1
Q
A patient with Graves’ disease is treated with carbimazole and propranolol. They have a sore throat and a mouth ulcer. What investigations should be performed, what could be causing the presenting complaint
A
FBC due to risk of agranulocytosis (low white blood cells)
As a side effect of carbimazole
2
Q
Thyroid receptor antibodies are positive in which condition
A
Graves’ disease
3
Q
What is the site of androgen production
A
Leydig cell
4
Q
what is the presentation of septic arthritis of a joint
A
joint swollen and to to touch
Difficult to bear weight if relevant
Reduced range of movement due to pain
Fever
Generally feeling unwell and tired
5
Q
What might show on an x-ray of chronic gout
A
tophi
Opacities in soft tissue and joint spaces
6
Q
What x-ray changes may show in rheumatoid and psoariatic arthritides
A
soft tissue swellings
Osteopenia
7
Q
Pencil in cup appearance is associated with which condition
A
psoriatic arthritis
8
Q
If infection of a joint is suspected, what is the most appropriate diagnostic investigation
A
aspiration of synovial fluid
9
Q
What are the resident cells within cartilage known as
A
chondrocytes
10
Q
Tingling and numbness in the ring and little finger with reduced sensation of these fingers and wasting of the hypothenar eminence suggest what pathology
A
cubital tunnel syndrome
11
Q
What condition is likely:
Fingers going blue/white in cold
Tightness of skin
Heartburn
Positive antinuclear and anti-centromere antibodies
A
systemic sclerosis
12
Q
What is the most common complication of systemic sclerosis
A
pulmonary hypertension
13
Q
If a patient presents with lower back pain that is worse in the morning and eased by exercise, what investigation is likely to be diagnostic
A
MRI of sacroiliac joints as ankylosing spondylitis is likely
14
Q
If Tinel’s test and Phalen’s test are positive, what pathology does this suggest
A
carpal tunnel syndrome
15
Q
What hand muscles can affected by carpal tunnel syndrome (3)
A
opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
16
Q
If a patient presents with a displaced intracapsular fracture of the hip, what is the most appropriate first line management option
(Patient has low mobility and dementia)
A
hemiarthroplasty
17
Q
what type of fracture shows on a radiograph affecting the radius with dislocation of the ulnar at the distal radioulnar joint
A
Galeazzi fracture
18
Q
Which fracture affects the ulnar with dislocation of the radial head at the elbow
A
Monteggia fracture
19
Q
What is a Nightstick fracture
A
an isolated fracture of the ulna
20
Q
Describe Smith’s fracture
A
extra-articular fracture of distal radius
Volar angulation
21
Q
Describe Colles fracture
A
extra-articular fracture of the distal radius with dorsal angulation
22
Q
A patient presents with pain and tenderness in the heel. The pain is worse in the morning and after rest and better after an NSAID.
They exercise daily
What is the likely diagnosis
What test should be carried out to confirm this
A
Plantar fasciits is most likely diagnosis
Windlass test should be carried out
23
Q
What is the Hawkin’s Kennedy test used to assess
A
Shoulder impingement
24
Q
A patient presents with sudden severe over back pain
Due to heavy lifting
Pain worse when coughing
What is most likely cause
A
acute disc tear
25
How to differentiate mechanical back pain from acute disc tear
Acute disc tear has a sudden onset
Acute disc tear is characterised by pain that is worse on coughing as this increases disc pressure
26
Where does pain in spinal stenosis tend to spread
legs
27
A patient has a suspected pathological fracture and requires treatment but is keen to avoid side effects. What management should be used
oral biphosphonates
28
what is the first line treatment for osteoporosis
biphosphonates
29
Which auto-antibody is the most specific indicator of rheumatoid arthritis
Anti CCP (anti cyclic citrullinated peptide)
30
What is the classic presentation of RA
Joint pain and stiffness worse in morning
Swelling in PIP and MCP joints
31
Why does RA typically not affect distal interphalangeal joints
DIPs have minimal quantities of sodium
32
33
Which paediatric hip condition is associated with:
Sudden onset hip pain
Difficulty weight bearing
Loss of internal rotation
Obesity
Slipped upper femoral epiphysis
34
What is the best first line management for SUFE
Surgical correction (pins femoral head to prevent further slipping)
35
What management is used for Perthes disease (2)
regular x-Ray
Avoiding physical activity
36
which paediatric hip condition is associated post-upper respiratory tract infection
transient synovitis
37
What management is used for transient synovitis
NSAIDS
38
When is a Pavlik harness used
in cases of development dysplasia of the hip
39
What influences turnover of the extra cellular matrix of articular cartilage in synovial joints
proteolytic enzymes
40
How is synovial fluid absorbed
synovial layer of the joint
41
What cells synthesis the extracellular matrix of articular cartilage
chondrocytes
42
which tissue does Dupuytren’s contracture mainly affect
Palmar fascia
43
Patient presents with progressive breathlessness, left side chest pain, weight loss
Former shipyard worker
Left pleural effusion with blood
Most likely diagnosis
mesothelioma
44
If antacids are not relieving reflux symptoms, what is the next step in management
Prescribe PPI if no other concerning features
45
History of
Blood diarrhoea
Abdominal pain
Pale, hypotension, dehydrated
Distended abdomen, diffusely tender
Other people around with similar symptoms
Not passed urine for 24 hours
Likely cause?
