in IE, what is enterococci faecalis assoc. with?
GU disease e.g. UTI
in IE, what proportion are caused by HACEK group? and what gram stain
3% and gram negative coccobacilli
what organism is assoc. with IE in IVDU?
what organism is assoc. with bowel cancer and IE?
what organism is assoc. with dental procedures and IE?
what organism causes IE in the 1st year of valve replacement?
in hep B, how long does the Hep B surface Ag have to be present for to indicate chronic infection?
what % of hep B cases go onto become chronic?
what % of hep C cases go onto become chronic?
85% (hep C=Chronic!)
if a patient with renal failure gets gout, what is the first line symptom control treatment and why not indomethacin/diclofenac?
- these are CI in renal failure
- so give colchicine
if after lap appendicectomy, the patient gets spiking temps what does that indicate? and so which Ix needs to be done?
40 year old man with hypertension is brought to the Emergency department with a severe headache and a painful left eye and ptosis and 'down and out' eye, what is cause?
posterior communicating artery aneurysm
what is the immediate treatment of an acute haemolytic transfusion reaction?
stop transfusion and saline started
which is the most commonest type of primary lung cancer?
squamous cell carcinoma
What is the differential for upper zone bilateral fibrosis in CXR?
what is the differential for lower zone bilateral fibrosis on CXR?
- drugs e.g. amiodarone
- Connective tissue disease e.g. rheumatoid arthritis
- idiopathic lung fibrosis
why are PEs more common in malignancy?
what is battle sign and what does it indicate?
- when get discolouration due to blood tracking behind the ear at mastoid process
- indicates basal skull fracture
if you see egg shell calcification at lymph nodes on CXR, what does that indicate?
what are the commonest complications of G6PD deficiency?
- neonatal jaundice
- haemolytic anaemia
what is the triad of features of intravascular haemolysis?
what 3 things would you see on the blood film of G6PD deficiency?
- Heinz bodies
- Bite cells
- Blister cells
What causes the formation of Heinz bodies?
deficient glutathione leads to oxidised metHb which precipitates out as Heinz bodies
which drugs can trigger haemolysis in G6PD deficiency?
what is dapsone used to treat?
which 2 diseases is paroxysmal cold Hburia assoc. with? and why do you get haemolysis in it?
- haemolysis due to IgG complement fixing antibodies which lyse RBC in the cold
what is the triad seen in PNH?
- thrombosis (get Budd Chiari syndrome)
which organ enlarges in spherocytosis and why?
spleen due to extravascular haemolysis - RBCs destroyed in reticuloendothelial system.
which 3 drugs can make psoriasis worse?
- beta blockers
what is the best diagnostic test for m.gravis?
nerve conduction studies with repetitive nerve stimulation
if there is a K>6 what is the treatment…give 2 options!
- 10mls of 10% calcium gluconate
- calcium chloride
- both protect myocardium
what 3 adverse risks does HRT carry?
- breast cancer
if bisphosphonates are not tolerated for osteopenia, whats the next treatment?
calcitonin (inhibits osteoclasts)
what is the diagnosis if a patient presents with vision loss, severe pain and hyperaemia (reddening) and a semi dilated, unreactive pupil?
what is the diagnosis if a pt presents with pain, photophobia, red eye (ciliary injection) and lacrimation
what is the diagnosis if a pt presents with purulent discharge, gritty sensation in the eye, and can present bilaterally
what is the diagnosis if a pt presents with history of projectile eye injury (drilling etc). Important features are pain, particularly on eye movements and lacrimation
corneal foreign body
what is the diagnosis if fluorescein staining shows a characteristic ulcer with a branching pattern
herpes simplex keratitis (dendritic ulcers)
what level of GCS requires intubation?
8 or less
20 year old man has recently returned from the Far East. He has had myalgia, headache, bouts of abdominal pain and diarrhoea for one week. He has a temperature of 390C, blood pressure of 130/ 60 mmHg, pulse rate of 104 beats per minute and oxygen saturations of 92% on air. what do you suspect and so which investigation?
- thick and thin blood films
name four SE of CCB?
- facial flushing
what is the tumour marker for myeloma?
what is the tumour marker for breast cancer?
what is acid phosphatase the tumour marker for?
when should barium not be used and why? whats the substitute?
- barium should not be used if suspect perforation as it will cause peritonitis if allowed into the peritoneal cavity (as in if there is a perf it will get in, not that it directly will cause the perf)
- use gastrograffin as a substitute