Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

High yield > High yield > Flashcards

High yield Flashcards

1
Q

What ages is cervical screening offered to women in the UK?

A

25-64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How often is cervical screening offered to the different age groups?

A

Age 25-49 - every 3 years

Aged 50-64 - every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 3 components of cervical screening?

A

Colposcopy
High risk HPV testing
Sampling with cytobrush for liquid cytology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Patient presents with bilateral wheeze and RR of 27/min. Diagnosed with asthma attack, what category of attack is patient suffering?

A 
Acute severe asthma
Requires one of:
PEF 33-50% of predicted
RR above or equal to 25
HR above or equal to 110
Inability to complete sentences in one breath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What name given to the type of technique used to remove skin cancer and assess the cell types

A

Mohs surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the benefits of Mohs surgery over other types of excision?

A

During the surgery, after each removal of tissue and while the patient waits, the tissue is examined for cancer cells. That examination informs the decision for additional tissue removal.

This allows complete margin control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the name of the skin type scale?

A

Fitzpatrick scale (1-6 white to black)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Gentleman drinks 4 cans of 440ml 7% strength lager a week. Work out the units he drinks in a week

A

12.32 units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the transformation zone of the cervix

A

Junction between the squamous cells of the exocervix, and the columnar cells of the endocervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name 3 enablers of self-management

A 
Agenda setting
- preparing in advance
- identifying issues and problems
Collabarative goal setting
- SMART goals
Follow up
- Proactive
- Soon - within 14 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give 4 barriers to self management

A 
Control beleifs 
Self efficacy
Depression
Poor family support
Weight problems
Behavioural beliefs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common type of skin cancer?

A

Basal Cell Carcinoma (BCC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the A-E approach for pigmented skin lesions

A 
Asymmetry
Borders
Colour
Diameter greater than 6mm
Evolution - has it changed over time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 4 domains of childhood development

A

Gross motor
Fine motor/vision
Speech/language
Social

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

3 Causes of cerebral palsy

A

Congenital infection (CMV)
Birth asphyxia/trauma
Head-trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define infertility

A

No conception after 1 year of unprotected vaginal sexual intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What key biochemical changes underlie polycystic ovarian syndrome (PCOS)

A

Primary defect - insulin resistance (acquired / inherited)
Hyperinsulinaemia → amplification of LH production
LH↑ - imbalance of steroidogenesis in ovary → androgens ↑

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What cancer are PCOS sufferes more likely to get?

A

Endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Give 4 contraindications for prescribing the COCP

A

Smokers aged 35 or more
Hypertension
History of venous thromboembolism
Migraine with aura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Give 4 skin disorders that occur with SLE

A

Photosensitive rash
Alopecia
Vasculitic rash
Malar rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What associated condition could cause repeated miscarriages in a woman with SLE?

A

Anti-phospholid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MOA of warfarin

A

Decreased synthesis of clotting factors X, IX, VII and II
- via the inhibition of vitamin K epoxide reductase
Remember 1972

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a normal INR range?

A

0.8-1.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Give 2 ECG features of Aortic Stenosis

A

LV hypertrophy

Taller R waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Classic triad of symptoms for Aortic Stenosis?

A

Angina/chest pain
Shortness of breath
Syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the negative symptoms of schizophrenia (4)

A

4 A’s

  • Alogia
  • Anhedonia
  • Apathy
  • Affective blunting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Give the first rank symptoms of schizophrenia

A 
1	Passivity
2	Somatic Hallucinations
3	Delusions of Perception
4	Thought insertation, broadcasting, withdrawal
5	Third Party Auditory Hallucinations
6	Thought Echo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If you felt that a patient needed to be sectioned, how could you do this and how long could you keep them for?

A

Sectioned under section 2 of the MHA. (for assessment)

Can be held for 28 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What scoring system is used to assess upper GI bleeds?

A

Rockall score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What test is used to confirm diabetes insipidus?

A

Water deprivation test
- No water intake for prolonged (4-18hrs) period, Measure body wt, urine output, + composition, No change in water loss after water deprivation indicates DI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Most common cause of breast lump?

A

Fibroadenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Why use Anastrozole in post-menopausal women for treatment of ER+ve breast cancer?

A

Anastrozole is an aromatase inhibitor.

Post-menopausal woman produce the majority of their oestrogen through aromatase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

4 other differentials to consider with a patient with suspected gout

A

Pseudogout
Septic arthritis
Reactive arthritis
Fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What common medication can predispose someone to gout?

A

Thiazide-like diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

After what times are Troponin T samples usually taken to identify biochemical evidence of cardiac ischaemia?

A

At presentation and 6 then 12 hours after onset of chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

2 causes of Left Ventricular Failure

A

MI

IHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What abnormality might be detected on auscultation in a patient with LVF

A

S3 gallop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the A-E signs of heart failure on CXR?

A

Alveolar oedema (bat wings)
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated upper lobe vessels (Pulmonary venous HTN)
Pleural Effusion (blunting of costophrenic angles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Give the CENTOR criteria

A

Absence of cough
Temperature >38
Cervical lymphadenopathy
Tonsillar exudate

Score of 3 or more is suggestive of group b strep infection

Offer penicillin V if that is case

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Clinical features of hepatic encephalopathy

A

Reversal of sleep pattern
Asterixis (Liver flap)
Loss of concentration
Constructional dyspraxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

6 causes of abdominal distension (6 Fs)

A 
Fat
Faeces
Flatus
Foetus
Fluid
Fibroids/Tumour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Causes of mitral stenosis

A

Rheumatic fever
SLE
Endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Most common murmur in pregnancy

A

Mitral stenosis (Mid diastolic murmur)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What ecg signs are seen in right bundle branch block?

A

MarroW

M shape in early V leads
W in later V leads

Opposite for LBBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Triad of nephrotic syndrome

A

Proteinuria
Oedema
Hypoalbuminaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Triad of pre eclampsia

A

Oedema
Proteinuria
Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What ejection fraction is suggestive of LVF?

A

<35

> 55 is normal
45-54 is mild LVSD
35-44 is moderate LVSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the 3 types of AF?

A

Paroxysmal - up to 7 days
Persistent - 7 days - 1 year
Permanent - 1 year+ and resistant to rhythm control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

3 main function of liver

A

Filter: absorbs venous blood via portal vein from GI tract
Excretion: eliminates unnecessary metabolites via bike duct
Metabolism: secretes useful nutrients into circulation via hepatic vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Underlying pathology of Crohns

A

Transmural inflammation
Involving whole GI Tracy
Discontinuous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

A6montholdchildisdehydratedand unconscious due to an accident resulting in burns over their head and upper body. They need urgent fluid replacement, what is your preferred route of access?

A

A”cut-down”1.5cmanteriorandsuperiortothemedialmalleolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is a hydrocoele?

A

Anaccumulationoffluidinthetunicavaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the likely histological assessment of a biopsied TB lesion?

A

Well­formedgranulomaswithcaseousnecrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What blood test would be diagnostic for Haemophilia A

A

LowplasmalevelsFactorVIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Define hallucination, illusion and delusion

A

Hallucination -Aperceptionexperiencedintheabsenceofanexternalstimulus,inanymodality
Illusion - A misperception of a real object/external stimulus
Delusion - A delusion is a belief that is firmly held on inadequate grounds, is not affected by rational argument or evidence to the contrary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How does a second order auditory hallucinations differ from third order auditory hallucinations?

A

Secondperson‐youarebeingtalkedto by the voices

Thirdperson‐patienthearsvoicestalingaboutthemandtalkingabouttheminthe3rdperson

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are the 2 types social of stigma?

A

Enacted stigma - real experience of -ve attitudes

Felt stigma - Fear that prejudice or discrimination may occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Define discrediting and discreditable stigma

A

Discreditable stigma: attribute, condition or impairment not immediate obvious or known by many e.g. mastectomy
Discrediting stigma: obvious and visible attribute, condition or impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

DescribeTHREEwaysinwhichdementiacanimpairdecisionmakingcapacity,withreferencetothecapacitycriteriaspecifiedintheMentalCapacityAct.

A

1.Dementiacanaffectshorttermmemory,sothepatientmaynotbeabletoretaintherelevantinformation.
2.Dementiacanaffectreasoningprocessesorjudgmentandsomayaffecttheabilitytounderstandtherelevantinformationortoweightheinformationtomakeachoice.
(Mayhaveamarkforimpairedunderstandingandabilitytoweighup,iflinkedtocognitiveimpairment/impairedreasoningprocess).
3.Inmoreadvanceddementia,patientsmaynotbeabletocommunicateandsofailthecommunicationcriteriaintheassessment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Describe mechanism underlying HbA1C formation

A

Haemoglobinundergoesglycationinvivo,atarateproportionaltobloodglucoseconcentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

ListTWOwaysinwhichdiabetesmellitusisatherogenic

A

Endothelialdysfunction

Increasedoxidativestress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Definition of concordance

A

Anegotiated,sharedagreementbetweenclinicianandpatientconcerningtreatmentregime(s),outcomesandbehaviours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Give 3 routine postnatal checks that will be carried out on the mother within 6 hours of birth

A

Assess volume of blood loss
Blood pressure
Contraction of Uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What 2 markers are screened for in a HIV test?

A

p24

IgG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the time limit for offering Post-exposure prophylaxis

A

72 hours after exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Signs of PE

A

Raised JVP
Tachycardia
Tachypnoae
Low O2 sats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

RIsk factors for PE

A 
COCP
Malignancy
Pregnancy
Recent VTE
Immobility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is meant by enacted and felt stigma?

A

Enacted stigma = real experience of negative attitudes or discrimination as a result of having a particular condition
Felt stigma = fear that prejudice or discrimination may occur as a result of having a particular condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Define terms discrediting and discreditable stigma

A

Discrediting stigma = obvious & visible attribute, condition or impairment
Discreditable stigma = attribute, condition or impairment not immediately obvious or known e.g. mastectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Define:
I. Sexuality
II. Sexual identity/orientation

A

i. Sexuality = umbrella term relating to private dimension in which people live out their sexual, intimate or emotional desires
ii. Sexual identity/orientation = describes the focus of a person’s sexual attractions & desires

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Which area of the brain degenerates in Parkinson’s?

A

Substansia Nigra pars compacta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Three dysmorphic features associated with Trisomy 21

A

Flat facial profile
Single deep transverse palmar crease
Short neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Most common heart defect in Trisomy 21 patients?

A

Atrioventricular septal defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Two common conditions associated with Trisomy 21

A

Duodenal atresia
Obstructive sleep apnoea
CHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What conditions are screend for in the heel prick test?

A 
Sickle cell
Cystic fibrosis
Congenital hypothyroidism
Inherited metabolic conditions 
- Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
- Homocystinuria (HCU)
- Maple syrup urine disease (MSUD)
- Glutaric Acidemia Type 1 (GA1)
- Isovaleric Acidemia (IV
- Phenylketonuria (PKU)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What do efficacy expectations predict?

A
  • Likelihood of individual’s engagement in activity or behaviour
  • Degree to which they will overcome obstacles
  • Likelihood of success in achieving and maintaining behaviour change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

How can efficacy expectations be enhanced?

A

o Positive mastery experiences
o Positive vicarious experiences
o Positive verbal persuasion
o Positive emotional readjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Define - equitable access

- equal access

A

Equitable access - is having access to the care that people need
Equal access - is having the same access to healthcare as everyone else

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Which organisation should food poisoning be reported to?

