EXTRA NUGGETS FROM QUESTIONS Flashcards
FALLS
What are the risk factors for falls in elderly?
DM
rheumatoid arthritis
>65
previous falls
depression
FALLS
What are the two recommended tests from NICE to assess patients at risk of falls?
- turn 180 test
- timed up and go test
FALLS
what are the management options to try and prevent further falls in future?
- strength and balance training
- home hazard assessment
- medication review
- vision assessment
NEPHRITIC SYNDROME
IgA deposition on renal biopsy would indicate which cause of nephritic syndrome?
IgA nephropathy
NEPHRITIC SYNDROME
Raised antistreptolysin O titre on blood serum would indicate which cause of nephritic syndrome?
Post strep glomerulonephritis
NEPHRITIC SYNDROME
Anti-GBM antibodies on blood serum would indicate which cause of nephritic syndrome?
goodpastures
NEPHRITIC SYNDROME
c-ANCA antibodies on blood serum would indicate which cause of nephritic syndrome?
glomerulomatosis with polyangitis
NAS
In a neonate with neonatal abstinence syndrome (NAS) what is the medical management?
IV phenobarbital
NEPHRITIC SYNDROME
ANA positive blood test would indicate which cause of nephritic syndrome?
SLE
TONSILITIS
what are the scoring systems that can be used to determine how likely there is a bacterial infection?
CENTOR
FeverPAIN
TONSILITIS
what are the components of the FeverPAIN criteria?
- Fever during previous 24hrs
- Purulence (pus on tonsils)
- Attend rapidly (within 3 days of symptom onset)
- Inflamed tonsils (severe)
- No cough or coryza
TONSILITIS
what do the FeverPAIN scores mean?
0 or 1 = low chance of strep infection (18%)
2 or 3 = moderate chance of strep infection (40%)
4 or 5 = high chance of strep infection (62-65%)
TONSILITIS
what are the components of CENTOR criteria?
- tonsillar exudate
- tender anterior cervical lymphadenopathy/lymphadenitis
- history of fever (>38)
- absence of cough
TONSILITIS
what do the scores for CENTOR criteria mean?
0-2 = low chance of strep (3-17%)
3-4 = higher chance of strep (32-56%)
TONSILLITIS
what is the antibiotic management for tonsillitis?
1st line = phenoxymethylpenicillin
for 10 days
If penicillin allergic 1st line = clarithromycin
TONSILLITIS
what safety netting advice can be given if antibiotics are not indicated?
- use simple analgesia
- return if pain has not settled after 3 days or if fever rises above 38.3
TONSILLITIS
what are the bacterial causes?
- Group A strep (S. Pyogenes)
- S. Pneumoniae
- H. Influenzae
- M. Catarrhalis
- S. Aureus
PREGNANCY BLOOD LEVELS
what is the cut off for Hb levels in:
i) first trimester
ii) second trimester
iii) third trimester
i) 110
ii) 105
iii) 100
PREGNANCY BLOOD LEVELS
A raised level of which liver enzyme is considered normal in pregnancy?
ALP
MOLAR PREGNANCY
what is a complete molar pregnancy?
when two sperm fertilise an ovum that contains no genetic material.
The sperm combine genetic material
No foetal material forms
MOLAR PREGNANCY
what is the karyotype of a complete molar pregnancy?
46 XX
MOLAR PREGNANCY
what is an incomplete/partial molar pregnancy?
two sperm fertilise a normal ovum at the same time
the cell has 3 sets of chromosomes
MOLAR PREGNANCY
what is the karyotype of a partial molar pregnancy?
69 XXY, 69XXX or 69XYY
ADHD
what should be measured at initiation of methylphenidate, following each dose adjustment and every 6 months?
pulse
BP
psych symptoms
appetite
weight
height
PARACETAMOL OVERDOSE
what is the definition of a staggered paracetamol overdose?
first and last paracetamol more than 1 hour apart
OCD
what class of medication is clomipramine?
tricyclic antidepressant
OCD
what is the medical management of OCD?
