#passmed 2022 > yhhhh > Flashcards

yhhhh Flashcards

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1
Q

What is Beta-thalassaemia major caused by? (2 things)

A
  1. Absence of Beta chains
  2. On Chromosome 11
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2
Q

What are the CF of Beta-thalassaemia major? (2 things)

What age does it present at?

A
  1. Failure to thrive
  2. Hepatosplenomegaly

Presents in 1st year of life

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3
Q

What will the bloods of Beta-thalassaemia major say? (3 things)

A
  1. Microcytic anaemia
  2. Raised: HbA2 + HbF
  3. Absent: HbA
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4
Q

How do you manage Beta-thalassaemia major?

A

Blood transfusion

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5
Q

What is a complication of repeated transfusions in Beta-thalassaemia major management?

How do you overcome this?

A

Iron overload

Overcome by: Iron chelation agent = Deferiprone

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6
Q

What is Wilson’s disease?

A
  1. Rare inherited disorder
  2. Copper accumulates in liver + brain
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7
Q

What is the treatment of Wilson’s Disease?

A

Copper chelator: Trientine

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8
Q

What is Azathioprine?

What conditions is it used to treat? (3 things)

A

Immunosuppresant

Treats:

  1. RA
  2. UC
  3. Crohn’s
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9
Q

What are the side fx of Azathioprine? (2 things)

A
  1. Pancreatitis
  2. Bone marrow depression
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10
Q

What are the side fx of Amiodarone? (3 things)

A
  1. Thyroid dysfunction
  2. Pulmonary fibrosis
  3. Hepatic fibrosis
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11
Q

What are the ECG signs of HypERkalaemia? (3 things)

A
  1. Small / absent P waves
  2. Wide QRS complex
  3. Tall tented T wave
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12
Q

What are the ECG signs of HypOkalaemia? (4 things)

A
  1. Prolonged PR interval
  2. Long QT interval
  3. ST depression
  4. Small / inverted T wave

some nigga on passmed comments:

in HYPOkalaemia …
U have not Pot and no T but a long PR and a long QT

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13
Q

What nerve is clarted when pt can’t keep a piece of paper from slipping from between THUMB and INDEX?

What will they do to compensate for this nerve clartation? What is this called?

A

Ulnar nerve (deep branch)

Extra flexing da thumb: Froment’s sign

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14
Q

What is the Cavernous sinus?

A

Paired venous sinus in Sphenoid bone

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15
Q

Where does the Cavernous sinus run FROM and TO?

A

From: Superior Orbital Fissure (SOF)

To: Petrous Temporal Bone

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16
Q

What is Medial and Lateral to the Cavernous sinus? (2+1 things)

A

Medial:

  1. Pituitary Fossa
  2. Sphenoid sinus

Lateral: Temporal lobe

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17
Q

What are the components of the Lateral wall of the Cavernous sinus from top to bottom? (4 things)

A
  1. Oculmotor nerve (3)
  2. Trochlear nerve (4)
  3. Ophthalmic nerve (V1)
  4. Maxillary nerve (V2)
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18
Q

What are the contents of the Cavernous Sinus?

A
  1. Internal carotid artery
  2. Abducens nerve (6)
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19
Q

What is the blood supply of the Cavernous Sinus? (2 things)

A
  1. Ophthalmic vein
  2. Superficial cortical veins
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20
Q

Where does the Cavernous Sinus drain into?

Via what? (2 things)

A

IJV

via: Sup + Inf Petrosal sinuses

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21
Q

What are the 4 stages of sleep in order and their associated EEG waves?

A

N1, N2, N3, REM

Theta, Sleep spindles, Delta, Beta (The Sleep Doctor’s Brain)

* N = non-RM stage

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22
Q

If you have a spinal injury, what is the loss of pain distribution?

What phenomena explains this?

A

Loss of pain sensation on OPPOSITE side from anywhere BELOW injury site

Spinothalamic tract DECUSATES in spinal cord 1 level above where stimulus enters, and da tract travels UPWARDS

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23
Q

What is da most common cause of sudden cardiac death in the yutesdem?

A

Hypertrophic Obstructive CardioMyopathy (HOCM)

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24
Q

What is the inheritence pattern of Hypertrophic Obstructive CardioMyopathy (HOCM)?

What is it’s prevalence?

