General revision - everything Flashcards
Which compound is released from damaged vessel walls and initiates the coagulation cascade?
Tissue factor
What drug class are used to manage the somatic symptoms of anxiety? Eg sweating, palpitations & hand tremors.
Name a contraindication to this drug class.
Beta blockers
Asthma & heart block
What is eclampsia?
Seizures that occur as a result of pre-eclampsia
Ferroportin is vital for what?
What compound blocks the action of ferroportin & what is the consequence of this?
Which organ produces this compound and in response to what 2 things?
Ferroportin is vital for iron absorption from gut & iron storage in cells, mainly liver
Hepcidin blocks ferroportin preventing further iron absorption
Liver produces hepcidin in response to:
1) high iron stores (when they are full and the body doesn’t need any more iron)
2) inflammation
State the 5 criteria of the Bishops Score:
~ state the characteristics seen in each criteria that indicate onset of labour
What is the Bishops Score used for?
→ Position of the cervix (anterior)
→ Effacement of the cervix (length - shorter = better)
→ Consistency of the cervix (soft)
→ Dilatation of the cervix (bigger = better)
→ Station of the presenting part (distance in cm in relation to the ischial spines)
Bishops score is used to assess whether induction of labour would be successful
What examination findings would be seen in a neck of femur #? (5)
Affected leg is shorter
Affected leg is externally rotated
Palpation of hip is painful
Patient cannot perform a straight leg raise
Bruising/soft tissue swelling in/around the hip area
Which electrolyte abnormality can blood transfusions cause?
Why does this happen?
Hypocalcaemia
When blood is donated, it’s mixed with sodium citrate to prevent it from coagulating. → The citrate in the blood can bind to the patient’s circulating calcium resulting in a decreased amount of free calcium = symptoms of hypocalcaemia
What is the definition of sepsis?
Life threatening organ dysfunction caused by a dysregulated host response to an infection
What are the common symptoms of a migraine? (5)
Unilateral, throbbing headache that’s aggravated by movement
Photophobia (light makes it worse)
Phonophobia (loud noises make it worse)
Nausea / vomiting
+/- Aura
Name 2 serious complications with the use of MAOI’s:
What are MAOIs mainly used to treat?
Hypertensive crisis (cheese reaction) Serotonin syndrome
Depression
What is the physiological cause of the menopause?
Ovarian failure* which results in oestrogen deficiency
* Decreased ovarian function due to very few follicles remaining
What are the 2 1st line investigations of prostate cancer?
What blood test can also be requested?
What imaging is best initially?
Digital rectal examination to examine the prostate
Urine dip
Prostate specific antigen (PSA)
MRI
If a patient presents with “the worst headache they’ve ever had”, what diagnosis is this suggestive of?
Subarachnoid haemorrhage
Commonly presents with a thunderclap headache
What is the function of the trigeminal nerve?
Motor function to muscles of mastication
Sensation of face
List some common symptoms/signs seen in pericarditis: (5)
Chest pain (pleuritic)
→ Worse when lying down / deep breaths
→ Better sitting forwards
Fever
Pericardial rub
Raised troponin
ECG changes: widespread, saddleshaped ST elevation
What type of dementia is characterised by a step wise decline?
Vascular dementia
Describe what nociceptive pain is:
Describe what neuropathic pain is:
Note whether they have a protective function or not.
Nociceptive pain = pain when there is tissue injury or illness (eg when you cut yourself)
~ has a protective function (the pain causes you to stop whatever is causing the pain)
Neuropathic pain = pain caused by nervous system damage / abnormality
~ no protective function, often occurs long after there has been trauma!
Which antidepressant class should be avoided in patients with suicidal ideation?
Tricyclic antidepressants - they are lethal in overdose
What is the function of the trochlear nerve?
Which muscle does it innervate?
Eye movement
Superior oblique muscle
What is the 1st line investigation in SUFE?
What is the management of SUFE?
Xray of hip
Surgery: correction of femoral head positon PLUS screw fixation
~ Prophylactic fixation of contralateral hip may be done
What is the typical presentation of someone with an extradural haemorrhage? (symptoms)
Head trauma +/- unconsciousness followed by lucid period (as the blood is pooling)
Progressive headache
Nausea / vomiting
Decreasing GCS
What xray findings are seen in heart failure? (ABCDEF)
A: alveolar oedema
B: Kerley B lines (caused by interstitial oedema)
C: Cardiomegaly
D: Upper lobe diversion (increased blood through the smaller blood vessels in the upper lobes - looks like cloudiness on xray)
E: Pleural Effusions
F: Fluid in the horizontal fissure
Give an example of a commonly used tricyclic antidepressant.
Amitriptyline
Which neurotransmitter do antipsychotics decrease?
Dopamine
What is the 1st line treatment of non-bacterial pericarditis?
What is the treatment of bacterial pericarditis?
NSAIDs (reduces the inflammation of the pericardium)
IV antibiotics
At what age does the menopause typically occur?
50y
What is urge incontinence?
What is stress incontinence?
What is functional incontinence?
Urge incontinence = incontinence of urine caused by a sudden need to urinate (caused by an overactive bladder)
Stress incontinence = incontinence of urine caused by increased abdominal pressure, eg coughing, laughing, exercise
Functional incontinence = incontinence of urine caused by not being able to access a toilet
What is the textbook cause of an extradural haematoma?
Trauma to the head, eg car crash/baseball bat to the head
A baby is considered non-viable before which gestational week?
Week 23
What is aortic dissection?
A tear in the tunica intima of the aorta allows blood to flow between the inner & outer layers of the walls of the aorta
What questionairre is used in general practice to grade the severity of a patient’s depression?
PHQ-9 questionairre
What is the prophylaxis management of haemophilia?
How is an acute episode of bleeding treated? (3)
Replacement of clotting factors via IV transfusions (VIII - A, IX - B)
1) Infusions of affected clotting factor (VIII or IX)
2) Desmopressin (DDAVP) - to stimulate VWF release
3) Tranexamic acid - reduces the rate of fibrinolysis so that clot remains for longer
What is a subdural haematoma?
Damage to which blood vessels cause a subdural haematoma?
A collection of blood between the dura mater and arachnoid mater
Tear in the bridging veins between the cortex and dura mater
List some common presentations of von Willebrand disease: (5)
→ nose bleeds
→ menorrhagia
→ bleeding gums when brushing teeth
→ prolonged, heavy bleeding during surgery/ trauma
→ easy bruising
Name the 3 types of emergency contraception available and:
- *a)** state the timeframe in which they are effective after UPSI
- *b)** state their mechanism of action against pregnancy
List 2 contraindictations of EllaOne
- *EllaOne**
a) effective up to 5 days after UPSI
b) delays ovulation
c) asthma, breastfeeding should be avoided for 1 week - *IUD (copper coil)**
a) effective up to 5 days after UPSI
b) copper is spermicidal + prevents implantation
c) insertion may cause PID - *Levonorgestrel**
a) effective up to 3 days after UPSI
b) delays ovulation
List some symptoms of opiate withdrawl: (8)
Aggitation
Anxiety
Runny nose
Runny eyes
Sweating
Diarrhoea
Insomnia
Uncontrollable yawning!
Increased BP & HR
What timeframe does postnatal depression occur within?
Within 6 months of giving birth
What is an extradural haemorrhage?
A collection of blood between the skull and the dura mater
What symptoms might PID present with? (5)
Bilateral abdominal pain
Vaginal discharge
Post coital bleeding
Fever
Adnexal tenderness
If premature delivery is likely, what should be given to the mother & why?
Corticosteroids - to encourage maturation of the fetal lungs
What are some common triggers of trigeminal neuralgia? (5)
Cold
Wind
Chewing
Talking
Touching face
Treatment of delirium is mainly managed pharmacologically: TRUE/FALSE
What does the management of delirium involve?
False - mainly non-pharmacological management:
→ Re-orientate the patient
→ Help them mobilise as much as possible
→ Normalise sleep-wake cycle
→ Discharge asap !!
A testicle that has a ‘bag of worms’ texture indicates what?
What is the underlying cause of this?
If this occurs on the left side (testicle), what should you be suspicous about?
Varicocele
Enlargement/dilation of the testicular veins
Renal cell carcinoma - causing compression of the left renal/ left testicular vein
List some risk factors for septic arthritis. (6)
IV drug users
Unprotected sex
Diabetes Mellitus
Underlying joint disease (OA/RA)
Immunosuppression
Older age
What is Budd-Chiari syndrome?
What is the classic presenting triad of this syndrome?
A syndrome in which there is hepatic vein obstruction
1) severe abdominal pain
2) ascites
3) tender, hepatomegaly
How long should someone continue their antidepressants for if they presented with their third+ episode of depression?
Life long
Name the most commonly used SSRI.
Sertraline
How is Binge Eating Disorder different from Bulimia Nervosa?
In Binge Eating Disorder, patient’s don’t purge themselves after eating
List 3 complications of HRT.
- Increased risk of breast cancer
- increased risk of venous thromboembolism
- Increased risk of endometrial cancer if oestrogen is given alone
List some symptoms of anorexia (7)
Lanugo hair
Cold intolerance
Blue hands / feet
Amenorrhoea
Dry skin
Hypotension
Weakness / fatigue
What classification system is used for aortic dissections?
Stanford classification
What is a common presentation of a cluster headache? (6)
Male with sudden onset, severe pain, behind one eye
Associated with:
~ watery, bloodshot eye
~ lacrimation
~ ptosis
~ miosis
~ runny nose (rhinorrhea)
What does SCID stand for?
Which immune cells are affected in SCID?
What are the 2 treatment options for SCID?
Severe combined immunodeficiency
Development of B cells & T cells is affected producing dysfunctional B & T cells
1st line = stem cell transplant
If not available: gene therapy
What screening tool is used to assess the likelihood of anorexia nervosa?
SCOFF questionairre
Anaphylaxis is what type of hypersensitivity reaction?
This type of reaction is mediated by what?
Type 1 hypersensitivity reaction
IgE mediated mast cell degranulation
What 2 tests can be performed to assess the level of cognitive impairment/ ability?
MMSE (mini mental state exam)
MOCA
Falls onto an outstretched hand commonly # which carpal bone?
Scaphoid bone
What is the 1st line medication for Parkinson’s disease?
