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Phase 3a > Last minute wrongness > Flashcards

Last minute wrongness Flashcards

1
Q

What are symptoms of digoxin toxicity? (5)

A
  • GI disturbance (N+V, abdo pain)
  • Dizziness
  • Confusion
  • Blurry/yellow vision
  • Arrhythmias
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2
Q

What are possible s/e of anti-cholinergic medications?

A
  • dry eyes
  • constipation
  • dry mouth
  • urinary retention
  • hypotension (postural)
  • delirium
  • hypothermia
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3
Q

What is the definition of postural hypotension?

A

A drop over 20 mmHg in systolic BP, and over 10 mmHg diastolic

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4
Q

What dementia may present with fluctuating cognition?

A

Lewy Body dementia

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5
Q

What scoring system is used in grading pressure ulcer risk?

A

Waterlow score

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6
Q

What medications are associated with a significant increase in mortality in dementia patients?

A

AntiPsychotics

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7
Q

What validated questionnaire can be used to confirm frailty in an individual?

A

PRISMA-7

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7
Q

What is a GP screening tool for dementia?

A

GPCOG

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8
Q

What medications should be avoided in people with dementia?

A

Anticholingerics (TCAs, amitriptyline), Benzos, steroids

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9
Q

What drug class is contraindicated for patients with Parkinsons? How might this affect delirium treatment?

A

Anti-psychotics. Instead, give benzo

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10
Q

What is the first line management of acute delirium if medical interventions are required?

A

IM or oral haloperidol

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11
Q

What management should be considered for patients with type 1 diabetes mellitus and a BMI >25?

A

Metformin in addition to insulin

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12
Q

What additional blood tests are done within the confusion screen (other than just FBC)?

A

TSH, B12, Folate, glucose

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13
Q

What is the long term prophylaxis of cluster headaches?

A

Verapamil

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14
Q

What cranial nerve is responsible for the corneal reflex?

A

5

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15
Q

What cranial nerve is responsible for a downward gaze and vertical diplopia?

A

CN IV

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16
Q

What cranial nerve is responsible for a loss of gag reflex?

A

CN X

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17
Q

In medication overuse headache, what manner should simple analgesia, triptans, and opioid analgesia be withdrawn?

A

Simple analgesia + triptans: stop abruptly
Opioid analgesia: withdraw gradually

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18
Q

What is the most common complication following meningitis?

A

Sensorineural hearing loss

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19
Q

What is the standard target time for thrombectomy in acute ischaemic stroke?

A

6 hours

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20
Q

What is the management for a patient who presents to their GP within 7 days of a clinically suspected TIA?

A

300mg aspirin immediately + specialist review within 24 hours

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21
Q

What is the next steps for bruising in a non-mobile infant?

A

Same day paediatric assessment

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22
Q

What are features which should prompt admission in croup?

A
  • <6 months
  • known upper airway abnormalities
  • frequent barking cough
  • easily audible stridor at rest
  • chest wall retraction (at rest)
  • significant distress, agitation, or lethargy, or restlessness
  • tachycardia
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23
Q

What is the tx and dosage for management of croup?

A

Dexamethasone (0.15mg/kg)

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24
Q

What is the first line treatment for a breastfed baby with GORD? What is first line in a bottle fed baby?

A

Alginate (Gaviscon) for breast fed. Bottle fed: thickened formula

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25
Q

What are the criteria for immediate request for CT scan of the head in children?

A
  • LOC >5 mins (witnessed)
  • amnesia >5 mins
  • abnormal drowsiness
  • three or more discrete episodes of vomiting
  • suspicion of NAI
  • seizure with no hx of epilepsy
  • GCS <14, or if less than <1 year <15
  • sign of open or depressed skull injury
  • sign of basal skill fracture
  • focal neurological deficit
  • dangerous mechanism of injury
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26
Q

What are the most common presentation of neonatal sepsis?

A

Grunting and other signs of respiratory distress

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27
Q

What rate should chest compressions be done for infants and children in paediatric BLS?

A

100-120/min

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28
Q

At what age do women always get a 2 week wait referral for a breast lump?

A

> 30 years

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29
Q

What is the criteria for CT head within 1 hour in adults?

A
  • GCS <13 on initial assessment
  • GCS <15 at 2 hours post injury
  • suspected open or depressed skull fracture
  • any sign of basal skull fracture
  • post trauma seizure
  • focal neurological deficit
  • more than 1 episode of vomiting
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30
Q

What are indications for a head CT within 8 hours of head injury (adults)?

A
  • > 65 years
  • any hx of bleeding or clotting disorders (including anticoagulants)
  • dangerous mechanism of injury
  • > 30 minutes amnesia of events
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31
Q

What is the most common cause of chronic pancreatitis?

A

Alcohol excess

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32
Q

When can the COCP be started after post partum, and why?

A

After 21 days due to risk of VTE. Will require additional contraception for 1st 7 days

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33
Q

When do women requires contraception after giving birth?

A

Day 21

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34
Q

What is the most common adverse effect of the POP?

A

Irregular vaginal bleeding

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35
Q

What is the requirements for expectant management of an ectopic pregnancy?

A

Unruptured embyro, <35mm, no heartbeat, asymptomatic, B-HCG <1000IU/L and declining

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36
Q

What is the advised management for post menopausal women with atypical endometrial hyperplasia?

A

Total hysterectomy with bilateral salpingo-oopherectomy, due to risk of malignant progression

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37
Q

What is the management of endometriosis?

A
  • first line: NSAIDs/paracetamol
  • 2nd line: COCP or progestogens
  • 3rd line or if fertility is concerned: GnRH and surgery.
  • if trying to conceive: laparoscopic excision or ablation of endometriosis plus adhesiolysis
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38
Q

What is the typical presentation of a ruptured ovarian cyst?

A

Sudden onset unilateral pelvic pain precipitated by intercourse or strenuous activity

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39
Q

When does HRT increase the risk of breast cancer?

A

When there is an added progestogen

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40
Q

What cancers does HRT increase the risk of?

A

Endometrial and breast

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41
Q

Which form of HRT does not increase the risk of VTE?

A

Transdermal

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42
Q

What medical management is given for women with hyperemesis gravidarum that have been admitted to hospital?

A

Normal IV saline plus added potassium

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43
Q

What is the first line management of hyperemesis gravidarum?

A

Anti-histamines: oral cyclizine or promethazine

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44
Q

What is the criteria for referral of N+V in pregnancy?

A
  • continued N+V and unable to keep down any oral antiemetics
  • continued N+V with ketonuria and/or weight loss greater than 5% (with tx of oral antiemetics)
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45
Q

What is the triad of hyperemesis gravidarum?

A

5% pre-pregnancy weight loss, dehydration, electrolyte imbalance

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46
Q

What crown rump length + no heart beat is diagnostic of a miscarriage?

A

Crown rump length greater than 7mm

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47
Q

What three features are needed for a diagnosis of PCOS?

A
  • infrequent or no ovulation
  • clinical or biochemical signs of hyperandrogenism (hirsutism, acne, elevated levels of total or free testosterone)
  • polycystic ovaries on ultrasound (>12 follicles or increased ovarian volume >10cm3)
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48
Q

What is the most common cause of post menopausal bleeding?

A

Vaginal atrophy

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49
Q

What is the management for any woman with known placenta praevia who goes into labour?

A

Emergency c-section

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50
Q

What is the SSRIs of choice in breastfeeding women?

A

Sertraline or paroxetine

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51
Q

What should be given in P-PROM?

