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1
Q

What genes are associated with Crohn’s? What other risk factors are there?

A

NOD2 (chromosome 16) & HLA-B27.

Smoking, refined sugar intake, autoimmune disease, female.

2
Q

Describe the pathology seen in the GI tract of a Crohns patient.

A

Skip lesions anywhere along the GI tract. Cobblestone mucosa: mucosal oedema and ulceration with ‘rose-thorn’ fissures. Transmucosal. Granulomatous.

3
Q

What extraintestinal complications can occur in IBD?

A

Uveitis, episcleritis, gallstones, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, amyloidosis.

4
Q

How do you treat an acute exacerbation of Crohns?

A

Fluid resus, IV corticosteroids, high dose 5-ASA analogues, analgesia, parenteral nutrition if required.

5
Q

What are the risk factors of UC?

A

FHx, increased serum pANCA, primary sclerosing cholangitis, autoimmune diseases.

6
Q

Treatment for Acute Cholecystitis?

A

analgesia (not morphine), antiemetics, IV fluids, NBM, IV antibiotics (Cephalosporin). Cholecystectomy

7
Q

Treatment for Acute ascending cholangitis?

A

Analgesia (not morphine), antiemetics, IV fluids, NBM, IV antibiotics (cefuroxime & Metronidazole). Urgent biliary drainage if obstruction is present. Cholecystectomy

8
Q

Causes of pancreatitis?

A

Gall stones, Ethanol, Trauma, Steroids, Mumps, Autoimmune conditions, Scorpion Venom, Hyperlipidaemia, Hypercalcaemia, ERCP, Drugs Pregnancy

9
Q

Assessment of Pancreatitis Severity

A

PaO2 55y, Neutrophils >15x10/L, Calcium 16 mmol/L, Enzymes(LDH) >600 units, Albumin 10g/L 3 positive factors within 48h of onset, should be transferred to ITU

10
Q

What is the treatment of Pancreatitis?

A

NBM, analgesia, IV fluids, hourly monitoring

11
Q

What are the causes of Liver Failure?

A

HALTED: Hepatitis Viral, Autoimmune Hepatitis, Leptospirosis (infection), Toxins, Enzyme deficiency (antitrypsin deficiency), Drugs (Paracetamol, isoniazid, halothane)

12
Q

What are the signs of Chronic Liver Disease?

A

Ascites/Asterixis/ankle oedema, Bruising, Clubbing, Dupuytren’s Contracture, Erythema (palmar)/Encephalopathy, hepatic Foetor, Gynaecomastia, Hepatosplenomegaly/Hair loss, Increase in parotid sice, Jaundice

13
Q

Signs of severe alcohol withdrawal

A

“When Sergy halts his habit madness runs amok” Wernickes encephalopathy, Seizures, Hypoglycaemia, Hypokalaemia, Hypocalcaemia, Malnutrition, Respiratory Alkalosis

14
Q

What is the treatment of severe alcohol withdrawal?

A

Chlordiasepoxide (po), Pabrinex (IV)

15
Q

DDx of Hepatomegaly

A

Cancer, Cirrhosis, Congestive cardiac failure, Constrictive pericarditis, Infiltration: fatty infiltration, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases

16
Q

DDx of Splenomegaly

A

Portal Hypertension, Haematological, Infection (Malaria, TB, Infective Endocarditis, Infectious mononucleosis, Brucellosis), Inflammation (Sarcoidosis)

17
Q

DDx of Abdominal Distension

A

Fat, Faeces, Fluid, Flatus (obstruction), Foetus, Full-sized tumour, Full bladder, Fibroids

18
Q

DDX of Haematemesis

A

Peptic Ulcer Disease, Gastroduodenal erosions/ulcers, Mallory-Weiss tear, Varices, Upper GI bleed, Vascular malformation, Hereditary telengectasia

19
Q

Hair loss on the scalp with a characteristic margin of exclamation mark hair shifts.

A

Alopecia Areata

20
Q

Benign overgrowth of fibroblastic tissue following skin injury, causing an excessively large scar. More common in Afro-Carribeans.

A

Keloid Scarring

21
Q

Fleeting erythematous rash, associated with fever cracked lips, red tongue, swollen hands, and swollen neck glands.

A

Kawasaki Disease (can lead to development of coronary artery aneurysms if not treated)

22
Q

Itchy lesion with an irregular edge, raised surface and variable pigmentation. Changing shape and size and can bleed.

A

Melanoma

23
Q

Slow growing ulcerated lesion with rolled pearly edges and telengiectasia. Normally on sun exposed area.