What is this medication usually given with & why?
Levodopa
Co-administered with Carbidopa - prevents L-dopa being converted into it’s active form in the systemic circulation thus more reaches the brain
Does 1st degree heart block need to be treated?
No
What is the peri-menopause?
The period of time from when symptoms of the menopause start, until 12 months after the last menstrual period
List some common symptoms of anaemia: (5)
→ Fatigue
→ SOB
→ Headaches
→ Pre-syncope / syncope
→ Palpitations
What medication is commonly used to treat oestrogen receptor positive breast cancers?
What drug class is this?
Tamoxifen
SERM - selective oestrogen receptor modulator
The Philadelphia chromosome is associated with what haematological condition?
The philadelphia chromosome (a mix of 2 chromosomes) results in what oncogenic gene?
Chronic myeloid leukaemia
BCR-ABL gene
Which 2 neurotransmitters do atypical antipsychotics affect?
Dopamine & serotonin
List some indications to induce labour: (6)
Prelabour rupture of membranes
Pre-eclampsia
Diabetes
Intrauterine fetal death
Obstetric cholestasis
Fetal growth restriction
List 2 methods of prophylaxis of preterm labour:
Vaginal progesterone pessary/gel - this prevents cervical ripening & decreases activity of the myometrium
Cervical cerclage - a stitch is put into the cervix to keep it closed until nearer term date
Interpret the following:
G3 P1
3 pregnancies of which only 1 has been delivered past 24 weeks gestation
What is a nihilistic delusion?
What condition is it usually a feature of?
A negative delusion (belief) of something decaying/missing - commonly people think they are rotting internally/ their organs are missing
Severe depression
What side effect is commonly associated with Olanzapine?
Weight gain
What is the management of an acute cluster headache attack?
100% oxygen through a mask
What are the key clinical features in lewy body dementia? (3)
Fluctuating confusion throughout the day
Visual hallucinations
Parkinsonism symptoms (poor mobility, tremor)
List some signs of respiratory distress: (8)
~ Raised respiratory rate
~ Using accessory muscles of breathing
~ Intercostal & subcostal recession
~ Nasal flaring
~ Tracheal tugging
~ Cyanosis
~ Abnormal airway nosies
~ Head bobbing
What is the treatment of von Willebrand disease?
List 2 contraindictations to the use of DDAVP:
- There is no day-to-day treatment. Treatment is given after a bleed or in preparation for surgery*
1) VWF concentrate IV
2) Desmopressin - stimulates the release of VWF
3) Tranexamic acid - inhibits fibrinolysis (clot breakdown)
Contraindictations: youung children, people with high cardiovascular risk
What grading system is used in prostate cancer?
The gleason score
What are 2 common complications of pericarditis?
Recurrent episodes of pericarditis can cause what?
Cardiac tamponade & pericardial effusion (fluid inbetween the 2 layers of pericardium)
Constrictive pericarditis
Interpret the following:
G2 P1
This lady has been pregnant twice but has only had 1 delivery past 24 weeks gestation
What is the typical presentation of someone with Legg-Calve-Perthes disease?
Gradual* onset limb & hip pain
Referred pain to the knee
Pain persists for >4 weeks
* Gradual due to the femoral head becoming increasingly ischaemic
What type of antipsychotic is Haloperidol?
Typical antipsychotic
What type of antipsychotic is Olanzapine?
Atypical antipsychotic
Name a criteria used to diagnose depression.
ICD-10
Which vessels remove deoxygenated blood from the brain?
Where do these veins drain into?
Bridging veins
Drain into venous sinuses → internal jugular vein
What features are seen in HELLP syndrome?
H - haemolysis
EL - elevated liver enzymes
LP - low platelets
What is the function of the facial nerve? (3)
Supplies muscles of facial expression
Taste to anterior 2/3 of tongue
Innervates submandibular & sublingual glands
What type of medication is used 1st line if someone presents with an acute manic episode with no aggitation?
An antipsychotic
What is the 1st line medication used to treat trigeminal neurlagia?
Carbamazepine
What are the 2 commonest causes of a subarachnoid haemorrhage?
Ruptured aneurysm, commonly in the cirle of willis
Severe head injury
What medication is used for treatment resistant Schizophrenia?
Clozapine
What is the 1st line investigation of a red, hot, swollen joint? (Suspicion of septic arthritis)
Aspiration of synovial fluid for cell count, gram stain & culture
What actually is delirium?
An acute confusional state
What is the function of the vestibulocochlear nerve?
Vestibular = hearing
Cochlear = balance
In what condition is there reversible airway obstruction?
What class of medications are used to treat this?
Name the medication used.
Asthma
Short acting beta agonists
Salbutamol
Name the 3 commonest drug classes to treat depression.
SSRI;s
SNRI’s
Tricyclic antidepressants
Name the 2 ways that anaemia can be categorised by:
- Looking at the mean corpuscular volume (MCV) of the RBCs
- The mechanism of cause of anaemia
(RBC size!)
Name the drug classes used in each of the 3 steps of the WHO pain ladder. Give an example of a drug in each class.
Explain how to use the WHO pain ladder.
Step 1: NSAIDs & paracetemol
~ Aspirin, Ibuprofen, Diclofenac
Step 2: Mild opioids (codeine) +/- NSAIDs/ paracetemol
Step 3: Strong opiods (morphine) +/- NSAIDs/ paracetemol
Start with step 1, if pain not tolerated, add in mild opioid. If not tolerated, swap mild opioid fo strong one with NSAID/ paracetemol still
What is pre-eclampsia?
Pregnancy-induced hypertension occurring after 20 weeks gestation with proteinuria.
When starting someone on an SSRI, what should you warn them about?
What is the name given to this?
They may feel worse for the first 10 days, but after this they should feel better
Activation syndrome
List some common symptoms of menopause. (6)
Hot flushes
Night sweats
Vaginal dryness
Reduced libido
Mood swings
Fatigue
What happens in Morbitz I (2nd degree heart block)?
Progressive lengthening of the PR interval until a beat is dropped (there is no QRS complex following 1 P wave)
Describe what coarctation of the aorta is:
List the clinical signs/ symptoms of coarctation of aorta: (3)
How would a child with coarctation of aorta usually present?
Narrowing of the descending aorta
1) Weak/ absent femoral pulse
2) Radio-femoral delay
3) Systolic murmur that’s loudest at the back
Presentation: sudden deterioration & collapse
What are the positive symptoms of schizophrenia? (3)
Hallucinations
Delusion
Disordered thinking
What tool is used to assess for alcohol use & problems?
FAST (fast alcohol screening tool)
A patient taking MAOI’s should be told to avoid what, & why?
Avoid tyramine-rich foods as tyramine reacts with the MAOI’s causing a hypertensive crisis
= cheese reaction
What medication would you start someone on if they present with their 1st episode of mania?
What contraindications are there to this medicine?
Lithium
Not ideal for women of child bearing age - discuss contraception with them
What is the management of PID?
Antibiotics: ofloxacin & metronidazole
Analgesia if severe pain
What are the clinical features of chorioamnionitis? (6)
Fever
Abdominal pain
Offensive vaginal discharge
Preterm rupture of membranes
Uterine tenderness
Maternal & foetal tachycardia
What type of pain will the WHO pain ladder be successful at helping?
What is the treatment for the other type of pain? (name 2 examples of drugs used)
Nociceptive pain = use WHO pain ladder
Neuropathic pain - WHO pain ladder doesn’t work
~ amitriptylline
~ gabapentin
~ duloxetine
What is the 1st line management of pre-eclampsia?
Labetolol (anti-hypertensive)
List 4 common causes of pathological #’s.
- Osteoporosis
- Tumours (within the bone)
- Hyperparathyroidism (causes bone thinning = weak bone)
- Paget’s disease (abnormal bone turnover = weak bone)
What are the 2 commonest causes of PID?
Gonorrhoea
Chlamydia
What side effects are commonly experienced after initiating metformin?
GI upset: nausea, vomiting, diarrhoea, bloating
You are working in A&E and a patient is hypotensive. What do you do to increase the BP?
How much of this would you give and over what time?
IV fluid resuscitation
500ml saline or plasmalyte bolus over 15 mins
Which cranial nerves are responsible for the afferent & efferent pathways of the corneal reflex?
Afferent = V1 nerve (ophthalmic)
Efferent = VII nerve (facial)
What is the function of the optic nerve?
Vision
What type of antipsychotic is Risperidone?
Atypical antipsychotic
Which cranial nerves are responsible for the afferent & efferent pathways of the gag reflex?
Afferent = IX nerve (glossopharyngeal)
Efferent = X nerve (vagus)
What are the 4 abnormalities seen in Tetralogy of Fallot?
What xray finding is seen in this condition?
What clinical sign may be seen on examination? - Why does this happen?
What is the definitive treatment and when does it occur?
1) Pulmonary valve stenosis
2) R ventricle hypertrophy
3) Ventricularseptal defect
4) Overriding aorta (L & R ventricle drain into aorta)
Boot shaped heart seen on xray
Central cyanosis - high pressure in R ventricle due to hypertrophy causes R→L shunt through ventricularseptal defect - less oxygenated blood enters systemic circulation
Surgical correction: performed when baby is 5kg (~ 6 months)
What investigation is used to diagnose an aortic dissection?
CT angiogram
Between which meningeal layers does a subarachnoid haemorrhage occur?
Between the arachnoid mater & pia mater
Which electrolyte imbalance is seen in anorexia nervosa?
Hypokalaemia (low K)
What are the 5 domains of development?
1) Gross motor skills
2) Fine motor skills
3) Speech & language skills
4) Social & self help skills
5) Hearing & vision
In haemotology, what is the function of G6PD?
What is the result of a G6PD deficiency?
List some common triggers of this: (3)
What ar the common clinical features seen? (3)
G6PD is an enzyme that attaches onto RBCs to protect them against oxidative stress
G6PD deficiency causes haemolysis of RBC when there is oxidative stress → haemolytic anaemia
1) Infection
2) Broad beans (fava beans)
3) Drugs (antimalarials, nitrofurantoin, aspirin)
1) Anaemia
2) Jaundice
3) Splenomegaly
What abnormality is seen in haemophilia A?
What abnormality is seen in haemophilia B?
