in chronic diabetic nephropathy compared to chronic kidney disease?
Chronic diabetic nephropathy typically shows large or normal sized kidneys, while chronic kidney disease usually presents with bilateral small kidneys.
64
What is the recommended adrenaline dose for anaphylaxis in children aged 6 months to 6 years?
The recommended dose is 150 mcg (0.15 ml of 1 in 1,000 solution).
65
Define hypocalcaemia in the context of kidney disease.
Hypocalcaemia indicates chronic kidney disease, as renal failure leads to reduced levels of metabolized vitamin D, resulting in decreased calcium reabsorption.
66
Explain the Berlin criteria for diagnosing ARDS based on chest x-ray findings.
Chest x-ray showing bilateral diffuse alveolar opacities is consistent with ARDS, along with acute onset within one week, a pO2/FiO2 ratio < 40kPa, and respiratory failure not fully explained by cardiac failure or fluid overload.
67
What does the CURB 65 scoring system assess?
CURB 65 assesses confusion, urea levels, respiratory rate, blood pressure, and age to evaluate the severity of pneumonia.
68
Identify the most common cause of hepatocellular carcinoma worldwide.
Hepatitis B is the most common cause of hepatocellular carcinoma worldwide.
69
What is the contraindication for verapamil in patients with tachycardia?
Verapamil is absolutely contraindicated in patients with broad complex tachycardia of unknown origin or known ventricular tachycardia (VT) due to the risk of severe hypotension and cardiovascular collapse.
70
How should adult patients with a hydrocele be evaluated?
Adult patients with a hydrocele require an ultrasound to exclude underlying causes such as a tumor.
71
What is the daily glucose requirement when prescribing fluids?
The glucose requirement is 50-100 g/day, regardless of the patient's weight.
72
Identify the most common cause of peritonitis in peritoneal dialysis patients.
Coagulase-negative Staphylococcus is the most common cause of peritonitis secondary to peritoneal dialysis.
73
What should be done when correcting a testicular torsion with a bell clapper deformity?
Both testes should be fixed to prevent the other testicle from rotating later.
74
What is the recommendation for pregnant women with mild or moderate gestational hypertension showing signs of pre-eclampsia?
They should be recommended to give birth within 24 - 48 hours.
75
Explain the significance of the '3 Cs' in relation to measles.
The presence of cough, coryza, and conjunctivitis ('3 Cs') is highly suggestive of measles.
76
What is the most common organism causing infective exacerbations of COPD?
Haemophilus influenzae is the most common organism causing infective exacerbations of COPD.
77
Why are oral anticholinergic medications contraindicated in myasthenia gravis?
Oral anticholinergic medications like oxybutynin or tolterodine can worsen neuromuscular symptoms in patients with myasthenia gravis.
78
What are the cancer risks associated with the combined oral contraceptive pill?
The combined oral contraceptive pill increases the risk of breast and cervical cancer but is protective against ovarian and endometrial cancer.
79
Describe benign rolandic epilepsy.
Benign rolandic epilepsy is characterized by partial seizures at night, with EEG showing centrotemporal spikes.
80
What should be done for a child with a limp and fever?
They should be referred for same-day assessment, even if transient synovitis is suspected.
81
What does the neonatal blood spot screening test screen for?
The test screens for sickle cell disease, cystic fibrosis, congenital hypothyroidism, phenylketonuria (PKU), and medium-chain acyl-CoA dehydrogenase deficiency (MCADD).
82
How can furosemide precipitate gout attacks?
Furosemide can increase uric acid reabsorption in the proximal tubule, leading to hyperuricaemia and precipitating gout attacks.
83
What is the recommendation for external cephalic version (ECV) in breech presentations?
ECV is recommended for women at or near term (36 weeks or more) with a breech presentation unless contraindications exist.
84
What is the treatment of choice for herpes simplex keratitis?
The treatment of choice is topical aciclovir.
85
What is required for patients taking hydroxychloroquine long-term?
They require a baseline ophthalmologic examination at the outset of treatment.
86
Identify the organism responsible for scarlet fever.
Group A haemolytic streptococci is responsible for causing scarlet fever.
87
What is the most common malignancy associated with acanthosis nigricans?
Gastrointestinal adenocarcinoma is the most common malignancy associated with acanthosis nigricans.
88
What are the requirements for a urea breath test?
No antibiotics in the past 4 weeks and no antisecretory drugs (e.g., PPI) in the past 2 weeks.
89
What symptoms are associated with SSRI discontinuation syndrome?
Symptoms include dizziness, electric shock sensations, and anxiety.
90
What does a relative afferent pupillary defect indicate?
It indicates an optic nerve lesion or severe retinal disease.
91
Define the diagnostic criteria for gestational diabetes mellitus (GDM).
The criteria include a fasting plasma glucose ≥5.6 mmol/L or a 2-hour post-load glucose ≥7.8 mmol/L.
92
What does Jacksonian movement indicate?
Jacksonian movement, characterized by clonic movements traveling proximally, indicates frontal lobe epilepsy.
93
What is the medication of choice for suppressing lactation?
Cabergoline is the medication of choice for suppressing lactation when breastfeeding cessation is indicated.
94
What should all patients with peripheral arterial disease take?
All patients should take clopidogrel and atorvastatin.
95
What does T wave inversion in right precordial leads indicate?
T wave inversion in leads V1-V3 in individuals over 14 years of age is a significant red flag for arrhythmogenic right ventricular cardiomyopathy (ARVC).
96
Differentiate between the uses of verapamil and sumatriptan.
Verapamil is used for long-term prophylaxis of cluster headaches, while sumatriptan is used as an acute rescue therapy.
97
What risks are associated with tamoxifen?
Tamoxifen increases the risk of venous thromboembolism (VTE) and endometrial cancer.
98
How often should sickle cell patients receive the pneumococcal polysaccharide vaccine?
Sickle cell patients should receive the vaccine every 5 years.
99
What does cryoprecipitate contain?
Cryoprecipitate contains factor VIII, fibrinogen, von Willebrand factor, and factor XIII.
100
Why is iron chelation therapy important in beta-thalassaemia major?
It is important to prevent complications of iron overload due to repeat transfusions.
101
What is the contraindication for statin therapy during pregnancy?
Statins are contraindicated in pregnancy due to the risk of congenital abnormalities.
102
What is the most common cause of death following a myocardial infarction?
Ventricular fibrillation is the most common cause of death following a myocardial infarction.
103
When should warfarin be stopped before planned surgery?
Warfarin is usually stopped 5 days before planned surgery, and surgery can proceed once the INR is less than 1.5.
104
What is the risk of administering verapamil in VT?
Intravenous administration of verapamil can precipitate cardiac arrest in patients with VT.
105
What are the effects of ACE inhibitors and diuretics on potassium levels?
ACE inhibitors can cause hyperkalaemia, while thiazide and loop diuretics can lead to hypokalaemia, often requiring potassium supplementation or monitoring.
106
What is the teratogenic risk associated with vitamin A?
Vitamin A is teratogenic in high doses, and pregnant women should not exceed a daily intake of >10,000 IU.
107
Which blood product has the highest risk of bacterial contamination?