A

Notification of Infectious Diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Give 4 signs of derlirium

A 
Disordered thinking
Euphoric, fearful, angry or depressed (Labile mood)
Language impaired
Illusions, hallucinations, delusions
Reversal of sleep pattern
Inattention
Unaware/disorientated
Memory deficits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Explain the breastfeeding method of contraception

A

To use this method, women must breastfeed exclusively, nursing at least every 4 hours during the day, and at least every 6 hours during the night.

It can be used until one of the following happens: first menstrual period, 6 months postnatal, infants nurse less often

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What contraception would you offer to a new mother who is breastfeeding?

A

Barrier methods (condoms)
POP (mini-pill)
Implant can be used 21 day after
Oestrogen containing contraception can interfere with milk production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is the minimum number of weeks post-delivery at which a cervical smear could be performed and why?

A

12 weeks.

NICE says:
Reschedule cervical screening (unless you think the woman will not re-attend), if the woman:
- Is menstruating.
- Is less than 12 weeks postnatal.
- Has a vaginal discharge or pelvic infection — treat the infection and take the sample on another occasion.

This is because of inflammatory changes during pregnancy making a smear test difficult to interpret

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Describe the characteristic appearance of Neisseria gonorrhoea when it is Gram stained and viewed under the microscope

A

gram-negative intracellular diplococci on microscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Give two features to identify small bowel on AXR

A

Central position

Valvulae conniventes - mucosal folds that cross the full width of the bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Describe the FRAMES model of alcohol interventions

A

Feedback: Give patient honest and feedback on their subtance misuse, including risks and negative consequences
Responsibility: Make it known they need to take responsibility for the use of alcohol
Advice: Honest straightforward advice on how to cut down
Menu: Options availble to help cut down
Empathy: Be empathetic and non- judgemental
Self-Efficacy: Express optimism that the individual can do this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the most common motor disorder in childhood?

A

Cerebral palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Give some examples of developemental milestones in each domain a 12 month old should have reached

A

Gross motor: Straight back sitting (9 months)
Walks alone
Fine motor/vision: Mature pincer grip
Speech/language: Understands common words
Uses one or two words
Social: Seperation anxiety
Dependence on parental figure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Definition of anxiety

A

A state of apprehension, uncertainty or fear, resulting from the anticipation of a realistic or imaginary threatening event or situation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Definiton of mental health

A

A state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What are the 6 primary emotions?

A 
Happiness
Fear
Sadness
Anger
Suprise
Disgust
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What diagnostic criteria should be used in suspected IBS?

A

Rome IV criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What biomarker should be checked in suspected IBS to rule out other organic causes to symptoms?

A 
Anti TTG  (rule out coeliacs)
Anti endomysial Ab (rule out coeliacs)
Faecal calprotectin (can help rule out IBD)
Faecal elastase (rules out pancreatic exocrine insufficiency)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Define diarrhoea

A

Abnormal passage of loose of liquid stools
More than 3 times daily
and/or
A volume of stool >200g/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What type of diarrhoea does cholera infection cause?

A

Secretory diarrhoea caused by toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Define gastroenteritis

A

Gastroenteritis e.g. any 2 of …

1. diarrhoea
2. abdominal pain / colic
3. nausea / vomiting
4. fever / myalgia / headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Give 3 causes of viral gastroenteritis

A

Rotavirus
Norovirus
Astrovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Give 3 causes of bacterial gastroenteritis

A

Campylobacter
E. Coli
Cholera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Describe Xray appearance of RA

A

Loss of joint space
Erosions
Soft tissue swelling
Soft bones (osteopenia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Describe Xray appearance of OA

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Give 4 extra-articular features of RA

A

Eyes: episcleritis, scleritis,
Heart & lungs: effusions, fibrosis, nodules
Skin & soft tissues: Rheumatoid nodules, vasculitis, rashes
Systemic: Weight loss, fever, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What biochemical markers would you check in a patient with suspected RA and why?

A

Rheumatoid factor as it is present in 70% of RA patients

Anti -CCP antibodies(most specific test for RA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Give 3 broad management options for RA

A

Exercise/physio
NSAIDs
DMARDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

How can you differentiate between inflammatory and non-inflammatory causes of joint pain?

A

Inflammatory causes of joint pain present with:

- Morning stiffness that should relieve with activity due to natural increases in cortisol levels through day
- Warmth over affected joint
- Redness
- Swelling/bogginess

Non-inflammatory causes of joint pain present with:

- Worse at end of day due to wear and tear aspect 
- Relieved by not using structures involved
- Crepitus
- Restriction of movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Describe dysplasia

A
  • Premalignant condition
    • Increased cell growth
    • Cellular atypia
    • Altered differentiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is clonality?

A

Tumours develop from a single cell – they form a monoclonal population arising from a single cell.

If clonality can be proved, this is strong evidence for neoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Define neoplasm

A

New abnormal growth of cells which persists after initiating stimulus has been removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is the key feature distinguishing between cancer and in-situ malignancy?

A

No invasion through basement membrane

Does have all other features of malignancy

  • Epithelial neoplasm with features of malignancy
  • Altered cell growth
  • Cytological atypia
  • Altered differentiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Define AKI

A

Abrupt loss of kidney function over a period of hours to days
Creatinine >120micromols/L (normal 60-120)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is the RIFLE criteria?

A

It is a classification of AKI
Risk Creatinine 1.5-2x baselines
Injury 2-3x
Failure >3x
Loss (>4 weeks)
ESRD (>3 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Give the 3 causes of anuria

A

Obstruction
Vascular catastrophe
Severe acute glomerulonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What complications may occur from an AKI?

A

Hyperkalaemia
Pulmonary oedema
Ureamia
Acidaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Short-term treatment for hyperkalaemia

A

10% Calcium gluconate (10mL) to stabilise cardiac membrane
Drive K+ into cells with 10 units insulin (Actrapid) in 50mL 20% glucose
Salbutamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Give 4 causes of hyperkalaemia

A

Drugs (ACEi, NSAIDs, ARBs)
Renal impairment
Iatrogenic (over replacement in fluids)
Haemolysis of sample

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Describe ECG changes seen in hyperkalaemia

A

Tall tented T waves
Flattened P waves
Broad QRS complexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What are the 3 types of AKI and give a cause of each

A

Pre renal - Inadequate renal perfusion due to NSAIDs
Intrinsic - Glomerulonephritis
Post-renal - Stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Define adherence

A

The extent to which a person’s behaviour corresponds with agreed recommendations from a health care provider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Define compliance

A

The fulfilment by the patient of the healthcare professional’s recommended course of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Describe 2 effects of poor concordance

A

Poor treatment outcomes for patients

Increased financial burden with excess urgent care visits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What 5 patient centred factors influence concordance?

A 
Demographics - Adolescents have poor concordance
Psychological
Health literacy
Patient-prescriber relationship
Patient knowledge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Define adolescence

A

A variable period between childhood and adulthood between 10-20 years of age characterised by rapid development in psychosocial domain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Describe how risk taking is linked to brain development in adolescence

A

Risk taking is normal part of adolescence
Disparity in maturation of limbic system and prefrontal cortex
Early development of limbic system leads to pleasure seeking, reward processing, sleep regulation
Protracted development of prefrontal cortex leads to redcued ability to control impulses and plan for future

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Why is self management challenging in adolescents?

A

They are working towards independence and autonomy
Developing new relationships with peers, family and clinicians
New environments and activities
Risk taking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Define a rough sleeper

A

People sleeping, about to bed down (sitting on/in or standing next to their bedding) or bedded down in the open air.

People in buildings or other places not designed for habitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Define statutory homeless

A

Someone who is eligible for public funds/has a local connection/unintentionally homeless AND have a priority need:

  • A household with dependent children
  • A household with a pregnant woman
  • Vulnerable because of physical or mental health
  • Aged 16 or 17 or aged 18-20 and previously in care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What is a sofa surfer?

A

Someone staying with family or on a friends sofa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What are the routes into homelessness?

A 
Welfare changes - reducing access to private rented sector. Cuts to legal aid, social housing etc.
Lack of affordable housing
Lack of new builds
Unemployment
Closure of longterm psych hospitals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Which antipsyhotic is associated with agranulocytosis?

A

Clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What is the bishops score? What is it used for?

A

The Bishop Score assessing cervical favourability and it is the most commonly used method to rate the readiness of the cervix for induction of labor.

Score of abover 8 is good for induction and a score below 6 is an unripe cervix for induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What is normal range of variability on a CTG?

A

5-25 bpm is seen as reassuring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

How to read a CTG (acronym)

A

DR C BRAVADO

DR – Define Risk
C – Contractions
BRa – Baseline Rate
V – Variability
A – Accelerations
D – Decelerations
O – Overall impression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Give some reasons to classify a pregnancy as high risk

A 
Gestational diabetes
HTN
Asthma
PROM
Pre-eclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Normal foetal heartrate?

A

100-160bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

When are foetal decelerations normal?

A

Decelerations start with uterine contractions and quickly resolve after
Theses are normal and are known as early decelerations caused by increased vagal tone due to increased pressure on the head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What is the sepsis 6?

A 
Give high flow oxygen
Take blood cultures
Give empirical antibiotics in line with trust guidelines
Measure serum lactate
Fluid resuscitation 
Monitor urine output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Which types of HPV are associated with cervical cancer?

A

HPV 16 and 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Who is the HPV vaccine offered to?

A

12-13 year old girls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What part of the cervix do most cervical cancers arise from?

A

Transformation zone at region between endo and ecto cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What period in days (ha) does the secretory phase of menstruation occur?

A

Day 13-28

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Define primary amenorrhoea

A
  • No menstruation by age 14 with failure of development of secondary sexual characteristics
    OR
  • No menstruation by age 16 with normal development of secondary sexual characteristics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Define primary and secondary dysmenorrhoea

A

1o - Pain in absense of pelvic pathology, occuring during menses
2o - Pain associated with pelvic pathology, typically starting before menstruation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Define menorrhagia

A

Menorrhagia is excessive menstrual bleeding over several consecutive cycles that interferes with the woman’s physical, emotional, social, and material quality of life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

What is the treatment for fibroids called?

A

Myomectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Give 4 common effects of housing on health

A

Cold - results in excess winter deaths
Overcrowding - Leads to communicable diseases, stress and poor educational attainment
Damp & mould - Resp. infections, allergies, asthma
Structural - lighting, stairs, rails - leads to accidents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Define surveillance

A

Ongoing collection, collation and analysis of data in preparation for action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Why is surveillance needed?

A

Monitor trends, early warning for outbreaks, can plan and monitor interventions better

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Who does what in communicable disease control?

A

Public health england - Legal obligation to take notifications and manage outbreaks

NHS - Lead and coordiante NHS response

CCGs - Support NHS england and trusts

PCTs - Support ix and management through taking samples and organising treatment

Hospital trusts - Provide microbiological advice regarding single cases of outbreaks

Local Authorities - Environmental health officers support ix of certain outbreaks which may have an environmental source. They can prosecute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Define the concepts Agent:Host factors:Environment in relation to spread of infectious diseases

A

Agent = the thing causing disease (virus/bacteria/fungi)
Host factors = factors that control whether you become infected and how you respond to infection. e.g. sexual behaviours, diet, age, gender
Environment = Crowding, surroundings, sanitation, availability of health services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Give 3 direct and 3 indirect modes of transmission

A

Direct - touching, sex, faeco-oral

Indirect - Vehicle, vector e.g. malaria, airbourne

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What are the stages in managing an outbreak?

