Extras from mock exams Flashcards by Jasmin bullock

when presented with a white out on CXR what is a clue to the cause?

whether the traches is being pulled toward the blackout (e.g lung collapse) or central (e.g consolidation/mesothelioma) if pushed away (e.g pleural effusion)

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what organisms cause post splenectomy sepsis?

haemophilus influenzae
strep pneumoniae
meningococci

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what makes up cushings triad?

hypertension (widened pulse pressure), bradycardia, irregular breathing

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alternating fever in a question is likely indicating what?

malaria infection

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what is used to treat cerebral oedema in patients with brain tumours?

dexamethasone

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what electrolyte imbalance can PPIs cause?

hyponatraemia

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when using an inhaler how long should you wait between 1st and 2nd puff of a dose?

at least 30 seconds

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what immunisation should men who have sex with men be offerred?

Hepatitis A

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how do cycloplegic drops (atropine or cyclopentolate) affect the pupil?

dilate the pupil

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how do pilocarpine drops affect the pupil?

constrict the pupil

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pleural fluid protein level of what is indicative of exudate?

> 30g/L

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what fluid and electrolyte changes does diarrhoea cause?

normal anion gap metabolic acidosis
loss of bicarb and reciprocal rise in serum chloride

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do we give prophylactic doxycyllcine forlyme disease in patients with tick bites?

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what surgery can be considered in patients with anal fissure who do not respond to medical management?

sphincterotomy

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what stoma can be used to defunction the colon to protect an anastamosis?

loop ileostomy

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investigation for glandular fever?

monospot test

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human and animal bites should be treated with what antibiotic?

co-amoxiclav

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what makes up the triangle of safety for chest drain insertion?

base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi

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what can a pregnant woman wanting to quit smoking be given?

nicotine replacment is suitable
varenicline and bupropion are contraindicated

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what is seen on histology with crohns?

granulomas, inflammation of all layers, increased goblet cells

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what are you likely to see on ABG in a patient who has received large volumes of 0.9% saline?

hyperchloraemic metabolic acidosis

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what is the initial management for euvolemic and hypervolemic hyponatraemic patients who don’t have severe symptoms?

fluid restriction

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patients with an A:CR of greater than what should be started on an ACEi?

> 30

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when would we consider referral for long term oxygen therapy in COPD?

pO2 of 7.3 - 8 kPa AND one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension

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what is the most common cause of peritonitis secondary to peritoneal dialysis?

coagulase negative staphylococcus e.g staph epidermidis

what type of hyperparathyroidism is most likely to cause the result of high calcium with normal PTH?

primary hyperparathyroidism

which type of replacement heart valve is used in younger patients?

mechanical as they last longer

what common drug can cause neutrophilia?

corticosteroids

treatment for intractable hiccups in palliative care?

chlorpromazine

what movements worsen lateral epicondylitis?

resisted wrist extension/suppination whilst elbow extended

How should levonorgestrel dose be adjusted for patients with BMI of >26 or weight over 70kg?

double their dose from 1.5mg to 3mg

how long after unprotected sexual intercourse can ulipristal be used?

120 hours (5 days)

what is a contraindication to ulipristal?

severe asthma

what should be done regarding usual contraception after emergency?

normal hormonal contraception can be continued immediately after levonorgestrel ulipristal affects hormonal contraception efficiency so stop taking for 5 days and use barrier contraception for these

what is Z score adjusted for?

age, gender and ethnic factors

what is the management of placental abruption depending if there is fetal distress or not?

placental abruption and fetal distress = immediate C section no fetal distress + <36weeks = admit and give steroids no fetal distress and >36 weeks = deliver vaginally

what is the most important risk to mention regarding the progesterone component of combined HRT?

increased breast cancer risk

how are cervical smears affected by pregnancy?

not done during pregnancy and postponed until 3 months post partum

how do we treat genital herpes?

oral aciclovir

treatment of fracture of proximal scaphoid pole fracture?

internal fixation as risk of avascular necrosis

what are some UKMEC3/4 contraindications to COCP?

smoking and over 35, VTE FHx, HTN, immobility, BRCA gene, migraine w aura, breast feeding <6 week post partum

how do we treat local anaesthetic toxicity?

IV 20% lipid emulsion

when prescribing controlled drugs what needs to b written in both figures and words?

quantity of tablets supplied

what is first line in managing acute stress disorders?

trauma focused CBT

how would you treat multiple ring enhancing lesions found on neuroimaging in a patient with HIV?

most likely diagnosis is toxoplasmosis which is treated with sulfadiazine and pyramethamine

symptoms of diarrhoea, flushing, hypotension and right sided murmur point to what unifying diagnosis?

carcinoid syndrome due to serotonin production from a tumour

what is most important initial step in managing MSCC?

give 16mg dexamethasone, this can be done first while awaiting while spine MRI

what should you manage a patients AF if they are septic?

treat the sepsis is as this is triggering the AF and more acute

how can you determine between SIADH and pseudohyponatraemia in a hyponatraemic patient who is euvolaemic?

in true hyponatraemia they will have a low serum osmolality. in pseudo it will be normal

what result in a ascitic aspiration would confirm SBP?