A

Autosomal dominant

1 in 500

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25
What is the pathophysiology of Hypertrophic Obstructive CardioMyopathy (HOCM)? (3 steps)
1. LV Hypertrophy 2. Decreased compliance 3. Decreased CO
26
What are the CF of Hypertrophic Obstructive CardioMyopathy (HOCM)? (5 things)
1. Often asymptomatic 2. Sudden death (bc ventricular arrythmias) 3. Syncope (usually after exercise) 4. SOB (worse on exertion) 5. Angina
27
What tract would get clarted in an ANTERIOR spinal cord lesion? What CF would you get?
Spinothalamic tract clarted Loss of Pain + Temp + Crude Touch BELOW lesion
28
What tract would get clarted in an CENTRAL spinal cord lesion? (2 things) What CF would you get? (2 things)
1. Spinothalamic tracts 2. Cervical cord 1. Loss of Pain + Temp + Crude Touch CONTRALAT BELOW lesion 2. Sensory + Motor deficits (more in upper limb tho)
29
What tract would get clarted in a DORSAL spinal cord lesion? What CF would you get?
Posterior columns (aka Medial Leminiscal Pathway) Loss of Fine touch, vibration, proprioception
30
What tract would get clarted in a TRANSVERSE spinal cord lesion? What CF would you get?
All tracts clarted AKA All motor + sensory pathways clarted Bilateral sensory + motor clartation below lesion
31
What tract would get clarted in a HEMISECTION spinal cord lesion? What CF would you get? (3 things)
Whole side clarted on one half 1. IPSILAT Paralysis 2. IPSILAT Loss of Vibration & Propriecpetion 3. CONTRALAT Loss of Pain & Temp (bc decusating spinothalamic)
32
What vit deficiency can cause a spinal cord lesion?
B12 deficiency
33
What column is clarted first in vit 12 deficiency?
Dorsal columns Then lateral columns
34
What channel does Digoxin inhibit?
Na+/K+ ATPase
35
What is Digoxin used to treat? (3 things)
1. AF 2. Atrial Flutter 3. HF
36
How does Digoxin work when it inhibits da channel dat it inhibits? (5 steps)
1. Inhibits Na+/K+ ATPase 2. Increases IC Na 3. Ca Influx in heart 4. Increased contractility 5. Increased CO
37
Apart from the Na+/K+ ATPase channel, what else does Digoxin inhibit?
AV Node (has vagomimetic fx on AV Node)
38
What are the vit K dependant clotting factors? Which is first to drop in concentration when you have low vit K? (aka in Coeliac disease --\> vit K malabsorption)
2, 7, 9, 10 First to drop: 7 (ronaldo)
39
What are Type 1, 2, 3, 4 Hypersensitivity reactions?
Anaphylactic Cell Bound Immune Complex Delayed hypersensitivity (ACID)
40
What is the mechanism of a Type 1 Hypersensitivity (Anaphylactic) reaction? What is an example?
Antigen reacts w IgE bound to Mast Cells EE is top (1st) broadband lol, MASTer is number 1 e.g. Anaphylaxis / Asthma / Eczema / Hayfever
41
What is the mechanism of a Type 2 Hypersensitivity (Cell bound) reaction? What is an example?
IgM / IgG binds to antigen on Cell surface MG coz i am top 2 lol e.g AI Haemolytic Anaemia / Pernicious Anaemia
42
What is the mechanism of a Type 3 Hypersensitivity (Immune complex) reaction? What is an example?
Free antigen + antibody (IgG, IgA) combine IgA like in GN immune complexes n dat e.g Post-Strep GN
43
What is the mechanism of a Type 4 Hypersensitivity (Delayed Hypersensitivity) reaction? What is an example?
T-cell mediated T cells are always Delayed bc dey were having Tea e.g TB
44
What artery is most likely to be damaged in a Submandibular removal surgery?
Facial Artery
45
What is Total Lung Capacity a measurement of?
Vital Capacity + Residual volume
46
What is Vital Capacity?
Max vol that can be expired after Max inspiration
47
What is the Residual volume?
Vol of air in lungs after Max Expiration
48
What happens to RBC in Sideroblastic anaemia? (2 steps)
1. RBC can't completely form Haem 2. Leads to Iron deposition forming a ring around nucleus (Ring Sideroblast)
49
What are the causes of Sideroblastic anaemia? (3 things)
1. TB meds: Isoniazid 2. Lead poisoning 3. Myelodysplasia (bone marrow cancer)
50
What are the Lab results for Sideroblastic anaemia? (3 things)
1. Hypochromic Microcytic Anaemia (Pale + Low MCV) 2. High Ferritin 3. High Transferrin saturation
51
What happens to RBC in Haemolytic Anemia?
AI destruction
52
What are the Lab results for Haemolytic anaemia? (3 things)
1. Normochromic + Normocytic Anaemia (Normal Colour + MCV) Haemolysis products: 1. High bilirubin 2. High LDH
53
Who commonly has Iron deficiency anaemia?
Young menstruating women
54
What are the lab results in Iron deficiency anaemia? (3 things)
1. Microcytic anaemia (Low MCV) 2. Low Ferritin 3. Low Transferrin saturation
55
Why is Megaloblastic anaemia called that?
Bone marrow produces large, immature RBCs (Megaloblasts)
56
What causes Megaloblastic anemia? (2 things)
1. Vitamin B12 deficiency 2. Folate deficiency
57
What are the Lab results in Megaloblastic anaemia? (2 things)
1. Macrocytic anamia (High MCV) 2. Low B12 / Folate
58
What is Pernicious anaemia?
AI condition causing low Intrinsic Factor
59
Where is Intrinsic Factor made? What is it needed for?
Made in gastric Parietal cells Needed for vit B12 absorption to help w EPO prod
60
Since Pernicious anaemia is an AI condition, who is more likely to have it?
Women Esp if already have other AI condition (e.g T1DM)
61
What are the Lab findings for Pernicious anaemia? (3 things)
1. Low Vit B12 2. Raised MMA 3. Parietal cell / Intrinsic Factor antibodies
62
What is a Common Cold caused by?
Rhinovirus
63
What is a Bronchiolitis caused by?
RSV
64
What is a Flu caused by?
Influenza
65
What is a Community-acquired Pneumonia caused by?
Strep pneumonia
66
What is Croup caused by?
Parainfluenza virus
67
What Microbiology techniques should you do for the following? DNA RNA Protein
**D**NA: **S**outh blotting **R**NA: **No**rthern blotting **P**rotein: **W**ester blotting S-NO-W D-Ro-P
68
Which Abx inhibit Cell Wall synthesis? (3 things)
1. Cephalosporins 2. Glyocpeptides (e.g Vancomycin) 3. Penicillins CGP books stop from making a brain Wall to knowledge lol
69
Which Abx inhibit Protein synthesis, by acting on the 50S ribosome subunit? (2 things)
1. Macrolides 2. Clindamycin 50cent j hus came wid da MAC j hus loves linda
70
Which Abx inhibit Protein synthesis, by acting on the 30S ribosome subunit? (2 things)
1. Aminoglycosides (e.g Gentamicin) (uk dis one) 2. Tetracyclines (e.g Doxycycline) (remember greg simons gave it to dat nigga)
71
Which Abx inhibit DNA synthesis? (2 things)
Quinolones (e.g. Ciprofloxacin) Quiche n Crypto in my DNA
72
Which Abx damages DNA?
Metronidazole Metro train runs over da DNA
73
Which Abx inhibits Folic acid synthesis? (2 things)
1. Sulphonamides 2. Trimethoprim sulphur cah sulfuric ACID, n get an acidic trimothy
74
Which Abx inhibits RNA synthesis?
Rifampicin R n R
75
What does the Musculocutaneous nerve innervate? (3 things)
1. Biceps brachii 2. Coracobrachialis 3. Brachialis
76
What is Troponin?
Compex of 3 proteins involved in Skeletal + Cardiac muscle contraction
77
What do the 3 proteins of Troponin bind to?
Troponin C: Calcium ions Troponin T: Tropomyosin --\> Troponin-Tropomyosin complex Troponin I: ActIn --\> Holds Troponin-Tropomyosin complex in place
78
Which cells in the Duodenum release CCK?
I cells
79
What does CCK do? (4 things)
1. Gallbladder: Contraction 2. Pancreas: Stimulates Exocrine Pancreas 3. Stomach: Delays gastric emptying (relaxes stomach) 4. Satiety: Induces satiety (vagal stimulation) GPSS
80
What medication can you give to reduce inflamm in RA? What is its MOA?
Rituxi**mab** Anti-CD20 Monoclonal Antibody -mab = **M**onoclonal **A**nti**B**ody
81
Where is Bilirubin turned from Unconjugated to Conjugated?
Liver
82
What arrythmia is Atrial Flutter a subtype of?
SVT
83
What is a risk factor for Atrial Flutter?
Valvular HD
84
How is Atrial Flutter treated?
Like AF: * Anticoag + Amiodarone * Beta blocker * Calcium channel blocker * Digoxin * Electrocardioversion ABCDE
85
How would a LBBB present in a ECG?
W pattern in V1 M pattern in V6
86
What would a LBBB lead to?
Delayed contraction of L ventricle
87
What will you see in Colonoscopy if there is severe mucosal ulceration in UC?
Pseudopolyps
88
What is the drainage of the Ovarian vessels + Uterine fundus? What is the significance of this?
Para-aortic lymph nodes Endometrial cancer in uterine fundus will spread to these lymph nodes
89
What is the drainage of the Uterus body?
External iliac lymph nodes
90
What is the drainage of the Cervix? (3 things)
1. External + Internal Iliac nodes 2. Presacral nodes
91
What stimulates satiety? What stimulates hunger?
Leptin Ghrelin
92
What is Pramipexole and what is it used for?
Dopamine agonist, used in Parkinsons to reduce L Dopa dose
93
What is a side fx of Pramipexole?
Addictive behaviours (gambling / hypersexuality)
94
What is the most important drug to give in Anaphylaxis?
IM Adrenaline
95
What are the CF of Clostridium difficile? (2 things)
1. Abd pain 2. Diarrhoea
96
What causes Clostridium difficile?
Clartation of normal gut flora by Abx
97
What Abx causes Clostridium difficile?
Cephalosporins (e.g Ceftriaxone)
98
Other than abx, what can also cause Clostridium difficile?
PPI
99
What Abx is FIRST line for Clostridium difficile?
Vancomycin
100
What is Niacin (aka Nicotinic acid) used for?
Hyperlipidaemia (aka high cholesterol) patients
101
How does Niacin (aka Nicotinic acid) work? (3 things)
1. Lowers cholesterol levels 2. Lowers triglyceride levels 3. Raised HDL levels
102
What are the side fx of Niacin (aka Nictonic acid)?
1. Flushing (bc prostaglandins) 2. Impaired glucose tolerance (insulin resistance) 3. Myositis (painful muscles)
103
When are Lymphocytes raised? (2 things)
1. Chronic inflamm 2. Acute viral inf
104
When are Eosinophils raised? (2 things)
1. Allergy 2. Parasitic infection
105
What is the most common cause of Cellulilitis (aka Soft tissue infection) in IV drug users?
Staph aureus
106
What is the most common cause of Cellulilitis (aka Soft tissue infection) in NON IV drug users?
Streptococcus pyogenes
107
What are the features of Staph aureus?
1. Gram POSITIVE 2. Catalase POSITIVE 3. Oxidase NEGATIVE 4. Beta haemolytic 5. Bacilli
108
What are the CF of Cellulitis? (3 things)
1. Erythema + pain + swelling 2. Commonly on shins 3. Fever
109
What is the treatment for Mild / moderate Cellulitis?
Flucloxacillin (type of penicillin)
110
What is the treatment for Mild / moderate Cellulitis if the pt has a penicillin allergy? (2 things)
1. Clarithromycin 2. Doxycline
111
What is the treatment for Mild / moderate Cellulitis if the pt has a penicillin allergy and is pregnant?
Erythromycin
112
What is the treatment for Severe Cellulitis?
Co-amoxiclav
113
What are the causes of Hypercalcaemia?
CHIMPANZEES C alcium supplementation H yperparathyroidism I atrogentic (Drugs: Thiazides) M ilk Alkali syndrome P aget disease of the bone A cromegaly + Addison's Disease N eoplasia Z olinger-Ellison Syndrome (MEN Type I) E xcessive Vitamin D E xcessive Vitamin A S arcoidosis
114
How would a Posterior Cerebral Stroke present in the eyes?
Contralateral homonymous hemianopia w Macular sparing (8 on pic)
115
What is Lidocaine? What is it used for? (3 things)
Local anesthetic (main function) + Antiarrhythmic drug 1. Haematoma block (to allow painless # reduction) 2. Ventricular arrhythmias 3. Premature ejac
116
What are the side fx of Lidocaine? (4 things)
1. Change in mental status 2. Low seizure threshold 3. HTN 4. Constipation
117
What is the fractions of blood supply to the liver?
Hepatic Portal Vein: 2/3 Hepatic artery: 1/3
118
What is the Hepatic Portal Vein supplied by? (3 things)
1. Sup + Inf Mesenteric veins 2. Splenic Vein
119
What is the function of Gluteus Medius n Minimus?
ABducts 3abs cah der not da Max lol
120
What is the function of Gluteus Maximus?
External rotation Extension mAximum EXtension EXternal XXX
121
What causes Macrocytic Anaemia?
Macro aka FAT rbc's so its: F - Folate (b9) n b12 deficiency A - Alcohol T - hypoThyroidism
122
How does Phenytoin (anti-epileptic) cause Macrocytic anaemia?
Phenytoin = Anti**F**olate (aka b9) Macrocytic anaemia (**F**AT rbc's)
123
What does Epstein-Barr Virus cause?
Glandular fever (sore throat + fever)
124
What does Human papillomavirus (HPV) cause?
Gynaecological malignancy
125
What is Ramsey Hunt syndrome?
Reactivation of Varcella Zoster virus @ geniculate ganglion of CN 7
126
What are the CF of Ramsey Hunt syndrome? (4 things)
1. Ear pain (1st feature) 2. Facial nerve palsy 3. Ear rash 4. Vertigo + Tinnitus
127
How do you manage Ramsey Hunt syndrome? (2 things)
1. Aciclovir 2. Corticosteroids
128
What are the post-MI complications? (11 things)
1. Cardiac arrest 2. Cardiogenic shock 3. Chronic HF 4. Tachyarrhythmias 5. Bradyarrhythmias 6. Pericarditis 7. Dresslers Syndrome 8. LV aneursym 9. LV free wall rupture 10. Ventricular septal defect 11. Acute Mitral regurg Carl Couldn't Connect The Bt Password, David Loves Lying Verbally Always
129
What's the most common cause of death Post-MI?
Cardiac arrest, pt develops VF
130
How does MI cause Cardiogenic shock? (4 steps)
1. Infarcation 2. Damages Ventricular Myocardium 3. Reduced EF 4. Cardiogenic shock
