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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?

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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

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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

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4
Q

What is the ICD-10 criteria for depression?

A

Persistent low mood
Loss of interest
Fatigue or low energy

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5
Q

Give 5 physical symptoms of depression

A

Sleep disturbance
Unexplained aches/pains
Appetite change
Loss of libido

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6
Q

Give 5 psychological symptoms of depression

A

Continuous low mood
Feeling hopeless
Tearful
Guilty

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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

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8
Q

Name a screening tool for depression that can be used in primary care

A

PHQ-9

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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

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10
Q

How would you manage moderate-severe depression?

A

High intensity psychological intervention
2. Anti-depressant –> SSRIs, SSNRI, NASSAs, TCA, MAOIs

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11
Q

Name 3 Selective Serotonin Reuptake Inhibitors (SSRIs)

A

Fluoxetine
Citalopram
Sertraline

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12
Q

Name a Selective Serotonin-Norepinephrine Reuptake Inhibitor (SSNRI)

A

Duloxetine

Venlafaxine

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13
Q

Name a Noradrenaline and specific serotogenic antidepressants (NASSAs)

A

Mirtazapine

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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

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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

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16
Q
A
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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

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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

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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

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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

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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

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22
Q

What is generalised anxiety?

A

Regular or uncontrollable worries about many different things in everyday life
- Subjective experience of nervousness

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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)

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24
Q

What is a panic disorder?

A

Having regular or frequent panic attacks without clear cause or trigger

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25
Q

What are the characteristic features of panic disorders?

A

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

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26
Q

What is a phobia?

A

Extreme fear or anxiety triggered by a particular situation

  • HAve anticipatory features
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27
Q

Give 2 examples of phobia

A

Agoraphobia = crowds, public places, leaving home
Claustrophobia = small, enclosed spaces
Arachnophobia = spiders
Social phobia

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28
Q

What are the characteristic features of PTSD?

A

Hyperarousal –> persistently heightened perception of current threat
Avoidance of situation/activities
Emotional numbing
Re-experiencing –> flashbacks, nightmares

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29
Q

Describe the treatment of anxiety

A

Psychoeduction, sleep hygiene, self guided CBT, relaxation techniques
CBT
Pharmacological treatments

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30
Q

What is included in a MSE?

A

Appearance and behaviour
Speech
Mood and Affect
Thought
Perception
Cognition
Insight

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31
Q

What formula is used to work out how many units of alcohol are in a drink?

A

Strength of drink (%ABV) X Volume (ml) / 1000

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32
Q

Name 4 possible alcohol withdrawal medications and how they work

A

Acamprosate –> relieves cravings- NMDA receptors antagonist
Disulfiram –> make you suffer when drinking - inhibits aldehyde dehydrogenase
Naltrexone –> block opioid receptors in the brain

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33
Q

Pathophysiology of DKA

A
  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
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34
Q

Features of DKA

A

> 3mmol/L

<Ph 7.35
>blood glucose 11mmol/L

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35
Q

What is raised in CAH?

A

17 hydroxyprogesterone

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36
Q

What are the features of CAH?

A

Increased androgens so virillisation of genitalia - clit hypertrophy
Precocious puberty
Early development of pubic hair
Salt wasting crisis
Hypokalaemia
Hypernatraemia
Metabolic acidosis

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37
Q

What is androgen insensitivity syndrome and the sx ?

A

46 XY
- Primary amenorrhoea
Undescended testes
Little or no pubic hair

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38
Q

where is wernicke aphasia?
What would it sound like?

A

superior temporal gyrus
Fluent but no comprehension

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39
Q

What is Broca’s aphasia?

A

Inferior frontal gyrus
Not fluent but comprehensive

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40
Q

What is BV and what is seen microscopically?

A

Overgrowth of gardnerella vaginalis
Produces aerobic lactobacilli
Clue cells

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41
Q

What and when are the tests for Downs?

A

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

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42
Q

Explain the menstrual cycle?

