Incorrect qs Flashcards
What is the triad of shaken bby syndrome?
retinal haemorrhage
subdural haematoma
encephalopathy
What CN palsy can uncontrolled diabetes present in? Which feature is missing in the presentation?
III
no involvement of pupils
due to small vessel damage supplying the nerve
What are the causes of microcephaly?
normal variation
familial
congenital infection
perinatal brain injury e.g. HIE
fetal alcohol syndrome
Patau syndrome
craniosynostosis
What is a craniopharyngioma? What can is cause? What visual field defect is it a/w?
benign tumour which grows near the pit gland
can cause diabetes insipidus
a/w lower bitemporal hemianopia
What does an acute on chronic subdural haematoma look like on CT?
swirl sign of dark blood surrounded by bright blood
What is a complication of chickenpox? How does it present? How is it managed?
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
How often should lithium be monitored?
when started/dose changed: once a week
once established: 3 monthly
always 12hrs after last dose
What levels should be monitored in a patient taking lithium?
U&Es + TFTs every 6mo
How is acute stress disorder and PTSD differentiated? What is the difference in 1st line tx?
PTSD >4wks after the event
acute stress disorder > trauma focussed CBT
PTSD > EMDRT
1st line tx for microcytic anaemia during pregnancy?
trial of oral iron
further ivx if no rise in Hb in 2wks
What is the preferred imaging modality for a suspected TIA?
if RFs for bleeding eg anti-coag/bleeding disorder > urgent CT
most-sensitive otherwise = diffusion weighted MRI
as likely no infarction just ischaemic changes
How is post-partum thyroiditis managed?
= self-resolving
if in the thyrotoxic phase > symptomatic tx > propanolol
What lifestyle factors can increase clozapine blood levels?
smoking cessation
alcohol binges
Which blood thinning medications are CI in pregnancy? What is the only alternative?
NOAC eg rivaroxaban (placental haemorrhage)
warfarin (warfarin embryopathy)
alternative = LMWH
What fasting plasma glucose levels trigger what treatment for GD?
7+ = insulin +/- metformin
<7 = trial of diet and exercise first, review in 1-2 weeks
What is a teratoma? What is the key US sign of one?
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
What is the triad of DKA?
acidaemia (metabolic acidosis)
hyperglycaemia
ketonaemia
What is the monospot test?
tests for infectious mononucleosis caused by EBV
Where are the sanctuary sites from chemotherapy in the body?
CNS (due to BBB) + testes
What is the management of sickle cell disease?
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)
What is included in a clotting screen?
PT
APTT (activated partial thromboplastin time)
fibrinogen
How does Haemophilia A/B present in a child?
x-linked recessive > only boys
easy bruising
bleeding into muscles/joints
extensive bleeding after surgery
How does VWD present in a child?
boys + girls
bleeding from mucous membranes eg gums, nosebleeds, menorrhagia
When there is cellular injury, what part of the clotting cascade is released?
tissue factor (1st component of extrinsic pathway)
What can cause septic arthritis?
most commonly - bacterial infection with haematological spread
can occur following a skin would eg chickenpox scar
Systemic B symptoms are seen in which 2 conditions? What are they?
night sweats + weight loss + unexplained fever
lymphoma + HIV
What are the 5 key RFs for DDH?
female
high birth weight
prematurity
breech birth
oligohydramnios
Which 2 bowel conditions is Down’s a/w?
duodenal atresia
Hirschsprung’s
Patients cannot eat cheese when taking which drugs? Why?
MAOi eg phenelzine
CHEESE EFFECT > high in tyramine which interacts with MAOi > acute attack of HTN
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) atypical antipsychotic
b) atypical antipsychotic + SSRI, usually olanzapine or fluoxetine
c) lithium
d) lithium + valproate (except in child-bearing age women)
What drugs are used for a) alcohol detox and b) maintenance of detox?
a) long acting benzo eg chlorodiazepoxide
b) acamprosate + disulfiram 6-12mo after abstinence started to prevent relapse + thiamine to replenish B1
Name short, intermediate and long acting benzos?