A

1) Confirm (verify diagnosis)
2) Immediate control
3) Convene an outbreak control team
4) Review epidemiological and microbiological info.
5) Case finding
6) Descriptive epidemiology
7) Analytical study (case control or cohort)
8) Declare outbreak over
9) Communication throughout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

With regards to communicable disease define sporadic

A

Occasional cases at irregular levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

With regards to communicable disease define endemic

A

Persistent low or moderate levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

With regards to communicable disease define hyper endemic

A

A higher persistent level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

With regards to communicable disease define cluster

A

Occurance exceeds expected level: may be a possible link

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

With regards to communicable disease define outbreak

A

Localised epidemic: 2+ cases or a single case of rare disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

With regards to communicable disease define Pandemic

A

Epidemic occuring worldwide affecting large amounts of people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

With regards to communicable disease define Epidemic

A

Occurance exceeds expected level: high probable or confirmed link

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

What are the different types of epidemic curve?

A

Point - suggests cases may be from a single event
Propagated - Begins like an infection from an index case but develops into a epidemic which propagates larger and larger
Continuous - Here exposure continues over a longer time so outbreak persists for longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Name the top 3 mental health disorders that account for the most DALYS globally

A

Depression and anxiety
Alcohol and drug use disorders
SCZ and BPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What is the most common mental health problem among men and women in europe?

A

F: Depression
M: Alcohol use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Give 4 factors that influence physical health of people with mental illness

A

Lifestyle - more likely to smoke, drink, have HTN/DM
Poor access to healthcare - Less compliance, difficulty understanding
Treatment SEs
Suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

How do you work out Mean Arterial Pressure (MAP)?

A

MAP = 1/3 * SBP + 2/3 * DBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Give the equation for ejection fraction

A

EF = (SV / EDV) ⋅ 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Describe the phases of cardiac conduction

A 
Phase 0 (Depolarisation) - Rapid Na+ influx 
Phase 1 (Early repolarisation) - Transient efflux of K+
Phase 2 (Plateau phase) - Slow influx of Ca 2+ and continues efflux of K+
Phase 3 (Repolarisation) - Ca2+ channels close but continued K + efflux returns TMP to -90mV 
Eventually normal ionic concentrations are restored via Na+/K+ ATPase, Na+-Ca2+ exchanger and Ca2+-ATPase
Phase 4 (Resting phase) - Constant slow leak of K+ out of cell but Na+ and Ca2+ channels are closed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Give some causes of anaemia of chronic disease (4)

A 
Infection
RA
Crohn's
TB
Endocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Aetiology of aplastic anaemia

A

Pancytopaenia (deficiency of all cellular blood elements)
Aplasia (hypocellularity of bone marrow)

Aplastic refers to inability of the stem cells to generate mature blood cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Give 4 causes of haemolytic anaemia

A

Hereditary spherocytosis
Haemoglobin abnormalities - Thalassaemia/sickle cell
Metabolic defects e.g. Glucose-6-phosphate dehydrogenase deficiency
Immune e.g. Autoimmune haemolytic anaemia, Haemolytic transfusion reactions
Paroxysmal nocturnal haemoglobinuria
Malaria
Drugs
Hypersplenism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Clinical features of aplastic anaemia

A

Anaemic symptoms
Increased infections due to low WCC (esp oral infections)
Bleeding (e.g. gums, epistaxis) / bruising as low platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

How does CKD lead to anaemia?

A

CKD leads to a reduction in production of EPO which gives as a result normocytic normochromic anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

What is a direct coombs test?

A

Direct Coombs’ test: identifies RBCs coated with antibody/complement and a positive result ususally indicates an immune cause to anaemias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

What is an indirect coombs test?

A

The indirect Coombs test is used to detect in-vitro antibody-antigen reactions. It is used to detect very low concentrations of antibodies present in a patient’s plasma/serum prior to a blood transfusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

3 causes of iron deficiency anaemia

A

Malabsorption
Poor diet
Blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

What Ix would you do for suspected iron deficiency anaemia?

A

FBC: Hb↓ MCV↓
Blood smear: microcytic, hypochromic RBCs
Iron studies: Serum ferritin ↓ Serum Iron↓

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

A 62 year old gentlemen presents with new onset anaemia and weight loss, what is your management?

A

As he is over 60 and has some cancer symptoms he should be referred via 2ww

Also consider 2ww referral if aged under 50 with rectal bleeding
AND Iron deficiency Anaemia symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Pathophysiology of pernicious anaemia

A

Autoimmune condition where there is atrophy of the gastric mucosa, with failure of Intrinsic Factor (and acid production) → B12↓ absorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

What would the LFTs show in a pre-hepatic cause of jaundice?

A

Unconjugated bilirubin - Increased
AST/ALT - Normal
ALP/GGT - Normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What would LFTs show in a post-hepatic cause of jaundice?

A

Conjugated bilirubin - Increased
AST/ALT - Slight increase
ALP/GGT - Large increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

Describe pathophysiology of cirrhosis

A
  • Entire liver architecture disrupted
  • Portal portal & portal-central bridging fibrosis
  • Nodules of proliferating hepatocytes surrounded by fibrosis
  • Vascular relationships lost abnormal communication resulting in portal and arterial blood bypassing hepatocytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Clinical features of anterior uveitis

A 
Unilateral
Dull pain in orbital region
Blurred vision
↓ visual acuity
Synechiae (iris adherence to cornea or lens)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Give 4 causes of anterior uveitis

A 
HSV
CMV
Seronegative arthropathies e.g. IBD, sarcoidosis
Eye trauma
TB
Syphillis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

How could you differentiate between bacterial, viral and allergic conjunctivitis?

A

Eye discharge is more watery in viral conjunctivitis
Purulent discharge is more likely bacterial
Allergic often has ropy mucoid discharge with itching as the main symptom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What is angle-closure glaucoma?

A

Angle-closure glaucoma (ACG) is a group of diseases in which there is reversible or adhesional closure of the anterior-chamber angle resulting in elevation of the intra-ocular pressure (IOP).

In the acute form, the IOP rises rapidly as a result of relatively sudden blockage of the trabecular meshwork by the iris, via the pupillary block mechanism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

Management of PCOS

A 
Weight loss!
COCP if not wishing to conceive  
	• Dianette if hirsutism	
Clomiphene citrate to induce ovulation if wishing to conceive
Metformin to control insulin resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

Give 4 causes of menorrhagia

A

Fibroids
Adenomyosis
Pelvic infection
Endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

Management of menorrhagia

A

Correct iron deficiency
NSAIDs - mefanamic acid for pain
Antifibrinolytics - tranexamic acid
Surgical ablation/removal of fibroids (myomectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

Define cerebral palsy

A

A primary abnormality of movement and posture secondary to a non-progressive lesion of developing brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

What is autistic spectrum disorder?

A

A developmental disorder characterized by difficulties in social interaction and communication and by restricted or repetitive patterns of thought and behaviour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

Define stress

A

Experiencing events that are perceived as endangering one’s physical or psychological well-being. The events are known as stressors and the result as the stress response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

What are the 4 broad manifestations of anxiety?

A

Physical e.g. chest tightness
Affective e.g. panic, terror
Cognitive e.g. worry, apprehension
Behavioural e.g. avoiding triggers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

MOA of copper coil

A

Prevention of fertilisation (cu effect on ova and sperm)
Cu effect on cervical mucus reduces sperm penetration
Endometrial inflammatory reaction prevents implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

What happens to LH and FSH levels after menopause?

A

Increase due to less -ve feedback from oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

What are the signs of menopause? (low oestrogen)

A 
Atrophic vaginitis
Endometrial atrophy
Loss of keratin
CVD, CVA
Bone depletion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

What is the indication for prescribing HRT?

A

Reducing vasomotor symptoms is the only correct indication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

Can you start HRT while still having periods?

A

Yes it will regulate them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

What are the risks of HRT

A 
Breast cancer			
- Increases with age and duration of use
Venous thromboembolism 	
- Most in year 1. May be less for patches
Stroke				
- Very low risk
Coronary heart disease		
- Only combined HRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

Benefits of HRT

A

Symptom control
Osteoporosis prevention
May reduce risk of CHD
Reduce colorectal cancer risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Define menopause

A

Biological stage in a woman’s life when menstruation ceases permanently due to the loss of ovarian follicular activity.

  • Mean age in UK 51 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

What is premature ovarian failure?

A

Menopause before the age of 40 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

Why do women get hot flushes?

A

Narrowing of the thermoneutral zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

Contraindication for oestrogen only HRT?

A

Women with a uterus unless used in conjunction with a mirena coil (Alone it can increase risk of endometrial cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

What type of HRT should be offered if women have had a period in the last year?

A

Cyclical HRT (combined progesterone and oestrogen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

When can you offer continuous HRT?

A

If a woman hasn’t had a period in a year post menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

CI for HRT

A 
History of Pulmonary Embolism
Abnormal liver function tests
Angina
Blood pressure of 180/98
Intermenstrual bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

Give 4 causes for male LUTS

A 
BPH
Prostate cancer
Overactive bladder
Bladder cancer
Urethral stricture
Neuropathic bladder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

What are 3 red flag symptoms for LUTS

A 
Haematuria
Recent severe symptoms
Pain
Palpable bladder and nocturnal incontinence – high pressure chronic retention
Abnormal DRE
Abnormal U&amp;Es and PSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

3 types of LUTS

A

Voiding - poor flow, hesitancy
Storage - frequency, urgency, incontinence, nocturia
Post-micturition - dribbling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

Treatments for LUTS

A

Voiding - Alpha-blockers (tamsulosin)
Storage - Beta agonist (mirabegron)
Post-mict - Urethral milking, pelvic floor exercises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

Treatment for acute urinary retention

A

Catheter (via urethra or suprapubic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

Give 3 differentials for a painless/minimally painful scrotal swelling

A 
Hydrocoele
Testicular tumour
Hernia
Spermatocoele
Varicocoele
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

Investigations for suspected testcular tumour

A

USS of testes
Tumour markers - beta-HCG and alpha fetoprotein (AFP)
Staging CT of chest, abdomen and pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

Management of testicular cancer

A

Radical orchidectomy with or without prosthesis
Chemotherapy
Sperm storage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

Differentials for acute painful scrotum

A 
Testicular torsion until proven otherwise.
Torsion of hydatid of Morgagni
Idiopathic scrotal oedema
Epididymorchitis
Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

Management of epididymorchitis

A

Analgesia

Doxycycline, ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

Give 4 causes of haematuria

A 
BPH
UTI
Malignancy
Stones
Trauma
Glomerulonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

What investigations would you carry out for a patient with haematuria?

A
  • Urine analysis (dipstix, culture, cytology)
  • FBC, U&Es, PSA, clotting
  • CT urogram (US)
  • Flexible cystoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

Risk factors for TCC of bladder

A

Smoking
Benzene compounds exposure
Drugs (cyclophosphamide, phenacetin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

Management of TCC

A

Transurethral resection of bladder tumour (TURBT)
Installation of mytomycin C
Staging for muscle invasive tumours
Radiotherapy or cystectomy for muscle invasive
Pallative chemo if metastasised

218
Q

What are the age related cut offs for PSA

A

40-49 >2.0
50–59 >3.0
60–6 >4.0
70 and over >5.0

219
Q

When should you refer for suspected prostate cancer?

