Mixed/Formatives etc Flashcards
Low impact tauma in old people, crescent shaped hypodensity on CT
Subdural haemorrhage
Man falls off horse, lucid interval, hyperdense biconvex on CT
Extradural haemorrhage
Huntington’s triple repeat of….
Glutamate
Two year slow onset of Parkinsonism, mainly affecting gait and lower limbs with no autonomic dysfunction
Vascular parkinsonism
What does LOAF stand for?
Lateral two lumbricals
Opponens pollicis
Abductos pollicis brevus
Flexor pollicis brevis
Fried egg frontal lobe brain tumour, presents with seizures and headache in a child
Oligodendrocytoma
Immediate management of TIA 3h ago if symptoms are now resolved
Aspirin 300mg
- don’t CT it won’t pick up, wait until spec clinic for MRI)
PLS affects which motor neurons
UMN
PMA affects which motor neurons
LMN
First synapse in somatosensory pathway of ST tract
Lumbar spinal cord
Function of vestibulospinal tract
Activates the antigravity extensory muscles
- extensor mechanism prevents you falling
Fixed dilated pupil, head trauma, unilateral descending tentorial herniation
Uncal herniation
Management of LEMS
3, 4- diaminopyridamine (no steroids involved)
Management of absencse seizure
Ethosuximide or valproate
Name an antidepressant used to block SSRI side effects
Mirtazapine
Schizophrenic symptoms from childhood, lack of close friends and severe social anxiety
Schizotypal personality disoorder
Depression, anxiety, irriability, physial health hanges e.g. chest rash
Substance misuse (consider if MH symptoms + physical symptoms)
Management of psychosis in PD
Atypical antipsychotics e.g. olanzapine
Management of delirium in PD
Lorazepam
Investigation for parkinsonism with dementia or LBD
CT
- DaT scan them if CT doesn’t show anything
Medical management of PTSD
Sertraline or venlafaxine
Biggest risk factor for puerperal psychosis
Bipolar disorder
Characteristic sign of SVT on ECG
<120ms QRS complexes
First line management of ectopic
IM methotrexate
First line inv of endometriosis
TVUS
Management of urge incontinence
Oxybutynin or mirabegron
Pain before period, sore pooping, tender nodular mass on pelvic exam
Endmetrial cysts
3rd line PET management
Methyldopa
First line inv for secondary amennhorroea
Urine beta hCG
Management of complete molar pregnancy
Surgical removal and send tissue for pathology
Pt comes in looking for a new contraception 2 days PP, she has BMI 41 and her partner has a vasectomy booked
Progesterone only pill
- don’t give long term due to vasectomy
- don’t give COCP due to weight
Ovarian tumour with transitional cels, coffee bean nuclei and fibrous stroma
Brenner
- comes from bladder
Hormone inhibiting contractility in late pregnancy
Progesterone
Hormone increasing contractility in late pregnancy
Oestrogen
Hormone increasing contractions and excitabilit and producing prostaglandins in late pregnancy
Oxytocin
Where should quinsy pts be treated?
Admit to hospital, risk of airway compromise
Imaging choice for kidneys specifically PCKD
US
Management of AKI in burns patient
Fluid challenge with crystalloid
Components of tetralogy of fallot
Pulmonary stenosis
VSD
Right ventricular hypertrophy
Overriding aorta
Can NPH present with tremor as well as triad?
Yes
Why do you get pink urine in G6PD?
Intramedullary cause of haemolysis
- therefore you get breakdown products in the urine e.g. haemoglobinuria
Prophylactic therapy for polycythemia vera
Aspirin
- due to risk of thrombosis
Arterial thrombosis stroke, 3 miscarriages, FHx early death, prolonged PT and APTT
Antiphospholipid
Elderly male with uncomplicated UTI who is penicillin allergic
Cotrimoxazole
What UTI abx given in 1st and 2nd trimester?
Nitrofurantoin
What UTI abx given in 3rd trimester?
Trimethoprim
Lumbar puncture in meningitis?
NOOOOO
- due to incr risk of raised ICP and coagulopathy
Which hormone gives negative feedback to hypothalamus during follicular phase?
Oestrogen
What happens to steady state plasma conc when you double the rate of admin of a FOK drug?
Steady state plasma conc doubles
What cells incr membrane resistance in central nervous system?
Oligodendrocytes
What is next step management in triple neg breast cancer pt who has had WLE and SNB?
