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Formative > January Formative > Flashcards

January Formative Flashcards

1
Q

Initial loss of consciousness following a blunt force head injury, followed by a lucid period, before further deterioration

A

Extradural haematoma

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2
Q

Older patient, low-impact trauma to the head. Causes progressive headache and confusion

A

Subdural haematoma

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3
Q
  • Ruptured berry aneurysm (or severe trauma)
  • Sudden onset symptoms: thunderclap headache (time taken from beginning of headache to its maximum pain is seconds), meningism, loss of consciousness
A

Subarachnoid haemorrhage

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4
Q

Subdural haemorrhage CT findings

A

Hypodense crescent-shaped appearance

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5
Q

Subarachnoid haemorrhage CT findings

A

Hyperdense signal in the subarachnoid
space

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6
Q

Extradural haemorrhage CT findings

A

Hyperdense biconvex lens appearance

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7
Q

Multiple sclerosis CSF finding ?

A

IgG oligoclonal bands

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8
Q

Tau proteins and amyloid proteins in CSF - diagnosis ?

A

Alzheimer’s

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9
Q

Xanthochromia in CSF - diagnosis ?

A

Subarachnoid haemorrhage

(Yellow/pink discolouration due to haemoglobin catabolism)

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10
Q

Which amino acid is overly expressed in Huntington’s disease?

A

Glutamate

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11
Q

Early clinical signs = clumsiness, agitation, and abnormal eye movements.
Later clinical signs = choreiform (irregular, involuntary) movements, bradykinesia, rigidity, speech and swallowing impairment, and weight loss.

Diagnosis ?

A

Huntington’s

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12
Q

Muscle fasciculations and weakness = LMN or UMN ?

A

LMN

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13
Q

Increased tone and brisk reflexes = LMN or UMN ?

A

UMN

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14
Q

Primary lateral sclerosis = UMN or LMN or both ?

A

UMN only

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15
Q

Amyotrophic lateral sclerosis (ALS) = UMN or LMN or both ?

A

Both UMN and LMN

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16
Q

Progressive muscular atrophy = UMN or LMN or both ?

A

LMN only

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17
Q

Patient presents with muscle fasciculations, weakness, increased tone, and brisk reflexes

Diagnosis ?

A

ALS (both UMN and LMN signs)

+ frontotemporal dementia + thenar atrophy

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18
Q

Reduced jaw and gag reflexes + tongue fasciculations = ?

A

Progressive bulbar palsy

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19
Q

Slow speech + brisk jaw reflex = ?

A

Pseudobulbar palsy

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20
Q

Which medications can cause drug-induced parkinsonism ?

(occurs weeks after starting the drug)

A

Chlorpromazine
Haloperidol
Lithium
Valproic acid
Metoclopramide

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21
Q

Cogwheel rigidity + shuffling gait ?

A

Parkinsonism

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22
Q

Involuntary spasms that begin early after exposure to antipsychotics (hours to days) are called ________ ?

A

Acute dystonic reactions

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23
Q

Medical term for restlessness = ?

A

Akathisia

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24
Q

Repetitive involuntary purposeless movements, usually orofacial
Onset many years after starting typical antipsychotics and the person often is not aware of it.

A

Tardive dyskinesia

(irreversible however it does not harm the person)

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25
Q

Which tract activates the extensor mechanism to prevent falls?

A

Vestibulospinal tract

(from vestibular nuclei of the pons and medulla)

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26
Q

Tract responsible for reflex to visual and auditory stimulus

A

Tectospinal tract

  • originates in the superior colliculus of the
    midbrain and extends down to the cervical spine
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27
Q

Tract responsible for control of breathing and cardiac control

A

Reticulospinal tract

  • originates in the reticular formation in the brainstem
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28
Q

Origin of the vestibulospinal tract ?

A

Vestibular nuclei in the pons and medulla

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29
Q

Path of the tectospinal tract ?

A

Origin = superior colliculus of the midbrain
then extends down to the cervical spine

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30
Q

Origin of the reticulospinal tract ?

