MCQ Bank 1 Flashcards
(197 cards)
1
Q
Tension headache
A
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
2
Q
russells sign
A
knuckle calluses from induced vomiting in anorexia
3
Q
ESR in anorexia
A
usually normally –> if high suspect other diagnosis
4
Q
POP :
how long is it before each is late?
A
3 HOURS FOR ALL
other than desogestrel = 12 hours
and drospiernone (DRSP)= 24 hours
5
Q
main advantage of POP
A
can be used when COCP contraindicated
(BUT smaller margin of error and IRREGULAR Bleeding more common)
6
Q
some disadvantages of POP
A
increased ovarian cysts
increased breast cancer
suceptible to enzyme inducers (as COCP)
7
Q
Defence mechanisms:
compensation
A
compensating with one aspect of life due to another not working
e.g. becoming good at job due to problems at home
8
Q
Defence mechanisms: displacement
A
taking something out on a less threatening recipient
9
Q
Defence mechanisms: identification
A
make youself like someone else to fit in/ be liked
10
Q
Defence mechanisms: conversion
A
physical symptoms with no physical cause (functional neurologic symptom
11
Q
Defence mechanisms:
- denial
- regression
A
DENIAL- dismiss external reality and focus on internal explanations to avoid uncomfortable situation
REGRESSION- regressing back to childhood behaviours e..g bed wetting
12
Q
Defence mechanisms:
- identification
- projection
A
- IDENTIFICATION: reproducing behaviours observed in others
- PROJECTION: accusing someone else of what you’ve done
13
Q
Defence mechanisms: splitting
A
all or none thinking - fail to recognise both positive and negative aspects
14
Q
Defence mechanisms: schizoid fantasy
A
making own imagination an escape
15
Q
Defence mechanisms: anticipation
A
anticipating problems before they arise
16
Q
Defence mechanisms: isolation of affect
A
not showing emotion e.g. house burnt down describing it in factual way
17
Q
Defence mechanisms: intellectualization
A
pattern of over analysing –> disctance yourself from your emotions e.g. someone diagnosed with terminal illness so you become expert in it
18
Q
Who to treat for influenza?
treatment? (1)
what is the vaccine options kids vs adults ? (2)
A
oseltamivir and zanamivir
high risk adults
vaccine:
adults IM (inactivateD)
lchildren oral live attenuated INTRANASAL spray
19
Q
contraindications influenza vaccine
A
EGG allergy
20
Q
lupus anticoagulant and miscarriages
A
antiphospholipid syndrome (does not mean SLE!)
21
Q
urge incontience:
what to warn patients about drug treatment
A
anticholinergics
take up to 4 weeks to work
A/w dry mouth, constipation, blurred vision
22
Q
After anticholinergics what other treatment can be tried for urge incontiennce
A
mirabegron
23
Q
TB management
A
RIPE: rifampicin, isoniazid, pyrazinamide, ethambutol for 2 months
followed by rifampicin and isoniazid (RI) for 10 months
24
Q
when to consider antidepressants
A
Hx of moderate or severe depression
>2years depression
mild depression complications the care of chronic health problem
25
causes binasal hemianopia
congenital hydrocephalus
26
homonoymous hemianopia in both eyes
DEFECT BHEIND THE OPTIC chiasm
e.g. stroke , trauma, tumor, infection, surgery
27
pulseless VT vs VT
pulseless --> unsynchronised defibrillation
VT with pule --> synchronised cardioversion
28
Small cell lung cancer vs squamous cell lung cancer
SMALL CELL:
- cushings (ectopic ACTH)
- SIADH (ADH)
- Lambert Eaton syndrome
SQUAMOUS CELL
- PTHrP
29
superficial vs deep dyspaneuria
Superficial:
inception, vaginal atrophy, perineal repair, poor sexual stimulation
Deep:
- PID, endometriosis, adenomyosis, cervicitis, prolapsed ovaries
30
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
31
ABPM vs HBPM
ABPM measures 14x during day and takes average
HBPM= 2 consecutive measurements 2x / days
32
appendicitis in pregnancy: where is pain and how to detect
POLYMORPHONUCLEAR LEUKOCYTES >80%
1st trimeters= Right lower quadrant
2nd= umbilicus
3rd= RUQ
33
when to put in recovery position seizure
AFTER The seizure
no need to always call ambulance if known epileptic
34
COPD oral corticosteroids
30mg prednisolone
35
COPD 1st choice Abx
amoxicillin
36
Pseudomonas aerguinosa=
Cystic fibrosis. - green coloured sputum
37
red currant jelly sputum pneumonia
Klebsiella
38
antepartum haemorrhage immediately after artificial ROM is suggestive of
vasa previa
39
baby blues: when do they occur
3-5th day postpartum --> 10th day
40
PCOS bloods
increased LH, LH:FSH (FHS normal)
testosterone levels increased, oestriol decreased
41
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)
42
vitamin d in pregnancy dose
10 micrograms
43
ADHD when must Sx be present before
12 years
44
secondary vs primary PPH
secondary = >24hr after delivery
45
causes secondar PPH
retained products
displacement blood lot
infection
abnormal involution of placental site
choriocarcinoma
--> GIVE ABC
46
eclampsia
1+ CONVULSIONS superimposed on pre-eclampsia:
47
HELLP syndrome
haemolysis
EL elevated liver enzymes
LP low platelets
48
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.