A

Basal Cell Carcinoma

24
Q

What is Koilonychia and what does it indicate?

A

Spoon shaped nails, Iron deficiency Anaemia

25
Q

What are the cardiac causes of clubbing?

A

Atrial myxoma, aneurysms, congenital CHF, infective endocarditis

26
Q

What nerve is damaged? Wrist drop and loss of sensation in the anatomical snuff box.

A

Radial nerve injury

27
Q

Loss of sensation in thumb, index, middle and lateral half of ring finger. What nerve is damaged?

A

Median nerve injury

28
Q

Claw hand deformity and loss of sensation in little finger and medial half of ring finger. What nerve is injured?

A

Ulnar Nerve

29
Q

What is Grad 1, 2 and 3 HTN? (Diastlic, Systolic)

A

Grade 1 = 140-159/90-99
Grade 2 = 160-179/100-109
Grade 3 >180/110

30
Q

What are the 2 types of HTN, and how are they different?

A

V-hypertension = predominantly Na-volume mediated; direct renin 5uU/ml

31
Q

How are V-hypertension and R-hypertension treated differently?

A
V-HTN = diuretics and vasodilators (CCBs, alpha blockers)
R-HTN = ACEI, ARB, B-blockers
32
Q

What is the immediate treatment for an MI? What other intervention can be offered for a STEMI

A

Morphine, Metaclopramide, Oxygen, Nitrates, Antiplatelets (Aspirin, Clopidogrel, Fondaparinux), B-blocker (unless CI)
PCI (percutaneuous coronary intervention) for STEMI

33
Q

What is considered a normal and a high normal blood pressure?

A

120-129/80-84

130-139/85-89

34
Q

AFTER AN ECG, what is the next investigation you should do on someone with a suspected MI?

A

Blood Test: Troponin (highest 8 hours after MI), serum cholesterol, FBC, U&Es (K), CRP, Glucose, CKMB

35
Q

What is the most important biomarker to check for a patient with chest pain and a previous heart attack in last 2 weeks?

A

CK-MB, less specific than troponin but is only raised for 3 days after an MI (troponin raised for 10 days)

36
Q

MI complications

A

Death, Arrhythmia, Rupture (of septum or outer walls), Tamponade, Heart Failure, Valve disease, Aneursym, Dressler’s Syndrome (autoimmune pericarditis 2-10 weeks after), Embolism, Re-infarction

37
Q

Causes of ST elevation?

A

Normal variant, Electrolyte imbalance, LBBB, Early Repolarization, Ventricular Hypertrophy, Aneurysm, Treatments, Injury (MI), Osbourne waves (hypothermia), Non-Occlusive vasospasm (Prinzmetal’s angina)

38
Q

What is the normal QRS duration?

A
39
Q

What are the causes of RAD?

A

RVH, Pulmonary Embolism, Anterolateral MI, WPW syndrome, Left posterior hemiblock

40
Q

ST depression in leads II, III, and aVF during exertion indicates what? What is the most likely pathology behind this finding?

A

Inferior myocardial ischaemia, most likely due to a ricght coronary artery occlusion

41
Q

How do you present an ECG?

A

This is a 12 lead ECG of Mr/Mrs… presenting with… taken on…
Rate… Rhythm… Axis…
P wave, QRS complex, PR interval, QT interval
ST segment, T wave.
In conclusion this is a 12 lead ECG of Mr.. Presenting with… showing… which is consistent with..

42
Q

Causes of LAD on ECG?

A

Left anterior hemiblock, Inferior MI, VT from LV focus, LVH, WPW sydrome

43
Q

Causes of LAD on ECG?

A

Left anterior hemiblock, Inferior MI, VT from LV focus, LVH, WPW sydrome

44
Q

What are the main symptoms of digoxin toxicity?

A

confusion, irregular pulse, loss of appetite, nausea, vomiting, diarrhea, palpitations, vision changes

45
Q

ST depression in leads V1-V3 with a dominant R wave in V2 indicates what? What is this patient also likely to be suffering from?

A

Posterior MI, rarely occur alone, so likely to accompany an inferior or lateral infarction.

46
Q

23yo F, 24h RIF pain. Tenderness and guarding in RIF. No menstrual symptoms. Abdominal and Pelvic US are normal. Initial DDx and managment?

A

Ectopic Pregnancy, Acute appendicitis.
Should do a FBC and urine sample (hCG), if this is not an option the next best investigation is a diagnostic laparoscopy.

47
Q

30yo M, severe colicky left loin pain, radiated to left groin. Initial ddx and investigation?

