A bit of everything Flashcards
1
Q
What 4 questions can be asked to assess mental capacity?
A
Does the patient Understand the information relevant to the decision?
Can the patient Retain the information?
Can they use the information to Weigh up the options and make a decision?
Can they Communicate their decision to you?
2
Q
What is DOLS?
A
Deprivation of Liberty Safeguards
DOLS are part of the MCA, the safeguards aim to ensure that people in care homes or hospitals who lack capacity are looked after in a way that has their best interests at heart
3
Q
What is an IMCA?
A
Independent Mental Capacity Advocate = a legal safeguard for people who lack capacity
They represent people when there is no one independent of service –> e.g. no family members/friends
4
Q
What is the ICD-10 criteria for depression?
A
Persistent low mood
Loss of interest
Fatigue or low energy
5
Q
Give 5 physical symptoms of depression
A
Sleep disturbance
Unexplained aches/pains
Appetite change
Loss of libido
6
Q
Give 5 psychological symptoms of depression
A
Continuous low mood
Feeling hopeless
Tearful
Guilty
7
Q
What investigations might you do in someone with depression and why?
A
Bloods –> glucose, U&Es, LFT, TFT, Ca, FBC, ESR/CRP
Imaging if there are features suspicious of an intracranial lesion
Done to exclude any organic cause
8
Q
Name a screening tool for depression that can be used in primary care
A
PHQ-9
9
Q
How would you among mild-moderate depression?
A
Active monitoring
Low intensity psychological intervention –> IAPT, CBT
Encourage lifestyle changes such as exercise, smoking cessation and healthy diet
10
Q
How would you manage moderate-severe depression?
A
High intensity psychological intervention
2. Anti-depressant –> SSRIs, SSNRI, NASSAs, TCA, MAOIs
11
Q
Name 3 Selective Serotonin Reuptake Inhibitors (SSRIs)
A
Fluoxetine
Citalopram
Sertraline
12
Q
Name a Selective Serotonin-Norepinephrine Reuptake Inhibitor (SSNRI)
A
Duloxetine
Venlafaxine
13
Q
Name a Noradrenaline and specific serotogenic antidepressants (NASSAs)
A
Mirtazapine
14
Q
Briefly describe section 2 of the mental health act
A
Admission for assessment –> allows compulsory admission for up to 28 days for assessment
15
Q
Briefly describe section 3 of the mental health act
A
Admission for treatment –> allows compulsory admission for up to 6
months for treatment
16
Q
A
17
Q
Briefly describe section 135 of the mental health act
A
A magistrate can authorise forced entry into a property where it is believed that a person is suffering from a mental health disorder
18
Q
Briefly describe section 136 of the mental health act
A
Used by police to take someone suffering from a mental health disorder form a public place to a place of safety
19
Q
Give 4 physical signs of anxiety
A
Restless
Difficulty falling asleep due to racing thoughts
Dizziness
GI Disturbance –> Nausea, diarrhoea, constipation
Increased HR, BP and sweating
Muscle tension
Shortness of breath
20
Q
Give 3 psychological symptoms of anxiety
A
Excessive worry
Uncontrollable racing thoughts
Difficulty concentration due to agitation or racing thoughts
Sense of dread and fearing the worst
Feeling tense and nervous and unable to relax
Rumination = thinking about bad experiences over and over again
–
148
Q
Name 3 possible causes of anxiety
21
Q
Name 3 possible causes of anxiety
A
Family history
Female
Traumatic events
Other mental health problems
Chronic illness
Medications –> antidepressants, corticosteroids, OCP
Menopause
22
Q
What is generalised anxiety?
A
Regular or uncontrollable worries about many different things in everyday life
- Subjective experience of nervousness
23
Q
What is social anxiety?
A
Experience of extreme fear or anxiety triggered by social situation (parties, workplaces, or everyday situations where you have to speak to a different person)
24
Q
What is a panic disorder?
A
Having regular or frequent panic attacks without clear cause or trigger
25
What are the characteristic features of panic disorders?
crescendo of the anxiety usually resulting in an exit from the direction
Somatic symptoms –> palpitations, sweating, trembling,SOB, chest pain, dizziness
Secondary fear of dying/losing control
26
What is a phobia?
Extreme fear or anxiety triggered by a particular situation
- HAve anticipatory features
27
Give 2 examples of phobia
Agoraphobia = crowds, public places, leaving home
Claustrophobia = small, enclosed spaces
Arachnophobia = spiders
Social phobia
28
What are the characteristic features of PTSD?