A

The reticular formation in the brain stem

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31
Q

Median nerve supplies:

A

LOAF

Lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

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32
Q

Seizures, severe headaches, blurred vision (due to raised ICP)

Can affect adults + children, most commonly in the frontal lobe

  1. What is the diagnosis?
  2. What can be seen on biopsy?
A
  1. Oligodendrocytoma
  2. ‘Fried egg’ appearance
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33
Q
  • Suspected brain tumour
  • Bilateral hemianopia and panhypopituitarism (pale, no axillary hair)
A

Pituitary carcinoma

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34
Q
  • unilateral conductive hearing loss
  • associated with the condition neurofibromatosis
A

Vestibular schwannoma

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35
Q

Transient ischaemic attack (TIA) - which drug is prescribed to minimise the risk of secondary insult ?

A

Aspirin 300mg

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36
Q

Which cranial nerve passes through the cribriform plate ?

A

Olfactory nerve

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37
Q

Which foramen does the vagus nerve pass through ?

A

Jugular foramen

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38
Q

CN VIII - motor/sensory/both ?

A

Vestibulocochlear nerve = sensory

Some say marry money but my brother says big brains matter more

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39
Q

Which foramen does the vestibulocochlear nerve pass through ?

A

Internal acoustic meatus

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40
Q

Which nerve is affected in uncal herniation?

A

Oculomotor

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41
Q

43-year-old has a fixed, dilated left pupil. He admits to hitting his head yesterday during his rugby game. Magnetic resonance imaging reveals a
unilateral descending tentorial herniation.

A

Uncal hernation

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42
Q

What is an uncal herniation?

A

Temporal lobe herniates posteriorly

Impinges on 3rd nerve

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43
Q

What is a subfalcine herniation?

A

One half of the cerebrum herniates across the midline

  • Causes compression of the anterior cerebral artery - - leading to motor and/or sensory weakness.
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44
Q

What is a cerebellar tonsillar herniation?

A

The cerebellum moves inferiorly

This compresses the medulla
- can lead to respiratory distress and death

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45
Q

What is a transcalverial herniation

A

A defect within the skull

Part of the brain herniates out through that opening

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46
Q

What is a central herniation?

A

Central part of the brain is inferiorly compressed towards the brainstem

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47
Q

The proportion of individuals carrying a particular allele of a gene (genotype) that also express the phenotype =

A

Penetrance

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48
Q

The genetic phenomenon which causes each generation to develop the disease at an earlier age =

A

Anticipation

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49
Q

In what conditions does anticipation occur ?

A

Common in trinucleotide repeat disorders

e.g. Huntington’s, myotonic dystrophy

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50
Q

Define ‘transformation’ in genetics

A

The transfer and incorporation of foreign DNA into a host genome

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51
Q

Treatment of Guillain-Barre syndrome?

A

Plasma exchange (removes autoantibodies)

IV Immunoglobulin

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52
Q

Treatment for Lambert-Eaton myasthenic syndrome = ?

A

3,4-diaminopyridine

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53
Q

Bilateral proximal muscle weakness of insidious onset

  • associated with small-cell lung cancer
  • causes reduced or absent reflexes

Diagnosis ?

A

Lambert-Eaton myasthenic syndrome

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54
Q

Anti-voltage-gated calcium channel antibodies = what condition ?

A

Lambert-Eaton myasthenic syndrome

*also do a CT to rule out malignancy

55
Q

Treatment for myasthenia gravis = ?

A

Pyridostigmine + steroids

56
Q

Treatment for chronic inflammatory demyelinating polyradiculoneuropathy = ?

A

Oral steroids

57
Q

Chloroquine - how does it affect myasthenia gravis ?

A

Precipitates or worsens myasthenia gravis

58
Q

Treatment for absence seizure ?

A

Ethosuximide or sodium valproate

*remember sodium valproate shouldn’t be prescribed to women of childbearing age

59
Q

Several sudden lapses of consciousness, stares blankly and rubs fingers together for ten seconds before returning to consciousness.

Diagnosis ?

A

Absence seizures

60
Q

Treatment for generalised tonic-clonic seizures ?

A

1st line = Sodium valproate or lamotrigine

2nd line = Levetiracetam or topiramate

61
Q

Treatment for myoclonic seizures ?

A

1st line = Sodium valproate
2nd line = Levetiracetam

62
Q

Treatment for focal seizures ?

