3a (1) Flashcards
1
Q
What is the sequence of puberty in females?
A
Breast buds-pubic hair-axillary hair-menarche
2
Q
At what age can menarche occur?
A
From 10y onwards, average age 13 and falling
3
Q
At what age should you investigate delayed menarche?
A
Around 15y
4
Q
At what age should you investigate no signs of puberty?
A
14y
5
Q
What hormonal axis control the menstrual cycle?
A
Hypothalamic-pituitary-ovarian (HPO) axis
6
Q
What is the role of the HPO axis?
A
Pulsatile production of GNRH by the hypothalamus stimulated the pituitary to produce the gonadotrophins (FSH and LH). These stimulate the ovary to produce oestrogen and progesterone.
7
Q
When in the cycle is the LH surge?
A
14 days before the onset of menstruation - the oestrogen level becomes high enough to stimulate a surge of LH, which stimulates ovulation
8
Q
Define menstruation
A
The loss of blood and uterine epithelial slough; lasts 2-7 days and is usually heaviest at the beginning. Normal loss is 20-80mL
9
Q
Define climacteric
A
The ovaries fail to develop follicles. Without hormonal feedback from the ovary, FSH and LH levels rise. Periods cease, usually at ~50y.
10
Q
How can you postpone menstruation?
A
Norethisterone 5mg/8h PO from 3 days before period due until bleeding acceptable, or 2 packets COCP back to back
11
Q
Define primary amenorrhoea
A
Failure to start menstruating. Ix in 15y, or 14y with no breast development
12
Q
Define secondary amenorrhoea
A
When periods stop for >6mo other than due to pregnancy. HPO axis disorders are common, ovarian and endometrial causes rare
13
Q
Define ovarian insufficiency/failure
A
May be secondary to chemotherapy, radiotherapy or surgery. Can be caused by genetic disorders, particularly those affecting the X chromosome. One X is needed for ovarian differentiation but 2 needed by oocytes
14
Q
Define oligomenorrhoea
A
Infrequent periods. Common in extremes of life when regular ovulation does not occur. Common cause throughout reproductive years is PCOS
15
Q
Define menorrhagia
A
Excessive blood loss
16
Q
Define dysmenorrhoea
A
Painful periods (+/- nausea or vomiting)
17
Q
Define primary dysmenorrhoea
A
Pain without organ pathology. Crampy with ache in back or groin, worse during first day or two. Excess prostaglandins cause painful uterine contractions, producing ischaemic pain.
18
Q
How could you treat primary dysmenorrhoea?
A
NSAIDs to inhibit the prostaglandins eg mefenamic acid, paracetamol, COCP
19
Q
Define secondary dysmenorrhoea
A
With associated pathology eg adenomyosis, endometriosis, chronic sepsis (chlamydia), fibroids. Treat cause
20
Q
What can cause intermenstrual bleeding?
A
A midcycle fall in oestrogen production, cervical polyps, ectropion, carcinoma, cervicitis/vaginitis, hormonal contraception, IUCD, STIs, pregnancy related
21
Q
What can cause post-coital bleeding?
A
Cervical trauma, polyps, cervical/endometrial/vaginal carcinoma, cervicitis/vaginitis, STIs
22
Q
What is the pathophysiology of respiratory distress syndrome?
A
Lack of surfactant causes alveolar collapse
23
Q
You are looking after a pregnant woman who is likely to give birth prematurely. What drugs should you give to a) mother and b) the child?
A
a) corticosteroids b) surfactant (intratracheal)
24
Q
What are the signs of RDS in the neonate?
A
Tachypnoea, intercostal recession, nasal flaring, tracheal tug
25
What are the possible complications of RDS?
Pneumothorax, chronic lung disease
26
What is transient tachypnoea of the newborn?
Tachypnoea that goes away - typically caused by too much fluid in the lungs - c-section a risk factor as normal birth squeezes fluid out
27
What can cause jaundice <24h post birth?
This is abnormal jaundice - haemolysis, infection
28
What can cause jaundice >24h post birth?
This can be normal - 50% of all neonates. Caused by liver immaturity and increased RBC breakdown, dehydration, bile duct obstruction, neonatal hepatitis.
29
Neonatal jaundice Ix
Bilirubin level blood test
30
Neonatal jaundice Rx
Phototherapy or if v serious exchange transfusion
31
What is NEC?
Necrotising EnteroColitis - bacterial invasion of ischaemic bowel wall, typically seen in premature infants
32
What are the symptoms of NEC?
Vomiting, poor feeding, distended abdomen, blood in stool. May progress to shock, perforation
33
NEC Rx
IV ABx, TPN, ITU
34
What are the features of Trisomy 21?
Craniofacial appearance - epicanthic folds, flat nasal bridge, Brushfield spots|Congenital heart defects (most commonly AVSD)|Duodenal atresia
35
What are the long term complications of Trisomy 21?
Leukaemia/solid tumour risk, hearing impairment, increased risk of Alzheimer's epilepsy
36
What are the most common congenital heart conditions?
VSD, PDA, ASD
37
What is Trisomy 13?
Patau's syndrome
38
What is Trisomy 18?
Edward's syndrome
39
If a child is cyanotic with a murmur what is the defect likely to be?
ToF, TGA
40
If a child is unwell what murmurs are likely?
Large VSD - can present with HF and FTT
41
What causes the murmur in ASD?
Increased flow across the pulmonary valve -systolic ULSE murmur
42
How do we treat ASD and does everyone need treatment?
Close ASD surgically - only patients with RV compromise need treatment. However there is a risk of paradoxical embolisation if ASD remains patent in later life
43
Where is the murmur is VSD?
LLSE generally - the larger the defect the quieter the murmur
44
Why is a large VSD a problem?
Large VSDs are larger than the aortic valve - results in heart failure
45
What needs to be avoided in VSD patients?
Eisenmenger syndrome (R>L shunting)
46
What does PDA sound like?
A constant murmur heard below left clavicle
47
PDA Rx
NSAIDs (inhibit prostaglandins) or closure of the duct with a coil at around 1y of age
48
What are the four features of ToF?
Pulmonary stenosis, overriding aorta, RVH, VSD
49
What might you see on XR in ToF?
Boot shaped heart - due to RVH
50
What is TGA?
Vessels are the wrong way round - there are two parallel circulations going on. Cyanotic, may not have a murmur. Need to maintain PDA and do urgent surgery
51
What is the immediate management of acute severe exacerbation of asthma in a child?
15/L O2 via NRB|Assess peak flow|Salbutamol nebs|Steroids
52
What are some features of life threatening asthma?
Silent chest|PEF <33%|Poor respiratory effort|Hypotension|Exhaustion
53
Name 2 organs involved in CF
Small bowel - malabsorption, lungs - recurrent infections
54
How do we screen babies for CF?
Immunoreactive trypsinogen test
55
How do we diagnose CF?
Sweat test
56
Name a bacteria that can commonly cause chronic infection in CF
Pseudomonas aeruginosa
57
Barking cough
Croup
58
Bronchiolitis age
90% before 1y
59
Bronchiolitis typical organism
RSV - Respiratory Syncytial virus
60
Bronchiolitis Sx
Breathing difficulties following coryzal Sx
61
Bronchiolitis Ix
RSV swab, O2 sats
62
Bronchiolitis Rx
Supportive
63
Croup age
6mo-6y
64
Croup organism
Parainfluenza virus
65
Croup Sx
Barking cough, stridor, worse at night
66
Croup Ix
O2 sats, AVOID EXAMINATION OF THROAT
67
Croup management
Oral corticosteroids, O2, intubation in airway obstruction (rare)
68
Epiglottitis age
1-6y
69
Epiglottitis organism
H. influenzae
70
Epiglottitis sx
High grade fever, no cough, rapid onset, child sitting upright to maintain airway
71
Epiglottitis rx
Intubate, cultures, ABx
72
Pertussis age
Infants that haven't had first jab, <4m
73
Pertussis organism
Bordatella pertussis
74
Pertussis sx
Week of coryzal sx followed by paroxysmal coughing phase - whooping following cough
75
Pertussis ix
Per-nasal swab to identify
76
Pertussis rx
Erythromycin
77
What is Septic arthritis?
Acute inflammation of the joint typically caused by s.aureus
78
Septic arthritis ix
Blood cultures, joint aspiration and culture
79
Septic arthritis rx
IV abx (fluclox)`
80
DDH age
Infants
81
Perthes age
4-10
82
SUFE age
Teens
83
Redcurrent jelly stool, drawing knees up to chest, paroxysmal abdominal colic pain
Intussusception
84
2 mo old brought to surgery with fever, temp over 38. Management?
Admit to hospital
85
Pyloric stenosis electrolyte abnormality
Hypochloraemic hypokalaemic metabolic alkalosis
86
What are the features of an atypical UTI in a child?
Seriously ill|Poor urine flow|Abdo or bladder mass|Raised creatinine|Septicaemia |Failure to respond on suitable abx within 48h|Infection with non E. coli organisms
87
Kawasaki disease rx
Aspirin and one dose IV immunoglobulin
88
Hirschprung disease signs and symptoms
Bilious vomiting, abdo distension, constipation, failure to pass meconium in first 48h
89
What birth weight is diagnostic for foetal macrosomia?
Anything over 4kg, no matter gestational age
90
What palsy can be caused by shoulder dystocia? What are the symptoms?
