1
Q
What blood test result makes you think Addison’s?
A
Hyperkalaemia and hyponutraemia
Don’t produce aldosterone, so don’t re absorb sodium to keep water so keeps potassium instead
2
Q
What are the two types of Addison’s?
A
Primary- adrenal cortex failure
Secondary- pituitary failure
3
Q
How do you differentiate between the two types of Addison’s?
A
Short syntactin test
Plasma cortisol is measured before and 30 minutes after giving Synacthen 250ug IM
4
Q
What test and result confirms neuroleptic malignant syndrome
A
Creatinine Kinase elevated (in 1000s)
5
Q
Tremors and lithium?
A
Fine tremor is side effect, corse tremor in toxicity
6
Q
secondary hyperparathyroidism is
A
hypocalcaemia causes increase in PTH to increase calcium
7
Q
chronic kidney disease- bone issues
A
low vit D (due to kidneys)
high phosphate (due to kidneys)
low calcium due to low vitamin d and high phosphate
2ry hyperparathyroidism
8
Q
impetigo treatment
A
hydrogen peroxide, then topical fusidic acid
9
Q
squint names
A
the nose: esotropia
temporally: exotropia
superiorly: hypertropia
inferiorly: hypotropia
10
Q
how to identify squint
A
cover ‘good eye’, the ‘bad eye’ will then move to the correct position (away from squint)
11
Q
yellow fever presentation
A
flu like illness → brief remission→ followed by jaundice and haematemesis
12
Q
Mobitz type 1 v 2
A
1- prolonging or PR interval until QRS dropped
2- P wave not always followed by QRS
13
Q
drugs that increase the risk of lithium toxicity
A
NSAIDs
ACEi & ARB
Beta-blockers
metronidazole
14
Q
lithium therapeutic range
A
0.4-1.0 mmol/L
15
Q
lithium toxicity features
A
coarse tremor
hyperreflexia
acute confusion
polyuria
seizure
coma
16
Q
management of lithium toxicity
A
fluids
monitor sodium and lithium levels every 4 hours (for lithium induced nephrogenic diabetes insipidus)
17
Q
what makes you think of syphilis
A
painless genital ulcer
18
Q
small bowel obstruction first line management
A
NG tube and IV fluids
19
Q
coeliac blood test
A
IgA tissue transglutaminase
IgA total
20
Q
coeliac disease vaccinations and why
A
pneumococcal, Haemophilus type B and meningococcus type C
hyposplenism due to excessive lymphocyte loss
21
Q
hyperkalaemia ecg changes
A
widening of QRS
22
Q
peri-op care for warfarin
A
stop warfarin 5 days before and start on treatment lmwh
after surgery
-restart prophylactic lmwh and warfarin
-when there’s no bleeding, increase lmwh to treatment dose
-stop lmwh when inr is in target range
23
Q
when do you suspect DIC
A
falling platelets and fibrinogen, increasing PT & APTT
increased fdp (fibrinogen degradation products)
trigger- sepsis, massive haemorrhage, obstetric haemorrhage, burns or trauma
24
Q
what does ffp have in
A
all coagulation factors
25
when is ffp used
DIC, plasma exchange, thrombotic thrombocytopenic purpura
26
what does cryoprecipitate have in
Fibrinogen, VIII, vWF, XIII, fibronectin
27
when do you use cryoprecipitate
Fibrinogen <1.5 g/L and bleeding
28
what does prothrombin complex concentrate have in
II, VII, IX, X, protein C, protein S
29
when do you use prothrombin complex concentrate
reversal of doacs and warfarin (not dabigatran)
30
where do you find more info about pts warfarin?
