Med School Mock Flashcards
List 2 common causes of acute otitis media in infants age group
- Streptococcus pneumoniae
- Haemophilus influenzae
Anatomically why are young children more prone to otitis media ?
Short eustachian tubes
What ABs could be prescribed ?
- Amoxicillin
- Clarithromycin (if penicillin allergy)
A complication of otitis media is meningitis, name 2 new symptoms you would warn parents to look out for ?
- Headache
- Photophobia
- Vomiting
- Hypotonia
- Non-blanching or purpuric rash
- Neck stiffness
What type of hearing loss is glue ear ?
- Conductive
Types of hearing loss
Conductive hearing loss.
Sensorineural hearing loss.
Mixed hearing loss.
Complication of otitis media that presents with post-auricular swelling and erythema ?
- Mastoiditis
List signs and symptoms you should enquire about when a pregnancy woman presents with blurring of vision
- Headache
- Nausea and vomiting
- Upper abdominal or epigastric pain
- Oedema
- Reduced urine output
- Brisk reflexes
High RFs for pre-eclampsia
- Pre-existing HTN
- PMHx
- Existing autoimmune condition e.g. SLE
- DM
- CKD
Moderate Risk Factors
- Older than 40
- BMI > 35
- More than 10 years since previous pregnancy
- Multiple pregnancy
- First pregnancy
- FHx
Conditions under which you would offer aspirin form 12 weeks
- One high risk factor
- Or more than one moderate risk factor
Medications for PE ?
- Labetalol
- Nifedipine
What would you expect to see on blood test for PE ?
- HELLP
- Haemolysis
- Elevated liver enzymes
- Low platelets
Triad of Parkinson’s
- Resting tremor
- Muscle rigidity
- Bradykinesia
How is Parkinson’s different to benign essential tremor ?
- Essential tremor worsens when holding arms outstretched
- Essential tremor worsens with activities such as writing whereas Parkinson’s tremor improves with purposeful actions
- Essential tremor is often symmetrical where PD is often asymmetrical
- Essential tremors has autosomal dominant trait where PD has no genetic trait
- Essential tremor improves with alcohol whereas PD tremor has no change
Name 2 side effects of levodopa
- Dry mouth
- Anorexia
- Palpitations
- Postural hypotension
- Psychosis
- Dyskinesia
- Dystonia
- Chorea
Parkinson’s Medications (not levo-dopa)
- Dopamine agonist e.g. bromocriptine
- MAO inhibitors e.g. rasagiline or selegiline
- COMT inhibitors e.g. Entacapone
Define a seizure
- Transient episode of abnormal electrical activity in the brain
Types of seizures
- Generalized tonic-clinic
- Focal
- Absence
- Atonic
- Myoclonic
- Juvenile myoclonic seizures
General advice for a child’s parents after a seizure
- Take caution with swimming and heights
- Shower rather than bath
- Record any further episodes
- If seizure lasts for more than 5 mins call ambulance or 2 mins with LOC
RFs for falls
- DM
- RA
- > 65
- Previous falls
- Polypharmacy
2 recommended tests from NICE to assess patients at risk of falls ?
- Turn 180 test
- Timed up and go test
Name management options to prevent Lorraine having future falls
- Strength and balance training
- Home hazard assessment
- Medication review
- Vision assessment
After a fall a patient develops dark brown/red urine. What could be the cause ? What blood test would suggest this condition and how would it be managed ?
- Myoglobinuria secondary to rhabdomyolysis
- Would be suggested by high levels of creatinine kinase and would be treated by IV fluids
Name 2 differentials for 4 day history of SOB, productive cough and generalized fatigue. PMH of COPD, HTN and previous MI
- Pneumonia
- PE
- Pleural effusion
- Pneumothorax
- Heart failure
Symptoms of COPD exacerbations
- SOB, productive cough and generalized fatigue
- Wheeze, fever, cyanosis, peripheral oedema, confusion
- Yellow-green phlegm
Name appropriate AB for COPD exacerbation in penicillin allergy
- Doxycycline, clarithromycin or azithromycin
What are the stages of the Transtheoretical model of health behaviour ?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
List 4 criteria for a life-threatening asthma attack
- PEFR less than 33% predicted
- Altered consciousness
- Cardiac arrhythmia
- Hypotension
- Cyanosis
- Poor respiratory effort
- Silent chest
- Confusion
1st line acute asthma treatment in hospital
- Nebulized salbutamol
- Followed by nebulized ipratropium bromide
- Followed by IV hydrocortisone if no impact
What would you monitor in a patient with acute asthma ?
- Oxygen sats
- PEF
What is the MOA for salbutamol ?
- Short acting beta-2 agonist
First rank symptoms of schizophrenia
- Auditory hallucinations
- Thought disorder
- Passivity phenomena
- Delusional perceptions
Poor prognostic indicators for schizophrenia
- Negative symptoms
- Low IQ
- Low socioeconomic status
- Social isolation
- FHx
Name atypical antipsychotics
- Aripiprazole
- Olanzapine
- Paliperidone
- Quetiapine
- Risperidone
Side effects of APs
- Weight gain
- Dyslipidemia
- Hyperprolactinaemia
- Impaired glucose tolerance
Possible side effects of the copper intrauterine device
- Spotting or cramping after insertion
- Period of heavier and more painful periods post insertion
- Infection
- Can fall out
What condition presents with watery, slightly grey discharge that smells fishy ? and how would you treat it ?