131
What's the treatment for Cardiogenic shock? (2 things)
1. Inotropic support 2. Intra-aortic balloon pump
132
How does MI cause Chronic HF? (3 steps)
1. Infarction 2. Damages Ventricular Mycoardium 3. Chronic HF
133
What is the treatment for Chronic HF? (3 things)
1. ACEi 2. Beta blockers 3. Spironolactone (reduce fluid overload) ABS for HF
134
What Tachyarrhythmias can you develop post-MI? (2 things)
1. VF 2. VT
135
What is the most common Bradyarrhythmias post-MI? Which MI in particular?
Atrioventricular block Common after INFERIOR MI (makes sense bc bottom of heart, atrioventricular kinda bottom or middle wtever)
136
What's the time frame for Pericarditis occuring post-MI?
48 hours after a Transmural MI (in 10% of pt)
137
When is the pain in Pericarditis worse?
@ lying flat
138
What can you hear in Pericarditis?
Pericardial rub (scratching / rubbing sound like leather on leather sound)
139
What will you see on an Echo of Perciarditis?
Perciardial effusion
140
What is Dresslers Syndrome? (2 things)
1. Type of pericarditis 2. Post-MI complication
141
What is the time frame for Dresslers syndrome to happen post-MI?
2-6 weeks after (compared to Pericarditis which is 48 hours)
142
What is the pathophysiology of Dresslers syndrome?
AI reaction vs antigenic proteins forming as Myocardium recovers after an MI
143
What are the CF of Dresslers Syndrome? (4 things)
1. Fever 2. Pleuritic chest pain 3. Pericardial Effusion 4. Raised ESR
144
What is the treatment for Dresslers Syndrome?
NSAIDs
145
How does an MI cause LV aneursym? (3 steps)
1. Ischaemic damage 2. Weakened myocardium 3. Aneursym
146
How do you see a LV aneursym on a ECG?
Persistent ST elevation (2+ weeks after MI) Mainly seen in precordial leads (V leads)
147
What does LV aneursym increase the risk of and how? How do you prevent this?
Stroke bc thrombus can form in aneursym Prevent by taking anticoag.
148
What is the time frame for a LV free wall rupture happening post-MI?
1-2 weeks post-MI
149
How does a LV free wall rupture present?
Acute HF secondary to Cardiac Tamponade
150
What are the CF of cardiac tamponade? (3 things)
1. Raised JVP 2. Pulsus paradoxus (drop in systolic BP by 10+ @ inspiration) 3. Diminished heart sounds
151
What is the treatment for LV free wall rupture? (2 things)
1. Pericardiocentesis (drain fluid in pericardium) 2. Thoracotomy (access to thoracic organs)
152
What is the time frame for a Ventricular Septal Defect to happen post-MI?
1st week after MI
153
What are the CF of a Ventricular Septal Defect? (2 things)
1. Acute HF 2. Pansystolic murmur
154
What investigation should you do for Ventricular Septal Defect and why?
Echo, to exclude Mitral regurg
155
What is the treatment for Ventricular Septal Defect?
Surgical correction
156
What MI is Acute Mitral regurg most common to occur after?
Infero-post MI
157
How can a MI cause an acute Mitral Regurg?
Ischaemia / papilllary muscle rupture
158
What are the CF of acute Mitral regurg? (2 things)
1. Pulm oedema 2. Early-mid _systolic_ murmur Remember widad said AS**_MR_** is systolic murmurs
159
What is the treatment for Acute Mitral Regurg? (2 things)
1. Vasodilator therapy 2. Surgical repair
160
What are the CF of Cystic Fibrosis? (4 things)
1. Newborn: Meconium ileus (bowel obst) 2. Recurrent chest infections 3. Failure to thrive (bc malabs) 4. Steatorrhoea (bc malabs)
161
What are the complications of Cystic Fibrosis? (4 things)
1. DM 2. Short stature 3. Delayed puberty 4. Infertility (total in male, subfertility in female)
162
How do you calculate CO?
CO = stroke volume x HR Stroke volume = end diastolic volume - end systolic volume
163
What is the MOA of Heparin?
Activates antithrombin 3
164
What is the MOA of Dabigatran?
Direct **T**hrombin inhibitor dabiga**T**ran
165
What is the MOA of Rivaroxaban?
Direct factor **X** inhibitor rivaro**X**aban
166
What CN mediate the cough reflex?
9 + 10
167
What CN are afferent and efferent in gag reflex?
Afferent: 9 Efferent: 10
168
In the Circle of Willis, what anatomical locaiton do the Vertebral arteries unite at to form the Basilar arteries?
Base of pons (pontine arteries from basilar artery is literally da pons area lol)
169
What valve disease is a S4 sound associated with?
Aortic stenosis
170
We said both AS and MR are systolic murmurs, but how do you differentiate between them?
AS = EJECTION systolic murmur MR = Pan-systolic murmur
171
How does a PE present on a ECG? (2 things)
1. Sinus tachycardia 2. T wave inversion in ant leads
172
What is the preventative measure for PE if everything else fails?
Inf Vena Cava filter (IVC is retroperitoneal btw)
173
What is Pernicious anaemia pathophys?
1. AI clartation of Intrinsic factor + Parietal cells 2. Intrinsic factor needed for B12 from intestines **_P_**ernicious cells n **_P_**arietal
174
What can a kidney infection UTI (aka pyelonephritis) lead to an infection in as well?
Psoas muscle
175
What is Gilberts Syndrome? (2 things)
1. Autosomal recessive conditin 2. Defective bilirubin conjugation
176
What are the CF of Gilberts Syndrome?
1. Unconjugated hyperbilirubinaemia 2. Jaundice (in times of stress)
177
What investigations can you do for Gilberts Syndrome?
Rise in bilirubin @: prolonged fasting / IV nicotinic acid
178
What is the treatment for Gilberts Syndrome?
No treatment required Widad said its a dumb disease, its so mild
179
What artery supplies the prostate gland?
Inferior vesical artery (branch of internal iliac artery)
180
What is the Epiploic foramen, and what are its borders?
Passage between Greater + Lesser Sac Borders: * Ant: R: Common bile duct / Behind: Portal vein / L: Hepatic artery * Post: IVC * Superior: Liver (caudate process) * Inf: Duodenum
181
What is the clinical (surgical) significance of the Epiploic foramen?
Pringles manoeuvre: clamping Anterior aspect of epiploic foramen Therefore occluding: 1. Common bile duct 2. Portal vein 3. Hepatic artery Done in Liver surgery _bleeding_
182
What level of Bilirubin do you need to start experiencing Jaundice?
35+
183
What is the sentinel (aka first) lymph node of the gall bladder?
Lund's node (aka cystic lymph node) cah remember choloCYSTitis n dat lol
184
What lymph nodes drain the large intestine?
Mesenteric lymph nodes
185
What are the lymphoid follicles around the ileum?
Peyers patches
186
What is Sarcoidosis?
Growth of inflamm cells (granulomas) anywer in body but mainly: * Lungs * Lymph nodes (bilateral hilar enlargement) * Eyes (red eye) * Skin (erythema nodosum = painful shin nodules)
187
Who gets Sarcoidosis more?
woman _niggas_
188
What things would be elevated in bloods in Sarcoidosis?
1. ACE levels 2. Calcium
189
What is the treatment for Sarcoidosis?
Steroids (prednisolone)
190
Where in the brain is the respiratory centre located?
Brainstem
191
What are the contents of the Superior Mediastinum? (11 things)
1. Longus choli muscles 2. Esophagus 3. Trachea 4. Vagus nerve 5. Phrenic nerve 6. Left recurrent laryngeal nerve 7. SVC = Right + Left Brachiocephalic Veins, L = Thoracic Duct 8. Arch of Aorta = Left Subclavian Artery + Left Common Carotid Artery + Brachiocephalic Trunk 9. Thymus 10. Sternohyoid muscle 11. Sternothyroid muscle LET VPL ...
192
What are the contents of the Posterior Mediastinum? (8 things)
1. Thoracic duct 2. Esophagus 3. Descending Aorta 4. Splanchnic nerves 5. Azygous vein 6. Hemiazygous vein 7. Accessory hemiazygous veini 8. Vagus nerve TED SAHAV
193
What are the contents of the Middle Mediastinum? (6 things)
1. Heart 2. Aortic Root 3. Main bronchi 4. Pericardium 5. Arch of azygous vein HAMPA
194
What are the contents of the Anterior Mediastinum? (3 things)
1. Thymic remnants 2. Lymph nodes 3. Fat TLF
195
What are all the instrinsic muscles of larynx innervated by? What is the exception?
Recurrent laryngeal nerve CricoThyroid - innervated by Superior External Laryngeal Nerve remember dis from ur pharyngeal arches table innit
196
At what level does the Inf Vena Cava cross the diaphragm?
T8 (8 letters in Vena Cava)
197
At what level does the Oesophagus cross the diaphragm?
T10 10 letters in Oesophagus
198
At what level does the Vagus Nerve cross the diaphragm?
T10 Vagus nerve is CN 10
199
At what level does the Thoracic Duct + Abdominal Aorta cross the diaphragm?
T12 12 letters in Thoracid Duct n Abdominal Aorta is only one left over wid it
200
What Paraneoplastic syndrome is most associated with Squamous cell carcinoma?
PTH related protein da calcium one innit
201
What is Ankylosing spondylitis?
A Spondyloarthropathy aka arthritis that also affects spine
202
What antigen is associated with Ankylosing spondylitis?
HLA-B27
203
Who is your common Ankylosing spondylitis pt?
Males aged 20-30 yrs old aka footballers
204
What are the CF of Ankylosing spondylitis? (3 + 4)
Spinal: 1. Back stiffness (worse in morning, better @ excercise) 2. Reduced forward flexion 3. Reduced chest expansion (bc _fused_ spine) (late) Extra atricular: 4 A's 1. Anterior uveitis 2. Aortic regurg 3. Apical fibrosis 4. Achilles tendonitis
205
Why is Ankylosing spondylitis also called Bamboo spine?
Cah Ankylosing means fusing, n da spine fuses together into one long bamboo stick
206
What are the management options for Ankylosing spondylitis? (3 things)
1. NSAIDs (pain) 2. Steroids (inflamm) 3. Anti-TNF meds (immunosuppresant cah isa AI condition)
207
Where in the kidney does most water absorption happen?
PCT (70%)
208
What are the side fx (aka contraindications) of Thiazide diuretics? (6 things)
1. Hyponatraemia + Hypokalaemia + Hypercalcaemia 2. Impaired glucose tolerance (--\> DM) 3. Dehydration 4. Postural hypotension 5. Impotence 6. **Gout** HID PIG
209
What are the nerve roots of the Musculocutaneous nerve?
C: 5,6,7
210
What are the nerve roots of the Axillary nerve?
C: 5,6
211
What are the nerve roots of the Radial nerve?
C: 5,6,7,8
212
What are the nerve roots of the Median nerve?
C: 6, 8 + T1
213
What are the nerve roots of the Ulnar nerve?
C8, T1
214
What is the tumour marker for Ovarian cancer?
CA125
215
What medication is given to reduce the size of the Prostate in prostate cancer? What is its MOA?
Finasteride MOA: 5-alpha reductase inhibitor: Converts testosterone into DHT --\> reduces prostate size
216
What pneumonia organism should be suspected when multiple people contract pneumonia in an **air conditioned** space?
Legionella pneumophila
217
What is commonly seen in Legionella pneumophilia? (2 things)
1. Hyponatraemia 2. Lymphopenia (low lymphocytes)
218
What pneumonia organism should be suspected in acoholics?
Klebsiella pneumoniae
219
What pneumonia organism should be suspected in patients w COPD?
H influenzae
220
What pneumonia organism should be suspected in patients after an influenza infection?
Staph aureus
221
What pneumonia organism should be suspected in patients with a DRY cough and atypical chest signs / CXR?
Mycoplasma pneumoniae
222
What is sometimes seen with Mycoplasma pneumoniae? (2 things)
1. AI haemolytic anaemia 2. Erythema (skin redness)
223
What pneumonia organism should be suspected in patients with a DRY cough and atypical chest signs and CXR?
224
What pneumonia organism should be suspected in patients with HIV?
Pneumocystis jiroveci
225
What is sometimes seen with Pneumocystis jiroveci pneumonia? (3 things)
1. Dry cough 2. Exercise induced desaturations 3. X chest signs
226
What are some complications of Diverticulitis? (2 things)
1. Perforation + Faecal peritonitis (Hinchey 4) 2. Colovesical Fistula
227
How would a patient with a Colovesical fistula as a result of Diverticulitis present? (2 things)
1. Urinary sepsis 2. Pneumaturia (bubbles in urine)
228
What is the CF of Vit A deficiency? (seen in Coeliac disease)
Night blindness vit A is also called Retinol, n is converted into Retinal, aka eye involvement lol
229
What is the medication for Anaphylaxis? What is its MOA?
Adrenaline Causes vasoconstriction (by acting on Alpha-adrenergic receptors) Bc Anaphylactic shock causes: Vasodilation + Increased vasc perm
230
What are the 2 most common Valve dysfunctions 2ndary to HF?
MR + TR
231
How would a leg present in an ANT vs POST hip dislocation?
ANT: Ext rot POST: Int rot
232
What are the borders of the Femoral Triangle?
1. Sartorius 2. Adductor longus 3. Inguinal ligament
233
What anticoag medication is a Direct factor Xa inhibitor?
Rivaroxaban
234
What anticoag medication directly inhibits Thrombin?
Dabigatran
235
What are the Afferent n Efferent nerves for the Lacrimation reflex?
Aff: Ophthalmic nerve (V1) Eff: CN 7
236
What are the Afferent n Efferent nerves for the Corneal reflex?
Aff: Nasociliary branch of Opthalmic N (CN V1) Eff: CN 7
237
What are the Afferent n Efferent nerves for the Gag reflex?
Aff: CN 9 Eff: CN 10
238
What are the Afferent n Efferent nerves for the Carotid sinus reflex?
Aff: CN 9 Eff: CN 10 (same as gag reflex)
239
What is the most abundant antibody in blood?
IgG hes a G
240
What does NICE guidelines say about ppl on Warfarin with INR 5-8 but NO bleeding? (2 things)