A

If PSA is markedly raised

DRE shows irregular, hard prostate (arrange PSA so he can take results with him to referral)

220
Q

What grading system is used for prostate cancers?

A

The Gleason score is used to classify the pattern of tumour growths found in prostate specimens.
The Gleason score is the sum of the two most common patterns of tumour growth. It ranges between 6 and 10 — that is, between (3 + 3) and (5 + 5).

221
Q

Differentials for chronic headache

A

Tenion headache - bilateral non-pulsatile headache without vomiting
Raised ICP - Worse on waking, lying or bending forwards
Medication overuse - Common culprits are paracetamol and codeine

222
Q

Differentials for acute headache

A

Meningitis - if meningism is present
Subarachnoid haemorrhage - worst ever headache, stiff neck, focal neuro signs
Head injury - pain at site of trauma
Sinusitis - Dull ache over sinuses with tenderness an post nasal drip
Acute glaucoma - Typically in elderly long sighted people, constant aching pain develops around one eye

If suspicious, refer for head CT to rule out severe causes.

223
Q

Symptoms of migraine

A

Visual or other aura lasting 15-30 mins followed by severe unilateral throbbing headache or isolated aura with no headache

224
Q

Triggers for migraine

A

Chocolate, cheese, wine, alcohol, lie-ins

225
Q

Treatment for migraine

A

NSAIDs, Triptans, prevention with B2 blockers or tricyclis

226
Q

What must be excluded in anyone >50 with subacute onset headache?

A

Giant cell arteritis
- Tender, thickened, pulseless temporal arteries, jaw claudiation with raised ESR.
Requires prompt steroids to avoid blindness

227
Q

What is sensitivity and how do you calculate it?

A

Sensitivity is the probability that a test will indicate disease among those with the disease

TP/(TP+FN)

228
Q

What is specificity and how do you calculate it?

A

Specificity is the proportion of people who do not have the disease that the test correctly identifies as not having the disease

TN/(TN + FP)

229
Q

What is PPV and how do you calculate it?

A

The probability that a person has the disease given that they have had a positive test result

TP/(TP + FP)

230
Q

What is NPV and how do you calculate it?

A

The probability that a person does not have the disease given that they have a negative test result

TN/(TN + FN)

231
Q

Give the Wilson and Junger criteria for screening

A
  1. Condition important health problem
  2. Treatment available
  3. Facilities for diagnosis and treatment should be available
  4. Should be latent stage of the disease
  5. Should be a test/examination for the condition
  6. Treatment acceptable to the population
  7. Natural history of disease should be adequately understood
  8. Agreed policy on who to treat
  9. Should be cost effective
  10. Case-finding should be a continuous process
232
Q

What are the main services offered by Coventry MIND?

A 
Support at home to address mental health and daily living needs
Accomodation support
Recovery and development groups
Befriending
Counselling
Gardening
Wellbeing hub
233
Q

What is social stigma?

A

Attributes, behaviours or pathological states that in some way sets a person apart from others and marks them as less acceptable or inferior

234
Q

What are the top 3 infectious disease categories?

A
  1. Respiratory infetions
  2. Diarrhoeal diseases
  3. HIV/AIDS
235
Q

Give 4 risk factors for HIV (many)

A 
Unprocted sex
Multiple partners
Sharing needles
Sex after alcohol/drugs
Having another STI
Blood transfusion before 1985
Living in a country with high HIV prevalence
Males who have sex with males
Mother with HIV before birth
236
Q

Global risk factors for infectious disease

A 
Poverty
War
Under-resourced healthcare services
Access to clean water
Environment
237
Q

What piece of legislaton prevents discrimination in the workplace for LGBTQI persons

A

Equalities act (Sexual orientation) 2007

238
Q

Teen pregnancy is associated with - ?

A

Social disadvantage
Poor education
Low aspiration

239
Q

Describe trends in common STIs

A

Chlamydia is most common
Syphillis and Gonorrhoea are on the rise
Large STI diagnosis increase in MSM

240
Q

Explain the increase in STIs

A 
Increase young people having sex
STI awareness
Easier service access
Better diagnosis
Artefact
241
Q

Why should you notify partners of patients with STI?

A

Protect partner from reinfection
Offer partner STI tests
Treatment
Inhibit further spread

242
Q

What important factors from a Hx do you want to ask a patient presenting with jaundice?

A

Demographic
GI symptoms - stool and urine colour, weight loss
Alcohol
Hepatitis risk factors - tattoos, travel, sexual hx

243
Q

What is the most sensitive blood test of synthetic liver function?

A

PT/INR

244
Q

Why might PT/INR increase in a jaundiced patient?

A

– Failure of synthetic function
– Failure of absorption of Vitamin K due impaired bile salt
excretion into gut by biliary obstruction

245
Q

What is the key investigation for jaundice?

A

Abdominal ultrasound

246
Q

What is Courvoirsier’s law?

A

This states that in the presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones.

247
Q

What is weight loss?

A

Weight loss of at least 5% of the patient’s usual body

weight that occurs within the preceding 6-12 months

248
Q

A patient presents with weight loss, give 4 questions you would ask to narrow differentials

A

Quantify the weight loss
Intentional or unintentional
Change in bowel habits
Appetite change

249
Q

What tool is used for patients at risk of malnutrition?

A

Malnutrition Universal Screening Tool (MUST)

250
Q

Give 4 differentials for weight loss with poor appetite

A

GI inflamation e.g. IBD
Cancer
Psychiatric disorders
Systemic infection e.g. HIV

251
Q

Give 4 differentials for weight loss with normal appetite

A

Malabsorption e.g. Coeliacs
Endocrine e.g. Diabetes
Drugs
Alcoholism

252
Q

Give 4 causes of malabsorption in the small intestines

A

Coeliac’s
Crohn’s
Lactose intolerance
Intestinal resection

253
Q

What are the complications of Coeliac’s?

A

Enteropathy-associated lymphoma (intestines)
Anaemia
Osteoporosis the leading to fractures
Small bowel and oesophageal carcinoma

254
Q

Oesophageal carcinoma risk factors

A

Smoking
Alchohol
FHx
Hiatus hernia

255
Q

What investigations would you perform in suspected oesopheageal cancer?

A 
Bloods
0 FBC, U&amp;Es, LFTs
Imaging and special tests
0 OGD ± biopsy / barium swallow
0 Staging CT / staging MRI/PET scan
256
Q

When should you refer patients for suspected colon cancer using 2ww?

A

40 or over with unexplained weight loss and abdo pain
OR
50 or over with unexplained rectal bleeding
OR
60 or over with
- Iron-deficiency anaemia or
- Changes in bowel habit

257
Q

What is pernicious anaemia?

A

Common haematological condition characteriseby
autoimmune destruction of the parietal cell and intrinsic
factor resulting in severe VITAMIN B12 deficiency.

258
Q

Treatment of pernicious anaemia

A

Treatment is with IM injections of hydroxycobalamin 3x weekly for 2 weeks then every 3 months

259
Q

What PMH do you want to find out in a sexual history?

A

Previous STIs/UTIs
HIV status
LMP if female
Last smear if >25 and female

260
Q

Definition of dysuria

A

Painful voiding of the urinary bladder

261
Q

Potential causes of dysuria

A 
UTI
Stones
Urethritis (STIs)
Bladder tumour
Prostatitis
262
Q

What is the most common causative organism in a UTI

A

E. coli

263
Q

What Ix would you like to do for a patient with dysuria?

A

Urine dip

Urine MCS

264
Q

Management of UTI

A

Uncomplicated - Trimethoprim or Nitrofurantoin

Complicated - Co-amoxiclav

265
Q

If a patient has an indwelling catheter can you diagnose a UTI from dipstick?

A

No as all catheters become colonised with bacteria so urine samples are always +ve for bacteria

266
Q

Differentials for genital discharge

A

Infective

  • Chlamydia
  • Gonnorhoea
  • Trichomonas
  • BV
  • Thrush (Candidiasis)

Non-infective

  • Polyp
  • Retained foreign body
  • Malignancy
267
Q

What is the Amsel criteria?

A 
A criteria for diagnosisng BV wth 3 indicating BV
White adherent discharge
Clue cells
\+ve whiff test
Vaginal pH >4.5
268
Q

Treatment for Chlamydia

A

Doxycycline/Azithromycin

269
Q

Treatment for Gonorrhoea

A

IM cephalosporin

270
Q

Treatment for BV

A

Metronidazole

271
Q

Differentials for genital ulcers

A

Herpes simplex 2 HSV2
Syphillis
HIV

272
Q

What are some AIDS defining illnesses

A 
Chronic HSV infection
Kaposi's sarcoma
Oesophaegal candidiasis
Pneumocystis pneumonia
CMV retinitis
Lymphoma due to EBV
273
Q

What is melana?

A

Dark black, tarry feces that are associated with upper gastrointestinal bleeding.
The black color and characteristic strong odor are caused by hemoglobin in the blood being altered by digestive enzymes and intestinal bacteria

274
Q

Management of H. Pylori

A

Triple therapy advised
Omeprazole, metronidazole, clarithromycin

Advise patient to stop smoking
Re-endoscope at 6 weeks to check for resolution of ulcer

275
Q

3 causes of an oesophageal bleed

A

Mallory-Weiss tear
Malignancy
Varices

276
Q

3 causes of a bleed from the stomach

A

Gastric ulcers
Gastric varices
Cancer

277
Q

Management of piles

A

Cons - High fibre diet, laxatives, analgesia, avoid strain
Medical - Injecton sclerotherapy
Surgical - Haemorrhoidectomy, arterial ligation

278
Q

What is diverticular disease?

A

Colonic diverticulosis refers to herniation of mucosa and submucosa through the muscular layer of the colonic wall (outpouching).

279
Q

What important factors would you like to gather in a history of a patient with dysphagia?

A 
Duration
Progression
Pain on swallowing (odynophagia)
Solids/Liquids/Both?
Regurgitation of food
Any weight loss
Smoking/alcohol hx
280
Q

What are the 3 phases of swallowing?

A

Buccal - voluntary
Pharyngeal phase - involuntary
Oesophogeal phase - involuntary

281
Q

Give 4 causes of dysphagia

A 
Myasthenia Gravis
Achalasia
Goitre
Stricture
Oesophageal spasm
Cancer
282
Q

What ix would you do for dysphagia?

A 
Bloods - FBC U+Es
CXR
Barium swallow
OGD
Staging CT scan
PET scan
283
Q

What are ALARM features for patients with GORD?

A 
Dysphagia
Evidence of GI blood loss
Persistent vomiting
Unexplained weight loss
Upper abdo mass

Any of these means patients need to be referred to hospital specialists

284
Q

Management of GORD

A

Cons - MDT, stop smoking, reduce alcohol, reduce weight
Medical - Antacids, PPIs, H2 receptor antagonists, ?H. Pylori eradication
Surgical - Nissen fundoplication

285
Q

How would you explain an OGD to a patient

A

Procedure:

  • Fasting for at least 4 hours
  • Procedure will take 5-15 mins
  • If you need to be sedated you will need someone to accompany you home

Risks and benefits

  • Diagnosis of your condition
  • Helps us guide treatment
  • Perforation
  • Aspiration

Obtain consent

286
Q

What is Barrett’s Oesophagus?