Erb's palsy. Adduction and internal rotation of arm
91
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
92
What is the most common cause of headache in children?
Migraine
93
At what age would the average child acquire the ability to sit without support?
7-8 months
94
A boy is noted to have a webbed neck and pectus excavatum
Noonan syndrome
95
An infant is found to have small eyes and polydactyly
Patau syndrome
96
A 7-year-old boy with learning difficulties and macrocephaly
Fragile X
97
Most common cause of severe early onset (first 7 days) sepsis in newborn infants
GBS
98
Most useful investigation to screen for complications of Kawasaki disease
Echocardiogram - for coronary artery aneurysms
99
Define precocious puberty in females
Development of secondary sexual characteristics before 8 years of age
100
Which vaccines should be avoided in immunocompromised patients?
Live attenuated vaccines - BCG, MMR, oral polio, yellow fever, oral typhoid, intranasal influenza, oral rotavirus
101
What symptoms of migraine are far more common in children than adults?
GI disturbances
102
Which booster vaccines do young people usually receive between the ages of 13-18 years?
Diptheria, Tetanus, Pertussis, Polio, Men ACWY
103
What blood test is appropriate for a child you suspect may have coeliac disease?
IgA and IgA tTG
104
What is the most common presenting feature of Wilms' nephroblastoma?
Abdominal mass
105
What is the mode of inheritance of Prader-Willi syndrome?
Imprinting - child does not receive gene from father and mother may be normal
106
How is Hirschprung's disease diagnosed?
Rectal biopsy
107
What is the quick way to tell if a condition is AD or AR?
AD conditions are mostly "structural"|AR conditions are mostly "metabolic"
108
A 14-year-old male being investigated for iron-deficiency anaemia is found to have numerous polyps in his jejunum. On examination he is also noted to have pigmented lesions on his palms and soles. What is the likely diagnosis?
Peutz-Jeghers syndrome
109
What is the most common complication of roseola infantum?
Febrile convulsions
110
A mother brings her 5-week old newborn baby to see you. She reports that she has noticed that his belly button is always wet and leaks out yellow fluid. On examination, you note a small, red growth of tissue in the centre of the umbilicus, covered with clear mucus. The child is otherwise well, apyrexial and developing normally. Diagnosis?
Umbilical granuloma
111
What is the most common cause of death of infants greater than one month but less than one year old?
SIDS
112
A 12-year-old female from Bulgaria presents to the surgery. She reports being unwell for the past 2 weeks. Initially she had a sore throat but she is now experiencing joint pains intermittently in her knees, hips and ankles. On examination there are some pink, ring shaped lesions on the trunk and occasional jerking movements of the face and hands. What is the most likely diagnosis?
Rheumatic fever
113
A 5-year-old girl is brought in to see her GP by her mother complaining of increased frequency of passing urine and dysuria. This has never happened before and she is otherwise well. The GP asks for a urine sample to be given before starting antibiotics. Pending culture results, he decides to prescribe a 3-day course of antibiotics. Which antibiotic would be most appropriate in this case?
Trimethoprim
114
A 3-year-old girl presented to the general practitioners 1 week ago for recurrent epistaxis and bruising on her flanks. Clotting has also been assessed and revealed a prolonged prothrombin time. |Hb 80g/l (115-135)|Platelets 100 * 109/l (150-450)|WBC 10.0 * 109/l (5.0-17.0)|Neutrophils 1.0 * 109/l (1.5-8.5)|Diagnosis?
Acute lymphoblastic leukaemia
115
A newborn baby is noted to have low-set ears, rocker bottom feet and overlapping of her fingers. What is the most likely diagnosis?
Edward's syndrome
116
Micrognathia|Posterior displacement of the tongue (may result in upper airway obstruction)|Cleft palate
Pierre-Robin syndrome
117
Hypotonia|Hypogonadism|Obesity
Prader-Willi syndrome
118
Short stature|Learning difficulties|Friendly, extrovert personality|Transient neonatal hypercalcaemia|Supravalvular aortic stenosis
William's syndrome
119
Features on examination of a baby with Down's syndrome?
Single palmar crease, sandal gap, Brushfield spots, epicanthic folds
120
What are the complications of congenital rubella?
Sensorineural deafness, congenital cataracts
121
Charlie is a 7 month old baby boy who presents to you with poor weight gain (50th to 10th centile), on examination he has an erythematous, blanching rash over his abdomen, colicky abdominal pain and vomiting after feeds. He has been breast feeding with top ups of 'Aptamil' formula. What is the most likely diagnosis?
CMP intolerance
122
Risk factors for DDH?
Female gender|Breech presentation|Family history|Firstborn|Oligohydramnios
123
6-year-old boy is diagnosed as having nephrotic syndrome. A presumptive diagnosis of minimal change glomerulonephritis is made. What is the most appropriate treatment?
Prednisolone
124
Which cells produce surfactant?
Type 2 pneumocytes
125
A baby is born by elective Caesarean section at 38 weeks performed due to pregnancy-induced hypertension. At one hour the female baby is noted to be grunting with mild intercostal recession. Oxygen saturations are 95-96% on air. What is the most likely cause of her respiratory distress?
Transient tachypnoea of the newborn
126
How are squints classified?
Squints may be classified as to where the eye deviates toward:|the nose: esotropia|temporally: exotropia|superiorly: hypertropia|inferiorly: hypotropia
127
What is the most likely outcome following the diagnosis of minimal change nephropathy in a 10-year-old male?
Full recovery but with later recurrent episode
128
First step of newborn resus
Dry the baby
129
What is the causative agent of roseola infatum?
HHV6
130
A 2-year-old boy is presented with multiple petechiae and excessive bruising on his shins. He was previously fit and well apart from a an illness two weeks ago which was diagnosed by the general practitioner as a viral upper respiratory tract infection and for which he was only given paracetamol. His symptoms today were only noticed by his mother half an hour ago. He is apyrexial. Investigations including blood smears reveal thrombocytopaenia with all other parameters reported as normal.
ITP
131
A 2 week old infant with a small chin, posterior displacement of the tongue and cleft palate
Pierre-Robin syndrome
132
Supravalvular aortic stenosis is found in a 3 year old boy with learning difficulties
William's syndrome
133
A 9-week-old is noted to have a small chin and rocker-bottom feet
Edwards syndrome
134
What is the recommended compression:ventilation ration for the newborn?
3:1
135
In the UK, what is the most common cause of death in children greater than one year old?
Accidents
136
Diagnostic criteria autism
Global impairment of language and communication|Impairment of social relationships|Ritualistic and compulsive phenomena
137
Croup treatment
Oral dexamethasone
138
Constipation treatmens
Advice on diet/fluid intake and movicol paediatric plan
139
Pityriasis rosea
Herald patch, lethargy, lesions only on trunk
140
Meningococcal septicaemia
Meningism, non-blanching rash
141
Scarlet fever
Strawberry tongue, facial sparing
142
Chicken pox
Itchy, starting on head before spreading. Macular->vesicular->papular
143
Measles
Starting on face, spreading to body. Koplik spots
144
What is the carrier rate of cystic fibrosis in the UK?
1 in 25
145
Recommended alcohol limits for men and women
14 units men 14 units women. Pregnant women abstain for first trimester then no more than 2 units per week.
146
What is a unit of alcohol?
A standard measure of the alcohol content of a drink, taking into account the strength (%ABV) and the volume (pint/litres), this is 8g of alcohol
147
Give some social and psychological risk factors for problem drinking
Drinking within the family|Childhood problem behaviour relating to impulse control|Early use of alcohol, nicotine and drugs|Poor coping responses to life events|Depression as a cause not a result of problem drinking
148
What is the link between deprivation and alcohol?
Adverse effects of alcohol exacerbated amongst lower socio-economic groups|More likely to experience negative effects directly and indirectly|Lack of money means less likely to protect themselves against negative health and social consequences
149
Most common causes of death due to alcohol
Accidents and violence|Malignancies|Cerebrovascular disease|Coronary heart disease
150
What amount of alcohol puts a patient at risk of liver damage?
No significant risk of liver damage at less than 30g alcohol a day. Average intake of men with cirrhosis 160g a day
151
Fatty liver symptoms
Rarely has symptoms - perhaps malaise or nausea. Completely reversible on withdrawing alcohol
152
Alcoholic hepatitis symptoms
Vary - anorexia, nausea, abdo pain, weight loss, susceptibility to infection. Severe is a medical emergency - ascites, bleeding, encephalopathy
153
What is the relationship between alcohol and CV disease?
Moderate alcohol intake can protect against IHD thought to be due to raised HDL lipids|Heavy alcohol use increases risk, hyperlipidaemia, raises blood pressure|Alcohol can precipitate arrhythmias notably AF
154
What is the relationship between alcohol and cancer?
25-50 head and neck cancers due to alcohol - mouth, larynx, pharynx, oesophagus. Also increased risk of liver, stomach, colon, rectum, pancreatic, breast cancer
155
What are the risks of drinking alcohol in pregnancy?
Can increase miscarriage risk, more likely to have LBW baby. Persisten drinking can cause Foetal Alcohol Syndrome - affects ~6000 babies born annually
156
What is Foetal Alcohol Sydrome?