Platelet transfusions have the highest risk of bacterial contamination compared to other types of blood products.
108
What does loss of corneal reflex suggest?
Loss of corneal reflex suggests the possibility of an acoustic neuroma.
109
What is the investigation of choice for suspected perianal fistulae in Crohn's disease?
MRI is the investigation of choice for suspected perianal fistulae in patients with Crohn's disease.
110
What symptoms indicate an acute haemolytic reaction during a blood transfusion?
Fever, abdominal pain, and hypotension during a blood transfusion indicate an acute haemolytic reaction.
111
How is symphysis-fundal height measured after 20 weeks of pregnancy?
After 20 weeks, symphysis-fundal height in cm equals the gestation in weeks.
112
What exacerbates lateral epicondylitis?
Lateral epicondylitis is worse on resisted wrist extension/supination while the elbow is extended.
113
What are the driving restrictions following a first unprovoked seizure?
Patients cannot drive for 6 months following a first unprovoked or isolated seizure if brain imaging and EEG are normal; if not, the restriction increases to 12 months.
114
What does electrical alternans suggest in a cardiac context?
Electrical alternans is suggestive of cardiac tamponade, characterized by an alternating beat-to-beat pattern in the amplitude or axis of the QRS complex.
115
What does the air crescent sign on chest x-ray indicate?
The air crescent sign is a characteristic finding of aspergilloma, where a crescent of air surrounds a radiopaque mass in a lung cavity.
116
What vitamin D supplement is recommended for pregnant and breastfeeding women?
The NHS advises a daily supplement of vitamin D 10 mcg for the bone health of pregnant and breastfeeding women.
117
What clinical findings are associated with ankylosing spondylitis?
Clinical findings include reduced chest expansion, reduced lateral flexion, and reduced forward flexion (Schober's test).
118
What must be reported to the coroner under the mental health act?
Any person's death occurring while under the mental health act, regardless of cause, must be reported to the coroner.
119
What fasting guidelines are recommended before surgery?
Patients are generally advised to fast from non-clear liquids/food for at least 6 hours before surgery and clear fluids for 2 hours before surgery.
120
What is the recommended treatment for croup?
A single dose of oral dexamethasone (0.15 mg/kg) should be taken immediately, regardless of severity.
121
What is the defining diagnostic criterion for acute myeloid leukaemia (AML)?
The presence of ≥20% blasts in the peripheral blood or bone marrow is the defining diagnostic criterion for AML according to WHO classification.
122
What tumor marker is associated with pancreatic cancer?
CA 19-9 is the tumor marker associated with pancreatic cancer.
123
How should vitamin B12 and folate deficiencies be treated?
In patients with both deficiencies, vitamin B12 deficiency must be treated first to avoid subacute combined degeneration of the spinal cord.
124
What should be done for Addison's patients with intercurrent illness?
Double the glucocorticoids while keeping the fludrocortisone dose the same.
125
What is the classic peripheral blood film finding in myelofibrosis?
The classic finding shows a leucoerythroblastic picture with immature red and white cell precursors and dacryocytes (teardrop-shaped red cells).
126
What is the initial therapy for type 2 diabetes mellitus if metformin is contraindicated?
If metformin is contraindicated and the patient has a risk of CVD, established CVD, or chronic heart failure, SGLT-2 monotherapy is recommended.
127
Describe the management approach for a patient with T2DM taking metformin.
Titrate up metformin and encourage lifestyle changes to aim for a HbA1c of 48 mmol/mol (6.5%). A second drug should only be added if the HbA1c rises to 58 mmol/mol (7.5%).
128
Explain the risks associated with intrahepatic cholestasis of pregnancy.
Intrahepatic cholestasis of pregnancy increases the risk of stillbirth; therefore, induction of labour is generally offered at 37-38 weeks gestation.
129
Define myelodysplasia and its potential progression.
Myelodysplasia may progress to acute myeloid leukaemia.
130
What is the recommendation for maternal antibiotic prophylaxis in GBS disease?
Maternal intravenous antibiotic prophylaxis should be offered to women with a previous baby with early- or late-onset GBS disease.
131
How is clubfoot characterized?
Clubfoot, or talipes equinovarus, is a congenital deformity characterized by the foot being turned inwards (inverted) and downwards (plantar flexed), with the key feature being that the foot cannot be easily or fully corrected into a neutral position passively.
132
Identify a latex-free alternative to condoms.
Polyurethane condoms are a latex-free alternative used for individuals with latex allergies.
133
What is a known cause of cholestasis?
Co-amoxiclav is a well-recognized cause of cholestasis.
134
When should alendronate be started in patients following a fragility fracture?
Start alendronate in patients aged 75 years and older following a fragility fracture, without waiting for a DEXA scan.
135
What should be done for patients on anticoagulants suspected of having a TIA?
Patients on warfarin, a DOAC, or with a bleeding disorder suspected of having a TIA should be admitted immediately for imaging to exclude a hemorrhage.
136
Describe the features of an L5 lesion.
L5 lesion features include loss of foot dorsiflexion and sensory loss on the dorsum of the foot.
137
How does dexamethasone affect outcomes in bacterial meningitis?
Dexamethasone improves outcomes by reducing neurological sequelae in the treatment of bacterial meningitis.
138
What does the Glasgow Coma Scale (GCS) measure?
The GCS measures motor (6 points), verbal (5 points), and eye opening (4 points) responses.
139
Explain cubital tunnel syndrome and its symptoms.
Cubital tunnel syndrome occurs when the ulnar nerve becomes compressed or irritated, leading to symptoms such as tingling in the little and ring fingers, worsening of symptoms when the elbow is bent for prolonged periods.
140
What are the clinical presentations of posterior hip dislocations?
Posterior hip dislocations present with a shortened and internally rotated leg.
141
What is the recommended approach when switching from fluoxetine to another SSRI?
Withdraw fluoxetine and leave a gap of 4-7 days before starting a low dose of the alternative SSRI due to fluoxetine's long half-life.
142
How should insulin doses be adjusted for surgery?
The once-daily insulin dose should generally be reduced by 20% on the day before and the day of surgery.
143
What is the management for Achilles tendonitis?
Management includes rest, NSAIDs, and physiotherapy if symptoms persist beyond 7 days.
144
Differentiate between radial tunnel syndrome and lateral epicondylitis.
Radial tunnel syndrome presents with pain typically distal to the epicondyle and worse on elbow extension/forearm pronation, while lateral epicondylitis presents with pain at the lateral epicondyle.
145
What are the characteristics of total anterior circulation infarcts (TACI)?
TACI involves the middle and anterior cerebral arteries and presents with unilateral hemiparesis and/or hemisensory loss of the face, arm, and leg, homonymous hemianopia, and higher cognitive dysfunction such as dysphasia.
146
Describe partial anterior circulation infarcts (PACI).
PACI involves smaller arteries of the anterior circulation and presents with 2 of the following: unilateral hemiparesis and/or hemisensory loss, homonymous hemianopia, and higher cognitive dysfunction.
147
What defines lacunar infarcts (LACI)?