Hyperarousal –> persistently heightened perception of current threat
Avoidance of situation/activities
Emotional numbing
Re-experiencing –> flashbacks, nightmares
29
Describe the treatment of anxiety
Psychoeduction, sleep hygiene, self guided CBT, relaxation techniques
CBT
Pharmacological treatments
30
What is included in a MSE?
Appearance and behaviour
Speech
Mood and Affect
Thought
Perception
Cognition
Insight
31
What formula is used to work out how many units of alcohol are in a drink?
Strength of drink (%ABV) X Volume (ml) / 1000
32
Name 4 possible alcohol withdrawal medications and how they work
Acamprosate –> relieves cravings- NMDA receptors antagonist
Disulfiram –> make you suffer when drinking - inhibits aldehyde dehydrogenase
Naltrexone –> block opioid receptors in the brain
33
Pathophysiology of DKA
1. Blood glucose raised due to peripheral insulin deficiency
2.Causes a rise in glucagon further raising the blood glucose
3.Leads to an accelerated breakdown of adipose tissue into free fatty acids which oxidise into ketones.
4.Hyperglycaemia and glycosuria lead to osmotic diuresis = dehydration
34
Features of DKA
>3mmol/L
blood glucose 11mmol/L
35
What is raised in CAH?
17 hydroxyprogesterone
36
What are the features of CAH?
Increased androgens so virillisation of genitalia - clit hypertrophy
Precocious puberty
Early development of pubic hair
Salt wasting crisis
Hypokalaemia
Hypernatraemia
Metabolic acidosis
37
What is androgen insensitivity syndrome and the sx ?
46 XY
- Primary amenorrhoea
Undescended testes
Little or no pubic hair
38
where is wernicke aphasia?
What would it sound like?
superior temporal gyrus
Fluent but no comprehension
39
What is Broca's aphasia?
Inferior frontal gyrus
Not fluent but comprehensive
40
What is BV and what is seen microscopically?
Overgrowth of gardnerella vaginalis
Produces aerobic lactobacilli
Clue cells
41
What and when are the tests for Downs?
Combined test at 11-14 (raised nuchal translucency, raised B-HCG, low PAPP-A)
Quadruple test 15-20 weeks ( Low Alpha feto protein, low unconjugated oestriol,, raised HCG and raised inhibin A)
Chorionic villious sampling - 10-12 week
Amniocentesis - 15 -20 week
42
Explain the menstrual cycle?
Follicular - FSH slowly rises and causes follicles to mature.
Maturing follicles produce oestrogen (oestrogen inhibits FSH) as the follicles mature, more oestrogen is produced until there is a peak which causes LH surge which causes ovulation. LH maintains corpus luteum. Corpus luteum produces progesterone and oestrogen which maintains and causes proliferation of the lining. Corpus luteum breaks down causing menstruation.
43
When should a breast referral be made?
Over 30 with an unexplained breast lump with or without pain
Over 50 with unexplained nipple changes
Over 30 with an unexplained lump in axilla
44
what are the first rank symptoms of schizophrenia?
third person auditory hallucination
Passivity phenomena
Delusion of perception
Thought disorders
45
What is sensitivity?
Proportion of the people who have the disease that were correctly identified.
46
What are the features of opioid misuse?
constricted pupils
drowsiness
rhinorrhea
Tremor
47
What is specificity?
Proportion of people who dont have the disease that were correctly excluded from the test
48
What is the cause of premature neonate RDS?
Deficient surfactant from T2 pneumocytes due to prematurity causing alveolar collapse. The baby will have fluid in their lungs during birth, when they take their first breath, the surfactant sould decrease the surface tension so the alveoli dont collapse. No surfactant = collapse
49
what is egalitarian?
Everyone is provided with all the necessary care
50
What is maximising?
An act is evaluated solely on its consequences
51
what is cyanosis?
more than 5g/dl of deoxygenated blood
52
what are the red flags for a CT <1 hour?
Vomiting more than once, GCS 13 on initial assessment, focal neuro, post traumatic seizure
53
What is syphillis?
treponema paliidum - sprochete bacterium
54
What are the features of primary syphillis?
chancre, local non tender lymphadenopathy
55
features of secondary syphillis?
generalised maculopapular rash, codylomata lata, alopecia
56
Features of tertiary syphillis?
neurosyphilis, cardiogenic
57
Investigations for syphillis?