What is the mode of inheritance of haemophilia?
What tests would you do to diagnose haemophilia and what results would you expect in haemophilia? (3)
Haemophilia A: deficiency of clotting factor VIII
Haemophilia B: deficiency of clotting factor IX
X linked recessive
1) Clotting factor tests - to look at levels of factors VIII & IX (low VIII in haemophila A & low IX in haemophilia B)
2) Blood test APTT*: prolonged
3) Blood test prothrombin: normal
* APTT = blood test that measures time taken for blood to clot
List the 4 treatment options for mania.
Antipsychotics
Mood stabilisers
Lithium
ECT (electro convulsive therapy)
What does this CT show?
Subdural haematoma
List some risk factors for transitional cell carcinoma of the bladder (3)
Smoking
Aromatic amines (rubber, dyes and chemicals)
Cyclophosphamide (chemo drug)
What are the 3 pathological features seen in the brains of patients with Alzheimers disease?
Amyloid plaques
Tau protein tangles
Reduced Ach
What is Perthes disease? (Legg-Calve-Perthes)
Avascular necrosis of the femoral head in children which is caused by disruption to the blood flow of the femoral head
Name the condition described:
“Episodes of binge eating with a sense of loss of control, followed by purging behaviour” - normal BMI
Bulimia nervosa
Interpet the following:
G2 P2
2 pregnancies of which both have been delivered past 24 weeks gestation
What is the Bishop Score used to assess?
It assess whether someone should have their labour induced
What monitoring does Clozapine require & why?
Weekly blood tests - associated with agranulocytosis
What hormone stimulates milk production?
What hormone stimulates milk contraction? (by contracting myoepithelial cells within the breast)
Prolactin
Oxytocin
What are the signs of hypercalcaemia?
“Stones, bones, abdominal moans & psychiatric groans”
Renal stones
Painful bones
GI: nausea, vomiting, constipation, indigestion
Neuro: fatigue, memory loss, depression, psychosis
Amitriptyline is used to treat which 2 clinical conditions?
Depression Mild pain (neuropathic)
What is a 3rd degree heart block in relation to the electical activity?
What would you see on an ECG?
No impulses are conducted between the atria & ventricles but both still contract independently at different rates
On the ECG: P waves & QRS complexes are out of sync & not related to each other at all
What is the 1st line medication used in pre-eclampsia to control blood pressure?
What is the 2nd line medication?
Labetalol
Nifedipine
What common hallucination is associated with delirium tremens?
Visual hallucinations involving insects
What is the 1st line medication used in mild/moderate Alzheimers?
Donepezil
Give 3 examples of foods/drinks patients on MAOI’s should avoid.
Cheese
Beer
Red wine
What is the main action of a statin?
To lower cholesterol
What 2 common features would you see on an ECG to indicate AF?
Absent P waves
Irregularly irregular rhytm
What type of formula is used to treat CMPA?
If the child still can’t tolerate this formula, what would they be swapped to?
Hydrolysed formula
An amino acid formula
What is lactate a marker of?
Is a high or low lactate good?
Hypoperfusion (reduced O2 reaching the tissues)
LOW lactate - the higher the lactate, the more tissues are without O2!
A diagnosis of pre-eclampsia requires what? (1 + 3)
BP 140/90 +
PLUS any of:
Proteinuria
Organ dysfunction (raised creatinine / elevated LFTs / seizures)
Placental dysfunction (eg, foetal growth restriction)
Which cranial nerves are responsible for the afferent & efferent pathways of the pupillary reflex?
Afferent = II nerve (optic)
Efferent = III nerve (oculomotor)
What genetic mode of inheritance is seen in haemophilia A & B?
Which sex is haemophilia more common in?
X linked recessive inheritance!
Males
What type of antipsychotic is Clozapine?
Atypical antipsychotic
List some clinical features of hypoglycaemia: (7)
Shaking
Sweating
Palpitations
Headache
Blurred vision
Hunger
Confusion
For a diagnosis of severe depression, how many additional symptoms from the ICD-10 criteria does the patient need to have?
8
Between which weeks gestation is the combined test usually performed?
Weeks 11 - 13
Name the 3 hormones that stimulate RBC production in the bone marrow:
Erythropoietin
Thyroid hormone
Androgens
What side effects are more likely with typical antipsychotics compared to atypical antipsychotics?
Extra-pyramidal symptoms (eg, parkinsonism symptoms, tremor, slurred speech, inability to stay still)
What are the core symptoms of depression according to the ICD-10 criteria?
- A depressed mood for most of the day that has been present for 2+ weeks
- Loss of interest or pleasure (anhedonia)
- Decreased energy
Capacity is decision specific: TRUE/FLASE?
True
What are some common side effects of Valproic acid? (3)
Which 2 conditions is valproic acid (sodium valproate) used to treat?
Nausea
Vomiting
Weight gain
1) Epilepsy
2) Bipolar disorder
What immunological mechanism is responsible for type 3 hypersensitivity reactions?
Give an example of a disease that is caused by type 3 hypersensitivity.
Immune complex deposition
SLE
What is the definition of psychosis?
The inability to distinguish the symptoms of hallcuinations, delusions and disordered thinking from that of reality
Around what week gestation should a booking appointment occur in?
Week 10
If someone presents with a thunderclap headache, what is the most likely diagnosis?
Subarachnoid haemorrhage
What is the function of the vagus nerve?
Motor & sensory innervation to pharynx (back of throat), heart, resp tract, GIT
Name the 4 main types of # & describe what they would look like.
1. Transverse # # is straight across the bone
2. Oblique # # is diagonally across the bone
3. Spiral # # that winds around the bone in a spiral manner
4. Complex/comminuted # # into lots of fragments of bone
A blood sugar below what is considered as hypoglycaemia?
4mmol/L
What Bishop Score would indicate induction of labour would be successful?
8 or more
What are fibroids?
Benign, smooth muscle tumours of the myometrium of the uterus
What is the difference between mania & hypomania?
In hypomania there are no psychotic symptoms & the episode isn’t severe enough to impact on their social / occupational functioning.
What is the 1st line investigation of suspected endometrial cancer?
What investigation is needed to diagnose & stage endometrial cancer?
Trans-vaginal ultrasound - to look for abnormal thickening of endometrium
Hysteroscopy with biopsy
Give examples of conditions that cause a macrocytic anaemia: (5)
What initial investigation would you do after identifying macrocytic anaemia & what would a high / low result suggest?
What blood test would also be useful?
1) B12 deficiency
2) folate deficiency
3) Bone marrow infiltration
4) Alcohol
5) Hypothyroidism
Blood film
Megaloblastic cells = B12, folate deficiency
Non-megaloblastic cells = Bone marrow infiltration, alcohol, hypothyroidism
Blood test: B12/folate assay
What condition may SGLT2 inhibitors be prescribed to manage?
What is the mechanism of action of SGLT2 inhibitors?
Type 2 Diabetes
Increase the excretion of glucose from the body
What treatment (if any) is required for a Morbitz I heart block?
No treatment needed unless symptomatic - often benign
What is often the first clinical feature seen in vascular dementia?
Aphasia (problems with communication)
* Memory is often spared until advanced disease
What is the definition of psychosis?
The inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality - they have a lack of insight into their condition
List 3 clinical features of bladder cancer:
Painless, frank haematuria
Recurrent UTIs
Hydronephrosis
What is the classic triad of symptoms seen in normal pressure hydrocephalus?
Urinary incontinence
Dementia
Gait abnormality
List the 5 most prevelant types of dementia:
Alzheimers disease
Vascular dementia
Lewy body dementia
Mixed dementia (when someone has a mixture of 2 dementia’s)
Frontotemporal dementia
What is the medical word for the inability to experience pleasure in things that you used to enjoy?
Anhedonia
Which 2 antipsychotics are associated with weight gain?
Olanzapine & Clozapine
What is a stanford type A and stanford type B aortic dissection?
Stanford type A: tear is within the ascending aorta or the arch of the aorta
Stanford type B: tear is within the descending aorta
It is performed in preterm labour with intact membranes
What is tocolysis?
When medications are used to stop uterine contractions.
What blood levels of Hb would indicate anaemia in:
- a -* females
- b -* males
Females: < 120 g/L
Males: < 140 g/L
Which diagnosis must you rule out if someone presents with post-menopausal bleeding?
Endometrial cancer
What are the 3 categories of symptoms of depression?
Psychological
Physical
Social
What symptoms does COPD commonly present with? (4)
Chronic SOB
Productive cough
Wheeze
Recurrent respiratory tract infections
What is the management of a baby with symptomatic patent ductus arteriosus? - what is the mechanism behind this?
When would this management not be used and why?
In these babies, what would the management be? - what is the timeframe for this?
Indomethacin (an NSAID) - it is a prostagland inhibitor so causes closure of ductus arteriosus
Not used in term babies as their patent ductus arteriosus isnt prostaglandin sensitive!
Watch & wait - most will close spontaneously within 1y. IF symptomatic, can be surgically ligated
What is the difference between petechiae & purpura?
What is ecchymoses?
- *Petechiae** < 3mm
- *Purpura** 4 - 10mm
Ecchymoses is bleeding under the skin that is larger than 1cm!
What do the 3 stages of labour consist of?
First stage - from the onset of labour (contractions) until 10cm cervical dilatation
Second stage - from 10cm dilatation until the baby is delivered
Third stage - from delivery of the baby to delivery of the placenta
What are the negative symptoms of schizophrenia? (4)
Apathy (lack of interest/ motivation)
Social withdrawal
Emotional blunting
Poverty of speech/ psychomotor retardation
What is priapism?
What is the biggest risk factor for it?
A painful erection that lasts for longer than 2 hours.
Sickle cell disease
What drug class is used for the treatment of Alzheimers disease & Lewy Body dementia?
Give an example of a medication from this class.
Acetylcholinesterase inhibitors
Donepezil
Give examples of conditions that cause a microcytic anaemia: (3)
What initial investigation would you do after identifying microcytic anaemia & what would high / low results suggest?
1) Iron deficiency
2) Thalassaemia
3) Secondary anaemia (anything that causes chronic inflammation)
Measure serum ferritin:
→ Low = iron deficiency anaemia
→ Normal/ high = thalassaemia / secondary anaemia
What treatment (if any) is required for 3rd degree heart block?