LACI involves perforating arteries around the internal capsule, thalamus, and basal ganglia, presenting with unilateral weakness or sensory deficit of the face and arm, pure sensory stroke, or ataxic hemiparesis.
148
What are the presentations of posterior circulation infarcts (POCI)?
POCI involves vertebrobasilar arteries and presents with cerebellar or brainstem syndromes, loss of consciousness, or isolated homonymous hemianopia.
149
Identify the symptoms of lateral medullary syndrome (Wallenberg's syndrome).
Lateral medullary syndrome presents with ipsilateral ataxia, nystagmus, dysphagia, facial numbness, and cranial nerve palsy, along with contralateral limb sensory loss.
150
What are the features of Weber's syndrome?
Weber's syndrome is characterized by ipsilateral III nerve palsy and contralateral weakness.
151
What does a calcified Ghon complex indicate on a chest X-ray?
A calcified Ghon complex may be seen on the chest X-ray of a patient with latent tuberculosis (TB).
152
What is a classic presentation of typhoid fever?
A classic presentation of typhoid fever includes rose spots and constipation as a significant clue.
153
What is the best initial investigation for MEN II syndromes?
The best initial investigation for MEN II syndromes is urinary metanephrines, which has replaced catecholamines as the NICE recommended investigation.
154
How is the severity of COPD classified?
The severity of COPD is based on FEV1 readings: moderate is FEV1 50-79%, severe is 30-49%, and very severe is <30%.
155
What is the treatment for chlamydia in pregnancy?
If pregnant, azithromycin, erythromycin, or amoxicillin may be used to treat chlamydia.
156
What immunization protocol is recommended for babies born before 28 weeks gestation?
Babies born prior to 28 weeks gestation should receive their first set of immunizations in the hospital due to the risk of apnoea.
157
What ECG abnormality is associated with hypercalcaemia?
The main ECG abnormality seen with hypercalcaemia is shortening of the QT interval.
158
What does isolated thrombocytopenia in a well patient suggest?
Isolated thrombocytopenia in a well patient points to a diagnosis of immune thrombocytopenic purpura (ITP).
159
What is the first-line treatment for ITP?
The first-line treatment for ITP is oral prednisolone.
160
Why is a chest X-ray important before starting biologics for rheumatoid arthritis?
It is important to perform a chest X-ray to look for tuberculosis (TB) prior to starting biologics for rheumatoid arthritis, as they can cause reactivation.
161
How does atopic eczema present in infants?
In infants, atopic eczema usually involves the face and extensor surfaces of the body, as opposed to its classical flexural distribution.
162
What is the most important risk factor for cervical cancer?
Human papillomavirus (HPV) infection, particularly types 16, 18, and 33, is by far the most important risk factor for cervical cancer.
163
What HPV types are linked to genital warts?
HPV types 6 and 11 are linked to the development of genital warts.
164
What test is recommended for H. pylori post-eradication therapy?
The urea breath test is the only test recommended for H. pylori post-eradication therapy.
165
What condition is suggested by burning thigh pain?
Burning thigh pain may suggest meralgia paraesthetica, which is caused by compression of the lateral cutaneous nerve of the thigh.
166
Which nerve is most likely to be injured during knee arthroplasty?
The common peroneal nerve is the nerve most likely to be injured during knee arthroplasty.
167
What is the function of gliptins (DPP-4 inhibitors)?
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1.
168
When should lithium levels be monitored after a dose change?
After a change in dose, lithium levels should be taken a week later and weekly until the levels are stable.
169
What tests are used to monitor treatment in haemochromatosis?
Ferritin and transferrin saturation are used to monitor treatment in haemochromatosis.
170
What medication is licensed for the treatment of intractable hiccups?
Chlorpromazine is licensed for the treatment of intractable hiccups.
171
What should be done if chorioretinitis is suspected?
If chorioretinitis is suspected, an HIV test must be performed.
172
What is the first-line treatment for infertility in PCOS?
Clomifene is typically used as the first-line treatment for infertility in polycystic ovary syndrome (PCOS).
173
What does a fasting glucose level between 6.1 and 7.0 mmol/l indicate?
A fasting glucose level greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG).
174
Define impaired glucose tolerance (IGT).
Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and an OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l.
175
How does CRP differ from ESR in SLE?
CRP is typically normal in systemic lupus erythematosus (SLE), in contrast to the ESR.
176
What condition can COCPs induce due to hormonal changes?
COCPs can induce erythema nodosum due to hormonal changes they cause.
177
What is the recommendation for ACE inhibitors in patients under 55 years?
Offer people aged under 55 years an ACE inhibitor or a low-cost ARB. If an ACE inhibitor is prescribed and not tolerated, offer a low-cost ARB.
178
What is associated with salicylate poisoning?
Salicylate poisoning is associated with respiratory alkalosis.
179
What is the initial management for acute lung injury (ALI)?
The initial management for ALI typically involves intravenous unfractionated heparin to prevent thrombus propagation, especially if the patient is not suitable for immediate surgery.
180
List the causes of massive splenomegaly.
Causes of massive splenomegaly include myelofibrosis, chronic myeloid leukaemia, visceral leishmaniasis (kala-azar), malaria, and Gaucher's syndrome.
181
What are the features of small cell lung cancer?
Small cell lung cancer typically presents with central lesions, arises from APUD cells, and is associated with ectopic ADH and ACTH secretion, leading to hyponatraemia and Cushing's syndrome.
182
What is Lambert-Eaton syndrome?
Lambert-Eaton syndrome is characterized by antibodies to voltage-gated calcium channels, causing a myasthenic-like syndrome.
183
What is the management for very early stage lung cancer?
Patients with very early stage lung cancer (T1-2a, N0, M0) are now considered for surgery, as supported by NICE guidelines.
184
What treatment is offered to patients with more extensive lung cancer disease?
Patients with more extensive lung cancer disease are offered palliative chemotherapy.
185
What are common causes of community-acquired pneumonia?
Common causes of community-acquired pneumonia include Haemophilus influenzae, Staphylococcus aureus, and Mycoplasma pneumoniae.
186
What are the symptoms of Legionella pneumophilia infection?
Legionella pneumophilia infection classically presents with flu-like symptoms, a dry cough, lymphopenia, deranged liver function tests, and hyponatraemia.
187
What blood film findings may indicate functional hyposplenism due to coeliac disease?
Functional hyposplenism due to coeliac disease may show Howell-Jolly bodies and target cells on a blood film.
188
What does basophilic stippling indicate?
Basophilic stippling is a sign of disturbed erythropoiesis and is associated with several causes of anaemia, but is not specific to hyposplenism in coeliac disease.
189
What do Heinz bodies represent and in which conditions are they found?
Heinz bodies represent damage to haemoglobin and are associated with Glucose-6-phosphate dehydrogenase (G6PD) deficiency and alpha-thalassaemia.
190
Describe tear drop poikilocytes and their association with myelofibrosis.
Tear drop poikilocytes are abnormally shaped red blood cells that can be seen in myelofibrosis, a bone marrow disorder.
191
Explain the association of spherocytes with hereditary spherocytosis.
Spherocytes are red blood cells that are spherical rather than disc-shaped, and they are most commonly associated with hereditary spherocytosis, a genetic condition that affects red blood cell membrane stability.