A

Renal colic. Unless, pregnant, CT scan is best option, otherwise would do renal US. Haematuria will also be present in 90% of cases.

48
Q

45yo man, sudden onset epigastric pain, constant. Had several previous episode. Drinks half a bottle of whisky a day. Initial DDx and Investigation?

A

Acute Pancreatitis.

Serum amylase is key to diagnosis. CT may help show more specific complications.

49
Q

What are the causes of ST depression?

A

Mitral Valve Prolapse, LV Hypertrophy, Hypokalaemia, Reciprocal ST depression, PE, Subendocardial Ischaemia, Subendocardial Infarct, Encephalon Haemorrhage, Dilated Cardiomyopathy, Shock, Toxicity (Digoxin, Quinidine)

50
Q

What is Salpingitis and what are the most common causes?

A

Infection and inflammation of the fallopian tubes, can be split into acute and chronic.
Bacteria: N.gonorrhoea, chlamydia trachomatis, Mycoplasma, Staphylococcus, Streptococcus.

51
Q

Abnormal smelling vaginal discharge, abdominal pain on having sex, fever, vomiting and nausea. Diagnosis? Investigations?

A

Salpingitis

Pelvic Exam, vaginal swab and blood tests.

52
Q

ECG changes after a STEMI

A

Tented T waves in the affected leads within mins (due to localised hyperkalaemia following myocyte ischemia)
ST elevation lasting 24-48 hours
T wave inversion develops in 1-2 days
Q waves, develop within days and remain permanently

53
Q

Causes of Pericarditis

A

Collagen Vascular disease, Aortic aneurysm, Radiation, Drugs (eg Hydralazine), Infections, Acute Renal Failure, Cardac Infarction, Rheumatic Fever, Injury, Neoplasms, Dresslers Syndrome

54
Q

Jones Criteria of Rheumatic Fever (Major)

A

Major: Carditis, Arthiritis, Subcutaneous Nodules, Chorea (Sydenhams), Erythema Marginatum, Required = evidence of Strep/recent scarlet fever

55
Q

Jones criteria of Rheumatic Fever (Minor)

A

Fever, Rheumatic Fever Hx, Arthralgia, Inflammatory cells, Long PR interval

56
Q

Main 3 Ddx of raised JVP

A

Right Heart Failure (or strain due to pulmonary hypertension), Tricuspid regurgitation, Constrictive Pericarditis

57
Q

Loud systolic murmur, radiates to carotids, ejection click heard at apex

A

Aortic stenosis (no ejection click if stenosis is due to calcification)

58
Q

Pan-Systolic murmur, radiates to axilla, SOB, left ventricular hypertrophy

A

Mitral Regurgitation

59
Q

Low pitched mid-diastolic murmur radiating to apex, best heard if patient rolled onto left side, tapping apex beat.
Commonest cause?

A

Mitral Stenosis, Rheumatic Fever

60
Q

Rumbling murmur increases with inspiration, best heard at lower left sternal edge, little radiation.

A

Tricuspid Stenosis

61
Q

High pitched puffing quality, best heard at left 2nd IS with patient leaning forward, radiates down left sternal border.

A

Aortic Regurgitation

62
Q

What are the classic triad of symptoms for aortic stenosis?

A

Angina, exertional syncope, exertion SOB

63
Q

Ddx of Sinus tachycardia

A

Sepsis, hypovolaemia, thyrotoxicosis, phaeochromocytoma

64
Q

SVT Management

A

1 - Vagal manoeuvre (carotid massage, valsalve manoeuvre)
2 - Adenosine (with continuous cardiac monitoring)
3 - DC cardioversion if evidence of haemodynamic compromise

65
Q

SVT Management

A

1 - Vagal manoeuvre (carotid massage, valsalve manoeuvre)
2 - Adenosine (with continuous cardiac monitoring)
3 - DC cardioversion if evidence of haemodynamic compromise

66
Q

ABCDE Criteria for worrying mole signs

A

Asymmetry, Border irregularity, colour variegation, diameter >6mm, elevation or enlargement of mole

67
Q

How do you measure Breslow thickness? At what depth does 5 year survival drop to only 50%?

A

Granular layer of epidermis to the deepest layer of tumour invasion.
>4mm

68
Q

Syndrome X?

