1. in IE, what is enterococci faecalis assoc. with?
    GU disease e.g. UTI
  2. in IE, what proportion are caused by HACEK group? and what gram stain
    3% and gram negative coccobacilli
  3. what organism is assoc. with IE in IVDU?
    staph aureus
  4. what organism is assoc. with bowel cancer and IE?
    strep bovis
  5. what organism is assoc. with dental procedures and IE?
    strep viridans
  6. what organism causes IE in the 1st year of valve replacement?
    staph epidermidis
  7. in hep B, how long does the Hep B surface Ag have to be present for to indicate chronic infection?
    6 months
  8. what % of hep B cases go onto become chronic?
  9. what % of hep C cases go onto become chronic?
    85% (hep C=Chronic!)
  10. 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
  11. if after lap appendicectomy, the patient gets spiking temps what does that indicate? and so which Ix needs to be done?
    • pelvic abscess
    • do Us
  12. 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
  13. what is the immediate treatment of an acute haemolytic transfusion reaction?
    stop transfusion and saline started
  14. which is the most commonest type of primary lung cancer?
    squamous cell carcinoma
  15. What is the differential for upper zone bilateral fibrosis in CXR?
    • TB
    • radiation
    • EAA
    • Ank spond
  16. 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
  17. why are PEs more common in malignancy?
    hypercoagulable state
  18. 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
  19. if you see egg shell calcification at lymph nodes on CXR, what does that indicate?
  20. what are the commonest complications of G6PD deficiency?
    • neonatal jaundice
    • haemolytic anaemia
  21. what is the triad of features of intravascular haemolysis?
    • jaundice
    • anaemia
    • Hburia
  22. what 3 things would you see on the blood film of G6PD deficiency?
    • Heinz bodies
    • Bite cells
    • Blister cells
  23. What causes the formation of Heinz bodies?
    deficient glutathione leads to oxidised metHb which precipitates out as Heinz bodies
  24. which drugs can trigger haemolysis in G6PD deficiency?
    • primaquine
    • dapsone
    • sulphonamides
    • aspirin
  25. what is dapsone used to treat?
    dermatitis herpeteformis
  26. 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
  27. what is the triad seen in PNH?
    • haemolysis
    • thrombosis (get Budd Chiari syndrome)
    • pancytopenia
  28. which organ enlarges in spherocytosis and why?
    spleen due to extravascular haemolysis - RBCs destroyed in reticuloendothelial system.
  29. which 3 drugs can make psoriasis worse?
    • beta blockers
    • lithium
    • anti-malarials
  30. what is the best diagnostic test for m.gravis?
    nerve conduction studies with repetitive nerve stimulation
  31. if there is a K>6 what is the treatment…give 2 options!
    • 10mls of 10% calcium gluconate
    • calcium chloride
    • both protect myocardium
  32. what 3 adverse risks does HRT carry?
    • cardiovascular
    • stroke
    • breast cancer
  33. if bisphosphonates are not tolerated for osteopenia, whats the next treatment?
    calcitonin (inhibits osteoclasts)
  34. what is the diagnosis if a patient presents with vision loss, severe pain and hyperaemia (reddening) and a semi dilated, unreactive pupil?
    acute glaucoma
  35. what is the diagnosis if a pt presents with pain, photophobia, red eye (ciliary injection) and lacrimation
    anterior uveitis
  36. what is the diagnosis if a pt presents with purulent discharge, gritty sensation in the eye, and can present bilaterally
    bacterial conjunctivitis
  37. 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
  38. what is the diagnosis if fluorescein staining shows a characteristic ulcer with a branching pattern
    herpes simplex keratitis (dendritic ulcers)
  39. what level of GCS requires intubation?
    8 or less
  40. 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
  41. name four SE of CCB?
    • facial flushing
    • oedema
    • headaches
    • dizziness
  42. what is the tumour marker for myeloma?
  43. what is the tumour marker for breast cancer?
  44. what is acid phosphatase the tumour marker for?
    prostate cancer
  45. 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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