E.coli
46
Diabetic patient has painful ulcer w hair loss and pain on elevation. What is the most appropriate management plan and why
revascularisation - this is an arterial ulcer
Revascularisation is needed to prevent necrosis
47
What is the most appropriate first line management for a venous ulcer
Compression
48
Progressive Short of breath when lying down
Easier to breath when propped up
Likely diagnosis
left sided heart failure
(Poor left ventricular output leads to fluid deposit in lungs)
49
Peripheral oedema suggests which type of heart failure
right sided
50
Slow growing lump low in anterior neck that moves with swallow
Likely diagnosis
Thyroid cyst
51
6mo weakness, lethargy, weight loss, hypotension, skin pigmentations, hyponatraemia, hyperkalamia
Diagnosis
Addison’s disease (hypoadrenalism)
52
How to confirm diagnosis of Addison’s disease
Synacthen test
53
Raised serum calcium with normal serum ALP and enlarged parathyroid gland
parathyroid adenoma
54
Management for parathyroid adenoma
do nothing but monitor calcium concentration
55
If TSH is normal despite low free thyroid hormones what does this suggest
a problem with the hypothalamus or secondary hypothyroidism
56
What are the test results for primary hypothyroidism
low T3 and T4
High TSH
57
For what causative organisms is a transmission based rather than standard infection protocol appropriate
C.difficile due to spores in faeces
58
Which prostaglandin is decreased due to ibuprofen
E2
59
What cells characterise chronic inflammation (2)
Lymphocytes and plasma cells
60
what cell type does granulomatous inflammation consist of
Histeocytes
61
What cell type is present in acute inflammation
neutrophils
62
Epithelial malignancy within lymph node
Cells producing keratin with intracellular bridging
What is likely diagnosis
metastatic squamous cell carcinoma
63
Which condition is associated with trisomy 21
Down’s syndrome
64
Hypernatraemia, hyperosmolarity, dehydration, and dilute urine characterise the presentation of which condition
diabetes insipidus
65
What test is used to confirm a diagnosis of diabetes inspidius
water deprivation test
66
What hormone is deficient in diabetes insipidus
ADH
67
Presentation (65 Harold) with recurrent pain, stiffness, swelling in big toe and ankle
Joints are tender, red, swollen, hot
X-ray: soft tissue swelling, juxta-articular erosions
On diuretics
Most likely diagnosis?
