MCQ Bank 1 Flashcards
Tension headache
last 30 mins - 7 days
N&V does NOT occue
sometimes photophobia or photophobia
management:
keep a headache diary
physiotherapy can help
if >2 days may consider prophylaxis treatment of amitryptilline/ CBT/ TENS
russells sign
knuckle calluses from induced vomiting in anorexia
ESR in anorexia
usually normally –> if high suspect other diagnosis
POP :
how long is it before each is late?
3 HOURS FOR ALL
other than desogestrel = 12 hours
and drospiernone (DRSP)= 24 hours
main advantage of POP
can be used when COCP contraindicated
(BUT smaller margin of error and IRREGULAR Bleeding more common)
some disadvantages of POP
increased ovarian cysts
increased breast cancer
suceptible to enzyme inducers (as COCP)
Defence mechanisms:
compensation
compensating with one aspect of life due to another not working
e.g. becoming good at job due to problems at home
Defence mechanisms: displacement
taking something out on a less threatening recipient
Defence mechanisms: identification
make youself like someone else to fit in/ be liked
Defence mechanisms: conversion
physical symptoms with no physical cause (functional neurologic symptom
Defence mechanisms:
- denial
- regression
DENIAL- dismiss external reality and focus on internal explanations to avoid uncomfortable situation
REGRESSION- regressing back to childhood behaviours e..g bed wetting
Defence mechanisms:
- identification
- projection
- IDENTIFICATION: reproducing behaviours observed in others
- PROJECTION: accusing someone else of what you’ve done
Defence mechanisms: splitting
all or none thinking - fail to recognise both positive and negative aspects
Defence mechanisms: schizoid fantasy
making own imagination an escape
Defence mechanisms: anticipation
anticipating problems before they arise
Defence mechanisms: isolation of affect
not showing emotion e.g. house burnt down describing it in factual way
Defence mechanisms: intellectualization
pattern of over analysing –> disctance yourself from your emotions e.g. someone diagnosed with terminal illness so you become expert in it
Who to treat for influenza?
treatment? (1)
what is the vaccine options kids vs adults ? (2)
oseltamivir and zanamivir
high risk adults
vaccine:
adults IM (inactivateD)
lchildren oral live attenuated INTRANASAL spray
contraindications influenza vaccine
EGG allergy
lupus anticoagulant and miscarriages
antiphospholipid syndrome (does not mean SLE!)
urge incontience:
what to warn patients about drug treatment
anticholinergics
take up to 4 weeks to work
A/w dry mouth, constipation, blurred vision
After anticholinergics what other treatment can be tried for urge incontiennce
mirabegron
TB management
RIPE: rifampicin, isoniazid, pyrazinamide, ethambutol for 2 months
followed by rifampicin and isoniazid (RI) for 10 months
when to consider antidepressants
Hx of moderate or severe depression
>2years depression
mild depression complications the care of chronic health problem
causes binasal hemianopia
congenital hydrocephalus
homonoymous hemianopia in both eyes
DEFECT BHEIND THE OPTIC chiasm
e.g. stroke , trauma, tumor, infection, surgery
pulseless VT vs VT
pulseless –> unsynchronised defibrillation
VT with pule –> synchronised cardioversion
Small cell lung cancer vs squamous cell lung cancer
SMALL CELL:
- cushings (ectopic ACTH)
- SIADH (ADH)
- Lambert Eaton syndrome
SQUAMOUS CELL
- PTHrP
superficial vs deep dyspaneuria
Superficial:
inception, vaginal atrophy, perineal repair, poor sexual stimulation
Deep:
- PID, endometriosis, adenomyosis, cervicitis, prolapsed ovaries
Uterine prolapse:
1st degree= cervix within vagina