A

Lamotrigine/carbamazepine

63
Q

What drug class is mirtazepine ?

A

Tricyclic antidepressant

64
Q

Side effects of sertaline

A
  • Nausea and headaches
  • Reduces libido
  • Vivid dreams
  • Transient increase in suicidal thoughts
  • Increased anxiety
65
Q

Drug used to combat side effects of SSRIs

A

Mirtazapine
(atypical antidepressant)

66
Q

Which bipolar medication causes hypothyroidism?

A

Lithium

67
Q

Schizotypal vs Schizoid vs Schizophrenic

A
68
Q

Schizotypal =

A
  • Odd thoughts, appearance, behaviour
  • Interpersonal difficulties and social anxiety
    **do not experience hallucinations or delusions
69
Q

Schizoid =

A

Voluntary social isolation and indifference to others

**do not experience hallucinations or delusions
**do not exhibit odd thoughts, appearance or behaviour

70
Q

Histrionic personality disorder =

A
  • Unstable emotions
  • Distorted self-image
  • An overwhelming desire to be noticed
71
Q

Schizoaffective disorder

A

Mood disorder + Psychosis

  • Psychosis appears even when neither manic nor depressed
72
Q

Which antidepressants causes dry mouth, constipation, and weight gain ?

A

Tricyclic antidepressants

(amitriptyline, clomipramine, dosulepin, imipramine, lofepramine, nortriptyline)

73
Q

Treatment for Parkinson-associated delusions

A

Atypical antipsychotics

(Typical antipsychotics exacerbate dopamine receptor antagonism which causes motor symptoms of Parkinsons)

74
Q

What receptors do atypical antipsychotics act on ?

A

Serotonin receptors

75
Q

What receptors do typical antipsychotics act on ?

A

Dopamine receptors

76
Q

1st line for medical-assisted detoxification in alcoholism?

A

Chlordiazepoxide

77
Q

66 y.o., poor memory, slowing of movement and seeing children in his house when nobody is there

Diagnosis ?

A

Parkinson’s

78
Q

Scan for Parkinson’s?

A

Dopamine active transfer (DAT) scan

79
Q

What does a DAT scan involve?

A

Injection of a radioactive tracer (ioflupane) which binds to dopamine transporters.

80
Q

Scan for dementia ?

A

SPECT (Single Photon Emission Computed Tomography) scan

81
Q

Example of a persecutory delusion ?

A

Secret agents following you

82
Q

Examples of a delusion of reference ?

A

Hidden signs in newspapers, on billboards, car registration plates etc.

83
Q

PTSD 1st and 2nd line treatments

A

1st line = trauma-focused CBT
2nd line = SSRIs or venlafaxine

84
Q

High-risk anorexia nervosa features:

A
  • BMI less than 13 with weight loss more than 1kg per week
  • Prolonged QT syndrome, HR less than 40, BP systolic less than 80
  • Core temperature less than 34 ºC
  • Unable to rise from squat without using arms for leverage
  • Cognitive impairment
85
Q

New mother - within 2 weeks:
- sleep disturbances
- confusion
- irrational ideas
- hallucinations
- mania
- delusions

A

Puerperal psychosis
(feature of bipolar disorder !!)

86
Q

Peaked T waves on ECG =

A

Hyperkalaemia
(Tall, tented T waves)

87
Q

No P waves =

A

Heart block

87
Q

Q waves in V1 on ECG =

A

Artifact of previous MI

88
Q

At fast rates, P waves can be difficult to visualise

How do you visualise them ?

A

Vagal manoeuvres or adenosine

89
Q

Supraventricular tachycardia - what rate ?

A

150-220bpm

90
Q

Right border of the heart is mainly which chamber ?

A

Right atrium

91
Q

Medical management of ectopic pregnancy =

A

IM methotrexate

92
Q

1st line surgical management of ectopic pregnancy ?

A

Laparoscopic salpingectomy

93
Q

Dyspareunia =

A

Pain having sex

94
Q

1st line investigation for endometriosis = ?

A

Transvaginal ultrasound

95
Q

Medical management of urge urinary incontinence = ?

A

Oxybutynin

96
Q

Surgical management of stress incontinence = ?