Gout
Negatively bifringement crystals, needle shaped
68
After metformin, what is the next appropriate step to escalate management of T2DM
adding SGLT2 inhibitor
69
What is a late complication of total hip replacement
loosening of prosthesis
70
What are early complications of hip replacement (3)
thromboembolic disease
infections
Dislocations
71
What is mostly likely fracture pattern after car accident causing damage to tibia
comminuted fracture
72
When do spiral fractures occur
due to rotational motion
73
What is meant by a comminuted fracture
fractures which occur in more than two places - associated with severe trauma a
74
Classic presentation of Paget’s disease
bowing of leg
Raised ALP
(Hearing loss)
75
What factor is most strongly associated with increased risk of weight gain, being overweight, and obesity
Sugary drink intake
76
What tissue does glucagon act on
liver
77
What does glucagon stimulate
glucose production by liver
78
Which class of drug causes satiety and can aid weight loss in management of T2DM
GLP11 receptor agonist
79
Which drug improves insulin sensitivity by act as. PPAR gamma agonist
TZDs
80
What diagnosis is likely if Thyroid hormones are low, TSH is normal, and patient experiences symptoms of hypothyroidism
hypothyroidism secondary to pituitary disease (hypothalamic or pituitary dysfunction)
81
Raised calcium with symptoms asosciated (thirst, nocturia, renal stones) suggests what pathology
primary hyperparathyroisism
82
Is calcium high or low in cases of hypoparathyroidism
low
83
General autonomic neuropathy as a complication of diabetes can include what symptoms
nocturnal diarrhoea
Warm peripheries
Bounding pulse
Postural hypotension
Impotence/erectile dysfunction
84
What is most appropriate initial imaging investigation for evaluation of a GI perforation
Erect chest x-ray
85
Why may someone developed anaemia and jaundice after staring penicillin
Antibodies binding to red cell surface antigens (type II hypersensitivity)
86
What is the anti-inflammatory mechanism by which corticosteroids word
inhibition of phospholipase A (decrease arachidonic acid production)
87
How can IPEX present
early onset diabetes
Eczema
Autoimmune thyroid itis
88
Mechanism of immune dysfunction in IPEX
defective production of regulatory T cells
89
What is most likely diagnosis:
58yr F, FH hypothyroidism + atrophic gastritis
Presenting: fatigue, macrocytosis, Pancytopenia
pernicious anaemia
90
What is most likely diagnosis
25yr M
Presentation: pain in legs and chest wall, breathlessness, needed red cell exchange transfusion
sickle cell disease
(Sickle cell crisis affecting pulmonary vasculature)
91
what is most likely diagnosis:
21yr F
Heavy periods, defective primary haemostasis
Normal blood count
Von Willebrand disease - affects platelet adhesion to site of injury
92
Normal PT, long APTT, normal platelets, normal fibrinogen
factor VIII deficiency (intrinsic pathway)
93
Long PT, normal APTT, normal platelets, normal fibrinogen
factor VII deficiency (Extrinsic pathway)
94
Long pT, long APTT, low platelets, low fibrinogen
DIC
95
How best to investigate haemoglobinopathy trait
haemoglobin analysis
96
What blood test results suggest haemoglobinopathy trait
disproportionate reduction in MCV and MCH compared to haemoglobin
97
Best investigation to investigate high haemoglobin with no history for secondary polycythaemia
analyses of JAK2 (myeloproliferative polycythaemia)
98
What condition is likely if a patient’s results show cytopenias and excess blasts
acute leukaemia
99
Important investigation for acute leukaemia
immunophenotyping to clarify lineage
100
What condition is likely if HbS is detected but HbA is not
sickle cell anaemia
101
Disproportionate reduction in MCV compared to haemoglobin suggests what condition
haemoglobinopathy
102
What condition is likely if blood film shows red cells without central pallor
Spherocytosis
103
Family history of what type of anaemia is likely to be seen in cases of spherocytosis
Haemolytic anaemia
104
Fever with no haemolysis (normal BP) after blood transfusion is due to what type of reaction
Febrile non-haemolytic transfusion reaction
105
Description of febrile non-haemolytic transfusion reaction
caused by antibodies directed against donor leukocytes and release of HLA antigens/cytokines
106
when can transfusion associated circulatory overload occur
when patients with chronic anaemia and compensatory high CO are given large volume of blood
107
Why may someone experience breathlessness due to a transfusion associated circulatory overload
pulmonary oedema
108
What can cause a patient to become breathless after infusion of fresh frozen plasma
transfusion released acute lung injury