<5hrs: ATOM - alprazolam, triazolam, oxazepam, midazolam
5-24hrs: TLC - temazepam, lorazepam, clonazepam
> 24hrs: CDeF - clorazepate, chlorodiazepoxide, diazepam, flurazepam
What is the triad of serotonin syndrome?
neuromuscular excitability
autonomic dysfunction (hypo/hypertension)
altered mental state
Which ADs are best avoided in a patient with depression and a hx of overdose?
tricyclics + venlafaxine = very toxic in overdose
Patients with depression are referred to psych when?
unresponsive to tx
high suicide risk
recurrent depression unsuccessfully managed in primary care
Which drugs are stimulants? What are their main effects?
cocaine
MDMA (ecstasy)
methamphetamine
khat
nicotine
increase pulse/RR/BP, dilate pupils, decrease appetite
Which drugs are hallucinogens?
LSD
ketamine
magic mushrooms
peyote cactus
(Cannabis + ecstasy can also have hallucinogenic properties)
What is the action of antipsychotics?
block postsynaptic dopamine D2 receptors > block the 4 dopaminergic pathways > blockage of mesolimbic pathway = antipsychotic
effect on other pathways = SEs
What is a threatened miscarriage?
ongoing pregnancy with vaginal bleeding
closed cervix
What is an inevitable miscarriage?
vaginal bleeding with open cervical os
When is early and late miscarriage defined?
<12 wks = early
12-24 wks = late
How is PID managed?
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
What is the best way of monitoring fetal growth on US?
abdominal circumference
When is symphysis fundal height a useful measure of fetal growth?
after 24wks in singleton pregnancies
How is stress incontinence treated?
- 3 months of pelvic floor training
- duloxetine (lots of MH SEs) or surgery eg retropubic mid-urethral tape
How is urge incontinence treated?
- bladder retraining
- oxybutynin
What is the treatment pathway for endometriosis?
- COCP
- IUS
- GnRH antagonist to suppress ovarian oestrogen production
- laparoscopy/hysterectomy
What is the first step in management of a pregnancy of unknown location?
repeat bHCG in 48hrs
How would bHCG change in an intrauterine pregnancy, ectopic and miscarriage?
bHCG doubles > intrauterine
rises but doesn’t double > ectopic
falls by half+ > miscarriage
What are the fetal complications of maternal chlamydia infection?
chorioamnionitis > PROM
vaginal delivery > neonatal conjunctivitis + pneumonia
What are the infectious causes of neonatal meningoencephalitis?
group B strep (vaginal commensal in mother)
herpes
How does pseudogout and gout present differently on aspiration?
pseudogout = positively birefringent crystals
gout = negatively birefringent needles
Define acute liver failure
encephalopathy + deranged coagulation in a person with a previously normal liver
What are some causes of acute liver failure?
viruses eg VZV, HSV, Hep A (never bacterial)
paracetamol overdose
pre-eclampsia developed into HELLP syndrome
fructose intolerance
Define postural hypotension
systolic drop >20mmHg
lay/sit still for 5 minutes and then stand
measure at 1 and 3 mins
How is an MI and aortic dissection distinguished?
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
How does heart block present?
chest pain
presyncopal sx, syncope
SoB
What are the signs of a PE on CXR and ECG?
fleischner sign - dilated central pulmonary vessel
westermark sign - collapse of vasculature distal to PE
hampton’s hump - wedge shaped infarct
sinus tachycardia +/- ST depression
How does pericarditis present?
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
How is pericarditis treated?
NSAIDs
+/- low dose colchicine if recurrent/continued for >14 days
How does pericarditis present?
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
How does B12 deficiency anaemia present?
low Hb, high MCV + MCH
a/w thrombocytopenia + leukopenia, in severe cases = pancytopaenia
MCV can be normal if there is co-existing IDA
How does sickle cell anaemia present?
possibly raised MCV due to reticulocytosis
high WCC
What is the treatment for each type of epilepsy?
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
Which anti-epileptic can exacerbate absence seizures?
carbamazepine
What is the most common type of brain tumour?
mets
from bronchi (most common), breast, bowel, bin, bidney
What are the two most common type of primary brain tumour in adults? How do they present on imaging?
