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3a (1) Flashcards

1
Q

What is the sequence of puberty in females?

A

Breast buds-pubic hair-axillary hair-menarche

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2
Q

At what age can menarche occur?

A

From 10y onwards, average age 13 and falling

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3
Q

At what age should you investigate delayed menarche?

A

Around 15y

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4
Q

At what age should you investigate no signs of puberty?

A

14y

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5
Q

What hormonal axis control the menstrual cycle?

A

Hypothalamic-pituitary-ovarian (HPO) axis

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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.

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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

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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

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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.

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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

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11
Q

Define primary amenorrhoea

A

Failure to start menstruating. Ix in 15y, or 14y with no breast development

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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

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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

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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

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15
Q

Define menorrhagia

A

Excessive blood loss

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16
Q

Define dysmenorrhoea

A

Painful periods (+/- nausea or vomiting)

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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.

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18
Q

How could you treat primary dysmenorrhoea?

A

NSAIDs to inhibit the prostaglandins eg mefenamic acid, paracetamol, COCP

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19
Q

Define secondary dysmenorrhoea

A

With associated pathology eg adenomyosis, endometriosis, chronic sepsis (chlamydia), fibroids. Treat cause

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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

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21
Q

What can cause post-coital bleeding?

A

Cervical trauma, polyps, cervical/endometrial/vaginal carcinoma, cervicitis/vaginitis, STIs

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22
Q

What is the pathophysiology of respiratory distress syndrome?

A

Lack of surfactant causes alveolar collapse

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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)

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24
Q

What are the signs of RDS in the neonate?

A

Tachypnoea, intercostal recession, nasal flaring, tracheal tug

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25
Q

What are the possible complications of RDS?

A

Pneumothorax, chronic lung disease

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26
Q

What is transient tachypnoea of the newborn?

A

Tachypnoea that goes away - typically caused by too much fluid in the lungs - c-section a risk factor as normal birth squeezes fluid out

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27
Q

What can cause jaundice <24h post birth?

A

This is abnormal jaundice - haemolysis, infection

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28
Q

What can cause jaundice >24h post birth?

A

This can be normal - 50% of all neonates. Caused by liver immaturity and increased RBC breakdown, dehydration, bile duct obstruction, neonatal hepatitis.

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29
Q

Neonatal jaundice Ix

A

Bilirubin level blood test

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30
Q

Neonatal jaundice Rx

A

Phototherapy or if v serious exchange transfusion

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31
Q

What is NEC?

A

Necrotising EnteroColitis - bacterial invasion of ischaemic bowel wall, typically seen in premature infants

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32
Q

What are the symptoms of NEC?

A

Vomiting, poor feeding, distended abdomen, blood in stool. May progress to shock, perforation

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33
Q

NEC Rx

A

IV ABx, TPN, ITU

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34
Q

What are the features of Trisomy 21?

A

Craniofacial appearance - epicanthic folds, flat nasal bridge, Brushfield spots|Congenital heart defects (most commonly AVSD)|Duodenal atresia

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35
Q

What are the long term complications of Trisomy 21?

A

Leukaemia/solid tumour risk, hearing impairment, increased risk of Alzheimer’s epilepsy

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36
Q

What are the most common congenital heart conditions?

A

VSD, PDA, ASD

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37
Q

What is Trisomy 13?

A

Patau’s syndrome

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38
Q

What is Trisomy 18?

A

Edward’s syndrome

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39
Q

If a child is cyanotic with a murmur what is the defect likely to be?

A

ToF, TGA

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40
Q

If a child is unwell what murmurs are likely?

A

Large VSD - can present with HF and FTT

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41
Q

What causes the murmur in ASD?

A

Increased flow across the pulmonary valve -systolic ULSE murmur

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42
Q

How do we treat ASD and does everyone need treatment?

A

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

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43
Q

Where is the murmur is VSD?

A

LLSE generally - the larger the defect the quieter the murmur

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44
Q

Why is a large VSD a problem?

A

Large VSDs are larger than the aortic valve - results in heart failure

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45
Q

What needs to be avoided in VSD patients?

A

Eisenmenger syndrome (R>L shunting)

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46
Q

What does PDA sound like?

A

A constant murmur heard below left clavicle

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47
Q

PDA Rx

A

NSAIDs (inhibit prostaglandins) or closure of the duct with a coil at around 1y of age

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48
Q

What are the four features of ToF?

A

Pulmonary stenosis, overriding aorta, RVH, VSD

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49
Q

What might you see on XR in ToF?

A

Boot shaped heart - due to RVH

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50
Q

What is TGA?

A

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

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51
Q

What is the immediate management of acute severe exacerbation of asthma in a child?

A

15/L O2 via NRB|Assess peak flow|Salbutamol nebs|Steroids

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52
Q

What are some features of life threatening asthma?

A

Silent chest|PEF <33%|Poor respiratory effort|Hypotension|Exhaustion

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53
Q

Name 2 organs involved in CF

A

Small bowel - malabsorption, lungs - recurrent infections

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54
Q

How do we screen babies for CF?

A

Immunoreactive trypsinogen test

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55
Q

How do we diagnose CF?

A

Sweat test

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56
Q

Name a bacteria that can commonly cause chronic infection in CF

A

Pseudomonas aeruginosa

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57
Q

Barking cough

A

Croup

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58
Q

Bronchiolitis age

A

90% before 1y

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59
Q

Bronchiolitis typical organism

A

RSV - Respiratory Syncytial virus

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60
Q

Bronchiolitis Sx

A

Breathing difficulties following coryzal Sx

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61
Q

Bronchiolitis Ix

A

RSV swab, O2 sats

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62
Q

Bronchiolitis Rx

A

Supportive

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63
Q

Croup age

A

6mo-6y

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64
Q

Croup organism

A

Parainfluenza virus

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65
Q

Croup Sx

A

Barking cough, stridor, worse at night

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66
Q

Croup Ix

A

O2 sats, AVOID EXAMINATION OF THROAT

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67
Q

Croup management

A

Oral corticosteroids, O2, intubation in airway obstruction (rare)

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68
Q

Epiglottitis age

A

1-6y

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69
Q

Epiglottitis organism

A

H. influenzae

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70
Q

Epiglottitis sx

A

High grade fever, no cough, rapid onset, child sitting upright to maintain airway

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71
Q

Epiglottitis rx

A

Intubate, cultures, ABx

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72
Q

Pertussis age

A

Infants that haven’t had first jab, <4m

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73
Q

Pertussis organism

A

Bordatella pertussis

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74
Q

Pertussis sx

A

Week of coryzal sx followed by paroxysmal coughing phase - whooping following cough

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75
Q

Pertussis ix

A

Per-nasal swab to identify

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76
Q

Pertussis rx

A

Erythromycin

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77
Q

What is Septic arthritis?

