1
Q
What is found on an X-ray on someone who has osteoarthritis?
A
- Loss of joint space
-Osteophytes forming at joint margins
-Subchondral sclerosis - Subchondral cysts
2
Q
What is found on an X-ray on someone who has rheumatoid arthritis?
A
- Loss of joint space
- Juxta-articular osteopenia
-Soft tissue swelling
-Periarticular erosions
-Subluxation
3
Q
What is the presentation of horners?
A
- miosis
ptosis
enophthalmos - no sweating
4
Q
What are the side effects of TB medications?
A
Rifampicin - Change in urine colour
Isoniazid - Peripheral neuropathy
Pyrazinamide - Hepatitis
Ethambutol - Optic neuritis
5
Q
What is the presentation of acute haemolytic reaction from a blood transfusion and what is the management?
A
- Abdominal pain
-Hypotensive
-Fever
TX = stop and give fluids
6
Q
What is the presentation of transfusion associated circulatory overload and what is the management?
A
Hypertensive
Pulmonary oedema
TX- slow or stop transfusion and give Loop diuretic and Oxygen
7
Q
What is the presentation and management of transfusion related acute lung injury and what is the management?
A
Hypoxia, pulmonary infiltrates, fever, hypotension
TX- stop transfusion and give oxygen and supportive care
8
Q
What are the causes of high albumin ascites?
A
- Cirrhosis, PV thrombosis, Budd chiari
9
Q
What are the causes of low albumin ascites?
A
Cancer, TB, nephrotic
10
Q
What is the most common cause of SBP and what is the prophylaxis?
A
E.coli and Ciprofloxacin
11
Q
What is the management of lithium toxicity?
A
IV fluids with isotonic saline and haemodialysis if severe
12
Q
What is the difference between PBC and PSC?
A
PSC links with UC and associated with cholangiocarcinoma. You do an MRCP
PBC - Associated with middle aged female, antimitochondrial antibodies and managed with Ursdeoxycholic acid
13
Q
What are the different types of testicular cancer ?
A
Germ cell - Seminoma or non seminomas.
Seminoma (high bHCG)
Non seminoma - teratoma and high AFP
Non germ cell = leydig and sertoli
14
Q
What are the two types of oesophageal cancer?
A
Adenocarcinoma - lower 1/3, associated with Barrets
Squamous cell carcinoma - upper 2/3, smoking
15
Q
What is the mc type of bladder cancer?
A
Transitional cell carcinoma
(schisto = squamous cell)
16
Q
What is the first line treatment for hepatic encephalopathy?
A
Lactulose + then the addition of rifaximim
17
Q
What are pre renal causes of acute kidney injury?
A
Hypoperfusion - dehydration, shock, renal artery stenosis, anaemia
18
Q
What are the renal causes of AKI?
A
Glomerulonephritis
Acute tubular necrosis
Acute interstitial nephritis
Rhabdomyolysis
19
Q
What are the post renal causes of AKI?
A
Compress/obstruction
- BPH
Renal stones
urinary retention
20
Q
What is acute interstitial nephritis?
A
Hypersensitivity reaction vs drugs - allopurinol and furosemide
SX - HTNM, fever, rash
21
Q
What is acute tubular necrosis?
A
necrotic tubular epithelium due to nephrotoxins and prolonged ischaemia
Dx - muddy brown casts
22
Q
What is the presentation of nephrotic syndrome?
A
- proteinuria
- low albumin
-oedema
Causes - minimal change, focal segmental glomerulosclerosis, membranous nephropathy (spike and dome)
23
Q
What is the presentation and cause of nephritis syndrome?
A
haematuria
HTN
Oedema
Causes - IgA nephropathy, post strep glomerulonephritis, Goodpastures
24
Q
What is the management of renal and ureteric stones?
A
<5mm = W+W
5-10 = shockwave
10-20 = shockwave or ureteroscopy
>20 = percutaneous nephrolithotomy
Ureteric
<10 =shockwave lithotripsy +/- alpha blockers
10-20 = ureteroscopy
25
What is the treatment of myoclonic seizures?
1st line = levetiracetam
26
What is the 1st line treatment of tonic or atonic seizures?
Lamotrigine
27
Where is a femoral hernia found?
inferolateral to pubic tubercle
28
where is an inguinal hernia found?
Superior and medial to pubic tubercle
29
What is the management of extracapsular sub and intra hip fracture?
Intra = dynamic hip screw
Sub = intramedullary nail
30
What is the management of intracapsular hip fracture?
Displaced = Total hip placement or hemi
Undisplaced = internal fixation or hemi
31
What would you see on bloods for osteomalacia?
high ALP, PTH
Low calcium and phosphate
32
What is Cushing's including causes and diagnosis ?
High cortisol
Causes= Cushings syndrome = adrenal adenoma
Cushings disease = Pituitary adenoma secreting ACTH
Ectopic ACTH
DX - hypokalameia met acidosis, hyperglycaemia
low dex test = cortisol levels not suppressed
ACTH level - ACTH low in ACTH independent and high in ACTH dependent.
High dex = pituitary tumour (cushing disease) suppressed but ectopic ACTH doesn't
33
What are the causes of Conns?
BL adrenal hyperplasia, adrenal adenoma - As increased aldosterone
Renal artery stenosis - As increased RAAS
34
What are the causes and presentation of SIADH?
SCLC, abscess, infection, drug, head trauma
headache, fatigue, hyponatraemia
35
What is the murmur in aortic regurg?
Early diastolic - high pitched and blowing
collapsing pulse, wide pulse pressure
36
What is the murmur in mitral stenosis?
Mid-late diastolic
37
What is the murmur in mitral regurg ?
Pansystolic - high pitched and blowing
38
What are causes of transudative pleural effusion (<25g/L)?
Heart failure
Nephrotic syndrome
Cirrhosis
Low albumin
39
What are causes of exudative pleural effusion (>35g/L)?
Pneumonia
Malignancy
Tuberculosis
Pulmonary Embolism
Rheumatoid arthritis
Pancreatitis
40
What is the management for stroke?
Under 4.5 hours = Thrombolysis
Under 6 hours and large vessel occlusion = thrombolysis and thrombectomy
6-24hours and large vessel occlusion and salvageable brain = Thrombectomy
41
What is type IV hypersensitivity reaction?
Allergic contact dermatitis
TB
Scabies
MS
42
What is the cause of cellulitis?
Strep pyogenes
43
What is the main cause of IE and most common cause after valve surgery?
Staph aureus
staph epidermis
44
What is seen on CT head for Herpes simplex encephalitis?
Temporal changes
45
What is seen on CT head for cerebral toxoplasmosis?
Single or multiple enhancing lesions
46
What are causes of a third nerve palsy and what is it?
Down and out
Ptosis
Painful - posterior communicating aneurysm - dilated pupil too
Vasculitis
DM
47
What is the sensitive and specific antibody in SLE?
antidsdna - Specific
ANA- sensitive - good to rule out
48
What is the triad for haemolytic uraemic syndrome?
