1
Q
What are the triad of symptoms for cardiac tamponade?
A
- Hypotension
- Muffled heart sound
- Jugular vein distension
2
Q
What are the 4 classifications that can be used for peripheral artery disease?
A
- Asymptomatic
- Claudication
- Critical limb ischaemia
- Acute limb ischaemia
3
Q
Name 6 signs of acute limb ischaemia?
A
- Pain
- Pallor
- Pulselessness
- Paraesthesia
- Perishing cold
- Paralysis
4
Q
What are some differentials for peripheral artery disease?
A
- Arthritis
- Venous claudication
- Spinal stenosis
5
Q
What are the 4 types of shock?
A
- Distributive
- Cardiogenic
- Hypovolaemic
- Obstructive
6
Q
What is shock?
A
A condition that occurs when the body is not receiving enough bloodflow
7
Q
What is distributive shock?
A
Extreme vasodilation leads to a sharp drop in blood pressure and insufficient organ perfusion
8
Q
Give 3 examples of distributive shock
A
- Septic
- Anaphylactic
- Neurogenic
9
Q
What is cardiogenic shock?
A
The heart is unable to meet the body’s demand for oxygen rich blood resulting in insufficient perfusion -> organ failure
10
Q
Give 3 examples of cardiogenic shock
A
Myocardial infarct
11
Q
What is hypovolaemic shock?
A
Loss of a large amount of blood volume causes lack of oxygen in organs
12
Q
Give 3 examples of hypovolaemic shock
A
- Burns
- Trauma
- Heavy GI bleed
13
Q
What is obstructive shock?
A
Where blood flow to/from the heart is obstructed, causing a large drop in blood pressure and widespread oxygen shortage
14
Q
Give 3 examples of obstructive shock
A
- Tension pneumothorax
- Cardiac Tamponade
- Tumours
15
Q
What investigations would you order for suspected infective endocarditis?
A
- Blood culture
- Echocardiogram
- Full blood count
16
Q
What are some complications of Infective Endocarditis?
A
- Pericarditis
- Myocardial infarction
- Pulmonary embolism
- Systemic infection
- Acute renal failure
17
Q
What investigation can be used to diagnose stable angina?
A
Stress ECG
18
Q
What drugs are used for TB treatment?
A
- Rifampicin
- Isoniazid
- Pyrazinimide
- Ethambutol
19
Q
What drug is used to treat Myasthenia Gravis?
A
Pyridostigmine
20
Q
What is the mechanism of Pyridostigmine?
A
It is a cholinesterase inhibitor, reduces the breakdown of ACh
21
Q
What is the treatment for Parkinson’s
A
Co-careldopa
Levodopa + Carbidopa that prevents its breakdown
22
Q
What is Ramsay-Hunt syndrome?
A
A form of shingles that affects the facial nerve, causing Bell’s palsy and a rash on the outer ears
23
Q
What is Charcot’s triad?
A
- Fever
- RUQ Pain
- Jaundice
24
Q
What does painless jaundice point to?
A
- Pancreatic cancer
- Cholangiocarcinoma
25
What pathogens tend to cause reactive arthritis?
GI - Salmonella, Shigella
GU - Chlamydia
26
What is the gold standard diagnosis for bronchiectasis?
High resolution CT chest
27
What is the inheritance pattern of alpha-1-antitrypsin deficiency?
Autosomal co-dominant
28
Which lung cancer has the main paraneoplastic involvement?
Small cell lung cancer
29
What lung cancer has PTHnrP?
Squamous cell cancer
30
What is the gold standard test for kidney stones?
Non contrast CT kidney ureter bladder (NCCTKUB)
31
What are the common causes of UTI?
Klebsiella
E. coli
Enterococcus
Proteus/Pseudomonas
Staphylococcus saprophyticus
32
What pathogens can trigger reactive arthritis?
Salmonella, shigella
33
What is minimal change disease?
A type of nephrotic syndrome where minimal changes are seen on light microscopy
34
What is the difference between nephrotic and nephritic disease?
In nephritic disease there is haematuria
35
Where in the kidneys does furosemide act?
The ascending limb of the loop of Henle
NKCC channels
36
Where in the kidneys do thiazide diuretics act?
Distal convoluted tubule
37
Where is iron absorbed?
Duodenum and proximal jejunum
38
What chromosome is linked to chronic myeloid leukaemia?
Philadelphia chromosome
39
In what cancer could platelets be raised?
CML
40
What are some signs of iron deficiency anaemia?
1. Brittle hair and nails
2. Koilonychia
3. Pale conjunctivae and skin
4. Systolic flow murmur
41
What causes a macrocytic megaloblastic anaemia?
Vitamin B12 or folate deficiency
42
How can you tell between B12 and folate deficiency?
Folate deficiency will not present with neurological symptoms
43
What is pharmacokinetics?
The action of the body on the drug
1. Absorption
2. Distribution
3. Metabolism
4. Excretion
44
What is pharmacodynamics?
The action of the drug on the body
45
What are some causes of iron deficiency anaemia?
1. Malabsorption
2. NSAIDS
3. Chronic kidney disease
4. Pregnancy
5. Heavy periods
46
What are some side effects of amitriptyline?