A

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.

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43
Q

When should a breast referral be made?

A

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

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44
Q

what are the first rank symptoms of schizophrenia?

A

third person auditory hallucination
Passivity phenomena
Delusion of perception
Thought disorders

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45
Q

What is sensitivity?

A

Proportion of the people who have the disease that were correctly identified.

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46
Q

What are the features of opioid misuse?

A

constricted pupils
drowsiness
rhinorrhea
Tremor

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47
Q

What is specificity?

A

Proportion of people who dont have the disease that were correctly excluded from the test

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48
Q

What is the cause of premature neonate RDS?

A

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

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49
Q

what is egalitarian?

A

Everyone is provided with all the necessary care

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50
Q

What is maximising?

A

An act is evaluated solely on its consequences

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51
Q

what is cyanosis?

A

more than 5g/dl of deoxygenated blood

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52
Q

what are the red flags for a CT <1 hour?

A

Vomiting more than once, GCS 13 on initial assessment, focal neuro, post traumatic seizure

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53
Q

What is syphillis?

A

treponema paliidum - sprochete bacterium

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54
Q

What are the features of primary syphillis?

A

chancre, local non tender lymphadenopathy

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55
Q

features of secondary syphillis?

A

generalised maculopapular rash, codylomata lata, alopecia

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56
Q

Features of tertiary syphillis?

A

neurosyphilis, cardiogenic

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57
Q

Investigations for syphillis?

A

VDRL, PCR/TPPA

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58
Q

TX for syphillis?

A

Benzathine penicillin G

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59
Q

What is the complication after ABX for syphillis?

A

Jarisch herxheimer reaction

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60
Q

what is the Mcroberts manouver?

A

hips and knees are flexed and abducted. provides a posterior tilt lifting pubic symphysis up

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61
Q

Rf for shoulder dystocia?

A

high maternal BMI
Prolonged labour
Gestational diabetes

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62
Q

Risk factors for GORD?

A

Hiatus hernia
Obesity
FHx of GORD
Downs

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63
Q

What are the symptoms of Brown sequard cord compression?

A

Hemisection
Ipsilateral corticospinal +DCML
Contralateral - spinothalmic

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64
Q

Treatment for cord compression?

A

Dexamethasone and surgical decompression

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65
Q

Symptoms of optic neuritis?

A

Decreased unilateral visual acuity
Poor discrimation of colour
Eye pain on movement
scrotoma

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66
Q

What is seen on CSf for bacteria?

A

cloudy, low glucose, high protein, polymorph WC

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67
Q

What is seen on CSF for virus?

A

clear, normal protein, lymphocytes

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68
Q

what is cerebral palsy?

A

a chronic disorder of movement and posture due to a non progressive brain abnormalities occurring before the brain has fully developed.

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69
Q

Toxicoplasmosis infection features? and TX

A

IUGFR, enceph
Pyremethamine and sulfadazine

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70
Q

Rubella infection features? Foetus and TX

A

Blueberry muffin rash, SNL, congenital cataracts

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71
Q

HSV foetal infection features? and Tx

A

encephalopathy
IV aciclovir

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72
Q

CMV infection features and TX?

A

BM rash, vague
Tx IV ganyclovir

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73
Q

Shyphillis infection foetus features?

A

Kerasitis, frontal bossing, SN deafness
TX IV benzathine penicillin

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74
Q

RF for ectopic preg?

A

IUD
PID
Endometriosis
Previous ectopic
IVF
Pelvic surgery

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75
Q

RF for cord prolapse?

A

Polyhdraminos
Prematurity
Artifical rupture of membranes

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76
Q

RF for vasa praevia ?

A

Placenta praevia
Multiple pregnancy
Low birth weight

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77
Q

Rf for placenta praevia

A

Previosu placenta praevia
Previous Csection
Multople pregnancies
>35
Uterine surgery

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78
Q

Rf for placenta increta?