Permanent pacemaker
List 5 signs of an LMN lesion:
Muscle weakness
Muscle wasting
Hypo-reflexia
Hypotonia
Fasiculations
What symptoms would be seen in moderate/severe aortic stenosis in children? (3)
What symptoms would be seen in moderate/severe pulmonary stenosis in children? (2)
Reduced exercise tolerance, exertional chest pain & syncope
Exertional SOB & fatigue
What is the management of Stanford type A aortic dissections?
Surgical management (aortic graft)
Between which weeks gestation is considered as a ‘term’ delivery?
37 - 42 weeks
What is an open #?
When there is direct communication between the external environment and the #
What changes occur at birth regarding the foetal circulation? (6)
1) foramen ovale closes
2) ductus arteriosus closes
3) ductus venosus closes (blood vessel connecting umbilical vein→IVC)
4) Pulmonary vascular resistance falls
5) Pulmonary blood flow increases
6) Systemic vascular resistance increases
Give examples of conditions that cause a normocytic anaemia: (4)
What initial investigation would you do after identifying normocytic anaemia & what would high / low results suggest?
1) Blood loss
2) Haemolysis of RBC (aka, haemolytic anaemia)
3) Bone marrow disease (failure/ cancer infiltration)
4) Secondary anaemia (eg, inflammation)
Reticulocyte count:
High reticulocyte = Blood loss, haemolysis
Low reticulocyte = Bone marrow disease, secondary anaemia
Which ethnic group is sepsis most common within?
Asians
What is chorioamnionitis?
Infection of the membranes in the uterus
What is the function of the abducens nerve?
What muscle does it innervate?
Eye movements
Lateral rectus muscle
What skills would you expect to see from each developmental domain in an 24m toddler?
- Gross motor (1)
- Fine motor (1)
- Language (1)
- Social (1)
- Self help (1)
Gross motor: climbs on play equipment (eg, slides)
Fine motor: scribbles with circular motion
Language: vocabulary of 30-50 words
Social: helps with simple household tasks
Self help: opens door by turning knob
What are the most common symptoms of a UTI? (6)
Dysuria
Increased frequency
Urgency
Foul smelling urine
Suprapubic pain
+/- haematuria
What is the physiological cause of pre-eclampsia?
Abnormal formation of the spiral arteries to the placenta resulting in high vascular resistance between placenta and maternal circulation
What medication should be prescribed with methotrexate to avoid toxicity?
Folic acid
What route is Dalteparin administered?
Subcutaneous injection
What are the 6 components of sepsis 6?
(take 3, give 3)
→ Take blood cultures
→ Measure blood lactate
→ Measure urine output
→ Give O2 if sats are below 94%
→ Give IV antibiotics
→ Fluid challenge (give IV fluids)
Why does the dose of Lamotrigine have to be titrated up SLOWLY?
High risk of developing Stevens Johnson’s syndrome (nasty, necrolysing rash)
What type of antipsychotic is Risperidone?
atypical antipsychotic
What is found within the subarachnoid space?
CSF (cerebralspinal fluid)
What is the medical word used to describe: ‘a loss of interest/motivation’
Apathy
What would you hear when ascultating someone with an atrial septal defect? (2)
Explain why you would hear these things!
Fixed, split 2nd heart sound → as blood is being shunted from L→R atria, there is more blood to flow through the pulmonary valve. This causes a delay in the valve closing compared to closing of aortic valve = split 2nd heart sound
Pulmonary flow murmur (ejection systolic murmur) → due to increased blood flowing through the valve
What immunological mechanism is responsible for type 2 hypersensitivity reactions?
Auto-antibody mediated receptor activation
Ventricular-septal defects are associated with which 2 genetic conditions?
What type of murmur is heard when there is a ventricular-septal defect?
Down syndrome, Turner’s syndrome
Pan-systolic murmur
What does SIRS stand for?
What clinical features would a patient have, to be diagnosed with SIRS?
Systemic inflammatory response syndrome
→ High/low temperature
→ HR > 90
→ RR > 20
→ High CO2
→ High WBC’s
What week of gestation is considered ‘term’? (and thus before this is ‘preterm’)
Week 37
Which anticonvulsant should be avoided in women of child bearing age & why?
Valproic acid - it causes neural tube defects
What are the 1st and 2nd line drug classes used for depression?
1st line: SSRI’s
2nd line: SNRI’s
List some clinical features seen in haemophilia: (5)
Haemarthrosis (bleeding into the joints)
Muscle haematoma
CNS bleeding
Prolonged bleeding after surgery/ trauma
Menorrhagia
What is a pathological #?
A # that didn’t require force/impact as the bone was diseased and thus weaker.
In utero, oxygenated blood enters the foetus through what vessel?
What is the course of this vessel to the heart?
Through what mechanism does most foetal blood bypass the lungs?
Most blood that does enter the pulmonary artery still bypasses the lungs - how?
What does this drain into?
Umbilical vein
Umbilical vein→ductus venosus (through liver)→IVC→R atrium
Foramen ovale inbetween 2 atria
Through the ductus arteriosus
Ductus arteriosus drains into aorta
In which age group is a subdural haematoma most common?
What is the most common cause of a subdural haematoma?
Older population
Common cause is a minor head injury
What are common signs of raised ICP? (4)
Headache that is worse in the morning & when bending over/coughing
Headache that is relieved by lying down
Papillodema
Vomiting
What is the prophylaxis used against pre-eclampsia?
Aspirin from 12 weeks gestation
What is the management of tension headaches?
Simple analgesia: NSAIDs / paracetemol
What happens in Morbitz II (2nd degree heart block)?
Each PR interval is normal lenght but occasionally the P wave isn’t followed by a QRS complex - dropped beat
What is receptive dysphasia?
Damage to which area of the brain results in receptive dysphasia?
When someone is unable to comprehend language but is able to physically say words (as a result they often say things that don’t make sense)
Wernicke’s area
A collapsing pulse is indicative of which valvular disease?
Aortic regurgitation
How long should someone continue their antidepressants for if they presented with their second episode of depression?
2 years
List some common causes of delirium (12)
(CHIMPS PHONED)
C - Constipation / urinary retention
H - Hypoxia
I - Infection
M - Metabolic disturbance
P - Pain
S - Sleeplessness (lack of sleep)
P - Prescriptions (anti-cholinergics, opiates)
H - Hypothermia/pyrexia
O - Organ dysfunction (hepatic or renal impairment)
N - Nutrition (poor)
E - Environmental changes
D - Drugs (over the counter, illicit, alcohol and smoking)
Between which weeks does labour & delivery usually occur?
37 - 42 weeks
Hyperprolactinaemia is a potential side effect of which class of psychiatric drugs?
What clinical features might males & females present with?
Antipsychotics
Males:
→ Erectile dysfunction
→ Gynaecomastia
→ Galactorrhoea
Females:
→ Galactorrhoea
→ Menstrual dysfunction
What is the cellular pathology that results in pernicious anaemia?
Autoimmune attack against intrinsic factor → B12 cannot be absorbed without intrinsic factor and patient becomes anaemic
What investigation is used to diagnose coarctation of aorta?
What is the initial management of coarctation of aorta? What does this do physiologically to help?
What are the 2 definitive managements of coarctation of aorta?
ECHO
Give prostaglandin E - this reopens the ductus arteriosis which increases cardiac ouput & relieves the strain on the L ventricle
Surgical repair (narrowed part is resected and the 2 ends are anastamosed together) or stent insertion
What 3 symptoms are characteristic of asthma?
WHEEZE
Cough
SOB
What is a complication of pre-eclampsia & eclampsia?
HELLP syndrome
What drug is given to rapidly reverse an opioid overdose?
Naloxone
What is pelvic inflammatory disease?
PID occurs when an infection spreads from the vagina into the cervix and up into the upper genital tract
What is cushings syndrome?
Name the hormonal control underlying the release of this compound, & the locations where each hormone are released from:
List the 4 main causes of cushings syndrome:
Excess cortisol
CRH (hypothalamus) → ACTH (anterior pituitary) → cortisol (adrenal cortex: zona fasiculata)
1) Long term steroid use (commonest cause)
2) Cushings disease (ACTH producing pituitary adenoma)
3) Adrenal adenoma
4) Ectopic ACTH secreting tumour (eg, small cell lung cancer)
What condition does the following statement indicate a diagnosis of?
” 50y with gradual change in behaviour over past 2 years. Clear personality change & quite withdrawn “
Frontotemporal dementia
What is the qSOFA score used for?
What 3 variables does the qSOFA consider?
A score of what suggests a poor prognosis?
Used on patients with a suspected/ confirmed infection to predict the patients who would likely require a higher level of care & have a poorer prognosis
→ BP
→ Mental state (level of conscousness)
→ Respiratory rate
Score of 2 or more
A patient with a DVT that suddenly has a large stroke is indicitive of what pathology?
An atrial septal defect - the clot from the leg passed through the septum and into the brain!
What is the normal range of platelets in blood?
150 - 400 x109/L
For a diagnosis of mild depression, how many additional symptoms from the ICD-10 criteria does the patient need to have?
4
What is the 1st line investigation in the diagnosis of fibroids?
Trans-vaginal ultrasound
What is the 1st line investigation of Cushing’s Syndrome?
Explain how this is conducted and the potential results:
What is the treatment of Cushing’s syndrome?
Dexamethasone suppression test
Patient takes low dose of dexamethasone at night & cortisol & ACTH levels are measured in the morning. If cortisol is high, test is repeated with a high dose of dexamethasone to work out the cause.
-
Low dose dexamethasone results:*
1) low cortisol & ACTH → normal (no cushings)
2) normal/ high cortisol → cushing’s syndrome -
High dose dexamethasone results:*
1) low cortisol & ACTH → pituitary adenoma
2) low ACTH, normal/ high cortisol → adrenal adenoma
3) normal/ high cortisol & ACTH → ectopic ACTH secreting tumour
Surgical removal of the tumour!
~ trans-sphenoidal resection of pituitary adenoma
What is the effect of opioid’s on someone’s pupils?
Pin prick pupils
What is the classic traid of clinical features seen in Wernicke’s encephalopathy?