VDRL, PCR/TPPA
58
TX for syphillis?
Benzathine penicillin G
59
What is the complication after ABX for syphillis?
Jarisch herxheimer reaction
60
what is the Mcroberts manouver?
hips and knees are flexed and abducted. provides a posterior tilt lifting pubic symphysis up
61
Rf for shoulder dystocia?
high maternal BMI
Prolonged labour
Gestational diabetes
62
Risk factors for GORD?
Hiatus hernia
Obesity
FHx of GORD
Downs
63
What are the symptoms of Brown sequard cord compression?
Hemisection
Ipsilateral corticospinal +DCML
Contralateral - spinothalmic
64
Treatment for cord compression?
Dexamethasone and surgical decompression
65
Symptoms of optic neuritis?
Decreased unilateral visual acuity
Poor discrimation of colour
Eye pain on movement
scrotoma
66
What is seen on CSf for bacteria?
cloudy, low glucose, high protein, polymorph WC
67
What is seen on CSF for virus?
clear, normal protein, lymphocytes
68
what is cerebral palsy?
a chronic disorder of movement and posture due to a non progressive brain abnormalities occurring before the brain has fully developed.
69
Toxicoplasmosis infection features? and TX
IUGFR, enceph
Pyremethamine and sulfadazine
70
Rubella infection features? Foetus and TX
Blueberry muffin rash, SNL, congenital cataracts
71
HSV foetal infection features? and Tx
encephalopathy
IV aciclovir
72
CMV infection features and TX?
BM rash, vague
Tx IV ganyclovir
73
Shyphillis infection foetus features?
Kerasitis, frontal bossing, SN deafness
TX IV benzathine penicillin
74
RF for ectopic preg?
IUD
PID
Endometriosis
Previous ectopic
IVF
Pelvic surgery
75
RF for cord prolapse?
Polyhdraminos
Prematurity
Artifical rupture of membranes
76
RF for vasa praevia ?
Placenta praevia
Multiple pregnancy
Low birth weight
77
Rf for placenta praevia
Previosu placenta praevia
Previous Csection
Multople pregnancies
>35
Uterine surgery
78
Rf for placenta increta?
Previosu csection
Uterine surgery
Hx of placenta praevia
>35
79
RF for endometrial ca?
nullparity
early menarche
late menopause
obesity
PCOs
Diabetes
80
Vulval Ca RF
HPV
Lichen sclerosis
VIN
Immunosuppresison
81
Cervical cancer RF
HPV
Multiple sexual partners
smoking
High parity
HIV
82
Ovarian Ca Rf
BRCA 1
Early menarche
LAte menopause
Nulliparity
83
What are the symptoms of endometriosis?
Dysparaenia
Dysmenorrhoea
Dysuria
Pelvic pain
84
What is seen on a pelvic examination with someone who has endometriosis?
fixed retroverted uterus
Tender uterus
Nodules
85
What is biochemically seen in PCOS?
LH:FSH ratio - LH raised
Low sex hormone binding globulin
possibly raised prolactin and testosterone
86
What is biochemically seen in menopause and premature ovarian failure?
Raised FSH and LH
87
what is the most common type of endometrial cancer?
Adenocarcinoma
88
Advantage of transtheoretical model?
acknowledges individual steps of readiness
Gives an idea of time frame
89
Disadvantage of transtheoretical model?
not all people move through each stage
No social cues
People go forward and back
90
what are the features of tuberous sclerosis?
ash leaf spots
Infantile spasms
developmental delay
Retinal harmatomas
Autosomal dominant
91
What are the features of neurofibromatosis 1 ?
Cafe-au-lait spots
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas
Scoliosis
Pheochromocytomas
92
What bacteria causes whooping cough?
Bordella pertussis - gram negtive coccobacillus
93
What immunisation is recommended for children with T1DM?
influenza
94
How do you calculate the APGAR score?
Colour - pink = 2, blue extremities =1, cyanosis = 0
Muscle tone - active movement =2, limb flection =1, flaccid
Reflex irritability - cries on stimulation = 2, grimace = 1
Pulse rate - >100=2 ,<100 = 1
Respiraotry effort - strong cry =2, weak = 1
95
what is the treatment for bacterial meningitis?