A

Previosu csection
Uterine surgery
Hx of placenta praevia
>35

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79
Q

RF for endometrial ca?

A

nullparity
early menarche
late menopause
obesity
PCOs
Diabetes

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80
Q

Vulval Ca RF

A

HPV
Lichen sclerosis
VIN
Immunosuppresison

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81
Q

Cervical cancer RF

A

HPV
Multiple sexual partners
smoking
High parity
HIV

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82
Q

Ovarian Ca Rf

A

BRCA 1
Early menarche
LAte menopause
Nulliparity

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83
Q

What are the symptoms of endometriosis?

A

Dysparaenia
Dysmenorrhoea
Dysuria
Pelvic pain

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84
Q

What is seen on a pelvic examination with someone who has endometriosis?

A

fixed retroverted uterus
Tender uterus
Nodules

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85
Q

What is biochemically seen in PCOS?

A

LH:FSH ratio - LH raised
Low sex hormone binding globulin
possibly raised prolactin and testosterone

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86
Q

What is biochemically seen in menopause and premature ovarian failure?

A

Raised FSH and LH

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87
Q

what is the most common type of endometrial cancer?

A

Adenocarcinoma

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88
Q

Advantage of transtheoretical model?

A

acknowledges individual steps of readiness
Gives an idea of time frame

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89
Q

Disadvantage of transtheoretical model?

A

not all people move through each stage
No social cues
People go forward and back

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90
Q

what are the features of tuberous sclerosis?

A

ash leaf spots
Infantile spasms
developmental delay
Retinal harmatomas
Autosomal dominant

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91
Q

What are the features of neurofibromatosis 1 ?

A

Cafe-au-lait spots
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas
Scoliosis
Pheochromocytomas

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92
Q

What bacteria causes whooping cough?

A

Bordella pertussis - gram negtive coccobacillus

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93
Q

What immunisation is recommended for children with T1DM?

A

influenza

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94
Q

How do you calculate the APGAR score?

A

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

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95
Q

what is the treatment for bacterial meningitis?

A

<3months= cefotaxime and amoxicillin
>3months - ceftriaxone

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96
Q

What is the kernig’s sign ?

A

Knees are flexed, a clinician extends the knee which cause resistance, pain or the knees wont flex

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97
Q

What is parkinson’s disease?

A

neurodegenrative disorder caused by degeneration of dopaminergic neurons within the substantia nigra.

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98
Q

What are the main features of parkinsons?

A

Bradykinesia
Rigidity
Tremor

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99
Q

What are other features of parkisnons?

A

mask like faces
drooling
Postural hypotension

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100
Q

What are causes of parkinsonism?

A

Parkinsons disease
Drug induced
Multiple system atrophy - Autonomic disturbance
Progressive supranuclear palsy - impairment of vertical gaze

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101
Q

What scoring system is used for prostate cancer?

A

Gleason

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101
Q

What are the causes of raised PSA?

A

BPH, prostate cancer, prostatitis

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102
Q

What LFT would be seen in prostate cancer?

A

Alkaline phosphate

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103
Q

What drug is given with levodopa and why?

A

Decarboxylase inhibitor and to reduce the peripheral breakdown of levodopa to reduce side effects

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104
Q

What are the features of brown sequard?

A

ipsilateral loss of fine touch, proprioception, vibration and ipsilateral hemiplegia
- contralateral loss of pain and temp sensation. Weakness below lesion

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105
Q

What causes otitis media?

A

Streptococcus pneumonia
Adenovirus
rhinovirus

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106
Q

what are the symptoms of pre-eclampsia?

A

Headache
papilledema
RUQ pain
hyperreflexia
Proteinuria

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107
Q

What are the high risk factors for pre-eclampsia?

A

DM
CKD
SLE/ALP

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108
Q

What are the moderate risk factors of pre-eclampsia?

A

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

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109
Q

When should you take aspirin in pregnancy?

A

Take it from 12 weeks until birth
- 1 high risk or 2 low

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110
Q

what are the common effects of levodopa?