1. Withhold 1 or 2 Warfarin doses 2. Reduce Maintenance Dose
241
What does NICE guidelines say about ppl on Warfarin with INR 5-8 with Minor bleeding? (2 things)
1. Stop Warfarin + IV Vit K 2. Restart Warfarin @ INR 5
242
What does NICE guidelines say about ppl on Warfarin with INR 8+ with NO bleeding? (3 things)
1. Stop Warfarin 2. Oral Vit K 3. Restart Warfarin @ INR 5
243
What does NICE guidelines say about ppl on Warfarin with INR 8+ with Minor bleeding? (3 things)
1. Stop Warfarin 2. IV Vit K 3. Restart Warfarin @ INR 5
244
What does NICE guidelines say about ppl on Warfarin with MAJOR bleeding, regardless of INR? (4 things)
1. Stop Warfarin 2. IV Vit K 3. IV Prothrombin Complex Concentrate / FFP 4. Restart Warfarin @ INR 5
245
Can Warfarin be used in breast feeding?
Yes
246
What are the causes of Hyperkalaemia? (7 things)
1. Meds (SAN: Spironolactone / ACEi / NSAIDs) 2. Acidosis (Met + Resp) 3. Cellular destruction (Burns) 4. Hypoaldosteronism (Addisons) / Haemolysis 5. Intake (Excessive) 6. Nephrons aka AKI 7. Excretion impaired MACHINE
247
Name 3 Enzyme inducers?
1. Rifampicin 2. Phenytoin (anti epileptic) 3. Carbamazepine (anti epileptic)
248
Name 3 Enzyme inhibitors? (6 things)
1. Isoniazid 2. Omeprazole 3. Abx: Ciprofloxacin / Erythromycin 4. Amiodarone (anti-arrhytmhic chemical cardioversion) 5. SSRIs (fluoxetine / Sertraline) (dey depress da enzyme lol) 6. Sodium valproate (anti-epileptic) IOAASS
249
What are the cardiac complications of Hyperthyroidism? (2 things)
1. High Output Cardiac Failure 2. AF
250
What are RED flags in back pain?
1. Thoracic back pain (T1 - T12 levels) 2. Keeps up at night Most likely MSCC (Metastatic Spinal Cord Compression)
251
What NSAID is CI in CVS disease?
Diclofenac
252
What are the differentials for someone w Erythema nodosum? (3 things)
1. Crohn's 2. TB 3. Sarcoidosis
253
What is a neuro complication of DM? What are its CF?
Autonomic neuropathy Triad: 1. Postural hypotension 2. Loss of resp arrhytmias (aka breathing doesnt control HR) 3. Erectile dysfunction
254
In cardiac arrest, what is a "non shockable" rhythm?
Pulseless-electrical activity (PEA) aka ECG shows stuff but u cant feel pulse or hear breath sounds
255
What should you do in a "non-shockable" cardiac arrest?
Chest compressions 30:2 rescue breaths Then adrenaline
256
What is the criteria for Severe asthma attack? (4 things)
1. PEFR 33-50% 2. Cant complete sentences 3. RR 25+ 4. HR 110+
257
What is the criteria for a Life threatening asthma attack? (8 things)
1. 33: PEFR below 33% 2. 92: Sats below 92 3. Cyanosis 4. Hypotension 5. Exhaustion / confusion 6. Silent chest 7. Tachycardia 8. **NORMAL PCO2** maryam said 33-92-CHEST
258
Why is normal PCO2 a sign of life threatening asthma attack?
Bc High RR in asthma attack should lower pCO2 but its not working If pCO2 is high... near-fatal asthma attack
259
What are the NICE guidelines for COPD management?
260
Who should be given a rescue pack in COPD? What is in this rescue pack?
Frequent exacerbations Prednisolone + Abx (amoxicillin)
261
When should a COPD pt with a rescue pack take the Abx in their rescue pack?
If they coughing up **purulent** sputum
262
What organism causes Acute epididymo-orchitis?
Chlamydia trachomatis
263
Bronchial + Hypopharyngeal Secretions is common in last few days of life. What palliative treatment can you give to treat this?
Hyoscine hydrobromide (antimuscarinic)
264
What are Alpha blockers mainly used for? (2 things)
1. HTN 2. BPH
265
What are the side fx of Alpha blockers? (4 things)
1. Postural hypotension 2. Drowsiness 3. SOB 4. Cough
266
What are the ECG findings for a PE? (4 things)
1. Sinus tachycardia 2. RBBB 3. Right axis deviation 4. S1Q3T3 (aka large S in lead 1, large Q in lead 3, inverted T wave in lead 3) (only in 20%)
267
What should you give to a Crohns pt w a Perianal fistula?
Oral metronidazole (abx) to stop it from getting infected
268
What is the 1st line for Abx for tonsilittis nigga?
Phenoxymethylpenicillin for 10 days
269
If a stroke pt is already on warfarin, wts your next step?
Urgent CT head scan Bc Stroke can be either: Haemorrhagic or Thrombotic, so you need to see which one it is b4 giving Aspirin 300mg, cah der already on blood thinners
270
What is the treatment for Restless Leg Syndrome? (uncontrollable urge to move legs esp at night)
Ropinirole (dopamine agonist) R n R
271
Why is Digoxin dangerous in AKI?
Can build up bc not cleared by kidney so is toxic in large amounts
272
What is a marker of POOR prognosis in RA?
Anti-CCP antibodies
273
What HTN meds should be stopped in AKI?
ACEi Bc dey worsen renal function
274
What meds are CI in AKI? (3 things)
1. Diuretics 2. ACEi 3. NSAIDs DAN
275
What is the 1st line SSRI for children and adoloscents?
Fluoxetine FluoxeTEENS lol
276
What is the 1st line investigation for Angina (stable chest pain of sus CAD aetiology)?
Contrast-enhanced CT coronary angiogram
277
Before doing a PCI in a STEMI pt, what should you give a pt? How does this change if they are already on an anticoag?
Aspirin + Prasugrel (dual antiplatelet therapy) If already on anticaog: Aspirin + Clopidogrel
278
What is a shoulder complication in 20% of Diabetics?
Frozen shoulder aka **Adhesive Capsulitis**
279
What movement is clarted in Frozen shoulder aka Adhesive Capsulitis? How long does this episode last?
Ext rot clarted Lasts 6 months - 2 yrs
280
What is the Tx for Frozen shoulder aka Adhesive Capsulitis? (3 things)
1. NSAIDs 2. Physio 3. Oral / intra-articular corticosteroids
281
What are the side fx of Phenytoin? (3 things)
1. Gingival hyperplasia (fat gums) 2. Hirsutism 3. Coarsening of facial features
282
What meds cause gingival hyperplasia (fat gums)? (3 things)
1. Phenytoin 2. Ca channel blockers (esp nifedipine) 3. Ciclosporin (immunosupressant)
283
What are the CF of Digoxin toxicity? (5 things)
1. Confusion 2. Yellow green vision 3. N+V 4. Gynaecomastia 5. Arrhythmias (AV Block / Bradycardia)
284
What can cause Digoxin toxicity? (2 things)
1. Thiazides aka (Bendroflumethiazide) (interact w digoxin directly) 2. Hypokalaemia (so any diuretics)
285
What are the complications of Blood transfusions? (9 things)
1. Acute Haemolytic 2. Non-Haemolytic febrile 3. Allergic / Anaphylaxis 4. Infective 5. Transfusion-related acute lung injury (TRALI) 6. Transfusion-associated circulatory overload (TACO) 7. Hyperkalaemia 8. Iron overload 9. Clotting ANA ITT-HIC
286
When do you get a Acute Haemolytic Reaction in blood transfusion?
Incomplatible blood (human error)
287
What are the CF of an Acute Haemolytic Reaction in blood transfusion? (3 things)
1. Fever 2. Hypotension 3. Abdominal pain
288
What is the management for an Acute Haemolytic Reaction in blood transfusion? (2 things)
1. Coombs test (confirms haemolytic anaemia Dx) 2. Fluid resus Widad said coombs test is wen u think u given da wrong blood type
289
When do you get a Non-haemolytic febrile reaction in blood transfusion?
Antibodies reacting w WBC + Cytokines in blood product @ storage
290
What are the CF of a Non-haemolytic febrile reaction in blood transfusion?
Fever + chills
291
What is the management of a Non-haemolytic febrile reaction in blood transfusion?
Paracetamol
292
When do you get a Anaphylaxis reaction in blood transfusion?
IgA deficiency
293
What are the CF of an Anaphylaxis reaction in blood transfusion? (4 things)
1. SOB 2. Wheezing 3. Hypotension 4. Angioedema
294
What is the management of an Anaphylaxis reaction in blood transfusion?
Adrenaline
295
When do you get a Transfusion-related acute lung injury (TRALI) in blood transfusion? (3 steps)
1. Host Neuts activated by donated blood 2. Increases vasc permeability 3. Pulm Oedema
296
What are the CF of a Transfusion-related acute lung injury (TRALI) in blood transfusion? (4 things)
1. Fever 2. Pulm infiltrates @ CXR 3. Hypotension 4. Hypoxia (low sats)
297
What is the management of a Transfusion-related acute lung injury (TRALI) in blood transfusion?
Oxygen
298
When do you get a Transfusion-associated circulatory overload (TACO) in blood transfusion? (2 things)
1. Transfusion too fast 2. Pre-existing HF
299
What are the CF of Transfusion-associated circulatory overload (TACO) in blood transfusion? (2 things)
1. Pulm oedema 2. HypERtension
300
What are the management for Transfusion-associated circulatory overload (TACO) in blood transfusion?
Loop diuretics (furosemide)
301
What happens to the pH in a paracetemol overdose? Why is this important?
Low PH (acidosis) Acidosis means poor prognosis
302
If RIF pain is worse after eating, what should you suspect? Why?
Meckels diverticulum Ectopic gastric mucosa secrete acid --\> bleeding + ulceration
303
If RIF pain + fever + WL + diarrhoea, what should you suspect?
Crohn's
304
What is the 1st line med for HTN pt who are diabetics, REGARDLESS of age?
ACEi / ARBs
305
What is the Toxicity Bear for Toxic meds? (7 meds)
1. Aspargine = Neurotoxic 2. Cisplastin = ototoxic + nephrotoxic 3. Vincristine / Vinblastin = Peripheral neuropathy (christ my nerves) + Myelosuppression (blast my bones) 4. Bleomycin = Lung fibrosis 5. Doxorubicin = Cardiotoxic 6. Ψ Cyclophosphamide = Nephrotoxic + Bladder toxic + SIADH 7. Methotrexate = Nephrotoxic + Myelosuppression
306
Why can you have Plethoric red facies (red face) in COPD? (3 steps)
**Polycythaemia** (COPD complication) 1. COPD 2. Chronic Type 2 Resp failure 3. **Polycthaemia** (high RBC aka raised Hb in bloods) (to compensate for long term hypoxaemia)
307
What are the findings of Type 1 Resp failure?
* PaO2: LOW * PaCO2: Normal / low * Bicarbonate: Normal Type 1 aka Hypoxaemia resp failure
308
What are the findings of Type 2 Resp failure?
* PaO2: Low * PaCO2: HIGH * Bicarbonate: Normal / Rising (defo raised in chronic Type 2) Type 2 aka Hypercapnic resp failure
309
What are the pathopneumonic features of Pagets disease of the nipple?
Starts as a erythematous rash in nipple THEN spreads to areolar tissue in late disease
310
How do you differentiate between Pagets disease and eczema in the breast?
Pagets: starts in nipple --\> spreads to areola later Eczema: starts in areola --\> spreads to nipple
311
Whats the difference between a Lipoma and Fibroadenoma of breast?
Lipoma - FIXED, non-painful, highly mobile, smooth, discrete Fibroadenoma - MOBILE, non-painful, mobile, smooth, discrete
312
Whats the difference between Fibroadenoma and Fibroadenosis of the breast? (4 things)
Fibroadenoma * Under 30yrs * Discrete * Painless * Mobile Fibroadenosis * Middle-aged * "Lumpy" breasts * Painful (sometimes) * Symptoms worse in pre-menstrual period
313
What should be arranged for pt with sus ruptured AAA?
Crossmatch 6 units blood
314
If angina is not controlled with a Beta blocker, what should be added?
Nifedipine (calcium channel blocker)
315
What are the 2 causes of pan-systolic murmurs? How do you differentiate between them? (4 things)
MR TR TR * Louder on _inspiration_ * Heard better @ L lower sternal border MR * Heard better @ apex
316
What are the types of Aortic dissection?
Type _A_ - **_A_**scending aorta (2/3 of cases) Type B - Descending aorta (distal to left Subclavian origin)
317
How are the different types of Aortic dissection managed?
Type A: **Surgery** + Control BP (IV labetalol) Type B: Only Control BP (IV labetalol)
318
What are the CF of Pericarditis? (6 things)
1. Non prod cough 2. SOB 3. Pleuritic chest pain (worse @ leaning back) 4. Pericardial rub 5. Tachycardia 6. Tachypnoea
319
What investigations should you do for sus acute pericarditis?
ALL patients with sus acute pericarditis should have: **Transthoracic** **ECHOcardiography (TTE)**
320
What are the ECG findings in pericarditis? (3 things)
1. PR depression (most specific ECG marker for pericarditis) 2. "Saddle shaped" ST elevation 3. GLOBAL / WIDESPREAD changes, not in specific territories of ECG
321
What should you know about a Pregnant woman with High cholesterol?
Statins are contraindicated in pregnancy
322
What BP meds affect glucose and insulin?
Thiazides: will cause hyperglycaemia Esp after meals
323
What are the treatments for Orthostatic hypotension? (2 things)
1. Fludrocortisone (increases Na reabs) 2. Midodrine
324
What's the most common cause of Congenital Heart Disease?
Ventricular septal defects (VSD)
325
Apart from Congenital, what can cause Ventricular septal defects (VSD)?
Post MI
326
What does VSD cause after a few weeks?
R HF
327
What are the complications of VSD? (4 things)
1. R HF 2. Aortic regurg 3. Asymptomatic + Pansystolic murmur @ L lower sternal edge 4. Louder P2
328
If a HTN who is on ACEi has a drop in eGFR, what should you do?
If it drops more than 20% --\> half ACEi dose
329
What is the rescue pack for asthma n COPD have? (2 things)
1. Prednisolone 2. Abx
330
What are the side fx of Beta blockers? (2 things)
1. Cold feet + hands 2. Insomnia / Nightmares
331
What are the side fx of Calcium channel blockers? (2 things)
1. Ankle oedema 2. Headaches
332
What is the abx for Staph aureus?
Flucloxacillin
333
What is the abx for Strep pneumoniae?
Penicillin
334