Small underweight babies, slack muscle tone|Mental retardation, behavioural and speech problems, characteristic facial appearance|Cardiac, renal, ocular abnormalities
157
What is the AUDIT questionnaire?
10 point questionnaire, takes 5 min. 8=likely hazardous drinking, 13 for women and 15 for men indicated alcohol dependence
158
What is the CAGE questionnaire?
Cut down|Angry or annoyed when criticised about drinking|Guilt|Eye opener
159
What pharmacological agents can prevent alcohol relapse?
None are particularly effective|Disulfiram (ANTABUSE) to sensitise against|Acamprosate, GABA blocker|Naltrexone used in specialist centres
160
ICD 10 definition of Alcohol Dependence Syndrome
Cluster of 3 of below symptoms in a 12 month period|Tolerance - more alcohol to achieve same effect|Characteristic psychological withdrawal|Difficulty controlling onset, amount and termination of use|Neglect of social and other areas of life|Spending more time obtaining and using alcohol|Continued use despite negative physical and psychological effects
161
What is Wernicke's Encephalopathy?
A serious disorder caused by vitamin B1 deficiency, often occurs on withdrawal of alcohol. Reversible, if left untreated can lead to Korsakoff's and death
162
What are the symptoms of Wernicke's Encephalopathy?
Triad of symptoms - acute mental confusion, ataxia and opthalmoplegia
163
What is the treatment of Wernicke's Encephalopathy?
IV/IM thiamine vitamin B1 (pabrinex)
164
What is Korsakoff's syndrome?
Amnestic disorder due to enduring B1 malnutrition. Not reversible. Diagnosed by CT scan
165
What are the symptoms of Korsakoff's syndrome?
Loss of spontaneity, initiative and confabulation
166
What is delirium tremens?
A short-lived (3-5 days) toxic confusional state which usually occurs as a result of reduced alcohol intake in alcohol dependence individuals with a long history of use
167
What are the symptoms of delirium tremens?
Clouding of consciousness/confusion/seizures. Hallucinations in any sensory modality. Marked tremor
168
What is the treatment of delirium tremens?
Supportive - fluids, benzodiazepine to prevent fitting
169
Myasthenia gravis
An acquired, organ-specific autoimmune disorder, of unknown cause, in which antibodies are directed against the postsynaptic acetylcholine receptor
170
Groups commonly affected by myasthenia gravis
Young women (20-35y), older men (60-75y, tend to have oculobulbar presentation
171
Myasthenia gravis general clinical features
Fatigability - all features worse after exercise and at end of day. Ptosis and opthalmoplegia presenting features in 50%. Limb reflexes normal or hyperactive but fatigue on repeated testing.
172
Myasthenia gravis features by system
Ocular - ptosis, diplopia|Other cranial muscles - weak face and jaw, dysarthria, dysphonia, dysphagia|Limb weakness - usually proximal - shoulder and hips|Neck weakness - neck flexion and extension - pts can present w difficulty lifting head|Resp muscle weakness - SoB
173
Myasthenia gravis Ix
Tensilon (edrophonium) test|Serum acetylcholine receptor and MUSK antibodies|Electromyography|Thymus imaging|autoantibodies|Spirometry - check VC
174
Myasthenia gravis Rx
Oral acetylcholinesterases - pyridostigmine|Thymectomy in those with thymic hyperplasia|Immunosuppression - with corticosteroids commonly
175
What dependence symptom: "I have moved from drinking wine, beer and whisky to just wine every day"
Narrowed repertoire
176
What dependence symptom: I used to drink one bottle, then I needed two, now three bottles of wine a|day
Tolerance/increased tolerance
177
What dependence symptom: I need to have a drink first thing in the morning to stop the shakes
Withdrawal
178
State two blood tests to screen for alcohol dependence and state how each is affected
GGT - raised|RBC MCV - raised|CDT - raised
179
Three days after his last drink the patient presents with agitation, tremors|and dilated pupils. He is also observed to be responding to visual hallucinations|which consist of "little spiders". What is the diagnosis?
Delirium tremens
180
An alcoholic patient with delirium is rushed to hospital as he is more confused and has ataxia,|ophthalmoplegia and nystagmus. What syndrome is he presenting with?
Wernicke's encephalopathy
181
If a patient with Wernicke's encephalopathy is not treated with pabrinex or thiamine, what condition might they develop?
Korsakoff's psychosis
182
Describe three blood indicators of thyroid disease which should be investigated in a patient with symptoms of hyperthyroidism.
TSH - low in primary hyperthyroidism, high in secondary hyperthyroidism|Free T4/T3 - raised levels confirm the diagnosis and give an indication of severity|Thyroid autoantibodies/anti-thyroid perioxidase - if Grave's disease or autoimmune thyroid disease suspected
183
Give three medications appropriate in hyperthyroidism and why they are appropriate.
Beta blockers - act to block effect of increased circulating thyroxine, relieves increased HR, anxiety, sweating|Carbimazole - inhibits production of thyroid hormones and is standard rx of thyrotoxicosis, however works over weeks not immediately|Lubricating eye drops/ointment - ease eye irritation
184
What important things must be done for a patient with newly diagnosed hyperthyroidism?
Information given about condition|Refer to thyroid service for further investigation and management|Refer to Opthalmology for eye assessment|Advise him to stop smoking as it significantly increases eye complications in Grave's disease
185
A 36-year-old woman consults her General Practitioner for contraceptive advice. She also has heavy, painful periods and wishes to know if there is anything that can be|done to reduce her menstrual losses and control the pain. She has two children aged|5 and 2 years and her family is complete. She smokes 20 cigarettes per day. Most appropriate rx?
Mirena IUS
186
A nine year old boy with eczema presents with increasing pruritis of his hands and behind his knees, despite regular use of emollients. On examination he is unkempt with generally dry skin, in particular on his hands and behind his knees. Here the skin|is very erythematous and painful. There are multiple pustules and a yellow crust is evident. What treatment is appropriate?
Flucloxacillin
187
A 24 year old woman presents to her local Emergency Department with a one-week history|of problems in her lower limbs. Her legs have felt increasingly heavy, numb to touch, weak and clumsy. She has not passed urine for the last twenty-four hours. She|has no pain. Two years previously she had some difficulties with cloudiness of vision|in her right eye, but never sought medical advice about this. Neurological examination|reveals normal vision with a relative afferent pupillary defect on the right. There is reduced sensation below T12. Lower limbs: increased tone, brisk tendon reflexes and extensor plantars. Upper limbs: normal. Dx?
MS
188
Researchers set out to determine whether the association between outdoor air pollution and stroke. They use census areas as their unit of analysis and obtain data on stroke incidence and the airborne concentration of fine particulate matter for each of these census areas. What study design?
Ecological study
189
Describe delirium tremens
Acute alcohol withdrawal|Peaks at 72h|Acute confusional state and hallucinations
190
Describe Wernicke's encephalopathy
Confusion, ataxia, opthalmoplegia
191
Describe Korsakoff's syndrome
Confabulation, retro and antegrade amnesia, personality changes
192
A woman has an ovarian cyst. Name 4 signs on USS suggestive of malignancy
Multiocular, bilateral, free fluid, mixture of cystic and solid
193
Name 4 preoperative blood tests before ovarian cancer removal and give rationale
FBC - anaemia|U&Es - renal function|Cross match and group and save - in case of blood loss|Clotting screen - risk of bleeding
194
Name the procedure used to remove ovarian malignancy
Salpingo-oophorectomy
195
What screening method is used to assess the risk of Down's syndrome antenatally?
Quad test
196
Name 4 risks of amniocentesis
Miscarriage|Club foot|Infection - amniocentitis|Rhesus disease if woman rhesus -ve
197
Name 3 chromosomal abnormalities and give karyotype
Edwards syndrome - trisomy 18|Pataus syndrome - trisomy 13|Kleinfelters syndrome - 47XXY
198
Give an example and explanation of a service that is supplied but not needed or demanded
Over 75 health check by GP - proven not to help and pts don't ask for it
199
Give an example and explanation of a service that is supplied and needed, but not demanded
Baby Guthries testing - mother would rather baby not harmed but needed for early diagnosis of conditions
200
Define epidemiological needs assessment
Deciding what a population needs based on the incidence and prevalence of certain diseases
201
Define comparative needs assessment
Individuals with similar characteristics to those receiving help, examines health status, utilization
202
Define corporate needs assessment
Getting input from a number of individuals or groups to decide what is needed most (press, patients, professionals, politicians)
203
Give two disadvantages of comparative needs assessment
Relative, not quantifiable
204
A child visits GP with fever/malaise, limp, hepatosplenomegaly. What two conditions do you want to rule out?
Leukaemia, septic arthritis
205
Name three classes of drugs for arthritis (not biologics) and give examples
NSAIDs - ibuprofen|DMARDS - methotrexate|Corticosteroids - prednisolone
206
9 month old child presents with redness in the creases of neck, axilla and groin, his|skin is peeling, what is the diagnosis
Scalded skin syndrome
207
What is the causative organism of scalded skin syndrome?
Staph aureus
208
Why does the skin peel in scalded skin syndrome?
Staph releases endotoxin between the layers of skin, makes the layers peel
209
What do you do if a child in your GP surgery becomes unresponsive?
Call for help/999|Assess ABCDE|Perform simple airways maneuvre
210
What two systems would you monitor after giving gentamycin?