1. Dry mouth
2. Confusion
3. Blurred vision
4. Urinary retention
47
What is used to treat heroin addiction?
Methadone
48
What is a complication of C. diff infection?
Pseudomembranous colitis
49
What is the 1st line treatment for osteoporosis?
Oral bisphosphonate and AdCal (Vit D and calcium supplement)
50
What is the 2nd line treatment for osteoporosis?
Denosumab - a monoclonal antibody to RANK ligand
51
What is the mechanism of action of bisphosphonates?
Inhibit bone resorption by inhibiting osteoclast activity
52
What is the 1st line treatment for migraine?
NSAIDS
53
What is the 2nd line treatment for migraine?
Triptans
54
What is the mechanism of action of Triptans?
Serotonin (5-HT1) receptor agonists - reduces inflammation and causes vasoconstriction
55
What are some causes of meningitis?
1. Neisseria meningitidis
2. Listeria monocytogenes (pregnant)
3. Streptococcus agalacticae (neonates)
4. Streptococcus pneumoniae (common)
56
What are the signs of a UMN lesion?
In UMN everything goes UP!
1. Increased muscle tone
2. Hyperreflexia
3. Spasticity
4. Muscle weakness
5. Positive Babinski sign
57
What are the signs of a LMN lesion?
1. Muscle atrophy
2. Fasciculations
3. Hyporeflexia
4. Decreased tone
5. Negative Babinski sign
58
What can be used to treat psychosis in Huntington's?
Haloperidol
59
What can be used to treat chorea in Huntington's?
Risperidone
60
Name some SSRIs
1. Sertraline
2. Fluvoxamine
3. Citalopram
61
What is the pharmacological treatment for Idiopathic Pulmonary Fibrosis?
Nintedanib and Pirfenidone
62
What is the treatment for motor neurone disease?
Riluzole
63
What is the treatment for Alzheimer's?
Rivastigmine - cholinesterase inhibitor
64
What is the treatment for Myasthenia Gravis?
Pyridostigmine
65
What are some causes of tension headaches?
1. Stress
2. Lack of sleep
3. Missed meals
4. Depression
66
What is the treatment pathway for a PE?
1. DOAC
2. LMWH such as Dalteparin
67
Is HIV a notifiable disease?
No
68
What is included in the 6 in 1 vaccine?
1. Diptheria
2. Polio
3. Tetanus
4. Hepatitis B
5. Whooping cough
6. Haemophilus Influenzae B
69
What is sarcoidosis?
An inflammatory disease characterised by the presence of non-caseating granulomas. It is a type of interstitial lung disease
70
What are the symptoms of sarcoidosis?
1. Malaise
2. Dry cough
3. Shortness of breath
4. Red nodules on shins
5. Low grade fever
71
What is the 1st line treatment for sarcoidosis?
Oral steroids 6-24 months + bisphosphonates
72
What is the treatment for a pneumothorax with no SOB and < 2cm rim on CXR?
No treatment required - follow up in 2-4 weeks
73
What is the treatment for a pneumothorax with SOB and/or a > 2cm rim on CXR?
Aspiration (Intercostal drain) and reassessment
74
What does CLL show on blood film?
Smudge cells
75
What does Philadelphia chromosome lead to?
CLL
76
What ages is ALL common in?
Children
77
What shows Auer rods on blood film?
AML
78
What are risk factors for thrombotic thrombocytopenia purpura?
1. Black
2. Female
3. Obesity
4. Pregnancy
79
What is the pathophysiology of thrombotic thrombocytopenia purpura?
A deficiency or inhibitor of the ADAMTS-13 enzyme leads to micro clots forming in the vasculature
80
In combined B12 and folate deficiency, what must you deal with first?
The B12!!! Due to neurological complications
81
What is the fluid / sodium profile for SIADH?
Euvolaemia + Hyponatraemia
82
How does insulin affected potassium?
Drives it into cells (treats hyperkalaemia)
83
What must patients with Addison's do if they feel unwell?
Double their steroid dose
84
What are the symptoms of Coeliac disease
1. Diarrhoea
2. Weight loss
3. Erythematous lesions
4. Bloating
5. Abdominal pain
6. Steatorrhea
85
What drugs are used in someone with stable ulcerative colitis?
Azathioprine & Infliximab
86
What is azothioprine?
DMARD
87
What is Mesalazine?
An amino salicylate (DMARD) used to treat IBD
88
What is the gold standard test for C.Diff infection?
Stool sample
89
What is a complcation of Crohn's disease?
Gallstones - Terminal ileitis leads to impairment of bile salt reabsorbtion - gallstones
90
What is the 1st line test for duodenal ulcers?
Urea breath test / Stool antigen test for H. pylori
91
What is the most common cause of ascending cholangitis?
E. Coli
92
What are the symptoms of pancreatic cancer?
1. PAINLESS JAUNDICE
2. Weight loss
3. Fatigue
93
What is the diagnostic test for pancreatitis?
Serum amylase / lipase elevated (>3x upper limit of normal)
Lipase is more sensitive than amylase
94
What do seminomas secrete?