<3months= cefotaxime and amoxicillin
>3months - ceftriaxone
96
What is the kernig's sign ?
Knees are flexed, a clinician extends the knee which cause resistance, pain or the knees wont flex
97
What is parkinson's disease?
neurodegenrative disorder caused by degeneration of dopaminergic neurons within the substantia nigra.
98
What are the main features of parkinsons?
Bradykinesia
Rigidity
Tremor
99
What are other features of parkisnons?
mask like faces
drooling
Postural hypotension
100
What are causes of parkinsonism?
Parkinsons disease
Drug induced
Multiple system atrophy - Autonomic disturbance
Progressive supranuclear palsy - impairment of vertical gaze
101
What scoring system is used for prostate cancer?
Gleason
101
What are the causes of raised PSA?
BPH, prostate cancer, prostatitis
102
What LFT would be seen in prostate cancer?
Alkaline phosphate
103
What drug is given with levodopa and why?
Decarboxylase inhibitor and to reduce the peripheral breakdown of levodopa to reduce side effects
104
What are the features of brown sequard?
ipsilateral loss of fine touch, proprioception, vibration and ipsilateral hemiplegia
- contralateral loss of pain and temp sensation. Weakness below lesion
105
What causes otitis media?
Streptococcus pneumonia
Adenovirus
rhinovirus
106
what are the symptoms of pre-eclampsia?
Headache
papilledema
RUQ pain
hyperreflexia
Proteinuria
107
What are the high risk factors for pre-eclampsia?
DM
CKD
SLE/ALP
108
What are the moderate risk factors of pre-eclampsia?
first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m² or more at first visit
family history of pre-eclampsia
109
When should you take aspirin in pregnancy?
Take it from 12 weeks until birth
- 1 high risk or 2 low
110
what are the common effects of levodopa?
dry mouth
psychosis
postural hypotension
111
What is regularly taken with levodopa and why?
decarboxylase inhibitor - decreased peripheral breakdown of levodopa to reduce side effects
112
what are examples of Parkinson's medication?
Dopamine receptor antagonist - Bromocriptine
Monoamine oxidase B inhibitors - selegilline
COMT (Catechol-O-Methyl Transferase) inhibitors - entacapone
113
What adverse effects are there when achieving a specific dose for Parkinson's medication?
on-off phenomenon - fluctuations in motor period.
end of dose wearing off
114
what advice would you give parents when there child has just been diagnosed with epilepsy?
Take caution with swimming
If a seizure happens >5 minutes ring 999
115
what tests are done to assess fall risk?
Turn 180 test
Timed up and go
116
What is seen due to rhabdomyolosis?
myoglobinuria
117
What are the Sx of infective exacerbation of COPD?
Fever
Productive cough
Wheeze
Fatigue
Cyanosis
Confusion
118
what is the cause of excerbation of COPD?
Haemophilus influenza
Streptococcus pneumoniae
119
What are the signs of life threatening attack?
Silent chest
Sats <92%
Cyanosis
Poor respiratory effort
Altered consciousness
PEF <33% best or predicted
120
What is the treatment regime for acute asthma?
nebulised salbutamol
nebulised ipatropium bromide
oral prednisolone or IV hydrocortisone if they cant tolerate it
IV magnesium sulphate
IV aminophylline
IV salbutamol
Senior review
121
what are the side effects of atypical antipsychotics?
Weight gain
Metabolic disturbance - impaired glucose tolerance
122
what are the side effects of emergency contraception?
Heavy/ painful periods
Infection
Coil coming out
123
What are the assessments used for depression ?
PHQ-9
HADS
124
What is the management of endometrial cancer?
total abdominal hysterectomy with bilateral salpingo-oophorectomy
125
When is the MMR vaccine given?
1 year and 3 year+4months
126
What are notifiable disease?
Scarlet fever, measles, rubella, mumps, TB
127
what are the features of a patients voice wo has schizophrenia?
third person auditory hallucinations
running commentary
hearing her own thoughts aloud
128
What in a MSE assessment would you consider a patient to have schizophrenia?
appearance - flamboyant and unusual
speech - pressurised
Thought disorder/grandiose delusion
129
What are the risk factors for IUGR?
Pre-eclampsia
smoking
previous IUGR
130
What investigations would you use to assess the fetus?
cardiotocography, ultrasound of amniotic fluid volume
131
Who is involved in the MDT for a consultant led patient?