Ears and kidneys
211
Parkinson's disease - describe the histology, area effected|and neurotransmitter involved
Lewy bodies in the substantia nigra in the basal ganglia. Reduced dopamine
212
Give two upper limb signs in Parkinson's
Cog wheel rigidity, pill rolling tremor
213
Name two drugs for treatment of Parkinson's
Levodopa, ropinirole
214
Name two drugs that would aggravate symptoms/signs of Parkinson's?
Metoclopramide, olanzipine
215
How does Parkinson's affect handwriting?
Micrographia that tails off
216
Given a patient with gait disturbance, incontinence and dementia you order a CT to rule out what?
Normal pressure hydrocephalus
217
Elderly man with COPD admitted for acute exacerbation and receives treatment, 4|days later he wishes to discharge himself, what four pieces of information are|required to plan his discharge?
Drugs, OT, physio, f/u appt, letter GP
218
Name the four principles of couple therapy
Promote communication|Change views of relastionship|Modifies dysfunctional behavior|Decreases emotional avoidance|Promotes strength
219
Name the four tests of negligence
Does the Dr have duty of care|Was there a breach of duty of care|Did the patient come to harm|Did the breach cause harm
220
Define the person approach to error
Looking for an individual who causes the error
221
Define the systems approach to error
What in the system caused the error to occur
222
A baby is born prematurely at 24 weeks gestation. What lung problem is he likely to develop soon after birth?
Respiratory distress syndrome
223
What pharmacological agent may be given prophylactically post delivery to reduce the severity of RDS?
Surfactant. Brands include Curosurf and Survanta
224
A baby with RDS is established on the ventilator and his condition is stable for 48 hours. Then his blood gases suddenly deteriorate and he develops a bradycardia. On examination of the chest there are no breath sounds audible on the right side|of the chest. The right side of the chest transilluminates. The cardiac apex beat is deviated to the left. Diagnosis?
Right pneumothorax
225
A neonate develops jaundice with a plasma unconjugated bilirubin concentration of 200|μmol/L (normal less than 20 μmol/L). What treatment will you recommend?
Phototherapy
226
A neonate suddenly develops apnoea and bradycardia and is found to have a distended|and discoloured abdomen and bilious vomiting.
Necrotising enterocolitis/NEC
227
A neonate has continuing jaundice. His urine is noted to be dark. What substance in the urine is causing this?
Conjugated bilirubin
228
Define cyanosis in physiological terms
Greater than 5 grams/decilitre of deoxygenated haemoglobin
229
A girl with VSD has had temperatures over the last two weeks, has increasing malaise and is eating less than ususal. On examination, she is|pyrexial. She is quite short of breath, looks cyanosed and pale. She now has a murmur. Investigations reveal a haemoglobin concentration of 8g/dl (11- 14g/dl) and a white cell count of 15 x 109/L (4-9 x 109/L). Diagnosis?
Subacute bacterial endocarditis
230
What investigations to confirm subacute bacterial endocarditis?
Blood cultures|Echocardiogram
231
What is meant by polyhydramnios?
Excessive amniotic fluid
232
State three clinical examination findings in polyhydramnios
Indistinct fetal parts|Fluid thrill|Ballotable fetal parts|Indistinct fetal heart beat by auscultation|Overdistended uterus|Symphyseal-fundal height larger than dates
233
Suggest two different factors which can lead to polyhydramnios
Fetal aneuploidy|Fetal infection|Placental abnormality (chorioangioma)|Macrosomia|Maternal diabetes|Idiopathic|Duodenal atresia/oesophageal atresia|Iso-immunisation|Fetal cardiac failure
234
Name two investigations that are important for the exclusion of causes of polyhydramnios
Detailed USS|Glycated Hb/GTT|TORCH screen
235
Indicate three main complications of polyhydramnios
Pre-term labour|Malpresentation|Prolapsed cord if spontaneous rupture of membranes
236
Define partial seizure
A seizure of focal onset - discharges originate from a specific part of the cortex. Common in pt with undiagnosed tumours. Simple: awareness unimpaired, no post-ictal symptoms. Complex: awareness impaired, mainly arise from temporal nerve, post-ictal confusion is common. Partial with secondary generalised (>60%) focal electrical disturbance initially that then causes convulsive generalised seizure
237
Generalised seizure rx
Sodium valproate or lamotrigine
238
Focal seizure rx
Carbamazepine or lamotrigine
239
Carbamazepine SE
N and V, drowsiness, P450 inducer, diplopia, dizziness, ataxia, agranulocytosis, SIADH
240
Sodium valproate SE
Increased appetite, weight gain, gastric irritation, nausea and diarrhoea, alopecia, ataxia, tremor, hepatitis, pancreatitis, teratogenic (neural tube defects), P450 inhibitor
241
Lamotrigine SE
Steven-Johnson syndrome
242
Seizure DVLA advice
Have to be seizure free for 3 years (1 year if only 1 seizure)
243
Anticonvulsant other medications advice
They interact with the P450 system so will affect the metabolism of other medications, also affects the efficacy of contraception (pill)
244
Define status epilepticus
A seizure lasting longer than 30 min or repeated seizures without recovery of conciousness
245
Status epilepticus rx
5 min: benzodiazepine (buccal/suppository/IV)|10 min later: further benzo|10 min later: IV phenytoin
246
Define syncope
Paroxysmal event in which the changes of behaviour, sensation or cognitive processes are caused by an insufficient blood or oxygen supply to the brain
247
Define non-epileptic seizure
Paroxysmal event in which changes of behaviour, sensation or cognition are caused by mental process associated with psychosocial distress
248
Factors suggestive of epilepsy
Tongue bite, cyanosed, postictal confusion, head turning
249
Factors suggestive of syncope
If from prolonged upright position, sweating prior, nausea, pallor
250
Factors suggestive of non-epileptic seizures
Longer duration, closed eyes, no cyanosis, ictal crying, speaking during tonic-clonic phase
251
A 26-year-old woman presents 3 months after giving birth to her first child. During labour she had a large post-partum haemorrage. She did not breastfeed but has not had a period since.
Sheehan's syndrome
252
Sheehan's syndrome
Sheehan syndrome describes hypopituitarism caused by ischemic necrosis due to blood loss and hypovolaemic shock. Agalactorrhoea, amenorrhoea, sx of hypothyroidism and hypogonadism
253
A 25-year-old woman presents 5 months after having dilation and curettage for a miscarriage. Since this procedure she has not had a period. A pregnancy test is negative. Hysteroscopy is performed which reveals the diagnosis.
Asherman's syndrome
254
Asherman's syndrome
Asherman's syndrome, or intrauterine adhesions, may occur following dilation and curettage. This may prevent the endometrium responding to oestrogen as it normally would (no periods).
255
A 28-year-old woman presents because she has not had a period for the past 9 months. She also describes fluid leaking from her nipples
Prolactinoma
256
A 36-year-old woman presents for a routine antenatal review. She is now 15 weeks pregnant. Her blood pressure in clinic is 154/94 mmHg. On reviewing the notes it appears her blood pressure four weeks ago was 146/88 mmHg. A urine dipstick is normal. There is no significant past medical history of note. What is the most likely diagnosis?
Pre existing hypertension. Pregnancy related blood pressure problems (such as pregnancy-induced hypertension or pre-eclampsia) do not occur before 20 weeks.
257
Most common type of ovarian pathology associated with Meigs' syndrome
Fibroma. Meigs' syndrome is a benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion
258
Most common benign ovarian tumour in women under the age of 25 years
Dermoid cyst (teratoma)
259
The most common cause of ovarian enlargement in women of a reproductive age
Follicular cyst
260
A 27-year-old woman presents complaining of heavy menstrual bleeding. She reports saturating her pads with blood regularly and frequently has to change them hourly. She is otherwise asymptomatic and has no desire to have children in the near future. Following a normal examination, what is the most appropriate management?
Intrauterine system
261
A 25-year-old woman at 25 weeks gestation presents with constant lower abdominal pain and a small amount of vaginal bleeding. On examination blood pressure is 90 / 60 mmHg
Placental abruption
262
A 31-year-old woman presents with painless vaginal bleeding at 15 weeks gestation. She has not yet had any antenatal care despite suffering from severe vomiting. On examination the uterus is large for dates
Hydatidiform mole
263
A 19-year-old woman presents with a two day history of central lower abdominal pain and one day history of vaginal bleeding. Her last period was 8 weeks ago. On examination her cervix is tender to touch
Ectopic pregnancy
264
A 30-year-old woman presents with an offensive 'fishy', thin, grey vaginal discharge. Testing the discharge shows the pH to be > 4.5. Treatment?
Oral metronidazole
265
A 27-year-old woman complains of an offensive 'musty', frothy, green vaginal discharge. On examination you an erythematous cervix with pinpoint areas of exudation. Treatment?
Oral metronidazole
266
A 22-year-old woman presents with a thin, purulent, and mildly odorous vaginal discharge. She also complains of dysuria, intermenstrual bleeding and dyspareunia. A swab shows a Gram negative diplococcus. Treatment?
IM ceftriaxone and oral azithromycin
267
Causes of primary PPH
Tone, tissue (retained placenta), trauma, thrombin (coagulation abnormalities). 4 Ts
268
Which vitamin, if taken in high doses, can be teratogenic?