Just b-hCG
95
In non seminomas (teratoma, choriocarcinoma) what is elevated?
AFP or b-hCG
96
What are risk factors for pseudogout?
1. Hypercalcaemia
2. Hypophosphataemia
3. Hypomagnesaemia
4. Hypothyroid
5. Haemachromatosis
6. Hyperparathyroidism
97
What is Felty syndrome?
Triad of rheumatoid arthritis, neutropenia and splenomegaly
98
What is the most common pathogen responsible for septic arthritis?
Staphylococcus Aureus
99
What is the most common pathogen responsible for septic arthritis in patients that have just had joint surgery?
Staphylococcus Epididermis
100
What is the most common pathogen responsible for septic arthritis in patients in young sexually active adults?
Neisseria Gonorrhoea
101
What is the 1st line management for reactive arthritis?
NSAIDs
102
What is a raised ALP indicative of?
Increased bone turnover or Cholestasis
103
What is given as prophylaxis for cluster headaches?
Verapamil
104
What are the symptoms of cluster headaches?
1. Unilateral pain around orbit
2. Rhinorrhoea
3. Lid swelling
4. Ipsilateral lacrimation
105
What is Uhthoff phenomenon?
A transient worsening of neurological symptoms related to MS when the body becomes overheated
106
What is primary prevention?
Aiming to prevent disease before it occurs, eg education
107
What is secondary prevention?
Aiming to reduce the impact of disease that has already occured, eg screening
108
What is tertiary prevention?
Aiming to reduce the impact of complications / permanent impairments of the disease, eg stroke rehabilitation
109
What is a side effect of Lamotrigine?
Large blistering rash throughout the body (Stevens-Johnson syndrome)
110
What is the difference between vascular Parkinsonism and Parkinson's disease?
Vascular Parkinsonism is more likely to have a bilateral onset with lower limb predominance
111
What is the pathology of Myasthenia Gravis?
Autoantibodies attack the post synaptic ACh receptors at the neuromuscular junction
112
What are the symptoms of Myasthenia Gravis?
Muscle fatigue and weakness, especially ocular, bulbar and proximal limb groups
113
What is the pathology of Lambert-Eaton Myasthenic Syndrome?
Antibodies attack the voltage gated calcium channels in the presynaptic membrane of the neuromuscular junction (this leads to reduced ACh release)
114
What differentiates Lambert-Eaton from Myasthenia Gravis?
LE improves with use / MG gets worse
115
What are the sepsis 6?
GIVE: O2, IV Abx, Fluids
TAKE: Cultures, Lactate, Urine output
116
What can cause an angina flare up?
1. Exercise
2. Stress
3. Cold weather
117
What is diabetic ketoacidosis?
Build up of ketones in the blood due to a lack of insulin restraining free fatty acid formation and oxidation into ketones
118
What would the blood profile look like in DKA?
1. High ketones
2. High glucose
3. Low bicarb
4. High potassium
5. Low CO2 (respiratory compensation)
119
What is the treatment for DKA?
IV fluids / electrolytes
IV insulin - watch for hypokalaemia
120
What are two complications of DKA treatment?
1. Cerebral oedema - fluid too fast
2. Hypokalaemia
121
What is peritonitis?
Inflammation of the peritoneum
122
What are some causes of peritonitis?
1. Pancreatitis / Appendicitis / Cholecystitis
2. Crohn's / Diverticulitis
3. Trauma
4. Perforation of colon
5. Contamination of peritoneal dialysis equipment
6. Cirrhosis of liver
123
What is the treatment for peritonitis?
1. IV fluids with electrolytes
2. Antibiotics (Cefalexin and Metronidazole)
3. If due to ascites - IV albumin
124
What are some risk factors for depression?
1. Recent incident (bereavement, loss of job)
2. Genetic predisposition
3. Chronic pain
4. Other neurological problems
5. Childhood abuse
6. Drug/alcohol abuse
125
What are some symptoms of depression?
1. Low self esteem
2. Muscle pain
3. Weight loss / gain
4. Lack of concentration
5. Feelings of isolation
6. Sleep problems
126
What does the PHQ-9 ask
1. Feeling tired
2. Poor appetite or overeating
3. Sleep problems
4. Feeling you are a failure
127
What is the treatment for bacterial meningitis before hosptal?
IM benzylpenicillin
128
What is the treatment for bacterial meningitis in hospital?
IV Cefotaxime
129
Why must patients on ACE inhibitors be monitored for renal function?
ACE inhibitors decrease GFR which can cause AKI
130
What joints are commonly affected in OA?
1. DIP / PIP
2. Hip
3. Base of thumb (Carpometacarpal joint)
131
What are some contraindications for using thrombolytic therapy?
1. Clotting disorder
2. Recent surgery
3. Active malignancy
4. Brain aneurysms
132
What surgical techniques can be used in ischaemic strokes?
1. Clot retrieval
2. Decompressive craniectomy
133
What are some risk factors for stroke?
1. AF!!!
2. Smoking
3. Obesity
4. Excess alcohol
5. Hyperlipidaemia
6. Diabetes Mellitus
134
What is the treatment for a pulmonary embolism?