Obstetrician
Midwife
Neonatologist
132
What would be a cause for raised creatinine and urea?
Renal tract obstruction
133
what do opioid medications act on?
Mu receptors
134
what is acidosis?
pH below 7.35
135
What is seen on a GBS CSF?
high protein and raised opening pressure
136
How do you determine if asthma is well controlled?
- pattern of salbutamol use
- persistence of sx -wheeze, nocturnal diurnation
- previous hospital admissons due to asthma
137
what are the investigations and TX for GBS?
Electromyography
IVIG and physio
138
What are types of peripheral neuropathy?
Charcot marie tooth
Mitochondrial disorders
139
what are 2 causes of GBS?
Camylobacter jejuni
Epstein barr virus
140
What blood tests are performed for alcohol dependence?
GGT raised
MCV raised
141
What are 4 things you would ask in a HX to a PX presenting with diarrhoea?
- presence of blood or mucus
- Abdominal pain
- Travel
-Weight loss
142
What Ix would be performed for diarrhoea?
FBC
ESR
Stool culture
Faecal calprotectin
143
What is seen on a CT with a person with Parkinsons?
Normal CT
144
What are the causes of weight loss and weakness in elderly people?
Frailty
Malignancy
Ageing
HF
145
What is seen histologically for Ulcerative colitis?
Mucosa layer only
Crypt distortion, abscess
146
What is deontology?
doing what is morally right, based on principles, rules, or duties, rather than focusing on the consequences of the action.
147
What i seen microscopically for crohns?
Inflammation of all layers, granulomas and goblet cells
148
What is seen microscopically for coeliac disease?
crypt hyperplasia and villous atrophy
149
What is passivity phenomena?
Bodily sensations been controlled by an external influence
150
What is delusions of persecution?
where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient
151
What is the criteria for antibiotics for otitis media?
- Sx for 4 or more days
-systemically unwell
- Immunocompromised
-<2 with bilateral otitis media
-acute otitis media with perforation
152
What are the Sx for mastoiditis and what is the management plan?
- Tenderness behind the ear
-ear sticking out more prominently
Clinical emergency - urgent same day referral
153
What is seen in nephrotic syndrome and what are the main causes?
- proteinuria
-hypoalbuminaemia
-oedema
Caused by minimal change disease
154
What is seen in nephritis syndrome?
Haematuria
proteinuria
155
What causes nephritic syndrome?
Henoch schonlein purpura
Post strep infection - weeks after
IgA nephropathy - days after
156
What is the drug used to treat Neonatal abstinence syndrome for cocaine?
IV phenobarbital
157
What is screened for at the 20 week scan?
- edwards
Patau
anencephaly
Gastroschisis
cleft lo[
bilateral renal agenesis
158
What are the female indications for early fertility referral?
Over 35
Amenorrhoea or oligomenorrhoea
Previous abdo/pelvic surgery
Previous sti/PID
159
What are the reasons for early fertility services in men?
- previous urogenital surgery
Previous sti
varicocele
Two abnormal semen results
160
What are the causes of polyhdraminios?
idiopathic
Diabetes
Multiple pregnancy
Foetal anaemia
Diaphragmatic hernia
161
Causes of oligohydraminois?
Pre-eclampsia
post term
ACE-inhibitors
PROM
renal genesis
162
What is a complete molar pregnancy?
empty egg being fertilised -XX
Snowstorm appearance
163
What is an incomplete pregnancy?
XXX
fertilisation of one egg and one sperm duplicated or 2 sperm
164
What is the definition of PPH?
>500ml of blood loss following the delivery of the baby
Minor <1000
Major is >1000 (moderate if 1000-2000) or severe if >2000
165
Common causes of PPH?
Tone
Placenta retention
Tear- trauma
Thrombin
166
What is the FIGO staging?
1 - confined to uterus
2 - carcinoma extends to the cervix but not beyond the uterus
3-carcinoma extends beyond uterus to ovaries
4-carcinoma involves bladder or bowel
167
What is Meig's syndrome ?
Complication of ovarian cysts
- Ovarian fibroma, ascites and plural effusion - Do CXR
168
What livery blood is raised in pregnancy?
ALP - increased burn turnover
169
What us the fever PAIN score?
- fever
pus on tonsils
attended within 3 days
inflamed tonsils
no cough
170
What is the centor criteria?