Vitamin A
269
A 38-year-old woman with a 4.5cm fibroid has been listed for a myomectomy following a 5 month history of heavy menstrual bleeding, What drug should be prescribed to be taken whilst awaiting surgery?
GNRH analogue (reduces size of fibroids)
270
What are the symptoms of a hydatidiform mole?
Hyperemesis, uterus large for dates, symptoms of thyrotoxicosis, high levels of serum bHCG
271
Select the most appropriate action based on the following smear result: normal smear
Repeat smear in 3 years
272
Select the most appropriate action based on the following smear result: moderate dyskaryosis
Refer to colposcopy
273
Select the most appropriate action based on the following smear result: borderline dyskaryosis (HPV negative)
Repeat smear in 3 years
274
Define incidence
The number of cases of a condition occurring in a given population during a specified time interval, e.g. 5 new cases per 1000 people per year
275
Define prevalence
The number of cases of a condition found in a given population at a specified point in time
276
What 3 conditions are screened for in the newborn heel prick test? Give their incidence and the test used to screen for each condition
Cystic fibrosis - 1:2,500 - immunoreactive trypsin|Phenylketonuria - 1:10,000 - phenylalanine|Congenital hypothyroidism - 1:10,000 - TSH
277
Define sensitivity
A measure of how good the test is a detecting individuals who have the condition. Sensitivity = true positive/(true positive+false negatives)
278
What are the outcomes if CF is left untreated in a newborn?
Lung disease, respiratory failure, heart/lung transplant|Malabsorption|Failure to thrive
279
PKU
Severe developmental delay|Seizures|Mousey odour
280
Hypothyroidism
Severe developmental delay|Growth failure/short stature|Constipation|Dry skin/hair loss
281
Name 2 screening procedures (not laboratory tests) carried out in every newborn baby in the UK
Universal hearing testing|Clinical examination of the hips
282
A 14 year old boy at your GP practice has suspected meningitis. What drug should be given before you send him to A+E and by what route?
Benzylpenicillin - IV or IM
283
You do a lumbar puncture in a 14 year old boy with suspected meningitis. The results show on microscopy there are 200 polymorphonuclear leukocytes per|high power field. Which organism is the most likely cause?
Group B Neisseria meningitidis
284
State two soluble components of CSF and whether their concentration in the CSF would be reduced or raised in meningococcal meningitis
Protein - raised|Glucose - reduced
285
Name two routinely administered childhood vaccinations which help to prevent meningitis
Haemophilus influenzae B|Meningitis C
286
Name antibiotics commonly used for prophylaxis in cases of bacterial meningitis
Rifampicin, ciprofloxacin
287
A 25 year old woman at 32 weeks gestation in her first pregnancy presents to her GP for a routine antenatal check. She is found to have the following: BP 150/100 mmHg, proteinuria '+'. She is otherwise well and asymptomatic. What condition does she have?
Pregnancy induced hypertension with proteinuria or pre-eclampsia
288
State two blood investigations that are indicated in pre-eclampsia
FBC (inc platelets)|Uric acid level|LFTs
289
State three complications that may develop following pre-eclampsia
Eclampsia |Placental abruption|HELLP|CVA|DIC|Fetal death|Renal failure|Hepatic failure
290
State two treatments for pre-eclampsia
Delivery if maternal condition deteriorates|Antihypertensives|Magnesium sulphate
291
State two factors which can predispose to the development of pre-eclampsia
Nulliparity|First baby with new partner|Twin pregnancy|Chronic hypertension|SLE|Renal disease|Strong FH
292
An alcoholic man on your ward developed abdominal pain over a period of twenty-four hours and he begins to|vomit and feels unwell refusing food because of the abdominal pain. What blood test would confirm the most likely cause of the pain and what would the diagnosis be?
Serum amylase - pancreatitis
293
Approximately what percentage of people, who drink heavily over an|extended length of time with a diagnosis of alcohol dependence|syndrome, will develop cirrhosis of the liver?
25%
294
What dangerous side-effect may occur (possibly resulting in death) if a patient drinks alcohol while taking antabuse (disulfiram), which enzyme does antabuse block and what biochemical product accumulates in the blood to cause this side-effect?
Hypotension, alcohol dehydrogenase, acetaldehyde
295
A 2 year old boy develops a puffy face, swollen lower legs and an enlarged abdomen. What test should the GP perform on his urine in the surgery? What is the likely diagnosis?
Test for protein. Nephrotic syndrome
296
What is the drug treatment for nephrotic syndrome?
Prednisolone
297
In a renal biopsy of a child with nephrotic syndrome, what histological finding would indicate a good prognosis or a bad prognosis?
Good prognosis - minimal lesion change|Bad prognosis - membranous glomerulonephritis, epithelial proliferation with crescents
298
Following a head injury, a 5 year old is admitted for observation. Because of|nausea, he is given intravenous fluids, including IV dextrose. Plasma analysis|conducted the next morning shows low Na. State two likely causes of the low Na
Being given IV dextrose with no electrolytes, SIADH
299
How would you treat SIADH?
Fluid restriction
300
A 14 year old boy visits his GP because of a 2-day history of very severe sore throat. On examination there are enlarged and reddened tonsils and a follicular exudate, and some cervical lymphadenopathy. Name two possible microbial causes
Streptococcus pyogenes|Epstein-Barr Virus|Adenovirus|Corynebacterium diphtheriae
301
Name some macrolide ABx
Erythromycin|Clarithromycin|Azithromycin
302
What are the internal and external boundaries of the epidural space?
Dura mater|Overlying bone
303
Name 2 drug therapies which would contraindicate an epidural anaesthetic
Anticoagulants (heparin, warfarin etc.), aspirin
304
Name two obstetrics reasons why a woman may be denied an epidural
Fetal distress, antipartum haemorrhage
305
What percentage of epidurals work satisfactorily?
85-92%
306
List three common complications of epidurals
Failure to achieve analgesia|Hypotension|Urinary retention|Headache due to dural tap|Delay of second stage
307
Sausage shaped mass in right upper abdomen
Intussusception
308
How is intussusception diagnosed?
USS
309
What is the definitive treatment for intussusception?
Air reduction/hydrostatic reduction
310
What stool features are characteristic of intussusception?
Red-currant jelly stool
311
Why might intussusception reoccur?
Anatomica; abnormality acting as lead for intussusception|Meckel's diverticulum|Polyp
312
A 33-year-old woman visits her general practitioner complaining of inability to conceive after two years of trying with a regular partner. She has a body mass index of 28 kg/m² and an existing diagnosis of polycystic ovarian syndrome. Which of the following drugs is most likely to help restore normal ovulation in this case?
Metformin. Weight loss first line in PCOS women but if the woman can't lose weight metformin can be added as it has a beneficial effect on ovulation and conception rates in these patients
313
What is the most common identifiable cause of postcoital bleeding?
Cervical ectropion
314
PCOS diagnostic criteria
PCOS should be diagnosed if 2/3 of the following criteria are present:|Infrequent or no ovulation (thus oligomenorrhoea is the correct answer in this scenario)|Clinical or biochemical signs of hyperandrogenism or elevated levels of total or free testosterone (no mention of 'low levels of oestrogen')|Polycystic ovaries on ultrasonography or increased ovarian volume
315
A 23-year-old woman who has been diagnosed with polycystic ovary syndrome (PCOS) is trying to become pregnant. She has already made any appropriate lifestyle changes and reduced her BMI to 25. However, she remains anovulatory. What is the most appropriate next step of treatment?
Clomifene
316
What is the first line investigation of suspected endometrial cancer?
TV USS
317
A couple in their 20s come into their GP after failing to conceive despite having regular sexual intercourse for 6 months, and ask you for advice. What is the most appropriate course of action for you to take?
Wait until they have been having regular intercourse for 12 months
318
A 30-year-old woman is 24 weeks pregnant and she receives a letter about her routine cervical smear. She asks her GP if she should make an appointment for her smear. All her smears in the past have been negative. What should the GP advise?
Reschedule the smear to occur at least 12 week post-delivery
319
A 25-year-old woman presents for her first cervical smear. What is the most important aetiological factor causing cervical cancer?
HPV 16 and 18
320
A 38-year-old patient who is undergoing in vitro fertilisation (IVF) for tubal disease presents 4 days after egg retrieval with abdominal discomfort, nausea and vomiting. OE her abdomen is visibly distended. Dx?
Ovarian hyperstimulation syndrome
321
Most common type of ovarian epithelial cell tumour
Serous cystadenoma
322
How soon after conception can hCG be detected in the blood?
As early as day 8
323
A 31-year-old woman complains of intermittent pain in the left iliac fossa for the past 3 months. The pain is often worse during intercourse. She also reports urinary frequency and feeling bloated. There is no dysuria or change in her menstrual bleeding. Dx?
Ovarian cyst
324
A 23-year-old woman complains of anorexia, vomiting, fever and abdominal pain. The pain was initially periumbilical but is now worse in the lower abdomen. Dx?
Appendicitis
325
A 28-year-old woman complains of a two year history of bad period pains which are not controlled by NSAIDs or the combined contraceptive pill. She also reports significant pains during intercourse. Dx?
Endometriosis
326
Sometimes referred to as chocolate cysts due to the external appearance
Mucinous cystadenoma
327
During a subfertility clinic you are asked to take a menstrual cycle history from a 30-year-old in order to establish on what day her mid-luteal progesterone level needs to be done. You clarify that the woman has a regular 35 day cycle. On which day would you carry out mid-luteal progesterone level?