1. SC Low molecular weight heparin
2. Start on DOAC
135
What investigations may you do in suspected prostate cancer?
1. Urine dipstick
2. Bloods for PSA
3. Digital rectal exam
Prostate biopsy is gold standard
136
What is used as pharmacological treatment in prostate cancer?
Goserelin
137
What is the treatment for Cushing's disease?
Trans-sphenoidal resection of the pituitary gland
138
What is the treatment for Cushing's syndrome?
1. Try to treat underlying cause
2. Adrenal steroid synthesis inhibitor, eg Metyrapone
139
What is the treatment for Conn's?
Spironolactone
140
What is the gold standard test for Conn's syndrome?
Selective adrenal vein catheterisation
141
At what size of abdominal aortic aneurysm does surgery become indicated?
5.5cm diameter
142
What are the symptoms of left sided colon cancer?
1. Rectal bleeding
2. Change in bowel habit
3. Change in stool consistency
143
What are the symptoms of right sided colon cancer?
1. Mass in right iliac fossa
2. Anaemia
3. Weight loss
144
What are the stages in Dukes bowel cancer staging?
1 - Only inner lining of bowel affected
2 - Spread through all bowel layers
3 - Lymph node involvement
4 - Metastases
145
What are some risk factors for prostatitis?
1. STIs
2. Catheters
3. Recent investigation (DRE, Biopsy)
146
What is the pathophysiology of gout?
Hyperuricaemia - uric acid precipitates out of solution
Deposits in areas of slowest blood flow eg, joints
147
What is an epileptic seizure?
Transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain
148
What is the inverse care law?
The idea that people who are most at need of care find it the hardest to access it
149
What is the pathophysiology of Huntington's?
Huntington gene contains triplet repeat of CAG
CAG codes for glutamine - excess levels of glutamine cause cell death
150
What is a marker for hepatocellular carcinoma?
Alpha fetoprotein
151
What is a marker for pancreatic cancer?
CA 19-9
152
What is a marker for ovarian cancer?
CA 125
153
What is a marker for breast cancer?
CA 15-3
154
What is the management for a severe case of giant cell arteritis that has started to affect vision?
IV methylprednisolone
155
What are some symptoms of mitral stenosis?
1. Haemoptysis
2. Shortness of breath
3. Heart racing
156
What is the management for small bowel obstruction?
Nil by mouth, IV fluids, NG tube aspiration
157
What are the stages of change in the transtheoretical model?
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Relapse
158
What is precontemplation?
No intention of changing behaviour
159
What is contemplation?
Aware a problem exists but no commitment to action
160
What is preparation?
Intent upon taking action
161
What is action?
Active modification of behaviour
162
What is maintenance?
Sustained change - new behaviour replaces old
163
What is relapse?
Fall back into old patterns of behaviour
164
What is the role of clavulonic acid in Co-Amoxiclav?
Inhibits beta lactamase which bacteria use to break down beta lactams
165
What is stage 1 - early COPD?
1. FEV1 > 80%
2. FEV1/FVC < 0.7
166
What is stage 2 - moderate COPD?
1. FEV1 < 80%
2. FEV1/FVC < 0.7
167
What is stage 3 - severe COPD?
1. FEV1 < 0.5
2. FEV1/FVC < 0.7
168
What is stage 4 - very severe COPD?
1. FEV1 < 0.3
2. FEV1/FVC < 0.7
169
What is the 1st line treatment for suspected testicular torsion?
Surgical exploration and untwisting if required
170
What is defined as early menopause?
Before 45
171
What antibody is commonest in dermatomyositis?
ANA
172
What is the most specific antibody in dermatomyositis?
Anti Mi-2
173
What are some causes of gallstones?
1. Supersaturation of bile
2. Gallbladder stasis
3. Gallbladder infection
4. Not enough bile salts
174
What is the gold standard investigation for portal hypertension?
Hepatic venous pressure gradient
175
What is Senna?
A stimulant laxative
176
What would the serum copper be in Wilson's disease?
LOW!
177
What can be given to prevent tumour lysis syndrome?
Allopurinol
178
What gives the best estimate of the activity of the intrinsic pathway of the coagulation cascade?
Activated partial thromboplastin time
179
What gives the best estimate for both extrinsic and common pathways?
Promthrombin time
180
What is a normal range for ejection fraction?
50-75%
181
Where is the most common place for adenocarcinomas to arise in the pancreas?
Head
182
When are NSAIDSs contraindicated?
1. GORD
2. Kidney disease
3. Heart failure
183
What is the treatment for Goodpasture's syndrome?
Prednisolone and cyclophosphamide for induction
Then continue oral prednisolone
184
When are epsilon waves fiund?
Arrythmogenic right ventricular cardiomyopathy
185
If clinic BP is over 140/90, what is the diagnostic investigation for hypertension?
24 hour ambulatory blood pressure monitoring
186
What can be given to reduce risk of sickle cell crisis?
Hydroxycarbamide
187
What are symptoms of renal cell carcinoma?
1. Haematuria
2. Flank pain
3. Abdominal mass
188
What is the first line investigation for renal cell carcinoma?