A

Occurs as a result of acid reflux
Causes metaplasia of squamous cells to columnar cells
Associated with increased risk of malignancy

287
Q

What is Achalasia?

A

Oesophageal aperistalsis
• Impaired relaxation of LOS

Leads to intermittent dysphagia to both solids and liquids.

288
Q

Management of achalasia

A

Symptomatic relief
Endoscopic balloon dilatation
Botox injection
Surgery

289
Q

What are the treatments for asthma (ladder) in adults

A

Step 1: Inhaled short-acting B2 agonist
Step 2: Add inhaled corticosteroid
Step 3: Add long-acting B2 agonist
Step 4: Increase inhaled steroid or add a 4th drug e.g. leukotriene receptor antagonist
Step 5: Daily steroid tablet but consider treatments to avoid steroid use

290
Q

What defines moderate asthma?

A

Increasing symptoms
PEF >50-75% best or predicted
No features of acute severe asthma

291
Q

Features of acute severe asthma

A 
Any one of:
PEF 33-50% best or predicted
Respiratory rate >/=25/min
Heart rate >/=110/min
Inability to complete sentences in one breath
292
Q

Features of life-threatening asthma

A 
In a patient with severe asthma any one of:
PEF <33% best or predicted
SpO2 <92%
PaO2 <8kPa
Normal PaCO2
Silent chest
Cyanosis
Poor respiratory effort
Arrhythmia
Exhaustion
Hypotension
293
Q

How would you initially assess an critically unwell or deteriorating patient?

A

ABCDE approach

294
Q

2 gross motor milestones that should be reached by age 6 months

A 
Any 2 from:
Little or no head lag on being pulled to sit
Lying on abdomen, good head control
Held sitting, lumbar curve
Lying on abdomen, arms extended
Lying on back, lifts and grasps feet
Pulls self to sitting
Held sitting, back straight
Rolls front to back
295
Q

What is stridor?

A

Stridor is a high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It is caused by a narrow or obstructed airway.

296
Q

What criteria are used to diagnose PCOS?

A

Rotterdam criteria

297
Q

Give one complication of pregnancy that PCOS sufferers are more likely to develop

A

Gestational diabetes
Pre-eclampsia
Preterm labour

298
Q

What blood test can be used to identify Antiphospholipid syndrome

A

Anti cardiolipin antibodies OR lupus anticoagulant

299
Q

Name 2 causes of aortic stenosis

A

Senile calcification
Rheumatic heart disease
Bicuspid valves (genetic defect)

300
Q

Define a TIA

A

A TIA is a sudden, focal, neurological deficit of vascular origin that lasts less than 24 hours

301
Q

Where is folic acid absorbed?

A

Jejunum

302
Q

What can cause folate deficiency?

A

Poor diet
Alcoholics
Coeliac disease
Crohn’s disease

303
Q

How are bacteria classified?

A

Classified on gram stain and shape
Gram = +ve or -ve
Shape = coccus or bacillus/rod

304
Q

What scoring system do you use for a patient with community accquired pneumonia?

A

CURB-65

Confusion
Urea >7mmol/L
Resp. rate >30/min
BP <90 systolic or <60 diastolic
Age 65 or over

Score of >1 admit
>2 then IV treatment

305
Q

Give 3 mechanisms or antimicrobial resistance

A 
Antibiotic efflux
Enzymatic degredation
Target mutation
Reduced permeability
Alternative metabolic pathways
306
Q

What is horizontal gene transfer?

A

Horizontal gene transfer is the process of exchanging mobile non-chromosomal genetic material such as plasmids between ‘unrelated’ individual bacterial cells

307
Q

What is vertical gene transfer?

A

Vertical gene transfer is the passing on of genetic information as part of the process of reproduction – in bacteria, the chromosomal genetic information is replicated prior to cell division

308
Q

What are the 3 ways in which horizontal gene transfer can occur?

A

Transformation: the uptake of short DNA fragments from the surrounding medium without direct cell-cell contact

Transduction: where DNA is transferred from one bacterial cell to another by bacteriophage, viruses that infect bacteria

Conjugation: which involves transfer of DNA from one bacterium to another by direct cell-cell contact

309
Q

What is antimicrobial stewardship?

A

Using the minimal possible antibiotics in a hospital
Using the cheapest antibiotic that will be effective
Not giving antibiotics to someone with a viral illness
Making antibiotic decisions based on the best evidence
Restricting antibiotic prescribing to “antibiotic stewards”
Stopping antibiotics being available over the counter
Finishing the course of an antibiotic

310
Q

Top 3 leading risk factors of death by sex

A

F: Stroke, IHD, LRTI
M: IHD, Stroke, COPD

311
Q

Top 3 risk factors globally

A

HTN, tobacco, high cholesterol

312
Q

How has the demographic transition affected the population pyramid?

A

Less of a pyramid and more of a diamond shape with a shrinking base and a growing top

313
Q

What are the differences between population and high risk strategy for reducing cardiovascular disease? (Think upstream downstream from 1st year)

A

Population strategy:

  • Attempts to control determinants of incidence rather than cases
  • Population based
  • More radical
  • More permanent

High risk strategy

  • Extension of traditional clinical approach
  • No lasting change
  • Repeated from generation to generation
314
Q

Give the 3 main drivers of increasing cardiovascular disease in developing countries

A

Diet

  • Shift from simple to processed foods
  • Increase in fat production and consumption

Physical inactivity

  • Rise of cards
  • Rise of obesity

Cultural change

  • Supermarketisation
  • Lifestyle
315
Q

What are the different approaches to reducing salt intake? Which is most effective?

A

Regulation and market control (most effective)
Taxation
Primary care (least effective)

316
Q

Define inequity in healthcare

A

When people with the same needs do not have the same level of access to the services they require

317
Q

Define inequality in healthcare

A

It is the systematic differences in health and illness across social groups

318
Q

Why should inequity in healthcare be addressed?

A

Principles of justice and fairness
Determinant of health inequalities
Duty under equalities act 2010

319
Q

Give 4 causes of inequitable access

A

Physical access
Geographical
Financial
Cultural - lack of interpreters, preferring same sex HCP
Clinician beliefs and attitude
Navigating through health and social care system

320
Q

How can barriers to access be reduced? (4 of many)

A

Multi-disciplinary approach
Driven from health needs assessment
Reducing physical and geographical barriers
Clinician shift to shared decision making
Reduce cost to individual
Reduce varition in service quality

321
Q

5 main function of the kidney

A 
Filtration - remove urea/creatinine
Regulation of ECF components
Electrolyte balance - Na+/K+
Acid-base balance
Endocrine function- RAAS
322
Q

Give 3 causes of primary nephrotic syndrome

A

Minimal change glomerulonephritis
Focal segmental glomerulosclerosis
Membranous glomerulonephritis

323
Q

Give 3 causes of secondary nephrotic syndrome

A 
SLE
Hep B and C
HIV
Diabetes mellitus
Malignancy
324
Q

Give 2 causes of nephritic syndrome

A

IgA nephropathy
Post-streptococcal glomerulonephritis
Goodpastures syndrome

325
Q

Give 5 common nephrotoxic drugs

A

NSAIDs - Inhibit vasodilatory PGs in afferent arteriole
ACEi - reduce BP and dilate efferent arteriole
Gentamicin - Directly cytotoxic
Furosemide
Penicillins
Cephalosporins

326
Q

What is oliguria?

A

<0.5 mls/Kg/hr of urine
OR
<400mls/day

327
Q

What is anuria?

A

0ml/day - <100mls/day

328
Q

What needs to be excluded before a diagnosis of anuria can be made?

A

Mechanical obstruction

329
Q

General management of AKI

A

Stop nephrotoxic drugs where possible
Monitor creatinine, sodium, potassium, calcium, phosphate, glucose
Identify and treat infection
Optimise fluid balance
Urgent relief of urinary tract obstruction
Refer to a nephrologist
Identify and treat acute complications
Referral to a nephrologist where indicated

330
Q

What is CKD?

A

Gradual loss of kidney function that occurs over months to years

331
Q

What can be found in urine that can help confirm multiple myeloma?

A

Bence-Jones proteins

332
Q

Describe the path of the common iliac down to the foot

A

Common iliac splits into external and internal iliac vessels
External iliac becomes common femoral at the inguinal ligament
The common femoral splits into profunda femoris and superficial femoral artery
Superfical femoral artery becomes popliteal artery as it passes the adductor hiatus
This gives off the anterior tibial artery in the popliteal fossa and then continues as the tibioperonial trunk
This then bifurcates into posterior tibial and peronial (fibular) arteries

333
Q

If a patient present with claudication in the gluteal muscles what level is the blockage present at?

A

Aorto/Iliac

334
Q

What medications may indicate patient is at risk of peripheral vascular disease?

A

Beta-blockers

335
Q

DDx of an acute cold leg

A

Embolus
Pressure/compression
Trauma
Thrombosis of aneurysm

336
Q

DDx of an acute warm leg

A 
DVT
Cellulitis
Osteomyelitis
Sciatica
Gout
OA
#
337
Q

Give 4 signs of PVD

A 
Hair loss
Shiny
Cyanosed
Dry skin
Ulcers
Reduced muscle bulk
338
Q

Describe the characterisitics of an arterial ulcer

A 
Often found at toes, feet or ankles
Punched out well defined edge
Necrotic base
Painful
Often small
339
Q

Describe characteristics of a venous ulcer

A 
Commonly found at medial gaiter region 
Edges poorly defined
Haemosiderin deposits around wound
Can be large
Minimal pain
340
Q

What would an ABPI value of >1.3 suggest?

A

Calcification of vessel

341
Q

Give the 6 Ps of ischaemia

A 
Pain
Pallor
Pulseless
Perishingly cold
Paralysis
Paraesthesia
342
Q

Give the 5 initial steps to halt bleeding after an injury

A 
Local vasoconstriction
vWF binds to surrounding collagen
Adhesion and aggregation of platelets
Platelets release ADP and TxA2
Activation of clotting cascade to create a fibrin clot
343
Q

What is haemophilia A?

A

A hereditary clotting disorder caused by deficiency in factor VIII
Most common haemophilia
X linked recessive so affects boys more than girls

344
Q

What blood tests results would you see in a patient with haemophilia A?

A

Elevated APTT with normal PT & vWF levels

345
Q

What is the treatment for haemophilia A?

A

Factor VIII infusion either prophylactically or at time of bleeding

346
Q

What is haemophilia B?

A

A herediatary clotting disorder caused by a deficiency in factor IX
X linked recessive
Also known as Christmas disease

347
Q

What is Disseminated Intravascular Coagulation (DIC)?

A

Mixture of initial thrombosis due to
– Generation of fibrin in vessel walls
– Activation of coagulation
Then bleeding tendency due to consumption of coagulation factors and fibrinolytic activation

348
Q

3 causes of DIC

A 
– Malignancy
– Sepsis
– Haemolytic transfusion reactions
– trauma/burns/surgery
– Liver disease
349
Q

Rx for DIC

A

No treatment unless bleeding
Treat underlying cause
Can use packed RBCs, Plt transfusion and FFP/cryo if bleeding

350
Q

What is the Well’s criteria for PE?