A

dry mouth
psychosis
postural hypotension

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111
Q

What is regularly taken with levodopa and why?

A

decarboxylase inhibitor - decreased peripheral breakdown of levodopa to reduce side effects

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112
Q

what are examples of Parkinson’s medication?

A

Dopamine receptor antagonist - Bromocriptine
Monoamine oxidase B inhibitors - selegilline
COMT (Catechol-O-Methyl Transferase) inhibitors - entacapone

113
Q

What adverse effects are there when achieving a specific dose for Parkinson’s medication?

A

on-off phenomenon - fluctuations in motor period.
end of dose wearing off

114
Q

what advice would you give parents when there child has just been diagnosed with epilepsy?

A

Take caution with swimming
If a seizure happens >5 minutes ring 999

115
Q

what tests are done to assess fall risk?

A

Turn 180 test
Timed up and go

116
Q

What is seen due to rhabdomyolosis?

A

myoglobinuria

117
Q

What are the Sx of infective exacerbation of COPD?

A

Fever
Productive cough
Wheeze
Fatigue
Cyanosis
Confusion

118
Q

what is the cause of excerbation of COPD?

A

Haemophilus influenza
Streptococcus pneumoniae

119
Q

What are the signs of life threatening attack?

A

Silent chest
Sats <92%
Cyanosis
Poor respiratory effort
Altered consciousness
PEF <33% best or predicted

120
Q

What is the treatment regime for acute asthma?

A

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
Q

what are the side effects of atypical antipsychotics?

A

Weight gain
Metabolic disturbance - impaired glucose tolerance

122
Q

what are the side effects of emergency contraception?

A

Heavy/ painful periods
Infection
Coil coming out

123
Q

What are the assessments used for depression ?

124
Q

What is the management of endometrial cancer?

A

total abdominal hysterectomy with bilateral salpingo-oophorectomy

125
Q

When is the MMR vaccine given?

A

1 year and 3 year+4months

126
Q

What are notifiable disease?

A

Scarlet fever, measles, rubella, mumps, TB

127
Q

what are the features of a patients voice wo has schizophrenia?

A

third person auditory hallucinations
running commentary
hearing her own thoughts aloud

128
Q

What in a MSE assessment would you consider a patient to have schizophrenia?

A

appearance - flamboyant and unusual
speech - pressurised
Thought disorder/grandiose delusion

129
Q

What are the risk factors for IUGR?

A

Pre-eclampsia
smoking
previous IUGR

130
Q

What investigations would you use to assess the fetus?

A

cardiotocography, ultrasound of amniotic fluid volume

131
Q

Who is involved in the MDT for a consultant led patient?

A

Obstetrician
Midwife
Neonatologist

132
Q

What would be a cause for raised creatinine and urea?

A

Renal tract obstruction

133
Q

what do opioid medications act on?

A

Mu receptors

134
Q

what is acidosis?

A

pH below 7.35

135
Q

What is seen on a GBS CSF?

A

high protein and raised opening pressure

136
Q

How do you determine if asthma is well controlled?

A
  • pattern of salbutamol use
  • persistence of sx -wheeze, nocturnal diurnation
  • previous hospital admissons due to asthma
137
Q

what are the investigations and TX for GBS?

A

Electromyography
IVIG and physio

138
Q

What are types of peripheral neuropathy?

A

Charcot marie tooth
Mitochondrial disorders

139
Q

what are 2 causes of GBS?

A

Camylobacter jejuni
Epstein barr virus

140
Q

What blood tests are performed for alcohol dependence?

A

GGT raised
MCV raised

141
Q

What are 4 things you would ask in a HX to a PX presenting with diarrhoea?

A
  • presence of blood or mucus
  • Abdominal pain
  • Travel
    -Weight loss
142
Q

What Ix would be performed for diarrhoea?

A

FBC
ESR
Stool culture
Faecal calprotectin

143
Q

What is seen on a CT with a person with Parkinsons?