Antibodies in donor plasma bind to patients white cells and cause degranulation by neutrophils,
Thus leading to lung injury
109
What gene is mutated in cases of sickle cell disease
globin gene
Via a point mutation
110
Acquired DNA mutations in haematopoietic stem cells leads to what condition
myelodysplasia
111
Hereditary spherocytosis is associated with mutations of…
mutations of structural red cells leads to proteins
112
MOA of Rivaroxiban
direct inhibitor of activated factor Xa
113
Which cells have bi-lobed nuclei and red cytoplasmic granules
eosinophils
114
shape of monocytes’ nucleus
horse shoe shaped
115
Which condition is associated with macroovalocytes and hypersegmented neutrophils
pernicious anaemia
116
Which condition is associated with excessive blast cells with auer rods
acute myeloid leukaemia (abnormal granulation occurs)
117
Which disorder causes excess production of platelets in bone marrow and lead to an increased risk of thrombosis - giant forms seen on blood film
essential thrombocythaemia
(Chronic myeloproliferative disorder)
118
asymptomatic lymphocytosis is likely to be caused by what
chronic lymphocytic leukaemia
119
backpain, hypercalcaemia, renal failure, and proteinuria (Bence Jones) is likely to be a presentation of what
multiple myeloma
120
Where is vitamin K absorbed
upper intestine
121
Is vitamin K water soluble or insoluble
insoluble in water
122
what is the protein target of Rituximab (hint: for non-Hodgkin’s lymphoma)
CD20
123
Protein target for drugs to treat chronic myeloid leukaemia
BCR-ABL1 tyrosine kinase
124
Which disorder is associated with an uncontrolled production of functioning blood cells
polycythaemia Vera
125
Which disorder is associated with uncontrolled production of immature blood cells in bone marrow
acute myeloid leukaemia
126
Which disorder is a clonal B cell disorder which can result in malignant circulating cells
Chronic lymphocytic leukaemia
127
In what disorder can smear cells be seen on blood film
chronic lymphocytic leukaemia
128
What should be used to treat autoimmune haemolytic anaemia
steroids
Folic acid
129
Drug-induced pancytopenia should be treated how
red cell transfusion (if symptomatic)
130
Patient presents after fall onto shoulder with pain over lateral clavicle and visible step deformity. Diagnosis?
clavicle shaft fracture
131
What causes membrane depolarisation for secretion of insulin
blocked KATP channels
132
after metformin what T2DM drug should be added
SGLT2i (dapagliflozin)
133
if HBA1c is over 48 but patient is asymptomatic, what is the next step
repeat measurement within four weeks
134
true/false: SGLT2i cause weight gain
false
135
management of DKA
500ml Saline IV
136
PTH effect of osteoblasts
activates osteoblasts
137
what factors are tested for in APTT
8, 9, 11, 12
138
treatment for primary myelofibrosis
supportive management
139
spread of electrical conductivity in the heart
sino-atrial node, atrioventricular node , bundle of His, left and right bundles, Purkinje fibres
140
Elevated PTH, low PO4, and raised ALP suggest what diagnosis
primary hyperparathyroidism
Excess PTH cause kidneys to remove PO4 from blood
ALP is increased due to increased bone turnover
141
What three tumours are associated with MEN1
parathyroid adenoma
Pancreatic insulinoma
Pituitary adenoma
142
what malignancy are psammoma bodies associated with
papillary thyroid carcinoma
143
which type of anti diabetic medication can cause hypoglycaemia
sulphonylureas
(Eg gliclazide)
144
what is most appropriate first line management of hypoglycaemia if the patient is unconscious
intramuscular glucagon
145
which type of diabetes is often picked up during screening for gestational diabetes
MODY glucokinase
146
what is a cutaneous manifestation of diabetes
rash under breasts
147
which skin manifestation is IBD associated with
erythema nodosum
148
Which skin manifestation is coeliac disease associated with
dermatitis herpetiformis
149
examples of skin manifestations of autoimmune thyroid disease (3)
Icthyosis
Myxoedema
Vitiligo
150
a slow growing lump that moves with swallowing low in anterior neck is likely to be what
thyroid cyst
151
best method for assessing ovulation
blood test for progesterone (day 21)
152
which hormone should be replaced first in panhypopituitarism
hydrocortisone (to prevent Addisonian crisis)
153
which condition is associated with a dry tap on bone marrow aspirate
marrow fibrosis (eg primary myelofibrosis)
154
which condition is associated with Reed-Sternberg cells
Hodgkin’s lymphoma
155
what is most common trigger of an aplastic sickle cell crisis
parvovirus B19
156
management of major haemorrhage to mitigate effects of anti platelet agent
Platelet transfusion
157