1st line = SSRI
2nd line = clomipramine
ANTIPSYCHOTICS
what is the treatment for tardive dyskinesia?
tetrabenazine
ANTIPSYCHOTICS
what is the medical management of neuroleptic malignant syndrome
bromocriptine or dantrolene
ANTIPSYCHOTICS
what is the medical management of acute dystonia?
procyclidine or benzatropine
OPIOID USE
what is the definition of opioid use disorder?
a harmful pattern of use is evident over a 12 month period or at least 1 month if use is continuous
THE BLACK REPORT
What did The Black Report show?
Confirmed social class health inequalities in overall mortality and that health inequalities were widening
THE BLACK REPORT
What were the recommendations from The Black Report?
Material - environmental causes
Artefact - product of how inequality is measured
Cultural/Behavioural - poor people to unhealthy things, own responsibility
Selection - ill sink in society
THEORIES OF CAUSATION
Name 3 theories of causation
Psychosocial
Neo-material
Life-course
THEORIES OF CAUSATION
What is the psychosocial theory of causation?
Effect of poverty on us psychosocially
Stressors are mainly social
Stress –> BP, cortisol levels
THEORIES OF CAUSATION
What is the neo-material theory of causation?
Poverty exposes people to health hazards
Hierarchy to public good
Money = goods
THEORIES OF CAUSATION
Explain the life-course theory of causation
Critical periods – greater impact at certain points in life course primarily childhoods (e.g. measles in pregnancy)
Accumulation – hazards and their impacts add up (e.g. hard blue collar work –> injuries –> reduced work opportunities)
Interactions and pathways – (e.g. sexual abuse in childhood –> poorer partner choices, increases exposure to violence etc.)
ETHICAL ANALYSIS
Name 2 approaches to ethical analysis
- Seedhouse’s ethical grid
2. The four quadrant approach
ETHICAL ANALYSIS
Describe the inner layer of Seedhouse’s ethical grid
Asks the question of whether the intervention is going to create autonomy, respect autonomy and treat all equally
ETHICAL ANALYSIS
Describe the second layer of Seedhouse’s ethical grid
Duties and motives
Is the intervention consistent with moral duties - keeping promises, telling the truth, minimising harm and maximising benefit
ETHICAL ANALYSIS
Describe the third layer of Seedhouse’s ethical grid
Consequentialist layer
Is the intervention going to provide the greatest benefit for the greatest number?
Who will benefit, society, individuals, a group?
ETHICAL ANALYSIS
Describe the outer layer of Seedhouse’s ethical grid
Is the intervention likely to be affected by external considerations e.g. risk, law, use of resources?
ETHICAL ANALYSIS
What are the advantages of Seedhouse’s ethical grid?
It provides structure and function for analysing ethical problems
Based on moral theory
ETHICAL ANALYSIS
What are the heading which make up the four quadrants approach?
- Medical indications - beneficence and non-maleficence
- Patient preferences - respect for autonomy
- Quality of life - beneficence and non-maleficence
- Contextual features - loyalty and fairness
DDH
what are the risk factors for developmental dysplasia of the hip?
female
FHx - 1st degree relative
breech after 36 weeks
multiple pregnancy
firstborn child
oligohydramnios
macrosomic baby
PYLORIC STENOSIS
what is the pathophysiology?
hypertrophy of the pyloric sphincter resulting in narrowing of the pyloric canal
CAH
what is the management of a salt-losing crisis?
IV fluids
dextrose
hydrocortisone
TETRALOGY OF FALLOT
what are the symptoms?
- blue tinge to lips, tongue and skin
- recurrent chest infections
- poor feeding
- breathlessness
who should be notified about notifiable diseases?
local health protection team
DUCHENE MUSCULAR DYSTROPHYY
what is the pathophysiology?
gene mutation of Xp21
dystrophin is absent so muscle is lost and replaced by adipose tissue
DUCHENE MUSCULAR DYSTROPHY
what are the investigations?
serum creatine kinase
electromyogram (EMG)
muscle biopsy
genetic testing
muscle MRI
DUCHENE MUSCULAR DYSTROPHY
what is the MDT management?
medical - corticosteroids
surgical - correct contractures
respiratory ventilation
physiotherapy
exercise
education
counselling
palliative care
at what point in time does physiological jaundice typically resolve in a preterm neonate and a term neonate?
