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in IE, what is enterococci faecalis assoc. with?
GU disease e.g. UTI
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in IE, what proportion are caused by HACEK group? and what gram stain
3% and gram negative coccobacilli
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what organism is assoc. with IE in IVDU?
staph aureus
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what organism is assoc. with bowel cancer and IE?
strep bovis
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what organism is assoc. with dental procedures and IE?
strep viridans
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what organism causes IE in the 1st year of valve replacement?
staph epidermidis
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in hep B, how long does the Hep B surface Ag have to be present for to indicate chronic infection?
6 months
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what % of hep B cases go onto become chronic?
5-10%
-
what % of hep C cases go onto become chronic?
85% (hep C=Chronic!)
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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
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if after lap appendicectomy, the patient gets spiking temps what does that indicate? and so which Ix needs to be done?
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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
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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
- asbestosis
- idiopathic lung fibrosis
-
why are PEs more common in malignancy?
hypercoagulable state
-
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?
silicosis
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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
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which drugs can trigger haemolysis in G6PD deficiency?
- primaquine
- dapsone
- sulphonamides
- aspirin
-
what is dapsone used to treat?
dermatitis herpeteformis
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which 2 diseases is paroxysmal cold Hburia assoc. with? and why do you get haemolysis in it?
- measles
- mumps
- haemolysis due to IgG complement fixing antibodies which lyse RBC in the cold
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what is the triad seen in PNH?
- haemolysis
- thrombosis (get Budd Chiari syndrome)
- pancytopenia
-
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
- lithium
- anti-malarials
-
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?
- cardiovascular
- stroke
- breast cancer
-
if bisphosphonates are not tolerated for osteopenia, whats the next treatment?
calcitonin (inhibits osteoclasts)
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what is the diagnosis if a patient presents with vision loss, severe pain and hyperaemia (reddening) and a semi dilated, unreactive pupil?
acute glaucoma
-
what is the diagnosis if a pt presents with pain, photophobia, red eye (ciliary injection) and lacrimation
anterior uveitis
-
what is the diagnosis if a pt presents with purulent discharge, gritty sensation in the eye, and can present bilaterally
bacterial conjunctivitis
-
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
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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?
- malaria
- thick and thin blood films
-
name four SE of CCB?
- facial flushing
- oedema
- headaches
- dizziness
-
what is the tumour marker for myeloma?
paraprotein
-
what is the tumour marker for breast cancer?
CA-153
-
what is acid phosphatase the tumour marker for?
prostate cancer
-
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
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