A

Objectifies risk of PE

Clinical signs and symptoms of DVT (+3)
PE is #1 diagnosis or equally likely (+3)
HR >100 (+1.5)
Immobilisation for at least 3 days or surgery in past 4 weeks (+1.5)
Previous objectively diagnosed PE or DVT (+1.5)
Haemoptysis (+1)
Malignancy w/ treatment within 6 months (+1)

<2 points consider D-dimer to rule out PE
2-6 consider D dimer
>6 consider CTPA D-dimer not needed

351
Q

Diagnostic criteria for Antiphospholipid syndrome

A 
• Lupus anticoagulant or;
• Anticardiolipin antibody or;
• Anti-b2-glycoprotein I antibody
On two or more occasions at least 12 weeks
apart
352
Q

When would you use thrombolytics?

A

• STEMI, if PCI not available within 90- 120mins
• Massive PE
• Ischaemic stroke
Options are
• Streptokinase (derived from bacteria, risk of allergic reaction)
• Alteplase, reteplase (recombinant tissue plasminogen activators)

353
Q

When would you use anti-platelet drugs?

A

• MI
Options are:
• Aspirin – COX inhibitor
• Clopidogrel – targets platelet ADP receptor
• Abciximab - GpIIb/IIIa inhibitor
• Ticagrelor (STEMI) – platelet aggregation inhibitor (P2Y 12 receptor antag)

354
Q

When would you use anticoagulants and give some examples

A

DVT, PE
Options are:
• Warfarin – coumarin (PO)
• LMWH (+MI) (SC) e.g. enoxaparin, tinzaparin, dalteparin
• Unfractionated heparin (IV) – risk of heparin-induced thrombocytopenia
• Dabigatran – direct thrombin inhibitor
• Rivaroxaban, apixiban – DOAC (direct factor Xa inhibitor)

355
Q

What complications can arise from obesity?

A

Metabolic complications – type II diabetes, with insulin resistance, hyperlipdaemia, ischaemic heart disease

Physical complications – increased osteoarthritis, particularly hips and knees, varicose veins, hermias, obstructive sleep apnoea

Hepatic complications – fatty infiltration of the liver with cirrhosis

Increased cancer risk – breast, ovary, endometrium, cervix, prostate, bowel

356
Q

Main general causes of obesity

A

Environment – By far the commonest cause.
Genetic factors
Endocrine (<1%)
Drugs

357
Q

Causes of a fixed dilated pupil

A

If unconscious then herniation
Oculomotor nerve palsy
Acute closed-angle glaucoma

358
Q

Symptoms of SIADH

A

Caused by the hyponatraemia
Mild – Nausea/Vomiting/Headache/Anorexia /Lethargy
Moderate – Muscle cramps/Weakness/Confusion/Ataxia
Severe – Drowsiness / Seizures / Coma

359
Q

Signs of SIADH

A

Decreased level of consciousness
Cognitive impairment
Focal or generalised seizures
Brain stem herniation – severe acute hyponatraemia (coma / respiratory arrest)
Hypervolaemia –pulmonary oedema / peripheral oedema / raised JVP / ascites

360
Q

What Ix would you do for suspected SIADH?

A 
Fluid status
Serum sodium
Serum potassium
Urinary sodium
TFTs
361
Q

What is the biochemical triad of DKA?

A

Ketonaemia, hyperglycaemia and acidaemia

362
Q

What is the clinical presentaiton of a patient with DKA?

A 
Polyuria with polydipsia – commonest presenting symptom
Weight loss
Fatigue
Dyspnoea
Vomiting
Preceding febrile illness
Abdominal pain
Polyphagia
Ketotic breath
363
Q

Define term immigrant

A

Anyone who moves to another country for 1 year+

364
Q

Define term asylum seeker

A

Person who claims asylum in the UK due to persecution in country of origin

365
Q

Give 3 common migrant health issues

A

FGM
Infectious diseases
No access to healthcare (illegal immigrants)

366
Q

What are the criteria for bariatric surgery?

A

All appropriate non-surgical measure have been tried
The person has been receiving or will receive intensive management in a tier 3 service
The person is generally fit for anaesthesia and surgery
The person commits to the need for long-term follow up
Have to have BMI of at least 40 without co-morbidity
OR 35 with recent onset T2DM

367
Q

What are BMI thresholds for action to prevent T2DM in Asian and African/Afro-carribbean populations?

A

23 is increased risk

27.5 is high risk

368
Q

MoA of Orlistat

A

Inhibits action of lipase in GI tract so 30% less dietary fat is absorbed

369
Q

What 2 school years is the national child measurement programme carried out in england?

A 
Reception (4-5)
Year 6 (10-11)
370
Q

A 48 year old gentlemen with T2DM is diagnosed with stage 1 HTN (BP ≥140/90) what is your management for him?

A

Assess cardiovascular risk and end-organ damage via:

  • fundoscopy
  • QRISK2
  • ECG
  • Proteinuria/haematuria
  • plasma glucose, GFR, cholesterol

Offer lifestyle advice

  • Reduce salt, alcohol, smoking
  • Exercise regularly

Offer ACEi initially then review

371
Q

Who should be offered antihypertensives?

A

NICE says to offer antihypertensives to people aged <80 with stage 1 if they have:

  • Target organ damage
  • Established CVD
  • Renal disease
  • Diabetes
  • 10 year risk of =/>20%

If stage 2 they should all be offered antihypertensives

372
Q

Why should ACEi not be used in pregnancy?

A

Reported to cause congenital malformations, stillbirths and neonatal deaths

373
Q

Give 4 causes of ascites

A 
Cirrhosis
HF
Bacterial peritonitis 
Acute pancreatitis
Renal failure
Pseudomembranous colitis
374
Q

DDx of acute diarrhoea (3 of many)

A 
Infection (Norovirus)
Drugs
Ischaemic colitis
IBD flare up
Diverticular disease
375
Q

What is hypospadias?

A

Opening of urethra on ventral surface of penis

376
Q

How does lichen planus present clinically?

A

Pruritic, purple, polygonal, planar papules and plaques

Remember the 6 P’s of lichen planus

377
Q

What condition is associated with this presentation? – A pink pearly nodule with telangiectasias, ulceration and rolled borders on the upper lip.

A

Basal cell carcinoma

378
Q

How does impetigo present?

A

Golden honey coloured crust over an erythematous base

379
Q

What is the pathogenesis of pemphigus vulgaris?

A

IgG antibody against desmoglein resulting in painful flaccid bullae or blisters that rupture easily on both skin and oral mucosa.

380
Q

What skin condition is caused by the pox virus and what is its presentation?

A

Molluscum contagiosum

Presents as an umbilicated papule.

381
Q

What are the signs of cardiac tamponade?

A

Beck’s Triad

Hypotension, muffled heart sounds and increased JVP.

382
Q

At which point in the menstrual cycle is a women most fertile?

A

The most fertile period of the menstrual cycle is from 5 days before ovulation to 1-2 days after.

So day 9-16 of menstrual cycle

383
Q

What does symmetrical intrauterine growth restriction (both the head circumference and abdominal circumference are lower than normal) suggest?

A

Chromosomal abnormality rather than placental insufficiency which would more likely present as asymmetrical

384
Q

Describe the first stage of labour

A

Starts when the effaced cervix is 3cm dilated and ends when the cervix is fully dilated at 10cm.

385
Q

What is the correct way to calculate the estimated date of delivery (EDD)?

A

First day of LMP + 9 months and 1 week

386
Q

At 28 weeks gestation where would you expect to feel the uterine fundus?

A

Halfway between umbilicus and xiphisternum

387
Q

Which period of gestation does the 2nd trimester represent?

A

13-28 weeks

388
Q

When will a pregnant patient expect to feel foetal movements?

A

18-20 weeks

389
Q

Definition of post-partum haemorrhage

A

Loss of >500ml of blood from the vagina within 24 hours of delivery

390
Q

Describe the underlying pathology of Grave’s disease

A

An autoimmune disease directed against thyroid stimulating hormone (TSH) receptors.
The autoantibodies stimulate the TSH receptors causing increased T3 and T4 production.

391
Q

What is gold standard Ix for diagnosing acromegaly?

A

Oral glucose tolerance test + Growth hormone measurement

392
Q

What is the cut-off for an acceptable weight loss in the first 7 days of life?

A

10%

Any more requires follow up/referral

393
Q

Which vaccinations are given as “Pre-school boosters” at around 3 years?

A

At around 3 years 4 months the 4-in-1 DTaP/IPV is given, along with the second dose of MMR.

394
Q

What two systems are used to predict prognosis and guide treatment for malignant melanoma?

A

Clark index- measures how deeply the melanoma has grown into the skin and which levels of the skin are affected.
I: confined to epidermis, in situ
II: invasion of the papillary dermis
III: filling of the papillary dermis, but no extension into the reticular dermis
IV: invasion of the reticular dermis
V: invasion of the subcutaneous tissue

Breslow thickness- measure thickness in millimitres from the overlying granular layer of the epidermis to the deepest easily identifiable tumour cells with an ocular micrometer.

395
Q

What is erythema multiforme and give its common causes

A

Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus (HSV).

It presents with a skin eruption characterised by a typical target lesion.

396
Q

What is dermatitis herpetiformis and what GI condition is it associated with?

A

Dermatitis herpetiformis (DH) is a rare but persistent immunobullous disease that has been linked to coeliac disease

397
Q

How does acute pancreatitis present clinically?

A

Epigastric/central abdominal pain
• Pain radiates to the back
• Helped by sitting forward
• Vomiting

Signs;
– Tachycardia, hypotension, pyrexia, ↑RR, ↓O2
sats, abdo pain, Cullens/Grey Turner’s sign,
peritonitic

398
Q

Signs of ascending cholangitis

A

Charcot’s triad

  1. Jaundice
  2. Fever, usually with rigors
  3. Right upper quadrant abdominal pain.
399
Q

Pathophysiology of asthma

A

Bronchial muscle constriction
Mucosal swelling/inflammation
Increased mucus production and plugging of bronchi

400
Q

Definition of stroke

A

Stroke is the sudden onset of focal neurological deficit
lasting more than 24 hours (or leading to death)
caused by a vascular problem.

401
Q

Rx for hypovolaemic hyponatraemia

A

Slow rehydration with normal Na+

402
Q

What Ix would you do for a patient with hyponatraemia?

A 
Serum osmolality (often low)
Urinary sodium (can help differentiate between SIADH and a reducition in circulating volume/addison's)
403
Q

Give 3 causes of hypokalaemia

A 
Extra-renal:
- Vomiting
- Diarrhoea
Renal:
- Diuretics
- Conn's
- Cushing's
- Steroids
404
Q

Definition of a Health Needs Assessment

A

A systematic method of identifying unmet health and healthcare needs of a population and making changes to meet these unmet demands

405
Q

What is the aim of a HNA?

A

To provide information to plan and change services for the better and to improve health

406
Q

What are the 3 components of a HNA?

A

Epidemiological - epidemiology of current health condtion and risk factors
Comparative - compare service and care between diff. population
Corporate - views of stakeholders

407
Q

Define self management support

A

Techniques that help patients choose healthy behaviours. Transforms care-giver relationship into partnership

408
Q

Define self efficacy

A

Ability to monitor ones condition and effect cognitive, behavioural and emotional responses necessary to manintain satisfactory QoL

409
Q

What bedside investigations would you undertake in someone with a supected TIA?