which nerve is most likely to be injured by a shoulder dislocation
Axillary nerve
158
first line management for AVN in hip joint pre-collapse
decompression surgery
159
what enzyme is used to diagnose Duchenne’s muscular dystrophy
Creatine phosphokinase
160
Best first line management of SUFE
surgical correction
161
most appropriate first line investigation for Morton’s neuroma
ultrasound scan
162
Most appropriate management of persistent lower back pain months after a fall
guided exercise program
163
external rotation of limb and groin pain in an elderly patient following a fall suggests what type of fracture
intracapsular hip fracture
164
forceful contraction of which muscle can cause an vaults ion fracture of femur
iliopsoas
165
what is most appropriate investigation to carry out for Giant cell arteritis
plasma viscosity
166
What is likely postoperative complication of fracture of neck of femur repair if femoral head shows evidence of collapse and cysts with normal inflammatory markers
avascular necrosis
High force displaced femoral neck fractures are associated with a high risk of Avascular necrosis
167
most approprate management if COPD patient is decompensating and there is evidence of CO2 retention (acidosis, oxygen sat is 81)
non-invasive ventilation
168
ECG of complete heart block
no correlation between QRS complexes and P waves
169
most approximate initial management of supraventricular tachycardia
valsalva manoeuvre
(Non-pharmacological intervention prioritised if narrow QRS)
170
when would a carotid sinus massage be used as management
younger patients with arrhythmia who are at risk of stroke
171
when is DC cardioversion used as management
in arrhythmias if the patient is not haemodynamically stable
172
Which porphyria is likely to present with systemic symptoms
acute intermittent porphyria
173
patient presents with hyperpigmentation, Hypertrichosis, solar uriticaria, blistering on hands, arms, and upper back, woods lamp shows pink fluorescence, what diagnosis is likely
porphyria cutanea tarda
174
best management for a spitz naevus
surgical excision
175
appearance of a spitz naevus
Red facial lesion - dome shaped papule with visible blood vessels
176
What is the target of endotoxins release by pathogen in Scalded skin syndrome
desmoglein 1 - thus epidermis falls apart
177
red scaly patch on shin, lack of sun protection, lack of symptoms suggests what
Bowen’s disease
178
Large red patch gone, now multiple small red lesions, on back, following lines of ribs, scale around edges suggests what condition
Pityriasis rosea
179
Itchy vesicular and excoriated rash points to what diagnosis
dermatitis herpetiformis
180
presentation of pityriasis rosea
initial patch which gives rise to generalised eruption with scale and itch
181
LDL is high or low in insulin resistance
High
182
triglycerides are high or low in insulin resistance
high
183
itch, jaundice, positive AMA suggests what diagnosis
primary biliary cirrhosis
184
Microbiology of Clostridium
gram +ve
Rod shaped
Anaerobic
Form spores
185
what biomarker makes diagnosis of pre-hepatic jaundice more likely
predominantly unconjugated bilirubin
186
Fall onto an outstretched hand is associated with what type of fracture
Colle’s fracture
187
After benzoyl peroxide and oral antibiotics what is the next step in acne management
Oral retinoids
188
which antibody is associated with atopic dermatitis
IgE
189
What is the gold standard investigation for any joint pathology
MRI
190
what parameters are needed to calculate DAS28 score
number of sore joints
Number of swollen joints
ESR
Global health score
191
diagnostic criteria for gestational diabetes (2)
fasting plasma glucose of 7
Random/2hr plasma glucose of 11.1
192
which type of anti-diabetic drug is contraindicated for patients with heart failure
TZDs
Second year med
flashcards
Decks in class (35)
# Cards
-
FoM217
-
Foundations - physiology24
-
Anatomy31
-
Anatomy high yield37
-
MSK principles8
-
Rheumatology13
-
Clinical MSK9
-
MSK questions182
-
Endocrine drugs19
-
Diabetes22
-
Endocrine physiology26
-
Thyroid24
-
Practice test questions192
-
Pituitary pathology/physiology48
-
adrenal pathology/physiology56
-
Sodium/calcium related pathologies17
-
Reproductive endocrine pathology40
-
Haematology week one58
-
Haematology week two27
-
Haematology week 343
-
Haematology physiology47
-
Derm questions37
-
Dermatology benign lesions14
-
Dermatology physiology8
-
Dermatology blistering disorders20
-
Dermatology - photo-pathologies14
-
Dermatology - Hair and nail pathology12
-
Dermatology - rashes13
-
Dermatology emergencies and systemic disease15
-
ENT pathology24
-
Goldmine14
-
Dermatology physiology17
-
ENT summary40
-
ENT pathologies52
-
Ophthalmology anatomy29