CT urogram
189
What is an alpha blocker that can be used in phaeochromocytoma?
Phenoxybenzamine
190
What is resected to reduce pressure on the median nerve in carpal tunnel syndrome?
Transverse carpal ligament
191
What are some symptoms of carpal tunnel syndrome?
1. Pain
2. Numbness
3. Parasthesia
4. Weaker grip
192
What can be diagnostic of pancreatitis?
1. Raised serum amylase / lipase (>3x baseline)
2. Raised urinary amylase
193
What is the treatment for a URTI in children?
Penicillin V (Phenoxymethylpenicillin) for 10 days QDS
194
What are the 5S of adrenal crisis?
1. Salt
2. Sugar
3. Steroids
4. Support
5. Search for precipitating illness
195
What are some symptoms of Addisonian crisis?
1. Hypotension (+ tachycardia)
2. Weakness
3. Confusion
196
What are some risk factors for folate deificiency?
1. Old age
2. Malabsorption
3. Alcohol intake
4. Diet
197
What is indicative of Hodgkin's lymphoma?
1. Reed Sternberg cells
2. Owl's eye appearance on blood film
198
What is the mechanism of beta lactam antibiotics?
Inhibit transpeptidation reactions needed to cross-link peptidoglycans in the cell wall
199
What is the management for an uncomplicated UTI?
Nitrofurantoin PO for 3 days
200
What are the ECG signs of hypokalaemia?
1. Small T waves
2. Long QT
3. ST depression
4. U waves
201
What are the ECG signs of hyperkalaemia?
1. Tall tented T waves
2. Prolonged QRS interval
3. Flattened P waves
4. Prolonged PR interval
202
What is the treatment for chlamydia?
Doxycycline or Azithromycin
203
What can be given as migraine prophylaxis?
Propranolol
Topiramate
Amitriptyline
204
What chromosome is affected in Wilson's?
Chromosome 13
205
What chromosome is affected in alpha-1-antitrypsin deficiency?
Chromosome 14
206
What are tender sacroiliac joints indicative of?
Ankylosing spondylitis
207
What investigation us usually used to confirm a diagnosis of bowel obstruction?
Abdomen CT
208
What are the causes of pancreatitis?
I - Idiopathic
G - Gallstones
E - ERCP
T - Trauma
S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion sting
H - Hypercalcaemia / Hyperlipidaemia
E - Ethanol
D - Drugs
209
What is the most common primary bone tumour in children and young adults?
Osteosarcoma
210
What pathogen is commonly linked to reactive arthritis?
Chlamydia pneumoniae
211
What drug class is the 1st line management that is used to induce remission in IBD?
Amino salicylate - Mesalazine
212
What parameters are in CHADSVASC
C - Heart failure
H - Hypertension
A - Age (1 pt > 65 2 pt > 75)
D - Diabetes
S - Stroke (2)
V - Vascular disease
A - Age again
S - Sex
213
What is the treatment for a pneumothorax?
Needle aspiration
214
What is De quervain's thyroiditis?
Inflammation of the thyroid characterised by a triphasic course of transient thyrotoxicosis, hypothyroidism and return to euthyroidism
215
What is the treatment for De Quervain's thyroiditis?
Aspirin and ibuprofen
216
What are the features of Parkinsonian tremor?
1. Worse at rest
2. Worse on distraction
3. Reduced on movement
4. Pill rolling
Usually asymmetrical
217
What does peroneal nerve palsy cause?
Inability to dorsiflex the foot
218
Where does idiopathic pulmonary fibrosis cause fibrosis?
Lower zone of lungs
219
What is the gold standard investigation for liver cirrhosis?
Liver biopsy - regenerative nodules surrounded by connective tissue
220
What is the treatment for low severity community acquired ammonia (CURB65 0 or 1)?
Oral amoxicillin at home
221
What is the treatment for moderate severity community acquired ammonia (CURB65 2)?
Amoxicillin + Clarithromycin
222
What is the treatment for moderate severity community acquired ammonia (CURB65 3)?
Co-amoxiclav + Clarithromycin
223
What is the 1st line investigation for peripheral arterial disease?
Ankle-brachial pressure index
224
What can be used to treat prolactinoma?
Oral cabergoline - dopamine agonists inhibit the pathway responsible for prolactin
225
What marker is most specific for highlighting acute liver damage?
ALT
226
What is the biggest risk factor for aortic dissection?
Hypertension
227
What is the treatment for pernicious anaemia?
IM hydroxocobalamin
228
What is indicative of anal haemorrhoids?
Itching and irritation in the anal region
229
What is given for migraine prophylaxis in pregnancy + asthma?
Amitriptyline - Propanolol CI in asthma - Topiramate CI in pregnancy
230
What is Kernig's sign?
Pain in the lower back when knee is extended and hip is held in flexion
231
What is Kernig's indicative of?
Meningitis
232
What features suggest a non epileptic seizure?
1. Crying / talking
2. Longer length
3. No post ictal symptoms
233
What is the mechanism of action of Alteplase?
Activates plasminogen to form plasmin
Plasmin breaks up the clot
234
What are some signs of COPD on chest xray?