192
Identify the coronary artery lesion associated with complete heart block following a myocardial infarction.
Complete heart block following a myocardial infarction is typically associated with a lesion in the right coronary artery.
193
How can you differentiate between a colostomy and an ileostomy based on location?
An ileostomy is usually located in the right iliac fossa, while a colostomy is more likely to be found in the left iliac fossa.
194
Explain the appearance and output characteristics of an ileostomy compared to a colostomy.
An ileostomy typically has a spouted appearance and produces liquid output, whereas a colostomy is flush with the skin and produces more solid output.
195
Define Light's criteria for classifying pleural effusions as exudates.
Light's criteria state that a pleural effusion is classified as an exudate if the effusion LDH level is greater than 2/3 the upper limit of serum LDH, pleural fluid LDH divided by serum LDH is greater than 0.6, or pleural fluid protein divided by serum protein is greater than 0.5.
196
What laboratory findings are required to diagnose tumor lysis syndrome?
Positive laboratory findings for tumor lysis syndrome require two or more of the following within 7 days of chemotherapy: uric acid > 475umol/l or a 25% increase, potassium > 6 mmol/l or a 25% increase, phosphate > 1.125mmol/l or a 25% increase, calcium < 1.75mmol/l or a 25% decrease.
197
Describe the clinical features of radial tunnel syndrome and how it differs from lateral epicondylitis.
Radial tunnel syndrome presents with tenderness distal to the common extensor origin and may include hand paraesthesia or aching at the wrist, while lateral epicondylitis presents with pain over the common extensor origin.
198
What is the recommended management for an undisplaced intracapsular hip fracture?
The management for an undisplaced intracapsular hip fracture includes internal fixation or hemiarthroplasty if the patient is unfit.
199
Explain the NICE recommendations for managing displaced intracapsular hip fractures.
NICE recommends replacement arthroplasty (total hip replacement or hemiarthroplasty) for all patients with a displaced intracapsular hip fracture, favoring total hip replacement for patients who can walk independently and are medically fit.
200
Identify the management approach for stable intertrochanteric fractures.
Stable intertrochanteric fractures are managed with a dynamic hip screw.
201
List the clinical features associated with femoral nerve injury.
Clinical features of femoral nerve injury include weakness in knee extension, loss of the patella reflex, and numbness of the thigh.
202
What are the complications that can occur post-myocardial infarction?
Complications post-myocardial infarction include acute mitral regurgitation, left ventricular free wall rupture, left ventricular aneurysm formation, pericarditis, and Dressler's syndrome.
203
Describe the clinical presentation of acute mitral regurgitation following a myocardial infarction.
Acute mitral regurgitation presents with sudden haemodynamic collapse, hypotension, flash pulmonary edema, and a new pansystolic murmur best heard at the apex.
204
Explain the typical clinical picture of left ventricular free wall rupture after a myocardial infarction.
Left ventricular free wall rupture typically presents with sudden hypotension, raised JVP, muffled heart sounds (Beck's triad), and can progress to pulseless electrical activity arrest.
205
What is the difference in presentation between left ventricular aneurysm formation and acute complications post-MI?
Left ventricular aneurysm formation develops weeks to months after a large MI and leads to chronic heart failure, while acute complications present with sudden deterioration.
206
Describe the characteristics of pericarditis occurring within 48 hours after a transmural myocardial infarction.
Pericarditis within 48 hours post-MI is characterized by typical pain that worsens when lying flat, a pericardial rub, and may show a pericardial effusion on echocardiogram.
207
What is Dressler's syndrome and when does it typically occur post-MI?
Dressler's syndrome is an autoimmune reaction that occurs 2-6 weeks after a myocardial infarction, characterized by fever, pleuritic pain, pericardial effusion, and raised ESR.
208
How is the severity of ulcerative colitis classified?
The severity of ulcerative colitis is classified as mild (< 4 stools/day with small blood), moderate (4-6 stools/day with varying blood and no systemic upset), and severe (>6 bloody stools/day with systemic upset features).
209
Explain the mechanism of action of thrombolytic drugs like alteplase.
Thrombolytic drugs like alteplase activate plasminogen to form plasmin, which degrades fibrin and helps dissolve thrombi, primarily used in ST elevation myocardial infarction.
210
What are the main clinical uses of alteplase?
Alteplase is used for acute ischemic stroke, ST-elevation myocardial infarction (STEMI), and massive pulmonary embolism, with specific timing for administration.
211
Describe the action of clopidogrel and ticagrelor as antiplatelet agents.
Clopidogrel irreversibly blocks the ADP (P2Y12) receptor on platelets, while ticagrelor reversibly blocks the same receptor, both preventing platelet activation and aggregation.
212
What is the role of heparin in anticoagulation therapy?
Heparin inhibits the conversion of fibrinogen to fibrin by activating antithrombin III, which inhibits factor Xa and thrombin, thus preventing new clots from forming.
213
List the components of the GRACE score used in cardiac risk assessment.
The GRACE score includes age, heart rate, blood pressure, cardiac function (Killip class), renal function (serum creatinine), cardiac arrest on presentation, and ECG findings.
214
What are the recommended adrenaline doses for infants and children in emergency situations?
For infants under 6 months, the dose is 100-150 micrograms; for children 6 months to 6 years, 150 micrograms; for 6-12 years, 300 micrograms; and for adults and children over 12 years, 500 micrograms.
215
Differentiate between restrictive and obstructive lung function tests.
In restrictive lung diseases like pulmonary fibrosis, both Forced Expiratory Volume in one second (FEV1) and Forced Vital Capacity (FVC) are reduced.
216
Describe the difference in FEV1 and FVC in obstructive versus restrictive lung diseases.
In obstructive lung diseases, FEV1 is significantly reduced due to difficulty in expelling air, while FVC may be normal or slightly reduced. In restrictive lung diseases, both FEV1 and FVC are reduced, but FVC is reduced more significantly.
217
Explain the significance of the FEV1:FVC ratio in lung disease diagnosis.
The FEV1:FVC ratio helps differentiate between obstructive and restrictive lung diseases. A ratio less than 0.7 indicates obstructive disease, while a ratio greater than 0.7 suggests restrictive disease.
218
Define FEV1 and its importance in pulmonary function tests.
FEV1 stands for Forced Expiratory Volume in 1 second, which measures how much air can be forcibly exhaled in one second. It is crucial for assessing lung function and diagnosing respiratory conditions.
219
How does the FVC differ between obstructive and restrictive lung diseases?
In obstructive lung diseases, FVC may be normal or slightly reduced, while in restrictive lung diseases, FVC is significantly reduced due to the inability of the lungs to expand fully.
220
Explain the implications of a low FEV1/FVC ratio.
A low FEV1/FVC ratio (<0.7) indicates an obstructive pattern, suggesting that the patient has difficulty expelling air from the lungs.
221
Describe the clinical features of a severe asthma attack in children.
Features include SpO2 < 92%, PEF < 33% of best or predicted, use of accessory neck muscles, silent chest, poor respiratory effort, agitation, altered consciousness, and cyanosis.