Ataxia (lack of coordination of movements)
Ophthalmoplegia (paralysis of the eye muscles)
Encephalopathy (brain damage)
Explain the pathology in each miscarriage & say whether miscarriage is certain or not:
a) Threatened miscarriage
b) Inevitable miscarriage
c) Complete miscarriage
d) Missed miscarriage
a) Threatened miscarriage:
Mild bleeding, mild/ no pain, cervical os is closed, foetus present intrauterine - Miscarriage may or may not occurr
b) Inevitable miscarriage:
Heavy bleeding, pain, cevical os is open, foetus currently present intrauterine - Miscarriage is inevitable
c) Complete miscarriage
+/- bleeding/ pain, cevical os closed, NO products of conception intrauterine anymore (all have been expelled) - Miscarriage has already occurred
d) Missed miscarriage
Asymptomatic, cevical os closed, foetus currently present intrauterine but is dead
What skills would you expect to see from each developmental domain in an 18m toddler?
- Gross motor (2)
- Fine motor (2)
- Language (1)
- Social (2)
- Self help (1)
- *Gross motor:** 1) walks up/down stairs unsupported
2) kicks a ball - *Fine motor:** 1) scribbles with crayon
2) builds towers with 4+ bricks
Language: 1) starts to join words into sentences
-
Social*: 1) early pretend play
2) says no when interfered with
Self help: 1) eats with fork
What are the common side effects after starting Lithium?
GI upset: nausea / vomiting, diarrhoea, decreased appetite
What would you expect to see in the blood results of a patient diagnosed with anorexia nervosa in regards to:
- K levels
- Cholesterol levels
- Sex hormone levels (FSH, LH, Oestrogen, Testosterone)
- GH levels
- Cortisol levels
- Hypokalaemia
- Hypercholesterolaemia
- Low sex hormones
- Raised GH
- Raised cortisol
What direction is blood shunted in a ventricular-septal defect?
What pathology can occur over time if a ventricular-septal defect isnt corrected? What causes this?
What condition does this result in and why?
What clinical sign will be seen when this happens?
L→R ventricle
Increased blood in R ventricle → increased blood (and thus pressure) in pulmonary circulation → pulmonary hypertension
Pulmonary hypertension causes Eisenmenger syndrome: pressure in R ventricle is higher than L which causes blood to be shunted from R→L
Central cyanosis (more blood is bypassing the lungs)
Very high levels of bilirubin in infants can cause what serious condition?
What type of bilirubin causes this condition & why?
What is the treatment of raised unconjugated bilirubin levels?
Kernicterus
Unconjugated bilirubin - it’s fat soluble so can cross the BBB whereas conjugated bilirubin is water soluble and thus cannot cross the BBB
Phototherapy (babies are placed under blue light)
How long does a migraine attack usually last for?
4 - 72 hours
What type of dementia is most common in the under 65’s age group?
Alcohol related brain damage (ARBD)
If there is a lesion on the R accessory nerve, which way would the tongue deviate towards?
Right deviation
(The tongue deviates TOWARDS the side of the lesion)
What is the function of the glossopharyngeal nerve? (3)
Taste to posterior 1/3 of tongue
Sensation from pharynx & tonsils
Movement of throat muscles (stylopharyngeus muscles)
An extradural haemorrhage is commonly caused by a tear in which artery?
A # in which part of the skull usually causes this tear?
Middle meningeal artery
A # of the pterion - the pterion is weakest part of the skull & lies above the middle meningeal artery
How long after starting the following contraception is additional protection (condom’s) needed?
a) combined contraceptive pill
b) progesterone-only pill
a) 7 days
b) 2 days
Which lobes of the brain are usually affected first in Alzheimers disease?
Parietal & temporal lobes
What is the difference between Hodgkins and Non-Hodgkins lymphoma?
Hodgkins lymphoma is characterised by the presence of Reed-Sternberg cells → Non-Hodgkins lymphoma does not have these cells.
* Reed-Sternberg cells are abnormally large lymphocytes that usually have multiple nuclei
List some risk factors of pre-eclampsia. (8)
Pre-existing hypertension
Previous pre-eclampsia / FH
Diabetes
Chronic kidney disease
Autoimmune conditions (eg SLE)
>40y
BMI >35
Multiple pregnancy
What are the clinical features of an amniotic fluid embolism? (5)
High RR
Tachycardia
Hypotension
Hypoxia
Disseminated intravascular coagulopathy
What valvular disease is indicated by a slow rising carotid pulse?
Aortic stenosis
To be diagnosed with dementia, what type of imaging is required?
None. Dementia is a clinical diagnosis - imaging is done occasionally to confirm the diagnosis
In haematology, what 3 things are considered as ‘B symptoms’?
Night sweats, weight loss, fever
List some clincial features seen in someone with bulimia nervosa (6)
Swollen parotid glands
Poor dentition (from the acid in the vomit)
Mouth sores
Eosophageal tears → haematemesis
Heart burn
Impulsivity: stealing, alcohol/drugs, smoking
What drug can be given to help someone withdraw from opiates?
Methadone
What are the 2 antibiotics used to treat UTI’s?
Which one is more favourable in pregnancy?
Nitrofurantoin - used in pregnancy
Trimethoprim
When looking at the mean corpuscular volume of RBCs (size), what are the 3 types that may be seen?
Microcytic anaemia (small size)
Normocytic anaemia (normal size)
Macrocytic anaemia (large size)
What drug class is the 1st line treatment of hypertension in:
- Caucasian people under 55y
- People over 55y OR black/Caribbean people of any age
* Give an example of a drug that may be used in each.*
What is a contraindictation to the drug class used in 1. & what would be used instead?
- ACEi - ramipril
- Calcium channel blocker - amlodipine
Contraindictation to ACEi = pregnancy! Use an ARB instead
What drug class are used as the 1st line treatment for depression?
SSRI’s
What is the function of the accessory nerve?
Innervates trapezius & sternocleidomastoid muscles
What medication is given in ARI as post-surgical prophylaxis of VTE & what drug class is it?
How long is it given for post-surgery?
Dalteparin - LMWH
30 days
Describe a cluster headache.
How long do they usually last for?
Sudden onset, unilateral pain behind one eye
Typically last between 15 mins - 3 hours
List some common signs of anaemia: (4)
→ Pallor of skin
→ Pallor of conjunctiva
→ Tachycardia
→ Raised respiratory rate
What pathology is seen in the condition: “transposition of the great arteries”?
What needs to occur postnatally to make it temporarily compatible with life? - Give examples of 3 things that could occur:
This condition is usually detected antenatally. What is given immediately after birth before the baby is transferred for surgical correction? - What does this do?
The pulmonary artery arises from the left ventricle & the aorta arises from the right ventricle (they’ve swapped)
There needs to be a shunt between R & L ventricles so that oxygenated blood goes to systemic circulation
1) patent ductus arteriosus (connection between pulmonary trunk & aorta)
2) atrioseptal defect
3) ventriculoseptal defect
Prostaglandin E is given - prevents the ductus arteriosus from closing
What are the typical triad of features seen in pre-eclampsia?
Hypertension that occurs after 20 weeks gestation
Proteinuria
Oedema (usually ankle)
What 3 things are measured in the combined test during pregnancy?
Nuchal translucency
PAPP-A hormone
Beta-hCG hormone
What is the function of the hypoglossal nerve?
Movement of the tongue
What is the management of Stanford type B aortic dissections?
Conservative management with BP control
What test would be used to test for an autoimmune cause of haemolytic anaemia?
What result would suggest an autoimmune cause & what would be seen in the lab?
DAT test (direct antiglobulin test) / coombs test (old name)
Positive result = immune mediated
Agglutination of RBCs (they clunp together)
What criteria is used to diagnose infective endocarditis?
Modified dukes criteria
What are the 3 divisions of the trigeminal nerve & what numbers are they given? (eg V1, V2, V3)
V1 = ophthalmic nerve
V2 = maxillary nerve
V3 = mandibular nerve
What type of medication is used for the maintenance of someone that has mania / bipolar disorder?
Mood stabilisers
Lithium
What are the main features of myeloma? (CRAB)
→ HyperCalcaemia
→ Renal failure
→ Anaemia
→ Bone disease
Roughly how long after stopping alcohol intake does delirium tremens present?
72 hours
Name all of the 12 pairs of cranial nerves and state their numbers.
I = olfactory nerve
II = optic nerve
III = oculomotor nerve
IV = trochlear nerve
V = trigeminal nerve
→ V1 = ophthalmic nerve
→ V2 = maxillary nevre
→ V3 = mandibular nerve
VI = abducens nerve
VII = facial nerve
VIII = vestibulocochlear nerve
IX = glossopharyngeal nerve
X = vagus nerve
XI = accessory nerve
XII = hypoglossal nerve
What murmur is heard in aortic stenosis & where would you heart it?
What murmur is heard in pulmonary stenosis & where would you hear it?
Ejection systolic murmur heard over right sternal border - radiates to carotids
Ejection systolic murmur heard over left sternal border - radiates to back
What is haemolytic uraemic syndrome (HUS)?
What disease does HUS usually follow from?
What is the commonest organism that causes HUS & what investigation is used to identify it’s presence?
What are the characteristic triad of features seen with HUS?
→ What invstigations would be done for each feature to identify them?
HUS occurs when there is thrombosis in small blood vessels throughout the body
Gastroenteritis
E.coli - stool sample will identify it
1) Haemolytic anaemia → FBC, blood film
2) AKI → U&E’s to measure serum urea
3) Thrombocytopenia → FBC
What is expressive dysphasia?
Damage to which area of the brain causes expressive dysphasia?
When someone has comprehension of language (they know what they want to say) but they are unable to physically say the words
Broca’s area
What type of hallucinations are common in lewy body dementia?
Visual hallucinations:
→ animals in the house
→ faces in the wallpaper
What is the commonest causative organism of septic arthritis?
Staphylococcus aureus
A deficiency in which vitamin can result in Korsakoff’s syndrome?
Thiamine - B1
Can clozapine be used whilst actively breastfeeding?
No
How might someone describe a tension headache?
Bilateral, non-pulsatile headache
“Feels like a tight band around my forehead”
Before starting someone on an antipsychotic, which bloods would you want to do? (4)
FBC
LFT
Lipid profile
Fasting blood sugar
What type of antipsychotic is Chlopromazine?