2nd degree= cervix comes through introits
3rd degree= entirely outside
cystocele= bladder= hold back posterior wall and anterior vagianl wall will come through
rectocele= hold back anterior wall and posterior will come through
ABPM vs HBPM
ABPM measures 14x during day and takes average
HBPM= 2 consecutive measurements 2x / days
appendicitis in pregnancy: where is pain and how to detect
POLYMORPHONUCLEAR LEUKOCYTES >80%
1st trimeters= Right lower quadrant
2nd= umbilicus
3rd= RUQ
when to put in recovery position seizure
AFTER The seizure
no need to always call ambulance if known epileptic
COPD oral corticosteroids
30mg prednisolone
COPD 1st choice Abx
amoxicillin
Pseudomonas aerguinosa=
Cystic fibrosis. - green coloured sputum
red currant jelly sputum pneumonia
Klebsiella
antepartum haemorrhage immediately after artificial ROM is suggestive of
vasa previa
baby blues: when do they occur
3-5th day postpartum –> 10th day
PCOS bloods
increased LH, LH:FSH (FHS normal)
testosterone levels increased, oestriol decreased
PCOS management
weight
COC pill
metformin (off licence) –> SECONDARY CARE ONLY
orlistat (weight loss)
if infertility a problem:
clomifene
metformin
laproscopic ovarian drilling or gonadotrophin (2nd line)
vitamin d in pregnancy dose
10 micrograms
ADHD when must Sx be present before
12 years
secondary vs primary PPH
secondary = >24hr after delivery
causes secondar PPH
retained products
displacement blood lot
infection
abnormal involution of placental site
choriocarcinoma
–> GIVE ABC
eclampsia
1+ CONVULSIONS superimposed on pre-eclampsia:
HELLP syndrome
haemolysis
EL elevated liver enzymes
LP low platelets
Vincents angina
a bacterial infection that causes inflammation of the tonsils and pharynx, also known as pharyngitis and tonsillitis. It’s caused by a combination of two types of bacteria, fusiform and spirochaetes, which is sometimes called a “fusospirochaetal” infection.
oesophageal spasm - symptoms?
management?
elderlly women
severe, central crushing retrosternal pain
gripping, pressing, stabbing pain
GLOBUS/ food regurgitation of food
–> corkscrew oesophagus (multiple simulateonousa oesophageal contractions)
oesophageal spasm managemnet
conservative
avoid hot/cold good
muscle relaxants –> isosorbide mononitrate and nifedipine and PPI
surgical: endoscopic balloon dilation of gastrooesophagela spincter
cluster headache management PROPHLYAXIS
prednisolone and verapamil
gravida vs parity
gravida= number pregnancies
parity= X+Y (X= number of pregnancies >24 weeks, Y= number <24weeks)
Whereby twins in X count as ONE (as 1 pregnancy)
dementia with Lewy bodies Vs Parkinsons - how quickly do symptoms develop
<1 year of each other = Lewy body
how long off work post STEMI
2 months for most jobs
1 month for sex
Malignant hyperthermia
lethal inhalation of anaesthesia or succinylcholine
genetic susceptibility
Sx:
- muscle rigidity, tachycardia, hyperaemia, mixed metabolic and reparatory acidosis
anticholinergic syndrome
caused by atropine or TCAs
–> confusion, restlessness, picking up objects imaginary, hot, dry skin, flushed appearance, myiasis, tachycardia, decreased bowel sounds, cardiovascular toxicity
neuroleptic malignna syndrome
dopamine antagonists e.g. antipsychotics, metocloparmide
–> hyperaemia, muscle rigidity, altered mental status, CK raised
when to not start antidepressants
during mania
organism spread by water sources e.g. air conditions/ hot tubs (1)
how diagnosed (1)
Legionella - gram -ve intracellular aerobic coccobacilli
(nothing specific on clinical presentation different from other pneumonias -> needs cultures!)