Day 28
328
Urge incontinence first line rx
Bladder retraining
329
Stress incontinence first line rx
Pelvic floor muscle retraining
330
A 16-year-old girl comes to your GP surgery worried that she has not yet started her periods. She is quite short, has a webbed neck, low set ears and widely spaced nipples. A heart murmur is heard on auscultation. What type of murmur are you most likely to hear?
Systolic loudest over the aortic valve
331
An obstetrician is preparing themselves to preform an emergency lower segmental caesarian section for a 24-year-old woman who is suffering from complications of pre-eclampsia. After making an incision through the skin and superficial and deep fascia, what layers will the obstetrician have to cut through to reach the fetus?
Anterior rectus sheath - rectus abdominis muscle - transversalis fascia - extraperitoneal connective tissue - peritoneum - uterus
332
A 23-year-old lady experiences heaviness and numbness in her left leg. These symptoms gradually get worse over one week. Two weeks later the heaviness in her left leg is worse but her symptoms remain confined to one limb. Examination of the left leg reveals a brisk knee and ankle jerk and an extensor plantar response. The patient mentions a four-week period of blurred vision in her left eye one year previously. Which test is the most likely to lead to a diagnosis?
MRI head
333
A 41-year-old patient who was diagnosed as having multiple sclerosis twenty years earlier comes to hospital with reduced mobility. For the first ten years of his illness he had relapsing and remitting neurological symptoms. He is admitted because he has been unable to transfer independently from his wheelchair to his bed for the last few days. He has had a permanent intra-urethral catheter for two years. Examination reveals a spastic paraparesis and pyrexia of 38 degrees. The chest sounds clear. Which test is most important to look for a cause of the current clinical state?
MSU
334
A 47-year-old man presents with reduced vision in his left eye. He has pain behind the eye and colours seem less bright. He has difficulty reading with the left eye. One month before developing the problem with his vision he was diagnosed with Bell's palsy. The Bell's palsy first affected the left side and three days later the right side. He has felt tired, ill and slightly out of breath for one month. Neurological examination reveals signs consistent with optic neuritis on the left and bilateral lower motor neurone facial palsies. Which test is most likely to reveal the diagnosis?
CXR and serum angiotensin converting enzyme (looking for sarcoidosis)
335
A 45-year-old man complains of a five to seven year history of problems with his |legs. The problems were quite subtle at first - he had some difficulty with running. For the last three years he has been aware that his legs become heavy and stiff if he walks more than two miles. Examination reveals a spastic paraparesis with brisk upper limb and patellar tendon reflexes, ankle clonus and extensor plantar responses. Joint position sense is absent in the toes; soft touch is reduced to both knees. Dx?
Primary progressive MS
336
An 18-year-old man who has previously been very fit and well wakes up with a pain between his shoulder blades. He also notices a woolly, numb sensation in his toes and an increasing problem with controlling his leg movements. His thigh muscles seem particularly weak. He cannot get out of a chair without using his arms to support himself. He has not discovered any problems with his bladder or bowels. Examination of eyes, cranial nerves, power, tone, sensation and coordination of the upper limbs is normal. There is proximal leg weakness and reduced sensation to pinprick and soft touch in a stocking distribution. Joint position sense is absent in the toes. Reflexes are absent in all limbs. Dx?
GBS
337
A 56-year-old woman had an episode of heaviness, clumsiness and stiffness in her left leg two years previously. She comes to hospital with problems with the right side of her face and her right arm. About one week earlier she noticed numbness in these areas. The numbness seemed to come on suddenly but became more marked over two days. Drinks could run out of the right side of the mouth and there were some word finding difficulties. Examination reveals expressive dysphasia, right-sided facial weakness. In the upper limbs there is weakness, increased tone, brisk reflexes arm and a positive Hoffman's sign on the right (absent on the left). In the lower limbs, tone is slightly increased on the left, tendon reflexes are brisk bilaterally, the plantar response is extensor on the left and flexor on the right. Dx?
Cerebrovascular disease
338
A 35-year-old female patient with a diagnosis of epilepsy is brought to the A&E department. When you get to see her, she has been in a seizure for 25 minutes. Her family confirm that her arms and legs have been shaking rhythmically throughout this time. The patient?s eyes and mouth are tightly shut. She has wet herself. Dx?
Nonepileptic seizures
339
A 75-year-old man with hypertension and high cholesterol presents with a sudden onset of mild left arm weakness. He has recovered within 4 days. Which of these investigations is most sensitive in confirming the location of the stroke?
MRI at day 1 with diffusion weighted imaging
340
A 20-year-old plumber presents with acute onset dizziness and ataxia. He noticed some neck pain whilst working three days earlier. Which of these investigations is most appropriate in confirming the CAUSE of the problem?
CT or MR angiography at day 1 (?dissection)
341
An 85-year-old women with an aortic valve replacement presents with a left sided weakness. She has a temperature. Last week she had a tooth extraction. Which of these is the first investigation you should organise to confirm the cause of the problem?
Blood cultures
342
A 30 year old women presents with slurred speech. This came on over two hours and is associated with a headache and nausea. She recalls a similar attack ten years ago. Examination reveals dysarthria and mild photophobia but she is otherwise well. The neurological signs resolve within twelve hours. What is the most likely diagnosis?
Migraine
343
An 80 year old man attends TIA clinic with three episodes of unilateral visual loss in his left eye lasting less than 5 minutes. He is a smoker, has hypertension and atrial fibrillation. He is apyrexial, hypertensive and has atrial fibrillation. He is admitted and two days later has an operation to reduce the chances of his having an event. What is the most likely cause of his symptoms?
Carotid artery stenosis
344
A 70-year-old man was admitted to hospital. His wife found him lying on the floor, drowsy and unwell. He is a little more awake by the time he arrives in hospital but is still drowsy and has bitten his tongue. You notice he has a severe left sided weakness in his arm and leg. Over the next 12 hours he gradually improves and he recovers fully. What is the most likely cause of his symptoms?
Epileptic seizure
345
An 80-year-old man suffers a stroke resulting in severe right sided hemiparesis and speech disturbance. The nurses wishes to insert an NG tube to deliver his medications. She thinks she can aspirate stomach contents through the tube. She asks you whether she can use the tube. What do you do in this situation?
Test the pH of the contents of aspirate from the tube and if this is not helpful, arrange a chest x-ray
346
First rank symptoms of schizophrenia
Hallucinations (3rd person auditory)|Delusional perception|Passivity phenomenon|Thought alienation
347
Causes of neonatal jaundice before 24h
RAGS|Rhesus incompatibility|ABO incompatibility|G6PD deficiency|Spherocytosis
348
Causes of chronic diarrhoea in children
5Cs|Crohn's|Colitis (Ulcerative)|Coeliac disease|Cystic fibrosis|CMP intolerance
349
Causes of seizures
VITAMIN|Vascular (stroke)|Infections|Trauma|AV malformation|Metabolic|Idiopathic|Neoplasm
350
Causes of ejection systolic murmur
PAAS|PS, AS, ASD, Severe anaemia
351
Kawasaki disease features
My Heart|Mucosal involvement (dry lips, strawberry tongue)|Hands and feet with edema and desquamination|Eyes non purulent bilateral conjunctivitis|Adenopathy often cervical unilateral|Rash usually truncal and pleomorphic|Temperature non remitting fever for at least 5 days
352
Cyanotic heart diseases - 5Ts
Tetralogy of Fallot|TGA|Truncus arteriosus|Tricuspid atresia, pulmonary atresia|Total anomalous pulmunary venous drainage
353
CURB-65
Confusion|Blood Urea >7|RR>30|BP - SBP<90, DBP<60|Age>65
354
PPH RFs
PARTUM|Prolonged labour, polyhydramnios, prev CS|APH|Recent Hx bleeding|Twins|Uterine fibroids|Multiparity
355
A 73 year old lady well known to you comes to your practice with a|worsening cough. She is bringing up moderate amounts of green sputum|and is a little distressed by the situation, but not confused. On|examination her blood pressure is 100/65 and her respiratory rate is 24.|You test her blood and her serum urea is 5.5 mmol/L. What is her CURB-|65 score?
1
356
One of your favourite patients comes to see you 1 month following an MI.|What 5 drugs should he be on for secondary prevention?
ACE-inhibitor, beta-blocker, statin, aspirin, clopidogrel (or|ticagrelor)
357
What tool is used to assess risk levels in domestic abuse?
DASH tool
358
What are the 3 key features of normal pressure hydrocephalus?
3 Ws - wacky, wobbly, wet dementia, gait disturbance,|urinary incontinence
359
A patient you saw several months ago who was suffering from constant|worries about minor matters returns to you complaining that she feels|tense. On examination she has a dry mouth and is tachycardic. It is clear|that the self-help strategies you offered have failed. What is the next step|of management?
CBT
360
Antipsychotics are dopamine D2 receptor antagonists. D2 receptors are located on 5 pathways but the actual treatment of psychotic symptoms only occurs via the mesolimbic pathway. What are the 4 other D2 receptor pathways?
Tubuloinfundibular pathway, chemoreceptor trigger zone,|mesocortical pathway, nigrostriatal pathway
361
Which class of anti-depressant is most likely to cause a hypertensive|crisis?