A

angina and positive exercised ECG test but normal coronary arteries on angiogram. Possibly caused by structural or functional abnormalities of coronary microvasculature

69
Q

Prinzmetal Angina

A

AKA Variant angina: angina at rest that occurs in cycles, caused by vasospasm rather than atherosclerosis. Associated with ST elevation during an attack

70
Q

Decubitus Angina

A

Angina on lying down at night, possibly precipitated by cold sheet or increased HR during a dream

71
Q

Murmur on the back below the left scapula, descending to the abdomen + wide pulse pressure

A

Aortic Dissection

72
Q

Risk factors of Aortic Dissection

A

HTN (90%), aortic atherosclerosis, Connective tissue disease, Congenital cardiovascular abnormalities, Aortitis, Iatrogenic, Trauma

73
Q

What is aortitis and what are the 5 main causes?

A

Inflammation of the aorta; Tertiary syphilis, autoimmune vasculitis, giant cell arteritis, Takayasu’s arteritis, RA

74
Q

Signs of aortic insufficiency?

A

collapsing ‘water-hammer’ pulse, wide pulse pressure, displaces thrusting apex beat, early diastolic murmur at lower left sternal edge (expiration, sitting forward)

75
Q

Where/how is Aortic regurgitation best heard?

A

Lower left sternal border; Patient sitting forward in expiration

76
Q

Austin Flint mid-diastolic murmur. What is it and what causes it?

A

murmur over the apex, caused by turbulent reflux (in AR) hitting the anterior cusp of the mitral valve and causing a physiological mitral stenosis

77
Q

What are Quincke’s and Becker’s sign and when are the seen?

A

Q = visible pulsation on nail-bed; B = visible pulsation of the pupils and retinal arteries. Seen in Aortic Regurgitation

78
Q

What are Corrigan’s sign and Muller’s sign when are they seen?

A

Visible pulsations in the neck (C) and of the uvula (Mullers). Seen in aortic regurge.

79
Q

How do you medically manage aortic regurgitation?

A

Vasodilators (e.g Nifedipine) + ACEi

80
Q

Signs of aortic stenosis? (pulse pressure, carotid pulse, apex, murmurs, thrills…)

A

narrow pulse pressure, slow-rising carotid pulse, forceful sustained thrusting undisplaced apex beat, palpable thrill in the aortic area, harsh systolic murmur at left sternal border radiating to the carotid artery and apex

81
Q

How does the Stanford classification divide aortic dissection? Which type has the worst prognosis?

A

Type A = ascending aorta
Type B = descending aorta, distal to the left subclavian artery.
Type A has worse prognosis and needs emergency surgery due to risk of cardiac tamponade

82
Q

Management of chronic AF?

A

B-blocker or Verapamil for rate control (Alternative = digoxin and amiodarone) and Anticoagulation

83
Q

What does a Swanz-Ganz catheter allow you to measure?

A

right atrial, right ventricular, pulmonary artery, pulmonary wedge, and left ventricular end diastolic pressure

84
Q

How do you treat Cardiogenic shock caused by LVF?

A

Give Noradrenaline, dobutamine and send to ITU

85
Q

Hx: Dyspnoea, wheeze, cough with pink frothy sputum. O/E: gallop rhythm, fine crackles throughout lung

A

Acute Left Ventricular failure causing pulmonary oedema

86
Q

Hx: ankle oedema, fatigue, decreased exercise tolerance, anorexia. O/E: raised JVP, hepatomegaly ascites

A

Right Ventricular failure

87
Q

3 types of Cardiomyopathy

A

Dilated, Hypertrophic, Restrictive

88
Q

Peripheral Stigmata of Infective Endocarditis

A

Fever and night sweats, Roth spots, Osler’s nodes, Murmur, Janeway lesions, Anaemia, Nail haemorrhage, Emboli

89
Q

Cloudy unpleasant smelling urine, dysuria (pain), suprapubic/flank pain, fever, malaise. MHx of chronic vesicoureteric reflux.

A

Chronic Pyelonephritis = renal inflammation and fibrosis. Can also be caused by DM, renal obstruction and untreated acute pyelonephritis.

90
Q

1st to 4th line treatment of HTN in

A
1st = ACEi
2nd = + CCB or diuretic
3rd = + CCB + diuretic 
4th = Spironolactone or a-blokcer
91
Q

5 main characteristics of TTP? Treatment?

A

Signs: Microangiopathic haemolytic anaemia, thrombocytopenia with purpura, acute renal insufficiency, neurological abnormalities, fever.
Treatment: plasma-exchange therapy

92
Q

Cystic Fibrosis: genetic inheritance, gene mutation, incidence, micro path, macro path

A

Autosomal recessive, mutation of CFTR gene (c7q), 1/2500 live births.
CFTR encodes a cAMP dependent Cl- channel, which regulates Na/Cl concentration in exocrine secretions (particularly in lung and pancreas).
Thick viscous secretions cause respiratory tract infections, pancreatic insufficiency, mal-absorption and male infertility.