Typical antipsychotic
What is the typical presentation of a subdural haematoma? (5)
Older person had a fall days-weeks ago
Progressive headache
Nausea / vomiting
Confusion
Reduced GCS
What is the normal range of haemoglobin in:
- Males
- Females
Males: 140 - 180 g/L
Females: 120 - 160 g/L
What syndrome is a complication associated with PID?
Fitz-Hugh-Curtis syndrome (inflammation of the liver capsule which forms adhesions with the anterior abdominal wall)
What is the name given for premature RBCs? (these are the RBCs just before they are released into the circulaton)
Reticulocytes
What is the function of haptoglobins?
They remove free haemoglobin from the circulation
Give an example of a commonly used sulfonylurea. - What condition are they commonly used to manage?
What is the mechanism of action of sulfonylureas?
Gliclazide - Type 2 Diabetes
Increase insulin release from the pancreas
Name the 3 meninges from the skull inwards.
Dura mater (underneath skull)
Arachnoid mater
Pia mater
What type of headache is associated with autonomic symptoms? (Ptosis, miosis, lacrimation, nasal congestion)
Cluster headache
The results of a womans cervical smear screening identifies the presence of high-risk human papillomavirus (hrHPV). What should happen next?
If the next step is positive, what should be done?
If the step was negative, what should be done?
The sample should be sent for cytology.
Cytology positive: Woman should be sent for colposcopy
Cytology negative: Woman should have another smear in 12 months
After starting an antidepressant, roughly how long does it take for the patient to notice it start working?
2-4 weeks
What is the function of the oculomotor nerve?
Eye movements
What are the steps of the 2nd stage of labour? (The steps/ movements of the baby as it moves along the birth canal) (7)
1) Engagement: foetus head is fully engaged with pelvis
2) Descent: foestus starts to descend along birth canal
3) Flexion: foetus head flexes towards chest
4) Internal rotation: foetus internally rotates to face mothers back
5) Extension: foetal head extends & is delivered
6) Restitution: foetus externally rotates to face anteriorly
7) Expulsion: anterior shoulder is delivered, followed by the rest of body
What is the 1st line treatment in all eating disorders?
CBT
How long should someone continue their antidepressants for if they presented with their first episode of depression?
6 months
Between which weeks of gestation would an induction of labour be offered?
Between weeks 41 - 42 gestation
Give the medical name for a red blood cell.
What is the name given to the production of RBCs?
What hormone is responsible for stimulation of RBC production?
Where is this hormone secreted from & why is it secreted?
Erythrocyte
Erythropoesis
Erythropoietin
Kidney in response to hypoxia
Name the 4 lobes of the brain.
Frontal lobe
Temporal lobe
Parietal lobe
Occipital lobe
What is the normal range of WBC in blood?
4 - 10 x109/L
Which class of antidepressants are used in treatment resistant depression?
MAOI’s
Women that are at high risk of having a baby with down’s syndrome are offered 2 tests to provide a definitive answer. What are these tests?
Chorionic villus sampling
Amniocentesis
List 5 signs of an UMN lesion:
Muscle weakness
Hyper-reflexia
Hypertonia
Positive clonus
Positive babinski sign (big toe moves up)
List some causes of intravascular haemolysis: (3)
List some causes of extravascular haemolysis: (4)
Intravascular:
→ Mechanical heart valve
→ Acute tranfusion reaction (if blood transfused is mis-matched)
→ Infections, eg malaria
Extravascular:
→ Hypersplenism (spleen works harder than normal)
→ Haemoglobinopathys (eg thalassaemia, sickle cell)
→ G6PD deficiency
→ Autoimmune haemolytic anaemia
What does ‘confabulation’ mean?
Occurs when there is memory loss & the brain fills in the gap of the missing information
What is the 1st line medication for hyperthyroidism?
When would this drug be contraindicated & what would be used instead?
Carbimazole
Contraindicated in pregnancy - Propylthiouracil used instead
For a diagnosis of moderate depression, how many additional symptoms from the ICD-10 criteria does the patient need to have?
6
What is the classical presentation of an aortic dissection?
Sudden onset ‘tearing’ chest pain (or interscapular pain) that radiates to the back
What is the main blood vessel that supplies the femoral head?
Femoral circumflex artery
What muscle helps to maintain continence?
Pelvic floor (pelvic diaphragm)
What condition are biguanised used to treat?
What is the most commonly used biguanide?
What is the mechanism of action of biguanides?
Type 2 Diabetes
Metformin
They increase sensitivity to insulin in the peripheries PLUS increase glucose uptake in the liver
What are the 5 main characteristic features of Cushing’s Syndrome?
What 4 clinical conditions/ signs can Cushing’s Syndrome cause?
1) Moon face
2) Central obesity
3) Proximal limb muscle wasting
4) Abdominal striae
5) Buffalo hump
1) Hypertension
2) Insulin resistance (hyperglycaemia → T2DM)
3) Osteoporosis
4) Easy bruising
What condition would be indicated by: “a child with a 3 day history of vomiting & diarrhoea”
What is the investigation of this condition?
If the diarrhoea was bloody, what would be the likely causative organism?
This organism increases the risk of developing what condition?
What are the 3 characteristic features of this condition?
What is the management of this condition?
Gastroenteritis
Stool sample sent for microscopy, culture & sensitivies (MCS)
E. Coli
Haemolytic Uraemic Syndrome (HUS)
1) Haemolytic anaemia
2) Thrombocytopenia
3) AKI
Supportive management as it self resolves - monitor fluid balance to detect a worsening AKI
What is Croup?
What is the commonest causative organism?
What are the common presenting features of croup? (6)
How long does croup usually last for?
What is the management of croup?
An URTI causing oedema & swelling of the larynx.
Parainfluenza virus
~ Increased work of breathing
~ Barking cough (sounds like a seal)
~ cold symptoms
~ hoarse voice
~ +/- stridor
~ +/- mild fever
1 - 2 days
Oral dexamethasone
Name the condition that is a non-reversible memory disorder often seen in alcoholics.
Korsakoff’s syndrome
There are 3 types of von Willebrand Disease, describe the problem associated with each type:
Which type(s) presents with the most severe symptoms?
Type 1: there isn’t enough VWF in the body
Type 2: there is enough VWF, however it is dysfunctional
Type 3: almost complete deficiency of VWF
Types 2 & 3 are more severe
A lesion at the optic chiasm produces what visual defect?
Bitemporal hemianopia
There are 2 types of 2nd degree heart block. What are they called?
What is the common pathology in a 2nd degree block?
Morbitz I & Morbitz II
In each type, a beat is dropped occasionally (missing QRS complex)
If someone presents to A&E with a psychotic episode (with no previous psychiatric diagnosis), what investigation should you do immediately & why?
Urinary toxicology - to rule out the use of illicit drugs as the cause
What is the 2nd line management of pre-eclampsia?
Nifedipine (anti-hypertensive)
What is the first line treatment approach in a newly diagnosed T2D?
If HbA1C fails to improve, what is the next step?
Lifestyle modification (diet, exercise, smoking, alcohol etc)
Metformin = 1st line medication
What does ‘akathisia’ mean?
Unpleasant sensation of restlessness
What is the gold standard treatment of non-muscle invasive bladder cancer?
What is the gold standard treatment of muscle invasive bladder cancer?
TURBT (transurethral resection of bladder cancer) + mitomycin C (chemo)
Cystectomy with urinary diversion (bladder is removed & the ureters are diverted)
What is otitis media?
List some symptoms of otitis media: (4)
What will you see on examination?
What is the 1st line management?
What is a concerning complication of otitis media?
Infection of the middle ear
~ ear pain (young children may tug at their ear)
~ reduced hearing in affected ear
~ URTI symptoms: fever, cough, sore throat, blocked nose (otitis media commonly follows from an URTI)
~ discharge if tympanic membrane perforates
~ bulging, red, inflammed tympanic membrane
~ if perforation: discharge & hole in the tympanic membrane
Simple analgesics
Mastoiditis
What is the 1st line treatment of fibroids under 3cm in size if the patient doesn’t need to remain fertile?
IUS (Mirena coil)
What is SUFE?
What age group & sex is it most common in?
What is the biggest RF for SUFE?
List some features seen in someone with SUFE: (3)
It’s when the head of femur is displaced along the growth plate (it looks like it has slipped off)
Teenage boys
Obesity
~ Hip/ groin/ knee pain with insidious onset
~ Restricted ROM of hip
~ Painful limp
What are 3 commonest pathogens responsible for causing neonatal sepsis?
What antibiotics are used in the 1st line management of neonatal sepsis?
1) Group-B strep
2) E.Coli
3) Listeria
IV penicillin & gentamicin
On an ECG, what is the normal lenght of the PR interval?
120 - 200ms
What are the 3 symptoms of Murphy’s Triad?
What condition do these symtpoms point towards?
List 3 complications of this condition:
What is the definitive management of this condition?
Abdominal pain, vomiting, fever
Appendicitis
1) Abscess formation
2) mass
3) peritonitis
Surgical removal of appendix
Name the condition described:
“Episodes of binge eating with a sense of loss of control, followed by purging behaviour” - BMI less than 17.5
Anorexia nervosa: binge purge subtype
What are the main risk factors associated with aortic dissection? (4)
Hypertension
Connective tissue diseases (eg, Marfans)
Cocaine use
Valvular heart disease
What neuropathological features would be seen on imaging of someone with Alzheimer’s disease? (2)
Amyloid plaques
Tau protein tangles
After starting an antipsychotic, roughly how long does it take for the patient to notice it start working?
Up to 8 weeks
What antipsychotic is used in treatment resistant patients?
Clozapine
Methotrexate is commonly used to treat what conditon?
Rheumatoid arthritis
Which STI is associated with septic arthritis?
Neisseria gonorrhoeae
List some symptoms of pre-eclampsia. (5)
Headache
Changes in vision (commonly blurred vision)
Nausea / vomiting
Ankle oedema
Upper abdominal pain
What medication is used in chronic bipolar disorder?
Lithium
Name the rotator cuff muscles.
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
List some risk factors for squamous cell carcinoma of the bladder (2)
Schistosomiasis infection
Long term catheterisation (10+ years)
What are the first 2 clinical features to show in Alzheimers disease?