A

10 days erythromycin to prevent chorioamniotitis, and antenatal corticosteroids

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52
Q

What are the symptoms of mania vs hypomania?

A
  • Mania: at least 7 days, severe functional impairment, psychotic symptoms
  • Hypomania: <7 days, can be high functioning, less severe
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53
Q

What can precipitate lithium toxicity?

A

Dehydration, renal failure, drugs (thiazide, ACE-I, ARBs, NSAIDs, metronidazole)

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54
Q

What are the features of lithium toxicity?

A

Coarse tremor, hyperreflexia, acute confusion, polyuria, seizure, coma

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55
Q

What are the adverse effectsof lithium?

A

N+V, diarrhoea, fine tremor, nephrotoxicity (nephrogenic diabetes insipidus), hypothyroidism, ECG (t wave flattening/inversion), weight gain, idiopathic intracranial hypertension, leucocytosis, hyperparathyroidism

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56
Q

What is an advance statement?

A

An advance statement is a record of someone’s preferences and values regarding future care if they were to become unwell and unable to make or communicate decisions about their care. An advance statement can be made verbally. It is not legally binding but must be taken into account during a best interests meeting.

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57
Q

What antibiotics lower seizure threshold?

A

Ciprofloxacin and other quinolones

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58
Q

What important interactions does SSRIs have?

A

NSAIDs (prescribe PPI), warfarin/heparin (avoid, prescribe mirtazapine), aspirin, triptans (serotonin syndrome, avoid)

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59
Q

What SSRI has the highest incidence of discontinuation symptoms?

A

Paroxetine

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60
Q

When stopping an SSRI, how long should the dosage be reduced over?

A

4 weeks, with the exception of fluoxetine

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61
Q

What are risk factors for falling in the elderly?

A
  • Previous fall
  • lower limb muscle weakness
  • visual problems
  • balance/gait disturbance
  • polypharmacy
  • incontinence
  • > 65
  • fear of falling
  • depression
  • postural hypotension
  • arthritis in lower limbs
  • cognitive impairment
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62
Q

What medications cause postural hypotension?

A

Nitrates, diuretics, anticholinergics, antidepressants, b-blockers, l-dopa, ACEI

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63
Q

What brain trauma may cause fluctuating consciousness?

A

Sub-dural

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64
Q

What is alogia? What is it associated with?

A

Paucity of speech. Seen as a negative symptoms in Schizophrenia

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65
Q

What test should be done after treatment of a UTI in pregnant women?

A

A test of cure MSU

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66
Q

How long should a DVT be treated for in a patient with active cancer?

A

6 months (DOAC)

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67
Q

What are the first line abx in COPD?

A

Doxycycline, clarithromycin, amoxicillin

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68
Q

What is the first line treatment for heartfailure? And the 4 pillars?

A

1st line: beta blocker, ACE-I. 4 pillars: add mineralocorticoid (spironolactone) + SGLT-2 inhibitors

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69
Q

What are examples of SGLT-2 inhibitors?

A

Canagliflozin, dapagliflozin, empagliflozin

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70
Q

What are the rules for missing pills of COCP, in regards to UPSI + extra protection?

A
  • 1 missed pill: take both, no additional contraception
  • 2 missed pills -> week 1; emergency contraception if sex in pill free week or week (+7 days condoms), week 2; no emergency contraception (+7 days condoms), week 3; finish pack + omit pill free week (+7 days condoms)
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71
Q

What are possible s/e of statins, and what can be measured?

A
  • myalgia: reported as cramps (measure serum creatinine kinase: if x5, stop statins)
  • liver impairment (measure LFTs)
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72
Q

What are important contraindications to statins?

A

Pregnancy, macrolide antibiotics (erythromycin, clarithromycin)

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73
Q

What is the dosage of statins for primary and secondary prevention?

A
  • primary: 20mg
  • secondary: 80mg
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74
Q

What are two drugs that can be used in smoking cessation? What are their MoAs?

A

Varenicline (partial acetylcholine receptor agonist) and buproprion (anti depressant)

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75
Q

What smoking cessation therapy can people with epilepsy not recieve?

A

Buproprion: reduces seizure threshold

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76
Q

Where should pulses be checked for in paediatric BLS?

A

Infant: Brachial and Femoral
Child: Femoral

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77
Q

When can a child with Scarlet Fever return to school in regards to abx?

A

24 hours after 1st antibiotic dose

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78
Q

What prophylactic medication is often given to children with sickle cell anaemia who have had a splenectomy?

A

Penicillin

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79
Q

What are risk factors developmental dysplasia of the hip?

A

Female, breech at 36 weeks, first pregnancy, prematurity, oligohydramnios, macrosomic baby

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80
Q

What investigation is done for duodenal atresia, and what is seen?

A

Double bubble sign on abdominal chest xray

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81
Q

What congenital cardiac conditions are cyanotic?

A

Tetraology of Fallot, Transposition of the great arteries, tricuspid atresia, truncus arteriosus,

4T’s

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82
Q

What drugs are high risk for Stevens-Johnson syndrome?

A

Penicillin, sulphonamides, AEDs, allopurinol, NSAIDs, COCP

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83
Q

What are indications for antibiotic prescription in otitis media?

A

Symptoms lasting more than 4 days or not improving, systemically unwell, immunocompromised, <2 years + bilateral, perforation or discharge

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84
Q

What is first line management of otitis media?

A

Amoxicillin = 1st line, if allergy given erythromycin or clarithromycin

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85
Q

What are causes of jaundice in the first 24 hours?

A

Rhesus haemolytic disease, G6PD deficiency, ABO incompatability, toxoplasmosis, syphilis, rubella, CMV, herpes, hepatitis

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86
Q

What are causes of prolonged jaundice?

A

Biliary atresia, hypothyroidism, UTI, breast milk jaundice, prematurity, TORCH infections (CMV, toxoplasmosis)

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87
Q

Remember to consider indications for bone marrow biopsy

What are the investigations done for ITP in children?

A

FBC (demonstrate isolated thrombocytopenia), blood film. Do bone marrow biopsy if abnormal features (lymphadenopathy, low/high WCC, failure to respond/resolve)

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88
Q

What murmur is heard in tetralogy of fallot and why?

A

Ejection systolic due to pulmonary stenosis

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89
Q

What is the antidepressant of choice in depression for a patient with bipolar?

A

Fluoxetine

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90
Q

What is the time frame and typical symptoms of neuroleptic malignant syndrome?

A

Pyrexia, muscle rigidity, autonomic lability (HTN, tachycardia), agitated delirium with confusion, raised CK (can lead to AKI). Starts within hours/days

Slower onset than serotonin syndrome

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91
Q

How long should a patient have symptoms of PTSD for a diagnosis?

A

1 month

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92
Q

What are adverse effects of sodium valproate?

A

Teratogenic (neural tube defects), nausea, weight gain, alopecia, ataxia, tremor, hepatotoxicity, pancreatitis, thrombocytopenia, hyponatraemia

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93
Q

What SSRI is proven to be safest post MI?

A

Sertraline

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94
Q

What SSRIs can lead to prolonged QT syndrome?

A

Citalopram (+ escitalopram)

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95
Q

What SSRI has a particularly increased risk of congenital malformations?

A

Paroxetine

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96
Q

What is the management for OCD?

A

If medication required, SSRI are 1st line. 2nd line is clomipramine (TCA)

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97
Q

What PHQ-9 score divides mild and severe depression?

A

16

16: not so young, sweet + dancing queen !