1. Hyperinflation!
2. Barrel chest
3. Bullae
235
How is disease progression monitored in Rheumatoid arthritis?
ESR and CRP levels
236
Name one life threatening complication of Rheumatoid arthritis
Felty's syndrome - Rheumatoid arthritis, splenomegaly and neutropenia
237
What are some extra articular complications of Rheumatoid arthritis?
1. Sjogrens syndrome
2. Pericarditis
3. Pleural effusions
4. Glomerulonephritis
5. Skin nodules
6. Vasculitis
238
What is the sensory loss in the perineum in Cauda Equina called?
Saddle anaesthesia
239
What is the treatment for Cauda Equina syndrome?
1. Immediate hospital admission
2. Emergency MRI
3. Lumbar decompression surgery
240
What are splinter haemorrhages?
Thin red lines on the nails seen in infective endocarditis
241
What sort of blood cultures are taken in infective endocarditis?
3s!
3 cultures, 3 different sites, 3 different times
242
What are some major criteria for infective endocarditis from the Duke's scale?
1. Vegetation on echocardiogram
243
What are some minor criteria for infective endocarditis from the Duke's scale?
1. Fever
2. Roth spots
3. Janeway lesions
4. Osler nodes
244
What are 2 possible complications from this condition?
1. Sepsis
2. Permanent valve damage
3. Pulmonary embolism
4. Kidney damage
245
What is the gold standard investigation for Mallory Weiss tears?
Upper GI endoscopy
246
What other investigations may be done in Mallory Weiss tear?
1. Coagulation profile
2. FBC
3. U&E
247
What is the Glasgow Blatchford Score used for?
A system to risk stratify patients with upper GI bleeds
248
What are some criteria in the Glasgow Blatchford Score?
1. Tachycardia
2. Melaena
3. History of hepatic disease
249
What is the treatment for Mallory Weiss tear?
Upper GI endoscopy and clipping + adrenaline
High dose PPI after surgery
250
Where are some common locations for kidney stones?
1. Ureteropelvic junction
2. Ureterovesical junction
3. Where the ureter crosses the iliac vessels
251
What radiological intervention can be used to treat renal tract stones?
Ultrasound shock wave lithotripsy
252
How should bisphosphonates be taken?
Take first thing in the morning on an empty stomach with a full glass of water
Stay upright for 30 minutes after taking them
253
What are 3 side effects of bisphophonates?
1. Oesophagitis
2. Osteonecrosis of the jaw
3. Oseophageal ulcers
254
What two signs can be used to test for meningitis on examination?
Kernig / Brudzinski sign
255
What would you see on chest X ray in aortic stenosis?
1. Cardiomegaly
2. Calcification aortic valve
3. Pulmonary oedema
256
What are some symptoms of septic infection?
1. Fever
2. Rigors
3. Sweating
4. Confusion or disorientation
257
What enzymes may be elevated in acute liver injury?
Gamma GT
258
What are some symptoms of delirium tremens?
1. Acute confusion
2. Tremor
3. Tachycardia
259
What are some causes of microcytic anaemia?
1. Iron deficiency
2. Thalassaemia
3. Lead poisoning
260
What blood tests can be used to diagnose iron deficiency anaemia?
1. Haemoglobin & mean cell volume
2. Serum ferritin
3. Blood film
261
What are some signs of iron deficiency anaemia?
1. Pallor
2. Koilonychias
3. Angular stomatitis
262
What should be done in older / postmenopausal patients with suspected iron deficiency anaemia?
Refer to gastroenterology as can be red flag for colorectal cancer
263
What is the cause of pneumonia people who have been to unhygienic hotels abroad get?
Legionella pneumophillia
264
What is the most common subtype of motor neurone disease?
Amyotrophic lateral sclerosis
265
What are the three types of motor neurone disease?
1. Amyotrophic lateral sclerosis
2. Progressive bulbar palsy
3. Primary lateral sclerosis
266
Which species of plasmodia is the most common cause of malaria?
P. falciparum
267
What is atropine?
Drug used to treat bradycardias
268
What drugs can be used in acute AF?
Pharmacological cardioversion - eg Amiodarone
269
When would you use electrical cardioversion in AF?
If the patient is haemodynamically unstable
270
What is the inheritance pattern of G6PD?
X linked recessive
271
What can cause a G6PD crisis?
1. Fava beans
2. Nitrofurantoin
3. Infection
272
What is Von Willebrand's disease?
A common autosomal dominant disease that makes you bleed more easily than normal because of a low level/ineffective Von Willebrand factor
273
What does Von Willebrand factor do?
Helps blood cells clot
274
What is haemophilia A?
Deficiency in clotting factor 8
275
What is haemophilia B?
Deficiency in clotting factor 9
276
What coagulation profile would be elevated in Haemophilia A and B?
Activated partial thromboplastin time - as this measures intrinsic pathway
277
What is the inheritance pattern for haemophilia?
X linked recessive
278
What is the gold standard investigation for peripheral artery disease?
Contrast angiography
279
What is the 1st line investigation for peripheral artery disease?
Ankle brachial pressure index
280
What are some characteristics of venous ulcers?
