BDS General Medicine Flashcards

24 sample cards from the General Medicine deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. What is the mainstay drug therapy for peptic ulcer disease, and how is H. pylori eradicated?

   Proton pump inhibitors (PPIs) suppress acid to promote healing. H. pylori is eradicated with triple therapy: a PPI plus two antibiotics (commonly amoxicillin and clarithromycin) for 7-14 days.

2. Compare Crohn's disease and ulcerative colitis in Inflammatory Bowel Disease.

   Crohn's: affects mouth-to-anus (skip lesions), transmural inflammation, non-caseating granulomas, cobblestone mucosa, fistulae/strictures. Ulcerative colitis: confined to colon/rectum, continuous mucosal/submucosal inflammation, crypt abscesses, bloody diarrhoea, no granulomas.

3. Which IBD is associated with smoking as a risk factor, and which is paradoxically improved by smoking?

   Smoking worsens/is a risk factor for Crohn's disease, whereas ulcerative colitis is more common in non-smokers/ex-smokers and may paradoxically be less severe in smokers.

4. Define liver cirrhosis pathologically.

   Irreversible, diffuse hepatic fibrosis with conversion of normal architecture into structurally abnormal regenerative nodules, resulting from chronic liver injury. It is the end stage of chronic liver disease.

5. List the major complications of decompensated cirrhosis.

   Portal hypertension leading to oesophageal varices (bleeding), ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, coagulopathy, and hepatocellular carcinoma.

6. What does the Child-Pugh score use to assess cirrhosis severity?

   It grades cirrhosis (classes A, B, C) using five parameters: serum Bilirubin, serum Albumin, Prothrombin time/INR, Ascites, and hepatic Encephalopathy.

7. Compare the transmission routes of hepatitis A, B, and C viruses.

   Hepatitis A: faecal-oral (contaminated food/water), acute only. Hepatitis B: blood, sexual, and vertical (perinatal) transmission, can be chronic. Hepatitis C: predominantly blood-borne (IV drug use), high rate of chronic infection.

8. Which hepatitis serological marker indicates immunity, and which indicates active/current infection in hepatitis B?

   Anti-HBs (surface antibody) indicates immunity (from vaccination or recovery). HBsAg (surface antigen) indicates active/current infection, and HBeAg indicates high infectivity/active replication.

9. Define stroke and distinguish the two main types.

   Stroke is an acute focal neurological deficit from a vascular cause lasting $> 24$ hours. Ischaemic stroke (about 85%): occlusion of a cerebral vessel (thrombosis/embolism). Haemorrhagic stroke (about 15%): rupture of a vessel causing intracerebral or subarachnoid bleeding.

10. What is a transient ischaemic attack (TIA) and why is it important?

    A transient focal neurological deficit due to temporary ischaemia, resolving fully (classically within 24 hours) without infarction. It is important as a warning sign of high subsequent stroke risk, requiring urgent evaluation.

11. What is the key acute treatment for ischaemic stroke and its time window?

    IV thrombolysis with alteplase (tPA), ideally given within 4.5 hours of symptom onset after haemorrhage is excluded on imaging. Mechanical thrombectomy is used for large-vessel occlusion, generally up to 6-24 hours in selected patients.

12. Define epilepsy and distinguish focal from generalized seizures.

    Epilepsy is a tendency to recurrent, unprovoked seizures from abnormal excessive neuronal discharge. Focal (partial) seizures begin in one hemisphere/region (may have preserved or impaired awareness); generalized seizures involve both hemispheres from onset (e.g., tonic-clonic, absence).

13. Define status epilepticus and state its emergency first-line drug.

    A seizure lasting $> 5$ minutes, or recurrent seizures without recovery of consciousness between them. It is a medical emergency; first-line treatment is a benzodiazepine (IV lorazepam or diazepam, or buccal/IM midazolam).

14. What is the core pathology of Parkinson's disease and its classic triad of signs?

    Degeneration of dopaminergic neurons in the substantia nigra pars compacta (with Lewy bodies), reducing striatal dopamine. Classic triad: resting tremor (pill-rolling), rigidity (cogwheel), and bradykinesia; postural instability is a fourth cardinal feature.

15. What is the most effective drug treatment for Parkinson's disease and why is it combined with carbidopa?

    Levodopa (L-DOPA), a dopamine precursor that crosses the blood-brain barrier. It is combined with carbidopa (a peripheral DOPA-decarboxylase inhibitor) to prevent peripheral conversion, reduce side effects, and increase central availability.

16. Define multiple sclerosis and its underlying pathology.

    A chronic autoimmune, inflammatory, demyelinating disease of the CNS in which the immune system attacks myelin, causing plaques/lesions disseminated in space and time. This slows/blocks nerve conduction, producing relapsing-remitting or progressive neurological deficits.

17. What is Uhthoff's phenomenon in multiple sclerosis?

    Transient worsening of MS symptoms (e.g., blurred vision) with an increase in body temperature, such as during exercise, fever, or a hot bath, due to heat-sensitive slowing of conduction in demyelinated fibres.

18. Define acute kidney injury (AKI) and its three categories by cause.

    AKI is a rapid decline in renal function over hours to days, with rising creatinine and/or reduced urine output. Causes: pre-renal (hypoperfusion), intrinsic/renal (e.g., acute tubular necrosis), and post-renal (obstruction of urine outflow).

19. State the diagnostic criteria for AKI (KDIGO).

    AKI is diagnosed by any of: rise in serum creatinine $\geq 26.5$ µmol/L within 48 hours; a $\geq 1.5$-fold rise in creatinine from baseline within 7 days; or urine output $< 0.5$ mL/kg/h for $\geq 6$ hours.

20. Define chronic kidney disease and how it is staged.

    CKD is abnormal kidney structure or function present for $\geq 3$ months. It is staged by GFR: G1 $\geq 90$, G2 60-89, G3a 45-59, G3b 30-44, G4 15-29, G5 $< 15$ mL/min/1.73m² (kidney failure), combined with albuminuria (A1-A3).

21. Write the eGFR/creatinine clearance concept and name the classic Cockcroft-Gault formula components.

    GFR estimates filtering capacity. Cockcroft-Gault estimates creatinine clearance: $$CrCl = \frac{(140 - age) \times weight \times (0.85\ if\ female)}{72 \times serum\ creatinine\ (mg/dL)}$$

22. List the common metabolic and systemic consequences of chronic kidney disease.

    Anaemia (reduced erythropoietin), renal bone disease/CKD-MBD (hyperphosphataemia, low vitamin D, secondary hyperparathyroidism), metabolic acidosis, hyperkalaemia, fluid overload/hypertension, and increased cardiovascular risk.

23. What ECG changes are associated with hyperkalaemia, a key danger in acute and chronic kidney disease?

    Progressive changes: tall peaked T waves, then flattened/absent P waves and prolonged PR, widening of the QRS complex, and ultimately a sine-wave pattern leading to ventricular fibrillation or asystole.

24. What is cor pulmonale and which chronic lung disease commonly causes it?

    Cor pulmonale is right ventricular hypertrophy and/or failure secondary to pulmonary hypertension from a chronic lung disorder. COPD is a common cause, via chronic hypoxaemia causing pulmonary vasoconstriction and increased right ventricular afterload.

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