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98
Q

What electrolyte disturbances are seen in refeeding syndrome?

A

Decreased phosphate, magnesium and potassium (U wave on ECG!)

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99
Q

What is the DSM-5 criteria for depression?

A

5 or more symptoms present in a 2 week period nearly every day, Must include 1 of low mood or anhedonia

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100
Q

What management should be given for women with premature rupture of membranes?

A

10 days of oral erythromycin, antenatal corticosteroids

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101
Q

What hormone should be measured and when for fertility?

A

Serum progesterone, 7 days before next menstrual period (often day 21 in a 28 day cycle)

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102
Q

What act currently dictates abortion laws?

A

1967 Abortion act, 1990 update

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103
Q

At what size would a fibroadenoma be excised?

A

3cm or more

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104
Q

What are protective factors for endometrial cancer?

A

Multiparity, COCP, smoking

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105
Q

What management should be taken for all women >55 years presenting with post menopausal bleeding?

A

Suspected cancer pathway: TVUS, and if abnormal endometrial thickness, then hysteroscopy with endometrial pipelle biopsy

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106
Q

What is normal endometrial thickness?

A

<4mm

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107
Q

What is the management of endometrial cancer?

A

Total abdominal hysterectomy with bilateral salpingo-opherectomy. High risk patients: postoperative radiotherapy

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108
Q

What is the management for dysmenorrhoea?

A

1st line: NSAIDs such as mefenamic acid

2nd line: COCP

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109
Q

What is the most common ovarian tumour?

A

Most are epithelial, and majority are serous carcinomas

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110
Q

What investigation should be carried out for all complex ovarian cysts?

A

Biopsied for malignancy

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111
Q

What is the commonest ovarian cyst?

A

Follicular

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112
Q

What is the likely dx for a woman with low grade fever, pain, and vomiting in early pregnancy, who have a palpable uterine mass?

A

Fibroid degeneration

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113
Q

What makes up the risk malignancy index in ovarian cancer?

A

US findings, menopausal status, CA125

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114
Q

Who should take high dose folic acid in pregnancy?

A
  • obese (>30 kg/m2)
  • taking AEDs
  • coeliac disease
  • diabetes
  • partner or woman has hx of neural tube defects
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115
Q

What is the normal and increased dose of folic acid in pregnancy, and when should it be taken until?

A

400mcg = normal, 5mg increased dose. Take until 12 weeks

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116
Q

What are risk factors for group B streptococcus infection in pregnancy?

A

Prematurity, prolonged rupture of the membranes, previous sibling GBS infection, maternal pyrexa

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117
Q

What is the antibiotic choice for group b strep in pregnancy?

A

IV Benzypenicillin

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118
Q

Which women should be given GBS treatment in pregnancy?

A
  • pyrexia (>38 degrees celsius) in labour
  • preterm labour
  • previous baby with early or late onset GBS
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119
Q

At what BP level should pregnant women be admitted?

A

> 160/110mmHg

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120
Q

Non pregnant, early pregnancy, late pregnancy, after childbirth

What are the cut off levels for tx for anaemia in pregnancy?

A

Non pregnant: 115
Early pregnancy: 110
Late pregnancy: 105
After birth: 100

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121
Q

What do the different Bishop’s Scores indicate?

A

<5: labour unlikely to start without induction
>8: cervix is ripe

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122
Q

How does Bishops score guide two pathways of labour?

A

<6: vaginal prostaglandins or oral misoprostol
>6: amniotomy and IV oxytocin

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123
Q

What should be monitored for women given magnesium in pregnancy?

A

Urine output, reflexes, resp rate + O2 saturations. Respiratory depression can occur (give calcium gluconate)

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124
Q

What is the management of simple endometrial hyperplasia without atypia?

A

High dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used

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125
Q

What is the age guidances for cervical screening?

A
  • every 3 years aged 24-49
  • every 5 years aged 50-64
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126
Q

What age is the cut off for premature ovarian failure?

A

<40 years

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127
Q

What is the classic presentation of vasa praevia?

A

Rupture of membranes followed immediately by (darkred) vaginal bleeding. Fetal bradycardia is seen

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128
Q

What are the features of Horner’s syndrome?

A

Miosis (small pupil), ptosis, enopthalmos (sunken eye), anhidrosis

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129
Q

When is lumbar puncture C/I?

A

GCS <9, haemodynamically unstable, active seizures, post-ictal, any signs of raised ICP

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130
Q

What tumours most commonly spread to the brain?

A

Lung, breast, bowel, skin, kidney

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131
Q

What is the most common brain tumour in adults?

A

Glioblastoma

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132
Q

What is the most common primary brain tumour in children?

A

Pilocytic astrocytoma

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133
Q

What nerve leads to carpal tunnel syndrome?

A

Median nerve

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134
Q

What level is cauda equina?

A

L4/5 or L5/S1

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135
Q

ABCDE

What are causes of peripheral neuropathy?

A

Alcohol, B12 deficiency, Cancer + CKD, Diabetes, Every Vasculitis

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136
Q

What type of anaemia is iron deficiency?

A

Microcytic

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137
Q

Which joints does OA typically affect?

A

Large joints or the small hand joints

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138
Q

What type of dementia is associated with motor neurone disease?

A

Frontotemporal

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139
Q

What is DKA tx?

A

0.9% NaCl at 10ml/kg/hour, insulin 0.1/kg/hr. When glucose is 14 mmol/l, add 10% dextrose at 125ml/kg/hr, and potassium (40mmol/l)

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140
Q

What is given for general maintenance fluids?

A

NaCl 0.9% with 5% dextrose and 10mml/l KCl/ 24 hours

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141
Q

How do you calculate replacement fluid?

A

Replacement = % dehydration * well weight (kg) * 10

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142
Q

How do you calculate % dehydration?

A

((well weight-ill weight)/ well weight)*100, or using mild =5%, moderate= 10%, severe =15%

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143
Q

What fluid is used for resuscitation?

A

0.9% NaCl 10ml/kg over 10 mins. Repeat up to 40ml/kg

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144
Q

What is seen on bacterial LP?

A

Turbid appearance, raised polymorphs (neutrophils), raised protein, decreased glucose

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145
Q

Which lung cancer can lead to Cushing’s syndrome?

A

Small Cell Carcinoma

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146
Q

What is the management of a stroke patient on warfarin?

A

Stop warfarin, give IV vitamin K and prothrombin complex concentrate

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147
Q

What is target warfarin INR?

A

2.5

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148
Q

What vaccines should be given to people with heart failure?

A

Annual influenza vaccine, single pneumococcal

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149
Q

What is an example of a thiazide like diuretic

A

Metolazone, indapamide

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150
Q

What might be seen if a patient takes statins and clarithromycin at the same time?

A

Increased CK, can lead to AKI

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151
Q

What is Cushing’s triad in a head injury?

A

Hypertension, bradycardia, wide pulse pressure/deep breathing

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152
Q

What does GTN do? Physiological impacts (BP/HR)

A

Vasodilation. Causes hypotension, tachycardia (leads to headache)

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153
Q

What is the treatment of Meniere’s disease?

A

Buccal or IM prochlorperazine

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154
Q

What hormone does ovulation strips track?

A

LH levels

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155
Q

What can be done to 100% confirm a dx of angina?

A

CT coronary angiography

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156
Q

What is the most common cardiac change in PE?

A

tachycardia

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157
Q

What antibiotics interact with alcohol?

