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Clinical Questions Flashcards

1
Q

School Exclusion advice:
1. Scarlet Fever
2. Rubella
3. Hand, foot & Mouth
4. Chickenpox
5. Diarrhoea & Vomiting

A
  1. 24hrs after commencing antibiotics
  2. 5 days from onset of rash
  3. No exclusion
  4. All lesions crusted over
  5. Until symptoms have settled for 48hrs
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2
Q

Red non-itchy rash, started at site of bite from tick. Centre of rash gives bulls eye appearance.
Name of rash?

A

Erythema migrans

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3
Q

Antibiotics used for animal bites?

A

Co-Amoxiclav.
If penicillin allergic- doxycycline and metronidazole

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4
Q

cOCP: missed pill, what do you do?
1. 1 missed pill?
2. 2 missed pill?

A
  1. Take last pill even if means taking two pills in one day
  2. Take last pill. Abstain from sex for 7 days.
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5
Q

Immunisation Schedule
1. 2 months
2. 3 months
3. 4 months
4. 12 months
5. 3-4 years
6. 12-13 years
7. 13-18 years

A
  1. 6 in 1 Vaccine (diphtheria, tetanus, whooping cough, polio, HiB & hepatitis B). Oral rotavirus vaccine. Men B
  2. 2nd 6 in 1 vaccine, 2nd oral rotavirus vaccine, PCV
  3. 3rd 6 in 1 vaccine. 2nd Men B
  4. HiB/Men C. MMR. 2nd PCV. 3rd amen B
  5. 4 in 1 vaccine, pre-school booster (diphtheria, tetanus, whooping cough and polio). 2nd MMR
  6. HPV vaccination
  7. 3 in 1, teenage booster (diphtheria, tetanus & polio), Men ACWY
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6
Q

Drugs causing Gingival Hyperplasia

A

Phenytoin, cyclosporin, calcium channel blockers.
Acute Myeloid leukaemia also causes

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7
Q

Emergency Hormonal contraception:
1. First-line & what timeframe?
2. Other two methods & timeframe. Instructions/when to avoid?

A
  1. Copper IUD, within 5 days
  2. Levonorgestrel, within 72hrs.
    Ulipristal, within 120hrs.
    If vomit within 3hrs levonorgestrel should repeat dose. Can start hormonal contraception straight away.
    Avoid ulipristal in severe asthma
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8
Q

Development Milestones, gross-motor
1. 3 months
2. 6 months
3. 9 months
4. 12 months
5. 2 years

A
  1. Supports head
  2. Sits with back straight
  3. Crawls/ pulls to stand
  4. Cruises/ walk with hand held. Refer at 18 months
  5. Runs
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9
Q

Fungal nail treatment
1. Limited involvement (<50% nail/ < 2 nails affected)
2. Extensive involvement

A
  1. Topical amorolfine 5% nail lacquer
  2. Oral terbinafine, 3 months for fingernails. 6 months for toenails.
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10
Q

URTI symptoms + amoxicillin -> rash =

A

Glandular fever (infectious mononucleosis)

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11
Q

What is the bishop score & what is it made up of?

A

Bishop score used to assess whether induction of labour will be required.
Cervical position (posterior, intermediate/anterior)
Cervical consistency (firm/intermediate/soft)
Cervical effacement (0-30%/40-50%/60-70%/80%)
Cervical dilatation (<1cm/1-2cm/3-4cm/>5cm)
Foetal station (-3/-2/-1/0/1/2)
<5 unlikely to start. >8 likely spontaneous.

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12
Q

Why is folic acid give in pregnancy?
How much and when should Folic acid supplementation be give during pregnancy.
1. All woman
2. Woman at high risk
(Which women are at high risk)

A

Prevention of Neural tube defect
400mcg given until 12th week of pregnancy
High risk woman should receive 5mg until 12th week of pregnancy.
High risk woman: previous NTD/FH, woman on anti-epileptics/diabetes, obese woman.