A

Acute inflammation of the joint typically caused by s.aureus

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78
Q

Septic arthritis ix

A

Blood cultures, joint aspiration and culture

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79
Q

Septic arthritis rx

A

IV abx (fluclox)`

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80
Q

DDH age

A

Infants

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81
Q

Perthes age

A

4-10

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82
Q

SUFE age

A

Teens

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83
Q

Redcurrent jelly stool, drawing knees up to chest, paroxysmal abdominal colic pain

A

Intussusception

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84
Q

2 mo old brought to surgery with fever, temp over 38. Management?

A

Admit to hospital

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85
Q

Pyloric stenosis electrolyte abnormality

A

Hypochloraemic hypokalaemic metabolic alkalosis

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86
Q

What are the features of an atypical UTI in a child?

A

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

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87
Q

Kawasaki disease rx

A

Aspirin and one dose IV immunoglobulin

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88
Q

Hirschprung disease signs and symptoms

A

Bilious vomiting, abdo distension, constipation, failure to pass meconium in first 48h

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89
Q

What birth weight is diagnostic for foetal macrosomia?

A

Anything over 4kg, no matter gestational age

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90
Q

What palsy can be caused by shoulder dystocia? What are the symptoms?

A

Erb’s palsy. Adduction and internal rotation of arm

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91
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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92
Q

What is the most common cause of headache in children?

A

Migraine

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93
Q

At what age would the average child acquire the ability to sit without support?

A

7-8 months

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94
Q

A boy is noted to have a webbed neck and pectus excavatum

A

Noonan syndrome

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95
Q

An infant is found to have small eyes and polydactyly

A

Patau syndrome

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96
Q

A 7-year-old boy with learning difficulties and macrocephaly

A

Fragile X

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97
Q

Most common cause of severe early onset (first 7 days) sepsis in newborn infants

A

GBS

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98
Q

Most useful investigation to screen for complications of Kawasaki disease

A

Echocardiogram - for coronary artery aneurysms

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99
Q

Define precocious puberty in females

A

Development of secondary sexual characteristics before 8 years of age

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100
Q

Which vaccines should be avoided in immunocompromised patients?

A

Live attenuated vaccines - BCG, MMR, oral polio, yellow fever, oral typhoid, intranasal influenza, oral rotavirus

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101
Q

What symptoms of migraine are far more common in children than adults?

A

GI disturbances

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102
Q

Which booster vaccines do young people usually receive between the ages of 13-18 years?

A

Diptheria, Tetanus, Pertussis, Polio, Men ACWY

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103
Q

What blood test is appropriate for a child you suspect may have coeliac disease?

A

IgA and IgA tTG

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104
Q

What is the most common presenting feature of Wilms’ nephroblastoma?

A

Abdominal mass

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105
Q

What is the mode of inheritance of Prader-Willi syndrome?

A

Imprinting - child does not receive gene from father and mother may be normal

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106
Q

How is Hirschprung’s disease diagnosed?

A

Rectal biopsy

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107
Q

What is the quick way to tell if a condition is AD or AR?

A

AD conditions are mostly “structural”|AR conditions are mostly “metabolic”

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108
Q

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?

A

Peutz-Jeghers syndrome

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109
Q

What is the most common complication of roseola infantum?

A

Febrile convulsions

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110
Q

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?

A

Umbilical granuloma

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111
Q

What is the most common cause of death of infants greater than one month but less than one year old?

A

SIDS

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112
Q

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?

A

Rheumatic fever

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113
Q

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?

A

Trimethoprim

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114
Q

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?

A

Acute lymphoblastic leukaemia

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115
Q

A newborn baby is noted to have low-set ears, rocker bottom feet and overlapping of her fingers. What is the most likely diagnosis?

A

Edward’s syndrome

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116
Q

Micrognathia|Posterior displacement of the tongue (may result in upper airway obstruction)|Cleft palate

A

Pierre-Robin syndrome

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117
Q

Hypotonia|Hypogonadism|Obesity

A

Prader-Willi syndrome

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118
Q

Short stature|Learning difficulties|Friendly, extrovert personality|Transient neonatal hypercalcaemia|Supravalvular aortic stenosis

A

William’s syndrome

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119
Q

Features on examination of a baby with Down’s syndrome?

A

Single palmar crease, sandal gap, Brushfield spots, epicanthic folds

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120
Q

What are the complications of congenital rubella?

A

Sensorineural deafness, congenital cataracts

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121
Q

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?

A

CMP intolerance

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122
Q

Risk factors for DDH?

A

Female gender|Breech presentation|Family history|Firstborn|Oligohydramnios

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123
Q

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?

A

Prednisolone

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124
Q

Which cells produce surfactant?

A

Type 2 pneumocytes

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125
Q

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?

A

Transient tachypnoea of the newborn

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126
Q

How are squints classified?

A

Squints may be classified as to where the eye deviates toward:|the nose: esotropia|temporally: exotropia|superiorly: hypertropia|inferiorly: hypotropia

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127
Q

What is the most likely outcome following the diagnosis of minimal change nephropathy in a 10-year-old male?

A

Full recovery but with later recurrent episode

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128
Q

First step of newborn resus

A

Dry the baby

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129
Q

What is the causative agent of roseola infatum?

A

HHV6

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130
Q

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.

A

ITP

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131
Q

A 2 week old infant with a small chin, posterior displacement of the tongue and cleft palate

A

Pierre-Robin syndrome

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132
Q

Supravalvular aortic stenosis is found in a 3 year old boy with learning difficulties

A

William’s syndrome

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133
Q

A 9-week-old is noted to have a small chin and rocker-bottom feet

A

Edwards syndrome

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134
Q

What is the recommended compression:ventilation ration for the newborn?

A

3:1

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135
Q

In the UK, what is the most common cause of death in children greater than one year old?

A

Accidents

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136
Q

Diagnostic criteria autism

A

Global impairment of language and communication|Impairment of social relationships|Ritualistic and compulsive phenomena

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137
Q

Croup treatment

A

Oral dexamethasone

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138
Q

Constipation treatmens

A

Advice on diet/fluid intake and movicol paediatric plan

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139
Q

Pityriasis rosea

A

Herald patch, lethargy, lesions only on trunk

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140
Q

Meningococcal septicaemia

A

Meningism, non-blanching rash

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141
Q

Scarlet fever

A

Strawberry tongue, facial sparing

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142
Q

Chicken pox

A

Itchy, starting on head before spreading. Macular->vesicular->papular

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143
Q

Measles

A

Starting on face, spreading to body. Koplik spots

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144
Q

What is the carrier rate of cystic fibrosis in the UK?