A

Bulking material injection therapy

97
Q

Medical management of urge incontinence in frail patients (concern about anticholinergic effects)

A

Mirabegron

98
Q

Hypertension management in pregnancy

A

Labetalol - contraindicated by asthma
Nifedipine
Methyldopa

99
Q

What pathological process does a cervical smear detect ?

A

Dysplasia

100
Q

Primary vs secondary amenorrhoea

A

Primary = never had period before
Secondary = had periods before

101
Q

Hyperemesis, bleeding and snowstorm appearance on USS

Diagnosis ?

A

Complete molar pregnancy (a.k.a. trophoblastic)

102
Q

Management of complete molar pregnancy ?

A

Surgical removal

+ tissue sent to histology

103
Q

Why is conservative management of molar pregnancy not an option?

A

Risk of choriocarcinoma

104
Q

Abortion induction medication ?

A

Oral mifepristone
then, sublingual misoprostol

105
Q

At what BMI is COCP contraindicated ?

A

> 39

106
Q
  • lower abdominal pain
  • nausea
  • intermittent post-coital bleeding for the past
    2-3 weeks
  • yellow discharge
  • high temperature
A

Pelvic inflammatory disease

107
Q

Most common cause of pelvic inflammatory disease =

A

Chlamydia/gonorrhoea

108
Q

First line investigation for pelvic inflammatory disease ?

A

Vulvo-vaginal swabs for chlamydia/gonorrhoea

109
Q

Treatment for post-partum haemorrhage ?

A

IV synctocinon

110
Q

Histology of ovarian mass shows:
- transitional epithelium (native to the
bladder, not the ovaries)
- coffee bean nuclei

A

Brenner epithelial ovarian tumour

  • often found incidentally during surgery or on pelvic
    examination
111
Q

Adnexa =

A

Ovary + fallopian tube

+ associated vessels and ligaments

112
Q

Hobnail cells on ovarian histology =

A

Clear cell ovarian tumour

113
Q

Endometriosis + chocolate cysts on ovarian histology

A

Endometroid epithelial ovarian tumour

114
Q

Does oestrogen promote or inhibit contractility in labour?

A

Oestrogen promotes contractility

115
Q

Which hormone inhibits contractility in the late stages of pregnancy?

A

Progesterone

116
Q

Primary sclerosing cholangitis = men or women ?

A

Predominantly men

117
Q

Primary biliary cholangitis = men or women ?

A

Women

118
Q

Primary biliary cholangitis signs & symptoms =

A
  • widespread itch with no rash
  • xanthelasma
  • antimitochondrial antibodies
119
Q

Antimitochondrial antibodies positive =

A

Primary biliary cholangitis

120
Q

Barrel chest + hyperresonance on auscultation =

A

Emphysema

121
Q

Fine crepitations, pink frothy sputum and
orthopnoea (dyspnoea when lying flat)

A

Pulmonary oedema

122
Q

Left ventricular failure (caused by pulmonary oedema, evidenced by cardiomegaly)

1st line treatment ?

A

Furosemide

123
Q

Which hallmark of cancer is present in the genetic condition Xeroderma Pigmentosum?

A

Disordered repair mechanism

124
Q

Xeroderma pigmentosum = deficiency in what enzyme ?

A

Endonuclease

  • UV light causes photoproducts to form which bind together and create lesions in DNA strands
  • Endonuclease fixes the hole left in the DNA strand
125
Q

Acute decline after sore throat: earache + fever + difficulty opening mouth

A

Peritonsillar abscess - requires surgery

126
Q

Polycystic kidney disease - what imaging modality ?

A

Ultrasound

127
Q

High creatinine levels indicate …

A

Blocked urinary tract / kidney problems / dehydration

128
Q

Hypovolaemia causing pre-renal AKI

Treatment = ?

A

Fluid challenge with crystalloid

129
Q

Tetralogy of Fallot =

A

PVOH
1. Pulmonary stenosis,
2. Ventricular septal defect
3. Overriding aorta
4. Hypertrophic right ventricle

130
Q

CAGE questionnaire =

A

Alcohol dependence

131
Q

Scale used to diagnose postnatal depression

A

Edinburgh Postnatal Depression Scale

132
Q

Subdural vs extradural CT findings?

A

Subdural = Banana
Extradural = Lemon

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