MAOI
362
You see a confused patient. He has an ataxic gait and when he sits down|you notice ptosis on his upper left eyelid and that he struggles to move his|left eye laterally. You can smell alcohol on his breath. How would you|treat him?
IM thiamine (Pabrinex) - this is Wernicke's encephalopathy
363
According to NICE guidance, which is the safest antidepressant to use in children/young people?
Fluoxetine
364
What is the treatment for paracetamol OD?
N-acetylcysteine
365
What is paviluzimab for and which group of children do you give to?
Vaccine against RSV. Prem babies, babies with heart or lung defects, immunocompromised infants
366
When are children most likely to get pertussis and why?
<2 months old - before they have vaccine
367
What is the 2nd line of treatment in children UNDER 5 with asthma?
Trial leukotriene receptor antagonist
368
How do you close a PDA?
IV ibuprofen, NSAIDs
369
4 features of Tetralogy of Fallot?
Large VSD, over-riding aorta, pulmonary stenosis, right ventricular hypertrophy
370
What features would make a UTI "atypical" in a child?
Systemically unwell/assoc septicaemia, failure to respond to appropriate ABx within 48h, recurrent UTIs, E Coli isn't causative organism
371
Baby born at 40 weeks by emergency C-section has a raised respiratory rate|shortly after birth. They are also grunting and have nasal flaring. What is the|most likely diagnosis?
Transient tachypnoea of the newborn
372
In someone with DMD what blood enzyme would be very high?
Creatinine Phosphokinase
373
What are the differential diagnoses of neonatal jaundice appearing less than 24h after birth?
ABO incompatabily, rhesus disease, congenital infection e.g. TORCH, Gilbert's syndrome
374
4 features of an innocent murmur
4S|Soft|Systolic|left Sternal edge|aSymptomatic
375
2 non-GI causes abdo pain?
Lower lobe pneumonia, testicular torsion
376
If a child fails to pass meconium in the first 24 hours of life, what conditions|are you concerned about?
CF, Hirschprung's, obstruction, malrotation
377
A fat 14 year old boy presents to A&E with sudden onset of knee pain, made worse by movement, what is the most likely diagnosis?
SUFE
378
Which bones in the body is most commonly affected by osteomyletitis?
Distal femur, proximal tibia
379
Blue appearance to the sclera indicates which disease?
Osteogenesis imperfecta
380
What are the risk factors for Development Dysplasia of the Hip?
Breech, oligohydramnios, female, >5kg birth weight, FHx
381
Protecting factors for ovarian cancer?
Anything that reduces ovulations: COCP, multiparity, breastfeeding, late menarche, early menopause
382
What is the first line treatment for fibroids in a woman who doesn't want to conceive?
Mirena IUS
383
What is the first line treatment for fibroids in a woman who DOES want to|conceive?
Tranexamic acid
384
When is the best time in a woman's cycle to perform a cervical smear?
Mid-cycle
385
A woman with some facial hair and a BMI of 30 comes into clinic telling you she|has had trouble conceiving. What diagnosis do you suspect, and what would be the most appropriate treatment in this lady?
PCOS, metformin/clomifene
386
A woman has deep dysparaeunia and pain on defecation - what is the most likely diagnosis and where is most probably affected?
Endometriosis, pouch of Douglas
387
List some indications for C-section
Placenta praevia, pre-eclampsia, post-maturity, IUGR, fetal distress, cord prolapse, failure to progress, abruption, active genital herpes
388
A 27-year-old woman comes into antenatal clinic at 12 weeks GA with a|BMI of 38 and BP of 148/92. This is her first pregnancy. What is the best course of management?
Low dose aspirin
389
What is HELLP syndrome?
Haemolysis, elevated liver enzymes, low platelets
390
When do you give Anti-D, when is it indicated?
28w to a rh-ve mother who hasn't been sensitised
391
You discover the presence of GBS in a woman who is 20 weeks pregnant.|What is the best course of management?
Intrapartum IV Benpen, don't need to do anything until then
392
How do you treat toxoplasmosis?
Spiramycin
393
What causes hyperchogenic bowel?
CMV, Down's, CF
394
A woman who is 41+3 weeks has a Bishop's score of 3. What does this|mean?
Unlikely to give birth spontaneously
395
A 67yo man was admitted with acute stroke to the A&E department. His symptoms started when we woke up this morning, at 7:30am. The imaging excluded intracranial haemorrhage. It is 1pm now and you were asked to take care of the patient. What would be the next step in your treatment, based on NICE guidelines and why?
Aspirin 300mg (OD, for 2wks, ±PPI) >> therapeutic window is|≤4.5hrs
396
A patient wish progressive decrease in his GCS score is brought by a helicopter to A&E|at the Northern General Hospital. CT head is done immediately, showing a biconvex|collection of blood. What type of haemorrhage? What is most likely cause? Why does blood show up bright on CT?
Extradural, trauma, blood contains iron
397
What criteria, based on imaging, are used for diagnosing MS?
McDonald criteria
398
What is Lhermitte's sign?
Electric shock travelling down the spine on neck flexion
399
What type of compound is levodopa?
Amino acid
400
Name 2 SE associated with levodopa
Nausea, dyskinesis, chorea, psychosis
401
Name 3 non-motor symptoms of PD
Depression, dementia, sleep disorders, anosmia
402
What is the treatment for status epilepticus?
IV lorazepam or buccal midazolam
403
In Wilson's disease, copper deposits form in the basal ganglia of the human brain.|Name two other, non-CNS sites of copper deposition.
Liver, cornea (Kayser-Fleischer rings)
404
What is a common cause of bacterial meningitis in neonates in the UK?
GBS, E.Coli, listeria
405
Your consultant comes and tells you there has been a patient admitted with Horner's|syndrome. He tells you to go and see him, as he exhibits a clear unilateral ptosis with|miosis. What other features of Horner syndrome would you expect to find on|examination of the patient? Name at least 2 other features
Anhidrosis, endopthalmos, loss of spinocillary reflex
406
Name 4 geriatric giants
Immobility, incontinence, instability/confusion, intellectual impairment, iatrogenesis
407
What is the management of acute delirium?
Antipsychotics e.g. haloperidol for aggression, continuity of staff taking care of pt, low lighting, clocks and calendars visible
408
What is the earliest sign of hyperkalaemia on ECG?
Tall tented T waves
409
Name complications of falls in the elderly
Rhabdomyolysis, pressure ulcers, dehydration
410
What is the syndrome associated with hyponatremia and what hormone is oversecreted?
SIADH, vasopressin
411
Give 3 biological causes of female sexual dysfunction
Age, menopause, hypothyroidism, neurological, medication SE
412
4 causes of erectile dysfunction
Age, diabetes, MS, CVD, neuro, high prolactin, psychological, androgen deficiency
413
3 causes of superficial dyspareunia
Insufficient lubrication, vaginismus, candidiasis, lichen sclerosis, atrophy
414
What Ix is used if ?chlamydia?
HVS -> NAAT (nucleic acid amplification test)
415
What is the oral thrush treatment?
Fluconazole
416
What complications may occur in multiple pregnancy?
High perinatal mortality|Spontaneous preterm delivery|Low birth weight babies|Twin to twin transfusion syndrome
417
30 y/o man comes to see you with wife. She complains he has been v low since losing job a month a month ago and is increasingly irritable
Adjustment disorder (occurs within 3mo of stressor)
418
40 y/o man refuses to come to OP clinic - says too scared to leave house. Whenever he goes to shops has panic attack and has to leave and a relative now does shopping for him
Agorophobia with panic disorder
419
25 y/o man involves in plane crash where some friends died, hasn't been on plane since. Insomnia and nightmare. Constant tension, arguing with partner
PTSD
420
30 y/o woman attends A&E after cutting wrist. Long history of similar attendances. Attributes her actions to a form of punishment
Borderline personality disorder
421
24 y/o woman seen in A&E due to SOB and palpitations. CXR, ECG, bloods NAD. Complains of similar episodes caused by stressful events and says every time it happens she feels like she is going to die
Panic disorder
422
40 y/o woman recently started on a medication complains of fainting when getting out of bed this morning. Also has dry mouth. FH depression
TCA
423
25 y/o man complaining of ED and loss of libido. Sweating and passing more urine than usual. What medication could cause?
SSRI
424
35 y/o woman complains of throbbing headache after "having drink with friends". BP is 200/120. What medication could cause?
MAOI
425
24 y/o man presents with fever, sore throat, lethargy. Mucosal ulceration in genital and perianal area. Has low WCC. What medication could cause?
Clozapine
426
60 y/o man found to be increasingly disorientated and aggressive. Pyrexial, complaining of pains in arms and legs. O/e rigid muscles. What drug could cause?
Haloperidol - NMS
427
Called to assess a man claiming to be a prince. He is a farmer. Wife says for past few days has been restless, pacing, not sleeping. Bought expensive gifts. In a prev episode he was talking very quickly, jumping from one topic to next
Bipolar affective disorder
428
Husband brings wife to clinic, says increasingly withdrawn. Poor sleep, early morning wakening. No longer engaging in gardening. Describes and apparition, hearing voices.