93
Q

What bacteria is most often associated with lung infections of CF patients? How does it present? How is it treated?

A

Pseudomonas aeruginosa, green sputum, Ciprofloxacin + Aminoglycoside

94
Q

How is CF screened in babys?

A

Tests for immunoreactive trypsin, which is increased in CF patients

95
Q

What might you see on a CXR of a patient with CF?

A

upper lobe fibrosis and increased bronchial markings

96
Q

2 most common caused of neonatal jaundice?

A

G6PD deficiency and Hereditary spherocytosis

97
Q

6 symptoms of scurvy? Treatment?

A
Spontaneous petechial (small purple spots), bruising, friable gingiva, loose teeth, bone pain, joint effusions. 
Treatment: Ascorbic acid
98
Q

5 signs of Henoch-Schonlein syndrome. What would be seen on a renal biopsy?

A

Most common systemic vasculitis in childhood. Often preceded by an infection
Signs: non-blanching palpable purpura rash (concentrated on lower extremities), colicky abdominal pain, arthralgia, oedema, renal disease symptoms (proteinuria, haematuria)
Characterised by IgA deposition in renal biopsy.

99
Q

6 symptoms and 4 clinical signs of Solitary aldosterone producing adenoma (AKA Conn’s). Treatment?

A

Symptoms: muscle weakness, cramps, polyuria, polydipsia, paraesthesia, tetany
Signs: HTN, high aldosterone, low renin, low K
Treatment: Spironolactone, surgical removal of adenoma

100
Q

CXR of Bronchiectasis may show..

A

Tram lines and ring shadows

101
Q

4 signs/symptoms of bronchiectasis

A

chronic productive mucopurulent cough (smelly green sputum if severe), haemoptysis, clubbing, coarse inspiratory crackles

102
Q

What would be seen in the LP of someone with bacterial meningitis?

A

Clear, cloudy or purulent appearance, elevated opening pressure, high WBC (>100), high protein (>50), low glucose (

103
Q

3 stages of Churg-Strauss Syndrome

A

1 - airway inflammation: asthma and allergic rhinitis
2 - hypereosinophila: lung and GI tissue damage
3 - vasculitis: cell death

104
Q

Treatment of Churg Strauss Syndrome

A

high does glucocorticoids +/- cyclophosphamide/azathioprine

105
Q

DDx of Collapse

A

Cardiac: vasovagal, arrhythmias, long QT syndrome, aortic stenosis, HOC, PE, postural hypotension
Neural: seizure
Metabolic: hypoglycaemia

106
Q

Angina Medical Treatment

A
1st = B-blocker (e.g. Matoprolol)
2nd = CCB (e.g Verapamil or Nifedipine)
3rd = long lasting nitrate (e.g. Isosorbide nitrate)
107
Q

List the TYPICAL Community Acquired Pneumonia Pathogens ad most common associations. What is the main antibiotic treatment?

A

Streptococcus pneumoniae
Haemophilius influenza = COPD
Moraxella c. = COPD
Mycoplasma pneumonia = 4-yearly pandemics

Treatment = Amoxicillin or Clarithromycin

108
Q

Hospital acquired Pneumonias and their treatment

A

Pseudomonas aeruginosa = Aminoglycoside + Ciprofloxacin
Gram -ve bacilli e.g Klebsiella
Anaerobes

Treatment = Aminoglycoside + cephalosporin IV

109
Q

ATYPICAL Community Acquired Pneumonias + Treatment.

A

Chlamydia pneumonia + C. psittaci = Tetracycline
Legionella pneumophilia = Fluroquinolone + Clarithromycin
Pneumocystis jiroveci = Co-trimoxazole

110
Q

What is the main aspiration pneumonia and its treatment? Who is at risk of aspiration pneumonia?

A

Streptococcus pneumonia = Cephalosporin + Metronidazole IV
Risk = those with stroke, myasthenia, bulbar palsies, decreased consciousness, oesophageal disease or poor dental hygiene.

111
Q

Atypical pneumonia presentations?

A

headache, myalgia, diarrhoea, abdominal pain

112
Q

Presentation for Infectious mononucleosis.