- preterm = 21 days
- term = 14 days
what are the causes of jaundice in newborns within first 24 hours?
rhesus disease of newborn
sepsis
congenital infections (TORCH)
what are the two main treatments for jaundice in neonates?
phototherapy
exchange transfusion
CHRONIC OTITIS MEDIA WITH EFFUSION
why is it important for there to be middle ear ventilation?
crucial for equalising pressure, preventing fluid build-up and maintaining optimal hearing
CHRONIC OTITIS MEDIA WITH EFFUSION
what is the conservative management?
nasal irrigation
antibiotics for acute exacerbations
NOONAN SYNDROME
what are the cardiovascular complications?
pulmonary valve stenosis
hypertrophic cardiomyopathy
ASD
NOONAN SYNDROME
what cancers are individuals at risk of getting?
leukaemia
neuroblastoma
what are the symptoms of neuroblastoma?
palpable abdominal mass
blueberry muffin rash
dark circles around eyes (racoon eyes)
proptosis
weight loss
bone pain
constipation
lymphadenopathy
what type of fracture is a “toddlers fracture” and where is it most commonly found?
spiral fracture
tibia
after treatment for nephrotic syndrome, what is the chance of recurrence?
20%
which is the most common heart defect in trisomy 21?
AVSD
SCHIZOPHRENIA
What features of voices would indicate a diagnosis of schizophrenia?
- hearing her own thoughts spoken aloud
- auditory third person hallucinations
- running commentary
- not command
what features of a mental state exam would support a diagnosis of bipolar disorder?
- over dressed/unusual dress
- agitation/overactivity
- pressure of speech
- thought disorder/flight of ideas
- elevated mood
- grandiose delusions
- expansive ideas
- hallucinations in keeping with mood
- disinhibition
what psychological therapies are considered in first episode psychosis?
CBT
psychoeducation
psychoanalytical therapy
IUGR
what are the risk factors for IUGR?
- booking BMI
- pre-existing HTN
- history of pre-eclampsia
- smoking
- substance abuse
what is the role of magnesium sulfate in premature births?
it provides neuroprotection
what causes low Hb in a person with suspected cancer?
- poor intake of folic acid/Fe
- anaemia of chronic disease
- presence of tumour
GUILLAIN BARRE
what are the findings of a lumbar puncture?
- raised protein
- normal WCC
- normal RBC
- raised opening pressure
- normal glucose
GUILLAIN BARRE SYNDROME
why should ABG not be used to monitor respiratory function?
Changes in ABG would occur after the onset of respiratory compromise and would be late in identifying the problem.
GUILLAIN BARRE
what is the management whilst in hospital?
IV immunoglobulins (IVIG)
prophylactic anticoagulation (dalteparin)
physiotherapy
ventilator support
ALCOHOL DEPENDENCE
name two blood tests to screen for alcohol dependence and how it is affected
GGT
MCV
CDT
they are all raised
MENINGITIS
describe the appearance of meningococcal bacteria on microscopy
gram negative diplococci
what is the first line treatment for morning sickness?
promethazine
what are the first line treatments for spasticity in multiple sclerosis?
baclofen or gabapentin
VARICOCELE
what is the most common presentation of a varicocele?
asymptomatic
ALCOHOL DEPENDENCE
what is the mechanism of action of acamprosate?
reduces cravings by activating GABA transmission
ALCOHOL DEPENDENCE
what is the mechanism of action of disulfiram?
it causes a build up of acetaldehyde when alcohol is consumed which causes unpleasant symptoms such as flushing, headache and anxiety
ALCOHOL DEPENDENCE
what is the mechanism of action of naltrexone?
acts as an opioid antagonist to reduce the pleasurable effect of alcohol
EPILEPSY IN PREGNANCY
which is the most common congenital abnormality from sodium valproate use in pregnancy?
hypospadias