1. Lower calf to medial malleolus
2. Irregular shape
281
What are some characteristics of arterial ulcers?
1. Distal extremities
2. Punched out appearance
282
Where do you listen for aortic valve murmurs?
2nd intercostal space right sternal border
283
Where you listen for mitral valve murmurs?
5th intercostal space left from sternum
284
What blood marker is first line investigation for heart failure?
N-Terminal Pro B-Natriuretic Peptide
285
What are some tests used to diagnose cystic fibrosis?
1. Heel prick test for newborns
2. Sweat electrolyte test (chloride)
3. Genetic screening
286
What does the heel prick test in babies test for?
1. Cystic fibrosis
2. Sickle cell disease
3. Congenital hypothyroid
4. Inherited metabolic diseases
5. Severe combined immunodeficiency
287
What are some causes of exudative effusions?
1. Pneumonia (infection)
2. Cancer
288
What are some causes of transudative effusions?
1. Heart failure
2. Hypoalbuminaemia
3. Nephrotic syndrome
4. Meig's syndrome (right sided effusion with ovarian malignancy)
289
What investigations can be done to confirm suspected effusions?
1. Sample of pleural aspirate
2. CXR - blunting of costophrenic angle
290
What is the management for pleural effusions?
1. Diuretics
2. Therapeutic aspiration
291
What is a complication of pleural effusion?
Empyema - Pockets of pus in the lungs
292
What bones are commonly affected in Paget's?
1. Skull
2. Vertebrae
3. Pelvis
4. Femur
293
What is Beck's triad?
Triad for cardiac tamponade
294
What is in Beck's triad?
1. Hypotension
2. Raised JVP
3. Muffled heart sounds
295
What is Cushing's reflex?
Body's response to raised intercranial pressure
296
What is in Cushing's reflex?
1. Widened pulse pressure
2. Bradycardia
3. Irregular respirations
297
What investigations could be used to diagnose cardiac tamponade?
1. CXR
2. Echocardiogram
3. ECG
298
What is the name of the procedure used to urgently relieve pressure in cardiac tamponade?
Pericardiocentesis
299
What antibodies indicate Addison's disease?
Anti 21 hydroxylase
300
What is the management for hypoglycaemia?
Intramuscular glucagon injection
301
Which nerves are responsible for shoulder abduction?
Suprascapular then axillary
302
What does TLR 3 detect?
Double strand RNA
303
What does TLR 4 detect?
LPS
304
What does TLR 5 detect?
Flagellin
305
What is absorption?
The transportation of the drug from the site of administration to the body circulation system
306
What is distribution?
The amount of drug available in circulating volume
307
What is metabolism?
The chemical reactions that change drugs into compounds which are easier to eliminate
308
What is excretion?
The removal of drugs from the body
309
What are some AIDS defining illnesses?
1. Kaposi sarcoma
2. Oesophageal candida
3. Pneumocystis pneumoniae
4. Toxoplasmosis
5. Cryptococcal septicaemia
310
What are some causes of nephrotic syndrome?
1. Minimal change disease
2. Membranous nephropathy
3. Focal and segmental glomerulosclerosis
311
What are some causes of nephritic syndrome?
1. IgA nephropathy
2. ANCA vasculitis
3. Goodpasture's syndrome
4. Post streptococcal glomerulonephritis
312
What is the treatment for renal stones <5mm with no signs of obstruction or infection
Watch and wait
313
What is the treatment for renal stones >5mm?
Ultrasound shock wave lithotripsy
314
What is the treatment for large stones >2cm or complex stones eg. staghorn?
Percutaneous nephrolithotomy
315
What can differentiate G6PD and beta thalassaemia major?
G6PD presents with jaundice
316
What are some symptoms of beta thalassaemia major?
1. Anaemia
2. Chipmunk face
317
What are some causes of pulmonary fibrosis?
1. Idiopathic pulmonary fibrosis
2. SIlicosis
3. Hypersensitivity pneumonitis
4. TB / Sarcoidosis
5. Drugs - Methotrexate
318
What are some signs on the hands of pulmonary fibrosis?
1. Clubbing
2. Acrocyanosis (Peripheral cyanosis)
319
What signs on CT will indicate pulmonary fibrosis?
1. Ground glass appearance
2. Honeycombing
320
Where does IPF cause fibrosis?
Predominantly lower zone fibrosis
321
What two medicines are used in idiopathic pulmonary fibrosis?
Nintedanib - Tyrosine kinase inhibitor
Pirfenidone - Reduces fibroblast actvitiy
322
What are signs of hypocalcaemia?
1. Trousseau's sign
2. Chvostek's sign
323
What are some Xray signs of ankylosing spondylitis?
1. Bamboo spine
2. Dagger sign
3. Syndesmophytes
4. Squaring of the vertebral bodies
324
What test can be used to assess a decrease in lumbar spine flexion?
Schober test
325
What are seronegative spondyloarthropathies?
1. Ank spond
2. Psoriatic arthritis
3. Enteropathic arthritis
4. Reactive arthritis
326
What are two signs of haemorrhagic pancreatitis?