- AKI
- microangiopathic haemolytic anaemia
-thrombocytopenia
49
What are the causes of metabolic acidosis - normal anion gap?
prolonged diarrhoea
Addison's
50
What are the causes of metabolic acidosis - raised anion gap?
DKA
aspirin poisoning
renal failure
51
When do you manage pericarditis with haemodialysis?
uraemia or encephalopathy
52
What are shockable rhythms?
VF
53
what are non shockable rhythms?
PEA
asystole
54
What are some complications post MI?
Death
rupture - free wall, VSD
oedema
Aneurysm of LV
Dresslers
55
What are some reversable causes of cardiac arrest?
Hypoxia, hyper/hypokalaemia, hypothermia, hypovolaemia
Tissue, trauma, thrombin, toxins
56
What can cause an upper quadrant bitemporal hemianopia?
pituitary tumour
57
What can cause a lower quadrant bitemporal hemianopia?
craniopharyngioma
58
What conditions are cANCA positive?
granulomatosis with polyangiitis
59
How does Wegener's (granulomatosis with polyangitis) present?
epistaxis, dyspnoea, rapidly progressive glomerulonephritis, saddle shaped nose deformity
60
What are pANCa positive conditions?
UC
PSC
antiGBM
crohns
eosinphilic granulomatosis with polyangitis
61
What is sarcoidosis?
multisystem disorder
- Presents with erythema nodosum, bilateral hilar lymphadenopathy, non productive cough, hypercalcaemia, raised ESR
62
What are the incubation periods for gastroenteritis causes?
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
63
What is the management for VF/VT?
Shock
CPR
After the third shock 1mg adrenaline and 300mg amiodarone
64
What is administered first in a non shockable rhythm?
1mg adrenaline
65
What is the presentation of haemophilia?
Haemoarthroses
haematomas
prolonged APTT
Everything else is normal
66
What are some complications of gonorrhoea?
urethral strictures
Infertility
Diseminated infection
epididymitis
67
what do you see on CSF analysis for bacterial meningitis?
1- Increased opening pressure
2- High WBC and polymorphs
3- low glucose
4- high protein
68
What do you see on CSF analysis for viral meningitis?
1- slightly high opening pressure
2- Low WBC , lymphocytes
3- normal glucose
4 - normal protein
69
What do you see on csf analysis for fungal meningitis?
1- normal or high opening pressure
2- low WBC, lymphocytes
3- low glucose
4- high protein
70
What do you see on csf for TB meningitis?
1- high opening pressure
2- low WBC, lymphocytes
3- low glucose
4-high protein
71
What do you prescribe for pain relief in palliative care normally and what do you prescribe in renal impairment?
Morphine
oxycodone if mild renal impairment
buprenorphine or fentanyl in severe renal impairment
72
What do you give for the treatment of pneumocystitis jiroveci and the prophylaxis when CD4 count <200/mm3?
co-trimoxazole
73
What do you prescribe to treat an animal bite?
co-amoxiclav
74
What scoring system is used in pancreatitis?
Glasgow
75
What is the management of inguinal hernias?
refer routinely for open mesh repair
76
What is given to prevent vasospasm in SAH?
nimodipine
77
What are some complications of chicken pox?
pneumonia
encephalitis
disseminated haemorrhagic chickenpox
arthritis
78
What is the investigation of choice for bowel perforation?
erect CXR
79
Give an example of an alpha 1 anatagonist?
tamsulosin
Doxazosin
80
Give me an example of a beta 1 agonist?
dobutamine
81
Give me an example of beta 1 antagonist?
atenolol
bisoprolol
82
Give me an example of a dopamine agonist?
ropinirole
83
Give me an example of a GABA agonist?
baclofen
benzodiazepine
84
What myocardial complication presents with HF secondary to cardiac tamponade - increased JVP, pulsus paradoxus?
left ventricular free wall rupture
85
What myocardial infarction complication presents with a pansytolic murmur?
VSD
86
How does acute mitral regurg present following an MI?
acute hypotension
pulmonary oedema
early-mid diastolic murmur
87
What leads and what artery is lateral on an ECG?
Left circumflex, AvLV5,V6,1
88
What leads and what artery are anteroseptal on an ECG?
V1-V4, LAD
89
What leads and what artery is inferior on an ECG?
RCA, II,III,AVF
90
What medications do you give in preserved ejection fraction HF?
empagliflozin
Spironolactone
91
What medications do you give in reduced ejection fraction HF?
ACE-i, BB, flozin, mineralcorticoid receptor anatgonist
92
What do you see histologically for crohns and UC?
crohns - goblet cells, granulomas
UC - depleted goblet cells, crypt abscesses
93
What are 3 extra intestinal features for crohns and UC?
Crohns - erythema nodosum, arthritis
UC- uevitis, PSC, arthritis, pyoderma gangrenosum
94
How does an anterior cerebral artery stroke present ?
contralateral hemiparesis and sensory loss, lower worse than upper
95
How does a middle cerebral artery stroke present?
contralateral hemiparesis and sensory loss worse in upper
Contralateral homonymous hemianopia
aphasia
96
How does a posterior cerebral artery stroke present?
contralateral homonymous hemianopia with macula sparing
visual agnosia
97
How does webers stroke (branches of the posterior cerebral artery that supply the midbrain) present?
ipsilateral CN3 palsy
contralateral weakness of upper and lower
98
How does a posterior inferior cerebellar artery present (lateral medullary syndrome )?
ipsilateral facial pain and temp loss
Contralateral: limb/torso pain and temp loss
ataxia
nystagmus
99
How does an anterior inferior cerebellar artery present (lateral pontine syndrome)?
symptoms similar to wallenberg but ipsilateral facial paralysis and deafness
100
What is the treatment for rosacea?
Topical ivermectin is first line
then add oral doxy
101
What is the management of bells palsy?
oral prednisolone and eye care
102
What are 4 extra articular manifestations of RA?
scleritis, pulmonary fibrosis, sarcoidosis, vasculitis, carpal tunnel syndrome
103
What is felty's syndrome?
RA + Splenomegaly + Low WCC
104
What is Klinefelter's syndrome?
47 XXY
Tall, gynaecomastia
small testes
Elevated gonadotrophin levels but low testosterone
105
What is perncious anaemia?
An autoimmune disorder affecting the gastric mucosa resulting in vit B12 deficiency
(antibodies to intrinsic factor)
106
How do you investigate pernicious anaemia?
FBC - macrocytic anaemia, low WCC and platelets
Anti intrinsic factor/ anti gastric parietal cell Ab's
107
How does osteomalacia present?
bone pain
muscle weakness
low vitD and calcium and phosphate
Raised ALP
108
What is a colles fracture?