A

1 in 25

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145
Q

Recommended alcohol limits for men and women

A

14 units men 14 units women. Pregnant women abstain for first trimester then no more than 2 units per week.

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146
Q

What is a unit of alcohol?

A

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

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147
Q

Give some social and psychological risk factors for problem drinking

A

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

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148
Q

What is the link between deprivation and alcohol?

A

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

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149
Q

Most common causes of death due to alcohol

A

Accidents and violence|Malignancies|Cerebrovascular disease|Coronary heart disease

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150
Q

What amount of alcohol puts a patient at risk of liver damage?

A

No significant risk of liver damage at less than 30g alcohol a day. Average intake of men with cirrhosis 160g a day

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151
Q

Fatty liver symptoms

A

Rarely has symptoms - perhaps malaise or nausea. Completely reversible on withdrawing alcohol

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152
Q

Alcoholic hepatitis symptoms

A

Vary - anorexia, nausea, abdo pain, weight loss, susceptibility to infection. Severe is a medical emergency - ascites, bleeding, encephalopathy

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153
Q

What is the relationship between alcohol and CV disease?

A

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

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154
Q

What is the relationship between alcohol and cancer?

A

25-50 head and neck cancers due to alcohol - mouth, larynx, pharynx, oesophagus. Also increased risk of liver, stomach, colon, rectum, pancreatic, breast cancer

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155
Q

What are the risks of drinking alcohol in pregnancy?

A

Can increase miscarriage risk, more likely to have LBW baby. Persisten drinking can cause Foetal Alcohol Syndrome - affects ~6000 babies born annually

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156
Q

What is Foetal Alcohol Sydrome?

A

Small underweight babies, slack muscle tone|Mental retardation, behavioural and speech problems, characteristic facial appearance|Cardiac, renal, ocular abnormalities

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157
Q

What is the AUDIT questionnaire?

A

10 point questionnaire, takes 5 min. 8=likely hazardous drinking, 13 for women and 15 for men indicated alcohol dependence

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158
Q

What is the CAGE questionnaire?

A

Cut down|Angry or annoyed when criticised about drinking|Guilt|Eye opener

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159
Q

What pharmacological agents can prevent alcohol relapse?

A

None are particularly effective|Disulfiram (ANTABUSE) to sensitise against|Acamprosate, GABA blocker|Naltrexone used in specialist centres

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160
Q

ICD 10 definition of Alcohol Dependence Syndrome

A

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

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161
Q

What is Wernicke’s Encephalopathy?

A

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

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162
Q

What are the symptoms of Wernicke’s Encephalopathy?

A

Triad of symptoms - acute mental confusion, ataxia and opthalmoplegia

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163
Q

What is the treatment of Wernicke’s Encephalopathy?

A

IV/IM thiamine vitamin B1 (pabrinex)

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164
Q

What is Korsakoff’s syndrome?

A

Amnestic disorder due to enduring B1 malnutrition. Not reversible. Diagnosed by CT scan

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165
Q

What are the symptoms of Korsakoff’s syndrome?

A

Loss of spontaneity, initiative and confabulation

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166
Q

What is delirium tremens?

A

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

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167
Q

What are the symptoms of delirium tremens?

A

Clouding of consciousness/confusion/seizures. Hallucinations in any sensory modality. Marked tremor

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168
Q

What is the treatment of delirium tremens?

A

Supportive - fluids, benzodiazepine to prevent fitting

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169
Q

Myasthenia gravis

A

An acquired, organ-specific autoimmune disorder, of unknown cause, in which antibodies are directed against the postsynaptic acetylcholine receptor

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170
Q

Groups commonly affected by myasthenia gravis

A

Young women (20-35y), older men (60-75y, tend to have oculobulbar presentation

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171
Q

Myasthenia gravis general clinical features

A

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.

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172
Q

Myasthenia gravis features by system

A

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

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173
Q

Myasthenia gravis Ix

A

Tensilon (edrophonium) test|Serum acetylcholine receptor and MUSK antibodies|Electromyography|Thymus imaging|autoantibodies|Spirometry - check VC

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174
Q

Myasthenia gravis Rx

A

Oral acetylcholinesterases - pyridostigmine|Thymectomy in those with thymic hyperplasia|Immunosuppression - with corticosteroids commonly

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175
Q

What dependence symptom: “I have moved from drinking wine, beer and whisky to just wine every day”

A

Narrowed repertoire

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176
Q

What dependence symptom: I used to drink one bottle, then I needed two, now three bottles of wine a|day

A

Tolerance/increased tolerance

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177
Q

What dependence symptom: I need to have a drink first thing in the morning to stop the shakes

A

Withdrawal

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178
Q

State two blood tests to screen for alcohol dependence and state how each is affected

A

GGT - raised|RBC MCV - raised|CDT - raised

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179
Q

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?

A

Delirium tremens

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180
Q

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?

A

Wernicke’s encephalopathy

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181
Q

If a patient with Wernicke’s encephalopathy is not treated with pabrinex or thiamine, what condition might they develop?

A

Korsakoff’s psychosis

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182
Q

Describe three blood indicators of thyroid disease which should be investigated in a patient with symptoms of hyperthyroidism.

A

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

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183
Q

Give three medications appropriate in hyperthyroidism and why they are appropriate.

A

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

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184
Q

What important things must be done for a patient with newly diagnosed hyperthyroidism?

A

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

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185
Q

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?

A

Mirena IUS

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186
Q

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?

A

Flucloxacillin

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187
Q

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?

A

MS

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188
Q

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?

A

Ecological study

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189
Q

Describe delirium tremens

A

Acute alcohol withdrawal|Peaks at 72h|Acute confusional state and hallucinations

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190
Q

Describe Wernicke’s encephalopathy

A

Confusion, ataxia, opthalmoplegia

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191
Q

Describe Korsakoff’s syndrome

A

Confabulation, retro and antegrade amnesia, personality changes

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192
Q

A woman has an ovarian cyst. Name 4 signs on USS suggestive of malignancy

A

Multiocular, bilateral, free fluid, mixture of cystic and solid

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193
Q

Name 4 preoperative blood tests before ovarian cancer removal and give rationale

A

FBC - anaemia|U&Es - renal function|Cross match and group and save - in case of blood loss|Clotting screen - risk of bleeding

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194
Q

Name the procedure used to remove ovarian malignancy

A

Salpingo-oophorectomy

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195
Q

What screening method is used to assess the risk of Down’s syndrome antenatally?