A

Metronidazole

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158
Q

What are signs of poor asthma control? (3)

A

Reduced effectiveness of bronchodilators, reduced exercise tolerance, waking up with asthma symptoms x3 weekly

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159
Q

What strains of HPV cause genital warts?

A

6 and 11

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160
Q

What is a key differential in children who are HIV positive with lymphadenopathy?

A

Kaposi’s sarcoma

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161
Q

When is the heel prick test done?

A

Days 5-9

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162
Q

What sensory region does L3 provide?

A

Anterior thigh

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163
Q

What is the inheritance of haemophilia A + B?

A

X-linked

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164
Q

At what age is Perthes observed to until surgery is performed?

A

6 years

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165
Q

What are risk factors for neonatal respiratory distress syndrome?

A

Prematurity, male sex, diabetic mother, c-section

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166
Q

When should a child with an undescended test be reviewed?

A

3 months

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167
Q

What is the cause of Roseola Infantum?

A

HHV-6

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168
Q

What height percentile means children should be reviewed by a paediatrician?

A

<0.4

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169
Q

What is first line investigation for queried reflux nephropathy?

A

Micturating cystourethrogram, DMSA scan is done later

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170
Q

What is the management for a child <3 months with a UTI?

A

Referral immediately to paediatrician

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171
Q

What is the management for a child under 6 months with a UTI?

A
  • first UTI: US within 6 weeks
  • recurrent or atypical: within illness US + MCUG
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172
Q

What is the management for recurrent UTIs in children (>6 months)

A

US within 6 weeks

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173
Q

What is the management of children with atypical UTIs (>6 months)?

A

US within illness

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174
Q

What is the school exclusion criteria for impetigo, and tx?

A

Exclude from school until lesions healed. Prescribe topical hydrogen peroxide 1%

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175
Q

What should all children with T1DM also be tested for?

A

Coeliac disease

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176
Q

What causes hand foot and mouth disease?

A

Coxscakie A16

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177
Q

What investigation is done for a newborn with queried hydrocephalus?

A

Ultrasound

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178
Q

What is the secondary prevention after a stroke?

A

Clopidogrel first line (plus dipyridamole). If Clopidogrel not regulated, then aspirin plus modified release dipyridamole

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179
Q

What is the management of myasthenia gravis?

A

Long acting acetylcholinesterase inhibitors: pyridostigmine. Also can add immunosuppression: prednisolone, azathioprine, cyclosporine

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180
Q

What is the management of myasthenic crisis?

A

Plasmanephresis, IV IG

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181
Q

What antibiotics can increase the risk of idiopathic intracranial hypertension?

A

Tetracyclines (doxy)

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182
Q

What is the pathophysiology of GBS?

A

Decreased motor nerve conduction velocity, secondary to demyelination

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183
Q

What derm findings are seen in Tuberous Sclerosis (3)

A
  • ash-leaf spots
  • shagreen patches
  • subungual fibromata
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184
Q

What is seen on eye examation, neurofibromatosis vs tuberous sclerosis?

A
  • neurofibromatosis: Iris hamartomas (Lisch nodules)
  • tuberous sclerosis: retinal haemorrhage
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185
Q

What is the differences on CT in acute vs chronic subdural?

A
  • acute: hyperdense (light)
  • chronic: hypodense (dark)
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186
Q

What is seen on CT in alzheimers?

A

Atrophy of cortex + hippocampus

187
Q

What nerve palsy might be seen in raised ICP?

A

3rd nerve palsy

188
Q

What is first line management for essential tremor?

A

Propanolol

189
Q

What is the cause of upper bitemporal hemianopia?

A

Pituitary tumour

190
Q

What is the cause of lower bitemporal hemianopia?

A

Craniopharyngioma

191
Q

What is seen on neurological examination in B12 deficiency?

A

Dorsal column affected first: loss of proprioception and vibration sense

192
Q

If a patient is B12 and folate deficient, which should be treated first and why?

A

Treat B12 deficiency first to avoid precipitating subacute combined degeneration of the cord

193
Q

What is the triad of Vestibular Schwannoma?

A

Vertigo, hearing loss, tinnitus

194
Q

What imaging is done for diffuse axonal injury?

195
Q

What is the management of a brain abscess?

A

3rd generation cephalosporin + metronidazole. Can add dexamethasone if oedema

196
Q

Which reflex is bicep, and which triceps?

A

Bicep: C5/6
Tricep: C7/8

197
Q

What is Todd’s paresis?

A

Post ictal weakness seen after a frontal lobe seizure

198
Q

What is the stopping regime for AEDs?

A

Stop if seizure free for >2 years, and stop over 2-3 months

199
Q

What are contraindications to thrombolysis?

A

Previous intracranial haemorrhage, intracranial neoplasm, SAH, LP within 7 days, active bleeding, pregnancy, uncontrolled HTN

200
Q

What neurological condition is associated with small cell carcinoma?

A

Lambert-Eaton Syndrome

201
Q

What are first line treatment of neuropathic pain, and an important regime note?

A

Amitriptyline, duloxetine, gabapentin, pregabalin. Must be given as monotherapy. Tramadol can be used as rescue therapy

202
Q

What is the drug class of oxybutynin?

A

Anti-muscarinic

203
Q

What is polypharmacy?

A

A patient taking 5 or more medications daily

204
Q

What must be ruled out as causes of seizures?

A

Hypoglycaemia and hypoxia

205
Q

What HTN drug MUST be stopped immediately in pregnancy?

206
Q

What are risk factors for gestational diabetes?

A

BMI >30kg/m2, previous macrosomic baby, previous gestational diabetes, first degree relative with diabetes, family origin with high prevalence

207
Q

What symptoms in early pregnancy would justify an assessment at early pregnancy assessment service?

A

Pain and abdo tenderness, pelvic tenderness, cervical motion tenderness, bleeding

208
Q

What is the first line management of a woman reporting reduced fetal movements in pregnancy?

A
  • first line: hand held doppler
  • if no heartbeat: immediate ultrasound
  • if heartbeat: CTG used for at least 20 mins to exclude fetal compromise
209
Q

What is the cutoff for a ‘macrosomic’ baby?

210
Q

When can same-day delivery be done for pre-eclampsia?

A

After 34 weeks

211
Q

What are the minimum requirements for managing an ectopic surgically?

A

> 35mm or B-hCG over 5000IU/L

212
Q

What is the pearl index of pregnancy?

A

The number of pregnancies that would be seen if 100 women used that method for a year

213
Q

What is the test of cure pathway in cervical screening?

A

individuals who have been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community

214
Q

What is the management of x1 and x2 inadequate cervical screenings?

A

x1: repeat at 3 months. x2: colposcopy

215
Q

What is the most common treatment of CIN?

A

LLETz (large loop excision of transformation zone)

216
Q

What is the management of vasomotor symptoms of menopause?

A

SSRIs

Fluoxetine for Flushes

217
Q

What is the time frame for various contraceptives to become effective?

A
  • Instant: IUD
  • 2 days: POP
  • 7 days: IUS, COCP, injection, implant, IUS
218
Q

What can epidural do to a womans blood pressure?

219
Q

When does POP count as a missed dose?

220
Q

How long does methotrexate needs to be stopped before pregnancy?

A

6 months in MEN AND WOMEN

221
Q

When is placenta praevia classically diagnosed, and what follow up would this trigger?

A

Dx at 20 week scan, rescan at 32 and 36 weeks

222
Q

What causes the whirlpool sign?

A

Ovarian torsion

223
Q

What is the management of PPH?