yellow book-
timing, dosing, target inr
31
3 criteria for anaphylaxis
sudden compromise in A, B or C
trigger
skin or mucosa changes- urticaria, flushing, angioedema
32
When do you give adrenaline in cardiac arrest
if unshockable, or after 3rd shock
then give every 2nd cycle (3-5 mins)
33
adrenaline dose cardiac arrest
1mg of 1:10,000, 10mls IV or IO
34
amiodarone dose in cardiac arrest
300mg IV or IO
35
when to give amiodarone in cardiac arrest
after 3rd shock
consider 150mg after 5th
36
4Hs and 4Ts
hypoxia
hypo/hyperkalaemia
hypovolaemia
hypo/hyperthermia
tension pneumothorax
toxins
tamponade (cardiac)
thrombosis
37
how can you categorise high or low Na+?
hypervolaemic
euvolaemic
hypovolaemic
38
causes of hypernatraemia
hypervolaemic
>giving too much saline
>steroid excess
euvolaemic
>diabetes insipidus
hypovolaemic
>diuretics
>dehydration (D&V, burns, >febrile)
>acute tubular necrosis
39
how do you test if someone is hypo, hyper or euvolaemic?
serum osmolality
raised in hypo and reduced in hyper
40
causes of hyponatraemia
hypervolaemic
>HF / cirrhosis
>acute tubular necrosis
euvolaemic
>Dehydration w/ water replacement
>SIADH
>acute fluid overload
hypovolaemic
>D&V
>thiazides
>Addison's
41
causes of delirium
PINCH ME
pain
infection
nutrition
constipation
hydration
medication
environment & electrolytes
uraemia (can be caused by bleeding from stomach)
hypernatraemia
42
how to read an x-ray
check pt details
Inspiration- R hemidiaphragm between 6th and 7th anterior rib
AP or PA- AP has large heart and flatter clavicles
Rotation- spinous processes in middle of ends of clavicles
Trachea- is it central
lung zones- 1/3 each for upper, middle, lower
43
sign of reduced lung volume on xray
rib crowding
44
Post-ROSC A to E
ABG
Bloods (routine)
CXR
Drug chart optimisation
ECG, Echo, Escalate
Family
45
when do you give stacked shocks?
witnessed and monitored cardiac arrest
46
what blood test do you do in anaphylaxis
mast cell tryptase
47
broad regular tachycardia
ventricular tachycardia
48
broad irregular tachycardia
Torsades, AF, BBB and AF
49
narrow regular tachycardia
supra ventricular tachycardia
- try valsalva and adenosine
50
broad irregular tachycardia
AF
51
Pacing shock in tachycardia is delivered when
what energy
VT, AF - 360j
SVT - 100, 200, 360j
52
A in A to E
is airway patent
are there any noises (snoring, stridor, choking, wheezing)
management- put in air way, suction airway
53
B in A to E
O2 sats
RR
trachea
chest expansion
percussion
auscultation
inspection- cyanosis, SOB, cough, cheyne-stokes, kussmaul's
ABG
CXR
management- give oxygen
54
C in A to E
CRT
pulse
bloods / cannula
BP
pallor
JVP
heart sounds
oedema
management- fluids, ECG,
55
D in A to E
Temperature
BM
GCS or ACVPU
Eyes
Drug chart
neurological- move arms and legs
Management- CT head
56
E in A to E
exposure from head to toe
57
cheyne-stokes
Cyclical episodes of apnoea and hyperventilation
Indicates dying
58
Kussmaul's
Rapid deep breathing
Associated with DKA
59
BPH medications
tamsulosin (alpha-1-antagonist)
then finasteride (5-alpha reductase inhibitor)
60
psoriatic arthritis x-ray findings
'plantar spur' and 'pencil and cup'
61
OA xray findings
'LOSS'- Loss of joint space, Osteophytes, Subchondral sclerosis, Subchondral cysts.
62
RA xray findings
'LESS'- Loss of joint space, Erosions, Soft bones, Soft tissue swelling.
63
Ankylosing spondylitis presentation / XR findings
sacroilitis
64
where are chlamydia and gonorrhoea swabs taken from
vulvo-vaginal first line
65
when should chalmydia testing take place
2 weeks after exposure
66
what do you do if you can"t do short synactin?