Loss of memory
Loss of executive function
What is Immune Thrombocytopenic Purpura (ITP)?
What blood abnormality does it result in?
What is the 1st line treatment for ITP?
If this doesn’t work, what do you add to the treatment?
Autoimmune attack of platelets (antibodies are made against platelets)
Results in thrombocytopenia (low platelet count)
1st line treatment: steroids
If steroids don’t work, add in IV IgG (immunoglobulins)
What are the 6 components of sepsis 6?
(take 3, give 3)
→ Take blood cultures
→ Measure blood lactate
→ Measure urine output
→ Give O2 if sats are below 94%
→ Give IV antibiotics
→ Fluid challenge (give IV fluids)
What is Tetralogy of Fallot also known as by leymans?
Physiologically, what is it & what are the 4 components to it?
“Hole in the heart”
A congenital heart condition that has 4 components:
1. Ventricular septal defect
- Pulmonary valve stenosis
- Right ventricular hypertrophy
- “Over-riding aorta” - aorta arises from both ventricles
What drug class is used as the 1st line treatment to manage an acute migraine attack?
Give an example of a commonly used drug from this class.
Triptan
Sumatriptan
What is the treatment of aortic / pulmonary valve stenosis in children?
What is a common complication of this procedure?
Balloon valvoplasty
Valve regurgitation due to damage of the cusps of the valve
Which class of drugs can be used to treat extra-pyramidal side effects of antipsychotics?
Anti-cholinergics
What does this CT show?
Extradural haematoma
List some causes for a decreased production of RBC’s in the bone marrow (4)
Bone marrow disorder
Chronic kidney disease (reduced secretion of erthyropoietin reduces RBC production!)
Hypothyroidism (thyroid hormones also stimulate RBC production)
Iron & vitamin B12 deficiency (these are needed for functional RBC production)
What investigation(s) are done for a UTI in: 1. Young women
- Children/ men/ women that are pregnant/ with recurrent infections
- Urine dip only
- MSSU sent for MC&S
If there is a lesion on the Right accessory nerve, which side would the uvula deviate towards?
Left deviation
(The uvula deviates away from the side of the lesion)
Women with a RF for gestational diabetes are investigated for gestational diabetes at what gestational week?
How is this investigated?
What additional investigation are women with a history of gestational diabetes given?
Week 24-28
OGTT
Women with a history of GD are given an OGTT at their booking appointment (~10 weeks) - if this is normal, it is repeated at weeks 24-28
Name the 2 types of lymphocytes and name where they each mature
T cells - thymus
B cells - bone marrow
In what part of the GIT is vitamin B12 absorbed?
What molecule is needed for the absorption of B12?
Which cells secrete this molecule?
Ileum
Intrinsic factor
Parietal cells within the stomach
A diagnosis of COPD is based upon the results of what? (2)
Clinical presentation (symptoms + history)
Spirometry
What test is commonly used to screen for down’s syndrome during pregnancy?
The combined test
Which muscles compose the pelvic diaphragm?
Levator ani (puborectalis, pubococcygeus, iliococcygeus) & coccygeus
What is the commonest cause of post partum haemorrhage?
What are the other causes of PPH? (the 4 T’s)
Atony of the uterus (failure of the uterus to contract)
→ Tone (atony of the uterus)
→ Tissue (retained placenta)
→ Trauma
→ Thrombosis
List some common symptoms of depression.
Low mood - often worse in the morning
Poor sleep (difficulty falling asleep, EMW, excessive sleep)
Fatigue
Changes in appetite & weight
Poor concentration / focus
Suicidal thoughts & planning
Anxiousness
Low libido
Psychomotor retardation
Social withdrawal
Define what dementia is.
Dementia is a syndrome (a collection of different symptoms) associated with an progressive decline in brain functioning
What age group is Perthes disease most common in?
Children aged 4-10y
What muscles does the oculomotor nerve innervate? (7)
Superior rectus muscle
Inferior rectus muscle
Medial rectus muscle
Inferior oblique muscle
Leveator palpebrae superioris muscle (eyelid)
Ciliary muscle (accomodation of pupils)
Constrictor pupillae (pupil size)
What traid of symptoms are associated with aortic stenosis?
- Heart failure
- Syncope
- Angina
What is the function of Von Willebrand Factor?
What abnormality results in von Willebrand disease?
What is the mode of inheritance of VWD?
VWF is vital for clot formation: • links platelets to the exposed, damaged vessel wall • stabilises factor VIII so that it can work for longer
A deficiency of, or dysfunctional VWF
Autosomal dominant
What tool is used to assess the severity of a pneuminia?
CURB-65 score
What is the average lifespan of a RBC?
How are RBCs removed from the circulation?
Which 2 organs are involved in this process?
120 days
The reticuloendothelial system removes RBCs from the circulation
Spleen & liver
What is a common trigger of tension headaches?
Stress
What are some common triggers for a migraine? (5)
Stress
Combined contraceptive pill
Chocolate
Sleep deprivation
Changes in the weather
What medication is used to treat a seizure in eclampsia?
IV magnesium sulphate
What is the 1st line medication used for tocolysis?
(A medication that is used to stop uterine contractions)
Nifedipine - a calcium channel blocker
Delirium can present in 2 extremes, what are these called?
List some common features of each type.
Hyperactive & hypoactive delirium
Hyperactive delirium:
→ aggitated / aggressive
→ disorganised thoughts
→ hallucinations
→ restlessness
Hypoactive delirium:
→ abnormal drowsiness
→ fatigue
→ less reactive
→ withdrawn
What symptoms are seen in lithium toxicity? (4)
Coarse tremor
Arrhythmias
Visual disturbances
CNS disturbances: seizures, slurred speech, confusion
What are 2 common triggers of cluster headaches?
Smoking
Alcohol
What are the 5 commonest in-utero causes of infection? (TORCH)
T - toxoplasmosis
O- other (syphilis & chickenpox (varicella-zooster virus))
R - rubella
C - cytomegalovirus
H - herpes simplex virus (HSV)
What is epididymo-orchitis?
What are the 2 commonest causes of it developing?
Inflammation of the epididymus & testis
STI’s (commonly chlamydia & gonorrhoea) & UTI’s (commonly E.coli)
Name a complication if a scaphoid # is left untreated.
Avascular necrosis of the scaphoid bone.
List the main clinical features of septic arthritis. (4)
Hot, painful, swollen joint
Usually only a single joint affected
Restricted movement in affected joint
Systemic features: fever & fatigue
What are the 1st rank symptoms of Schizophrenia? (ABCD)
A - Auditory Hallucinations
B - Broadcasting of Thought
C - Controlled Thought (delusions of control)
D - Delusional Perception
What are the 6 components of sepsis 6?
(take 3, give 3)
→ Take blood cultures
→ Measure blood lactate
→ Measure urine output
→ Give O2 if sats are below 94%
→ Give IV antibiotics
→ Fluid challenge (give IV fluids)
What is the medical word that describes the inability to feel pleasure?
What condition is this a key feature of?
Anhedonia
Depression
List the 4 signs of labour:
Rupture of membranes
Regular, painful contractions
‘Show’ (mucus plug covering the cervix)
Dilating cervix (on examination)
What 5 factors are assessed using the Bishop Score for induction of labour?
Fetal station (this is how far down into the pelvis the babies head is palpated in relation to the ischial spines)
Cervical position (as the cervix ripens, it moves more anteirorly)
Cervical dilatation (as the cervix ripens, it dilates)
Cervical effacement (as the cervix ripens, it becomes shorter)
Cervical consistency (as the cervix ripens, it becomes softer)
What are hypersensitivity reactions?
Exaggerated immune responses that cause damage to tissues/ blood
Name the 2 divisions of the immune system:
Innate & adaptive immune systems
What are the fertility sparing surgical managements for fibroids? (3)
Myomectomy (removes the fibroid from the uterine wall)
Radiofrequency ablation (induces necrosis of the fibroid so that it no longer bleeds)
Uterine artery embolism
What does ‘dystonia’ mean?
What psychiatric drug class can cause dystonia?
Involuntary muscle spasms/contractions (hypertonia)
Antipsychotics
What’s a common side effect of SSRI’s that causes poor patient compliance?
Sexual dysfunction
What clinical signs would be seen in someone with an aortic dissection?
Radio-radial delay
Radio-femoral delay
BP is different between L & R arms
What common side effect should all patients be advised about when starting Carbamazepine?
What 2 conditions is carbamazepine commonly used to treat?
A rash
Epilepsy & neuropathic pain
In a psychotic patient, too much dopamine results in what?
Positive symptoms: hallucinations, delusions, thought disorders
What is the difference between pre-eclampsia and gestational hypertension (pregnancy-induced hypertension)?
Gestational hypertension occurs after 20 weeks gestation without proteinuria
Pre-eclampsia is when hypertension occurs after 20 weeks gestation with proteinuria
What is a life-threatening side effect of clozapine?
What monitoring does clozapine need for early detection of this side effect?
Agranulocytosis
Weekly FBC
What is the initial management of an open #?
- Tetanus & antibiotic prophylaxis
- Photograph the wound, cover it and stabilise the limb (photo so that the wound isn’t uncovered every time a new clinician assesses the patient)
- Operate within 24h*
* If there is neurovascular compromise, operate within 6h!
If a T2D cannot tolerate metformin, what class of drugs are they switched to instead? (These are usually the 2nd line treatment option)
Give an example of a drug within this class.
What is the mechanism of action of these drugs?
What is a severe side effect that needs to be monitored?
Sulfonylureas
Gliclazide
They increase insulin secretion from the pancreas
Hypoglycaemia
What is the medical word for a high platelet count?
What is the medical word for a low platelet count?
Thrombocytosis
Thrombocytopenia
List the triad of symptoms that Parkinsons Disease presents with.
Bradykinesia
Tremor (pin-rolling)
Rigidity (cog-wheel)
Name a serious complication of a neck of femur #.
Avascular necrosis of the femoral head.
If a woman is *Rh- and is carrying a Rh+ baby and there is no intervention, what will happen during delivery/ when there is mixing of blood?
Why does this happen?
When should this be checked for during pregnancy?
What can be given as prophylaxis for this?