A

Quad test

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196
Q

Name 4 risks of amniocentesis

A

Miscarriage|Club foot|Infection - amniocentitis|Rhesus disease if woman rhesus -ve

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197
Q

Name 3 chromosomal abnormalities and give karyotype

A

Edwards syndrome - trisomy 18|Pataus syndrome - trisomy 13|Kleinfelters syndrome - 47XXY

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198
Q

Give an example and explanation of a service that is supplied but not needed or demanded

A

Over 75 health check by GP - proven not to help and pts don’t ask for it

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199
Q

Give an example and explanation of a service that is supplied and needed, but not demanded

A

Baby Guthries testing - mother would rather baby not harmed but needed for early diagnosis of conditions

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200
Q

Define epidemiological needs assessment

A

Deciding what a population needs based on the incidence and prevalence of certain diseases

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201
Q

Define comparative needs assessment

A

Individuals with similar characteristics to those receiving help, examines health status, utilization

202
Q

Define corporate needs assessment

A

Getting input from a number of individuals or groups to decide what is needed most (press, patients, professionals, politicians)

203
Q

Give two disadvantages of comparative needs assessment

A

Relative, not quantifiable

204
Q

A child visits GP with fever/malaise, limp, hepatosplenomegaly. What two conditions do you want to rule out?

A

Leukaemia, septic arthritis

205
Q

Name three classes of drugs for arthritis (not biologics) and give examples

A

NSAIDs - ibuprofen|DMARDS - methotrexate|Corticosteroids - prednisolone

206
Q

9 month old child presents with redness in the creases of neck, axilla and groin, his|skin is peeling, what is the diagnosis

A

Scalded skin syndrome

207
Q

What is the causative organism of scalded skin syndrome?

A

Staph aureus

208
Q

Why does the skin peel in scalded skin syndrome?

A

Staph releases endotoxin between the layers of skin, makes the layers peel

209
Q

What do you do if a child in your GP surgery becomes unresponsive?

A

Call for help/999|Assess ABCDE|Perform simple airways maneuvre

210
Q

What two systems would you monitor after giving gentamycin?

A

Ears and kidneys

211
Q

Parkinson’s disease - describe the histology, area effected|and neurotransmitter involved

A

Lewy bodies in the substantia nigra in the basal ganglia. Reduced dopamine

212
Q

Give two upper limb signs in Parkinson’s

A

Cog wheel rigidity, pill rolling tremor

213
Q

Name two drugs for treatment of Parkinson’s

A

Levodopa, ropinirole

214
Q

Name two drugs that would aggravate symptoms/signs of Parkinson’s?

A

Metoclopramide, olanzipine

215
Q

How does Parkinson’s affect handwriting?

A

Micrographia that tails off

216
Q

Given a patient with gait disturbance, incontinence and dementia you order a CT to rule out what?

A

Normal pressure hydrocephalus

217
Q

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?

A

Drugs, OT, physio, f/u appt, letter GP

218
Q

Name the four principles of couple therapy

A

Promote communication|Change views of relastionship|Modifies dysfunctional behavior|Decreases emotional avoidance|Promotes strength

219
Q

Name the four tests of negligence

A

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
Q

Define the person approach to error

A

Looking for an individual who causes the error

221
Q

Define the systems approach to error

A

What in the system caused the error to occur

222
Q

A baby is born prematurely at 24 weeks gestation. What lung problem is he likely to develop soon after birth?

A

Respiratory distress syndrome

223
Q

What pharmacological agent may be given prophylactically post delivery to reduce the severity of RDS?

A

Surfactant. Brands include Curosurf and Survanta

224
Q

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?

A

Right pneumothorax

225
Q

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?

A

Phototherapy

226
Q

A neonate suddenly develops apnoea and bradycardia and is found to have a distended|and discoloured abdomen and bilious vomiting.

A

Necrotising enterocolitis/NEC

227
Q

A neonate has continuing jaundice. His urine is noted to be dark. What substance in the urine is causing this?

A

Conjugated bilirubin

228
Q

Define cyanosis in physiological terms

A

Greater than 5 grams/decilitre of deoxygenated haemoglobin

229
Q

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?

A

Subacute bacterial endocarditis

230
Q

What investigations to confirm subacute bacterial endocarditis?

A

Blood cultures|Echocardiogram

231
Q

What is meant by polyhydramnios?

A

Excessive amniotic fluid

232
Q

State three clinical examination findings in polyhydramnios

A

Indistinct fetal parts|Fluid thrill|Ballotable fetal parts|Indistinct fetal heart beat by auscultation|Overdistended uterus|Symphyseal-fundal height larger than dates

233
Q

Suggest two different factors which can lead to polyhydramnios

A

Fetal aneuploidy|Fetal infection|Placental abnormality (chorioangioma)|Macrosomia|Maternal diabetes|Idiopathic|Duodenal atresia/oesophageal atresia|Iso-immunisation|Fetal cardiac failure

234
Q

Name two investigations that are important for the exclusion of causes of polyhydramnios

A

Detailed USS|Glycated Hb/GTT|TORCH screen

235
Q

Indicate three main complications of polyhydramnios

A

Pre-term labour|Malpresentation|Prolapsed cord if spontaneous rupture of membranes

236
Q

Define partial seizure

A

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
Q

Generalised seizure rx

A

Sodium valproate or lamotrigine

238
Q

Focal seizure rx

A

Carbamazepine or lamotrigine

239
Q

Carbamazepine SE

A

N and V, drowsiness, P450 inducer, diplopia, dizziness, ataxia, agranulocytosis, SIADH

240
Q

Sodium valproate SE

A

Increased appetite, weight gain, gastric irritation, nausea and diarrhoea, alopecia, ataxia, tremor, hepatitis, pancreatitis, teratogenic (neural tube defects), P450 inhibitor

241
Q

Lamotrigine SE

A

Steven-Johnson syndrome

242
Q

Seizure DVLA advice

A

Have to be seizure free for 3 years (1 year if only 1 seizure)

243
Q

Anticonvulsant other medications advice

A

They interact with the P450 system so will affect the metabolism of other medications, also affects the efficacy of contraception (pill)

244
Q

Define status epilepticus

A

A seizure lasting longer than 30 min or repeated seizures without recovery of conciousness

245
Q

Status epilepticus rx

A

5 min: benzodiazepine (buccal/suppository/IV)|10 min later: further benzo|10 min later: IV phenytoin

246
Q

Define syncope

A

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
Q

Define non-epileptic seizure

A

Paroxysmal event in which changes of behaviour, sensation or cognition are caused by mental process associated with psychosocial distress

248
Q

Factors suggestive of epilepsy

A

Tongue bite, cyanosed, postictal confusion, head turning

249
Q

Factors suggestive of syncope

A

If from prolonged upright position, sweating prior, nausea, pallor

250
Q

Factors suggestive of non-epileptic seizures

A

Longer duration, closed eyes, no cyanosis, ictal crying, speaking during tonic-clonic phase

251
Q

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.