A

ECG

Blood glucose - rule out hypoglycaemia as a cause of neuro signs

410
Q

What the is range of gestational age for the foetus to be classified as preterm baby?

A

24-37 weeks (before 24 weeks it is classed as spontaneous abortiong/miscarriage even though some babies can survive earlier than this point)

411
Q

Explain what elements are required for successful claim of clinical negligence against a doctor

A

The doctor or other healthcare professional owed a duty to take care of the claimant and not cause injury;
There was a breach of that duty to take care;
That breach of duty has caused harm to the claimant; and
Damage or other losses have resulted from that harm.

412
Q

What age do women commence breast screening?

A

50 years of age

413
Q

Give 3 clinical features of a breast lump that would warrant a 2WW referral

A

aged 30 and over and have an unexplained breast lump with or without pain or

aged 50 and over with any of the following symptoms in one nipple only:
discharge
retraction
other changes of concern - ‘peau d’orange’, tethering, bony pain(mets)

414
Q

Two indications for use of an NG tube

A

Unsafe swallow
Unable to swallow
Unable to maintain adequate nutritional intake
Drainage of stomach contents

415
Q

Describe management of pressure ulcers

A

Dressing that promotes a warm, moist healing environment to treat grade 2, 3 and 4 pressure ulcers.

Topical antimicrobial dressings to treat a pressure ulcer where clinically indicated,

Repositioning, air mattresses, air cushions

Nutritional supplements and hydration

416
Q

Give 3 examination findings in RA

A

Symmetric swelling of wrist, metacarpophalangeal, or proximal interphalangeal joints
Ulnar deviation of MCP joints and phalanges
Z-deformity of the thumb
Swan-neck & Boutonniere deformity of interphalangeal joints
Volar (anterior) subluxation of digits
Rheumatoid nodules under skin

417
Q

Give 3 examination findings in OA

A

Affects distal interphalangeal joints & 1st carpometacarpal joints.
Heberden’s nodes present = enlargement of base of distal phalanx
Bouchard’s nodes = enlargement of the PIP
Bunions may present on the feet
Limited movement, grinding (crepitation)

418
Q

What are the broad areas assessed in the MSE? (8)

A 
Appearance and behaviour
Speech
Thought
Mood
Perception
Insight
Cognition
419
Q

What 3 types of embryonic tissue is the eye derived from?

A 
Mesoderm of the head region
- Lens 
The neural tube (neuro-ectoderm)
- Retina 
Surface ectoderm
- Corneoscleral and uveal tunics
420
Q

What are the macula and fovea?

A

Macula is the area between the two temporal arcades
Fovea is small central area of the macular containing high density of cones

  • Area concerned with fine detailed vision
421
Q

Physiological relevance of choroid

A

Nourishes the outer layers of the retina
Regulates retinal heat
Assists in the control of intraocular pressure
Pigment absorbs excess light decreasing reflection.

422
Q

What is the underlying cause of cataract in older people?

A

Lens cells grow throughout life and there become more densely packed with time
Densely packed cells stiffen the lens leading to loss of accommodation = presbyopia
Densely packed cells become opaque=cataract

423
Q

What 3 muscles control the eyelids

A

Orbicularis oculi = closes (CN VII)

Levator palpebrae superioris = opens (CN III)

Superior tarsal muscle = opens (Sympathetic)

424
Q

What veins can be accessed in the cubital fossa?

A

Cephalic, basilic or median cubital veins

425
Q

Borders of cubital fossa

A

Superior – Epicondylar line

Lateral – Brachioradialis

Medial – Pronator teres

426
Q

What nerves are at risk with cannulation into cubital fossa?

A

Medical and lateral cutaneous nerves of forearm

427
Q

What structures are at risk when cannulating the cephalic vein in the anatomical snuffbox?

A

Superficial branch of radial nerve

Radial artery

428
Q

Describe the path of the great saphenous vein

A

Passes up medial aspect of lower limb
Anterior to medial malleolus
Along posterior region of medial tibial border (alongside saphenous cutaneous nerve)
Posterior to patella
Then through saphenous opening ~3cm inferior and lateral to the pubic tubercle

429
Q

Describe path of short saphenous vein

A

Passes from lateral foot up posterior leg into popliteal fossa
Posterior to lateral malleolus
Ascends midline leg (posterior) alongside sural cutaneous nerve
Into popliteal fossa via crural fascia and into popliteal vein

430
Q

What two positions can the IJV be accessed from for central venous cannulation?

A

Lesser supraclavicular fossa

Posterior border of SCM

431
Q

What nerves are at risk when attempting to cannulation the EJV

A 
Accessory nerve (CNXI)
Cutaneous branches of cervical plexus
432
Q

Borders of femoral triangle

A

Superior border - Inguinal ligament
Lateral border - Medial border of sartorius
Medial border - Medial border of the adductor longus muscle
Roof - Fascia lata
Floor - Pectineus, iliopsoas and adductor longus

433
Q

What are Langer’s lines?

A

Lines of tension/cleavage (Langer’s) which help guide the orientation of surgical incisions
Determined by direction of collagen fibres
Incisions along lines heal better

434
Q

What type of incision allows adequate exposure while aligining with tension lines?

A

Z-plasty

435
Q

What surgical approach would you take to access the mediastinum and why?

A

Median sternotomy
Avoids intercostal muscles and neurovascular bundle, internal thoracic artery & vein and provides good mediastinal access

436
Q

Borders of the triangle of safety and its use

A 
Posterior axillary fold  (lat. dorsi and teres minor)
Anterior axillary fold (Pec. major and minor)
Nipple line (4/5th ics)

Used for chest tube insertion

437
Q

What incision is used to access the anterior and posterior compartments of thigh?

A

Lateral fasciotomy incision

438
Q

Describe surgical approach to ankle

A

Incision made midway between tibia & fibula heading towards 4th metatarsal base
Intermediate dorsal cutaneous nerve id
Extensor tendons retracted

439
Q

Describe surgical approach to shoulder

A

Anterolateral approach made
ID coracobrachialis and work at lateral side
Medial side is the suicide

440
Q

Whatisthegoldstandardinvestigationfordiagnosis of TB?

A

Dischargedpusorbiopsymaterialfordirectstainingand culture

441
Q

Describe the legal positon regarding a 16 year old refusing treatment

A

A child deemed competent can consent to treatment and this cannot be overridden.
A refusal of treatment can be overrideen by someone with authority to consent e.g. parent
If there is parental disagreement then the court can be asked to make the decision on what is in the best interests of the patient.

442
Q

What is a vesicle?

A

A raised lesion filled with serous fluid that is <5mm diameter

443
Q

What type of epithelium lines the labia minora?

A

Non-keratinised stratified squamous

444
Q

What is the major determinant of the clinical manifestations of a virus?

A

Tropism of the virus for specific tissues and cell types

445
Q

Give 2 direct cytopathic effects of viruses once they have entered cells

A

Induction of apoptosis
Production of toxic proteins
Production of degradative enzymes

446
Q

Give 2 reasons why a combo of chemotherapy agents are used to treat patients

A

More effective due to different MoA
Reduces chance of resistance
Different toxicities

447
Q

What cell types would be increased if a patient is give G-CSF

A

Neutrophils
Eosinophils
Basophils

448
Q

How do you calculate relative risk reduction?

Example:
Risk of disease in control group is 5% and 3% in treatment group what is RRR

A

Absoulte risk reduction by control event rate

2/5 x 100 = 40%

449
Q

What are the 4 classes of anti-arrhythmic drugs and where do they act?

A

Class 1 : Sodium channel blockers (membrane stablising)
Class 2: Beta blockers (reduce adrenergic input)
Class 3: Potassium channel blockers
Class 4: Calcium channel blockers

450
Q

Pathways involving which neurotransmitter are involved in the pathogenesis of confusion?

A

Acetylcholine

451
Q

What is beta oxidation?

A

Process in which fatty acids are broken down in mitochondria to generate acetyl-coA

452
Q

How do class 1c antiarrhythmics stabilise heart rhythm?

A

By slowing conduction in all parts of the heart

453
Q

Give 3 reasons it is possible to detain someone under the Mental Health Act 2007

A

Hold to allow a formal psychiatric assessment
Psychiatric assessment with a view to treat
Treatment for a psychiatric disorder

454
Q

Why is AF a risk factor for vascular dementia?

A

AF causes turbulent flow in the atrium leading to thrombus formation and emboli can end up in cerebral vasculature

455
Q

What timescale does HbA1c reflect glycaemic control over?

A

The preceding 2-3 months

456
Q

How do sulphonylureas increase the secretion of insulin?

A

Inhibition of the ATP sensitive K+ channels in the plasma membrane meaning K+ cannot efflux causing influx of Ca2+ and activation of normal machinery that releases insulin.

457
Q

What would you see on fundoscopy in a patient with age related macular degeneration

A

Dry AMD will show drusen (yellow/white accumulations of extracellular material in the macula)

Wet AMD will show choroidal neovascularisation

458
Q

3 questions you would want to ask a patient who presents with TIA about their presenting complaint

A

Any sensory losses
Dysphagia
Dysphasia
Visual disturbance

459
Q

3 risk factors for TIA

A 
HTN
Smoking
AF
Diabetes
Previous TIA/Stroke
460
Q

3 common causative organisms for otitis media

A

H. Influenzae
Strep. pneumonia
Staph. Aureus

461
Q

3 serious complications of progressive middle ear infection

A

Mastoiditis
Labyrinthitis
Brain abscess
Epidural abscess

462
Q

3 complications of pneumonia

A 
Empyema
Pleural effusion
Sepsis
Pneumothorax
Lung abscess
463
Q

Two factors that increase risk of developmental hip dysplasia

A 
Breech presentation
Female
FHx
Oligohydramnios
1st born
464
Q

4 layers of epidermis

A

Stratum corneum
Granular cell layer
Spinous cell layer
Basal cell layer

465
Q

3 Cells found in epidermis

A

Keritanocytes - produce proteins
Melanocytes - secrete melanin
Merkel cells - light touch

466
Q

Functions of skin

A 
Physical barrier 
Protection against infection/ UV
Prevent water loss
Vit. D synthesis
Wound healing
Sensation
Temp. regulation
Psychosocial
467
Q

How can you describe a lesion? (Pneumonic)

A 
Size
Shape
Colour
Associated change
Margins
Morphology

SSCAMM

468
Q

Features of nodular BCC

A 
Small, shiny, skin-coloured swelling
Telangiectasia at edge
Rolled edge and central ulcer
Bleed spontaneously
Slow growing
469
Q

NICE advice for sun protection

A

Seek shade between 11-3
Wear covering clothing e.g. hats
Suncream with minimum spf 15 and 4* UVA
Keep kids under 6 months out of direct sunlight

470
Q

Grades of pressure ulcers

A

Grade 1: Redess of intact skin
Grade 2: Partial thickness skin loss involving epidermis, dermis or both.
Grade 3: Full thickness skin loss involving damage to subcutaneous tissue.
Grade 4: Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures

471
Q

Give 3 differentials for superficial neck lumps

A

Sebaceous cyst
Lipoma
Abscess

472
Q

2 differentials for midline neck lump

A

Thyroglossal duct cyst
Goitre
Cyst
Thyroid malignancy

473
Q

4 differentials for anterior triangle neck lumps

A

Lymph nodes
Branchial cyst
Salivary gland swelling
Carotid aneurysm

474
Q

2 differentials for posterior triangle neck lumps

A

Lymph nodes

Subclavian artery aneurysm

475
Q

NHYA classification of HF

A

Class 1 - symptoms only when exerting self to levels that would limit a healthy individual
Class 2 - symptoms on normal exertion
Class 3 - symptoms with less than normal exertion
Class 4 - symptoms of HF at rest

476
Q

4 causes of T1 respiratory failure

A 
Pneumonia
PE
Pulmonary oedema
Asthma
Fibrosis
ARDS
477
Q

4 causes of T2 respiratory failure

A 
COPD
Opiates
Fibrosis
Asthma
Myasthaenia Gravis
478
Q

MRC dyspnoea scale

A

1 - Not troubled by breathlessness except during strenuous exercise
2 - Short of breath when hurrying or walking up a slight hill
3 - Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
4 - Stops for breath after walking about 100 m or after a few minutes on the level
5 - Too breathless to leave the house, or breathless when dressing or undressing

479
Q

How do you confirm diagnoses of COPD

A

Spirometry - FEV1 and FVC

The ratio will be <70% showing an obstructive pattern

480
Q

What criteria are used to determine if a patient needs home oxygen?