What happens if you give Na too fast in SIADH? What is the prognosis?
Central Pontine Myelinolysis (CPM) 50% death
335
What is Clomifene?
Treatment for PCOS induced infertility
336
What are the side fx of Clomifene? (3 things)
1. Flushing 2. Vaginal bleeding 3. Ovarian hyperstimulation syndrome (OHSS) --\> resp distress (SOB, pleural effusion)
337
What should you give HF pt w Hypotension? (1st n 2nd line)
1. FIRST LINE: Dobutamine (inotrope) 2. SECOND LINE: Adrenaline
338
What should you give HF pt w Resp Failure?
CPAP
339
We said ABS for HF, but what is the most important medication for ACUTE HF?
Furosemide (loop diuretic)
340
What are the medication causes of QT prolongation? (3 things)
1. Amiodarone 2. SSRI 3. Haloperidol
341
What are the electrolyte causes of QT prolongation? (3 things)
1. Hypokalaemia 2. Hypocalcaemia 3. Hypomagnesaemia
342
What are the ECG findings of Ant, Post, and Inf MI?
Ant: ST elevation @ V1-4 Inf: ST elevation @ II, III, aVF Post: tall R waves in V1-2
343
If JVP rises on inspiration, what sign is this, and what is the condition
Kussmauls sign Constrictive pericarditis
344
What type of stoma is done in an emergency setting of Colonic tumour w risk of perforation?
End colostomy
345
What are the cancers of the colon vs anus?
Colon: Adenocarcinoma Anus: Squamous cell carcinoma
346
What can constipation cause in the rectum?
Haemorrhoids (painless)
347
What do you see in the toilet with haemorrhoids?
Blood in the toilet pan
348
What should you sus when dey have a midline Sentinal skin tag @ external inspection of der bum?
Fissure in ano
349
Are Fissure in ano painful?
Yes
350
What stomas are flush to the skin, and which are Spouted, and why?
Colostomy: flush to skin Ileostomy: Spouted (aka away from skin bc small bowel contents are acidic n will clart da skin)
351
When are haemorrhoids painful?
If they are thrombosed
352
What is the grading system for internal haemorrhoids?
Grade 1: DO NOT prolapse out of anal canal Grade 2: Prolapse @ pooing but reduce by demselves Grade 3: Can be manually reduced Grade 4: CAN NOT be reduced
353
What is mesenterich ischeamia?
Heart attack of da colon
354
What should you give in chronic anal fissures? (3 things)
1. Laxatives 2. Local anaesthetic 3. Topical GTN (aaah thats the stuff)
355
What are the options for ACUTE Anal fissure? (4 things)
1. Soften stool (aka high fibre + fluid diet) (laxatives) 2. Lubricants (before pooing) 3. Topical anaesthetics 4. Analgesia
356
What are the management options for Chronic anal fissures? (3 things)
1. Continue ACUTE management options 2. Topic GTN 3. Sphincterectomy (if GTN not working)
357
What is the treatment for Torsade de pointes?
IV magnesium sulfate
358
How do you get Cardiac tamponade?
Fluid in pericardium (like getting stabbed)
359
What are the CF of cardiac tamponade? (3 things)
Becks triad: 1. Raised JVP 2. Hypotension 3. Muffled heart sounds @ ausc
360
What are the 1st line Abx of choice for an infective exacerbation of COPD? (3 things)
1. Amoxicillin 2. Clarithromycin 3. Doxycycline 1 of dem not all 3 lol
361
What Abx is given for prohylaxis of a COPD pt with freqeuent infective exacerbations?
Azithromycin
362
What can reduce the risk of sudden death in HOCM?
Implantable cardioverter defibrillator (ICD)
363
What abx can cause Torsade de pointes?
Azithromycin / Clarithromycin (Macrolide)
364
What is the treatment for pulmonary oedema?
IV furosemide
365
What are the ECG findings of Digoxin toxicity? (3 things)
1. Short QT interval 2. ST depression (downsloping) 3. T wave inversion
366
What are the CF of Digoxin toxicity? (2 things)
1. Anorexia 2. Confusion
367
What is S1 caused by?
T + M closure (tricuspid + mitral)
368
What is S2 caused by?
A + P closure (aortic + pulmonary)
369
When is S1 soft? (2 things)
1. Long PR 2. MR
370
When is S1 loud?
MS
371
When is S2 loud?
Pulmonary HTN (bc loud P2)
372
When is S2 soft?
AS
373
What is S3 caused by?
Diastolic filling of ventricle
374
When is S3 considered normal?
If under 30 yrs old
375
When is a S3 heard? (3 things)
1. MR 2. LV failure (e.g dilated cardiomyopathy) 3. Constrictive pericarditis
376
What is S4 caused by?
Atrial contraction against stiff ventricle
377
What does S4 coincide with on a ECG?
P wave (bc **atrial contraction** against stiff ventricle)
378
When will you get a S4? (3 things)
1. AS 2. HTN 3. HOCM
379
What is the treatment for syptomatic relief of Angina pt with HR 70+ ?
Ivabradine (HCN aka funny channel blocker)
380
What are the side fx of Ivabradine?
Visual disturbances eyevabradine
381
What is narrow vs broad complex tachycardia?
QRS less than 120ms = narrow (SVT) QRS more than 120ms = broad (VT)
382
What are the adenosine DOSES for management of SVT after valsava manouvre and carotid sinus massage have failed?
6mg --\> 12mg --\> 18mg
383
Who is adenosine CI in for SVT management? What do you give instead?
Asthmatics Give verapamil
384
What do you do if ur 3 doses of Adenosine fail in SVT management?
DC cardioversion
385
What are the 1st line management options for Pericarditis? (2 things)
NSAID (ibuprofen) + Colchicine
386
Are bilateral pleural effusions transudate or exudate?
Transudate (source: comment on passmed)
387
How is a Posterior MI confirmed?
ST elevation and Q waves in POSTERIOR lead placement _(V7-9)_
388
How do you confirm a diagnosis of cardiac tamponade?
Echo
389
What is a skin side fx of amiodarone?
Grey skin appearance
390
What are the CF of Aortic dissection? (5 things)
1. Tearing Chest / Back pain 2. HTN 3. AR 4. Pulse deficit (no pulse in carotid / brachial / femoral) 5. Pulse difference (difference in 20+ systolic between arms) THAPP
391
What is CURB65 score for pneumonia?
Confusion Urea 7+ Resp Rate 30+ BP 90/60 - 65+ age 0-1 fine 2 = hospital care 3+ = ICU
392
Which lung cancer is gynaecomastia most commonly assoc with?
Adenocarinoma
393
What are the causes of Upper zone pulmonary fibrosis? (5 things) What will you hear?
TEARS fall from the sky 1. TB 2. Extrinsic Alveolitis 3. Ankylosing Spondylitis 4. Radiotherapy 5. Sarcoid APICAL crackles (upper zone crackles)
394
What are the causes of Lower zone pulmonary fibrosis? (5 things) What will you hear?
CRABS are on the ground 1. Cryptogenic (aka Idiopathic) 2. RA 3. Asbestosis 4. Bleomycin 5. Systemic slerosis / scleroderma Basal crackles
395
What is Quincke's sign?
Nailbed pulsation Sign of AR (therefore assoc w early-mid diastolic murmur)
396
When is S3 normal?
Under 30 yrs old 3 n 3
397
When is S4 normal?
Over 40 4 n 4
398
What causes S3?
LVF n MR --\> Pulm oedema S threee hard to breeeath
399
What causes S4?
HOCM n AS --\> sudden death S4 hit da floor
400
Which COPD pt should be ASSESSED for Long Term Oxygen Therapy (LTOT)? (4 things)
1. Blue: Cyanosis / sats 92-% 2. Breathing: Airway obst / FEV1: 30-% 3. Blood: Secondary polycthaemia (high Hb) 4. Ballooning: Peripheral oedema / Hepatomegaly / Raised JVP
401
How do you assess a COPD pt to see if they need LTOT?
2 ABG's, 3 weeks apart
402
After you assesses a COPD pt, who should you give LTOT for?
If PaO2: LESS than 7.3 kPa OR 7.3 - 8 kPa PLUS one of: 1. Peripheral oedema 2. Pulmonary hypertension 3. Secondary polycythaemia
403
Who should you NOT offer LTOT for in COPD pt?
ppl still smoking
404
Who should you refer for 2ww for sus lung cancer? (2 things)
1. Sus CXR 2. 40yr + w unexplained haemoptysis
405
What criteria determines if a sore throat is BAC or viral?
Centor criteria
406
What are the Centor Criteria?
1. Tender anterior cervical lymphadenopathy 2. Fever Hx 3. Absence of cough 4. Presence of tonsillar exudate 3+ = BAC (aka GAS) T-FAP
407
What are the ECG findings of Hypercalcaemia?
Shortening of QT interval
408
What is CI in VT?
Verapamil (ca channel blocker)
409
What is the most common organism causing infective exacerbation of COPD?
H influenza
410
What is the long term medications post-MI? (4 things)
1. Dual antiplatelet therapy 2. ACEi 3. Beta blocker 4. Statin DABS
411
What will you hear in a Atrial septal defect? (3 things)
1. Ejection systolic murmur 2. Louder on inspiration 3. Fixed split S2
412
Who are Atrial septal defects common in?
Downs syndrome
413
What is a contraindication for Chest drain insertion?
INR 1.3+
414
What should be sus in YOUNG pt with chest pain?
Myocarditis
415
What are the causes of the Myocarditis? (4 things)
1. Viral (coxsckie B / HIV) 2. BAC 3. AI 4. Drugs: Doxorubicin
416
What are the CF of myocarditis? (4 things)
1. YOUNG pt, acute hx 2. Chest pain (doesnt change with breathing / position) 3. SOB 4. Arrhytmias
417
What investigations should you do for Myocarditis? (2 things)
1. Bloods 2. ECG
418
What will bloods show you in Myocarditis? (3 things)
1. Raised inflamm markers 2. Raised cardiac enzymes 3. Raised BNP
419
What will ECG show you in Myocarditis? (3 things)
1. Tachycardia 2. Arrhytmias 3. ST elevation / T wave inversion
420
What are the management options for Myocarditis? (2 things)
1. TUC (abx if BAC) 2. Supportive (for HF / arrhythmias)
421
What are the complications of Myocarditis? (3 things)
1. HF 2. Arrhytmias --\> sudden death 3. Dilated cardiomyopathy (late)
422
What bloods will Total Parenteral Nutrition (TPN) clart?
LFT's high everything
423
What is the tumour marker for breast cancer?
CA15-3
424
What is the analgesia of choice for Renal colic?
IM Diclofenac (its voltarol lol)
425
When do you use Neuromuscular blocking drugs?
To paralyse muscles to allow for Intubation
426
What are the 2 types of Neuromuscular blocking drugs?
Depolarizing n Non-depolarizing
427
What is the MOA of Depolarizing Neuromuscular blocking drugs?
Binds to nAChR's --\> persistent depolarization of Motor end plate
428
What is the MOA of Non depolarizing Neuromuscular blocking drugs?
Competitive antagonist vs nAChR's
429
What is an example of a Depolarizing Neuromuscular blocking drug?
Succinylcholine aka Suxamethonium
430
What is an example of a Non depolarizing Neuromuscular blocking drug?
Pancuronium like pancreas lol
431
What are the side fx of Depolarizing Neuromuscular blocking drugs like Suxamethonium? (3 things)
1. Fasiculations (muscle twitches) 2. Malignant hyperthermia 3. Hyperkalaemia
432
What are the side fx of Non depolarizing Neuromuscular blocking drugs like Pancuronium?
Hypotension
433
How do you reverse Depolarizing Neuromuscular blocking drugs like Suxamethonium?
You can't
434
How do you reverse Non depolarizing Neuromuscular blocking drugs like Pancuronium?
Acetylcholinesterase inhibitors (neostigmine)
435
Which Neuromuscular blocking drugs is the one of choice for intubation?
Depolarizing (Suxamethonium)
436
What are the CI for Suxamethonium (Depolarizing Neuromuscular blocking drug)? (2 things) Why?
1. Acute angle glaucoma 2. Penetrating eye injuries Bc Suxamethonium increased inra-ocular pressure
437
What surgical complication is more likely to occur with Open surgery than in Laparoscopic?
Adhesions
438
How do you manage an obstructed Urinary stone with signs of infection? (2 things)
1. IV abx 2. Urgent renal decompression
439
What is a Extradural (epidural) haematoma?
Bleeding into space between Dura mater + Skull
440
What are the most common causes of Extradural (epidural) haematomas? (2 things)
1. Car crash (acceleration-deceleration injury) 2. Blow to side of head
441
Which part of the head do most Epidural haematomas occur?
Temporal region
442
What artery is clarted by the skull # in Epidural haemotomas?
Middle meningeal artery
443
What is the shape of the Epidural haematoma bleeding on a scan?
Lemon shape Lemon pie = e-PIE-dural lol
444
What is a Subdural haematoma?
Bleeding into Outermost Meningeal layer
445
What lobes of the brain do Subdural haematomas most commonly occur? (2 things)
1. Frontal lobe 2. Parietal lobe
446
What are the RF for Subdural haematomas? (3 things)
1. Age 2. Alcohol 3. Anticoag 3 A's for Subdural
447
Which has a slower onset of symptoms, Epidural or Subdural?
Subdural SSSlow SSSubdural
448
What symptoms might you get in Subdural haematomas?
Fluctuating confusion / consciousness
449
What shape are Subdural haematomas on a scan?
Banana shape su**B** = **B**anana
450
What symptoms does a Subarachnoid haemorrhage (SAH) classically cause?
Sudden occipital headache SAH at da back in da occipital area cah SAiHdev played back in midfield not upfront lol i can feel it in my brem lol
451
When do you get Subarachnoid haemorrhage? (2 things)
1. Spontaneously after Cerebral aneurysm 2. Traumatic brain injury
452
What is seen in a Subarachnoid haemorrhage in a scan?
Bleeding in the back of the brain i can feel it in my brem
453
What is a Intracerebral (intraparenchymal) haemorrhage (IPH)?
Collection of blood within brain substance
454
What are the causes / RF for Intracerebral (intraparenchymal) haemorrhages (IPH)? (5 things)
1. Brain tumour 2. HTN 3. Aneurysms 4. Trauma 5. Infarct (esp stroke pt undergoing thrombolysis) BHATI
455
What pt will Intracerebral (intraparenchymal) haemorrhage (IPH) patients present similarly to?
Stroke patients This is why u gotta do a CT head for all stroke pt b4 thrombolysis to rule dis out
456