A

Presents: fever, sore throat, fatigue, headache, malaise, pharyngitis, lymphadenopathy, white exudate on tonsils, splenomegaly

113
Q

Investigations (and findings) in Infectious Mononucleosis

A

Paul Bunnell/Monospot test = heterophile antibodies
FBC = Leukocytosis
Blood Film = Lymphocytosis
Serology (accurate but rarely needed) = IgM and IgG antibodies

114
Q

4 defining features of Nephrotic Syndrome

A

proteinuria (>3.5g/24h), oedema, hypoalbuminaemia, hyperlipidaemia

115
Q

Peripheral stigmata of Graves Disease (not seen in toxic multinodular goitre).

A

Thyroid acropachy, periorbital oedema, proptosis, exophthalmos, pretibial myxoedema

116
Q

Symptoms of Bornholm disease. What is the causative virus?

A

Fever, attack of severe pain in lower chest exacerbated by movement (pain comes on suddenly and is often one side, can make it hard to breath)
Caused by the Coxsackie B virus

117
Q

Definition and treatment of paracetamol overdose. best way to test liver function?

A

> 150mg/Kg or >12g total = Overdose
Treatment = N-acetylcysteine (10% develop allergic reaction), alternative = Methionine
PTT = best indicator of liver damage

118
Q

Presentation of paracetamol overdose

A

Initially = nausea, vomiting, lethargy, RUQ pain

At 72h = jaundice, confusion, coagulopathy, hypoglycaemia, hepatomegaly

119
Q

Signs of Hypercalcaemia

A

Kidney stones, polyuria, polydipsia, bone pin, constipation, depression, confusion, lethargy

120
Q

Causes of Hypercalcaemia

A

90% = hyperparathyroidism or malignancy
Others: Calcium supplements, Immobilisation, Iatrogenic, Multiple Myeloma, Milk-Alkali syndrome, Paget’s disease, Addison’s disease, Zollinger-Ellison syndrome, Excessive Vit A or Vit D, Sarcoidosis

121
Q

Reasons for dialysis in Acute Kidney Injury

A

Metabolic acidosis, Hyperkalaemia, Intoxication (Salicylic acid, Lithium, Isopropranol, Mg based diuretics, Ethylene glycol), Fluid overload refractory to diuretics, Signs or uraemia

122
Q

Aetiology and 4 symptoms of Alport’s Syndrome

A

Familial nephropathy due to abnormal type IV collagen. Can be inherited in x-linked, AR or AD pattern.
Symptoms: Gross haematuria (precipitated by infection), sensorineural hearing loss, renal failure, central retinopathy

123
Q

What is Tietze’s syndrome and how does it present? Treatment?

A

Costochondritis
Insidious onset of anterior chest wall pain, made worse by movement and inspiration. Pain on palpation. Treated with NSAIDs (rule out other ddx).

124
Q

What investigations are carried out on someone with suspected Nephrotic syndrome? Most common cause?

A

24h urine protein or spot urine protein-creatinine ration. Renal biopsy needed to make a definitive diagnosis.
Most common cause is Diabetic nephropathy

125
Q

Occupational lung disease (mining), marked by inflammation and scarring in nodular lesions of the upper lobes of the lung. Presents with SOB, cough, fever and cyanosis

A

Silicosis - irreversible condition with no cure. Treat symptoms.

126
Q

10% rule of Phaeochromocytoma

A

10% bilateral, 10% malignant, 10% extradrenal… 25% hereditary

127
Q

Genes associated with Phaeochromocytoma

A

MEN2A, MEN2b, VHL

128
Q

Clinical signs of Phaeochromocytoma

A

Increased urinary and serum catecholamines, metanephrines and normetanephrines.
Raised VMA in 24h urine.

129
Q

DDx of a red eye

A
Angle glaucoma (painful red eye, vomiting, impaired vision, haloes around light)
Uveitis (photophobia, pain, lacrimation, blurred vision)
Acute conjunctivitis (itchy red eye)
130
Q

What would be seen on examination of a patient with Acute closed angle glaucoma?

A

red eye, hazy cornea, loss of red reflex, fixed and dilated pupil, hard and tender eye, cupped optic disc, visual field defect, raised IOP

131
Q

3 signs of Felty’s Syndrome

A

Rheumatoid arthiritis + splenomegaly + neutropenia

132
Q

Cystic hygroma definition and presentation

A

Congenital benign collection of lymphatic sacs; cysts contain clear fluid and transilluminate brightly
Presentation: soft, fluctulant lump, transilluminates, normally on posterior triangle of neck

133
Q

Presentation of Branchial cyst? Investigation?

A

Non-tender fluctulant swelling anterior to the sternocleidomastoid, at the junction of it’s upper and middle thirds. Can become enlarged and inflamed after a respiratory tract infection
Investigation: fine needle aspiration (creamy yellow turbid fluid containing cholesterol crystals)

134
Q

Top 5 UK hospital-acquired infections.