9am cortisol
67
what is relative afferent pupillary defect?
normal eye appears to dilate when light is shone in affected eye (it should constrict)
68
what causes RAPD
retinal detachment
optic neuritis (MS)
69
threadworms treatment
oral mebendazole
70
where is most saliva produced?
submandibular gland
71
3rd nerve palsy sx
u/l eye fixed in down & out position
ptosis
dilated pupil
absent light reflex
intact consensual light reflex (optic nerve is fine)
72
what does VSD increase your risk of
endocarditis
73
most common childhood cancer
acute lymphoblastic leukaemia
74
when do you thrombolyse PE
massive, hypotension, confirmed on scan
75
hypercalcaemia and suppressed PTH suggests
malignancy
76
psoriasis guttate hx
2 weeks after strep infection
tear drop papules
77
clinical trial phases
1- safety - side effects
2- efficacy on small scale - dosing
3- efficacy on large scale - compare to existing treatments
4- post market surveillance
78
NOF surgeries
intracapsular
undisplaced- internal fixation or hemi arthroplasty
displaced- total or semi
extracapsular
intertrochanteric- DHS
subtrochanteric- intramedullary
79
alzheimer's rf
age
family hx
caucasian
down's syndrome
cerebrovascular disease
Lack of hearing
80
alzheimer's sx
memory loss
disorientation
difficulty naming objects or people
personality change
apathy
81
blood supply to eye
internal carotid > ophthalmic artery
ipsilateral
82
when do you refer haematuria?
one episode of visible without UTI, or persists after treatment of UTI if over 45
60 years and over and have non-visible haematuria and either dysuria or a raised WCC
83
2ww investigations for haematuria
flexi cyctoscopy
CTAP (can add chest)
USS renal tract
84
causes of painful red eye
corneal abrasions and foreign bodies
corneal ulcers
chemical injury
anterior uveitis
scleritis
acute angle closure glaucoma
endophthalmitis
85
why does infective endocarditis cause back pain?
osteomyelitis
86
endocarditis causative organisms
staphylococcus aureus
streptococci viridans, A,B,C,D,G
HACEK
aspergillus
candida
87
IgA vasculitis (HSP) sx
abdominal pain
non blanching rash
arthralgia
recent urti
protein or blood in urine
88
dressler's syndrome
post MI pericarditis
89
what is a case series
group of patients with similar condition
aims to identify common features
good for rare diseases
no control group
can't identify causality / confounding
90
cross sectional study
prevalence or frequency of disease at a particular point in time
collect data on exposure and outcome of interest
investigates distribution of diseases
good for public health
prone to selection bias as sample may not represent population, can't identify confounding
91
case control study
compares those with the disease and those without to determine risk factors
good for rare diseases
prone to selection bias
cannot establish causality, just association
92
cohort study
follows individuals over time to investigate relationship between risk factor and outcome
can be prospective (follows people for a time) or retrospective (looks back in time)
selection bias
attrition bias (lost to follow up)
recall bias
93
meta-analysis
combining outcomes from all relevant studies
publication bias
limited by lack of data
94
ecological study
environmental factors and health outcomes
analyse patterns and trends
95
Randomised controlled trial
determine efficacy of intervention
controls confounding factors
usually ethical concerns
strict inclusion / exclusion criteria may limit application to populations
96
relative risk calculation
RR=(IE/(IE+IN))/(CE/(CE+CN))
intervention events
intervention non-events
control events
control non-events
97
anaemia of chronic disease iron levels
low iron, ferritin, and TIBC
98
what is Pemberton's sign
red face, SOB, stridor, distended neck veins when arms are above head
sign of svco
99
causes of svco
malignancy, goitre, iatrogenic (central lines)
100
pulmonary fibrosis causes
upper zone - TB, hypersensitivity pneumonitis, occupational or pneumoconiosis, ank spond, sarcoid
lower zone - connective tissue, alpha 1 anti-trypsin deficiency, medication, bronchiectasis, aspiration, asbestosis, idiopathic
101
tension pneumothorax signs on xr
mediastinal shift
wide rib spaces
diaphragm pushed down
102
pneumothorax causes
spontaneous
1ry- tall, male, eds, marfan's
2ry- asthma, cold, CF
traumatic
baro- divers
mechanical- central line, knife wounds
103
FEV1/FVC ratio in obstructive pattern
<0.7
104
FEV1/FVC ratio in restrictive pattern
normal or raised
105
what 3 things make you think of alport syndrome?