144
Q

What are the causes of weight loss and weakness in elderly people?

A

Frailty
Malignancy
Ageing
HF

145
Q

What is seen histologically for Ulcerative colitis?

A

Mucosa layer only
Crypt distortion, abscess

146
Q

What is deontology?

A

doing what is morally right, based on principles, rules, or duties, rather than focusing on the consequences of the action.

147
Q

What i seen microscopically for crohns?

A

Inflammation of all layers, granulomas and goblet cells

148
Q

What is seen microscopically for coeliac disease?

A

crypt hyperplasia and villous atrophy

149
Q

What is passivity phenomena?

A

Bodily sensations been controlled by an external influence

150
Q

What is delusions of persecution?

A

where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient

151
Q

What is the criteria for antibiotics for otitis media?

A
  • Sx for 4 or more days
    -systemically unwell
  • Immunocompromised
    -<2 with bilateral otitis media
    -acute otitis media with perforation
152
Q

What are the Sx for mastoiditis and what is the management plan?

A
  • Tenderness behind the ear
    -ear sticking out more prominently
    Clinical emergency - urgent same day referral
153
Q

What is seen in nephrotic syndrome and what are the main causes?

A
  • proteinuria
    -hypoalbuminaemia
    -oedema

Caused by minimal change disease

154
Q

What is seen in nephritis syndrome?

A

Haematuria
proteinuria

155
Q

What causes nephritic syndrome?

A

Henoch schonlein purpura
Post strep infection - weeks after
IgA nephropathy - days after

156
Q

What is the drug used to treat Neonatal abstinence syndrome for cocaine?

A

IV phenobarbital

157
Q

What is screened for at the 20 week scan?

A
  • edwards
    Patau
    anencephaly
    Gastroschisis
    cleft lo[
    bilateral renal agenesis
158
Q

What are the female indications for early fertility referral?

A

Over 35
Amenorrhoea or oligomenorrhoea
Previous abdo/pelvic surgery
Previous sti/PID

159
Q

What are the reasons for early fertility services in men?

A
  • previous urogenital surgery
    Previous sti
    varicocele
    Two abnormal semen results
160
Q

What are the causes of polyhdraminios?

A

idiopathic
Diabetes
Multiple pregnancy
Foetal anaemia
Diaphragmatic hernia

161
Q

Causes of oligohydraminois?

A

Pre-eclampsia
post term
ACE-inhibitors
PROM
renal genesis

162
Q

What is a complete molar pregnancy?

A

empty egg being fertilised -XX
Snowstorm appearance

163
Q

What is an incomplete pregnancy?

A

XXX
fertilisation of one egg and one sperm duplicated or 2 sperm

164
Q

What is the definition of PPH?

A

> 500ml of blood loss following the delivery of the baby
Minor <1000
Major is >1000 (moderate if 1000-2000) or severe if >2000

165
Q

Common causes of PPH?

A

Tone
Placenta retention
Tear- trauma
Thrombin

166
Q

What is the FIGO staging?

A

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
Q

What is Meig’s syndrome ?

A

Complication of ovarian cysts
- Ovarian fibroma, ascites and plural effusion - Do CXR

168
Q

What livery blood is raised in pregnancy?

A

ALP - increased burn turnover

169
Q

What us the fever PAIN score?

A
  • fever
    pus on tonsils
    attended within 3 days
    inflamed tonsils
    no cough
170
Q

What is the centor criteria?

A

Tonsillar exudate
anterior cervical lymphadenopathy
fever of 38 degrees
absence of cough

171
Q

What is the management of endometriomas - if fertility is a priority?

A

Laparoscopic ovarian cystectomy with excision of the cyst wall

172
Q

What is a staggered overdose?

A

First and last drug 1 hour apart

173
Q

What is the treatment for pneumocystis pneumonia?

A

co -trimoxazole

174
Q

What is the order of preference for women for STI testing?

A

endocervical, vulvovaginal, first catch urine

175
Q

What is the Black report?

A

1980 - inequalities in health
- artefact
health or social selection
materialist/structuralist
cultural/behavioural

176
Q

What are the signs and symptoms of a primary HIV infection?

A
  • fever
    -llymphadenopathy
    myalgia
177
Q

What are longstanding HIV Sx?

A

Can be asx then progressive immune dysfunction can cause
- TB or pneumocystis pneumonia
meningitis
malignancy

178
Q

What are the investigations for HIV?

A

HIV antibody test - IgM or IgG
p24 antigen

179
Q

What is the treatment for HIV?

A

combination antiretroviral therapy

180
Q

What are the opportunistic infections for HIV?

A

pneumocystis pneumonia
Candidiasis
CMV
Kaposi’s sarcoma - caused by HHV8 (multiple purple/brown lesions on skin)
lymphoma
Cervical cancer - cant clear HPV

181
Q

What is the difference between a simple and complex febrile seizure?

A

A simple seizure is <15 minutes - - generalised seizure
A complex seizure >15 minutes - focal seizure

182
Q

What is chvostek’s sign?

A

hypocalcaemia tap facial nerve to get twitching of nerve

183
Q

What is hoovers sign?

A

weakness of voluntary hip extension - feel pressure under heel of affected leg

184
Q

when should you start an alendronic acid?

A

– ≥65 and on long-term steroids should be offered bone
protection even without a DEXA scan

185
Q

what is the function of nimodipine?

A

21d course of nimodipine is used to prevent vasospasm as it targets the brain vasculature

186
Q

What is the management of impetigo?

A
  • Hydrogen peroxide 1% cream - if systemically well
  • Fusidic acid
    -Oral flucloxacillin
187
Q

What is the management of chicken pox exposure in pregnancy?

A
  • check varicella antibodies
  • if none give varicella immunoglobulin immediately
    -Oral aciclovir if rash
188
Q

What is a grandiose delusion?

A

idea that the person themselves are powerful/crucially
important beyond truth

189
Q

What is need?

A

An ability to benefit from an intervention

190
Q

What is comparative need?

A

Comparison between severity, range of intervention and cost - screening resources for HPV in an affluent area compared to low socioeconomic area

191
Q

What is a health needs assessment?

A

A systematic approach to reviewing health issues affecting a population and what changes are required.

192
Q

How would you evaluate health services?

A

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
Q

what is relative risk?

A

risk in exposed group over risk in unexposed group

194
Q

What is attributable risk?

A

How much of the risk is actually due to a certain risk factor

195
Q

what is an epidemiological study and give a pro and a con ?

A

A study looking at trends in data at a population level
+= prevalence and correlation , readily available data
-= doesnt show causation

196
Q

what is a cross sectional study and give a pro and con?

A

looking at a specific disease and collects data on them at defined points of time.
+= Quick and cheap
-=reverse causality and recall bias

197
Q

What is a case control study and what is a pro and con?

A

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
Q

what is a cohort study and what is a pro and con?

A

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
Q

What is the epidemiological assessment approaches? (assessment to assess health needs)

A
  • defines size of problems, population, services available
    += uses existing data/ provides data on disease incidence and mortality
    -= doesn’t consider felt need
200
Q

What is the comparative approach?

A

2 demographically different services compared
+= quick and cheap
-= difficult to find comparable population

201
Q

What is a corporate approach?

A
  • 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
Q

What is the treatment for opioid NAS?

203
Q

what is the ICD 11 criteria for opioid misuse?

A

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
Q

What is kallman?

A

xlinked recessive
- delayed puberty
- hypogonadism
-anosmia

205
Q

What is klinefelter?

A

47xxy
Taller
Gynaecomastia
small testes
high gonadotrophin
low testosterone

206
Q

What aspects are assessed in the bishop score?

A

position
consistency
effacement
dilation
fetal station

207
Q

When is the palmar grasp?

208
Q

When is the pincer grip?

209
Q

Sit without support?

A

6 months(9 month referral)

210
Q

What is the management for COPD, steroid responisve (asthma Sx)?

A

SABA or SAMA as required
Then add LABA and ICS
Then add lama

211
Q

What is the management for COPD, non steroid responsive ?

A

SABA or SAMA then
LABA and LAMA
Then add ICS

212
Q

What are the features of steroid responsive COPD?

A

History of asthma / atopy
- Bloods: Eosinophilia
- Diurnal variation of PEFR of 20% or more or FEV1 variation day-to-day of 400ml

213
Q

what is zopiclone?

A

a gaba agonist
- used for sleep

214
Q

What is otitis externa?

A

infectious caused by staphylococcus aureus/allergies/swimming

Sx
- itch/pain/discharge
Tx
-topical abx

215
Q

What is ramsay hunt syndrome?

A

caused by reactivation of vzv in ganglion on 7th nerve
- auricular pain
-facial nerve palsy
-rash around ear

Tx - aciclovir and corticosteroids

216
Q

Difference between conduct disorder and oppositional defiant disorder?

A

oppositional defiant towards authorative figures but still does well at school (conduct is more severe, affects social problems)

217
Q

What causes horizontal diplopia?

218
Q

What causes vertical diplopia?

219
Q

What is the romberg test?

A

assess balance and proprioception

220
Q

When do you review a benign murmur?

221
Q

How do you measure small for gestational age?

A

Abdominal circumference less than 10th centile for gestation

222
Q

What changes are there in von willerbands disease?

A

prolonged bleeding time
APTT may be prolonged
factor 8 levels may be reduced

223
Q

What is the typical blood picture for disseminated intravascular coagulation?

A

low platelets
low fibrinogen
raised PT and APTT

224
Q

What is seen in haemophilia?

A

only prolonged APTT

225
Q

what should be monitored if a patient is on venlafaxine?

A

Blood pressure

226
Q

What is seen on biochem for a pateint with anorexia?

A

low magnesium, phosphate,calcium
high cortisol and high cholesterol and high growth hormone
low sex hormones
metabolic alkalosis

227
Q

What are the side effects of TCAs?

A

dry mouth
blurred vision
constipation
urinary retention

228
Q

When can expectant management be performed for an ectopic pregnancy?

A

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
Q

When is the management for ectopic surgical?

A

Size >35mm
Can be ruptured
Pain
Visible fetal heartbeat
hCG >5,000IU/

230
Q

What is the management for nausea and vomiting in pregnancy?

A

antihistamines: oral cyclizine or promethazine
oral ondansetron (risk of cleft palate)or metoclopramide - only used for 5 days

231
Q

What is a APH?

A

Antepartum haemorrhage is defined as bleeding from the genital tract after 24 weeks pregnancy, prior to delivery of the fetus

232
Q

What bit does CP affcet in spastic type?

A

Upper motor neurones

233
Q

What does CP affect in dyskinetic?

A

basal ganglia and substantia nigra

234
Q

What bit does CP affect in ataxic?

A

cerebellar

235
Q

what are the Sx of Downs syndrome?

A

epicanthal folds
single palmer crease
flat face
hypotonia
small low set ears

236
Q

What is the first line test for CMPA?

A

skin prick/patch testing

237
Q

What is the long term management for CMPA?

A

follow up in allergy clinic
Histamines

238
Q

What is the first line investigation for PROM?

A

Speculum examination - poo; of fluid in posterior vaginal fornix

239
Q

What are the risk factors for incontinence?

A

Pregnancy
obesity
previous deliveries
Increasing age

240
Q

What are non pharmacological ways to prevent falls?

A

Increased salt intake
Fluids -stay hydrated
Get up slowly

241
Q

What are causes of pneumonia?

A

Streptococcus pneumonia
Haemophilus influenza
Mycoplasma pneumonia- atypical

242
Q

What are the signs and symptoms of pneumonia?

A

a cough with sputum
dyspnoea
fever
chest pain

243
Q

What are the oxford stoke classification?

A

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
Q

What is lateral medullary syndrome?

A

Posterior inferior cerebellar artery
- wallenberg
ipsilateral facial pain and temp loss + horners
contralateral limb pain and temp loss
ataxia and nystagmus

245
Q

What is webers syndrome?

A

ipsilateral 3 nerve palsy
contralateral weakness

246
Q

What is the definitive diagnosis for a TIA?

A

Specialist referral within 24 hours for a diffuse weighted MRI showing ischemia

247
Q

What are indicators of a poor prognosis of schizophrenia?

A
  • strong family history
    gradual onset
    Low IQ
    social withdrawal
    lack of obvious precipitant
248
Q

What are the risk factors for schizophrenia?

A

Black, migration, urban environment, cannabis , FHx, male

249
Q

What are 3 types of psoriasis?

A
  • plaque psoriais
    -guttate psoriasis
    -pustular
250
Q

Lifestyle changes for psoriasis?

A
  • smoking cessation
    reduce alcohol
251
Q

What is first line management for psoriasis?

A

potent corticosteroid and vitamin D analogue

252
Q

What causes diabetic foot disease?

A

peripheral neuropathy - loss of sensation
PAD

253
Q

How is neuropathic pain managed?

A

TCa
pregabalin
gabapentin

254
Q

What is osteomyelitis?

A

infection of the bone
mc cause is staph aureus or salmonella if sickle cell disease

255
Q

What is the investigation and management for osteomyelitis?

A

MRI
Flucloxacillin

256
Q

What are the risk factors for sleep apnoea?

A

Obesity
acromegaly
marfans
large tonsils

257
Q

What is the assessment and management for obstructive sleep apnoea?

A

Epworth sleepiness scale
CPAP

258
Q

What is intussusception?

A

invagination of one portion of the bowel into the lumen of the adjacent bowe

259
Q

What are the stages of CKD?

A

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
Q

what is AKI stage 1?

A

Increase in creatinine to 1.5-1.9 times baseline
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours

261
Q

What is AKI stage 2?

A

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
Q

What is AKI stage 3?

A

Increase in creatinine to ≥ 3.0 times baseline
Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours,

263
Q

What is AKI?

A

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
Q

What fluids do you give in maintenance?

A

0.9% saline + 5% glucose

265
Q

What fluids do you give in resus and how much do you give?

A

0.9% saline
10ml/kg in <10mins

266
Q

How do you calculate the replacement fluids?

A

dehydration x 10x weight

267
Q

How do you figure out the percentage dehydration?

A

well weight- now weight divided by well weight times 100

268
Q

What is the correct dose for administering insulin in DKA?

A

(0.1units/kg/hr)

269
Q

what are the features of adenomyosis?

A

dysmenorrhoea
menorrhagia
enlarged, boggy uterus

270
Q

when are the cervical screen?

A

25-49 every3 years
49-64 every 5 years

271
Q

What are the tests for DDH?

A

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
Q

What are the other signs for DDH?

A

symmetry of leg length
level of knees when hips and knees are bilaterally flexed

273
Q

what are the sx of lithium toxicity?

A

coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
seizure

274
Q

What are the adverse affects of lithium?

A

nausea/vomiting, diarrhoea
fine tremor
weight gain

275
Q

what is the definition of preeclampsia?

A

≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following:
proteinuria

276
Q

2 causes of postural hypotension?

A

medications -antihypertensives, levodopa
hypovolaemia

277
Q

What tests do you do before giving Lithium?

A

ECG
U+Es
TFT

278
Q

What is atypical depression?

A

eat more
sleep more
periods of happy

279
Q

What electrolyte inbalance can be caused in DKA?

A

initially high potassium , then after insulin Tx can cause hypokalaemia

280
Q

What is the difference between serotonin syndrome and neuroleptic malignant syndrome?

A

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
-

Phase 3A (5 decks)

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