222
What is the first-line treatment for mild-to-moderate ulcerative colitis?
Aminosalicylates (5-ASAs) such as mesalamine, sulfasalazine, and balsalazide are the first-line therapy for mild-to-moderate ulcerative colitis.
223
How should severe colitis be managed in a hospital setting?
Severe colitis should be treated with intravenous steroids as first-line therapy, and intravenous ciclosporin may be used if steroids are contraindicated.
224
Explain the role of immunomodulators in ulcerative colitis treatment.
Immunomodulators like azathioprine and 6-mercaptopurine are used for patients who do not respond to or are intolerant of 5-ASAs and corticosteroids, helping to modulate the immune response and reduce inflammation.
225
Describe the management strategy for maintaining remission in ulcerative colitis after a flare.
For maintaining remission, options include daily or intermittent topical aminosalicylates, oral aminosalicylates, or azathioprine/mercaptopurine for patients with severe relapses.
226
What are the potential causes of a prolonged QT interval?
Causes include congenital syndromes, certain drugs (like amiodarone and tricyclic antidepressants), electrolyte imbalances, acute myocardial infarction, myocarditis, hypothermia, and subarachnoid hemorrhage.
227
How does a raised anion gap relate to metabolic acidosis?
A raised anion gap suggests increased production or reduced excretion of fixed/organic acids, such as lactic acid, urate, or ketones, indicating conditions like sepsis or diabetic ketoacidosis.
228
What is the significance of measuring Total Lung Capacity (TLC) in lung disease diagnosis?
Measuring TLC is essential to confirm restrictive lung disease, as spirometry alone may suggest restriction but does not confirm it.
229
Explain the management of perianal fistulae in Crohn's disease.
Management includes using MRI for diagnosis, treating with oral metronidazole, anti-TNF agents for closure, and placing a draining seton for complex fistulae.
230
Describe the effects of thiazide diuretics on kidney stones and gout.
Thiazide diuretics prevent calcium stones by reducing urinary calcium, but they can increase serum uric acid levels, raising the risk of gout flares.
231
What is the role of glucocorticoids in inducing remission for ulcerative colitis?
Glucocorticoids, such as oral, topical, or intravenous forms, are generally used to induce remission in ulcerative colitis, with budesonide as an alternative for certain patients.
232
How is a mixed pattern of lung disease characterized in terms of FEV1 and FVC?
A mixed pattern is characterized by both a reduced FEV1 and a reduced FVC, indicating the presence of both obstructive and restrictive components.
233
Describe the skin manifestations of CREST syndrome.
Thickening, tightening, and hardening of the skin, typically starting in the fingers and progressing proximally.
234
Explain Raynaud's phenomenon in the context of CREST syndrome.
It involves vasospasm-induced color changes (pallor, cyanosis, and erythema) in the fingers and toes in response to cold or stress.
235
How does gastrointestinal involvement present in CREST syndrome?
It can cause dysphagia, gastroesophageal reflux, and motility disorders affecting the esophagus, stomach, and intestines.
236
What pulmonary complications are associated with CREST syndrome?
Common complications include interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH), leading to shortness of breath, cough, and chest pain.
237
Define renal involvement in CREST syndrome.
Scleroderma renal crisis, characterized by rapidly progressive renal failure and malignant hypertension, is a life-threatening complication of systemic sclerosis.
238
Describe the musculoskeletal involvement in CREST syndrome.
It includes joint pain, stiffness, and contractures due to fibrosis of the joint capsules and tendons.
239
What is the significance of ANA positivity in systemic sclerosis?
ANA is positive in 90% of cases, indicating an autoimmune process.
240
Explain the association of anti-scl-70 antibodies in systemic sclerosis.
These antibodies are associated with diffuse cutaneous systemic sclerosis and a higher risk of severe interstitial lung disease.
241
What is the relationship between anti-centromere antibodies and systemic sclerosis?
Anti-centromere antibodies are associated with limited cutaneous systemic sclerosis.
242
Describe the key features of Antiphospholipid syndrome (APS).
APS is characterized by autoantibodies against phospholipids leading to a prothrombotic state, with normal bleeding time and recurrent thromboses.
243
How does Disseminated Intravascular Coagulation (DIC) affect clotting factors?
DIC causes widespread activation of coagulation, leading to consumption of clotting factors and platelets, resulting in prolonged PT/APTT and low platelets.
244
What is the genetic basis of Factor V Leiden?
Factor V Leiden is caused by a mutation leading to activated protein C resistance, resulting in thrombophilia.
245
Explain the clinical presentation of Haemophilia A.
Haemophilia A presents with deep bleeding into joints and muscles, primarily affecting males due to its X-linked recessive inheritance.
246
What distinguishes Haemophilia B from Haemophilia A?
Haemophilia B is due to Factor IX deficiency and is clinically identical to Haemophilia A, also known as Christmas disease.
247
Describe the pathophysiology of Immune Thrombocytopenic Purpura (ITP).
ITP involves autoimmune destruction of platelets, leading to low platelet counts and mucocutaneous bleeding.
248
What laboratory findings are associated with liver disease affecting coagulation?
Liver disease shows decreased synthesis of clotting factors, prolonged PT, and may present with thrombocytopenia.
249
How does Vitamin K deficiency affect coagulation tests?
Vitamin K deficiency leads to prolonged PT and APTT due to decreased levels of vitamin K-dependent clotting factors.
250
What is the role of von Willebrand factor in hemostasis?
Von Willebrand factor is essential for platelet adhesion and stabilizes Factor VIII, and its deficiency leads to impaired platelet function.
251
How does warfarin therapy affect coagulation?
Warfarin is a vitamin K antagonist that decreases levels of Factors II, VII, IX, and X, leading to prolonged PT and APTT.
252
What is the significance of PEFR in asthma management?
PEFR (Peak Expiratory Flow Rate) is used to assess asthma control, with values >75% indicating good control.
253
Describe the clinical features of a moderate asthma exacerbation.
In a moderate exacerbation, PEFR is 50-75% of best or predicted, speech is normal, and respiratory rate is <25/min.
254
What are the signs of a life-threatening asthma exacerbation?
Life-threatening exacerbation includes PEFR <33% of best or predicted, oxygen saturation <92%, and signs of exhaustion or confusion.
255
Explain the role of empagliflozin in managing type 2 diabetes with heart failure.
Empagliflozin is an SGLT2 inhibitor that lowers HbA1c, promotes weight loss, and provides cardiovascular benefits, particularly in heart failure.
256
What are the key tumor markers associated with ovarian cancer?
CA 125 is the tumor marker associated with ovarian cancer.
257
Describe the association of PSA in cancer diagnosis.
Prostate specific antigen (PSA) is associated with prostatic carcinoma.
258
What is the hallmark finding in Acute Myeloid Leukemia (AML)?
The hallmark finding in AML is the presence of Auer rods in myeloblasts.
259
How does Atropine function in treating bradycardia?
Atropine is the first-line treatment for bradycardia, increasing heart rate by blocking vagal effects.
260
What is the significance of T wave inversion in diagnosing ARVC?
T wave inversion in the right precordial leads (V1-V3) is a major criterion for diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC).