A
  • ABCDE
  • massage fundus
  • oxytocin + prostaglandins + ergometrine
  • tamponade with balloon
  • B-lynch suture
  • sub/total hyesterectomy
224
Q

What cancers does COCP increase and decrease the risk of?

A

Increase: breast + cervical

Decrease: ovarian + endometrial

225
Q

What Edinburgh post natal depression score indicates management needed?

226
Q

What scan results + b-HCG levels indicate an ectopic?

A

b-HCG >1500 and unseen on ultrasound

227
Q

What is the most common cause of encephalitis?

228
Q

What does radial nerve palsy cause?

A

Wrist drop

229
Q

When is booking clinic?

230
Q

When is the dating scan?

A

10-13+6 weeks

231
Q

When is anomaly scan?

A

18-20+6 weeks

232
Q

What are risks of long lie after a fall?

A

Pressure ulcers, dehydration, rhabdomyolysis, hypothermia

233
Q

What investigations does NICE suggest for all frail adults?

A

‘Turn 180 degrees’ test and ‘timed up and go’ test

234
Q

What cognition test is often used in GP?

235
Q

What is drug management for PTSD?

A

SSRI or venlafaxine

236
Q

How long is drug detox in the community vs in hospital?

A

Community: 12 weeks, Inpatient: 4 weeks

237
Q

When should blood tests be done upon starting Clozapine?

A

1 blood test weekly for 18 weeks, then fortnightly until a year

238
Q

When should lithium levels be check after dose change?

A

Weekly until stable

239
Q

When stable, how often should lithium levels be checked?

A

Every 3 months, including renal and thyroid function

240
Q

What levels might be raised in blood tests DKA?

A

Creatinine and sodium

241
Q

How can gastric and duodenal ulcers be differentiated?

A

Gastric ulcers: worsened by eating, duodenal: worsened by hunger

242
Q

What is the management of fibroids <3cm?

A

Same as heavy bleeding pathway

Requires contraception: IUS (1st line), COCP

No contraception: mefanamic acid or TXA (start on first day of period)

243
Q

What can shrink fibroids prior to surgery?

A

GnRH agonists

244
Q

What surgery can be done to improve fertility for someone with fibroids?

A

Myomectomy

245
Q

When is a membrane sweep done?

A

Done at 40 weeks if nulliparous, or 41 if parous

246
Q

What drug is contraindicated in post partum haemorrhage if a woman is asthmatic?

A

Carboprost

247
Q

What is the primary monitoring concern for SSRIs?

248
Q

What is monitored on SNRIs?

A

Blood pressure: can cause hypertension

249
Q

What should be monitored on clozapine?

A

WCC + constipation

250
Q

What should be monitored annually for antipsychotics?

A

BMI + prolactin + HbA1c + FBC + U+Es + LFTs + pulse/BP + ECG

251
Q

What is first line management of GAD?

A

Sertraline

252
Q

What is second line management for GAD?

A

Second SSRI or SNRI

253
Q

What is the main worrying electrolyte abnormality if a patient after a long lie has rhabdomyolysis?

A

Hyperkalaemia from the muscle breakdown

254
Q

What are the main causes of infectious exacerbation of cystic fibrosis?

A

S.aureus, P.aeuroginosa, H,influenzae

255
Q

What investigation is done for all patients presenting with AKI?

A

Urinalysis: if no abnormalities, then abdominal ultrasound

256
Q

What are 4 important drugs that have nephrotoxic potential?

A

ACE-I, ARBs, diuretics, NSAIDs

257
Q

What are the risk factors for osteoporosis?

A

SHATTERED: steroids, hyperthyroidism, alcohol/smoking, thin (BMI <22), testosterone deficiency, early menopause, renal/liver failure, erosive/inflammatory bone disease, diet (low calcium)

258
Q

What DEXA score indicates osteoporosis?

259
Q

What strains of HPV increase risk of cervical cancer?

A

16, 18, 33

260
Q

What must the crown rump length be to identify a viable pregnancy?

261
Q

What is the medical management of miscarriage?

A

Vaginal misoprostol

MISO because MISOerable

262
Q

What is the management of tardive dyskinesia?

A

Tetrabenzene

263
Q

What is the management for acute dystonic reactions?

A

Procyclidine

264
Q

What is section 135 vs 136?

A

135: police from home, 136: police from public

265
Q

What is section 5(4) and how long does it last?

A

Nurse hold for 6 hours

266
Q

What is section 5(2) and how long does it last?

A

Doctors hold for 72 hours

267
Q

What is the criteria for malignant HTN?

A

> 180/120 mmHg AND retinal haemorrhage/ papilloedema/life threatening symptoms/symptoms of phaeochromocytoma

268
Q

What are the 4 layers of Seedhouses’ Ethical Grid?

A

External considerations, core rationale, deontological layer, consequential layer

Want to install a DECC in my HOUSE

269
Q

What are the 4 quadrants?

A

Medical interventions, patient preferences, contextual features, QoL

My Patient’s Quality Care

270
Q

What is the most specific/sensitive marker of rheumatoid arthritis?

A

Anti-CCP Ab

271
Q

What deformities are associated with RA?

A

Z-shaped thumb deformity, swan neck deformity, ulnar deviation, boutonierre’s

272
Q

What symptoms are associated with Edward’s?

A

Micrognathia (small jaw), low set ears, rockerbottom feet, overlapping fingers

273
Q

What are causes of fetal hydrops?

A

Severe anaemia (B19, a-thalassaemia, haemorrhage, ABO/Rh incompatability), chromosomal, cardiac issues, chorioangioma, parvovirus

274
Q

What is reassuring baseline + variability in CTG monitoring?

A

Baseline: 110-160
Variability: 5-25 BPM

275
Q

What is abnormal baseline and variability in CTG monitoring?

A

Baseline: <100 or >180
Variability: <5 for 50 mins, >25 for 25 mins

276
Q

What are the 4 types of deceleration?

A

Prolonged, early, late, variable

277
Q

What decelerations indicate umbilical cord compression?

A
  • prolonged: 2-10 minutes, drop 15 BPM
  • variable: unrelated to contractions
278
Q

What decelerations indicate hypoxia of the fetus?

A

Late deceleration after contraction

279
Q

6 steps

What is the sequalae of induction of labour?

A

Membrane sweep -> vaginal prostaglandins (E2) -> oral prostaglandins (misoprostol) -> oxytocin IV -> amniotomy (break waters) -> cervical ripening balloon

280
Q

What is given to paracetamol overdose + over what time?

A

Acetylcysteine: infused over 1 hour

281
Q

When should a child with otitis media be referred to ENT? (3)

A

> 6 episodes in 12 months, persistent effusion >3 months bilaterally, or >6 months unilaterally

282
Q

What makes up the FEVERPain score?

A
  • fever in past 24 hours
  • absence of cough/coryza
  • symptoms <3 days
  • purulent tonsils
  • inflamed tonsils
283
Q

Why should amoxicillin be avoided in tonsilitis?

A

Can lead to widespread maculopapular rash

284
Q

What is the score interpretation for the FEVERPain score?

A

0-1: no abx
2-3: delayed prescription
4-5: phenoxymethicillin

285
Q

What is red flags for paediatric constipation?

A

> 48 hours passing meconium, present from birth, ribbon stools, distension

286
Q

What is the difference between HSP and ITP?

A

HSP has more systemic symptoms: fever, abdo pain, polyarthritis, kidney involvement

287
Q

What conditions may cause a pan-systolic murmur?