A

Sheehan’s syndrome

252
Q

Sheehan’s syndrome

A

Sheehan syndrome describes hypopituitarism caused by ischemic necrosis due to blood loss and hypovolaemic shock. Agalactorrhoea, amenorrhoea, sx of hypothyroidism and hypogonadism

253
Q

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.

A

Asherman’s syndrome

254
Q

Asherman’s syndrome

A

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
Q

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

A

Prolactinoma

256
Q

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?

A

Pre existing hypertension. Pregnancy related blood pressure problems (such as pregnancy-induced hypertension or pre-eclampsia) do not occur before 20 weeks.

257
Q

Most common type of ovarian pathology associated with Meigs’ syndrome

A

Fibroma. Meigs’ syndrome is a benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion

258
Q

Most common benign ovarian tumour in women under the age of 25 years

A

Dermoid cyst (teratoma)

259
Q

The most common cause of ovarian enlargement in women of a reproductive age

A

Follicular cyst

260
Q

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?

A

Intrauterine system

261
Q

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

A

Placental abruption

262
Q

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

A

Hydatidiform mole

263
Q

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

A

Ectopic pregnancy

264
Q

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?

A

Oral metronidazole

265
Q

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?

A

Oral metronidazole

266
Q

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?

A

IM ceftriaxone and oral azithromycin

267
Q

Causes of primary PPH

A

Tone, tissue (retained placenta), trauma, thrombin (coagulation abnormalities). 4 Ts

268
Q

Which vitamin, if taken in high doses, can be teratogenic?

A

Vitamin A

269
Q

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?

A

GNRH analogue (reduces size of fibroids)

270
Q

What are the symptoms of a hydatidiform mole?

A

Hyperemesis, uterus large for dates, symptoms of thyrotoxicosis, high levels of serum bHCG

271
Q

Select the most appropriate action based on the following smear result: normal smear

A

Repeat smear in 3 years

272
Q

Select the most appropriate action based on the following smear result: moderate dyskaryosis

A

Refer to colposcopy

273
Q

Select the most appropriate action based on the following smear result: borderline dyskaryosis (HPV negative)

A

Repeat smear in 3 years

274
Q

Define incidence

A

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
Q

Define prevalence

A

The number of cases of a condition found in a given population at a specified point in time

276
Q

What 3 conditions are screened for in the newborn heel prick test? Give their incidence and the test used to screen for each condition

A

Cystic fibrosis - 1:2,500 - immunoreactive trypsin|Phenylketonuria - 1:10,000 - phenylalanine|Congenital hypothyroidism - 1:10,000 - TSH

277
Q

Define sensitivity

A

A measure of how good the test is a detecting individuals who have the condition. Sensitivity = true positive/(true positive+false negatives)

278
Q

What are the outcomes if CF is left untreated in a newborn?

A

Lung disease, respiratory failure, heart/lung transplant|Malabsorption|Failure to thrive

279
Q

PKU

A

Severe developmental delay|Seizures|Mousey odour

280
Q

Hypothyroidism

A

Severe developmental delay|Growth failure/short stature|Constipation|Dry skin/hair loss

281
Q

Name 2 screening procedures (not laboratory tests) carried out in every newborn baby in the UK

A

Universal hearing testing|Clinical examination of the hips

282
Q

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?

A

Benzylpenicillin - IV or IM

283
Q

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?

A

Group B Neisseria meningitidis

284
Q

State two soluble components of CSF and whether their concentration in the CSF would be reduced or raised in meningococcal meningitis

A

Protein - raised|Glucose - reduced

285
Q

Name two routinely administered childhood vaccinations which help to prevent meningitis

A

Haemophilus influenzae B|Meningitis C

286
Q

Name antibiotics commonly used for prophylaxis in cases of bacterial meningitis

A

Rifampicin, ciprofloxacin

287
Q

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?

A

Pregnancy induced hypertension with proteinuria or pre-eclampsia

288
Q

State two blood investigations that are indicated in pre-eclampsia

A

FBC (inc platelets)|Uric acid level|LFTs

289
Q

State three complications that may develop following pre-eclampsia

A

Eclampsia |Placental abruption|HELLP|CVA|DIC|Fetal death|Renal failure|Hepatic failure

290
Q

State two treatments for pre-eclampsia

A

Delivery if maternal condition deteriorates|Antihypertensives|Magnesium sulphate

291
Q

State two factors which can predispose to the development of pre-eclampsia

A

Nulliparity|First baby with new partner|Twin pregnancy|Chronic hypertension|SLE|Renal disease|Strong FH

292
Q

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?

A

Serum amylase - pancreatitis

293
Q

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?

A

25%

294
Q

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?

A

Hypotension, alcohol dehydrogenase, acetaldehyde

295
Q

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?

A

Test for protein. Nephrotic syndrome

296
Q

What is the drug treatment for nephrotic syndrome?

A

Prednisolone

297
Q

In a renal biopsy of a child with nephrotic syndrome, what histological finding would indicate a good prognosis or a bad prognosis?

A

Good prognosis - minimal lesion change|Bad prognosis - membranous glomerulonephritis, epithelial proliferation with crescents

298
Q

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

A

Being given IV dextrose with no electrolytes, SIADH

299
Q

How would you treat SIADH?

A

Fluid restriction

300
Q

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

A

Streptococcus pyogenes|Epstein-Barr Virus|Adenovirus|Corynebacterium diphtheriae

301
Q

Name some macrolide ABx

A

Erythromycin|Clarithromycin|Azithromycin

302
Q

What are the internal and external boundaries of the epidural space?

A

Dura mater|Overlying bone

303
Q

Name 2 drug therapies which would contraindicate an epidural anaesthetic

A

Anticoagulants (heparin, warfarin etc.), aspirin

304
Q

Name two obstetrics reasons why a woman may be denied an epidural

A

Fetal distress, antipartum haemorrhage

305
Q

What percentage of epidurals work satisfactorily?

A

85-92%

306
Q

List three common complications of epidurals

A

Failure to achieve analgesia|Hypotension|Urinary retention|Headache due to dural tap|Delay of second stage

307
Q

Sausage shaped mass in right upper abdomen

A

Intussusception

308
Q

How is intussusception diagnosed?

A

USS

309
Q

What is the definitive treatment for intussusception?

A

Air reduction/hydrostatic reduction

310
Q

What stool features are characteristic of intussusception?

A

Red-currant jelly stool

311
Q

Why might intussusception reoccur?

A

Anatomica; abnormality acting as lead for intussusception|Meckel’s diverticulum|Polyp

312
Q

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?

A

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
Q

What is the most common identifiable cause of postcoital bleeding?

A

Cervical ectropion

314
Q

PCOS diagnostic criteria

A

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
Q

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?

A

Clomifene

316
Q

What is the first line investigation of suspected endometrial cancer?

A

TV USS

317
Q

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?