A

PaO2 <7.3

Must NOT be smoking

481
Q

Describe the appearance of acute guttate psoriasis

A

Salmon pink papules +/- scales
Scattered discrete lesions mainly on trunk
Can evolve into chronic plaque form

482
Q

Describe appearance of chronic plaque psoriasis

A

Well defined dull red plaques with loosely adherent whitish scale
Bilateral and often symmetrical
Nails commonly involved
Can have single lesion or lesions localised to site - mainly elbow, knees, sacral region, scalp, palms and soles

483
Q

Nails changes in psoriasis

A 
Pitting
Oncholysis
Oil spots
Transverse ridging
Subungal hyperkeratosis
484
Q

Causative agent of acne vulgaris

A

Propionibacterium acnes

485
Q

Pathology underlying acne

A

Follicular plugging prevents drainage of sebum
Androgens stimulate sebaceous glands
Inflammatory response
Intense inflammation leads to scarring

486
Q

Features of acne skin lesions

A

Comedones
Papules and pustules
Nodules
Scars

487
Q

Features of rosacea

A 
Erythema
Papules
Nodules
No comedones
Symmetrical
488
Q

What is the most common primary immunodeficiency?

A

Common variable immunodeficiency

489
Q

4 types of primary immunodeficiency

A

Phagocytes deficiency
Complement deficiencies
Severe combined immuno-deficiencies
Predominantly antibody deficiencies

490
Q

Gold standard Ix for CGD

A

Nitro-tetrazolium blue (NBT) - Normal phagocytes reduce this to a dark blue pigment

491
Q

Treatment for CGD and CVID

A

CGD - Prophylactic abx, recombinant IFN gamma , bone marrow/ stem cell transplant (curative)
CVID - Prophylactic immunoglobuin transfusions every 3-4 weeks

492
Q

What test can be done to confirm diagnosis of anaphylaxis?

A

Serum tryptase

493
Q

What are the requirements for an ADRT to be considered valid?

A 
Be an adult (over 18) when decision made
Capacity to make decision
Freedom from coercion
Informed decision
ADRT must also state precisely the treatment to be refused and the circumstances in which it applies
494
Q

State 3 things you need to do ensure a patient has sufficient information to consent to being screened

A

Give clear and accurate information about benefits and risks
Tailor the information to individual patient
Take into account patient’s views, preferences and concerns about adverse outcomes.
Provide supplementary material to facilitate discussion

495
Q

Describe legal concepts of battery and negligence

A

Uninvited invasion of bodily integrity (physical contact against patient’s valid consent), or the “unlawful application of force

Negligence is harm caused by a doctor’s failing to correctly discharge their duty of care.

496
Q

Explain what is meant by the Bolam test

A

The Bolam test is a legal mechanism for determining a doctor’s liability in the context of a negligence claim.

497
Q

3 elements that are required in order to bring a successful negligence claim

A

Duty of care: whenever one can reasonably foresee that one’s conduct may cause harm to another

Breach of duty: the claimant must show that the defendant fell below the required standard of care

Causation: the claimant must establish that (s)he would not have come to harm but for the actions of the doctor

498
Q

What are the two definitions of death that are relevant to organ donation

A

Brain stem death: irreversible cessation of brain stem function

Circulatory death: irreversible cessation of cardiorespiratory function

499
Q

What is the acid test?

A

How to decide whether someone is being deprived of liberties (by lady hale)

Objective - Person must be under continuous supervision and control and not free to leave
Subjective - Person lacks capacity to consent to their living arrangements

500
Q

Describe and explain an ethical consideration that might be relevant when considering implementing a screening programme.

A

Respecting patient autonomy.
This may require that patients are given the freedom to decide whether to participate in a screening programme, given enough information to make an informed choice, and in an environment where they are free from coercion (e.g. pressure from the treating clinician).

501
Q

Define a schema

A

A cohesive, repeatable action sequence possessing component actions that are tightly interconnected and governed by a core meaning.

502
Q

2 ways that child builds up knowledge

A

Assimilation - An existing schema works well for a new situation so new knowledge is assimilated into existing schema

Accomodation - No exisiting schema fits the new situation, so schema must be altered to accommodate new informtion.

503
Q

Factors affecting concordance

A 
Patient centred
Therapy related
Social and economic 
Healthcare system
Disease
504
Q

Define attribution bias

A

We attribute our errors to situational factors but others errors to character flaws

505
Q

What’s meant by discounting of disconfirmatory evidence?

A

Tendency to stick with a diagnosis once it’s been chosen even when conflicting information comes in

506
Q

What is availability bias?

A

Tending to come up with a solution that happens to be on your mind

507
Q

What is affective bias?

A

Basing your decisions on emotional reaction to a patient

508
Q

What is meant by the danger space in the neck?

What is its significance?

A

Potential space between the alar fascia and prevertebral fascia that communicates with the posterior mediastinum to diaphragm level

509
Q

What do the carotid sinus and carotid body sense?

A

Carotid sinus senses pressure

Carotid body senses mainly PO2 and PCO2

510
Q

What are the B symptoms of lymphoma

A 
Night sweats
Fever
Weight loss
Persistent tiredness
N+V
511
Q

3 signs which would be relevant to lymphoma

A 
Hepatomegaly
Splenomegaly
Anaemia
Other palpable lymph nodes
Systemic features (fever, anorexia)
512
Q

3 features of a breast lump that could be indicative of breast cancer

A 
Firmness or hard irregularity
Tethering
Lymphadenopathy 
Nipple changes
Ulceration of breast
Peau d'orange
513
Q

Give a medical treatment for ectopic pregnancy

A

Methotrexate

Avoid pregnancy because of persisting teratogenic effect on foetus

514
Q

Two predisposing causes for ectopic pregnancy

A

PID
IUD
Tubal/gynaecological surgery

515
Q

What hormone is measured in early pregnancy and what is its function

A

hCG

Acts on corpus luteum to secrete oestrogen and progesterone

516
Q

What scoring system is used for acute pancreatitis?

A 
Glasgow-Imrie
PaO2 <8kPa
Age >55
Neutrophils >15
Ca2+ <2
Renal: Urea >16
Enzymes: LDH >600
Albumin <32g/L
Sugar: Glucose >10mmol/L
517
Q

Two systemic manifestations of gonorrhoea

A

Skin rash - erythema nodosum
Eye problems - keratoconjunctivitis
Joint problems - Reactive Arthritis

518
Q

Symptoms of hyponatraemia

A 
Gait instability
Concentration and cognitive deficits
Headache
Vomiting
Drowsiness
Seizures
519
Q

Which murmur is most associated with AF

A

Mitral Stenosis

520
Q

Boundaries of the neck

A

Superior boundary
- Inferior mandible and base of skull

Inferior boundary
- Manubrium, clavicle and actinium to spinous process of C7

521
Q

Three clinical signs on abdominal examination that would be elicited in a patient with ascites

A 
Shifting dullness
Fullness in flanks
Fluid thrill
Herniae
Dilated superficial abdominal veins
522
Q

Boundaries of carotid triangle

A

Ant - omohyoid (sup. belly)
Sup - Digastric (pos. belly)
Post - SCM

523
Q

Submandibular triangle borders

A

Sup - Inferior border of mandible

Inf - Digastric (ant. and post. bellies)

524
Q

Where is the lower back

A

Area in between base of 12th ribs, buttock creases and mid axillary line

525
Q

What is the mental capacity act 2005?

A

Sets out legal framework for making decisions for people who lack capacity to make decisions for themselves

526
Q

5 key principles of MCA

A 
Assume capacity unless proven otherwise
Unwise decision doesn't mean lack of capacity
Best interests 
All practicable help given
Least restrictive
527
Q

Features of subcortical dementia

A

Apathetic
Forgetful and slow
Impaired visuospatial abilities
Depression of mood

528
Q

Features of cortical dementia

A

Higher cortical abnormalities
Dysphasia
Agnosia
Apraxia

529
Q

2 examples of subcortical dementia and 2 examples of cortical

A

Subcortical

  • HD
  • Parkinson’s
  • Normal pressure hydrocephalus

Cortical

  • Alzheimers
  • Creutzfeld-Jakob disease
  • Frontotemporal dementia
530
Q

What is the most common infectious organism responsible for bronchiolitis?

A

Respiratory syncytial virus (RSV)

531
Q

What test should be used to confirm a diagnosis of gestational diabetes?

A

2 hour OGTT - value of 7.8mmol/L or above is diagnostic

532
Q

Give 3 risk factors for a woman developing gestational diabetes

A

BMI > 30
Previous gestational diabetes
FHx of diabetes mellitus

533
Q

3 complications of gestational diabetes in mother/baby/foetus

A

Shoulder dystocia
Macrosomia
Higher risk of preeclampsia and later diabetes

534
Q

What is the target range of fasting blood glucose for women with gestational diabetes?

A

5.3mmol/L

535
Q

What foetal investigations should be offered to mothers with gestational diabetes?

A

USS for foetal growth and amniotic fluid volume - every 4 weeks from 28 to 36 weeks

USS for congenital malformations should be offered at 20 weeks

536
Q

What does NICE recommend post partum for women who had gestational diabetes?

A

Women should be offered lifestyle advice and offered a fasting plasma glucose measurement but not a OGTT

537
Q

4 causes of azoospermia

A

Vasectomy
Hypogonadism
Undescended testes
Anti-sperm antibodies

538
Q

Give 2 further investigations to help assess cause of azoospermia

A

Serum LH

Serum FSH

539
Q

Two options for a couple who are infertile due to azoospermia

A

Adoption

Donor insemination

540
Q

Give 2 risk factors for developing psoriasis

A

Drugs e.g. Lithium, beta blockers, alcohol
Genetic link - first degree relative suffering from it
Stress

541
Q

What is the Koebner phenomenon?

What conditions is it associated with?

A

It is the development of a skin lesion at the site of an injury

Occurs in psoriasis, vitiligo, lichen plants, viral warts

High yield (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions