Miscellaneous

Question 1

Signs of benzodiazepine overdose?

Treatment?

Answer 1

Slurred speech, ataxia, drowsiness, respiratory depression, coma

Flumenazil

Question 2

Signs of opiod overdose?

Treatment?

Answer 2

Miosis, CNS and respiratory depression, euphoria, +ve response to naloxone

Ventilation then naloxone

Question 3

Alcohol overdose treatment?

Answer 3

Benzodiazepines

Question 4

Signs of cocaine overdose?

Treatment?

Answer 4

Dilated pupils, hallucinations, paranoia, angina and sudden cardiac death, perforated nasal septum

Benzodiazepine

Question 5

Depression symtoms and management?

Answer 5

At least 2 weeks with 5 or more of the following symptoms (must include depressed mood or anhedonia): 
D - depressed mood 
I -interest diminished/anhedonia 
G - guilt or feelings of worthlessness
S - sleep disturbances 
S - suicidal ideation
P - psychomotor retardation or agitation  
A - appetite/ weight changes 
C - concentration decreases 
E - energy reduction 

*no evidence of manic or hypomanic episodes

CBT and SSRIs = 1st line = sertraline, fluoxetine, citalopram

Question 6

Key symptoms of delirum?

Answer 6

Hallucinations, disturbance in sleep, cognitive dysfunction, altering levels of consciousness

Treat underlying cause, consider haloperidol

Question 7

Generalised anxiety disorder management?

What drug is given for severe disabling anxiety which may be associated with insomnia? It is only given in the short term.

Answer 7

SSRI, SNRI or atypical antidepressant (citalopram, duloxetine, venlafaxine) and or CBT

Benzodiazepines

Question 8

Fibroadenoma symptoms

Answer 8

Well defined mobile breast mass that fluctuates with menstrual cycle PAINLESS (unlike fibrocystic breasts which are TENDER and fluctuate with menstrual cycle)

Mammography
Breast ultrasound
Biopsy

Question 9

Atrophic vaginitis symptoms?
Investigation?
Treatment?

Answer 9

Vaginal dryness, burning, itching, discharge
Urinary frequency, dysuria, recurrent UTIs
Discomfort with intercourse/light bleeding

DIAGNOSIS of exclusion! Must do a transvaginal ultrasound(TVUS) to rule out endometrial cancer

Topical oestrogen = 1st line
Also use lubricants and moisturisers

also called genitourinary symptoms of menopause

Question 10

Testicular torsion symptoms investigation management

Answer 10

Testicular pain - SUDDEN ONSET, may be associated with nausea and vomiting
Affected testicle is HIGH-RIDING
Scrotal swelling, erythema
No pain relief with elevation of scrotum (-ve Prehn’s sign) - rules out epididymitis
ABSENT CREMASTERIC REFLEX on the affected side = diagnostic

Doppler ultrasound - absent or decreased blood flow in the affected testicle
Grey-scale ultrasound - presence of fluid and the whirlpool sign

Emergency surgical consult

Question 11

What is the management pathway for an unexplained breast lump?

Answer 11

Women 30 and over - should be referred under a 2-week wait for triple assessment in breast clinic

>35 = Mammogram 
<35 = Ultrasound

Question 12

What are the differentials for breast

1. Lump
2. Discharge
3. Erythema

Answer 12

Lump - fibroadenoma, fibrocystic disease, cyst, cancer

Discharge - duct ectasia(tender lump around areola +/- green discharge), Ductal papilloma(clear or blood stained discharge no lump), cancer

Erythema/ pain - mastitis, breast abscess(walled-off lump)

Question 13

When does breast cancer screening occur?

Answer 13

50-70 YO every 3 years

Question 14

When do you do 2WW referral for breast signs?

Answer 14

30 or over with unexplained breast lump

Or 50 or over with nipple discharge, retraction or other changes of concern

Question 15

What medication is given for a breast cancer patient that is ER +ve and post menopausal?

Answer 15

Anastrazole

Letrozole

Question 16

What medication is given for a breast cancer patient that is ER +ve and pre menopausal?

Answer 16

Tamoxifen

Question 17

What medication is given for a breast cancer patient that is HER2 +ve?

Answer 17

Trastuzumab (Herceptin)

Question 18

What are the range for lab values for the following?

Na
K
U
Cr

Answer 18

Na+ : 133-146
K+ : 3.5-5.3
U: 2.5-7.8
Cr: 59-104 men, 45-84 women

Question 19

Femoral hernia are located _ and _ to pubic tubercle.

What are signs of strangulation?

Management of femoral hernia?

Answer 19

• inferior and lateral
• strangulation - tenderness and erythema, vomiting, obstipation
• URGENT SURGICAL referral. Femoral hernias have a high risk of strangulation

Question 20

What are some causes of onycholysis?

Answer 20

Trauma
Thyrotoxicosis
Fungal infection
Psoriasis

Question 21

What are the causes of euvoleamic hyponatremia?

How would diagnose SIADH?

Answer 21

Diagnosis of exclusion.
First, TFTs to rule out hypothyroidism
Then short synACTHen test to rule out adrenal insufficiency

Then proceed with special tests for SIADH

Question 22

Name some causes of crackles/crepitations on auscultation of lungs

Answer 22

Pulmonary fibrosis

Pulmonary oedema

Question 23

Calculate GCS for a patient

Answer 23

Eyes (4) Voice(5) Movement(6)

- look this up! Comes up in exams

Question 24

Define these terms in desease screening:

Sensitivity
Specificity
Positive predictive value
Negative predictive value

Answer 24

Sensitivity - the probability that when the disease is present, the test is positive. High sensitive test used for screening as it is good at ruling OUT disease when result is negative. “SN-N-OUT”
= TP/(TP + FN)

Specificity - probability that when the disease is absent, the test is negative. Used for confirmation after a positive screening test. Also known as true negativity rate. Good at ruling IN disease when positive. “SP-P-IN”
= TN/(TN + FP)

Positive predictive value - probability that a person who has a positive test result actually has the disease

Negative predictive value - probability that a person with a negative test result actually does not have the disease.

Question 25

How do you calculate sensitivity and specificity? How do you set up the two by two table?

Answer 25

Sensitivity = TP/(TP + FN)
Specificity = TN/ (TN + FP)
Left column all the people that have disease, right column is all that don’t

Question 26

How do you calculate positive predictive value and negative predictive value? How do you set up the calculation table?