A

Wait until they have been having regular intercourse for 12 months

318
Q

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?

A

Reschedule the smear to occur at least 12 week post-delivery

319
Q

A 25-year-old woman presents for her first cervical smear. What is the most important aetiological factor causing cervical cancer?

A

HPV 16 and 18

320
Q

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?

A

Ovarian hyperstimulation syndrome

321
Q

Most common type of ovarian epithelial cell tumour

A

Serous cystadenoma

322
Q

How soon after conception can hCG be detected in the blood?

A

As early as day 8

323
Q

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?

A

Ovarian cyst

324
Q

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?

A

Appendicitis

325
Q

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?

A

Endometriosis

326
Q

Sometimes referred to as chocolate cysts due to the external appearance

A

Mucinous cystadenoma

327
Q

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?

A

Day 28

328
Q

Urge incontinence first line rx

A

Bladder retraining

329
Q

Stress incontinence first line rx

A

Pelvic floor muscle retraining

330
Q

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?

A

Systolic loudest over the aortic valve

331
Q

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?

A

Anterior rectus sheath - rectus abdominis muscle - transversalis fascia - extraperitoneal connective tissue - peritoneum - uterus

332
Q

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?

A

MRI head

333
Q

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?

A

MSU

334
Q

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?

A

CXR and serum angiotensin converting enzyme (looking for sarcoidosis)

335
Q

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?

A

Primary progressive MS

336
Q

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?

A

GBS

337
Q

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?

A

Cerebrovascular disease

338
Q

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?

A

Nonepileptic seizures

339
Q

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?

A

MRI at day 1 with diffusion weighted imaging

340
Q

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?

A

CT or MR angiography at day 1 (?dissection)

341
Q

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?

A

Blood cultures

342
Q

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?

A

Migraine

343
Q

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?

A

Carotid artery stenosis

344
Q

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?

A

Epileptic seizure

345
Q

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?

A

Test the pH of the contents of aspirate from the tube and if this is not helpful, arrange a chest x-ray

346
Q

First rank symptoms of schizophrenia

A

Hallucinations (3rd person auditory)|Delusional perception|Passivity phenomenon|Thought alienation

347
Q

Causes of neonatal jaundice before 24h

A

RAGS|Rhesus incompatibility|ABO incompatibility|G6PD deficiency|Spherocytosis

348
Q

Causes of chronic diarrhoea in children

A

5Cs|Crohn’s|Colitis (Ulcerative)|Coeliac disease|Cystic fibrosis|CMP intolerance

349
Q

Causes of seizures

A

VITAMIN|Vascular (stroke)|Infections|Trauma|AV malformation|Metabolic|Idiopathic|Neoplasm

350
Q

Causes of ejection systolic murmur

A

PAAS|PS, AS, ASD, Severe anaemia

351
Q

Kawasaki disease features

A

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
Q

Cyanotic heart diseases - 5Ts

A

Tetralogy of Fallot|TGA|Truncus arteriosus|Tricuspid atresia, pulmonary atresia|Total anomalous pulmunary venous drainage

353
Q

CURB-65

A

Confusion|Blood Urea >7|RR>30|BP - SBP<90, DBP<60|Age>65

354
Q

PPH RFs

A

PARTUM|Prolonged labour, polyhydramnios, prev CS|APH|Recent Hx bleeding|Twins|Uterine fibroids|Multiparity

355
Q

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?

A

1

356
Q

One of your favourite patients comes to see you 1 month following an MI.|What 5 drugs should he be on for secondary prevention?

A

ACE-inhibitor, beta-blocker, statin, aspirin, clopidogrel (or|ticagrelor)

357
Q

What tool is used to assess risk levels in domestic abuse?

A

DASH tool

358
Q

What are the 3 key features of normal pressure hydrocephalus?

A

3 Ws - wacky, wobbly, wet dementia, gait disturbance,|urinary incontinence

359
Q

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?

A

CBT

360
Q

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?

A

Tubuloinfundibular pathway, chemoreceptor trigger zone,|mesocortical pathway, nigrostriatal pathway

361
Q

Which class of anti-depressant is most likely to cause a hypertensive|crisis?

A

MAOI

362
Q

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?

A

IM thiamine (Pabrinex) - this is Wernicke’s encephalopathy

363
Q

According to NICE guidance, which is the safest antidepressant to use in children/young people?

A

Fluoxetine

364
Q

What is the treatment for paracetamol OD?

A

N-acetylcysteine

365
Q

What is paviluzimab for and which group of children do you give to?

A

Vaccine against RSV. Prem babies, babies with heart or lung defects, immunocompromised infants

366
Q

When are children most likely to get pertussis and why?

A

<2 months old - before they have vaccine

367
Q

What is the 2nd line of treatment in children UNDER 5 with asthma?

A

Trial leukotriene receptor antagonist

368
Q

How do you close a PDA?

A

IV ibuprofen, NSAIDs

369
Q

4 features of Tetralogy of Fallot?

A

Large VSD, over-riding aorta, pulmonary stenosis, right ventricular hypertrophy

370
Q

What features would make a UTI “atypical” in a child?

A

Systemically unwell/assoc septicaemia, failure to respond to appropriate ABx within 48h, recurrent UTIs, E Coli isn’t causative organism

371
Q

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?

A

Transient tachypnoea of the newborn

372
Q

In someone with DMD what blood enzyme would be very high?

A

Creatinine Phosphokinase

373
Q

What are the differential diagnoses of neonatal jaundice appearing less than 24h after birth?

A

ABO incompatabily, rhesus disease, congenital infection e.g. TORCH, Gilbert’s syndrome

374
Q

4 features of an innocent murmur

A

4S|Soft|Systolic|left Sternal edge|aSymptomatic

375
Q

2 non-GI causes abdo pain?

A

Lower lobe pneumonia, testicular torsion

376
Q

If a child fails to pass meconium in the first 24 hours of life, what conditions|are you concerned about?

A

CF, Hirschprung’s, obstruction, malrotation

377
Q

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?

A

SUFE

378
Q

Which bones in the body is most commonly affected by osteomyletitis?

A

Distal femur, proximal tibia

379
Q

Blue appearance to the sclera indicates which disease?

A

Osteogenesis imperfecta

380
Q

What are the risk factors for Development Dysplasia of the Hip?

A

Breech, oligohydramnios, female, >5kg birth weight, FHx

381
Q

Protecting factors for ovarian cancer?

A

Anything that reduces ovulations: COCP, multiparity, breastfeeding, late menarche, early menopause

382
Q

What is the first line treatment for fibroids in a woman who doesn’t want to conceive?

A

Mirena IUS

383
Q

What is the first line treatment for fibroids in a woman who DOES want to|conceive?