Tonsillar exudate
anterior cervical lymphadenopathy
fever of 38 degrees
absence of cough
171
What is the management of endometriomas - if fertility is a priority?
Laparoscopic ovarian cystectomy with excision of the cyst wall
172
What is a staggered overdose?
First and last drug 1 hour apart
173
What is the treatment for pneumocystis pneumonia?
co -trimoxazole
174
What is the order of preference for women for STI testing?
endocervical, vulvovaginal, first catch urine
175
What is the Black report?
1980 - inequalities in health
- artefact
health or social selection
materialist/structuralist
cultural/behavioural
176
What are the signs and symptoms of a primary HIV infection?
- fever
-llymphadenopathy
myalgia
177
What are longstanding HIV Sx?
Can be asx then progressive immune dysfunction can cause
- TB or pneumocystis pneumonia
meningitis
malignancy
178
What are the investigations for HIV?
HIV antibody test - IgM or IgG
p24 antigen
179
What is the treatment for HIV?
combination antiretroviral therapy
180
What are the opportunistic infections for HIV?
pneumocystis pneumonia
Candidiasis
CMV
Kaposi's sarcoma - caused by HHV8 (multiple purple/brown lesions on skin)
lymphoma
Cervical cancer - cant clear HPV
181
What is the difference between a simple and complex febrile seizure?
A simple seizure is <15 minutes - - generalised seizure
A complex seizure >15 minutes - focal seizure
182
What is chvostek's sign?
hypocalcaemia tap facial nerve to get twitching of nerve
183
What is hoovers sign?
weakness of voluntary hip extension - feel pressure under heel of affected leg
184
when should you start an alendronic acid?
– ≥65 and on long-term steroids should be offered bone
protection even without a DEXA scan
185
what is the function of nimodipine?
21d course of nimodipine is used to prevent vasospasm as it targets the brain vasculature
186
What is the management of impetigo?
- Hydrogen peroxide 1% cream - if systemically well
- Fusidic acid
-Oral flucloxacillin
187
What is the management of chicken pox exposure in pregnancy?
- check varicella antibodies
- if none give varicella immunoglobulin immediately
-Oral aciclovir if rash
188
What is a grandiose delusion?
idea that the person themselves are powerful/crucially
important beyond truth
189
What is need?
An ability to benefit from an intervention
190
What is comparative need?
Comparison between severity, range of intervention and cost - screening resources for HPV in an affluent area compared to low socioeconomic area
191
What is a health needs assessment?
A systematic approach to reviewing health issues affecting a population and what changes are required.
192
How would you evaluate health services?
DONABEDIAN
- assessment whether service achieves its objectives
- structure- staff, buildings, equipment (number of ICU beds per 1000 population)
-process - number of prescriptions/ screening
-outcome - mortality rate
193
what is relative risk?
risk in exposed group over risk in unexposed group
194
What is attributable risk?
How much of the risk is actually due to a certain risk factor
195
what is an epidemiological study and give a pro and a con ?
A study looking at trends in data at a population level
+= prevalence and correlation , readily available data
-= doesnt show causation
196
what is a cross sectional study and give a pro and con?
looking at a specific disease and collects data on them at defined points of time.
+= Quick and cheap
-=reverse causality and recall bias
197
What is a case control study and what is a pro and con?
A group of people with a disease and a group of people without who are the same sex/age and look at associations and risk factors.
+=good for rare outcome
-=Prone to bias, difficult to find appropriate control group
198
what is a cohort study and what is a pro and con?
Prospective study that has a group of people with an exposure and outcome in mind. follow them over time
+= causation, lower chance of bias
-=takes a long time, large sample
199
What is the epidemiological assessment approaches? (assessment to assess health needs)
- defines size of problems, population, services available
+= uses existing data/ provides data on disease incidence and mortality
-= doesn't consider felt need
200
What is the comparative approach?
2 demographically different services compared
+= quick and cheap
-= difficult to find comparable population
201
What is a corporate approach?
- Asks the population what their health needs assessment are - focus groups/meetings
+= based on felt and expressed need/wide range of views
-= difficult to distinguish need from demand/ bias by dominant personalities.
202
What is the treatment for opioid NAS?
Morphine
203
what is the ICD 11 criteria for opioid misuse?
A harmful pattern of use is evident over a 12 month period or at least 1 month if use is continuous.