What will you see in a scan of (Intracerebral (intraparenchymal) haemorrhage (IPH)?
Hyperdense lesion in brain substance
457
What is the treatment for Intracerebral (intraparenchymal) haemorrhage (IPH)?
Small: Conservative Large: Surgery
458
How should Diabetes meds (metformin n co) be managed on DAY BEFORE surgery?
Take as normal
459
How should Metformin be managed on DAY OF surgery operation?
If once / twice daily: take as normal If 3 times daily: miss lunchtime dose morning / afternoon operation doesnt matter
460
How should Sulfonylurea (gliclazide) be managed on DAY OF surgery operation?
If once daily: miss dose (morning or afternoon op) If twice daily: miss morning dose / miss both doses if afternoon op
461
How should DDP4i (Sitagliptin) be managed on DAY OF surgery operation?
Take as normal
462
How should SGLT2i (canaglifozin) be managed on DAY OF surgery operation?
Miss on day (morning or afternoon pm)
463
How should ONCE DAILY INSULIN be managed on DAY BEFORE / DAY OF surgery operation?
Reduce dose by 20% on day before + day of surgery (morning or afternoon op)
464
How should Twice daily insulin be managed on DAY BEFORE / DAY OF surgery operation?
Day before: Take as normal Day of: Half morning dose, evening dose as normal (morning or afternoon pm)
465
What tests should you do in your Pre-op assessment of an Elective surgery pt? (7 things) mnemonic
1. DVT / PE assessment + thromboprophylaxis plan 2. Blood tests (FBC / UnE / LFTs / Clotting / Group n Save) 3. Sickle cell test 4. Pregnancy test 5. Urinalysis 6. CXR 7. ECG Dan Brings Silly People Uncooked Cookies Everyday
466
How long should patients fast from non clear liquids n food for b4 surgery?
6 hours
467
How long should patients fast from clear liquids for b4 surgery? Examples of clear liquids?
2 hours water / coffee or tea without milk
468
What are the bloods of someone in DIC? (3 + 2 things)
RAISED: 1. PT 2. APTT 3. D-dimer LOW: 1. Fibrinogen 2. Platelets
469
How is Total Parenteral Nutrition (TPN) done?
Thru Subclavian vein
470
What elec imbalance is a common complication of Subarachnoid Haemorrhages (SAH)?
Hyponatraemia (N+V + loss of consciousness) SAH --\> SIADH
471
How do you manage a life threatening rise in Intra-cranial pressure, e.g in epidural haematoma? What should you do in meantime?
Surgery Meantime give: IV mannitol / furosemide
472
How do you manage diffuse Cerebral oedema?
Decompressive craniotomy
473
How do you manage OPEN depressed skull #s? (2 things)
1. Surgical reduction 2. Debridement
474
How do you manage CLOSED depressed skull #s?
Non-operatively if minimal displacement
475
Who is it appropriate to monitor Intra-Cranial Pressure (ICP) and who is it mandatory to monitor it?
GCS 3-8 w normal CT scan = appropriate GCS 3-8 w abnormal CT scan = must
476
What is the pupil presentation of a CN3 compression secondary to tentorial herniation? (2 things)
1. Unilat dilation 2. No / slow light reponse
477
What is the pupil presentation of a Bilat CN3 palsy or Poor CNS perfusion? (2 things)
1. Bilat dilation 2. No / slow light reponse
478
Which pt are MORE sensitive to Non-depolarizing anaesthetic agents (aka Pancuronium)?
Myasthenia gravis * Non-repolarizing agents: Antagonist for nAChR's --\> produces paralysis by their blockade * Since MG pt have FEWER nAChR's --\> more sensitive to its blockade * Depolarizing agent (aka Suxamethonium) acts ON receptors --\> produces paralysis * MG pt will be resistant to dis
479
What are the CF of Mesenteric infarction? (3 things)
1. Sudden onset pain 2. Vomiting 3. Bloody diarrhoea (sometimes)
480
What is the FIRST LINE investigation for bladder cancer?
Cystoscopy
481
How many hours should you wait after these events to do an accurate PSA test? (according to NICE)
Prostate biopsy: 6 wks UTI: 4 wks DRE: 1 wk Vigorous exercise / ejaculation: 48 hrs
482
What are "Stag-horn" renal calculi made up of? What type of urine do they form in?
Struvite dey form in alkaline urine
483
What test tests the Exocrine function in chronic pancreatitis?
Faecal elastase
484
Who warrants to have a URGENT CT head scan? (4 things)
1. GCS less than 13 2. Post-traumatic seizure 3. Sus open / depressed skull # 4. 2+ vomiting episodes
485
When do you get Spondylolisthesis? (2 things)
1. Stress # 2. Spondylolysis
486
How is Minor / Radically Symptomatic Spondylolisthesis managed?
**M**inor: Active **m**onitoring Radically **S**ymptomatic = **S**pinal decompression + **S**tabilisation
487
What GI condition is Ankylosing spondylitis (aka bamboo spine) strongly associated with?
UC
488
What should you think about if a pt has an ISOLATED fever in first 24 hrs after surgery?
Physiological reaction to op
489
What is the initial management of Acute Limb Ischaemia? (3 things)
1. Analgesia 2. IV Heparin 3. Vasc review
490
What is a 3- cm AAA, and how do you manage?
Dis is normal, not an AAA
491
What is a 3 - 4.4cm AAA, and how do you manage?
Small aneurysm Rescan every 12 months
492
What is a 4.5 - 5.4cm AAA, and how do you manage?
Medium aneursym Rescan every 3 months
493
What is a 5.5+ cm AAA, and how do you manage?
Large aneurysm (rare) 2ww to Vasc surgery
494
What is Hydrocephalus? When do you commonly get it?
Too much CSF in ventricular system Common complication of Intraventricular haemorrhages
495
What are the CF of Hydrocephalus? (3 things)
1. Headache (worse @ morning / lying down / valsalva) (Coma (if severe) 2. Papilloedema 3. N+V
496
What is the FIRST line investigation for sus Hydrocephalus?
CT head
497
What is the treatment for Acute Severe Hydrocephalus?
External ventricular drain (EVD) (insert in lat ventricle to drain)
498
What are the side fx of Bisphosphonates? (given for osteoporosis innit)
Oesophagitis takhali9 min one O yajeek al tani (osteoporosis --\> oesophagitis lol)
499
What is the management for Hypercalcaemia? (4 things)
1. Fluids (1st line) 2. Bisphosphonates 3. Calcitonin 4. Steroids (for sarcoidosis)
500
When is aspirin CI?
PUD
501
What is PKD a risk factor for?
SAH
502
How much blood do you have to lose in haemorrhagic shock for your BP to drop?
30% blood loss
503
What bloods will suggest Renal adenocarcinoma?
Polycthaemia (high Hb)
504
What sign in a CT KUB will indicate that someone had a ureteric stone that has passed?
Peri-ureteric fat stranding
505
What pre-op management should you do for pt taking prednisolone?
Hydrocortisone supplementation
506
What is the biggest risk factor for Testicular cancer?
Infertility 3x da risk
507
What monoclonal antibody can you give for RA?
Infliximab
508
What monoclonal antibody can you give for Crohns?
Infliximab
509
What monoclonal antibody can you give for CRC?
Bevacizumab
510
What monoclonal antibody can you give for HER2 breast cancer?
Trastuzumab (aka herceptin)
511
What monoclonal antibody can you give for Lung fibrosis? What other meds can u give?
Nintedanib (tyrosine kinase inhibitor) Pirfenidone (anti-fibrotic n anti-inflamm)
512
What monoclonal antibody can you give for kidney transplants?
Basiliximab basil my cousin wid da kidney bean fool
513
What meds should you give for Overrreactive bladder?
Antimuscarinic aka Oxybutynin
514
What can Depolarizing anaesthetics (aka suxamethonium) cause?
Malignant hyperthermia
515
What are classical signs of Basilar skull #s?
Raccoon eyes: perio-orbital bruising Battles sign: post auricular bruising
516
After GTN spray and Beta blockers for anginga prophylaxis, what should you give?
Nicorandil Niko omilana for da heart pain
517
What other CT disorder can cause pleural effusion apart from RA?
SLE
518
How do you confirm a diagnosis of SLE?
Antinuclear Antibody (ANA) titre test
519
What ECG changes warrant urgent PCI / thrombolysis? (3 things)
1. 2+ mm ST elevation in V1-6 (in 2+ consecutive leads) 2. 1+ mm ST elevation in II, III, aVF (in 2+ consecutive inf leads) 3. New LBBB
520
What investigationS (plural) r needed to confirm asthma diagnosis? (2 things)
1. FeNO (fractional exhaled nitric oxide) test 2. Spirometry w bronchodilator reversibility
521
What should you prescribe for a asthma exacerbation?
1. Oral prednisolone (once daily for 5 days + stat dose now) 2. Step up current routine
522
How do you know in an ABG if resp acidosis is being compensated for? Is it acute or chronic?
If HCO3 is raised, then kidney is trying to compensate Chronic bc metabolic compensation takes long
523
How does the congenital abn of Coarcation of the aorta present?
Weakened femoral pulses
524
What med is CI in VT?
Verapamil
525
What meds is CI in moderate-severe Aortic Stenosis?
ACEi
526
What is the most common cause of Mitral Stenosis?
Rheumatic fever
527
What is the diagnostic test for Obstructive Sleep Apnoea?
Polysomnography (PSG) PSG for finished sleepy players like messi
528
What is the most common causative organism for Inf Endocarditis, esp in IV drug users?
Staph aureus kohli said staph aureus is in skin so obv iv drug users will be putting dat inside der body
529
What will you see on a ECG of hypothermia? (3 things)
1. Bradychardia 2. J waves 3. Prolonged PR n QT n QRS intervals _J_ hus is _COLD_
530
What should you advise for pt Warfarin due to undergo surgery?
531
What will you see ina ECG of LV aneurysm (MI complication)?
Persistent ST elevation
532
What is the most common organism of Septic arthritis?
Staph aureus
533
What are the CF of septic arthritis? (2 things)
1. Joint pain + swelling 2. Fever
534
What investigation MUST you do for Septic arthritis?
Synovial fluid sampling preferrably b4 abx
535
What is the tx for septic arthritis? (3 things)
1. Flucloxacillin (Clindamycin if penicillin allerg) 2. Needle aspiration (to decompress) 3. Arthroscopic lavage (if needed)
536
How do you investigate a Psoas abscess?
CT abdomen
537
What is Hydroxychloroquine used to treat? (2 things)
1. RA 2. SLE
538
What are the side fx of Hydroxychloroquine?
Retinopathy (visual loss)
539
How do you investigate an Achilles tendon rupture?
US
540
What is the test for Meniscal tears?
McMurrays test (painful click heard)
541
Who is most likely to get Trochanteric bursitis?
Women 50-70 yrs
542
What are the CF of Trochanteric bursitis? (2 things)
1. Pain @ lat side of hip / thigh (unilat) 2. Tenderness @ greater trochanter palpation
543
Where is the most common site of stress #s?
2nd metatarsal shaft
544
What is used to manage Acute flare ups of RA?
IM Methylprednisolone
545
What is the tx for gout? (2 things)
1. NSAIDs 2. Colichine (of NSAIDs CI e.g PUD)
546
How do you differentiate between Psoriatic arthritis and RA?
Psoriatic arthritis is ASYMMETRICAL polyarthritis PA: Dactylyitis (global swelling of finger --\> sausage finger)
547
Who usually has Lateral epicondylitis (aka tennis elbow)?
45-55 yr olds playing tennis / house painting
548
What are the CF of Lateral epicondylitis (aka tennis elbow)? (3 things)
1. Pain + tender @ lateral epicondyle 2. Pain worse @ wrist ext vs resistance + elbow ext 3. Lasts 6months - 2yrs
549
What is the tx for Lateral epicondylitis (aka tennis elbow)? (4 things)
1. Avoid muscle overload 2. Simple analgesia 3. Physio 4. Steroid inj
550
What is Raynaud's phenomenon?
Exagg vasoconstrictive response of finger arteries to cold / emotional stress
551
What are the CF of Raynaud's phenomenon?
Bilat fingers turning white --\> blue --\> red
552
Who is most likely to have Raynaud's phenomenon?
30 yr old women
553
What is Compartment syndrome?
Raised pressure within Closed anatomical space
554
What is Compartment syndrome a complication of? (2 things)
1. Supracondylar #s 2. Tibial shaft injuries
555
What are the CF of Compartment syndrome? (3 things)
1. Pain @ movement (even passive) 2. Parasthesiae 3. Paralysis of muscle group (sometimes)
556
How is a dx of Compartment syndrome made? (2 things)
1. Measurement of intracompartmental pressure (20+ = abn, 40+ = diagnostic) 2. NO XR pathology seen
557
What is the tx for Compartment syndrome? (3 things)
1. Fasciotomy (cut fascia to relieve tension) 2. IV fluids incase of myoglobinuria complication (bc can result in renal failure) 3. Amputation
558
What is a stress #, and what is it caused by?
Small hairline # Caused by repetitive activiting + loading of normal bone
559
What is the CF of stress #s? (2 things)
1. Painful but rarely displaced 2. May present LATE after injury (will see Callus formation around # on XR)
560
What is the tx for stress #?
Immobilisation (if early)
561
How do you differentiate between causes of Marfans vs Ehlers Danlos?
Mar**F**ans = **F**ibrillin 1 mutation Ehler Danlos = Collagen 3 mutation
562
What are the CI for Sulfasalazine (DMARD + IBD tx)? (2 things)
1. G6PD deficiency 2. Allergy to aspirin / sulphonamides
563
What does a +ve femoral nerve stretch test indicate?
Hip pain --\> Referred lumbar spine pain
564
What are the causes of Osteomalacia? (2 things)
1. Vit D deficiency 2. CKD (again low vit D activation)
565
What are the CF of Osteomalacia? (3 things)
1. Bone pain 2. Bone muscle tenderness 3. Waddling gait
566
What is the tx for Osteomalacia? (2 things)
1. Vit D suppl 2. Ca suppl (if low dietary intake)
567