A

Tranexamic acid

384
Q

When is the best time in a woman’s cycle to perform a cervical smear?

A

Mid-cycle

385
Q

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?

A

PCOS, metformin/clomifene

386
Q

A woman has deep dysparaeunia and pain on defecation - what is the most likely diagnosis and where is most probably affected?

A

Endometriosis, pouch of Douglas

387
Q

List some indications for C-section

A

Placenta praevia, pre-eclampsia, post-maturity, IUGR, fetal distress, cord prolapse, failure to progress, abruption, active genital herpes

388
Q

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?

A

Low dose aspirin

389
Q

What is HELLP syndrome?

A

Haemolysis, elevated liver enzymes, low platelets

390
Q

When do you give Anti-D, when is it indicated?

A

28w to a rh-ve mother who hasn’t been sensitised

391
Q

You discover the presence of GBS in a woman who is 20 weeks pregnant.|What is the best course of management?

A

Intrapartum IV Benpen, don’t need to do anything until then

392
Q

How do you treat toxoplasmosis?

A

Spiramycin

393
Q

What causes hyperchogenic bowel?

A

CMV, Down’s, CF

394
Q

A woman who is 41+3 weeks has a Bishop’s score of 3. What does this|mean?

A

Unlikely to give birth spontaneously

395
Q

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?

A

Aspirin 300mg (OD, for 2wks, ±PPI)&raquo_space; therapeutic window is|≤4.5hrs

396
Q

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?

A

Extradural, trauma, blood contains iron

397
Q

What criteria, based on imaging, are used for diagnosing MS?

A

McDonald criteria

398
Q

What is Lhermitte’s sign?

A

Electric shock travelling down the spine on neck flexion

399
Q

What type of compound is levodopa?

A

Amino acid

400
Q

Name 2 SE associated with levodopa

A

Nausea, dyskinesis, chorea, psychosis

401
Q

Name 3 non-motor symptoms of PD

A

Depression, dementia, sleep disorders, anosmia

402
Q

What is the treatment for status epilepticus?

A

IV lorazepam or buccal midazolam

403
Q

In Wilson’s disease, copper deposits form in the basal ganglia of the human brain.|Name two other, non-CNS sites of copper deposition.

A

Liver, cornea (Kayser-Fleischer rings)

404
Q

What is a common cause of bacterial meningitis in neonates in the UK?

A

GBS, E.Coli, listeria

405
Q

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

A

Anhidrosis, endopthalmos, loss of spinocillary reflex

406
Q

Name 4 geriatric giants

A

Immobility, incontinence, instability/confusion, intellectual impairment, iatrogenesis

407
Q

What is the management of acute delirium?

A

Antipsychotics e.g. haloperidol for aggression, continuity of staff taking care of pt, low lighting, clocks and calendars visible

408
Q

What is the earliest sign of hyperkalaemia on ECG?

A

Tall tented T waves

409
Q

Name complications of falls in the elderly

A

Rhabdomyolysis, pressure ulcers, dehydration

410
Q

What is the syndrome associated with hyponatremia and what hormone is oversecreted?

A

SIADH, vasopressin

411
Q

Give 3 biological causes of female sexual dysfunction

A

Age, menopause, hypothyroidism, neurological, medication SE

412
Q

4 causes of erectile dysfunction

A

Age, diabetes, MS, CVD, neuro, high prolactin, psychological, androgen deficiency

413
Q

3 causes of superficial dyspareunia

A

Insufficient lubrication, vaginismus, candidiasis, lichen sclerosis, atrophy

414
Q

What Ix is used if ?chlamydia?

A

HVS -> NAAT (nucleic acid amplification test)

415
Q

What is the oral thrush treatment?

A

Fluconazole

416
Q

What complications may occur in multiple pregnancy?

A

High perinatal mortality|Spontaneous preterm delivery|Low birth weight babies|Twin to twin transfusion syndrome

417
Q

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

A

Adjustment disorder (occurs within 3mo of stressor)

418
Q

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

A

Agorophobia with panic disorder

419
Q

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

A

PTSD

420
Q

30 y/o woman attends A&E after cutting wrist. Long history of similar attendances. Attributes her actions to a form of punishment

A

Borderline personality disorder

421
Q

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

A

Panic disorder

422
Q

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

A

TCA

423
Q

25 y/o man complaining of ED and loss of libido. Sweating and passing more urine than usual. What medication could cause?

A

SSRI

424
Q

35 y/o woman complains of throbbing headache after “having drink with friends”. BP is 200/120. What medication could cause?

A

MAOI

425
Q

24 y/o man presents with fever, sore throat, lethargy. Mucosal ulceration in genital and perianal area. Has low WCC. What medication could cause?

A

Clozapine

426
Q

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?

A

Haloperidol - NMS

427
Q

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

A

Bipolar affective disorder

428
Q

Husband brings wife to clinic, says increasingly withdrawn. Poor sleep, early morning wakening. No longer engaging in gardening. Describes and apparition, hearing voices.

A

Severe depressive episode with psychotic symptoms

429
Q

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

A

Narcissistic personality disorder

430
Q

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

A

OCD

431
Q

25 y/o woman in OP clinic. Provocatively dressed, copious makeup. Exaggerates emotions, self-centred. Trying to seduce you

A

Histrionic personality disorder

432
Q

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

A

Catatonic schizophrenia

433
Q

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

A

Paranoid schizophrenia

434
Q

28 y/o woman, cyclical pain with deep dyspareunia. Has been trying for a baby for a year and has been unsuccessful

A

Endometriosis

435
Q

30 y/o woman referred with pelvic pain. Vaginal exam and pelvic USS NAD. Complains of stress at work and emptying bowels relieves discomfort

A

IBS

436
Q

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

A

Adenomyosis

437
Q

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

A

Placental abruption

438
Q

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”

A

Renal calculus

439
Q

40 y/o woman, urgency, frequency, nocturia. Recently treated by GP with ABx for UTI

A

Urge incontinence

440
Q

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

A

Overflow incontinence

441
Q

A patient who has recently given birth describes leaking urine “continuously”

A

True incontinence

442
Q

38 y/o para 3 gravida 3 woman complains of urine leakage when coughing. “exercises” have helped slightly but still continues to have problems

A

Stress incontinence

443
Q

26 y/o woman complains of leakage when coughing or straining. Waking up at night to use bathroom. MS analysis and urodynamics NAD

A

Functional incontinence

444
Q

17 y/o girl suffering from irregular menstrual cycle, acne, hirsutism. In stable relationship with boyfriend. Suitable medication?

A

COCP

445
Q

35 y/o woman with heavy painful periods. Suitable medication?