FOOSH
transverse fracture of the radius
109
What is a galeazzi fracture?
radial shaft fracture with associated dislocation of the distal radioulnar joint
direct blow
110
What is a pott's fracture?
bimalleolar ankle fracture
forced foot eversion
111
What is a bennets fracture?
caused by fist fights
intra articular fracture of the first carpometacarpal joint
112
How does ramsay hunt syndrome present?
reactivation of vzv on 7th cranial nerve
- auricular pain
facial nerve palsy
vesicular rash around ear
vertigo and tinnitus
113
How do you treat ramsay hunt syndrome?
oral aciclovir and corticosteroids
114
What are some causes of otitis media?
streptococcus pneumonia
haemophilus influenza
rhinovirus
115
How does herpes zoster opthlamicus present and how is it treated?
vesicular rash around eye
rash on tip or side of the nose
TX = oral antiviral
116
What is orthostatic hypotension?
drop in BP (>20/10) within 3 minutes of standing
116
What does HNPCC increase your risk of?
colon cancer
endometrial cancer
pancreatic cancer
117
What is the management of alcoholic ketoacidosis?
IV saline and thiamine
118
How does SLE present?
rash sparing nasolabial folds
photosensitivty
raynauds
livedo reticularis
fatigue
fever
lymphadenopathy
119
What are the causes of postural hypotension?
diuretic
antihypertensives
hypovolaemia
120
How do you diagnose acromegaly?
Serum IGF level
OGTT
121
How does acromegaly present?
macroglossia
gapped teeth
spade like hands
bitemporal haemanopia
headache
sweating
obstructive sleep apnoea
122
How does anterior hip dislocation present?
shortened and externally rotated leg
shortened and internally rotated is in posterior hip dislocation
123
What are some causes of erythema multiforme?
HSV
mycoplasma
penicillin, allopurinol
SLE
sarcoidosis
124
What is the definition of GORD?
excessive entry of gastric contents into the oesophagus through the gastro-oesophageal junction
125
What factors exacerbate GORD?
lying down, alcohol, hiatus hernia, drugs
126
What is the gold standard test for reflux?
oesophageal pH manometry
127
What is the initial and appropriate management of epistaxis?
- ask patient to sit with their forward and their mouth open + pinch the cartilaginous area of the nose firmly
- can cauterise the nose, use a topical antiseptic like naseptin or pack the nose
128
What is the area in the nose where epistaxis occurs?
Kiesselbach's plexus
129
What is seen on a CT for subarachnoid haemorrhage?
acute blood (hyperdense/bright on CT) is typically distributed in the basal cisterns, sulci and in severe cases the ventricular system.
130
What are these antibodies 'anti-streptolysin O titre' used o confirm?
post strep glomerulonephritis
131
where are tear drop poikilocytes found?
myelofibrosis
132
What is the management of depression PHQ-9 <16 and >16?
<16 = CBT
>16= CBT and medication
133
What is the diagnostic investigation for boerhaave's syndrome?
CT contrast swallow
134
What is pre-eclampsia?
new onset BP >140/90 after 20 weeks and 1 of proteinuria, organ dysfunction
135
What shows an unfavourable prognosis for hodgkins lymphoma?
large mediastinal lymphadenopathy
ESR>50 without B symptoms
ESR>30 with B Sx
Age>50
4 lymph node sites involved
136
What are the risk factors for erectile dysfunction?
CVD, obesity, DM, alcohol, SSRIs, beta blockers
137
What are some symptoms of mania and hypomania ?
pressured speech
hyperactivity
flight of ideas
euphoria
irritable
poor attention
++ psychotic Sx with mania
138
What are some signs and symptoms of CKD?
pallor
hypertension
pruritus
bruising
purpura
139
What are some complications of haemodialysis and peritoneal dialysis?
haemodialysis - site infection, hypotension, air embolus
peritoneal dialysis - peritonitis, sclerosing peritonitis, constipation
140
What are some features of hypothyroidism?
weight gain, lethargy, dry, cold, coarse hair, constipation, carpal tunnel syndrome
141
What is the mechanism of aspirin?
blocks the action of cyclooxygenase 1 and 2. Blocks thromboxane A2 formation in platelets reducing the ability of platelets to aggregate
142
What are some signs of iron deficiency anaemia?
fatigue
SOB
koilonychia
atrophic glossitis
angular stomatitis
palpitations
143
How does hyperemesis gravidarum present?
N+V
ketonuria
5% weight loss
dehydration
high T4 too - check thyroid function
144
What are the side effects of lithium and lithium toxicity?
lithium - N+V, fine tremor, nephrogenic diabetes insipidus
weight gain
Toxic - seizure, coarse tremor, polyuria, confusion
145
What can be used to treat metastatic bone pain in palliative care?
opioids, bisphosphonates and fentanyl
146
which form of melanoma is the most aggressive?
nodular
147
Which form of melanoma is the most common?
superficial spreading
148
What medications cause idiopathic intracranial hypertension?
cocp
steroids
tetracyclines
retinoids
lithium
149
what is the treatment of raynauds?
CCB - nifedipine
150
What do you see on a blood film in AML?
auer rods
151
How does CML present and what is the management?
(Philadelphia chromosome - 9 and 22)
splenomegaly, lethargy, increase i granulocytes
imatinib
152
How does CLL present?
smudge cells
lymphocytosis
(Richter transformation)
153
How does cerebellar syndrome present?
Dysdiadochokinesia
ataxia
nysagmus
intention tremor
slurred speech
hypotonia
vertigo
154
How should TPN be administered?
Through a central vein
155
What is rapidly progressive glomerulonephritis and what are some causes?
rapid loss of renal function associated with the formation of epithelial crescents in the glomeruli
causes- goodpastures, wegners, SLE
156
After a diagnosis and delivery of a baby with gastroschisis - what is the managemnt plan?
straight to theatre within 4 hours
157
When do you stop ACE-i before surgery?
discontinue 24hours before surgery
158
What would it show on the water deprivation test for psychogenic poydipsia?
low starting plasma osmalality
>400 final urine osm
Osm >400 urine osm post DDAVP
159
What are some signs of depression and atypical depression?
low mood
loss of pleasure
no sleep
decrease in appetite
fatigue
over 2 weeks
atypical - weight gain, more sleep, mood will lighten after positive events
160
What are some types of psoriasis?
guttate, placque, pustular
161
What are the causes of AAA rupture?
trauma, HTN, connective tissue disorder, atherosclerosis, mycotic aneurysm
162
What is a true vs false aneurysm?
True is dilatation in the artery of all 3 layers due to weakened blood vessel wall.
false is a collection of blood around a blood vessel wall that communicates with the lumen
163
What is NNT?
the number of patients who need to be treated for one person to benefit
164
What is a delirium scoring system?
4AT
165
What are some causes of urinary retention and what investigations would you do?
BPH, UTI, medications like amitriptyline
Urine culture
Bladder USS
FBC , U+E
166
What is the term given to bone disease in patients with renal failure and what is the treatment?
renal osteodystrophy
Treatment - reduced dietary intake of phosphate
Vit D aanlogues
167
What is the function of PTH?
increase osteoclast activity - phosphate and calcium release
Increase calcium reabsorption from kidney
increased hydroxylation of vit D
168
At what sites does hydroxylation of vitamin D occur?