- persistent desire to cut down
-using larger amounts over a longer period thean was intended
-a lot of time obtaining, using
-craving
-failure to work, duties at home
204
What is kallman?
xlinked recessive
- delayed puberty
- hypogonadism
-anosmia
205
What is klinefelter?
47xxy
Taller
Gynaecomastia
small testes
high gonadotrophin
low testosterone
206
What aspects are assessed in the bishop score?
position
consistency
effacement
dilation
fetal station
207
When is the palmar grasp?
6 months
208
When is the pincer grip?
9 months
209
Sit without support?
6 months(9 month referral)
210
What is the management for COPD, steroid responisve (asthma Sx)?
SABA or SAMA as required
Then add LABA and ICS
Then add lama
211
What is the management for COPD, non steroid responsive ?
SABA or SAMA then
LABA and LAMA
Then add ICS
212
What are the features of steroid responsive COPD?
History of asthma / atopy
- Bloods: Eosinophilia
- Diurnal variation of PEFR of 20% or more or FEV1 variation day-to-day of 400ml
213
what is zopiclone?
a gaba agonist
- used for sleep
214
What is otitis externa?
infectious caused by staphylococcus aureus/allergies/swimming
Sx
- itch/pain/discharge
Tx
-topical abx
215
What is ramsay hunt syndrome?
caused by reactivation of vzv in ganglion on 7th nerve
- auricular pain
-facial nerve palsy
-rash around ear
Tx - aciclovir and corticosteroids
216
Difference between conduct disorder and oppositional defiant disorder?
oppositional defiant towards authorative figures but still does well at school (conduct is more severe, affects social problems)
217
What causes horizontal diplopia?
CN 6
218
What causes vertical diplopia?
CN 4
219
What is the romberg test?
assess balance and proprioception
220
When do you review a benign murmur?
1 month
221
How do you measure small for gestational age?
Abdominal circumference less than 10th centile for gestation
222
What changes are there in von willerbands disease?
prolonged bleeding time
APTT may be prolonged
factor 8 levels may be reduced
223
What is the typical blood picture for disseminated intravascular coagulation?
low platelets
low fibrinogen
raised PT and APTT
224
What is seen in haemophilia?
only prolonged APTT
225
what should be monitored if a patient is on venlafaxine?
Blood pressure
226
What is seen on biochem for a pateint with anorexia?
low magnesium, phosphate,calcium
high cortisol and high cholesterol and high growth hormone
low sex hormones
metabolic alkalosis
227
What are the side effects of TCAs?
dry mouth
blurred vision
constipation
urinary retention
228
When can expectant management be performed for an ectopic pregnancy?
An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining
229
When is the management for ectopic surgical?
Size >35mm
Can be ruptured
Pain
Visible fetal heartbeat
hCG >5,000IU/
230
What is the management for nausea and vomiting in pregnancy?
antihistamines: oral cyclizine or promethazine
oral ondansetron (risk of cleft palate)or metoclopramide - only used for 5 days
231
What is a APH?
Antepartum haemorrhage is defined as bleeding from the genital tract after 24 weeks pregnancy, prior to delivery of the fetus
232
What bit does CP affcet in spastic type?
Upper motor neurones
233
What does CP affect in dyskinetic?
basal ganglia and substantia nigra
234
What bit does CP affect in ataxic?
cerebellar
235
what are the Sx of Downs syndrome?
epicanthal folds
single palmer crease
flat face
hypotonia
small low set ears
236
What is the first line test for CMPA?
skin prick/patch testing
237
What is the long term management for CMPA?
follow up in allergy clinic
Histamines
238
What is the first line investigation for PROM?
Speculum examination - poo; of fluid in posterior vaginal fornix
239
What are the risk factors for incontinence?
Pregnancy
obesity
previous deliveries
Increasing age
240
What are non pharmacological ways to prevent falls?
Increased salt intake
Fluids -stay hydrated
Get up slowly
241
What are causes of pneumonia?
Streptococcus pneumonia
Haemophilus influenza
Mycoplasma pneumonia- atypical
242
What are the signs and symptoms of pneumonia?
a cough with sputum
dyspnoea
fever
chest pain
243
What are the oxford stoke classification?
Total anterior circulation - unilateral hemiparesis, homonymous hemianopia, dysphasia
Partial - 2 of the above
Lacunar - unilateral weakness, pure sensory, ataxic
Posterior circulation infarcts - cerebellar syndromes/LOC/ homon hemi
244
What is lateral medullary syndrome?