A

Tranexamic acid

446
Q

45 y/o woman suffering from dysmenorrhoea and wants a medication to help with pain as she is having to take time off work

A

Mefanamic acid

447
Q

60 y/o woman suffering from loss of appetite, poor libido, anhedonia. Tearful, complaining of regular hot flushes. Suitable medication?

A

Venlafaxine

448
Q

60 y/o woman suffering from dyspareunia, vaginal dryness

A

Topical oestrogens, lube for sex

449
Q

45 y/o woman on antiepileptic therapy complains of acne and increased facial hair. What med?

A

Phenytoin

450
Q

25 y/o man presents with visual field defects two months after starting a new anticonvulsant

A

Vigabatrin

451
Q

32 y/o woman on treatment for TLE complains of tremor, drowsiness, thinning hair. Also has mildly raised liver enzyme levels. What med?

A

Sodium valproate

452
Q

24 y/o man who has recently started adjunctive antiepileptic therapy complains of rash with blisters in mouth and flu symptoms. What med?

A

Lamotrigine (Steven-Johnson syndrome)

453
Q

45 y/o woman with L sided facial palsy, vertigo. Impaired hearing on L side and vesicular rash noted around external auditory meatus

A

Ramsay Hunt syndrom

454
Q

55 y/o man with recurrent spontaneous attacks of vertigo, hearing loss, tinnitus. Attacks last up to 2h, sometimes associated with vomiting

A

Meniere’s disease

455
Q

40 y/o man complaining of severe sudden onset headache 4h ago, like being kicked in head. Has vomited 2x, stiff neck

A

SAH

456
Q

40 y/o businesswoman complains of headache that feels like tight band around head

A

Tension headache

457
Q

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?

A

Giant cell arteritis - high dose oral pred, aspirin

458
Q

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?

A

Cluster headache. High flow oxygen, sumatriptan

459
Q

24 y/o woman. unilateral throbbing headache lasting 6h with vomiting, photophobia. Had several episodes in past. What could prevent?

A

Migraine. Sumatriptan

460
Q

56 y/o woman, unilateral stabbing pain on surface of scalp and around eye. Precipitated by washing or touching area

A

Trigeminal neuralgia - opthalmic division

461
Q

28 y/o obese woman complains of headache, double vision which is worse when lying down. Papilloedema but no focal signs, CT NAD

A

Benign intracranial hypertension

462
Q

30 y/o man complains of dull headache that is worse when lying down or coughing. Recently suffered a seizure

A

Raised ICP - urgent imaging needed

463
Q

70 y/o woman complains of headache, drowsiness, unsteadiness over last couple of days. No papilloedema. Fell over 3w ago

A

Chronic subdural haemorrhage

464
Q

60 y/o woman, bilateral proximal muscle weakness in legs, dysphagia. Purple rash on cheeks

A

Polymyositis

465
Q

40 y/o man, progressive weakness in arms and legs after an episode of diarrhoea. Flaccid weakness of limbs, no reflexes

A

Guillain-Barre

466
Q

55 y/o man with bilateral progressively worsening muscle weakness. Marked wasting of lower limb muscles, very brisk lower limb reflexes. Sensation normal

A

MND

467
Q

What are the 3 types of MND?

A

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
Q

13 y/o boy presents with bilateral pes cavus with clawing of toes. Atrophy of peroneal muscles and reduced reflexes and sensation distally

A

Charcot-Marie-Tooth

469
Q

30 y/o secretary presents with bilateral leg weakness and blurred vision. Fundoscopy reveals pale optic discs bilaterally

A

MS

470
Q

MS investigations

A

MRI - demyelinating plaques|CSF shows oligoclonal bands of IgG on electrophoresis

471
Q

Inability to dorsiflex foot after blow to side on knee

A

Common peroneal nerve

472
Q

Winged scapula, inability to raise arm above horizontal

A

Long thoracic nerve

473
Q

Sensory loss bilaterally below level of umbilicus

A

T10

474
Q

Inability to rotate head to right and to shrug left shoulder

A

Accessory nerve

475
Q

35 y/o woman with MS complains of diplopia. Inability to abduct pupil on one side

A

LR6SO4, 3

476
Q

Non-rhythmic jerky purposeless movements in the hands of 55 y/o man

A

Huntington’s disease

477
Q

Grimacing and involuntary chewing in a 75 y/o woman on long-term treatment with neuroleptics

A

Tardive dyskinesia

478
Q

45 y/o woman complains of pain behind R eye, mouth sagging on R side

A

Bell’s palsy

479
Q

62 y/o woman with stiff spastic tongue, “Donald Duck” speech. Brisk jaw jerk, laughing inappropriately

A

Pseudobulbar palsy

480
Q

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

A

Syringomyelia - fluid filled cavity within spinal cord

481
Q

34 y/o woman complains of generalized weakness in muscles, diplopia, weakening of voice if talking for more than 30s. Bilateral ptosis

A

Myasthenia gravis

482
Q

15 y/o boy has several coffee-coloured patches on body. Lisch nodules in eyes

A

Type 1 neurofibromatosis

483
Q

70 y/o man has several blackouts and falls every day. Blackouts last several seconds, preceded by palpitation. Looks flushed on recovery

A

Stokes-Adam attack. Give pacemaker

484
Q

21 y/o student with hyperventilation, tachycardia, light-headedness after blacking out

A

Panic attack

485
Q

34 y/o woman falls to ground after hearing some bad news

A

Vasovagal syncope

486
Q

60 y/o woman who has recently started antihypertensive medication has a fall after getting out of bed

A

Postural hypotension - diuretics, beta blockers, levodopa, TCAs

487
Q

70 y/o woman requires treatment for troubling trigeminal neuralgia

A

Carbamazepine

488
Q

65 y/o man cannot tolerate levodopa. Alternative?

A

Bromocriptine - dopamine receptor agonist

489
Q

A patient on therapy for Parkinson’s requires urgent treatment for acute psychosis

A

Clozapine

490
Q

Projectile vomiting, olive shaped lump

A

Pyloric stenosis

491
Q

Machine like murmur under left clavicle

A

PDA

492
Q

Blue sclera

A

Osteogenesis imperfecta

493
Q

Redcurrant jelly stool

A

Intussusseption

494
Q

Immobile infant with femur fracture

A

NIA

495
Q

White/clay coloured stool

A

Biliary atresia

496
Q

Walking up legs to standing position

A

DMD

497
Q

What tests are included in the Guthrie test?

A

Congenital hypothyroidism, sickle cell, thalassaemia, CF, MCAD, PKU, G6PD, MSUD

498
Q

Child smiles at mother, watches faces

A

6 weeks

499
Q

Friendly to all individuals, drinks from a cup if held to lips

A

6 months

500
Q

Is shy with strangers, may understand certain phrases. Will hold out arms and feet for sleeves and shoes

A

12m

finals (8 decks)

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