Liver,kidney
169
What is the definition of a TIA?
a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.
170
What are the features on pre proliferative diabetic retinopathy?
microaneurysm
blot haemorrhages
cotton wool spots (areas of retinal infarction)
171
What are features of proliferative diabetic retinopathy?
retinal neovascularisation
maculopathy
172
What is the treatment of proliferative retinopathy?
panretinal laser photocoagulation
Intravitreal VEGF inhibitors
173
Give some causes of bilateral hilar lymphadenopathy?
Sarcoidosis
TB
Malignancy
174
What are two skin manifestations of sarcoidosis?
erythema nodosum
lupus pernio
175
What is the characteristic histology finding for sarcoidosis?
non caseating granuloma
176
What investigations can be done for sarcoidosis?
tissue biopsy
CXR
Blood tests - hypercalcaemia, ACE raised, ESR raised, deranged LFTs
177
What are some granulomatous diseases?
Sarcoidosis, TB, Crohn's, granulomatosis with polyangiitis,
178
What are the investigations for TB?
sputum culture
interferon gamma assay
Sputum smear
mantoux - latent
179
What are some causes of pericarditis?
Infection - viral
MI
RA,SLE
malignancy
180
What are some causes of left ventricular failure?
IHD
dilated cardiomyopathy
hypertrophic cardiomyopathy
Aortic valve disease
181
What score system would you use to rule out a PE?
PERC
182
What is the cause of a rust coloured sputum pneumonia?
strep pneumonia
183
What are the features of acute liver failure?
hepatic encephalopathy
jaundice
coagulopathy
N+V
Weight loss
Pallor
Ascites
Splenomegaly
Fever
abdominal pain
184
What are the complications of GORD?
adenocarcinoma
Barrets
Oesophageal stricture
185
What are some complications of meningitis?
death, hearing loss, learning disability
186
What are histological findings that are needed in a breast MDT meeting?
tumour size
lymph node involvement
Tumour grade
HER2, oestrogen positive
187
What is the screening for breast cancer?
50-71
every 3 years
188
What is the imaging screening for BRCA1 positive?
MRI annually
189
What class of drug is used to treat UC?
5-ASA, aminosalicylate
190
What blood samples do you need to collect in infective endocarditis?
>3 blood samples
>6hours apart
take samples from different sites
191
What is the treatment for wet macular degeneration?
anti-VEGF
Prevents neovascularisation
192
What are some risk factors of ARMD?
FHX
Smoking
Cardiovascular disease
obesity
193
What is the pathophysiology of Parkinson's?
progressive degeneration of dopaminergic neurons in substantia nigra
194
What treatments can be used in Parkinson's?
Selegiline - MAO-B
entacapone - COMT
ropinirole - Dopamine agonist
195
What are some signs and symptoms of SLE?
fatigue
malar rash
fever
hair loss
Raynaud's
depression
196
What are the antibodies found in SLE?
anti double stranded dna
anti smith
rule out!! - ANA
197
What are some complications of SLE?
pericarditis
HTN
Anaemia
Pulmonary fibrosis
198
What is in Virchow's triad?
Blood stasis
endometrial injury
hypercoagulable state
199
Name 3 drugs along with their doses that should be given in an asthma attack?
oxygen 15L/minute
5mg salbutamol
40mg prednisolone
200
What abnormalities would you see on U+Es in someone with anorexia?
hypokalaemia due to vomiting
hyponatraemia due to excess water intake
hyperkalaemia due to dehydration
201
What is the medico-legal term for making decisions for people under 16?
Gillick competence
202
What are some risk factors for refeeding syndrome?
Low BMI <16
rapid weight loss
dehydration
use of diet pills
203
Give a brief overview of refeeding syndrome?
- caused by a sudden introduction of glucose after prolonged starvation
- when blood glucose is low, cell metabolism slows down, when glucose is introduced it causes insulin to be released, pushing glucose into cells
- This causes a demand for phosphate, potassium and magnesium
-Leading to hypophosphataemia, hypokalameia, hypomagnasaemia
204
What is the mechanism of bisphosphonates?
reduce the activity of osteoclasts and inhibits bone resorption
205
What T score would be classed as osteopenia?
-1.0 - -2.5
206
What is the surgery performed for rectal carcinoma?
anterior resection
207
What are some causes of megaloblastic and non megaloblastic MCV?
Megaloblastic
folate deficiency
B12 deficiency
Non megaloblastic
hypothyroidism
liver disease
alcohol excess
208
What are 3 causes of B12 deficiency?
veganism
coeliac disease
crohns
pernicious anaemia
209
Why do you have to replace B12 before folate?
due to risk of subacute degeneration of the spinal cord
210
What is the definition of infertility?
the failure to achieve a pregnancy after 12months or more of regular unprotected sexual intercourse
211
What is the difference between primary and secondary infertility?
primary infertility relates to couples who have never concieved
secondary infertility refers to couples who have concieved at least once before
212
How does ovarian hyperstimulation syndrome cause SOB?
hyperstimulated ovaries release vasoactive mediators
increased capillary permeability causes fluid shift from intravascular compartment to third space compartments
SOB due to pleural effusion
213
What are 3 main structures in the inner ear?
semi-circular canals
vestibule
cochlea
214
What is the pathophysiology of menieres?
excessive buildup of endolymph in the labryrinth of the inner ear
increasing the pressure and disrupting the sensory signals
215
What are the physiological abnormalities of anorexia?
low FSH,LH, oestrogen
hypokalameia
imapired glucose
raised cortisol and growth hormonehigh cholesterol
216
What is the management of non muscle invasive bladder cancer?
TURBT
Mitomycin C
BCG immunotherapy
high risk - radical cystectomy considered
217
What is the management of muscle invasive bladder cancer?
radical cystectomy
or radio and chemo
218
what are some side effects of typical antipsychotics?
haloperidol, chlorpromazine
Antimuscarinic Sx - dry mouth, urinary retension
EPSE
impaired glucose tolerance
prolonged QT
219
What are some side effects of atypical antipsychotics?
clozapine, olanzapine, risperidone
weight gain
hyperprolactinaemia
increased risk of VTE
220
What is a hernia?
The abnormal protrusion of a structure through a defect or weakness in the wall of the cavity that normally contains it.