- glioblastoma = poor prognosis
solid tumour with central necrosis + contrast-enhancing rim - meningioma = benign
extra-axial with well-defined border between tumour + parenchyma, often at falx cerebri/superior sagittal sinus/convexity/skull base
What are 3 paediatric brain tumours
- pilocytic astrocytoma - benign, most common
histology - rosenthal fibres - craniopharnygioma - benign
solid/cystic tumour of the sellar region from Rathke’s pouch, presents with hormonal disturbance/ disturbance
How should a child with DKA who is clinically dehydrated be treated?
IV fluids (0.9% NaCl 10ml/kg) over 48hrs (rapid correction can lead to cerebral oedema)
+ SC insulin (0.1 units/kg/hr)
How will bloods and urine in DKA present?
hyperglycaemia
metabolic acidosis
ketonaemia
hyperkalaemia (comes down with fluids/insulin - monitor for low K+)
mildly elevated Na + creatinine if dehydrated
What are the 4C’s of measles?
cranky
cough
coryza
conjunctivitis
Koplik spots - on buccal mucosa
Where does a measles rash generally start?
behind ears and spreads downwards
Which medications can cause SJS?
abx
allopurinol
anti-epileptics
+ viral infections
What is juvenile myoclonic epilepsy?
myoclonic jerks up to 2hrs after waking
periods of absence which disrupt schooling, learning normal
10-20yrs at onset
What is benign rolandic epilepsy?
focal seizures with abnormal sensation in tongue/face
interferes with speech, drooling
may also happen in sleep - these often progress to tonic clonic seizures
What is Lennox-Gastaut syndrome?
age of onset 1-3yrs
mix of seizures, especially atonic and tonic
neuro-developmental arrest or aggression
How to investigate a child with first-time seizures?
EEG and follow up
MRI if unclear/atypical features (then CT)
Don’t start anti-epileptics before knowing sub-type
What are the 4 key complications of chickenpox?
bacterial superinfection
cerebellitis
DIC
progressive disseminated disease
How does bacterial versus viral meningitis present on LP?
Bacterial meningitis - turbid appearance, raised polymorphs, raised protein, low glucose
Viral meningitis - clear appearance, raised lymphocytes, normal/raised protein, normal/low glucose
What are the 2 cardinal sx of wilm’s tumour?
abdominal mass
painless haematuria
How does Kallman syndrome present?
delayed onset puberty + no facial/pubic hair
small penis and testes
reduced sense of smell
poor balance
learning disabilities
What are the extra-pyramidal side effects caused by anti-psychotics?
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
How can EPSEs of anti-psychotics be treated?
anti-cholinergic (due to increased cholinergic neurotransmission) eg procyclidine
tardive dyskinesia treated with tetrabenazine
Which APs cause EPSEs?
do not occur with clozapine
less likely + less prominent with atypical APs
What are the time scales for PTSD tx?
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
What drugs are used for opiate detoxification?
methadone or buprenorphine
2nd line = lofexidine (preference or mild/uncertain dependance)
How is delirium tremends managed
hospital admission
1st = oral lorazepam
2nd = haloperidol or IV lorazepam
What is the 2nd line pharmacological tx for OCD?
- SSRI
- another ssri or clomipramine (TCA with anti-obsessional properties - if had adequate trial of 1+ SSRI and has preference for/against trying another SSRI)
How are PHQ scores interpreted?
5, 10, 15, 20 cut offs for mild, mod, mod severe and severe
How are GAD scores interpreted?
5, 10, 15 cut offs for mild, mod and severe
What are the side effects of SSRIs?
hyponatraemia (due to SIADH)
long QT syndrome
short term increase in risk of suicide - monitor every 2-4 weeks for first 3 mo
What is considered an adequate trial of an SSRI before changing?
4 weeks
For how long after a depressive episode should a patient continue taking ADs?
1st time = 6 mo
2+ episodes = 2 years
How often should people on clozapine after blood tests initially?
every week for 18wks
then fortnightly until 1 yr
monthly after this