49
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)
50
oesophageal spasm managemnet
conservative
avoid hot/cold good
muscle relaxants --> isosorbide mononitrate and nifedipine and PPI
surgical: endoscopic balloon dilation of gastrooesophagela spincter
51
cluster headache management PROPHLYAXIS
prednisolone and verapamil
52
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)
53
dementia with Lewy bodies Vs Parkinsons - how quickly do symptoms develop
<1 year of each other = Lewy body
54
how long off work post STEMI
2 months for most jobs
1 month for sex
55
Malignant hyperthermia
lethal inhalation of anaesthesia or succinylcholine
genetic susceptibility
Sx:
- muscle rigidity, tachycardia, hyperaemia, mixed metabolic and reparatory acidosis
56
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
57
neuroleptic malignna syndrome
dopamine antagonists e.g. antipsychotics, metocloparmide
--> hyperaemia, muscle rigidity, altered mental status, CK raised
58
when to not start antidepressants
during mania
59
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
60
prion disease
fatal neurodegenerative diseases
- progressive dementia
- motor dysfunction
can have behavioural changes, myoclonus, visual disturbances, movement problems, incoordination
61
when are DOACs not recommended
antiphotosphilpid syndrome
prosthetic heart vales
pregnant/breastfeeding
severe hepatic impariemnt
eGFR <30, avoid if < 15
62
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)
63
COCP reduces risk of what cancers
ovarian
endometrial
colorectal
64
definition secondary amenorrhoea
stopped for >6 months
65
phlegmasia creulea dolens
severe swollen leg DVT
66
asbestos increases which cacners
gastric
colon
renal adenocarinoma
gastrointestinal lymphoma
67
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
68
when do trop levels peak
rise 2-4hr post STEMI
peak 18-24hr
can remain high for 2 weekst
69
trop levels and CKD
raised in CKD
70
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
71
beryllliosis
aerospace, nuclear, telecommunications, semi-conductor, electrical industry
72
TFTs in hyperemesis gravidarum
can get high T4 due to hgierh serum BHCG, which has TSH-like activity
73
melasma or chloasma
macules (freqcle like sports) and larger patches appearing on fact, cheeks, upper lips
triggers:
pregnancy
hormonal contraceptives
sun exposure
74
unprovoked vs provoked DVT: what comes under unprovoked
NO CAUSE OR not easily correctable e.g. active cancer or thrombophilia
(for unprovoked treatment indefinite)
75
Majolin ulcer
skin malignancy that arise where scars/ chronic wounds were/ BURN SCARS
burns scans most common inciting condition
aggressive, metastasis early
76
round punched out ulcer on distal margin of foot
arterial ulcer
77
diabetic foot ulcer
plantar aspect of foot, tip of toe
deep, surrounded by calus
dry cracked calluses
78
6Ps of acute ischaemia
pale
pulseless
pain
paralysed
paraesthesia
perishingly cold
79
HAP 1st line ABx
co-amoxiclav
>48hr into admission
80
cranial nerves
LR6 SO4
81
what drug to give after thrombolysis
heparin or LMWH
then later I Beta blocker then ACEi
82
atropine doses in bradycardia
0.5mg repeat every 3-5mins until 3mg
83
ABCD2 score
risk of stroke post TIA
84
serum angiotensin converting enzyme (ACE)
sarcoidosis
85
bulls myringitis
Mycoplasma pneumonia sign (rare)
86
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
87
streptokinase
thrombolytic agent
88
lipid modifying drugs in pregnancy
stop 3 months before conceivinga
89
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
90
which pill causes breakthrough bleed
POP
COCP causes breakthrough bleed if underused e.g. diarrhoea, concurrent antiepileptic treatment, to low prescription
91
brief psychotic disoder
1-30 days psychosis
92
primary morphological chacatersitic of HCM
asymmetrical septal hypertrophy
93
Anterior pituitary releases..
LH, FSH, GH, TSH, ACTH, prolactin
94
Posterior pituitary releases...