221
What are two extra renal manifestations of APKD?
mitral valve prolapse
berry aneurysm
222
Why does apkd cause renal stones?
renal cysts block collecting ducts leading to urinary stasis and stone formation
223
What are some symptoms of DKA?
polyuria
polydipsia
abdo pain
nausea
headache
kussmaul breathing
pear drop breath
224
What are some symptoms of Parkinson's - 5 ?
bradykinesia
shuffling gait
intention tremor
cog wheel rigidity
postural instability
hallucinations
depression
225
What is a bence jones protein?
light chains in urine
226
What is the pathological process resulting in myeloma?
clonal proliferation of plasma cells and paraprotein production
227
What are some complications of pneumonia?
pleural effusion
sepsis
228
What is the treatment of severe pneumonia?
clarithromycin and co amoxiclav
229
What are pre-renal causes of AKI?
renal artery stenosis
hypovolaemia
230
What are some complications of AKI?
pulmonary oedema
haemorrhage
231
What are 2 indications for dialysis in a patient with AKI?
metabolic acidosis
persistent hyperkalaemia
uraemic encephalopathy
232
What are some risk factors for pseudogout?
hemochromatosis
OA
increasing age
233
What is the investigation of choice for pseudogout?
polarised light microscopy of synovial fluid
234
In diabetes insipidus is the urine and plasma osmalality high or low?
urine - low
plasma -high
235
What are some triggers of sickle cell crises?
cold air
hypoxia
dehydration
236
What are some prehepatic causes of jaundice?
Sickle cell disease
G6PD deficiency
237
What are some risk factors for hernias?
heavy lifting
obesity
prematurity
male
238
What are some complications of haemorrhoids?
strictures
ulceration
239
What are some causes of macroscopic haematuria?
UTI
nephritis
Schisto
renal stones
240
What are some causes of raised PSA?
prostate cancer
UTI
Prostatitis
DRE
Urine retention
241
What are the 4 rotator cuff muscles?
supraspinatus - abducts
infraspinatus
teres minor -adducts
subscapularis - adducts
242
What are some causes of unilateral facial paralysis?
stroke
bells palsy
Ramsay hunt syndrome
MS
GBS
acoustic neuroma
243
What investigations do you order in a trauma?
AP Xray of chest, pelvis
CT head and then CT abdomen
244
What are the causes of acute limb threatening ischaemia?
thrombus - rupture of atherosclerotic plaque
embolus - secondary to AF
245
What is the management of acute limb threatening ischaemia?
initial - heparin, iv opioids
Definitive - thrombolysis
embolectomy
bypass surgery
246
What is pemphigus vulgaris?
an autoimmune disease caused by antibodies
mucosal ulceration
nikolsky's sign - separation of skin layers when rubbed
Management - steroids
247
What is bullous pemphigoid?
autoimmune condition
no mucosal involvement
biopsy + immunofluorescent
management - steroids
248
What is seen in hypertensive retinopathy?
arteriovenous nipping
cotton wool exudates
flame and blot haemorrhages
papilloedema
249
What are some causes of cataracts?
smoking
long term steroid
trauma
DM
250
What are the sign and sx of cataract?
reduced vision
faded colour vision
halos around lights
- defect in the red reflex
251
What are some complications post cataract surgery?
retina detachment
endopthalmitis
posterior capsule opacification
252
How does duloxetine work?
SNRI - inhibits the reuptake of noradrenaline at the synapse meaning there is increased NA available and this increases the tone of the internal urethral sphincter
253
What are some risk factors of SUFE?
Obesity
local trauma
chemotherapy
254
What is talar shift?
the gap between tibia, fibula and talas is shifted
255
How does a hip fracture present?
shortened and externally rotated
pain
256
What is limited in adhesive capsulitis?
external rotation
257
What are some treatments for diabetic retinopathy?
pan retinal laser photocoagulation
intravitreal VEGF inhibitors
258
What is tumour lysis syndrome?
occurs from breakdown of the tumour cells and the subsequent release of chemicals from the cell - hyperkalaemia, hyperphosphate and low calcium and high urea
Lab results + one of:
- increased serum creatinine
- cardiac arrhythmia
-seizure
259
What medication can you give to prevent tumour lysis syndrome?
allopurinol
rasburicase
260
What is the most common cause of neutropenic sepsis?
staph epidermis
261
What is the treatment of neutropenic sepsis?
tazobactam and piperacillin
262
What are the signs of aortic regurg?
Quincke's - nailbed pulsing
De Musset - head bobbing
collapsing pulse
wide pulse pressure
263
When would you omit metformin before surgery?
Taken twice a day = continue
3 times a day = omit lunchtime
264
What diabetes meds do you omit for surgery?
flozin - omit day of
metformin - 3 times daily - omit lunch time
gliclazide - morning and one dose = omit - morning and 3 dose just omit morning one, afternoon = omit all doses that day
265
When do you get cervical smears?
Every 5 years
25-64
266
What is the Philadelphia mutation ?
translocation of 9 and 22
267
Give some symptoms of graves disease?
exopthalmos
tremor
lid lag
pretibial myxedema
268
Give some risk factors of placenta abruption?
previous
pre-eclampsia
smoking
cocaine
269
What is part of the APGAR score?
colour
pulse
grimace
activity
respiratory effort
270
Give some causes of delirium?
infection
insomnia
hypoglycaemia
opioids
environmental change
271
What are 3 non pharmacological ways to treat delirium?
reduce polypharmacy
promote good sleep
have a clock in view
encourage family to visit
maintain environment
272
What laxative do you avoid in opioid induced constiptaion?
bulk forming
273
What laxatives do you give in opioid induced constipation?
stimulant and osmotic
274
What are legally binding documents for DNACR?
Advanced decision to refuse treatment
275
What is a document that is used for thought on CPR and end of life?
Respect form
276
Give 2 storage SX?
urgency, frequency
277
Give two voiding sx?
hesitancy, weak stream
278
What zone of the prostate is affected in prostate cancer?
peripheral
279
What is the gleason score?
prostate cancer
- the two most common tumour patterns across all samples are graded based on their differentiation
- the sum of the two grades is the gleason score
280
What is the first line screening test for downs syndrome?
combined test
281
What tests can be done to detect downs syndrome?
chorionic villious sampling, amniocentesis, non invasive pre-natal testing
282
What does tolvapatan do ?
reduce the growth rate of cysts
283
How does CKD cause anaemia?
Anaemia of chronic disease
decreased EPO production
EPO is needed to stimulate RBC production
284
What is the Wallace rule of 9s ?
head+ neck = 9
Arm = 9
anterior of leg =9
posterior part of leg= 9
anterior abdomen =9
anterior chest=9
285
What is the parkland formula?
4ml x body weight x total body surface area
286
Give 2 symptoms of smoke inhalation?
SOB
Wheeze
Cough
Headache
cyanosis
287
What affect does carbon monoxide have on oxyhaemoglobin dissociation curve ?
Carbon monoxide has a greater affinity for haemoglobin than oxygen
Causing the curve to shift to the left
Left shift → increased affinity of haemoglobin for oxygen / so haemoglobin holds onto
oxygen more tightly
Reducing the release of oxygen to tissues, causing hypoxia and the associated
symptoms
288
What is the difference between indirect and direct hernia?
direct inguinal = the bowel enters the inguinal canal directly through a weakness in the posterior wall of the canal
Indirect = the bowel enters the inguinal canal via the deep inguinal ring
289
What type of hernia is seen in infants and why?
indirect
occurs because a patent processes vaginalis
290
What nerve can be damaged if there is reduced sensation on his upper anteromedial thigh?
ilioinguinal
291
What is the pathophysiology of wet and dry macular degeneration?