—> URINARY ANTIGEN
prion disease
fatal neurodegenerative diseases
- progressive dementia
- motor dysfunction
can have behavioural changes, myoclonus, visual disturbances, movement problems, incoordination
when are DOACs not recommended
antiphotosphilpid syndrome
prosthetic heart vales
pregnant/breastfeeding
severe hepatic impariemnt
eGFR <30, avoid if < 15
when to use warfarin over DOAC (3)
> 120kg
eGFR <30
significant liver dysfunction
(use DOAC where possible as in general they have less likely to cause major bleeding)
COCP reduces risk of what cancers
ovarian
endometrial
colorectal
definition secondary amenorrhoea
stopped for >6 months
phlegmasia creulea dolens
severe swollen leg DVT
asbestos increases which cacners
gastric
colon
renal adenocarinoma
gastrointestinal lymphoma
neural tube defects in pregnancy- how to detect §
US for all high risk women )positive serum alpha-fetoprotein, previously affected child)
–> if unable to see on US –> amniocentesis
when do trop levels peak
rise 2-4hr post STEMI
peak 18-24hr
can remain high for 2 weekst
trop levels and CKD
raised in CKD
CXR; upper lobe lung nodules, eggshell calcification of lymph nodes
Silia (coal workers pneubmoconiosis)
usually asyptomatic but may have cough/ exertion dyspnoea
lung transplant only treatment option
beryllliosis
aerospace, nuclear, telecommunications, semi-conductor, electrical industry
TFTs in hyperemesis gravidarum
can get high T4 due to hgierh serum BHCG, which has TSH-like activity
melasma or chloasma
macules (freqcle like sports) and larger patches appearing on fact, cheeks, upper lips
triggers:
pregnancy
hormonal contraceptives
sun exposure
unprovoked vs provoked DVT: what comes under unprovoked
NO CAUSE OR not easily correctable e.g. active cancer or thrombophilia
(for unprovoked treatment indefinite)
Majolin ulcer
skin malignancy that arise where scars/ chronic wounds were/ BURN SCARS
burns scans most common inciting condition
aggressive, metastasis early
round punched out ulcer on distal margin of foot
arterial ulcer
diabetic foot ulcer
plantar aspect of foot, tip of toe
deep, surrounded by calus
dry cracked calluses
6Ps of acute ischaemia
pale
pulseless
pain
paralysed
paraesthesia
perishingly cold
HAP 1st line ABx
co-amoxiclav
>48hr into admission
cranial nerves
LR6 SO4
what drug to give after thrombolysis
heparin or LMWH
then later I Beta blocker then ACEi
atropine doses in bradycardia
0.5mg repeat every 3-5mins until 3mg
ABCD2 score
risk of stroke post TIA
serum angiotensin converting enzyme (ACE)
sarcoidosis
bulls myringitis
Mycoplasma pneumonia sign (rare)
SLE (Lupus) diagnosis: >4 feaures of
malar rash
discoid lupus
photosensitivity
oral/ nasopharyngeal ulcers
non erosive arthritis
pleurites or pericarditis
renal involvement
seizures/ pschosis
anti-DNA antibody
anti SM
positive Antinuclear antibody
streptokinase
thrombolytic agent
lipid modifying drugs in pregnancy
stop 3 months before conceivinga
what are the only lipid lowering drugs tp be considered in pregnnacy/ lactation
bile acid sequestrates or resins (e.g. Colesevelam) as they are not absorbed into bloodstream
which pill causes breakthrough bleed
POP
COCP causes breakthrough bleed if underused e.g. diarrhoea, concurrent antiepileptic treatment, to low prescription
brief psychotic disoder
1-30 days psychosis
primary morphological chacatersitic of HCM
asymmetrical septal hypertrophy
Anterior pituitary releases..
LH, FSH, GH, TSH, ACTH, prolactin
Posterior pituitary releases…
ADH, oxytocin
Hypothalamus releases
GnRH, GNRH, somatostatin, TRH, CRH
COPD spirometry: pre or post bronchodilator
POST bronchodilator
tender breast lump - size varies with menstrual cycle
breast cystt
diagnostic test for mysasthenia gravis
acetylcholine receptor antibody test
myasthenia gravis treatment
acetylcholinesterase inhibitors (e.g. pyridostigmine)
–> as it worsens –> immunomodulatory agents like stories, azathioprine, cyclosporin, mycophenolate mofetil
CO poisoning what colour skin
cherry red
shockable
VF and pulseless VT
what nerve palsy in idiopathic intracranial hypertension
cranial nerve 6
clozapine- when is risk of agranulocytosis highest?