What is pain @ longitudinal compression of thumb a sign of?
Scaphoid #
568
What are the tx options for Extracapsular hip #s? (2 things)
1. Stable intertrochanteric: DHS 2. Subtrochanteric: Intramedullary device (IMD)
569
How do you diagnose Ankylosing spondylitis?
Pelvic XR: Sacro-ilitis aka Subchondral erosions / Sclerosis (early) Not bamboo spine bc das LATE
570
What hand fracture is commonly missed in XR? Why?
Scaphoid # Bc not evident on XR straightaway line will be present after few days (pt will complain of persistent anatomical snuffbox pain)
571
What are the side fx of Bisphosphonates? (2 things)
1. Oesophageal stuff: Oesophagitis / ulcers 2. Hypocalcaemia
572
What are the CF of drug induced lupus? (3 things)
1. Face rash 2. Pleuritis 3. Athralgia / myalgia
573
What is the age and onset of Polymyalgia Rheumatica (PMR)?
60 yrs Rapid onset
574
What are the CF of Polymyalgia Rheumatica (PMR)? (5 things)
1. **Polyarthalgia + Polymyalgia (lol)** 2. Morning stiffness @ prox limb muscles, but NOT weakness (strength no weakness in PMR lol) 3. Fever (low grade) 4. Lethargy 5. Night sweats
575
What will investigations show you in Polymyalgia Rheumatica (PMR)? (2 things)
1. Raised ESR n CRP 2. NORMAL Creatine kinase n antiCCP
576
What is the tx for Polymyalgia Rheumatica (PMR)?
Prednisolone Should react dramatically, if not --\> refer to specialist for alternative dx
577
If you sus Polymyalgia Rheumatica (PMR), but you have raised antiCCP or Creatinine kinase, what should you sus instead?
Raised antiCCP: RA Raised Creatinine kinase: Polymyositis
578
What is long term steroid use (aka for RA) a RF for?
AVN
579
What is the tx for Monomorphic VT vs Polymorphic VT?
Monomorphic: Amoidarone Polymorphic: IV magnesium sulfate
580
What organism are Sickle cell ppl more likely to be infected w?
Samonella Sickle cella samonella rhymes lol
581
How do Posterior hip dislocation present?
Shortened + Internally rot leg
582
What marker can be used to diagnose SLE?
anti-dsDNA
583
How do you differentiate between Greenstick vs Buckle (torus) fractures?
Greenstick: widened gap Buckle (torus): like squeezing 2 cheestrings together --\> head parts flatten out bc pressure
584
Apart from colles #, what FOOSH also cause?
Acromioclavicular joint injury
585
What is the treatment for the different grades of Acromioclavicular joint injuries?
Grade 1-2: Conservative (rest + sling) Grade 3-6: Surgery
586
What is the treatment for Ankylosing Spondyltitis? (2 things)
1. NSAIDs 2. Exercise + Physio
587
What is a risk of using Ciprofloxacin?
Tendon problems (tendinitis / rupture)
588
What is Pagets disease of the bone?
Increased uncontrolled bone turnover
589
What are the CF of Pagets disease of the bone? (3 things)
1. Bone pain (spine / pelvis / femur) 2. Tibia bowing 3. Skull bossing
590
What investigation results will prove Pagets disease of the bone?
Isolated raised ALP
591
What is the tx for Pagets disease of the bone?
Bisphosphonates
592
What do you get after taking antipsychotics for a long time?
Tardive dyskinesia 1. Excessive blinking 2. Lip smacking 3. Dysphagia
593
What should you do for Treatment resistant depression?
ECT (electroconvulsive therapy)
594
What can you get if you stop taking SSRIs? (4 things)
1. Mood changes 2. Insomina 3. Diarrhoea 4. Sweating MIDS
595
How long should Lithium levels be checked after the dose is given?
12 hours
596
What is PTSD symptoms before 4 weeks called?
Acute stress disorder (ptsd has 4 letters so diagnosed after 4 wks)
597
What meds is given for treatment RESISTANT schizophrenia?
Clozapine (atypical antipsychotic)
598
What are the side fx of Atypical antipsychotics (e.g Clozapine)? (6 things)
1. Weight = **O**besity (**O**lanzapine) + Glucose intolerance (-\> DM) 2. Immune = Agranulocytosis (only Clozapine) + Neutropaenia 3. CVS = Myocarditis + Arrhythmias
599
Can you use SSRIs in pregnancy?
No 1st trimester --\> Congenital heart defects (esp Paroxetine) 3rd trimester --\> Pulmonary HTN for baby
600
What is a side fx of SSRI you will see in bloods?
Hyponatraemia
601
What are the side fx of SSRIs? (3 things)
1. GI symptoms (+ GI bleeding) 2. Hyponatraemia 3. Anxiety + agitation
602
What SSRIs have beh drug interaction? (2 things)
1. Fluoxetine 2. Paroxetine
603
What are the side fx of Typical antipsychotics (aka haloperidol n Chlopromazine)? (4 things)
Extrapyramidal side fx 1. Parkinsonism 2. Acute dystonia (muscle contraction e.g Torticollis / Oculogyric crisis) 3. Restlessness (akathisia) 4. **T**ardive dyskinesia (abn invol movemets e.g chewing n jaw pouting) **T**ardive w **T**ypical dat way ull remember is extrapyramidal n remember da rest \*Torticollis = tilting head down
604
What mental health disorder can cause Hypothyroidism?
Anorexia
605
What SSRI can cause Torsade de pointes?
Citalopram (used for major depressive disorder) causes long QT syndrome
606
How do you manage Angina?
For attacks: GTN spray **A**spirin + Statin (1st line) **B**eta / **C**a blocker (monotherapy or both) (1st line still) * If Ca blocker Monotherapy: Verapamil * If Duotherapy: Beta blocker + Nifedipine (safer Ca blocker) If can't handle Duotherapy, instead add: **I**vabradine / **N**icorandil (ABC IN)
607
What should you monitor when giving SNRI's (aka Venlaxafine)?
BP Bc SNRI's can cause HTN
608
What should you monitor when giving Atypical antipsychotics (aka Clozapine)?
FBC Bc can cause Agranulocytosis
609
What should you monitor when giving SSRI's (aka Sertraline)?
UnE's Bc can cause Hyponatraemia
610
How do you manage Acute dystonia secondary to Typical Antipsychotics (aka Haloperidol)?
Procyclidine
611
What is Serotonin Syndrome? (3 things)
Reaction to SSRIs 1. Rigidity 2. Hyperreflexia 3. Autonomic dysfunction
612
How do you treat Serotonin Syndrome?
Benzodiazepines (diazepam)
613
What is the treatment for Tardive dyskinesia (side fx of Typical antipsychotic)?
Tetrabenazine T T T
614
What is Hutchinson's Sign?
Involvment of Nasociliary nerve (from V1) in Herpes Zoster Virus aka Herpes Zoster Opthalmicus (V1 innit) Rash Affects: Eyelid, Eye, Nose
615
What is clarted in Aniscoria of the Right Eye, aka Right pupil dilated at bright light?
Right **Ciliary** Ganglion
616
What is Dermatomyositis?
Multisystem disease characterised by: 1. Skin changes 2. MSK weakness
617
What are the skin changes in Dermatomyositis? (5 things)
1. Scaly scalp 2. Heliotrope: rash around eyes 3. Shawls sign: rash on back n neck 4. Gottrons sign / papules: on hands n knees 5. Raynauds
618
What is the antibody for Dermatomyositis?
Anti-Jo1 antibody Jo has bad skin lol Widad aid dis one has **_Dermato_**myositis is da only one wid skin in da name
619
What kind of MSK weakness do you see in Dermatomyositis? (2 things)
Weakness n fatigue @ everyday activities e.g: 1. Climbing stairs 2. Rising from sitting on couch
620
What is Cradles Cap in babies? (2 things)
1. Scaly rash on babys head 2. Otherwise well
621
How do you treat Cradles Cap in babies?
Olive oil den Baby shampoo
622
What is the triad for Spinal (e.g Lumbar) Abscesses?
1. Fever 2. Back pain 3. Neurological deficit (aka numbness / weakness)
623
What is Reactive Arthritis? (2 things)
1. Type of Spondylolarhritis 2. Arthritis happenining after Infection (clue in name Reactive innit)
624
What is special abt culturing joints of Reactive Arthritis? (2 things)
1. You won't see the pathogens that caused the primary infection 2. NO WBC
625
What are the CF of Reactive Arthritis? (3 things)
1. Conjuctivitis (see) 2. Urethritis (pee) 3. Arthritis (climb a tree) cant see, pee, or climb a tree
626
What is the antibody associated with Reactive Arthritis?
HLA-B27 (like AS)
627
What are the main causative organisms of infections that cause Reactive Arthritis? (3 things)
1. **Campylobacter** 2. Salmonella 3. Shigella All diarrheal infections
628
What is the tx for Reactive Arthritis?
NSAIDs
629
What are the CF of the infections that cause Reactive Arthritis? (4 things)
1. Fever 2. Nausea 3. Abd pain (_crampy_) - (remember cah **_Campy_**lobacter) 4. **Diarrhoea**
630
What is Juvenile idiopathic arthritis (JIA)? (2 things)
1. Arthritis in kids under 16 yrs old 2. Lasts more than 6 weeks
631
What are the CF of Juvenile idiopathic arthritis (JIA)? (3 things)
1. Fever (intermittent) 2. Rashes (evanescent, aka disappear quickly) 3. **Arthritis**
632
What markers will be positive / negative in Juvenile idiopathic arthritis (JIA)? (2 things)
1. ANA = positive 2. RF: negative (obv)
633
What conditions have HLA-B27? (2 things)
1. Ankylosing spondylitis 2. Reactive Arthritis
634
What conditions have HLA-DQ2/DQ8?
Coeliac disease remember we said like d squared lol
635
What conditions have HLA-DR2?
Goodpastures
636
What conditions have HLA-DR3? (3 things)
1. Dermatitis herpetiformis 2. Sjogren's syndrome 3. Primary Biliary Cirrhosis
637
What conditions have HLA-DR4? (2 things)
1. T1DM 2. RA
638
What do you do for Mongolian blue spot in babies?
Reassure parents
639
What should you sus in a teenager with no significant PMHx but with palpable lymph nodes?
Cancer e.g Hodgkins Lymphoma
640
What is a GI side fx of Bendroflumethiazide?
Diarrhoea
641
What does a positive c-ANCA or p-ANCA result mean you have?
AI vasculitis
642
What does a positive anti-SS-A (Ro or La) result mean you could have? (3 things)
1. Sjogren syndrome 2. SLE 3. RA anti-SS-A literally is: anti–**Sjögren's-syndrome**-related antigen A autoantibodies La more associated w Sjorgen syndrome
643
What does a positive anti-ss-DNA or anti-ds-DNA result mean you could have? (2 things)
1. SLE 2. Drug induced lupus
644
What does a positive Anti-Mitochondrial Antibodies (AMA) test mean you could have? (4 things)
1. **Primary biliary cirrhosis (mainly)** 2. AI hepatitis 3. SLE 4. RA
645
What does a positive Rheumatoid factor (RF) mean you could have/
1. RA 2. SLE (also positive anti-ds-DNA) 3. Scleroderma 4. Sjögren's syndrome (also positive anti-SS-A (Ro)) 5. Vasculitis (also positive c-ANCA)
646
What are the 2 tumour markers for Testicular cancer?
1. AFP 2. bHCG
647
What is Sjogren syndrome? (2 things)
1. AI condition 2. Affects EXOCRINE glands --\> dry mucosal surfaces
648
How can you get Sjogren syndrome? (2 things)
1. Primary 2. Secondary to RA / other CT disorders
649
Which gender gets Sjogrens syndrome more?
Women (9:1)
650
What are the CF of Sjogrens syndrome? (4 things)
1. Dry eyes 2. Dry mouth + Recurrent Parotitis 3. Athralgia / Myalgia (Raynauds) 4. Dry vagina
651
What investigations will prove a Dx of Sjogrens syndrome? (4 things)
1. RF: positive 2. ANA: positive 3. Anti- Ro/La: positive 4. Schirmer's test: positive
652
What is the Tx for Sjogrens syndrome? (2 things)
1. Artificial Saliva + Tears 2. Pilocarpine (stim saliva prod)
653
What is Systemic Sclerosis (aka Scleroderma)?
Condition of hardened sclerotic skin + CT
654
Which gender is more likely to have Systemic Sclerosis (aka Scleroderma)?
Females (4:1)
655
What are the CF of LIMITED Systemic Sclerosis (aka Scleroderma)? (5 things)
1. Calcinosis 2. Raynauds 3. Esophagus dysmotilty 4. Sclerodactyly (fingers fusing together) 5. Telangiectasia (like spider naevi) CREST
656
What are the CF of DIFFUSE Systemic Sclerosis (aka Scleroderma)? (4 things)
1. Poor prognosis 2. Resp involvement: ILD, Pulmonary Artery HTN (both --\> death) 3. Renal disease 4. HTN
657
What antibodies are associated w Systemic Sclerosis (aka Scleroderma)? (4 things)
1. ANA 2. RF (30%) 3. LIMITED: anti-centromere antibodies 4. DIFFUSE: scl-70 antibodies
658
What is some Tx for Systemic Sclerosis (aka Scleroderma)? (5 things)
1. Methotrexate (immunosuppressant) 2. Bisphosphonates (for Calcinosis) 3. Emollients (Scleroderma) 4. ACEi (for Renal complications) 5. Nifedipine (for Raynauds) M-BENA
659
What is Temporal Arteritis? (2 things)
1. Inflammation of temporal artery 2. Pt with PMR get it
660
What are the CF of Temporal Arteritis? (7 things)
1. Headache 2. Lethargy 3. Pain at chewing 4. Visual problems (blurring + diplopia) 5. Tender + palpable temporal artery 6. PMR cf: Morning stiffness (no weakness) 7. Rapid onset (1 month)
661
What will investigations tell you its Temporal Arteritis? (3 things)
1. ESR + CRP raised 2. Creatine kinase NORMAL (like in PMR) 3. Temporal artery biopsy (skip lesions)
662
What is the Tx for Temporal arteritis? (2 things)
1. Urgent high dose steroids (even b4 biopsy) * Prednisolone (if no visual loss) * Methylprednisolone (@ visual loss) 1. Bisphosphonates (to protect vs long term steroids above)
663
What happens wen you give Trimethoprin (anti-folate) and Methotrexate? (2 things)
1. Fatal Myelosuppression (w inf, anaemia, bleeding) 2. Fatal Pancytopaenia (low Hb, RBC, platelets)
664
What are the Urate crystals like in the joint aspiration in Gout? (3 features)
1. Needle shaped 2. Negatively birefringent 3. Monosodium
665
What are the crystals like in the joint aspiration in PSEUDOGOUT? (2 features)
1. Weakly _Positively_ birefringent 2. Rhomboid-shaped crystals
666
How do you reduce the risk of side fx with Methotrexate?
Take Folic acid with it (das why taking trimethoprim aka anti-folate with it is bad)