Wet ARMD - wet is neovascular/ new blood vessels are formed, blood vessels leak and cause oedema and faster vision loss than dry
Dry - accumulation of extracellular deposits between retinal pigment epithelium and bruchs membrane
292
Name 3 skin lesions that suggest chronic plaque psoriasis?
extensor surfaces
raised
red
itch
auspitz sign
293
When would you refer to derm for psoriasis?
significant impact on physical, social wellbeing
pustular psoriasis
extensive involvement
294
What is oligoarthritic vs polyarthritis?
oligo - <4 joints involved
poly ->4 joints involved
295
What is section 4?
allows emergency detainment for the purpose of assessment for 72 hours
can be made by AMHP and doctor
296
What 2 serological markers are used initially in Hep B screening?
HBsAG
anti -HBc
297
Which marker gives a direct count of viral load for hep B?
HBV DNA
298
What is injected in the Hep B vaccine?
HBsAG
299
Which hepatitis B serological marker indicates immunity post vaccination?
Anti-HBs
300
What crystals do you see in gout and pseudogout?
monosodium urate - gout
calcium pyrophosphate - pseudogout
301
What drug class is allopurinol?
xanthine oxidase inhibitor
302
If allopurinol is ineffective to prevent gout what can be used?
Febuxostat
303
what is the drug and dose given in peri-arrest brady?
atropine 500mgc then repeat dose
then transvenous pacing
304
What is the duration of a normal QRS?
under 0.12s
305
What 2 reflexes do you do in a death verification?
pupils
corneal
306
What is scurvy?
vitamin C deficiency
easy bruising
Poor wound healing
Gingivitis with bleeding and receding gums
Sjogren's syndrome
307
What is the action of heparin?
activates antithrombin 3
forms a complex that inhibits factor Xa
308
What abx cause ototoxicity?
aminoglycosides - gentamicin
309
What is the parkland formula?
4x body weight x percentage burn
first 8 hours give 50% of fluids
310
What is seen on an ECG for PE?
sinus tachycardia
S1 Q3 T3
RBBB
311
What are some complications of jaundice?
HCC
Renal failure
312
What is jaundice?
bilirubin 2.5-3mg/dl
313
What is in a eGFR result?
Age
Gender
Ethnicity
creatinine
314
What is seen on an ECG for hypercalcaemia?
shortened QT
J waves
315
What is the management of hypercalcaemia?
Rehydration with normal saline
Bisphosphonates
316
What is the gene mutation in CML?
BCR/ABL
317
What are some features of GCA?
jaw claudication
vision changes
scalp tenderness
pyrexia
raised ESR
318
What are cyanotic heart diseases?
ToF
Transposition of GA
319
What is seen in the WBC for EBV?
atypical lymphocytes
320
How long can you not play contact sports for after EBV?
4 weeks
321
How long do you have off driving after a TIA or stroke?
1 month
322
How long off driving do you have following ACS?
4 weeks
1 week if successful angioplasty
323
Give me some RF for endometrial Ca?
nulliparity
early menarche
late menopause
obesity
DM
PCOS
324
What are some RF for ovarian cancer?
early menarche
late menopause
nulliparity
BRCA1
325
What is seen in limited Systemic sclerosis?
Calcinosis, raynauds, oesophageal dysmotility, sclerodactyly, telangiectasia
anti-centromere
face and distal limbs
326
What is seen in diffuse systemic sclerosis?
trunk and proximal limbs
ILD
PAH
catopril used
Scl - 70 antibodies
327
What are some RF for pre eclampsia?
HTN
First preg
Over 40
BMI over 35
DM
Autoimmune disease
75-150mg aspirin from 12 weeks to birth
328
When should women take folic acid in pregnancy ?
all women should take 400mcg of folic acid until the 12th week of pregnancy
women at higher risk of conceiving a child with a NTD should take 5mg of folic acid from before conception until the 12th week of pregnancy
329
What are the adverse effects of vincristine ?
peripheral neuropathy
330
What are the adverse effects of cisplatin?
nephrotoxicity, peripheral neuropathy
331
What is an adverse effect of hydroxyurea?
myelosuppression
332
What are the adverse effects of cyclophosphamide?
haemorrhagic cystitis
TCC
333
What is the management of Hodgkin's lymphoma?
ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine)
BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone): alternative regime with better remission rates but higher toxicity
334
What is the tx of non hodgkins lymphoma?
rituximab - screened for hep B before
CHOP chemo meds
335
What causes a pale stool and dark urine?
Increased bilirubin leaks into the bloodstream causing the urine to become darker
Little or no bile reaches the intestines
Without bile pigments (like stercobilin), stool loses its normal brown colour
336
What is rhabdomyolysis?
AKI
elevated creatine kinase (CK)
myoglobinuria: dark or reddish-brown colour
hypocalcaemia (myoglobin binds calcium)
elevated phosphate (released from myocytes)
hyperkalaemia (may develop before renal failure)
metabolic acidosis
337
What are some initial steps in the management of hypoglycaemia?
oral glucose, IM gucagon or IV glucose
U+E bloods
collateral HX
offer food/drink
IV fluids
338
What can cause hypoglycaemia?
excess insulin
intercurrent illness
reduced oral intake
Addisons
Alcohol
insulinoma
339
How can you investigate hypoglycaemia?
serum insulin and peptide levels
340
What would a high insulin and high C-peptide level suggest?
endogenous insulin production
- insulinoma, sulfonylurea abuse
341
What would high insulin and low C-peptide level suggest?
exogenous insulin
- insulin overdose
- factitious disorder
342
What would a low insulin nd low C-peptide level suggest?
non insulin related cause
- alcohol induced
sepsis
adrenal insufficiency
343
What is HHS?
hyperglycaemia - increased serum osmolality - osmotic diuresis - severe volume depletion
MArked hyperglycaemia
raised serum osmalality
no ketones, lactic acuid
344
What are the precipitating factors of HHS?
intercurrent illness
dementia
sedative drugs
345
What is the management of HHS?
fluid replacement
IV 0.9% saline
VTE prophylaxis
only insulin if glucose levels don't fall
346
what are the features of trigeminal neuralgia?
unilateral pain
evoked by touch, cold wind
347
What is the Ix for trigeminal neuralgia?
MRI
348
What are some features of CoA?
infancy - heart failure
adult- hypertension
radio-femoral delay
mid systolic , maximal over the back
assocx with turners, bicuspid aortic valve
349
How is CoA investigated?