ADH, oxytocin
95
Hypothalamus releases
GnRH, GNRH, somatostatin, TRH, CRH
96
COPD spirometry: pre or post bronchodilator
POST bronchodilator
97
tender breast lump - size varies with menstrual cycle
breast cystt
98
diagnostic test for mysasthenia gravis
acetylcholine receptor antibody test
99
myasthenia gravis treatment
acetylcholinesterase inhibitors (e.g. pyridostigmine)
--> as it worsens --> immunomodulatory agents like stories, azathioprine, cyclosporin, mycophenolate mofetil
100
CO poisoning what colour skin
cherry red
101
shockable
VF and pulseless VT
102
what nerve palsy in idiopathic intracranial hypertension
cranial nerve 6
103
clozapine- when is risk of agranulocytosis highest?
EARLIER in treatment (FBC taken WEEKLY to start with then drops to monthly)
104
Cerebellar disease
DANISH
dysdiadochokinesia
ataxia
nysthagmus
intuition tremor
slurred speech
hypotonia
105
hemiballismum
involuntary flinging motions of the extremities due to infarct/ haemorrhage in contralateral sub thalamic nucleus
106
involuntary irregular random flowing movements which flit from one part of the body to the other
Chorea
107
movement disorders during sleep + dementia =
Parkinsons (nocturnal akinesia)
108
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)
109
Dissociative fugue
purposeful travel beyond usual range
maintenance of self care
dissociative amnesia
110
restless leg syndrome
subjective experience of restlessness interfering with sleep
111
Carbamazepine (for trigeminal neuroalgia) - what to monitor
FBC as --> aplastic anaemia
if doesn't work --> SPECIALIST
112
2 core Sx of depression
low mood + loss of pleasure in activities
113
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
114
acid-fast bacilli test for Mycobacteria Tuberculosis - what type of sample is it
sputum sample
115
management syphilis
benzathine BENZYLPENECILLIN
116
Listeria
soil, wood, decaying matter
ingestion of food products (unpasteurised milk/ seafood)
--> AVOID IN PREGNNACY
managment= amoxicillin and gentamicin
117
Congenital taxoplasmosis
severe CNS problems (cerebral calcifications and hydrocephalus)
fatigue, mailaise, low grade fever, lymphadenopathy, myalgia
managemnt= Spiramycin
118
Diagnosis guillia barre
CLINICAL
nerve conduction studies and LP (elevated protein, no elevation of CSF cell sounds)
119
Treatment guillian barre
HIGH DOSE INTRAVENOUS IMMUNOGLOBULINS or plasma exchange
120
hypothermia ECG changes (< 35 oC)
QT elcongation
J waves
QRS widening
PR elongation
AF
121
what is Teethes syndome
smilar to chostochondritis but --> swelling of costal cartilages (in chostochondritis there is no swelling)
122
myoclonic seizures
brief shock like jerks of muscle of group of muscles, usually conscious
123
how can you provoke an absence seizure
hyperventilate for 3-5mins in children (can be diagnostic!)
124
facial pain and raised EsR
consider temporal arteritis
125
normal pressure hydrocephalus triad
dementia
urinary incentinence
gait disturbance
= NO papilloedema, normal CSF pressure
ELDERLY PATIENTS
--> ventriculoperitoneal shunts
126
how many weeks is postterm and preterm
PRETERM= <37
POSTTERM= 42+
127
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
128
small hard brass lump teathered to skin
breast cancer
129
acute mental confusion, ataxia and opthalmoplgeia
Wernickes encephalopathy
130
what can precipitate Wernickes encephalopathy in hospital?
giving GLUCOSe without thiamine
131
chaplains syndrome
pulmonary fibrosis, usually in coal miners who have rheumatoid arthritis
CXR= multiple rounded well defined nodules - treat with steroids
132
pregnancy Sx cased by increased venous distensibility and pelvic congestion
haemorrhoids
133
pelvic ligament and muscle relaxation in pregnnacy --->
back pain
134
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
135
weeks gestation abortion is allowed up until
24 weeks
(no upper limit if risk to mothers life)
136
coital cephalgia
headache with sexual activity
137
how does COCP work
acts on hypo-pituitary-ovarian axis by suppressing LH and FHS and inhibiting ovulation
138
pancoats tumor
horners syndrome
ipsilateral reflex sympathetic dystrophy
unilateral recurrent laryngeal nerve palsy
phrenic nerve involvement
arm oedema
superor vena cava syndrome
139
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
140
carbimazole and pregnancy
SAFE
141
drop in BP during inspiration
pulsus paradoxus
142
pulsus alternans
strong pulse followed by weak pulse
linked with heart failure, especially L ventricular failure
143
audible wheeze - most likely diagnosis
ASTHMA ONLY
not characteristic of lung carcinoma, PE, pleural effusion or cardiomegaly
144
when to start iron supplements in pregnnacy
Hb low, MCV low ---> 200mg ferrous sulphate
145
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
146
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)
147
myasthenia gravis - what scan do they need eventually