Posterior inferior cerebellar artery
- wallenberg
ipsilateral facial pain and temp loss + horners
contralateral limb pain and temp loss
ataxia and nystagmus
245
What is webers syndrome?
ipsilateral 3 nerve palsy
contralateral weakness
246
What is the definitive diagnosis for a TIA?
Specialist referral within 24 hours for a diffuse weighted MRI showing ischemia
247
What are indicators of a poor prognosis of schizophrenia?
- strong family history
gradual onset
Low IQ
social withdrawal
lack of obvious precipitant
248
What are the risk factors for schizophrenia?
Black, migration, urban environment, cannabis , FHx, male
249
What are 3 types of psoriasis?
- plaque psoriais
-guttate psoriasis
-pustular
250
Lifestyle changes for psoriasis?
- smoking cessation
reduce alcohol
251
What is first line management for psoriasis?
potent corticosteroid and vitamin D analogue
252
What causes diabetic foot disease?
peripheral neuropathy - loss of sensation
PAD
253
How is neuropathic pain managed?
TCa
pregabalin
gabapentin
254
What is osteomyelitis?
infection of the bone
mc cause is staph aureus or salmonella if sickle cell disease
255
What is the investigation and management for osteomyelitis?
MRI
Flucloxacillin
256
What are the risk factors for sleep apnoea?
Obesity
acromegaly
marfans
large tonsils
257
What is the assessment and management for obstructive sleep apnoea?
Epworth sleepiness scale
CPAP
258
What is intussusception?
invagination of one portion of the bowel into the lumen of the adjacent bowe
259
What are the stages of CKD?
stage 1 (G1) – above 90ml/min
stage 2 (G2) – 60 to 89ml/min,
stage 3a (G3a) – 45 to 59ml/min
stage 3b (G3b) – 30 to 44ml/min
stage 4 (G4) – 15 to 29ml/min
stage 5 (G5) – 15ml/min,
260
what is AKI stage 1?
Increase in creatinine to 1.5-1.9 times baseline
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours
261
What is AKI stage 2?
Increase in creatinine to 2.0 to 2.9 times baseline
Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours
262
What is AKI stage 3?
Increase in creatinine to ≥ 3.0 times baseline
Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours,
263
What is AKI?
Increase in serum creatinine by >26.5 mmol/l within 48 h, or
Increase in serum creatinine > 1.5x the baseline within the last 7 days, or
Urine output < 0.5 ml/kg/h for 6 hours
264
What fluids do you give in maintenance?
0.9% saline + 5% glucose
265
What fluids do you give in resus and how much do you give?
0.9% saline
10ml/kg in <10mins
266
How do you calculate the replacement fluids?
dehydration x 10x weight
267
How do you figure out the percentage dehydration?
well weight- now weight divided by well weight times 100
268
What is the correct dose for administering insulin in DKA?
(0.1units/kg/hr)
269
what are the features of adenomyosis?
dysmenorrhoea
menorrhagia
enlarged, boggy uterus
270
when are the cervical screen?
25-49 every3 years
49-64 every 5 years
271
What are the tests for DDH?
Barlow test: attempts to dislocate an articulated femoral head - quickly adduct and push
Ortolani test: attempts to relocate a dislocated femoral head - quickly abduct
272
What are the other signs for DDH?
symmetry of leg length
level of knees when hips and knees are bilaterally flexed
273
what are the sx of lithium toxicity?
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
seizure
274
What are the adverse affects of lithium?
nausea/vomiting, diarrhoea
fine tremor
weight gain
275
what is the definition of preeclampsia?
≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following:
proteinuria
276
2 causes of postural hypotension?
medications -antihypertensives, levodopa
hypovolaemia
277
What tests do you do before giving Lithium?
ECG
U+Es
TFT
278
What is atypical depression?
eat more
sleep more
periods of happy
279
What electrolyte inbalance can be caused in DKA?
initially high potassium , then after insulin Tx can cause hypokalaemia
280
What is the difference between serotonin syndrome and neuroleptic malignant syndrome?
Serotonin syndrome - caused by SSRI's, MAOI
- fast onset
-hyperreflexia
dilated pupils
-tachycardia
Neuroleptic - caused by antipsychotics
- slower onset -days
hyporeflexia
rigidity
normal pupils
High CK
-
281