A

MRSA, VRE (Vancomycin resistant enterococci), ESBL, Pseudomonas, Acinetobacter.

135
Q

Difference between Seminomas and Teratomas.

A

Seminoma: 30-40yo, arise from seminiferous tubules, B-hCG production
Teratoma: 20-30yo, arise from germ cell tumours, aFP and B-hCG production

136
Q

Lower Urinary Tract Symptoms

A

Voiding symptoms: hesitancy, terminal dribbling, weak stream

Storage symptoms: nocturia, frequency, urgency

137
Q

Symptoms of Wegener’s Granulomatosis

A

Glomerulonephritis, nosebleeds, hearing loss, gingivitis/oral ulcerations, eye inflammation, haemoptysis, subglottal stenosis, arthiritis, purpura

138
Q

Definition of cirrhosis

A

Fibrosis with nodular regeneration

139
Q

CURB65 scoring

A

Used in Pneumonias

Confusion, Urea >7mmol/L, RR > 30bpm, BP 65

140
Q

Abdominal pain, raised IgM, raised ALP and antimitochondrial antibodies.

A

Primary Biliary Cirrhosis

141
Q

6 P’s of Acute limb ischaemia

A

Painful, Pale, Pulseless, Perishing Cold, Paraesthetic, Paralysed

142
Q

4 condition in Tetrad of Fallot

A

VSD, Over-riding aorta, RVH, Pulmonary stenosis

143
Q

LP results of viral meningitis

A

Clear appearance, high WBC (10-1000), high protein (>50mg), normal glucose (>60%)

144
Q

LP results of Guillain-Barre

A

Xanthochromia + high protein

145
Q

LP results of MS

A

Oligoclonal bands, slightly high protein

146
Q

LP results of TB

A

clear/opaque appearance, high opening pressure, high WBC, low glucose, high protein

147
Q

LP results of Subarachnoid Haemorrhage

A

Xanthochromia/bloody appearance, high opening pressure, high protein

148
Q

6 main types of generalized seizures

A

GrandMal, Absence, Myoclonic, Clonic, Tonic, Atonic

149
Q

4 types of partial seizure

A

Simple Motor, Simple sensory, Simple psychological, Complex

150
Q

Type of seizure? Loss of consciousness, convulsions, muscle rigidity, tongue biting, incontinence

A

Grand-Mal / Tonic-Clonic (generalized seizure)

151
Q

Type of seizure? Loss of consciousness for seconds only, no convulsions

A

Abscense (Generalized seizure)

152
Q

Type of seizure? Sporadic/isolated jerking movements ‘like electrical shocks’

A

Myoclonic (generalized seizure)

153
Q

Type of seizure? Repetetive, jerking movements involving both sides at the same time

A

Clonic (Generalized seizure)

154
Q

Type of seizure? Muscle stiffness and rigidity, no loss of consciousness

A

Tonic (Generalized seizure)

155
Q

Type of seizure? loss of muscle tone, particularly arms and legs, often results in a fall

A

Atonic (generalized seizure)

156
Q

Type of seizure? Awareness is retained, jerking, muscle rigidity, spasms, head turning

A

Simple motor (partial)

157
Q

Type of seizure? Awareness is retained, unusual sensations affecting the vision, hearing, smell, taste or touch

A

Simple sensory (Partial)

158
Q

Type of Seizure? impairment of awareness, automatisms such as lip smacking, chewing, fidgeting, walking or other repetitive, involuntary but coordinated movements

A

Complex partial

159
Q

2+ episodes of neurological dysfunction separated in time and space (normally temporary visual or sensory loss)

A

Multiple Sclerosis

160
Q

Muscle weakness which increases with exercise, diplopia, drooping eyelids, SOB, proximal limb weakness, facial paresis, oropharyngeal weakness.

A

Myasthenia Gravis

161
Q

Myasthenia Gravis treatment?

