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Phase 3a > Incorrect qs > Flashcards

Incorrect qs Flashcards

1
Q

What is the triad of shaken bby syndrome?

A

retinal haemorrhage
subdural haematoma
encephalopathy

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2
Q

What CN palsy can uncontrolled diabetes present in? Which feature is missing in the presentation?

A

III
no involvement of pupils

due to small vessel damage supplying the nerve

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3
Q

What are the causes of microcephaly?

A

normal variation
familial

congenital infection
perinatal brain injury e.g. HIE
fetal alcohol syndrome
Patau syndrome
craniosynostosis

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4
Q

What is a craniopharyngioma? What can is cause? What visual field defect is it a/w?

A

benign tumour which grows near the pit gland

can cause diabetes insipidus
a/w lower bitemporal hemianopia

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5
Q

What does an acute on chronic subdural haematoma look like on CT?

A

swirl sign of dark blood surrounded by bright blood

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6
Q

What is a complication of chickenpox? How does it present? How is it managed?

A

invasive group A streptococcal soft tissue infections eg necrotising fasciitis

rapidly evolving rash with disproportionate pain +/- blue discolouration of skin

very broad spec abx until sensitivities known

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7
Q

How often should lithium be monitored?

A

when started/dose changed: once a week
once established: 3 monthly

always 12hrs after last dose

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8
Q

What levels should be monitored in a patient taking lithium?

A

U&Es + TFTs every 6mo

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9
Q

How is acute stress disorder and PTSD differentiated? What is the difference in 1st line tx?

A

PTSD >4wks after the event

acute stress disorder > trauma focussed CBT
PTSD > EMDRT

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10
Q

1st line tx for microcytic anaemia during pregnancy?

A

trial of oral iron

further ivx if no rise in Hb in 2wks

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11
Q

What is the preferred imaging modality for a suspected TIA?

A

if RFs for bleeding eg anti-coag/bleeding disorder > urgent CT

most-sensitive otherwise = diffusion weighted MRI
as likely no infarction just ischaemic changes

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12
Q

How is post-partum thyroiditis managed?

A

= self-resolving

if in the thyrotoxic phase > symptomatic tx > propanolol

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13
Q

What lifestyle factors can increase clozapine blood levels?

A

smoking cessation
alcohol binges

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14
Q

Which blood thinning medications are CI in pregnancy? What is the only alternative?

A

NOAC eg rivaroxaban (placental haemorrhage)
warfarin (warfarin embryopathy)

alternative = LMWH

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15
Q

What fasting plasma glucose levels trigger what treatment for GD?

A

7+ = insulin +/- metformin
<7 = trial of diet and exercise first, review in 1-2 weeks

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16
Q

What is a teratoma? What is the key US sign of one?

A

benign neoplasms derived from multiple germ cell layers
range of tissues can be produced within them eg skin, hair, blood, fat, bone, nails, teeth
inner lining contains white shiny masses projecting from the wall toward the centre of the cyst = Rokitansky protuberance seen on US

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17
Q

What is the triad of DKA?

A

acidaemia (metabolic acidosis)
hyperglycaemia
ketonaemia

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18
Q

What is the monospot test?

A

tests for infectious mononucleosis caused by EBV

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19
Q

Where are the sanctuary sites from chemotherapy in the body?

A

CNS (due to BBB) + testes

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20
Q

What is the management of sickle cell disease?

A

prophylactic penicillin (most will have had a splenectomy)
hydroxycarbamide (prevent vaso-occlusive complications)
blood transfusions (if severely anaemic/reduce proportion of Hbs)

stem cell transplant = curative (but high risk)

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21
Q

What is included in a clotting screen?

A

PT
APTT (activated partial thromboplastin time)
fibrinogen

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22
Q

How does Haemophilia A/B present in a child?

A

x-linked recessive > only boys

easy bruising
bleeding into muscles/joints
extensive bleeding after surgery

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23
Q

How does VWD present in a child?

A

boys + girls

bleeding from mucous membranes eg gums, nosebleeds, menorrhagia

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24
Q

When there is cellular injury, what part of the clotting cascade is released?