a CT throax for ?thyoma as 10% have thyme
148
management myasthenia gravis
acetylcholinesterase inhibitors (e.g.. pyridostigmine)
others: immunomodulatory, monoclonal antibodies, plasma exchange , thymectomy
149
woman, mild chronic abdominal pain that suddenly intesnsifies, fluid below fallopian tubes
rupture of ectopic cyst
150
degenerating myoma (fibroma)
mixed echo dense or echolucent appearance
151
antibodies linked to which disease:
- antimitochondrial
- ANA
- anticentromere
- Anti-Ro, anti-La
- PBC
- non specific but SLE
- CREST
- Sjorgrens syndrome
152
lupus vulgaris
painful cutaneous TB skin lesions with nodular appearahce
sharply marginated, red-brown pappules of gelatinous consistency
153
munchhausen by proxy
when carere/ parent produces factitious illness in a child or adult in their care
154
hypochondriasis vs somatisation
hypochondriacs fear a specific disease
somatisation = multiple somatic complaints
155
Chest drains:
fluid level swings with inspirations
removal of chest drain with EXPIRATIION
chest tube should not be clamped
insert into 5th ICS
156
bowel cancer screening
50-74 every 2 years
157
targeted lung cancer screening
55-74 lo dose CT scan every 2 years
158
haemophilus durecyi
painful genital ulcer (Chancroid)
A/W tender inguinal lymphadenopathy
159
when do HCG levels raise in pregnnacy
day 11
- peak weeks 10-12 weeks gestation
160
lung abscess management
clindamycin
161
ophthalmoplegia (e.g. nystagmus)
ataxia
acute mental confusion
Wernickes encephalopathy
162
Wilsons disease
autosomal recessive
asymmetrical tremor
depression and behavioural patterns
163
Causes of HAP
Strep pneumonia OR haemophilus influenza
LATE onset= pseudomonas aeruginosa or other antimicrobial resistant opportunistic gram -ve bacteria or MRSA
164
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)
165
when does over th counter pregnancy test become +ve
9 days post conception
(remain positive 5 days post fetal death)
166
treatment oral candidasis
topical nystatin or miconazole
OR
systemic fluconazole, ketoconazole or itraconazole anti fungal
167
What liver enzyme raises rapidly in pregnancy
ALP (as produced by the Planeta)
168
Coagulation factors and prengnacy
pregnancy is HYPERCOAGULABLE state
but blood APTT/PT etc all stay the same ranges
169
How do FBC and U&E change in pregnancy
WCC increases
platelets fall
U&E: increase in kidney size and perfusion --> serum levels drop
170
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
171
Fregoli syndrome
person is falsely identified in strangers
(Capgras is when some ins supplanted b a stranger who is their exact double)
172
Ekboms syndrome
delusion of infestation with insects
173
Gansers syndrome
syndrome of approximate answers
174
waddling gait when trying to run
"climbing u the legs" when rising from floor
psychoypertrophy of the calves
Duchenne muscular dystrophy
(Gowers sign)
175
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
176
not walking by 18 months, delayed motor milestones and global developmental delay
Duchenne muscular dystrophy
177
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)
178
Duchenne musclar dystrophy
autosomal recessvie
carriers asymptomatic
179
Duchenne muscular dystrophy
MDT management
180
Friedreichs ataxia - most likely cause of death
cardiomyopathy
181
most common inherited autosomal recessive ataxia in the UK
Friedreichs ataxia
onset <20 years
general clumsiness or deterioration of athletic performance
182
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
183
causes of infertility in women: drugs
NSAIDS
spirolactone
cytotoxic drugs
neuroleptic drugs
recreational drugs
cycle-oxygenase inhibitors
184
male infertility: what common GI drug causes oligosperma
sulfalazine
185
"tightening" rather than pain after 20 weeks
Braxton-hicks contractions
186
sudden severe abdominal pain after coughing/trauma in pregnnacy --> rupture of inferior epigastric vessels
rectus muscle haematoma
187
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
188
systolic ejection murmur increases on standing and decreases with squatting
HCM
189
Myotonic dystrophy
cataracts, muscle weakness, frontal balding
presents OLDER than Duchenne muscular dystrophy
190
Duchenne Muscular dystrophy prognosis
most require ventilatory support by 25 years of age
most lose ability to walk by 12 year
191
Most common muscular dystrophy in adults
Myotonic dystrophy
autosomal dominant
--> anticipation
192
when to do progesterone level for infertility in 35 day cycle
28!!!! day
193
fascioscapulohumeral muscular dystrophy
progressive difficulty whistling and sucking through a straw
194
sleep apnoea and HTN
increase risk of HTN
195
potassium in diet and HTN
LOW potassium diet --> HTN
196
SOB, clubbing, heamoptysis and weight loss
What is first line investigation?
CXR
197
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