- Bacterial vaginosis
- Metronidazole
How does syphilis present ?
- Chancre/genital ulcer
How does chlamydia present ?
- Post-coital or intermenstrual bleeding
- Increased or purulent vaginal discharge/cervical discharge/deep dyspareunia/ dysuria/ pelvic pain/ pelvic tenderness
How would chlamydia present specifically on a male?
- Dysuria
- Urethral discharge
- Urethral discomfort
- Testicular pain
- Epididymo-orchitis
What is the causative organism of syphilis ?
- Treponema Pallidum
Name NICE recommended screening tools for depression ?
- PHQ-9
- HADS
- BDI-II
How long would you review a patient starting on SSRIs ?
- 1 week
RFs for endometrial cancer
- Increased age
- Early menarche
- Late menopause
- Nulliparity
- T2DM
Protective factors for endometrial cancer
- COCP
- Mirena coil
- Increased pregnancy
- Smoko
MC complication of measles
- Otis media
Who should be notified for a notifiable disease ?
- Local public health team
Name 4 beliefs indivisibles must have if they are to change their behaviour according to the Health Belief Model
- Belief that they are susceptible to the condition
- Believe in serious consequences
- Believe taking action reduces susceptibility
- Believe that benefits of actions outweigh costs
Theories of behaviour change
- Theory of planned behaviour
- Stages of change
- Transtheoretical model
- Social norms theory
- Motivational interviewing
First rank features of schizophrenia
- Auditory hallucinations
- Thought disorder
- Delusional perceptions
- Passivity phenomena
Explain the type of auditory hallucinations that would indicate schizophrenia
- Auditory third person hallucinations
- Running commentary not command
- Hearing her own thoughts spoken aloud
Explain the thought disorders that would present in schizophrenia
- Thought insertion
- Thought broadcast
- Thought withdrawal
Explain passivity phenomena in schizophrenia
- Bodily sensations being controlled by external influence
- Actions/impulses/feelings – experiences which are imposed on the individual or influenced by others
Explain delusional perceptions in the context of schizophrenia
- A two stage process where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient
- E.g. The traffic light is green therefore I am king
Second rank features of schizophrenia
- Impaired insight
- Negative symptoms
- Incongruity/blunting of affect
- Anhedonia
- Alogia
- Avolition
- Social withdrawal
- Neologisms – made up words
- Catatonia
What features of a mental state exam would make you think mania ?
- Appearance – over or under dressed. Flamboyant/unusual dress
- Behaviour – agitation or overactivity
- Speech – pressure of speech
- Thought disorders – flight of ideas – grandiose delusions
- Elevated mood
- Disinhibition
Psychological treatments for psychosis ?
- CBT
- Hearing voices group
- Psychoeducation
- Psychoanalytical therapy
Annual checks for patients on APs
- Blood tests – U&Es, LFTs, TFTs
- BMI
- ECG
- Blood pressure
Components of a MSE
- Appearance and behaviour
- Speech
- Emotion
- Perceptions
- Thoughts
- Insight
- Cognition
RFs for IUGR
- HTN
- Pre-eclampsia
- Social Hx of smoking or drug use
- Previous Hx of IUGR
Methods for assessing the fetus at 30 weeks gestation
- Cardiotocography (CTG)
- US measurement of fetal growth
- US measurement of amniotic fluid volume
Name members of an MDT who should be involved in a pregnancy at risk of preterm
- Obstetrician
- Anesthetist
- Pediatrician/Neonatologist
- Midwife
Most common cell origin of ovarian cancers
- Epithelial
- Around 90%
Most common type of ovarian cancer
- Serous carcinoma
Presenting features of ovarian cancer
- Abdominal distension and bloating
- Abdominal and pelvic pain
- Urinary symptoms e.g. Urgency
- Early satiety
- Diarrhoea
Treatments for life-threatening asthma
- Oxygen
- Nebulized salbutamol
- Nebulized ipratropium
- Corticosteroids oral or IV
IV treatments you would give to a patient not responding to nebulized treatments in severe or life threatening asthma
- Salbutamol
- Aminophylline
- Magnesium
- Hydrocortisone
When determining who well asthma is controlled what features of the condition would you ask about
- Pattern of medication use – pattern of salbutamol use
- Persistence of symptoms e.g. Wheeze or cough on exertion
- Involvement of secondary care e.g. previous hospital attendances
Findings of a LP in a patient with GBS
- Raised protein
- Normal white cell count
- Raised opening pressure
- Normal glucose
What investigation will confirm a diagnosis of GBS
- Nerve conduction studies
- Name generalised demyelinating peripheral neuropathies
- GBS
- Charcot Marie Tooth
- Mitochondrial disorders
Infective triggers of GBS
- Campylobacter jejuni
- Cytomegalovirus
- EBV
- HEP A,B,C,E
- Management of GBS
- Intravenous immunoglobulin
- Prophylactic anti-coagulation
- Physiotherapy
- Ventilator Support
In which situations can rhabdomyolysis present ?
Seizure
Collapse e.g. elderly fall and found hours later
Ecstasy
Crush Injury
Drugs e.g. statins + clarithromycin
Features of rhabdomyolysis
AKI
Elevated CK
Myoglobinurina: dark or redish-brown colour
Hypocalcaemia
Hyperkalaemia
Metabolic acidosis
Management of rhabdomyolysis
IV Fluids
C. First line investigation for post-menopausal bleeding and what is the next step if there is endometrial thickening ?
- Transvaginal US
- Pipelle biopsy