667
How should you manage Antiphospholipid syndrome?
If dx by accident w NO VTE (PE/DVT): Daily low dose aspirin If dx after a VTE: Life long Warfarin
668
What is Interferon-alpha used to treat?
Hepatitis B+C
669
What are the side fx of Interferon-alpha?
Flu like symptoms
670
If you're starting someone on long term steroids, what should you also give them? (3 things)
1. Bisphosphenates (alendronic acid) 2. Vitamin D 3. Calcium suppl Bc steroids clart da bones in longterm
671
When are NSAIDs CI in elderly pt?
If taking warfarin --\> risk of GI bleeds (so if dey have gout, give colchicine instead of NSAIDs)
672
What are the investigation results for Osteoporosis and Osteogenesis Imperfecta?
Calcium, Phosphate, PTH, ALP ALL NORMAL
673
What does Sjogrens syndrome increase the risk of?
Lymphoid cancers aka **Lymphoma**
674
What is the physical examination test for Ankylosing spondylitis?
Schober's test less than 5cm remember dat draw 3 X's on da persons lower spine n get dem to bend forward
675
How should you take Bisphosphonates? (3 things)
1. Take 30 mins b4 breakfast 2. Beh water pls 3. Sit upright for 30 mins after
676
What is an early X ray finding of RA?
Juxta-articular osteoporosis/osteopenia
677
What conditions can cause Pseudogout? (2 things)
1. HyperPTH (high PTH, high calcium, low phosphate) 2. Acromegaly
678
What are the Ca, P, PTH, ALP levels in Osteomalacia?
Low Ca Low P High PTH (bc low Ca) High ALP (weak bone --\> osteoblasts tryna fix it by secreting more ALP) (remember osteomalacia low Ca n vit D)
679
What are the Ca, P, PTH, ALP levels in Pagets disease of the bone?
Normal Ca Normal P Normal PTH High ALP Pagets disease = isolated rise in ALP
680
What are the Ca, P, PTH, ALP levels in Hypo PTH?
Low Ca (bc low PTH) High P Low PTH Normal ALP (bones are fine in hypo PTH)
681
What are the Rotator cuff muscles of the shoulder? (4 things)
1. Supraspinatus 2. Infraspinatus 3. Teres minor 4. Subscapularis SITS
682
What is the function of the Supraspinatus?
Shoulder abduction before Deltoid * FIRST 20 degrees = supraspinatus * 20-90 degrees = Deltoid * Rest = trapezius
683
What is the function of the Infraspinatus?
Lat rot
684
What is the function of the Teres minor? (2 things)
1. Adduction 2. Lat rot (same as infraspinatus one above in SITS list lol)
685
What is the function of the Subscapularis? (2 things)
1. Adduction (same as Teres minor above it in SITS) 2. Med rot
686
What medications can increase the risk of Stress #s?
Bisphosphonates even tho bisphosphonates r mena protect bone, dey cause stress #s, wow dis is STRESSful to learn
687
What are the side fx of Sulfasalazine (DMARD)? (2 things)
1. Oligospermia (low sperm count) (reversible) 2. Lung fibrosis / pneumonitis
688
What is the relation between Methotrexate and Pregnancy?
Both men AND women must stop Methotrexate 6 months before trying to conceive
689
What is the NAME of the thing you will see on a XR of Ankylosing spondylitis?
Syndesmophytes
690
What scoring system is useful for Ehlers Danlos?
Beighton score (assesses hypermobility)
691
What is Fibromyalgia? (2 things)
1. Widespread pain around body 2. Tender points @ specific anatomical sites
692
Who is most likely to have Fibromyalgia?
Women 30-50 yrs old
693
What are the CF of Fibromyalgia? (3 things)
1. Chronic pain @ random sites / all over 2. Lethargy + Headaches + Sleep disturbance 3. Cognitive impairment (dey call it _Fibro_ fog cah **_fibro_**ymyalgia)
694
What is the Tx for Fibromyalgia? (4 things)
1. Explanation 2. CBT 3. Aerobic exercise 4. Meds: Pregabalin / Amitriptyline / Duloxetine (PAD) is all in der head lol
695
What Complement are assoc w SLE?
C3 n C4 will be LOW
696
What does RA put you at the risk of?
IHD remember rheumatic fever n all dat
697
What does the Z score on DEXA scan take into account? (3 things)
1. Age 2. Gender 3. Ethnicity
698
What is the risk of giving Amoxicillin for sore throats? What should you give instead?
If it's Glandular fever (EBV), you will cause them Steven-Johnson Syndrome (painful rash + flu-like symptoms) Penicillin V 500mg QDS 10 days
699
Where is the shoulder pain in PMR?
Shoulder GIRDLE
700
What should you suspect if Cancer + Raised CK?
Polymyositis
701
What is a variant and antibodies for Polymyositis?
Subtype: dermatomyositis anti-Jo-1 antibodies (Jo has bad skin)
702
What are the complications of RA? (5 things)
1. Eyes: Keratoconjunctivitis sicca / scleritis 2. Heart: IHD 3. Reps: Fibrosis / Pleural effusion 4. Feltys Syndrome (RA + Splenomegaly + Low WBC) 5. Joints: Osteoporosis
703
What are the side fx of Methotrexate? (4 things)
1. **Mouth ulcers** 2. Lung fibrosis / Pneumonitis 3. Lung fibrosis 4. Myelosuppresion (esp w Trimethoprin)
704
What should you check for before prescribing Azathioprine?
TPMT deficiency (Thiopurine MethylTransferase Deficiency)
705
What is the tx for Pseudogout? (3 things)
1. NSAIDs 2. Steroid inj 3. Aspirate (to exclude septic arthritis)
706
What can you give in bony metastases of cancer to prevent pathological #s? (2 things)
1. Bisphosphonates 2. Denosumab Deno lol
707
How do you manage acute RA flare ups?
IM methylprednisolone
708
Why do you get **_C_**oca cola urine with **_C_**ompartment syndrome? (6 steps)
1. High pressure in fascial compartment 2. Muscle breakdown 3. Myoglobin released into blood stream (rhabomyolysis) 4. Myoglobin deposits in Renal Tubules 5. AKI 6. Myoglobin --\> Coca cola urine (+ve for blood)
709
What scan should you do for sus osteomyelitis?
MRI OsteoMRIlitis
710
What is Squaring of thumbs a sign of?
OA thumbs stiff in moring for a few _minutes_ (not 1 hour like in RA)
711
How do you manage subluxation of radial head (aka pulled elbow)
Passive supination of elbow joint whilst flexed @ 90 degrees
712
What UTI abx can you use in 1st trimester, 3rd trimester, and breast feeding?
1st trimester = Nitrofurantoin 3rd trimester + breast feeding: Trimethoprim (n before t in alphabet)
713
What is an easy first line management for meningitis (aka raised ICP)?
Tilt head of bed to 30 degrees
714
What meds can increase the hepatotoxicity of paracetamol overdose?
Carbamazepine (enzyme inducer) Bc increases breadkdown of parcaetamol into NAPQI (toxic metabolite)
715
What is the most common kidney cancer?
Renal adenocarcinoma ima simple man, i see loin mass, i put renal adenocarcinoma
716
What should you do for adult with sus hydrocele?
Refer urgently for US to see if tumour hydrocele is fine to reassure in newborns only
717
Which cancer is most commonly assoc w acanthosis nigricans (found in neck, groin, and armpit)?
Gastric adenocarcinoma
718
How do you treat a SAH? (4 things)
1. Coil (by interv neuroradiologist) 2. Craniotomy (sometimes) 3. **Nimodipine (prevents Vasospasm) (finding nemo to stop spazzing)** 4. Ext ventricular draining / shunt (if Hydrocephalus)
719
How do you confirm dx of Primary Sclerosing Cholangitis?
MRCP
720
How do you differentiate between DI and SIADH?
Plasma conc HIGH = DI (rhymes lol) Plasma conc LOW = SIADH Also DI causes polyuria + polydypsia (siadh doesnt)
721
What are the NICE guidelines for management of an Acute Stroke? (3 things)
1. Thrombolysis (within 4.5 hours) 2. Thrombectomy (within 6 hours) 3. Tx dose Aspirin (if not suitable for thrombectomy)
722
What do you give for Heroin (opioid) detoxification rehab? (2 things)
1. Methadone 2. Buprenorphine
723
What do you give for Heroin (opioid) overdose?
Naloxone OD means NalOXone
724
What is the tx for Cellulitis? 1. 1st line Mild moderate: 2. Allergic to penicillin: 3. Allergic to penicillin + pregnant: 4. Severe:
1. 1st line Mild moderate: Flucloxacillin 2. Allergic to penicillin: Clarithromycin / Doxycline 3. Allergic to penicillin + pregnant: Eryhtormycin 4. Severe: Co-amoxiclav
725
What is the tx for Otitis externa?
Topical Ciprofloxacin + Dexamethasone abx + steroid
726
What is the tx for acute Otitis media?
Oral amoxicillin
727
What should you do for new onset dysphagia?
RED FLAG URGENT ENDOSCOPY regardless of age or other symptoms
728
What is a side fx of Clozapine? (3 things)
1. Constipation (clozapine constapine) 2. Agranulocytosis (fatal low WBC) 3. Reduced seizure threshold (cah is a atypical antipsyhotic wid all da metabolic side fx)
729
What is the tx for Acute stress disorder (aka pre PTSD)?
Trauma focused CBT
730
What is Torticollis?
Stiff neck twisted in random position Acute dystonia related side fx of Typical antipsychotics
731
What is **_S_**omatisation disorder?
When patient keeps coming in w **_S_**ymptoms for 2+ yrs n refuses to accept reassurance of negative results
732
What is hypo**_C_**hondriasis?
When pt keeps believing they have **_C_**ancer n refuses to accept negative results
733
What should you give an ADULT vs CHILD wid anorexia nervosa? (3 + 1 things)
Adult: 1. Eating disorder focussed CBT (ED-CBT) 2. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) 3. Specialist Support Clinical Management (SSCM) Child: 1. **Family based therapy**
734
What are the criteria for Anorexia nervosa dx? (3 things)
DSM 5 criteria 1. Restricting dietary intake 2. Fear of gaining weight 3. Denying seriousness of low body weight
735
What can be used with CBT in severe PTSD?
Eye Movement Desensitisation and Reprocessing (EMDR)
736
What is the first line meds for PTSD if CBT n EMDR hasnt worked?
**Venlaxafine (SNRI)** Sertraline (SSRI)
737
What are the side fx of SSRI discontinuation? (3 things)
1. Electric shock sensations 2. Dizziness 3. Anxiety EDA, wagaftal fluoxetine? (an egyptian saying: wts dis, u stopped ur fluoextine?
738
What does the BNF say is the safer SSRI to use in ppl w unstable angina / post MI?
Sertraline **_s_**afe **_s_**ertraline
739
What is Imipramine?
Tricyclic antidepressant (TCA) not used much for depression these days, more for neuropathic pain
740
What are the side fx of Tricyclic antidepressants (e.g Amitriptyline / Imipramine)? (4 things)
Antimuscarinic side fx 1. Can't see = blurred vision 2. Can't pee = urinary retention + overflow incontinence 3. Can't spit = dry mouth 4. Can't sh\*\* = constipation
741
What are the Schneider first rank symptoms for Schizophrenia? (4 things)
A = Auditory hallucinations (2nd / 3rd person) B = Broadcasting / thought withdrawal or insertion C = Controlled (feel like der being controlled) D = Delusional perception
742
What is purging? (3 things)
Behaviour of bulimia that follows binge behaviour (over eating) 1. Self induced vomiting 2. Using laxatives 3. Over exercisign
743
What are the CF of Anorexia nervosa? (3 things)
1. Low BMI 2. Enlarged salivary glands 3. Bradycardia + Hypotension
744
What are the physiological abn that are RAISED in Anorexia Nervosa? (6 things)
Gs n Cs raised: 1. **G**H (tryna compensate innit) 2. **G**lucose (n LOW glucose tolerance) 3. Salivary **G**lands 4. **C**ortisol 5. **C**holesterol 6. **C**arotinaemia (yellow skin)
745
What are the physiological abn that are LOW in Anorexia Nervosa? (4 things)
1. FSH 2. LH 3. Oestrogen / Testosterone 4. Potassium FLOP
746
What should you give if taking a SSRI + NSAID?
Give PPI bc Gi bleed risk
747
What should you think about with a pt on Prednisolone w Psychosis symptoms?
Steroid induced phsychosis
748
What is the timeline for side fx stuff of Alcohol Withdrawal? (3 things)
Sypmtoms: 6-12 hours Seizures: 36 hours Delirium tremens: 72 hours 72-36-18 (half each time, n 6+12 is eighteen lol)
749
What is contraindicated in SSRIs and why?
Triptans can cause Serotonin syndrome
750
What can chronic lithium toxicity cause?
Hypothyroidism
751
What is a side fx of Benzodiazepines?
Anterograde Amnesia
752
When a pt is abt to start ElectroConvulsive Therapy (ECT) what should you do to the Sertraline?
Reduce dose
753
What do SSRIs cause if taken in pregnancy in 1st and 3rd trimester?
1st Trimester: Congenital heart defects 3rd Trimester: Persistant pulmonary HTN in baby
754
What can Lithium do to the FBC?
Raise WBC But its fine, dey acc use lithium for pt with chemo for cancer for dis specific reason
755
What is the MOA of benzodiazepines?
Enhance effect of GABA (main inhibitory neurotransmitter)
756
What class of antidepressant is Mirtzapine?
NaSSA NASA goes to Mars (mirtzapine)
757
What are some useful side fx of Mirtzapine?
Increased appetite (Mmm) Sleepiness (Zzz) **Mmm**irt**Zzz**apine
758
What is the best CBT for Borderline?
Dialectical behaviour therapy (DBT) das raacist der tryna say ppl with borderline have weird dialects
759
How do you differentiate between Mania n Hypomania?
Mania lasts more than 7 days Mania has psycho stuff like Auditory hallucinations / Delusions
760
Which atypical antipsychotic is the most Appropriate to give bc least side fx?
Aripiprazole Most Appropriate is Aripiprazole
761
What are the results of scores of a Mini Mental State Examination (MMSE)?
Normal: 24 - 30 Mild Impairment: 20 - 23 Moderate: 10 - 19 Severe: 9-
762
How long does ICD-10 say symptoms have to be present for for a Dx of depressive episode to be made?
2 weeks
#passmed 2022
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