EARLIER in treatment (FBC taken WEEKLY to start with then drops to monthly)
Cerebellar disease
DANISH
dysdiadochokinesia
ataxia
nysthagmus
intuition tremor
slurred speech
hypotonia
hemiballismum
involuntary flinging motions of the extremities due to infarct/ haemorrhage in contralateral sub thalamic nucleus
involuntary irregular random flowing movements which flit from one part of the body to the other
Chorea
movement disorders during sleep + dementia =
Parkinsons (nocturnal akinesia)
thymoma features
1/3= Sx due to compression of surrounding organs e.g. superior vena cava syndrome, dysphagia, cough, chest pain
1/3 = associated autoimmune disorder e.g. myasthenia gravis
1/3= asymptomatic (found incidentally on CT or CXR)
Dissociative fugue
purposeful travel beyond usual range
maintenance of self care
dissociative amnesia
restless leg syndrome
subjective experience of restlessness interfering with sleep
Carbamazepine (for trigeminal neuroalgia) - what to monitor
FBC as –> aplastic anaemia
if doesn’t work –> SPECIALIST
2 core Sx of depression
low mood + loss of pleasure in activities
classes of AF: paroxysmal, persistent and permanenant? (3)
lone AF? (1)
paroxysmal= >30s but <7 d
persistent = >7 d
permanent = failed to terminate with cardioversion
Lone AF= no causes (~10%) and other investigations normal
acid-fast bacilli test for Mycobacteria Tuberculosis - what type of sample is it
sputum sample
management syphilis
benzathine BENZYLPENECILLIN
Listeria
soil, wood, decaying matter
ingestion of food products (unpasteurised milk/ seafood)
–> AVOID IN PREGNNACY
managment= amoxicillin and gentamicin
Congenital taxoplasmosis
severe CNS problems (cerebral calcifications and hydrocephalus)
fatigue, mailaise, low grade fever, lymphadenopathy, myalgia
managemnt= Spiramycin
Diagnosis guillia barre
CLINICAL
nerve conduction studies and LP (elevated protein, no elevation of CSF cell sounds)
Treatment guillian barre
HIGH DOSE INTRAVENOUS IMMUNOGLOBULINS or plasma exchange
hypothermia ECG changes (< 35 oC)
QT elcongation
J waves
QRS widening
PR elongation
AF
what is Teethes syndome
smilar to chostochondritis but –> swelling of costal cartilages (in chostochondritis there is no swelling)
myoclonic seizures
brief shock like jerks of muscle of group of muscles, usually conscious
how can you provoke an absence seizure
hyperventilate for 3-5mins in children (can be diagnostic!)
facial pain and raised EsR
consider temporal arteritis
normal pressure hydrocephalus triad
dementia
urinary incentinence
gait disturbance
= NO papilloedema, normal CSF pressure
ELDERLY PATIENTS
–> ventriculoperitoneal shunts
how many weeks is postterm and preterm
PRETERM= <37
POSTTERM= 42+
ashermans syndrome
intrauterine adhesions in uterus
most frequency occurs due to D&C
can cause amenorrhoea
other causes: TB, chronic endometriosis, prolonged rupture of membranes
Diagnosis= Hysteroscopy
Sonohysterography
Treamtent= surgical
small hard brass lump teathered to skin
breast cancer
acute mental confusion, ataxia and opthalmoplgeia
Wernickes encephalopathy
what can precipitate Wernickes encephalopathy in hospital?