A

tissue factor (1st component of extrinsic pathway)

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25
Q

What can cause septic arthritis?

A

most commonly - bacterial infection with haematological spread

can occur following a skin would eg chickenpox scar

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26
Q

Systemic B symptoms are seen in which 2 conditions? What are they?

A

night sweats + weight loss + unexplained fever

lymphoma + HIV

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27
Q

What are the 5 key RFs for DDH?

A

female
high birth weight
prematurity
breech birth
oligohydramnios

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28
Q

Which 2 bowel conditions is Down’s a/w?

A

duodenal atresia
Hirschsprung’s

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29
Q

Patients cannot eat cheese when taking which drugs? Why?

A

MAOi eg phenelzine

CHEESE EFFECT > high in tyramine which interacts with MAOi > acute attack of HTN

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30
Q

What is the tx for bipolar disorder in a) acute manic/mixed episode b) depressive episode and c) long-term maintenance and d) long-term maintenance has not worked?

A

a) atypical antipsychotic
b) atypical antipsychotic + SSRI, usually olanzapine or fluoxetine
c) lithium
d) lithium + valproate (except in child-bearing age women)

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31
Q

What drugs are used for a) alcohol detox and b) maintenance of detox?

A

a) long acting benzo eg chlorodiazepoxide
b) acamprosate + disulfiram 6-12mo after abstinence started to prevent relapse + thiamine to replenish B1

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32
Q

Name short, intermediate and long acting benzos?

A

<5hrs: ATOM - alprazolam, triazolam, oxazepam, midazolam

5-24hrs: TLC - temazepam, lorazepam, clonazepam

> 24hrs: CDeF - clorazepate, chlorodiazepoxide, diazepam, flurazepam

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33
Q

What is the triad of serotonin syndrome?

A

neuromuscular excitability
autonomic dysfunction (hypo/hypertension)
altered mental state

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34
Q

Which ADs are best avoided in a patient with depression and a hx of overdose?

A

tricyclics + venlafaxine = very toxic in overdose

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35
Q

Patients with depression are referred to psych when?

A

unresponsive to tx
high suicide risk
recurrent depression unsuccessfully managed in primary care

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36
Q

Which drugs are stimulants? What are their main effects?

A

cocaine
MDMA (ecstasy)
methamphetamine
khat
nicotine

increase pulse/RR/BP, dilate pupils, decrease appetite

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37
Q

Which drugs are hallucinogens?

A

LSD
ketamine
magic mushrooms
peyote cactus

(Cannabis + ecstasy can also have hallucinogenic properties)

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38
Q

What is the action of antipsychotics?

A

block postsynaptic dopamine D2 receptors > block the 4 dopaminergic pathways > blockage of mesolimbic pathway = antipsychotic
effect on other pathways = SEs

39
Q

What is a threatened miscarriage?

A

ongoing pregnancy with vaginal bleeding
closed cervix

40
Q

What is an inevitable miscarriage?

A

vaginal bleeding with open cervical os

41
Q

When is early and late miscarriage defined?

A

<12 wks = early
12-24 wks = late

42
Q

How is PID managed?

A

start 14d abx immediately before return of swabs
treat broad spec: doxycycline, metronidazole + IM ceftriaxone
leave in recently inserted coil - remove after 72hrs if no improvement and give other emergency contraceptive

43
Q

What is the best way of monitoring fetal growth on US?

A

abdominal circumference

44
Q

When is symphysis fundal height a useful measure of fetal growth?

A

after 24wks in singleton pregnancies

45
Q

How is stress incontinence treated?

A
  1. 3 months of pelvic floor training
  2. duloxetine (lots of MH SEs) or surgery eg retropubic mid-urethral tape
46
Q

How is urge incontinence treated?

A
  1. bladder retraining
  2. oxybutynin
47
Q

What is the treatment pathway for endometriosis?

A
  1. COCP
  2. IUS
  3. GnRH antagonist to suppress ovarian oestrogen production
  4. laparoscopy/hysterectomy
48
Q

What is the first step in management of a pregnancy of unknown location?