Echo
CT aorta
350
What is the TX of CoA?
open surgery
balloon angioplasty and stent insertion
351
If a DoL needs to be put in place, state 2 requirements that need to be followed to ensure it is valid
avoid if possible
in patients best interest
only for immediate intervention
short a period as possible
alternatives considered
352
Give two treatments for proximal artery occlusion?
angioplasty
stent
353
How would a graft occluded leg look?
cool, pale foot
absent pulse in graft
354
What does compartment syndrome present like?
swollen, tense and tender calf and pink foot
pain on dorsiflexion
355
What are areas that are good to discuss during a diagnosis of cancer?
signpost to spiritual care
alternative therapies
management of pain
mental health support
end of life care
Do not discuss euthanasia
356
Give 3 examples of simple measures to reduce the rate of painful sickle cell crises?
avoid dehydration
avoid alcohol
avoid cold
avoid smoking
357
What would you see in a patient with ascites?
shifting dullness
fluid thrill
358
What are 3 causes of confusion in a patient with liver cirrhosis?
hepatic encephalopathy
GI bleed
Sepsis
Alcohol withdrawal
359
What are the different treatments for hyponatraemia?
hypovolemic - normal saline
euvolemic(SIADH) or hypervolemic - fluid restrict, demeclocycline, Vaptans
360
What is the sickle cell crises management?
analgesia
fluids
oxygen
blood transfusion
exchange transfusion
361
What are the types of sickle cell crises?
thrombotic crises
acute chest syndrome
aplastic crises
sequestrian crises
362
What is thrombotic crises?
precipitated by infection, dehydration, deoxygentaion
infarcts occur in various organs
363
How does acute chest syndrome present?
Vaso-occlusion within pulmonary microvasculature
Dyspnoea, chest pain, hypoxia
364
What is aplastic crises?
caused by infection with parovirus
sudden fall in haemoglobin and in reticulocyte count due to bone marrow suppression
365
What is sequestrian crises ?
sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia
Increased reticulocyte count
366
What is deprivation of liberty safeguards?
legal framework designed to protect people who lack the mental capacity to make decisions about their care and being deprived of their liberty
367
What is the purpose of DoLs?
protect vulnerable people from unlawful detention
prevent abuse
368
What is familial hypercholesterolaemia?
AD
Total cholesterol level greater than 7.5 and/or
a personal or family history of premature coronary heart disease
369
What is a complication of carotid endarterectomy?
primary haemorrhage causing airway obstruction
370
What are some RF for obstructive sleep apnoea?
obesity
macroglossia
marfans syndrome
371
What are the assessments and study of OSA?
epworth sleepiness scale
multiple sleep latency test
polysomnography
372
What is the management of OSA?
weight loss
CPAP
373
What drug class is imatinib?
tyrosine kinase inhibitor
374
How do ascending and descending aorta dissection present differently?
Forward (ascending) - unequal arm pulses and BP
stroke, renal failure - chest pain
Backward (descending) -aortic incompetence, regurgitation
MI - inferior pattern
375
What are some features of ankylosing spondylitis?
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
376
What is FVC?
Breathe out as much as you can after max inhalation
377
What is FEV1?
The amount you breathe out in 1 second
378
What spirometry pattern do you see in obstructive lung disease?
FEV1 reduced
FVC reduced or normal
<0.7
379
What spirometry do you see in restrictive lung disease ?
FEV1 reduced
FVC significantly reduced
>0.7
380
What are some causes of obstructive and restrictive lung disease?
obstructive - asthma, COPD, bronchiectasis
Restrictive - pulmonary fibrosis, asbestosis, sarcoidosis, ankylosing spondylitis
381
How can osteomyelitis present on an XRAY?
regional osteopenia
periosteal changes
focal cortical loss
382
When do you stop or increase a statin?
Increase if LDLs don't drop by 40%
Stop if CK raised 5x ULN consistently for many readings
Stop if AST or ALT are raised 3xULN
383
When do you stop ACE-i?
stop i if K+ goes >5.5
Stop if creatinine >30% from their baseline
384
When do you stop metformin?
eGFR<30
385
When do you stop heparin?
platelets drop by 30%
386
What diabetes meds do you give in CKD?
egFR >30 = metformin and SGLT2i
20-30 = DPP4 and flozin
<20 = DPP4 or pioglitazone
387
What are some features of CF?
meconium ileus
recurrent chest infections
malabsorption
short
nasal polyps
bronchiectasis
388
What are the fat soluble vitamins?
ADEK
389
What does a full thickness burn look like?
white/brown
no blisters
no pain
390
What does a superficial burn look like?
red , painful , blisters
391
How does moderate asthma present?
RR <25
speech normal
PEFR 50-75
<110bpm
392
How does severe asthma present?
PEFR 33-50%
cant complete sentences
RR>25
>110bpm
393
How does life threatening asthma present?
PEFR<33%
<92% sats
silent chest
cyanosis
exhaustion, confusion
394
What are the investigations for cushings?
Dexamethasone test
25hr urinary cortisol
MRI pituitary
395
What is the management of a tension pneumothorax
needle thoracostomy is most commonly performed in the 5th intercostal space at the mid-axillary line on the affected side using a large-bore cannula
396
Can people fly after a pneumothorax?
NO - 2 weeks after drainage if there is no residual air
1 week post fine CXR
397
What are some causes of a widened mediastinum?
thoracic artery problem
lymphoma
tumour of thymus
398
After an STI why do you need to go back tot he GP?
Test of cure
399
How do you calculate an anion gap?
(Na+K)-(Cl+HCO)
400
What are some RF for gestational diabetes?
previous macrosomia baby
previous gestational diabetes
Relative with diabetes
401
What are some management options for acne?
a fixed combination of topical benzoyl peroxide with topical clindamycin
oral doxy
402
What are some non medical management for peptic ulcer disease?
smaller meals
health meals
avoid trigger foods
403
What are some signs of raised ICP?
papilledema
Cushing triad - hypertension, irregular breathing, bradycardia
404
What are some causes of ketosis?
alcoholic ketosis
DKA
euglycemia ketoacidosis
405
What is the investigation for aortic dissection?
CT - chest, abdo and pelvis
Transoesophageal echocardiography for unstable
406
What would you see on an XRAY for Ankylosing spondylitis?
sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
'bamboo spine' (late & uncommon)
syndesmophytes
chest x-ray: apical fibrosis
407
What are some signs of EBV?
splenomegaly
fever
lymphadenopathy
408
What are some complications of EBV?
splenic rupture
Guillain barre syndrome
Encephalitis
Meningitis
409
What position should you be in for anaphylaxis?
supine with legs raised to maximise venous return to the heart
410
What are the zones of the adrenal gland?
zona glomerulosa
zona fasciculata
Zona reticularis
Medulla
411
What are 2 Sx and sign of cushings?
Weight gain
Acne
hair growth
Sign - abdominal striae, hirtuism, moon face
412
What cells in the CNS are damaged in MS?
oligodendrocytes
413
What can a high vaginal swab test for?
bacterial vaginosis, trichomonas vaginalis, candida and Group B streptococcus
414
What is the pathophysiology of acute angle closure glaucoma?
The iris bulges forward and seals off the trabecular meshwork from the anterior
chamber
This prevents aqueous humour from draining
Increasing the ocular pressure
Which further exacerbates the angle closure, and places pressure on the optic nerve
415
What does timolol do?
reduce production of aqueous humour
416
What is the treatment of acute angle glaucoma?
laser iridotomy
417
What are the pain features of CTS?
worse at night
relieved by shaking hand
intermittent
418
What are the nerve roots of the median nerve?
C6-T1
419
What is mirizzi syndrome?
Gallstones become impacted in cystic duct
causes compression
resulting in jaundice
420
What is coning?
(Raised intracranial pressure causes)
Herniation of the cerebellar tonsils through the foramen magnum
Leads to compression to the brainstem
(and respiratory arrest
421
When does screening for gestational diabetes take place?
24-28 weeks
422
What are 3 narrow points of the urinary tract?
vesicoureteric junction
crossing the pelvic brim
pelviureteric junction
423
What is the triad of pyelonephritis?
loin pain
nausea
fever
424
What are some signs of spontaneous pneumothorax?
hyper-resonant lung percussion
reduced breath sounds
reduced lung expansion
tachypnoea
tachycardia
425
What are some signs of tension pneumothorax?
respiratory distress
tracheal deviation away from the side of the pneumothorax
hypotension
426
What are the borders in the triangle of safety?
Pectoralis major, Latissimus dorsi, 5th intercostal space
427
What are the types of neonatal jaundice?
physiological - breastfeeding
pathological - ABO, Torch
Prolonged - biliary atresia
428
What are barlow and ortolani tests?
Barlow test: attempts to dislocate an articulated femoral head
Ortolani test: attempts to relocate a dislocated femoral head
429
What are 3 causes of primary and secondary amenorrhoea?
primary - turners, anorexia, AIS
secondary - ashermans, sheehans, premature ovarian failure
430
What is the impact of PCOS on oestrogen and progesterone levels and how
this relates to an increased risk of endometrial cancer
Women with PCOS ovulate infrequently so do not produce enough progesterone but they continue to produce oestrogen.
Irregular menstruation means that the endometrial lining does not shed regularly.
This results in endometrial hyperplasia and increases the risk of endometrial cancer.
431
How long on finasteride does it take to see results?
6 months
432
What is the COPD standby medication?
prednisolone and an antibiotic
433
When should people with CKD be started on an ACE-i?
ACR>30 mg/mmol
434
What are the different stages of COPD?
1- mild = FEV1>80%
2- moderate = 50-79%
3 - severe = 30-49%
4 - very severe = <30%
435
When can someone be discharged after an acute asthma attack?
stable on their discharge medication for 12-24 hours
inhaler technique checked and recorded
PEF >75% of best or predicted
436
What is the HEP B serology for acute and chronic infection?
HbSAg and IgM anti-HBc = acute
IgG antiHBc = chronic
437
Where does brocas aphasia arise from?
inferior frontal gyrus
438
Where does wernickes aphasia arise from?
superior temporal gyrus
439
What would you see on examination on someone with testicular torsion?
swollen, tender testicle retracted upwards
cremasteric reflex is lost
elevation of testes doe snot ease the pain
440
What would you see on examination of someone with epididymis-orchitis?
Hot, pain swelling, prehn sign
441
What is the treatment of quinsy?
IV fluids, analgesia
IV penicillin and metronidazole
442
What are some indications for considering ICU admission for a patient with pneumonia?
Severe pneumonia curb 3-5
hypotension
LOC
drowsiness
PaO2 <8
443
What are some signs and symptoms of hypokalaemia?
muscle weakness
hypotonia
fatigue
palpitations
444
Some signs of hyperkalaemia?
weakness
palpitations
N+V
445
Signs of hypocalcaemia?
trousseau
chvovstek
lethargy
seizures
446
How do you convert codeine to morphine?
divide by 10
447
Explain the 'double effect doctrine
An action that has both a good effect and a harmful side effect can be acceptable if the intention is to achieve the good effect, not the harm.
448
What 3 drug classes can you not have at term and why?
NSAIDs = premature close of ductus arteriosus
ACE-i = low amniotic fluid
tetracyclines = affect bone growth
449
How do you calculate osmolality?
Calculated Osmolality (mOsm/kg) = (2 × [Sodium]) + ( [Glucose] / 18) + ( [BUN] / 2.8) or just urea??
450
What are the symptoms of aortic stenosis?
narrow pulse pressure
slow rising pulse
S4
LVH
451
452
When do you give a bioprosthetic valve?
>65 for aortic valves and >70 for mitral valves
453
How does lithium cause diabetes insipidus?
lithium desensitises the kidneys ability to respond to ADH in the collecting ducts
454
What are red flags in a consultation suggesting human trafficking?
timid/tense
not registered with services
accompanied by controlling person
frequent movement
inconsistent history
455
What are some risk factors for ectopic pregnancy?
Endometriosis
IVF
IUD
previous gynae surgery
PID
456
What scale can be used to assess OCD?
Y-BOCs scale
457
What are 5 symptoms of schizophrenia?
thought disorders
auditory hallucinations
delusional perception
neologism
passivity phenomena
catatonia
458
What is the most common cause of primary hyperparathyroidism?
solitary adenoma
459
What are some examples of health inequalities that could impact vaccine intake?
Language barrier
lack of education
homelessness
460
What are some symptoms of anterior uveitis?
small/irregular pupil
blurred vision
lacrimation
hypopyon
photophobia
461
What is a primary spontaneous and secondary spontaneous pneumothorax?
Primary = Bullae rupture in patients without underlying lung disease
Secondary= Occurs in patients with underlying lung disease
462
What is a traumatic pneumothorax?
Due to penetrating or blunt chest trauma
463
What is a difference between chlamydia and gonorrhoea?
CT = asx
CT= clear/white dc whereas G more yellow/green
464
What are some complications of chlamydia?
PID
Infertility
Reactive arthritis
epididymitis
465
How does insulin cause hypokalaemia?
Insulin stimulates the Na⁺/K⁺-ATPase pump in cell membranes
466
What MND only affects LMN and what only affects UMN?
UMN - primary lateral sclerosis
LMN - progressive muscular atrophy
467
What can prolong life in MND?
riluzole
PEG
NIV
468
How does MND present?
fasciculations
LMN and UMN
limb weakness
469
Give 3 complications of otitis media?
mastoiditis
meningitis
brain abscess
470
What are 3 differences between squamous cell and melanoma?
SCC = arise from squamous cells, red scaly lump, slower growing
Melanoma = arise from melanocytes , dark, irregular lesion, dangerous mets
471
What is gastroparesis?
chronic high blood sugar damages the vagus nerve leading to slow or uncoordinated gastric emptying
472
What is the lights criteria?
if the protein level is between 25-35 g/L, Light's criteria should be applied. An exudate is likely if at least one of the following criteria are met:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
Final year
flashcards
Decks in class (4)
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