giving GLUCOSe without thiamine
chaplains syndrome
pulmonary fibrosis, usually in coal miners who have rheumatoid arthritis
CXR= multiple rounded well defined nodules - treat with steroids
pregnancy Sx cased by increased venous distensibility and pelvic congestion
haemorrhoids
pelvic ligament and muscle relaxation in pregnnacy —>
back pain
COCP missed pill
> 24hr late (if less than that then you can take 2 together and continue as normal) –> have emergency contraception if 2+ COCP missed pills
weeks gestation abortion is allowed up until
24 weeks
(no upper limit if risk to mothers life)
coital cephalgia
headache with sexual activity
how does COCP work
acts on hypo-pituitary-ovarian axis by suppressing LH and FHS and inhibiting ovulation
pancoats tumor
horners syndrome
ipsilateral reflex sympathetic dystrophy
unilateral recurrent laryngeal nerve palsy
phrenic nerve involvement
arm oedema
superor vena cava syndrome
MRC SOB scale (standard) COPD
1- no problems
2- uphill SOB
3- slower on ground level because of SOB
4- 100m SOB or few mins on ground level
5- to SOB to leave house
carbimazole and pregnancy
SAFE
drop in BP during inspiration
pulsus paradoxus
pulsus alternans
strong pulse followed by weak pulse
linked with heart failure, especially L ventricular failure
audible wheeze - most likely diagnosis
ASTHMA ONLY
not characteristic of lung carcinoma, PE, pleural effusion or cardiomegaly
when to start iron supplements in pregnnacy
Hb low, MCV low —> 200mg ferrous sulphate
MRC scale for muscle power 0-5
0= no muscle contraction
1= flicker
2= some active movement
3= movement against gravity
4= against resistance
5= normal
myasthenia gravis - how to diagnose
Diagnosis:
Hx and Exam, AND
2 +ve diagnostic tests e.g. serological and electrodiagnositc
(e.g. serum anti-AChR antibodies and electromyography under repetitive stimulation)
myasthenia gravis - what scan do they need eventually
a CT throax for ?thyoma as 10% have thyme
management myasthenia gravis
acetylcholinesterase inhibitors (e.g.. pyridostigmine)
others: immunomodulatory, monoclonal antibodies, plasma exchange , thymectomy
woman, mild chronic abdominal pain that suddenly intesnsifies, fluid below fallopian tubes
rupture of ectopic cyst
degenerating myoma (fibroma)
mixed echo dense or echolucent appearance
antibodies linked to which disease:
- antimitochondrial
- ANA
- anticentromere
- Anti-Ro, anti-La
- PBC
- non specific but SLE
- CREST
- Sjorgrens syndrome
lupus vulgaris
painful cutaneous TB skin lesions with nodular appearahce
sharply marginated, red-brown pappules of gelatinous consistency
munchhausen by proxy
when carere/ parent produces factitious illness in a child or adult in their care
hypochondriasis vs somatisation
hypochondriacs fear a specific disease
somatisation = multiple somatic complaints
Chest drains:
fluid level swings with inspirations
removal of chest drain with EXPIRATIION
chest tube should not be clamped
insert into 5th ICS
bowel cancer screening
50-74 every 2 years
targeted lung cancer screening
55-74 lo dose CT scan every 2 years
haemophilus durecyi
painful genital ulcer (Chancroid)
A/W tender inguinal lymphadenopathy
when do HCG levels raise in pregnnacy
day 11
- peak weeks 10-12 weeks gestation
lung abscess management
clindamycin
ophthalmoplegia (e.g. nystagmus)
ataxia
acute mental confusion
Wernickes encephalopathy
Wilsons disease
autosomal recessive
asymmetrical tremor
depression and behavioural patterns
Causes of HAP
Strep pneumonia OR haemophilus influenza
LATE onset= pseudomonas aeruginosa or other antimicrobial resistant opportunistic gram -ve bacteria or MRSA
Modified Dukes criteria for IE
Major
- Blood culture
- Echo
Minor
- Temp >38oC
- Oslers nodes and roth spots
- microbiological evidence (blood cultures)
- embolic phenomenon
- risk factors (congenital heart condition/ IVDU)