renal failure
sensorineural hearing loss
ocular abnormalities in a child
106
Common side effects of steroids
Insomnia
Mood alteration
Upper GI upset
Increased appetite
Fluid retention
Weight gain
Oral or perianal candida
Shingles or other Harper reactivation
107
Safety information for steroids
Double dose on acute illness
Carry steroid card
Don’t stop suddenly
108
MSK side effects of steroids
Osteoporosis
Avascular necrosis
Proximal myopathy
109
How does myeloma cause renal impairment
Dehydration
Hypercalcaemia
Renal stones
Light chain deposition
Cast nephropathy
Amyloid
Nephrotoxic drugs
Infection
Urate nephropathy
Hyperviscosity
110
Sx of hyper viscosity
Bleeding- mucosal, persistent bleeding, menorrhagia
SOB, fatigue, hypotension
Vision changes- blurring / loss
Headaches, vertigo, ataxia, coma
111
Drugs that affect warfarin
Decrease levels
St John’s wort
Phenytoin
Carbamazepine
Increase levels
Clarithromycin
Amiodarone
Metronidazole
112
Non drug things that affect warfarin
113
Non drug things that affect warfarin
Broccoli, kale, spinach- don’t change quickly, inform clinic
Avoid cranberry juice
1-2 drinks / day, no binge drinking
114
Drugs not to take on doacs
NSAIDs and aspirin
Renally cleared
115
live vaccines
MMR
BCG
oral typhoid
oral polio
yellow fever
116
cardiac complication down's syndrome
ASD
VSD
ToF
PDA
117
non-cardiac complications of down's syndrome
sub fertility
learning difficulties
repeated respiratory infections
glue ear
ALL
hypothyroidism
alzheimer's
antlantoaxial instability
118
features of wenicke's encephalopathy
CAN OPEN
Confusion
Ataxia
Nystagmus
Ophthalmoplegia
PEripheral Neuropathy
119
lower vs upper motor neuron signs
upper-
hyperreflexia
upping plantars
hypertonia
contractures
lower-
diminished or absent reflexes
reduced tone
atrophy
down going plantars
120
Bacteria most commonly causing cellulitis
Staphylococcus Aureus
Group A streptococcus
Streptococcus Pyrogenes
121
What abx do you give in cellulitis
Fluclox
122
Conditions associated with ASD
Epilepsy
ADHD
Anxiety
Dyspraxia
Fragile X
Tuberous sclerosis
Pathological demand avoidance syndrome
Visual impairment
Hearing impairment
123
Complications of alcoholic liver disease
Spontaneous bacterial peritonitis
Acute kidney injury, sepsis, hypoglycaemia, pneumonia pressure sores, variceal bleeding, ascieties
124
how do you calculate serum osmolality
2[Na] + Urea + glucose
125
cherry red sport suggests what
central retinal artery occlusion
126
bronchiectasis history
chronic cough
copious amounts of sputum
childhood pneumonia & recurrent chest infections
127
bronchiectasis pathophysiology
impaired mucocilliary clearance
mucus hyper secretion
organism colonisation
permanent dilation and thickening of bronchi
128
what is a varicocele
enlarger Veins in the scrotum
feel like Vorms (worms)
129
what is a hydrocele
fluid around the testicle in the tunica vaginalis
transilluminates
130
BCC key features
ulcerated
shiny surface
rolled edge
overlying telangiectasia
131
SCC key features
red
fast growing
rough
bleed
132
what do you give for stroke prevention in AF
apixaban / rivoxaban
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Year 5
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