261
Describe the genetic abnormalities associated with Acute Promyelocytic Leukemia (APML).
APML is characterized by t(15;17) translocation, along with t(8;21) and inv(16) in some cases.
262
Explain the typical clinical presentation of Chronic Myeloid Leukemia (CML).
CML often presents with fatigue, splenomegaly, and is frequently asymptomatic. Laboratory findings include leukocytosis, left shift, and basophilia.
263
Define the Philadelphia chromosome and its significance in CML.
The Philadelphia chromosome is a genetic abnormality resulting from the BCR-ABL1 t(9;22) translocation, which is a hallmark of Chronic Myeloid Leukemia.
264
How does the progression of Chronic Myeloid Leukemia (CML) occur?
CML progresses from a chronic phase to an accelerated phase and then to a blast crisis, typically treated with tyrosine kinase inhibitors.
265
Describe the characteristics of Chronic Lymphocytic Leukemia (CLL).
CLL involves mature B lymphocytes, primarily affects older adults (median age 70), and is often asymptomatic with findings of lymphocytosis and smudge cells on blood film.
266
Explain the significance of Reed-Sternberg cells in Hodgkin Lymphoma (HL).
Reed-Sternberg cells are characteristic of Hodgkin Lymphoma and are identified by their CD15+ and CD30+ markers, indicating a good prognosis with treatment.
267
What are the common symptoms associated with Non-Hodgkin Lymphoma (NHL)?
NHL typically presents with lymphadenopathy, systemic symptoms, and may involve extranodal sites, with prognosis varying by subtype.
268
List the absolute contraindications to thrombolysis in stroke management.
Absolute contraindications include previous intracranial hemorrhage, seizure at stroke onset, intracranial neoplasm, suspected subarachnoid hemorrhage, and uncontrolled hypertension.
269
Describe the mechanism of action of sulfonylureas in diabetes management.
Sulfonylureas augment pancreatic insulin secretion, which can lead to increased insulin levels and potential hypoglycemia.
270
Explain the role of GLP mimetics in diabetes treatment.
GLP mimetics, such as exenatide, enhance insulin secretion, suppress glucagon release, slow gastric emptying, and promote satiety.
271
What is the initial management for Hirschsprung's disease?
Initial management involves rectal washouts or bowel irrigation, followed by definitive surgical intervention to remove the affected segment of the colon.
272
Identify situations where routine oxygen therapy is not recommended.
Oxygen therapy should not be routinely used in cases of myocardial infarction, stroke, obstetric emergencies, and anxiety-related hyperventilation without evidence of hypoxia.
273
List the causes of hyperkalemia.
Causes of hyperkalemia include acute kidney injury, certain medications (e.g., potassium-sparing diuretics, ACE inhibitors), metabolic acidosis, Addison's disease, and rhabdomyolysis.
274
What does the presence of HBsAg indicate in hepatitis B infection?
HBsAg indicates ongoing infection; if present for more than 6 months, it suggests chronic hepatitis B disease.
275
Explain the significance of anti-HBs in hepatitis B testing.
Anti-HBs indicates immunity to hepatitis B, either from previous infection or vaccination, and is negative in chronic disease.
276
Describe the features of Multiple Sclerosis (MS).
MS is characterized by spasticity, hyperreflexia, and demyelination of the CNS, leading to sensory and motor deficits in a relapsing-remitting pattern.
277
What are the common drugs that reduce mortality in left ventricular failure?
Drugs that reduce mortality in left ventricular failure include ACE inhibitors, beta-blockers, angiotensin receptor blockers, and aldosterone antagonists.
278
How long should a patient with a stroke or TIA refrain from driving?
Patients should refrain from driving for 1 month after a stroke or TIA, and may need to inform the DVLA if there are residual neurological deficits.
279
Identify the groups recommended to receive the BCG vaccine according to the Greenbook.
The BCG vaccine is recommended for infants in high TB incidence areas, those with TB-exposed parents, tuberculin-negative contacts, and healthcare workers.
280
What defines impaired glucose tolerance (IGT)?
IGT is defined as fasting plasma glucose less than 7.0 mmol/l and a 2-hour OGTT value between 7.8 and 11.1 mmol/l.
281
What is the antidote for warfarin overdose?
The antidote for warfarin is vitamin K.
282
Explain the surgical options for rectal tumors.
For rectal tumors, surgical options include abdominoperineal resection for distal tumors and low anterior resection for mid to upper rectal tumors.
283
Describe the antibiotic treatment for meningitis in infants under 3 months.
In infants under 3 months, the recommended antibiotic treatment is IV amoxicillin (or ampicillin) plus IV cefotaxime.
284
What are the effects associated with anterior cerebral artery strokes?
Strokes in the anterior cerebral artery typically result in contralateral hemiparesis and sensory loss, with greater impact on the lower extremity.
285
Identify the symptoms associated with middle cerebral artery strokes.
Middle cerebral artery strokes can cause contralateral hemiparesis and sensory loss, with greater impact on the upper extremity, as well as aphasia and contralateral homonymous hemianopia.
286
What is the significance of the posterior cerebral artery in stroke?
Strokes in the posterior cerebral artery can lead to contralateral homonymous hemianopia with macular sparing and visual agnosia.
287
Describe the characteristics of a brainstem stroke in the midbrain.
It is characterized by an ipsilateral cranial nerve III palsy (oculomotor nerve) and contralateral hemiparesis (weakness).
288
Explain the symptoms associated with Wallenberg syndrome.
Symptoms include ipsilateral facial pain and temperature loss, contralateral limb/torso pain and temperature loss, ataxia, and nystagmus.
289
Define the symptoms of anterior inferior cerebellar artery syndrome.
Symptoms include ipsilateral facial paralysis and deafness, along with contralateral weakness.
290
How does a lacunar stroke present clinically?
It presents with either isolated hemiparesis, hemisensory loss, or hemiparesis with limb ataxia.
291
What are the risk factors for pre-eclampsia?
Risk factors include being aged 40 or older, nulliparity, pregnancy interval of more than 10 years, family history of pre-eclampsia, previous history of pre-eclampsia, BMI of 30kg/m^2 or above, pre-existing vascular or renal disease, and multiple pregnancy.
292
Explain the typical presentation of presbycusis.
It is characterized by bilateral high-frequency hearing loss, difficulty hearing high-pitch sounds, and challenges in distinguishing certain consonants, particularly in noisy environments.
293
Describe the symptoms of acute angle closure glaucoma.
Symptoms include severe pain, decreased visual acuity, seeing haloes, a semi-dilated pupil, and a hazy cornea.
294
What is the significance of measuring progesterone on day 21 of the menstrual cycle?
It is used to assess ovulation, as progesterone levels peak approximately 7 days after ovulation.
295
How should patients with epilepsy manage their driving restrictions?
Patients must not drive and must inform the DVLA; restrictions vary based on seizure history and medication status.
296
Explain the features of a meniscal tear in the knee.
Symptoms include intermittent pain, locking, catching, and swelling that develops hours after injury, with localized pain over the joint line.
297
What are the common causes of erythema nodosum?