A

VSD, mitral regurgitation, tricuspid regurgitation

288
Q

What conditions may cause a ejection systolic murmur?

A

Aortic stenosis, pulmonary stenosis, Turners syndrome (bicuspid aortic valve)

289
Q

What is the most common congenital cardiac cause of heart failure?

A

Ventricular Septal Defect

290
Q

What procedure is done for Hirschsprung disease?

A

Swenson procedure

291
Q

What procedure is done for Biliary Atresia?

A

Kasai Portoenterotomy

292
Q

What is the treatment of minimal change disease?

A

High dose prednisolone for 4 weeks

293
Q

What is the management of obstetric cholestasis?

A

Ursodeoxycholic acid

294
Q

What is the dosage of adrenaline in anaphylaxis?

A
  • <6 months: 100-150mg
  • 6 months- 1 year: 150mg
  • 1-12 years: 300mg
  • adult: 500mg
295
Q

What enzyme can be measured to determine true anaphylaxis?

A

Serum tryptase

296
Q

What are signs of alcohol dependence?

A
  • drink = PRiority
  • COmpulsion to drink
  • STereotyped drinking
  • TOlerance
  • RElief from drinking
  • WIthdrawal symptoms
  • Rapid REinstatement after stopping

PR COST TO REWIRE

297
Q

What are the key features of serotonin syndrome?

A

Neuromuscular hyperactivity (tremor, hyper reflx, rigid), autonomic dysfunction (tachycardia, diarrhoea, shivering), altered mental state

298
Q

What is 2nd line tx of ADHD?

A

Lisdexamfetamine

299
Q

When should a child be admitted for IV fluids after gastroenteritis?

A

If in clinical shock

300
Q

What is the management of viral wheeze?

A

Salbutamol inhaler with spacer

301
Q

What hormone levels are seen in premature ovarian failure?

A

Raised FSH + LH, low oestradiol

302
Q

What nerves are affected in Erb’s palsy?

303
Q

What cervical length indicates risk of preterm labour?

304
Q

What are the two options of prophylaxis of preterm labour?

A
  1. Vaginal progesterone (1st line)
  2. Cervical cerclage if previous premature birth of cervical trauma (such as cone biopsy)

Between16 and 24 weeks if cervical length <25mm on TVUS

305
Q

What can be tested to diagnose P-PROM?

A

Insulin like growth factor binding protein-1 and placental alpha-microglobulin-1 (PAMG-1)

306
Q

How is preterm labour with intact membranes diagnosed?

A
  • <30 weeks: clinical diagnosis
  • > 30 weeks: TVUS, if cervical length <15mm, then dx. Can also check if raised fetal fibronectin levels
307
Q

What drug can be used to stop labour? Between what weeks is it used?

A

Tocolysis with nifedpine, between 24 and 35 weeks

308
Q

When is IV magnesium sulphate given for neuroprotection?

A

If preterm labour <34 weeks

309
Q

When are antenatal steroids used (gestation wise)?

310
Q

What are risk factors for placenta praevia?

A

Previous c-section, previous pregnancy with it, smoking, increased maternal age, assisted reproduction, structural abnormalities

311
Q

What hallucinations are seen in delirium tremens?

A

Lilliputian (little people)

312
Q

What is the major cause of hyperandrogenism in post menopausal women?

A

Ovarian hyperthecosis (why old women get hairy chins!)

313
Q

What score can be calculated to decide if someone can detox from alcohol in the community?

A

AUDIT score

314
Q

What is the management for c.diff?

A

10 days vancomycin

315
Q

What causes syphilis, and what shape is it?

A

Treponema Pallidum, Spirochaetae

316
Q

What antibodies are raised in primary biliary cholangitis?

A

Anti mitochondrial antibodies

317
Q

What classifies a UC flare up as ‘severe’?

A

> 6 stools/day with blood

318
Q

What is the sick day rules for steroids?

A

Double all steroids except for fludrocortisone

319
Q

When are sick day rules for steroids used?

A

When a patient is systemically unwell, for example with a temperature or D+V

320
Q

When should a child with bronch be immediately referred?

A

Apnoea, looks severly unwell, severe respiratory distress (>70 RR), central cyanosis

321
Q

When should O2 be given in bronch?

322
Q

How are patients in an acute asthma attack monitored?

A

Peak flow and oximetry

323
Q

When is oxygen given in an asthma attack, and what levels are you aiming for?

A

Give if <94%, aim for 94-98%

324
Q

What is first line treatment of acute asthma attack + dosage?

A

Nebulised salbutamol in an oxygen driven inhaler, up to x10 puffs

325
Q

Which children should go to hospital for asthma exacerbation?

A

All life threatening/severe

326
Q

Which inhaler is preventer, and which reliever?

A

Preventer: brown, ICS
Reliever: blue, salbutamol

327
Q

When does the dosage of levonorgestrel need to be changed?

A

If BMI >26 then double the dose

328
Q

When should an ambulance be called in febrile seizures?

A

If >5 minutes

329
Q

What assessments should children have after seizure?

A

Specialist assessment within 2 weeks of first seizure with a paediatric neurologist. Should have EEG + MRI + ECG

330
Q

What is the rules for driving after a TIA?

A

No driving for a month. If multiple TIAs, then 3 months

331
Q

What is the first step of newborn resus?

A

x5 inflation breaths

332
Q

Who should be screened for DDH?

A

+ve FHx for hip problems, breech presentation at or after 36 weeks, multiple pregnancy

333
Q

What is the first line management after 4 months in DDH?

334
Q

What causes a ipsilateral field defect?

A

Optic nerve lesion

335
Q

What is seen with the pupil on a surgical 3rd nerve palsy?

A

Dilated (indicates compression)

336
Q

What lobe is Broca’s in?

337
Q

What lobe is Wernicke’s in?

338
Q

What area of a stroke is associated with contralateral homonymous hemianopia? Where is the lesion?

A

MCA (in tract, after the chiasm)

339
Q

What are the symptoms of a PCA stroke?

A

Contralateral homoymous hemianopia with macular sparing. Visual agonisa

340
Q

What type of stroke is most associated with aphasia?

341
Q

How can you differentia PICA and AICA strokes?

A
  • both have vertigo, vomiting, dysphagia, ipsilateral facial pain + temp loss, and contralateral limb pain + temp loss
  • AICA also has facial paralysis and deafness
342
Q

How is MS dx?

A

MRI with contrast (to view the demyelinating lesions)

343
Q

What are the UKMEC levels, and what do they mean?

A
  • UKMEC1: no restriction
  • UKMEC2: advantages >disadvantages
  • UKMEC3: disadvantages>advantages
  • UKMEC4: unacceptable risk
344
Q

What is the treatment of myoclonic seizures?

A

Men: sodium valproate
Females: levetiracetam

345
Q

What is the treatment of tonic/atonic seizures?

A

Males: sodium valproate
Females: lamotrigine

346
Q

What AED may worsen absence seizures?

A

Carbamazepine

347
Q

What is the tx for spasticity?

A

Baclofen (GABA-B receptor agonist which acts as a muscle relaxant)

348
Q

How might foetal alcohol syndrome affect head size?

A

Can lead to microcephaly

349
Q

What is the description of an ataxic gait?

A

Wide based gait with loss of heel toe walking

350
Q

What is the psychological intervention in OCD?

A

CBT + ERP (exposure and response prevention)

351
Q

Which antipsychotics are most likely to cause acute dystonic reaction?