A

Anticholinesterases & Immunotherapy

162
Q

Clinical diagnosis of Type 1 Neurofibromatosis (Recklinghausen’s disease)

A

2/7 of: 6+ café au lait spots, axillary freckling, 2+ neurofibromas, optic glioma, 2+ lisch nodules (iris harmatomas), osseous lesion, Fhx in first degree relative

163
Q

Acute ascending weakness in a lower motor neurone pattern, absent reflexes

A

Guillian-Barre Syndrome

164
Q

Presentation of CLL

A

recurrent infections, easy bruising, FLAWS, enlarged rubbery non tender lymph nodes, smear cells, lymphocytosis, splenomegaly, +ve direct coombs test

165
Q

Presentation of CML

A

sweats, splenomegaly, FLAWS, bruising, epistaxis, abdominal discomfort, early satiety, high WCC, peripheral immature granulocytes, Philadelphia chromosome

166
Q

Triad of symptoms seen in Wernicke’s

A

Opthalmoplgia with nystgmus, ataxia, encephalopathy

167
Q

Causes of Cavitating lung lesions

A

Infection: TB, Staph, Klebsiella
Inflammation: WG, RA
Infarction: PE
Malignancy

168
Q

Causes of Mononeuritis Multiplex

A

(WARDS PLC) Wegeners Granulomatosis, AIDS, Amyloid, Rheumatoid, Diabetes mellitus, Sarcoidosis, PAN, Leprosy, Carcinomatosis

169
Q

Causes of Polyneuropathies

A

(DAVID) Diabetes, Alcoholism, Vitamin Deficiency (B1, B12), Infective (Gullain Barre), Inherited (CMT), Drugs (Isoniazid)

170
Q

Symptoms of Carpal Tunnel syndrome. Which nerve is trapped?

A

aching pain in hand and arm, paraesthesia in thumb, index and middle fingers, pain relieved by shaking it, worse at night

171
Q

Best way to diagnose a Mononeuropathy?

A

Electromyography (EMG)

172
Q

Signs of Ulnar nerve pathology?

A

weakness/wasting of medial wrist flexors, can’t cross fingers, claw hand, weak little finger abduction, sensory loss of medial 1 and a half fingers

173
Q

Signs of radial nerve pathology

A

Wrist and finger drop with elbow flexed and arm pronated - radial nerve can be damaged by compression against the humerus

174
Q

Symptoms of Guillain-Barre Syndrome

A

Hx of recent resp or GI illness
Acute flaccid paralysis, proximal and symmetrical muscle weakness of lower limbs, ascending weakness, diminished reflexes, paraesthesia and numbness, aching/throbbing pain

175
Q

Main features of Myelofibrosis

A

Night sweats, fever, weight loss, HEPATOSPLENOMEGALY, LEUKOERYTHROBLASTIC cells, DACROCYTES (tear-drop shaped RBCs), Low Hb

176
Q

Treatment of Myelofibrosis

A

Marrow support, stem cell transplant. Median survival = 5years

177
Q

Signs of Polycythaemia Rubra Vera

A

Hyperviscosity: headaches, dizziness, tinnitus, visual disturbance. Itch an erythromelagia (especially after a hot bath). Facial plethora, splenomegaly

178
Q

Treatment of Polycythaemia Rubra Vera

A

Venesection
Higher risk patients = Hydroxycarbamide
Woman of child-bearing age = a-interferon

179
Q

Symptoms of bulbar palsy (PBP = 10% of MND)

A

LMN lesion
flaccid, wasted, fasciculating tongue, absent/normal jaw jerk, absent gag reflex, nasal/hoarse speech, dysarthria, dysphagia

180
Q

Symptoms of a pseudobulbar palsy (seen in PLS, a type of MND)

A

UMN lesion
brisk jaw jerk; spastic, slow tongue; spastic, slow dysarthria; increased jaw jerk, increased pharyngeal/palatal reflexes; emotional incontinence and mood change

181
Q

CXR of patient with CF

A

upper lobe fibrosis and increased bronchial markings

182
Q

CXR of patient with Sarcoidosis

A

Bilateral hilar lymphadenopathy

183
Q

DDx of CXR showing small calcified nodules in lungs

A

Varicella pneumonitis, TB, Histoplasmosis, chronic renal failure

184
Q

Causes of bilateral hilar lymphadenopathy

A

Sarcoidosis, Infection (TB, pneumoconiosis), Malignancy, Organic dust disease (Silicosis), Extrinsic allergic alveolitis

185
Q

Cause of upper zone fibrotic shadowing on CXR

A

TB, Extrinsic Allergic Alveolitis, Ankylosing spondylitis, Radiotherapy, Sarcoidosis

186
Q

Causes of Mid Zone fibrotic shadowing on CXR

A

Progressive massive fibrosis

187
Q

Causes of Lower Zone fibrotic shadowing on CXR

A

Idiopathic pulmonary fibrosis, Asbestosis

188
Q

6 symptoms + 2 signs of Waldenstrom’s Macroglobulinamia

A

Symptoms: Nose bleeds, blurred vision, retinal haemmorhage, weight loss, splenomegaly, cervical lymphadenopathy
Signs: Lymphoplasmacytoid B cells, IgM