Causes include infections (like streptococci and tuberculosis), systemic diseases (like sarcoidosis), malignancies, and certain drugs.
298
Describe the typical features of scleritis.
It presents with severe pain, tenderness, and may be associated with underlying autoimmune diseases.
299
How does a patient with a patellar tendon rupture typically present?
They experience sudden anterior knee pain and an inability to straight leg raise or extend the knee, often with visible deformity of the patella.
300
What is the role of atorvastatin in patients with type 1 diabetes?
It is offered for primary prevention of cardiovascular disease in patients over 40, with diabetes for more than 10 years, or with established nephropathy or other risk factors.
301
Explain the driving restrictions for patients with syncope.
For a simple faint, there are no restrictions; for a single explained episode, 4 weeks off; for a single unexplained episode, 6 months off; and for two or more episodes, 12 months off.
302
What is the typical presentation of anterior uveitis?
It presents with acute onset pain, blurred vision, photophobia, and a small, fixed oval pupil.
303
Describe the symptoms of endophthalmitis.
Typically presents with a red eye, pain, and visual loss following intraocular surgery.
304
How does a stroke affecting the posterior cerebral artery manifest?
It can lead to visual agnosia, anopia, and macular sparing.
305
What are the common symptoms of a frontal lobe seizure?
They may include head/leg movements, posturing, post-ictal weakness, and Jacksonian march.
306
Explain the significance of the 'locked-in' syndrome.
It is a condition resulting from a basilar artery stroke, where the patient is aware but cannot move or communicate due to paralysis.
307
What is the typical management for acute ischemic stroke with confirmed occlusion?
Thrombectomy should be offered as soon as possible within 6 hours of symptom onset, along with intravenous thrombolysis if within 4.5 hours.
308
Describe the features of a posterior cruciate ligament injury.
It typically presents with posterior knee pain, mild swelling, and a reduced range of knee flexion.
309
What are the common findings in patients with lacunar strokes?
Common findings include hemiparesis, hemisensory loss, and ataxia.
310
How does the presentation of conjunctivitis differ between bacterial and viral causes?
Bacterial conjunctivitis typically has purulent discharge, while viral conjunctivitis has clear discharge.
311
What is the typical presentation of a patient with a retinal artery occlusion?
They may experience sudden vision loss, often described as a curtain falling over the visual field.
312
Describe the conditions under which SGLT-2 inhibitors should be added to metformin treatment.
SGLT-2 inhibitors should be added to metformin if the patient has a high risk of developing cardiovascular disease (QRISK ≥ 10%), established cardiovascular disease, or chronic heart failure. Metformin should be established and titrated before introducing the SGLT-2 inhibitor.
313
Explain the significance of Courvoisier's law in clinical diagnosis.
Courvoisier's law states that a palpable, non-tender, enlarged gallbladder accompanied by painless jaundice is unlikely to be due to gallstones, suggesting the possibility of malignancy.
314
Define the common causes of early neonatal jaundice presenting within 24 hours after birth.
Common causes include hemolytic disease (rhesus incompatibility, ABO incompatibility, glucose-6-phosphate dehydrogenase deficiency, spherocytosis), infection, autoimmune hemolytic anemia, Crigler-Najjar syndrome, and Gilbert's syndrome.
315
How is rheumatoid arthritis identified through early x-ray findings?
Early x-ray findings in rheumatoid arthritis include loss of joint space, juxta-articular osteoporosis, soft-tissue swelling, periarticular erosions, and subluxation.
316
Explain the relationship between hypokalaemia and long QT syndrome.
Hypokalaemia can lead to long QT syndrome, which occurs when the QT interval exceeds 450ms, increasing the risk of Torsade de Pointes, a life-threatening polymorphic ventricular tachycardia.
317
Describe the typical presentation of an ulnar nerve lesion.
Classic presentations of an ulnar nerve lesion include sensory loss to the little finger and wasting of the hypothenar eminence.
318
What is the first-line treatment for a mild-moderate flare of distal ulcerative colitis?
The first-line treatment is topical (rectal) aminosalicylates.
319
Explain the implications of prescribing bisphosphonates to patients on corticosteroids.
A prophylactic bisphosphonate should be prescribed to any patient taking corticosteroids that are likely to be continued for at least 3 months to prevent osteoporosis.
320
How does the appearance of a painless red eye help in diagnosis?
The appearance of a painless red eye can help distinguish conditions; for example, episcleritis appears as a segmented area of redness, while subconjunctival hemorrhage looks diffusely red, and conjunctivitis presents with discharge and itchiness.
321
What are the recommended antibiotics for treating asymptomatic bacteriuria in pregnancy?
NICE recommends immediate antibiotic prescription of either nitrofurantoin (to be avoided near term), amoxicillin, or cefalexin for a 7-day course.
322
Describe the typical features of William's syndrome.
William's syndrome is associated with supravalvular aortic stenosis and features such as a small upturned nose, long philtrum, wide mouth, full lips, small chin, and puffiness around the eyes.
323
What is the significance of a low or undetectable level of plasma C-peptide in diabetes diagnosis?
A low or undetectable level of plasma C-peptide indicates absolute insulin deficiency, which is characteristic of type 1 diabetes, while elevated levels suggest type 2 diabetes.
324
Explain the treatment options for genital warts based on their characteristics.
For multiple, non-keratinised warts, topical podophyllum is recommended, while solitary, keratinised warts are treated with cryotherapy.
325
How does the management of a patient with a history of myocardial infarction change regarding NSAIDs?
Diclofenac is contraindicated in patients with any form of cardiovascular disease, including a history of myocardial infarction, and naproxen is recommended as it has a more favorable cardiovascular risk profile.
326
What are the common causes of normal anion gap metabolic acidosis?
Common causes include Addison's disease, bicarbonate loss, chloride retention, and certain drugs.
327
Describe the clinical presentation of central retinal artery occlusion (CRAO).
CRAO typically presents with sudden, painless vision loss in one eye, poor direct pupillary light response, normal consensual light reaction, and fundoscopic findings of a pale and opaque retina with a cherry-red spot.
328
What is the typical management for a breast abscess in lactating women?
Staphylococcus aureus is the most common cause of breast abscesses in lactating women, and appropriate antibiotics should be administered.
329
Explain the importance of monitoring GCS in head injury patients.
Monitoring the Glasgow Coma Scale (GCS) is crucial in head injury patients; a GCS < 13 on initial assessment or < 15 at 2 hours post-injury indicates the need for a CT head scan.
330
What are the potential complications of using macrolides like clarithromycin?
Macrolides can cause torsades de pointes, a potentially life-threatening arrhythmia.
331
How does achalasia present in patients?
Achalasia presents with dysphagia affecting both solids and liquids from the start.
332
What is the recommended approach for treating a stye associated with conjunctivitis?
Topical antibiotics are only recommended for a stye if it is associated with conjunctivitis.
333
Describe the typical features of Down's syndrome in relation to congenital heart defects.
Down's syndrome is most commonly associated with atrioventricular septal defects.
334
What is the significance of a palpable gallbladder in the context of jaundice?
A palpable gallbladder in the presence of jaundice may indicate underlying malignancy rather than gallstones, as per Courvoisier's law.