Severe depressive episode with psychotic symptoms
429
Patient walks into clinic and demands to see consultant not trainee, then storms out. Referral letter says he has few friends due to inability to tolerate "stupidity and selfishness", "puts up with" wife, "despairs" nobody else can meet high standards
Narcissistic personality disorder
430
35 y/o female reports she washes her hands 20x a day, checks switches on appliances 5x before leaving house. If does not do gets anxious
OCD
431
25 y/o woman in OP clinic. Provocatively dressed, copious makeup. Exaggerates emotions, self-centred. Trying to seduce you
Histrionic personality disorder
432
Called to assess 16 y/o by mother. Adopting peculiar positions, copying speech and movements. When you go to see him he is staring at the ceiling. He is mute
Catatonic schizophrenia
433
Husband brings wife to hospital as she is increasingly disturbed. Has been staying in house as feels watched by neighbours who are "out to get her". Doesn't trust husband. Hears voices at night which tell her people are out to get her, sees shadowy figures at end of bed speaking a peculiar language
Paranoid schizophrenia
434
28 y/o woman, cyclical pain with deep dyspareunia. Has been trying for a baby for a year and has been unsuccessful
Endometriosis
435
30 y/o woman referred with pelvic pain. Vaginal exam and pelvic USS NAD. Complains of stress at work and emptying bowels relieves discomfort
IBS
436
32 y/o woman with pelvic pain. Suffering for over a year. bHCG -ve, on bimanual exam you note boggy uterus with mild tenderness on palpation. USS reveals enlarged uterus with heterogenous texture
Adenomyosis
437
Patient referred from A&E with 250ml vaginal bleed. Sudden onset pain, gush of blood, faint but quickly regained consciousness. BP 100/60, pulse 120
Placental abruption
438
Primigravida, 22w gestation. Irritation on urination, frequency, blood in urine. Back pain, bilateral loin tenderness, vomited several times, excruciating loin to groin pain that "comes and goes"
Renal calculus
439
40 y/o woman, urgency, frequency, nocturia. Recently treated by GP with ABx for UTI
Urge incontinence
440
45 y/o woman complains of leaking urine when changing posture and playing sport. Urine stream slow and hesitant. Frequently feels bladder not completely emptied
Overflow incontinence
441
A patient who has recently given birth describes leaking urine "continuously"
True incontinence
442
38 y/o para 3 gravida 3 woman complains of urine leakage when coughing. "exercises" have helped slightly but still continues to have problems
Stress incontinence
443
26 y/o woman complains of leakage when coughing or straining. Waking up at night to use bathroom. MS analysis and urodynamics NAD
Functional incontinence
444
17 y/o girl suffering from irregular menstrual cycle, acne, hirsutism. In stable relationship with boyfriend. Suitable medication?
COCP
445
35 y/o woman with heavy painful periods. Suitable medication?
Tranexamic acid
446
45 y/o woman suffering from dysmenorrhoea and wants a medication to help with pain as she is having to take time off work
Mefanamic acid
447
60 y/o woman suffering from loss of appetite, poor libido, anhedonia. Tearful, complaining of regular hot flushes. Suitable medication?
Venlafaxine
448
60 y/o woman suffering from dyspareunia, vaginal dryness
Topical oestrogens, lube for sex
449
45 y/o woman on antiepileptic therapy complains of acne and increased facial hair. What med?
Phenytoin
450
25 y/o man presents with visual field defects two months after starting a new anticonvulsant
Vigabatrin
451
32 y/o woman on treatment for TLE complains of tremor, drowsiness, thinning hair. Also has mildly raised liver enzyme levels. What med?
Sodium valproate
452
24 y/o man who has recently started adjunctive antiepileptic therapy complains of rash with blisters in mouth and flu symptoms. What med?
Lamotrigine (Steven-Johnson syndrome)
453
45 y/o woman with L sided facial palsy, vertigo. Impaired hearing on L side and vesicular rash noted around external auditory meatus
Ramsay Hunt syndrom
454
55 y/o man with recurrent spontaneous attacks of vertigo, hearing loss, tinnitus. Attacks last up to 2h, sometimes associated with vomiting
Meniere's disease
455
40 y/o man complaining of severe sudden onset headache 4h ago, like being kicked in head. Has vomited 2x, stiff neck
SAH
456
40 y/o businesswoman complains of headache that feels like tight band around head
Tension headache
457
55 y/o woman presents with headache that has lasted a few weeks. Jaw pain during meals, scalp tender on palpation. What would you give?
Giant cell arteritis - high dose oral pred, aspirin
458
30 y/o man, rapid-onset pain around left eye every night for last 2w with lid swelling, eye watering and flushing. Has bouts every 3m. Treatment?
Cluster headache. High flow oxygen, sumatriptan
459
24 y/o woman. unilateral throbbing headache lasting 6h with vomiting, photophobia. Had several episodes in past. What could prevent?
Migraine. Sumatriptan
460
56 y/o woman, unilateral stabbing pain on surface of scalp and around eye. Precipitated by washing or touching area
Trigeminal neuralgia - opthalmic division
461
28 y/o obese woman complains of headache, double vision which is worse when lying down. Papilloedema but no focal signs, CT NAD
Benign intracranial hypertension
462
30 y/o man complains of dull headache that is worse when lying down or coughing. Recently suffered a seizure
Raised ICP - urgent imaging needed
463
70 y/o woman complains of headache, drowsiness, unsteadiness over last couple of days. No papilloedema. Fell over 3w ago
Chronic subdural haemorrhage
464
60 y/o woman, bilateral proximal muscle weakness in legs, dysphagia. Purple rash on cheeks
Polymyositis
465
40 y/o man, progressive weakness in arms and legs after an episode of diarrhoea. Flaccid weakness of limbs, no reflexes
Guillain-Barre
466
55 y/o man with bilateral progressively worsening muscle weakness. Marked wasting of lower limb muscles, very brisk lower limb reflexes. Sensation normal
MND
467
What are the 3 types of MND?
Progressive muscular atrophy - wasting often begins in distal muscles of hand then spreads, fasciculation common|ALS - progressive spastic tetraparesis/paraparesis. LMN signs|Progressive bulbar palsy - dysarthria, dysphagia
468
13 y/o boy presents with bilateral pes cavus with clawing of toes. Atrophy of peroneal muscles and reduced reflexes and sensation distally
Charcot-Marie-Tooth
469
30 y/o secretary presents with bilateral leg weakness and blurred vision. Fundoscopy reveals pale optic discs bilaterally
MS
470
MS investigations
MRI - demyelinating plaques|CSF shows oligoclonal bands of IgG on electrophoresis
471
Inability to dorsiflex foot after blow to side on knee
Common peroneal nerve
472
Winged scapula, inability to raise arm above horizontal
Long thoracic nerve
473
Sensory loss bilaterally below level of umbilicus
T10
474
Inability to rotate head to right and to shrug left shoulder
Accessory nerve
475
35 y/o woman with MS complains of diplopia. Inability to abduct pupil on one side
LR6SO4, 3
476
Non-rhythmic jerky purposeless movements in the hands of 55 y/o man
Huntington's disease
477
Grimacing and involuntary chewing in a 75 y/o woman on long-term treatment with neuroleptics
Tardive dyskinesia
478
45 y/o woman complains of pain behind R eye, mouth sagging on R side
Bell's palsy
479
62 y/o woman with stiff spastic tongue, "Donald Duck" speech. Brisk jaw jerk, laughing inappropriately
Pseudobulbar palsy
480
27 y/o woman with wasting and weakness of small muscles of hand. Loss of pain and temperature sensation over trunk and arms, intact vibration sense
Syringomyelia - fluid filled cavity within spinal cord
481
34 y/o woman complains of generalized weakness in muscles, diplopia, weakening of voice if talking for more than 30s. Bilateral ptosis
Myasthenia gravis
482
15 y/o boy has several coffee-coloured patches on body. Lisch nodules in eyes
Type 1 neurofibromatosis
483
70 y/o man has several blackouts and falls every day. Blackouts last several seconds, preceded by palpitation. Looks flushed on recovery
Stokes-Adam attack. Give pacemaker
484
21 y/o student with hyperventilation, tachycardia, light-headedness after blacking out
Panic attack
485
34 y/o woman falls to ground after hearing some bad news
Vasovagal syncope
486
60 y/o woman who has recently started antihypertensive medication has a fall after getting out of bed
Postural hypotension - diuretics, beta blockers, levodopa, TCAs
487
70 y/o woman requires treatment for troubling trigeminal neuralgia
Carbamazepine
488
65 y/o man cannot tolerate levodopa. Alternative?
Bromocriptine - dopamine receptor agonist
489
A patient on therapy for Parkinson's requires urgent treatment for acute psychosis
Clozapine
490
Projectile vomiting, olive shaped lump
Pyloric stenosis
491
Machine like murmur under left clavicle
PDA
492
Blue sclera
Osteogenesis imperfecta
493
Redcurrant jelly stool
Intussusseption
494
Immobile infant with femur fracture
NIA
495
White/clay coloured stool
Biliary atresia
496
Walking up legs to standing position
DMD
497
What tests are included in the Guthrie test?
Congenital hypothyroidism, sickle cell, thalassaemia, CF, MCAD, PKU, G6PD, MSUD
498
Child smiles at mother, watches faces
6 weeks
499
Friendly to all individuals, drinks from a cup if held to lips
6 months
500
Is shy with strangers, may understand certain phrases. Will hold out arms and feet for sleeves and shoes
12m