when does over th counter pregnancy test become +ve
9 days post conception
(remain positive 5 days post fetal death)
treatment oral candidasis
topical nystatin or miconazole
OR
systemic fluconazole, ketoconazole or itraconazole anti fungal
What liver enzyme raises rapidly in pregnancy
ALP (as produced by the Planeta)
Coagulation factors and prengnacy
pregnancy is HYPERCOAGULABLE state
but blood APTT/PT etc all stay the same ranges
How do FBC and U&E change in pregnancy
WCC increases
platelets fall
U&E: increase in kidney size and perfusion –> serum levels drop
Secondary cause of HTN should be considered if
<40yo
low K+ or high Na
eGFR reduced
proteinuria or haematuria (without UTI)
sudden onset or worsening
Fregoli syndrome
person is falsely identified in strangers
(Capgras is when some ins supplanted b a stranger who is their exact double)
Ekboms syndrome
delusion of infestation with insects
Gansers syndrome
syndrome of approximate answers
waddling gait when trying to run
“climbing u the legs” when rising from floor
psychoypertrophy of the calves
Duchenne muscular dystrophy
(Gowers sign)
Frederichs ataxia
autosomal recessive ataxia
degenerative disease that primary affects nervous system and heart
A/W cardiomyopathy nd diabetes
onset <20 years
unsteadiness of gait
progressive ataxia, dysarthria, decreased proprioception/ vibration sense and muscle weakness
not walking by 18 months, delayed motor milestones and global developmental delay
Duchenne muscular dystrophy
initial investigation Duchenne muscular dystrophy
serum creatine kinase (CK)
more precise diagnosis: genetic analysis, muscle biopsy, clinical observation
(aim to diagnose early to allow genetic counselling for family)
Duchenne musclar dystrophy
autosomal recessvie
carriers asymptomatic
Duchenne muscular dystrophy
MDT management
Friedreichs ataxia - most likely cause of death
cardiomyopathy
most common inherited autosomal recessive ataxia in the UK
Friedreichs ataxia
onset <20 years
general clumsiness or deterioration of athletic performance
Sperm count
asthenozoospermia
azoospermia
oligostpermia
hypospermia
teratospermia
asthenozoospermia= rescued sperm motility
azoospermia= no sperm
oligostpermia= low sperm count
hypospermia= reduced sperm volume
teratospermia= poor sperm morphology
causes of infertility in women: drugs
NSAIDS
spirolactone
cytotoxic drugs
neuroleptic drugs
recreational drugs
cycle-oxygenase inhibitors
male infertility: what common GI drug causes oligosperma
sulfalazine
“tightening” rather than pain after 20 weeks
Braxton-hicks contractions
sudden severe abdominal pain after coughing/trauma in pregnnacy –> rupture of inferior epigastric vessels
rectus muscle haematoma
brief, sharp, stabbing pain or longer lasting dull ache that prengnay women feel in lower groin/ abdomen in second trimester due to uterus pulling on the round ligament
round ligament pain
systolic ejection murmur increases on standing and decreases with squatting
HCM
Myotonic dystrophy
cataracts, muscle weakness, frontal balding
presents OLDER than Duchenne muscular dystrophy
Duchenne Muscular dystrophy prognosis
most require ventilatory support by 25 years of age
most lose ability to walk by 12 year
Most common muscular dystrophy in adults
Myotonic dystrophy
autosomal dominant
–> anticipation
when to do progesterone level for infertility in 35 day cycle
28!!!! day
fascioscapulohumeral muscular dystrophy
progressive difficulty whistling and sucking through a straw
sleep apnoea and HTN
increase risk of HTN
potassium in diet and HTN
LOW potassium diet –> HTN
SOB, clubbing, heamoptysis and weight loss
What is first line investigation?
CXR
Missed miscarriage vs inevitable vs incomplete
MISSED= NO PAIN (and no fetal heartbeat)
INCOMPLETE= pain +/-, retained products/ no real heartbeat, open Os
INEVITABLE= pain ++, lots of bleeding, open Os