335
How does the presentation of retinal detachment differ from central retinal artery occlusion?
Retinal detachment often presents with flashes of light or a curtain-like shadow over the visual field, while CRAO presents with a pale and opaque retina with a cherry-red spot.
336
What are the implications of prescribing corticosteroids in relation to neutrophil levels?
Corticosteroids can induce neutrophilia, leading to elevated white blood cell counts.
337
Explain the management of recurrent otitis externa following antibiotic treatment.
Recurrent otitis externa after numerous antibiotic treatments should raise suspicion of a Candida infection.
338
What is the typical presentation of a patient with Klinefelter syndrome?
Klinefelter syndrome is associated with hypogonadism.
339
Describe the normal developmental variation of bow legs in children.
Bow legs in a child under 3 years is a normal variant that usually resolves by the age of 4 years.
340
Describe the treatment for hypertension in the setting of acute ischaemic stroke.
Hypertension (>185/110 mmHg) should be treated prior to thrombolysis in the setting of acute ischaemic stroke.
341
Explain the NICE urgent cancer referral guidelines for patients aged 45 and over.
Patients aged 45 and over should be urgently referred if they have unexplained visible haematuria without urinary tract infection, or visible haematuria that persists or recurs after treatment of urinary tract infection.
342
Define the criteria for non-urgent cancer referral according to NICE guidelines.
Patients aged 60 and over with recurrent or persistent unexplained urinary tract infection should be referred non-urgently.
343
How should unexplained unilateral ear ache be managed according to the guidelines?
Unexplained unilateral ear ache lasting more than 4 weeks with unremarkable otoscopy should be referred under the 2 week wait.
344
What are the referral criteria for suspected laryngeal cancer?
Consider a suspected cancer pathway referral for laryngeal cancer in people aged 45 and over with persistent unexplained hoarseness or an unexplained lump in the neck.
345
Explain the referral criteria for suspected oral cancer.
Referral for oral cancer is considered for unexplained ulceration in the oral cavity lasting more than 3 weeks or a persistent lump in the neck.
346
Describe the treatment options for genital warts.
Multiple, non-keratinised warts can be treated with topical podophyllum, while solitary, keratinised warts can be treated with cryotherapy.
347
What is the recommended timing for thrombectomy in acute ischaemic stroke?
Thrombectomy should be offered as soon as possible within 6 hours of symptom onset, along with intravenous thrombolysis if within 4.5 hours.
348
How should secondary prevention be managed after an ischaemic stroke?
Clopidogrel is recommended ahead of aspirin plus modified-release dipyridamole for secondary prevention after an ischaemic stroke.
349
What is the first-line antiplatelet therapy for patients after an ischaemic stroke?
Clopidogrel 75 mg once daily is the first-line antiplatelet therapy after an ischaemic stroke.
350
Describe the management of blood pressure in patients post-ischaemic stroke.
Antihypertensive treatment should begin in all patients with systolic BP >130 mmHg during the post-acute phase.
351
What is the recommended statin therapy for patients with ischaemic stroke or TIA?
All patients should receive high-intensity statin therapy, such as atorvastatin 40–80 mg at night, regardless of baseline LDL level.
352
Explain the follow-up recommendations for patients started on statins.
Patients should be followed up at 3 months with a full lipid profile; if non-HDL cholesterol has not fallen by at least 40%, adherence and lifestyle changes should be discussed.
353
What is the QRISK3 tool used for?
QRISK3 is used to estimate a 10-year cardiovascular disease risk for people aged 25–84 years.
354
Define the treatment threshold for statin therapy according to NICE.
NICE recommends a treatment threshold of a 10% 10-year risk for starting statin therapy, lowered from the previous 20%.
355
What should be done if a patient's lipid reduction is inadequate after starting statins?
If lipid reduction is inadequate, discuss adherence and lifestyle changes, and consider increasing the statin dose.
356
How should statin therapy be managed in older adults?
Consider offering statins to older adults (≥85 years) even in the absence of high 10-year risk due to age-related increased risk.
357
What is the recommendation for statin use in patients with diabetes or chronic kidney disease?
People with diabetes or chronic kidney disease are considered high-risk and should be prescribed statins regardless of QRISK.
358
What precautions should be taken regarding statin use in pregnancy?
Statins are contraindicated in pregnancy and should be stopped 3 months before conception and not restarted until after breastfeeding.
359
Describe the initial statin treatment for primary prevention according to NICE guidelines.
Atorvastatin 20 mg is recommended for primary prevention in patients with a 10-year risk of cardiovascular disease of 10% or greater, aiming for a ≥40% reduction in non-HDL cholesterol after 2–3 months.
360
Explain the targets for secondary prevention of cardiovascular disease as per NICE.
For secondary prevention, Atorvastatin 80 mg is recommended with targets of LDL-C ≤ 2.0 mmol/L and non-HDL-C ≤ 2.6 mmol/L.
361
Identify the type of murmur associated with mitral regurgitation.
A pansystolic murmur is associated with mitral regurgitation.
362
What type of murmur is linked to aortic stenosis?
An ejection systolic murmur is associated with aortic stenosis.
363
Describe the murmur associated with patent ductus arteriosus.
A continuous 'machinery' murmur is associated with patent ductus arteriosus.
364
Explain the significance of a late diastolic murmur.
A late diastolic murmur is associated with mitral stenosis.
365
What type of murmur is typically caused by aortic regurgitation?
Aortic regurgitation typically causes an early diastolic murmur.
366
List specific causes of Dupuytren's contracture.
Specific causes include manual labour, phenytoin treatment, alcoholic liver disease, diabetes mellitus, and trauma to the hand.
367
Outline the criteria for urgent referral for suspected oesophageal cancer.
Urgent referral is needed if the patient has dysphagia or is 55 years or older with weight loss and any of the following: upper abdominal pain, reflux, or dyspepsia.
368
Identify the referral criteria for suspected stomach (gastric) cancer.
Referral via the suspected cancer pathway is necessary if there is an upper abdominal mass consistent with stomach cancer.
369
What conditions warrant non-urgent referral for patients aged 55 and older?
Non-urgent referral is warranted for treatment-resistant dyspepsia, upper abdominal pain with low haemoglobin, or raised platelet count with associated symptoms.
370
Describe the NICE guidelines for admitting children with croup.
NICE suggests admitting any child with moderate or severe croup, those under 3 months of age, known upper airway abnormalities, or uncertainty about diagnosis.
371
What are the criteria for a 2-week wait referral to oral surgery for mouth ulcers?
Criteria include unexplained oral ulceration or mass persisting for over 3 weeks, unexplained red or red and white patches, one-sided pain in the head and neck area for over 4 weeks, unexplained neck lumps, persistent sore throat, or oral cavity signs lasting over 6 weeks.
372
Explain the ECG changes associated with anteroseptal coronary artery issues.
Anteroseptal changes are seen in leads V1-V4 and are associated with the left anterior descending artery.
373
What are the reciprocal changes typically seen in STEMI?
Reciprocal changes in STEMI include horizontal ST depression, tall broad R waves, upright T waves, and a dominant R wave in V2.
1. MSRA Passmed
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