1. Cullen's sign - Periumbilical bruising
2. Grey Turner sign - Flank bruising
327
What can be given in Graves' to help treat eye swelling?
Corticosteroids
328
How might gallstones cause vitamin K deficiency?
Gallstone blocks bile tract - bile can't be release - fat malabsorption - fat soluble vitamins ADEK not absorbed
329
What shape is a subdural haemorrhage on head CT?
Crescent shaped hyperdense
330
What shape is an extradural haemorrhage on head CT?
Biconvex shaped hyperdense
331
What shape is subarachnoid haemorrhage on head CT?
Hyperdense material in the subarachnoid space
332
What cancers metastasise to bone?
Prostate
Breast
Thyroid
Lung
Kidney
333
What cancers metastasise to brain?
Lung
Breast
Melanoma
334
Where is PSA produced?
Luminal cells of prostate
335
How does the joint damage occur in osteoarthritis?
Apoptosis of chondrocytes - loss of cartilage
336
What is the pathophysiology of bronchiectasis from infection?
Infection causes release of inflammatory mediators - This impairs cilia function and attracts immune response - tissue damage
337
What does coagulase do?
Converts fibrinogen to fibrin
338
What sort of hypersensitivity is IgA nephropathy?
Type 3
339
What can be seen in the kidneys in IgA nephropathy?
IgA deposits and glomerular mesangial proliferation
340
What are two differentials for kidney damage and haemoptysis?
1. Goodpasture's
2. Wegener's granulomatosis
341
What is the treatment for Goodpasture's and Wegener's?
Corticosteroids + cyclophosphamide
342
What condition is IgA nephropathy linked to?
Henloch-Schonlein purpura
343
What is the pathophysiology of IgA nephropathy?
IgA immune complexes deposit in the kidney
344
How does histamine cause inflammation?
Vasodilation
345
What drugs would you give in thyroid storm?
1. Propranolol
2. Carbimazole
3. Potassium iodide
346
What is a monoclonal paraprotein?
One immunoglobulin produced excessively
347
What sort of anaemia does myeloma cause?
Normocytic normochromic
348
What are some signs of life threatening asthma?
1. Confusion
2. Silent chest
3. Cyanosis
349
Signs of left heart failure?
1. Cardiomegaly
2. Pink frothy sputum
3. Pulmonary oedema
4. Tachycardia
350
Signs of right heart failure?
1. Hepatomegaly
2. Ascites
3. Tachycardia
4. ^JVP
351
What colour does Zielhs Neelsen stain with TB?
Pink
352
What are the 3 types of IBS?
1. Diarrhoea
2. Constipation
3. Mixed
353
What are the symptoms of IBS?
1. Abdominal pain relieved by defecation
2. Bloating
3. Change in bowel habit
354
What is lead time bias?
When a disease is picked up earlier through screening so it looks like they are "living longer with the disease" but actually they are just being picked up in an earlier stage
355
What is length time bias?
When patients with less severe disease are more likely to have those diseases detected through screening
356
What is secondary prevention?
Aiming to reduce the impact of a disease or injury that has already occured
357
What is tertiary prevention?
Aim to reduce the impact of an illness or injury which has lasting effects
358
What should be done in COPD if a patient is not coping on a SABA alone>
Add a LAMA + LABA
359
What is the most common hormone secreted by carcinoid tumours?
Serotonin
360
What are some side effects of excess serotonin secretion?
1.Diarrhoea
2. Abdominal pain
3. Flushing
4. Wheeze
361
What is toxic multinodular goitre (Plummer's disease)?
Growth of multiple nodules in the thyroid gland which produce excess thyroid hormone
362
How can you differentiate Graves' from toxic multinodular goitre?
1. Exopthalmos in Graves'
2. Rough goitre in TMG
363
What condition has patchy uptake nuclear scintigraphy?
Toxic multinodular goitre
364
What are some signs of hydrocephalus?
1. Gait disturbance
2. Cognitive impairment
3. Incontinence
365
What's the best investigation for suspected hydrocephalus?
CT head
366
What would you see on head CT in hydrocephalus?
Dilated ventricles in the absence of sulcal enlargement
367
What would the blood profile in GIlbert's syndrome show?
Raised unconjugated bilirubin
368
How does calcium gluconate work in treating hyperkalaemia?
Stabilisation of cardiomyocyte membrane potentials (prevents life threatening arrythmias)
369
How does insulin work in treating hyperkalaemia?
Shifts K+ into cells (give dextrose as well to avoid hypo)!
370
Where is the most common location for an ectopic pregnancy?
Ampulla
371
What is stage 1 AKI?
1. Creatinine 1.5x to baseline
2. Urine <0.5ml/kg/hr for 6-12 hrs
372
What is stage 2 AKI?
1. Creatinine 2x to baseline
2. Urine <0.5ml/kg/hr for 12-24 hrs
373
What is stage 3 AKI?
1. Creatinine 3x to baseline
2. Urine output <0.3ml/kg/hr for 24+ hrs
3. Anuria for 12 hrs
4. Creatine > 354
374
What are symptoms of croup?
1. Seal cough
2. Fever
3. SOB
2a Mocks
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