WCC over 250 with 90% neutrophils

criteria for referral to liver transplant centre after paracetamol OD?

pH<7.3 Or all three of: INR>6.5, creatinine >300, encephalopathy

what electrolyte imbalance precipitates digoxin toxicity?

hypokalaemia

why might abdo ultrasound be done initially over abdo CT in a woman with suspected appendicitis?

it is better at also looking for gynaecological causes

what is the antidote for ethylene glycol poisoning (antifreeze)?

fomepizole

what is the diagnosis and management of a rash presenting as a herald patch followed by secondary lesions in a christmas tree pattern on the trunk?

pityriasis rosea, self-resolving but give topical corticosteroids for symptom releif of itching

what is management of different centor scores?

exudate, lymphadenpathy, tempover 38, no cough ABx only given for score of 3 or more

what are some ways to help TBI before specialist treatment?

hyperventialtion to keep PaCO2 low- cerebral vasocontriction so less ICP position head up at 30 degrees to reduce ICP

what is clinical equipoise?

This is the assumption that there is not one 'better' intervention present (for either the control or experimental group) during a trial

what is the name of the lace like rash assciated with antiphospholipid syndrome?

livedo reticularis

what are signs of congenital syphilis?

sensorineuraldeafness, desquamating rash, hutchinsons teeth, osteochondritis

what investigation should be considered in women >50 experiencing IBS like symptoms

Ca-125

what position should you put kids in when having a tet spell and why?

bring their knees to their chest this compresses the femoral arteries increasing peripheral vascular resitance reducing the magnitude of the shunt

a patient with raised anti-histone antibodies is likely to have what diagnosis?

drug induced lupus

on NAAT screening and obligate intracellular bacterium causing clear urethral discharge or a gram negative diplococci causing purulent urethral discharge are likely to be what organisms?

first is chlamydia trachomatis second is neisseria gonorrhoeae

what causes syphilis?

treponema pallidum

can a patients physical health symptoms be treated under the mental health act?

generally no, assess the patients capacity to refuse treatment

a baby born that becomes unwell after a few days and starts yawning frequently is likely to have what?

opioid withdrawal following maternal drug use

what is the defnitive management of ascending cholangitis?

ERCP

in palliative care what med can be used to help with colicky pain?

hyoscine butylbromide. antispasmodic so helps slow peristalsis to relieve colicky pain

what is the treatment for non-lactational mastitis?

co-amoxiclav

in a patient with pleural effusion seen on x ray what is the next step in management?

pleural aspirate for diagnosis of cause

what protein level in pleuritic fluid would indicate transudate or exudate?

transudate <30g/l exudate >30g/l

what criteria help tell if pleural fluid with protein between 25-30 id exudative or transudative?

lights criteria: one of the following then exudate likely pleural fluid protein divided by serum protein >0.5 pleural fluid LDH divided by serum LDH >0.6 pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

what drugs can cause SIADH?

SSRIs, tricyclics, sulphonylureas, carbamazepine, vincristine and cyclophosphamide

what antibiotic prophylaxis given for SBP?

ciprofloxacin

what should be given first line in myxoedemic coma?

hydrocortisone and levothyroxine

what is the preferred antiplatelet for secondary prevention of stroke?

clopidogrel

how long are we covered with tetanus vaccine?

10 years

what type of aphasia: Classically due to a stroke affecting the arcuate fasiculus - the connection between Wernicke's and Broca's area Speech is fluent but repetition is poor. Aware of the errors they are making. Comprehension is normal

conduction aphasia

first line test for acromegaly?

serum insulin-like growth factor 1 (IGF-1)

what is initial management of acute limb ischaemia?

IV heparin and vascular review

what is classic finding on renal biopsy of minimal change disease?

Podocyte fusion and effacement of foot processes on electron microscopy

what medication would you start in a diabetic patient with urinary ACR of 3mg/mmol or more?

ACE inhibitor or ARB

what electrolyte abnormality is likely to be seen after prolonged diarrhoea?

metabolic acidosis with hypokalaemia

treatment of facial erythema in rosacea?

brimonidine (alpha 2 agonist)

what are risk factors for idiopathic intracranial hypertension?

obesity and tetracycline use

treatment of seborrhoeic dermatitis of scalp?

ketoconazole shampoo as this is caused by overgrowth of malassezia yeasts