A

repeat bHCG in 48hrs

49
Q

How would bHCG change in an intrauterine pregnancy, ectopic and miscarriage?

A

bHCG doubles > intrauterine
rises but doesn’t double > ectopic
falls by half+ > miscarriage

50
Q

What are the fetal complications of maternal chlamydia infection?

A

chorioamnionitis > PROM
vaginal delivery > neonatal conjunctivitis + pneumonia

51
Q

What are the infectious causes of neonatal meningoencephalitis?

A

group B strep (vaginal commensal in mother)
herpes

52
Q

How does pseudogout and gout present differently on aspiration?

A

pseudogout = positively birefringent crystals
gout = negatively birefringent needles

53
Q

Define acute liver failure

A

encephalopathy + deranged coagulation in a person with a previously normal liver

54
Q

What are some causes of acute liver failure?

A

viruses eg VZV, HSV, Hep A (never bacterial)
paracetamol overdose
pre-eclampsia developed into HELLP syndrome
fructose intolerance

55
Q

Define postural hypotension

A

systolic drop >20mmHg
lay/sit still for 5 minutes and then stand
measure at 1 and 3 mins

56
Q

How is an MI and aortic dissection distinguished?

A

AD: maximally painful at time of onset, migration of pain caudally, weak L sided pulse, HTN is biggest RF

MI: builds in intensity from onset

57
Q

How does heart block present?

A

chest pain
presyncopal sx, syncope
SoB

58
Q

What are the signs of a PE on CXR and ECG?

A

fleischner sign - dilated central pulmonary vessel
westermark sign - collapse of vasculature distal to PE
hampton’s hump - wedge shaped infarct

sinus tachycardia +/- ST depression

59
Q

How does pericarditis present?

A

rapid onset severe sharp pleuritic chest pain in L anterior chest and radiating down arm, relieved by sitting forward and made worse lying down
SoB
illness preceeding

60
Q

How is pericarditis treated?

A

NSAIDs
+/- low dose colchicine if recurrent/continued for >14 days

61
Q

How does pericarditis present?

A

rapid onset severe sharp pleuritic chest pain in L anterior chest and radiating down arm, relieved by sitting forward and made worse lying down
SoB
illness preceding

62
Q

How does B12 deficiency anaemia present?

A

low Hb, high MCV + MCH
a/w thrombocytopenia + leukopenia, in severe cases = pancytopaenia

MCV can be normal if there is co-existing IDA

63
Q

How does sickle cell anaemia present?

A

possibly raised MCV due to reticulocytosis
high WCC

64
Q

What is the treatment for each type of epilepsy?

A

generalised tonic-clonic: males - sodium valproate females - lamotrigine/levetiracetam

focal:
lamotrigine/levetiracetam
2nd line: carbamazepine/zonisamide

absence:
ethosuximide
2nd line: males - SV, females - lam/lev

myoclonic:
males - SV
females - lev

tonic/atonic:
males - SV
females - lam

65
Q

Which anti-epileptic can exacerbate absence seizures?

A

carbamazepine

66
Q

What is the most common type of brain tumour?

A

mets

from bronchi (most common), breast, bowel, bin, bidney

67
Q

What are the two most common type of primary brain tumour in adults? How do they present on imaging?

A
  1. glioblastoma = poor prognosis
    solid tumour with central necrosis + contrast-enhancing rim
  2. meningioma = benign
    extra-axial with well-defined border between tumour + parenchyma, often at falx cerebri/superior sagittal sinus/convexity/skull base
68
Q

What are 3 paediatric brain tumours

A
  1. pilocytic astrocytoma - benign, most common
    histology - rosenthal fibres
  2. craniopharnygioma - benign
    solid/cystic tumour of the sellar region from Rathke’s pouch, presents with hormonal disturbance/ disturbance
69
Q

How should a child with DKA who is clinically dehydrated be treated?

A

IV fluids (0.9% NaCl 10ml/kg) over 48hrs (rapid correction can lead to cerebral oedema)
+ SC insulin (0.1 units/kg/hr)

70
Q

How will bloods and urine in DKA present?