A

First gen antipsychotics: haloperidol, chlorpromazine

352
Q

What specific S/e can anti-psychotics increase the risk of in elderly people?

A

Stroke/VTE events

353
Q

Which antipsychotic particularly reduces seizure threshold?

354
Q

What antipsychotic best manages negative symptoms of schizophrenia?

355
Q

What is the management of otitis externa?

A

Topical antibiotic or combined topical antibiotic with a steroid

356
Q

What is the pathophysiology of pyloric stenosis?

A

Hypertrophy of the pyloric sphincter, resulting in narrowing of the pyloric canal

357
Q

What deficiency is CAH linked to?

A

21-hydroxylase enzyme

358
Q

What is the inheritance of CAH?

359
Q

What hormone changes are seen in CAH?

A
  • low aldosterone
  • low cortisol (high glucose)
  • high testosterone
360
Q

What is the presentation of CAH?

A

‘Virilised genitalia’. Poor feeding, vomiting, dehydration, arrhythmias. Will make a female patient more female. There will also be skin pigmentation (melanocyte simulating hormone released alongside cortisol)

361
Q

What is a risk for a patient with a atrial septal defect that has a DVT?

A

Could travel up to the brain and cause a stroke

362
Q

What are the features of PDA? (5)

A
  • left subclavicular thrill
  • continous machinery murmur
  • large volume, bounding, collapsing pulse
  • wide pulse pressure
  • heaving apex beat
363
Q

What heart condition might lead to a murmur heard infraclavicularly and sub-scapularly?

A

Coartication of the aorta

364
Q

What is the exclusion criteria for measles?

A

4 days from rash onset

365
Q

What is the exclusion criteria for rubella?

A

5 days after rash onset

366
Q

Who should notifiable diseases be reported to?

A

‘Proper Officer’ at the Local Health Protection Team. They then tell the Health Protection Agency

367
Q

What is the inheritance of Duchenne’s?

368
Q

What is the pathophysiology of Duchennes?

A

Dystrophin (protein) is absent, which is required for muscle architecture. Muscle is lost and replaced by adipose tissue

369
Q

What medical intervention can slow progression of Duchennes?

370
Q

What heart condition is linked to Duchennes?

A

Cardiomyopathy

371
Q

When should physiological jaundice resolve in a term/pre-term baby?

A

Term: 14 days
Pre-Term: 21 days

372
Q

What are the main 2 tx options for neonates with jaundice?

A

Phototherapy, blood transfusion

373
Q

What is the ‘male Turner’s’?

374
Q

What cardiac compx are associated with Noonans?

A

Pulmonary valve stenosis, hypertrophic cardiomyopathy

375
Q

What cardiac issues does Williams syndrome cause?

A

Supravalvular aortic stenosis

376
Q

What cardiac conditions are associated with Downs?

A

Endocardial cushion defect, VSD, tetralogy of Fallot

377
Q

What are the features of congenital rubella?

A
  • sensorineural deafness
  • congenital cataracts
  • heart disease
    -growth retardation
  • purpuric skin lesions
  • microphthalmia
378
Q

How is vesicoureteric reflux diagnosed?

A

Micturating cystourethrogram

379
Q

What is ‘toddler’s fracture’?

A

Spiral fracture of the tibia

380
Q

When should a child with a limp be referred urgently?

A
  • fever
  • <3
  • suspect NAI
  • > 9 with potential SFE
381
Q

What screening programmes are there in pregnancy?

A
  • infectious diseases (HepB, HIV, syphilis)
  • sickle cell + thalassaemia
  • Fetal anomaly (Down’s, Edwards, Pataus)
382
Q

What screening programmes are there in newborn babies?

A
  • NIPE
  • newborn hearing screening programme
  • newborn blood spot screening programme (SCD, CF, phenylketonuria, hypothyroidism)
383
Q

What screening programmes are there in adults?

A
  1. AAA
  2. Bowel
  3. Breast
  4. Cervical
  5. Diabetic Eye
384
Q

How many screening programmes are there in the UK?

385
Q

What ages is the NHS breast cancer screening programme offered between?

A

50-70 years

386
Q

How often do women recieve breast cancer screening?

A

Every 3 years

387
Q

What is the imaging of choice in children older than 6 months if recurrent UTI?

A

DMSA (if <3 months, can do MCUG aswell)

388
Q

What is the bowel screening programme?

A

FIT screening every 2 years to men and women aged 60-74 years

389
Q

What is the screening programme for AAA?

A

Single abdominal ultrasound for men >65

390
Q

What is diabetic eye screening?

A

All diabetics invited for eye screening, if >12 years. Every 2 years

391
Q

What HbA1c is diagnosed of diabetes?

A

48 mmol/mol (and 7 fasting, and 11 random)

392
Q

What are the features of West Syndrome?

A
  • ‘Salaam’ attacks: flexion of the head, trunk, arms. Followed by extension of arms
  • progressive mental handiscap
  • EEG: hypsarrhythmia
393
Q

What is are the risk factors (5) and protective factor (1) for hyperemesis?

A

Increase:
-multiple pregnancies
- trophoblastic disease
- nulliparity
- obesity
- FHx/PMHx

Decrease:
- smoking

394
Q

What are inflation breaths in neonatal resus?

A

5 breaths of air via facemask

395
Q

What is Asherman’s syndrome?

A

Intrauterine adhesions, commonly following D+C

396
Q

What are the paediatric dose for low, moderate and high dose ICS?

A
  • low: <=200 mg
  • moderate: 200-400mg
  • high: >400mg

OF BUDESONIDE or EQUIVALENT

397
Q

How many weeks after a TOP should there be a negative test?

A

4 weeks, though women should do a multi-level pregnancy test at 2 weeks

398
Q

What type of insulin is used to treat gestational diabetes?

A

Short acting insulin

399
Q

What is the definition of menorrhagia?

A

An amount that the woman considers to be excessive. Old definition= >80 ml per menses

400
Q

What is the relationship between long term atypical antipsychotics and polyuria/polydipsia?

A

Long term atypical antipsychotics can lead to the development of glucose dysregulation and diabetes

401
Q

What is the mechanism of action of metformin in PCOS?

A

Increases peripheral insulin sensitivity

402
Q

What is the test for degenerative cervical myelopathy done during examination?

A

Hoffman’s

403
Q

What is the investigation of degenerative cervical myelopathy?

A

MRI of the cervical spine

404
Q

What is the management of degenerative cervical myelopathy?

A

Urgent surgical review

405
Q

When can contraception be restarted after use of levonorgestrel or ulipristal?

A
  • levonorgestrel: immediately
  • ullipristal: 5 days
406
Q

What method of hearing testing is used for screening newborns?

A

Otoacoustic emissions

407
Q

What hearing test is done if otoacoustic emission test is abnormal?

A

Auditory brainstem response test

408
Q

What hearing test is done at school entry in the UK?

A

Pure tone audiometry

409
Q

According to Schneider’s first rank symptoms, what features of voices indicate a dx of schizophrenia?

A

Hearing own thoughts spoken aloud, running commentary, auditory third person hallucinations

410
Q

What can cause a rise in urea and creatinine?

A

Dehydration, kidney failure, if the patient is making a lot of new protein (anabolic), or breaking down a lot of protein.

411
Q

What is the definition of osteoporosis?

A

Presence of bone mineral density (BMD) of less than 2.5 standard deviations (SD) below the young adult mean density

412
Q

What investigations should be done after a fall? (3 categories)

A
  1. Bedside test: blood pressure (lying and standing), blood glucose, urine dip, ECG
  2. Bloods: FBC, U+Es, LFTs, bone profile
  3. Imaging: xray of chest/injured limbs, CT head, ECHO
413
Q

What does a bone profile blood test consist of?