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13
Q

How to manage umbilical hernia in newborn/children

A

Umbilical hernia typically self resolve by 3 years

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14
Q

Management of patient following fragility fracture
1. >75 years
2. <75 years

A
  1. Assumed to have osteoporosis, start on oral bisphosphonate, no need for DEXA scan
  2. DEXA scan should be arranged, results can be entered in FRAX assessment to determine risk of ongoing fracture, and manage accordingly
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15
Q

Management of STDs
1. Chlamydia (1st/2nd line)
2. Gonorrhoea

A
  1. Doxycycline 100mg BD for 7 days. Azithromycin 1g single dose
  2. IM Ceftriaxone 1g single dose
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16
Q

Development milestones: speech and hearing
1. 3 months
2. 6 months
3. 9 months
4. 1 years
5. 2 years
6. 3 years

A
  1. Turns towards sound
  2. Double syllables (adad, erleh)
  3. Says mama & dada
  4. Knows and responds to name
  5. Combines 2-6 words
  6. Short sentences (3-5 words, count to 10)
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17
Q

Drug monitoring requiring blood tests
1. Statins
2. ACEi
3. Amiodarone
4. Methotrexate
5. Azathioprine
6. Lithium
7. Sodium Valproate
8. Glitazones

A
  1. LFT
  2. U&Es
  3. TFT & LFT
  4. FBC, U&E, LFT
  5. FBC, LFT
  6. Lithium, TFT, U&E
  7. LFT
  8. LFT
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18
Q

COPD inhaler treatment pathway

A
  1. SABA or SAMA
  2. SABA &
    if no Asthmatic features- LABA + LAMA.
    If Asthmatic features- LABA + ICS
  3. LABA + LAMA + ICS
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19
Q

Post-partum, at what day do woman require contraception

A

Day 21

20
Q

Childhood Syndromes
1. Patau syndrome (trisomy 13)
2. Edwards syndrome (trisomy 18)
3. Fragile X
4. Noonan syndrome
5. Williams sundrome

A
  1. Microcephalic, Cleft lip/palate, polydactyly
  2. Low set ears, rocker bottom feet, micrognathia (small jaw)
  3. Learning difficulties, macrocephaly
  4. Webbed neck, short stature, pulmonary stenosis, pectus excavatum
  5. Short stature, extrovert personality, learning difficulty
21
Q

Name the live attenuated vaccines that are contraindicated in immunocompromised patients

A

Yellow fever
Oral polio
Varicella
MMR
Tuberculosis

22
Q

Drugs to avoid during Breastfeeding

A

Antibiotics (ciprofloxacin, tetracycline, sulphonamides)
Psychiatric drugs (lithium, benzodiazepines)
Carbimazole
Methotrexate
Aspirin
Amiodarone

23
Q

Ovarian cyst types
1. Most common & simple
2. Most common cancer
3. Chocolate cysts
4. Lined with epithelial tissue, hair/skin/teeth

A
  1. Follicular cyst
  2. Serious carcinoma
  3. Endometriotic cyst
  4. Cystic teratomas
24
Q

Incubation period for diarrhoea , triggers & symptoms
1. Bacillus cereus
2. Salmonella/e.coli
3. Shigella/ campylobacter
4. Giardiasis

A
  1. 1-6hrs, undercooked rice, vomit/diarrhoea
  2. 12-48hrs, watery diarrhoea- travellers diarrhoea
  3. 48-72hrs, crappy abdo pain, blood diarrhoea
    4 >7 days, prolonged bloody diarrhoea
25
Q

Overdose management
1. Paracetamol (& if within 1hr)
2. Salicylate
3. Opioids
4. Benzodiazepines
5. TCA

A
  1. N-acetylcysteine, activate charcoal
  2. Urinary alkalisation (IV bicarbonate)
  3. Naloxone
  4. Flumanezil
  5. IV bicarbonate
26
Q

Antiplatelet treatment:
1. ACS, medical management or PCI
2. TIA/ischemic stroke/ PAD

A
  1. Aspirin lifelong & ticagrelor 12 months
  2. Clopidogrel lifelong
27
Q

Maculopapular rashes
1. Starts behind ears, conjunctivitis, koplik spots
2. Fever, lymphadenopathy, begins at face
3. Pink-red rash, starts at chest l

A
  1. Measles
  2. Rubella
  3. Roseola infantum
28
Q

Cytotoxic agents adverse effects
1. Cyclophosphamide
2. Bleomycin
3. Doxorubicin
4. Methotrexate
5. Vincristine
6. Cisplatin

A
  1. Haemorrhagic cystitis
  2. Lung fibrosis
  3. Cardiomyopathy
  4. Myelosuppression, liver/lung fibrosis
  5. Peripheral Neuropathy
  6. Ototoxicity
29
Q

Angina performs treatment
1. Develop tolerance to medication
2. First line for stable angina
3. Is contraindicated if given beta blocker

A
  1. Isosorbide mononitrate
  2. Beta blocker
  3. Verapamil, risk of complete heart block
30
Q

Contraceptives - time until effective
1. IUD
2. POP
3. cOCP, injection, implant, IUS

A
  1. Instant
  2. 2 days
  3. 7 days
31
Q

Diabetes management pathways.

A

First line: met Forman
If CVD: add SGLT2
Second line DPP4 inhibitor (gliptin), pioglitazone, sulfonylurea (gliclazide)

32
Q

Allergy tests:
1. Food allergies/pollen
2. Wasp/bee stings
3. Contact dermatitis

A
  1. Skin prick test
  2. Radioallergosorbent test
  3. Skin patch testing
33
Q

Referring for Development Delay

A

Sits without support, 6 months (refer at 12 months)
Walks unsupported, 13-15 months (refer at 18 months)
Smiles 6 weeks (refer at 10 weeks)
Knows about 2-6 words, 13-15 months (refer at 18 months

34
Q

Cataracts, Muscular weakness & frontal balding, name the condition

A

Myotonic dystrophy

35
Q

Childhood Seizures

A

Benign Rolandic Epilepsy- most common epilepsy, 15%, 7-10yrs, focal motor aware seizures at night. Twitching face & dribbling. Children will grow out, no need for meds.

Childhood Absence Epilepsy- 12%, 4-10yrs, very brief, changes or will become unconscious, seizures respond to meds, 90% grow out of seizures.

Juvenile myoclonic epilepsy- 12-18yrs, brief muscle jerks or tonic clinic, occur when waking up, medication may be needed for life, photosensitive epilepsy.

Infantile spasms (west syndrome)- 1st year of life, prev brain injury or genetic malformation, brief spasms of whole body, antiepileptics & steroids used. May develop learning problems or progress to Lennox gastaut syndrome.

Lennox gustaut- 3-5yrs, tonic and atonic, develop learning difficulties, difficult to treat with antiepileptics.

36
Q

Seizure inducing medication.

A

Bupropion (smoking cessation)
Tramadol
TCA’s, Benzodiazapine
Amphetamine, cocaine,

37
Q

Steroid Ladder (mild, moderate, potent, very potent)

A

Mild- Hydrocortisone
Moderate- Betnovate RD, eumovate
Potent- Betnovate
Very potent- Dermovate

38
Q

Long term antipsychotic symptoms

A

Akathisia- inability to sit still
Dystonia- abnormal posturing e.g. torticollis
Tardive dyskinesia- repetitive involuntary movements, e.g. lip smacking, puckering lips, grimacing

39
Q

Define the below
- Somatisation
- Conversion
- Hypochondriasis

A
  • Somatisation- multiple somatic complaints, no organic pathology, partient refuses to accept reassurance or negative test results
  • Conversion- alteration or loss of physical function, presumed to be expression of underlying psychological conflict
  • Hypochondriasis- fear of having serious disease, based on misinterpretation of bodily symptoms
40
Q

Children rashes
- measles
- chickenpox
- fifth disease

A
  • measles: incubation period 8 days, then presents with 3Cs (cough, conjunctivitis & coryzal sx), can have koplik spots (white buccal spots), rash appears after 14 days. Fever & rash last 10 days, they are contagious 4 days before/after rash.
  • chickenpox: incubation period 2 weeks, rash appears in scalp, face, trunk, progresses over 12hrs, crusts over.
  • fifth disease: transmit through respiratory secretions, incubation of 1 week, mild prodrome lasts 3 days headaches, fever. Then go onto develop slapped cheek rash on face
41
Q

Amiodarone side effects

A

Pulmonary fibrosis
Corneal deposits
Skin pigmentation (blue-grey discolouration, when exposed to sunlight)
Thyroid disturbance
Hepatotoxicity

42
Q

Metformin

A

Should not be used if eGFR <30%
Increased risk of lactic acidosis (buildup of metformin)
Alcohol also should be minimised/avoided, increases risk of lactic acidosis and hypoglycemic effect.

43
Q

Development milestones (Fine Motor & Vision)
- 6 weeks
- 3 months
- 6 months
- 9 months
- 12 months
- 2 years

A
  • palmar grip, fixes and follows eyes
  • reaches for objects, visually alert
  • palmar grasp, pass objects from one hand to another
  • points with finger
  • starts developing handedness
  • tower of 6
44
Q

Development milestones (social behaviour)
- 6 weeks
- 3 months
- 12 months
- 18 months

A
  • smiles (refer at 10 weeks)
  • laughs
  • waves bye bye
  • uses spoon
45
Q

Anti-epileptics (1st line + in pregnancy)
- Tonic clonic
- Partial
- Absence

A
  • sodium valproate (lamotrigine)
  • lamotrigine
  • ethosuximide

MSRA (2 decks)

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