A

hyperglycaemia
metabolic acidosis
ketonaemia
hyperkalaemia (comes down with fluids/insulin - monitor for low K+)

mildly elevated Na + creatinine if dehydrated

71
Q

What are the 4C’s of measles?

A

cranky
cough
coryza
conjunctivitis
Koplik spots - on buccal mucosa

72
Q

Where does a measles rash generally start?

A

behind ears and spreads downwards

73
Q

Which medications can cause SJS?

A

abx
allopurinol
anti-epileptics

+ viral infections

74
Q

What is juvenile myoclonic epilepsy?

A

myoclonic jerks up to 2hrs after waking
periods of absence which disrupt schooling, learning normal
10-20yrs at onset

75
Q

What is benign rolandic epilepsy?

A

focal seizures with abnormal sensation in tongue/face
interferes with speech, drooling
may also happen in sleep - these often progress to tonic clonic seizures

76
Q

What is Lennox-Gastaut syndrome?

A

age of onset 1-3yrs
mix of seizures, especially atonic and tonic
neuro-developmental arrest or aggression

77
Q

How to investigate a child with first-time seizures?

A

EEG and follow up
MRI if unclear/atypical features (then CT)

Don’t start anti-epileptics before knowing sub-type

78
Q

What are the 4 key complications of chickenpox?

A

bacterial superinfection
cerebellitis
DIC
progressive disseminated disease

79
Q

How does bacterial versus viral meningitis present on LP?

A

Bacterial meningitis - turbid appearance, raised polymorphs, raised protein, low glucose

Viral meningitis - clear appearance, raised lymphocytes, normal/raised protein, normal/low glucose

80
Q

What are the 2 cardinal sx of wilm’s tumour?

A

abdominal mass
painless haematuria

81
Q

How does Kallman syndrome present?

A

delayed onset puberty + no facial/pubic hair
small penis and testes
reduced sense of smell
poor balance
learning disabilities

82
Q

What are the extra-pyramidal side effects caused by anti-psychotics?

A

due to D2 receptor blockade in the nigrostriatal pathways

parkinsonism
acute dystonia (long-term = tardive dyskinesia) - bizarre body movements eg tongue protrusion, torticollis, oculogyric crisis
akasthisia - restlessness

83
Q

How can EPSEs of anti-psychotics be treated?

A

anti-cholinergic (due to increased cholinergic neurotransmission) eg procyclidine

tardive dyskinesia treated with tetrabenazine

84
Q

Which APs cause EPSEs?

A

do not occur with clozapine
less likely + less prominent with atypical APs

85
Q

What are the time scales for PTSD tx?

A

1st line = trauma focussed CBT (at least 1mo after trauma)
active monitoring if present <1mo after trauma

EMDR = presented between 1 and 3mo, non-combat trauma, prefer EMDR over CBT

86
Q

What drugs are used for opiate detoxification?

A

methadone or buprenorphine
2nd line = lofexidine (preference or mild/uncertain dependance)

87
Q

How is delirium tremends managed

A

hospital admission
1st = oral lorazepam
2nd = haloperidol or IV lorazepam

88
Q

What is the 2nd line pharmacological tx for OCD?

A
  1. SSRI
  2. another ssri or clomipramine (TCA with anti-obsessional properties - if had adequate trial of 1+ SSRI and has preference for/against trying another SSRI)
89
Q

How are PHQ scores interpreted?

A

5, 10, 15, 20 cut offs for mild, mod, mod severe and severe

90
Q

How are GAD scores interpreted?

A

5, 10, 15 cut offs for mild, mod and severe

91
Q

What are the side effects of SSRIs?

A

hyponatraemia (due to SIADH)
long QT syndrome
short term increase in risk of suicide - monitor every 2-4 weeks for first 3 mo

92
Q

What is considered an adequate trial of an SSRI before changing?

A

4 weeks

93
Q

For how long after a depressive episode should a patient continue taking ADs?

A

1st time = 6 mo
2+ episodes = 2 years

94
Q

How often should people on clozapine after blood tests initially?

A

every week for 18wks
then fortnightly until 1 yr
monthly after this

Phase 3a (11 decks)

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