A

Serum phosphate, albumin, ALP, calcium (total and adjusted)

414
Q

What results are seen in a bone profile in osteoporosis?

A

Everything normal

415
Q

What value on the sweat test indicates cystic fibrosis?

A

> 60 mEq/l

416
Q

What are differentials for abdominal distension in children?

A

Intra-abdominal mass, Kwashiokor, food intolerance, coeliac, intestinal obstruction, constipation + impaction

417
Q

What is seen on microscopy in minimal change disease?

A

Loss of podocyte foot processes, abnormality may not be seen

418
Q

Name 3 causes of nephritic syndrome?

A

IgA nephropathy, Good pastures, HSP, post streptococcal glomerulonephritis, SLE, HUS

419
Q

Name 3 causes of nephrotic syndrome?

A

Diabetes, infection, minimal change disease

420
Q

Why are patients with nephrotic syndrome more likely to develop a VTE?

A
  • hypercoaguability: increased fibrinogen and hyperlipidaemia
  • loss of antithrombin
421
Q

When would you refer to nephrology in AKI? (paeds+adults?)

A
  • hx of renal transplant
  • unknown AKI cause
  • inadequate tx response
  • AKI complications: significant electrolyte abnormalities
  • stage 3
  • CKD 4 or 5
422
Q

What LFTs are seen in alcoholics?

A
  • raised AST and ALT
  • AST:ALT ratio >1.5
  • raised GGT
  • raised ALP
423
Q

What are risk factors for reduced fetal movements (8)?

A
  • posture
  • distraction (just notice them less)
  • placental position
  • medication (alcohol, opiates, benzos)
  • fetal position
  • body habitus
  • amniotic fluid volume (oligo and polyhydramnios)
  • SGA
424
Q

What is the recommendation for delivery for women with type 1 or 2 diabetes (+ no other complications)?

A

Induced labour or (if indicated) c-section between 37-38+6

425
Q

How long after a membrane sweep should a woman go into labour?

426
Q

What is the next step if there is a negative spirometry result, and still high clinical suspicion of asthma?

A

Fractional exhaled nitric oxide (FeNO) test

427
Q

What requirements should be met for discharge after an acute asthma attack?

A

Peak Expiratory Flow should be >75% of best or predicted. For paeds, also SpO2 >92% on air, stable on 4-hourly bronchodilators

428
Q

What drugs may be used in the tx of neuroleptic malignant syndrome?

A

Bromocriptine (dopamine agonist) and dantrolene (treats spasticity). Can also use benzos to control agitation (lorazepam)

429
Q

What is neurological investigation is done in myasthenia gravis, and what is the finding?

A

Single fibre electromyography: fibres don’t respond to nerve stimulation

430
Q

What are 5 symptoms of MND?

A
  • mixture of lower motor neuron and upper motor neurone signs
  • fasciculations
  • absence of sensory pain
  • wasting of small hand muscles + calves
  • asymmetric limb weakness
431
Q

What is the type of MND with the worst prognosis?

A

Progressive bulbar palsy

432
Q

What drug is used in the tx of MND?

433
Q

What is a characteristic feature of guillain barre syndrome?

A

Progressive, symmetrical weakness of the limbs. Ascending, with reduced reflexes

434
Q

What is Tinel’s test?

A

Tapping causes paraesthesia (carpal tunnel)

435
Q

What are causes of carpal tunnel?

A

Idiopathic, rheumatoid arthritis, pregnancy, oedema (eg, heart failure)

436
Q

What is the conservative management of carpal tunnel syndrome?

A

Corticosteroid injection, wrist splints at night

437
Q

What must be monitored in GBS, and how often?

A

Respiratory function, using FVC. Should be checked every 4 hours.

438
Q

What are unique side effects of the depot injection?

A

Weight gain and osteoporosis

439
Q

What cells are affected in MS?

A

Oligodendrocytes

440
Q

What is the acute tx for kawasaki?

A

IVIG and high dose aspirin

441
Q

What emergency tx may be given in croup before escalation to ICU?

A

High flow oxygen, nebulised adrenaline

442
Q

What are signs of decompensated congenital heart disease?

A

Poor feeding, dyspnoea, tachycardia, weak pulse, cold peripheries, engorged neck veins

443
Q

What are risk factors for surfactant deficient lung disease?

A

Male sex, diabetic mother, c-section, second born of twins, premature

444
Q

What is the definition of cerebral palsy?

A

A chronic disorder of movement and posture due to non-progressive brain abnormalities occurring before the brain is fully developed

445
Q

What are the 4 classifications of cerebral palsy?

A

Spastic (most common), dyskinetic, ataxic, mixed

446
Q

What is the treatment of cerebral palsy?

A
  • MDT
  • diazepam
  • baclofen (for spasticity)
  • orthopaedic surgery
447
Q

What is felt on examination in intussusception?

A

Sausage shaped abdominal mass

448
Q

What are the three possible treatment options for intussusception?

A
  1. air reduction (first line)
  2. barium enema
  3. laparotomy
449
Q

What is the investigation for cauda equina?

A

Urgent MRI

450
Q

What is the management of hypercalcaemia?

A
  • rehydration with normal saline
  • bisphosphonates + calcitonin
451
Q

What are features of thought disorder in schizophrenia? (3)

A

Knight’s move, neologisms, odd logic

452
Q

What is the definition a delusion?

A

A firmly held false belief that is outside of normal social and cultural ideas

453
Q

What is the MoA of anti-psychotics?

A

Dopamine antagonists

454
Q

What electrolyte disturbances are seen in refeeding syndrome, and which is hallmark?

A

All low; hallmark is hypophosphataemia, which may lead to cardiac issues

455
Q

What is the cause of roseola infantum?

456
Q

What is the cause of Erythema infectiosum?

A

Parvovirus B19 (slapped cheek syndrome)

457
Q

What are risk factors for placental abruption?

A

Maternal hypertension, maternal smoking, maternal trauma, increasing maternal age, multiparity, fetal growth restriction, previous abruption

458
Q

What are hCG levels in downs vs edwards vs pataus?

A
  • increased in Downs
  • decreased in Patau and Edwards
459
Q

What are the risks of gestational diabetes?

A

Congenital abnormalities, preterm labour, foetal lung maturity is worse, macrosomia (increased risk of shoulder dystocia), sudden fetal death

460
Q

What is the definition of pre-eclampsia?

A

New onset blood pressure >140/90 mmHg after 20 weeks of pregnancy, and proteinuria and/or other organ involvement

461
Q

What is the 5 components of the Bishop score

A
  1. cervical dilatation
  2. station of the fetal head
  3. position of the cervix
  4. effacement of the cervix
  5. consistency of the cervix
462
Q

What are the most common causes of meningitis?

A

Neisseria meningitidis, S.pneumoniae

463
Q

What is the leading cause of death in GBS?

A

PE: therefore, need VTE prophylaxis

464
Q

What are common triggers of GBS?

A

Campylobacter jejuni, CMV, EBC

465
Q

What is the tx of pneumonia in children? (1st line, 2nd line, if mycoplasma suspected, if with influenza)

A
  • 1st line: amoxicillin
  • 2nd line: add macrolides
  • Mycoplasma: macrolifes
  • Influenca: co-amoxiclav

Phase 3a (19 decks)

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