*Rh = rhesus
The women will start developing anti-D antibodies after any sensitising event (commonly giving birth)
If someone is rhesus negative, they don’t have the D antigen on their RBC’s so if their blood comes into contact with someone that is rhesus positive then their blood will start producing antibodies against the foreign antigens.
Rh status of mother & baby is checked at the booking appointment (week 10)
If mother is negative & baby is positive, prophylaxis = anti D injection at 28 weeks gestation PLUS immediately after any sensitising events
What condition is methotrexate predominantly used to treat?
What birth defects are associated with methotrexate use? (2)
Rheumatoid arthritis
Cleft palate
Hydrocephalus
If a # is displaced, what 2 things are required in the management of it?
Reduction of the # (to put it back into the correct place)
Immobilisation of the bone (for healing)
What investigations should you do to diagnose PID? (5)
Pelvic examination
Pregnancy test (to rule out ectopic)
STI swabs
Transvaginal ultrasound
Bloods
When would the ventricles release BNP?
A high BNP suggests what condition?
BNP is secreted in response to ventricular stretching
A high BNP suggests heart failure
SIRS + infection = ?
What is the condition called if a patient has end organ damage as a result of sepsis?
What is the difference between severe sepsis & septic shock?
Sepsis
Severe sepsis
In septic shock, the patient has hypotension as well as severe sepsis
How do you diagnose a UTI in older people (65y +) in hospital?
Why do we do this?
Urine sample → lab analysis of urine culture (NOT URINE DIP)
Older people commonly have asymptomatic bacteriuria which would show as a false positive for infection on a urine dip
What ECG finding is seen in hyperkalaemia?
Peaked T waves
In bundle branch blocks, are the QRS complexes wider or narrower than usual?
What is the normal time/num. of boxes of a QRS complex?
Wider than usual
Normally, QRS complexes are no wider than: 120ms = 3 small boxes
Interpret the following:
G1 P1
This woman has been pregnant once & has delivered one baby after 24 weeks gestation
What is the screening tool for delirium?
A score of what indicates possible delirium?
Who should be screened for delirium upon admission to hospital?
4AT
4 or more
Anyone over 65y!
What skills would you expect to see from each developmental domain in a 12m toddler?
- Gross motor (2)
- Fine motor (2)
- Language (2)
- Social (1)
- Self help (2)
- *Gross motor:** 1) stands without support
2) starts to walk without help (by 18m) - *Fine motor:** 1) stacks 2+ blocks
2) picks up 2+ toys in 1 hand - *Language:** 1) know’s the meaning of 1 or 2 words
2) uses mama / dada specifically for parents
Social: 1) points to things of interest
- *Self help:** 1) feeds themself with spoon
2) lifts cup to mouth and drinks
Below which BMI is considered as anorexic?
Below BMI of 17.5
In a centrifuge, what 3 components will blood separate into?
Name some cells that will be found in each component.
Plasma
→ Clotting factors
→ Albumin (& other proteins)
→ Antibodies
Buffy coat
→ Platelets
→ WBC’s (leucocytes)
Red blood cells
What is the typical presentation of trigeminal neuralgia?
Recurrent, short episodes of severe stabbing pain, affecting one side of the face, in the trigeminal nerve distribution (usually V2 / V3)
What is the function of the olfactory nerve?
Sense of smell
Is a ductal carcinoma in-situ (DCIS) an invasive/non-invasive form or breast cancer?
Non-invasive
What is mixed state delirium?
It’s when someone fluctuates between hyperactive delirium & hypoactive delirium
What does thrombocytopenia mean?
List some common presentations of thrombocytopenia: (5)
Low platelet count
→ Petechiae
→ Ecchymosis (bruising)
→ Nose bleeds
→ Bleeding gums
→ Menorrhagia
What clinical finding is seen when the scaphoid bone is fractured?
Pain on palpation of the anatomical snuffbox
What is Kawasaki disease?
What are the 6 common features of Kawasaki disease? CREAM
What is the main complication of Kawasaki disease? - What investigation is done to screen for this?
What is the treatment of Kawasaki disease?
A systemic medium vessel vasculitis
- *Fever for 5+ days** PLUS
- *C** - conjunctivitis (red eyes)
- *R** - rash
- *E** - oedema/ erythema of hands & feet
- *A** - adenopathy (usually cervical)
- *M** - mucosal invovlement (strawberry tongue, cracked lips)
Coronary artery aneurysm - ECHO
Treatment: aspirin (to reduce risk of thrombosis) & IV immunoglobulins IVIg) (to reduce risk of coronary artery aneurysms)
What condition presents with rapid onset confusion that is precipitated by alcohol withdrawal?
Delirium tremens
What is 1st degree heart block?
A continually prolonged PR interval of more than 200ms
What investigations are done initially if bladder cancer is suspected? (3)
Urine culture (to rule out UTI)
CT urogram (contrast CT of the urinary tract)
Flexible cytoscopy
List 4 risk factors for Hodkins lymphoma:
→ Smoking
→ Epstein barr virus
→ HIV
→ Immunosuppression
What is the classic triad that suggests a renal cell carcinoma?
Flank pain
Haematuria
Mass in the flank area
What skills would you expect to see from each developmental domain in a 6m infant?
- Gross motor (2)
- Fine motor (2)
- Language (2)
- Social (2)
- Self help (1)
- *Gross motor**: 1) rolls over
2) starts to sit without support - *Fine motor:** 1) uses 2 hands to pick up large objects
2) transfers toy from 1 hand to another - *Language:** 1) responds to name
2) 2 syllable babble - *Social:** 1) reaches for familiar people
2) pushes things they don’t want away
Self help: 1) feeds self small food
The following would be red flags in a child’s development if they hadn’t achieved them by what age?
1) Social smile
2) Sitting unsupported
3) Walking unsupported
4) Words
1) No social smile by 2 months
2) Not sitting unsupported by 9 months
3) Not walking unsupported by 18 months
4) No words by 2 years
What is a delusional perception?
When someone see’s/hear’s something and associates it with something unrelated.
Eg, someone see’s a street lamp flicker and then believes that they are destined to be the next king
Delayed puberty & anosmia (lack of smell) would suggest what condition?
What is the physiological cause behind delayed puberty in this condition?
Kallmann’s syndrome
Hypogonadotropic hypogonadism: hypothalamus doesn’t secrete enough GnRH to stimulate anterior pituitary to secrete LH & FSH → little testosterone/ oestrogen secreted
What the are diagnostic values of type 2 DM:
1) Random blood glucose
2) Fasting plasma glucose
3) 2h glucose tolerance
4) HbA1C
What is required for a T2DM diagnosis in:
a) symptomatic patient
b) asymptomatic patient
1) Random blood glucose: 11.1 mmol/l
2) Fasting plasma glucose: 7 mmol/l
3) 2h glucose tolerance: 11.1 mmol/l
4) HbA1C: > 48 mmol/mol
a) 1 of the above criteria + symptoms
b) 2 of the above criteria from 2 days (if asymptomatic)
A 65 year old man with diabetes has developed painful peripheral diabetic neuropathy.
Name a medication & it’s drug class, used as 1st line in treating this.
Amitriptylline - tricyclic antidepressant
What is the 1st line management of an ovulatory cause of infertility?
What is the 2nd line management if the above doesn’t help?
What is the 3rd line management if the woman is still unable to get pregnant?
If all of the above fail, what is the final management to assist in successful pregnancy?
Lifestyle modification: weight loss, exercise, diet
2nd line: Clomiphene
3rd line: Laparoscopic ovarian drilling
Assisted conception
Describe the damage involved in each degree of perineal tears:
~ First degree tear
~ Second degree tear
~ Third degree tear: 3A, 3B, 3C
Fourth degree tear
What is the management of the various tears?
First degree: Tear limited to the superficial perineal skin or vaginal mucosa only
~ Don’t reqire treatment
Second degree: Tear extends to perineal muscles and fascia, but the anal sphincter is intact
~ Require a simple stitch (midwife can do this)
Third degree: tear involves the external anal sphincter
3A - less than 50% thickeness of sphincter is torn
3B - more than 50% thickeness of sphincter is torn
3C - External & internal anal sphincters torn
~ Requires surgical correction
Fourth degree: tear extends to the rectal mucosa
~ Requires surgical correction
The drugs below are antidotes to overdoses of what substances?
a) Naloxone
b) Flumazenil
c) N-acetyecysteine
a) Opioids
b) Benzodiazepines
c) Paracetemol
What is the classic triad of presenting symptoms seen in normal pressure hydrocephalus?
Dementia, urinary incontinence, gait disturbance
What is the medical management of an abortion? - Between which weeks can this be done?
What is the surgical management of abortion? - Between which weeks can this be done?
Medical management: 5-25+5 weeks
1) Mifepristone (progesterone antagonist → degeneration of endometirum & increases uterine sensitivity to prostaglandins)
2) 36-48h later, give Misoprostol (prostagland analogue → contraction of myometrium & expulsion of uterine contents)
Surgical management: 5-12 weeks
Misoprostol given to woman before procedure to ‘prime’ the uterus → transcervical suction of uterin contents!
In PCOS, would you expect the following to be low, normal or high?
1) Testosterone
2) Sex hormone binding globulin
3) LH
4) FSH
5) Insulin
6) LH:FSH ratio
1) Testosterone - high (insulin promotes release of androgens)
2) Sex hormone binding globulin - low (insulin decreases SHBG production)
3) LH - high
4) FSH - low (low FSH results in follicles not maturing and turning into cysts)
5) Insulin - high (insulin resistance is a feature of PCOS)
6) LH:FSH ratio - high (High LH & low FSH)
Describe the discharge associated with each condition below:
1) Bacterial vaginosis
2) Candidiasis
3) Chlamydia
4) Gonorrhoea
5) Trichomoniasis
1) Watery, FISHY discharge
2) Thick, white discharge (cottage cheese)
3) Watery, odourless discharge
4) Yellow discharge
5) Frothy, green discharge
What is the most likely diagnosis of the following:
Unvaccinated child presents with a fever, sore throat & difficulty swallowing. The child is sitting forward and drooling.
What is the management of this?
Epiglottitis
1) Secure airway!!!!!
2) IV antibiotics (ceftriaxone) + Steroids (dexamethasone)