Radiotherapy
- unless maybe there was cancer left behind in nodes not sure
Investigation for male breast lump
US
- due to dense breast tissue
- may go on to do biopsy/mammo etc
What’s the underlying mechanism behind urge incontinence in old female pt with Hx T2D?
Detrusor muscle overactivity
- T2D related bladder atony would cause stress like symptoms and dribbling
Contraindication to progesterone only implant
Active breast cancer
Wells score >4, what’s the first line investigation?
Urgent CTPA
Episodes of blacking out with strong family history incl sudden death and ECG changes
Brugada syndrome
Best way to analysea 16 gene panel for long QT
Whole genome/exome sequencing
- looking for point mutation in muliple genes
What can you detect in chromosomal microarray?
Copy Number Variations (CNV)
80 yo with hot tender breast and overlying cellulitis with no response to 2 courses of abx
Inflammatory breast cancer
- urgent 2ww to breast clinic
What type of stricture is specific to Crohn’s?
Ileal stricture
Management of acute liver failure with neutrophilic ascitic tap in alcoholic?
Broad spectrum abx
- to mange the bacterial peritonitis
- can’t give emergency liver transplant due to active alcoholism
Red jelly sputum pneumonia post-op for bowel obstruction in CF pt
Klebsiella pneumonia
- klebs is a gut commensal
Slow progressive bilateral conductive hearing loss, normal ear appearance, 35 yo
Otosclerosis
Acute onset painful eye, raised ICP symptoms, optic nerve cupping, red reflex present
Acute closed-angle glaucoma
Antipsychotic drug causing withdrawal seizures
Benzodiazepines
Mx of AAA <45mm, 45-54mm, >54mm
<45mm yearly US
45-54mm 3 monthly US
>54mm red for surg assessment
Old man with loss of motor and bladder control, loss of pain and temperature sensation from T10 down, not Hx trauma
Anterior spinal artery ischaemia
- causes damage to anterior 2/3 of spinal cord causing upper and lower CS and ST loss of function
Triad of diagnostic criteria for hyperemesis gravidarum
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
Creamy or green +/- blood nipple discharge
Duct ectasia
First line ER positive breast cancer medical management
Tamoxifen - premeno
Anastrozole - post meno
How can you determine if pt will have axillary clearance or SNB?
Pre op axillary US
Cut off for metformin treatment in GH
> 7 (use insulin)
Post menopausal post coital dark red bleeding - most common cause
Vaginal atrophy
- FL oestrogen creams
Prevention of vasospasm in SAH
Nimodipine
Howell-Jolly bodies and siderocytes on blood film suggest
Hyposplenism or post splenectomy
Basophilic stippling and cabot rings on blood film suggest
Lead poisoning
- think lead = metal = ring
TRALI vs TACO
Essentially both fluid overloaded butttttttttttt
- TRALI = hypotension (manage with O2)
- TACO = hypertension (manage with diuretics)
a benign ovarian tumour
ascites
pleural effusion
Meig’s syndrome
Which types of miscarriages have open cervical os?
Open your Is
- incomplete and inevitable
A normocytic anaemia with low serum iron, low TIBC but raised ferritin in a patient with a chronic illness is typical of
Anaemia of chronic disease
Best investigation for fistula e.g. vesicovaginal fistula after prolonged difficult delivery presenting with dribbling incontinence
Urinary dye studies
How long should you wait to restart COCP after ullipristal emerg contraception?
5 days
What do the antibodies mean in chickenpox exposure pregnancy questions?
IgG: G = Got antibodies
IgM: M = Met someone with the virus (infected)
Vaginal bleeding at less than 6 weeks gestation
Monitor expectantly and advise to repeat pregnancy test in 7 days. If negative, this confirms miscarriage. If positive, or continued or worsening symptoms, refer to the early pregnancy assessment unit
Med to be taken before fibroid surgery that can help decr size
GnRH agonist e.g. Leuprolide
Big risk factor for hyperemesis gravidarum
Trophoblastic disease
When is lack of foetal movements a concern to you?
After 28 weeks
- fewer than 10 movements in 2 hours
- do doppler and then CTG
When should preg people with hyperemesis be admitted to hosp for IV fluids?
1) Not keeping down antiemetics or fluids
2) Ketonuria and/or weight loss >5%
3) Comorbidity e.g UTI and can’t take oral Abx
When is AFP raised in pregnancy?
Neural tube defects
FL inv vestibular schwannoma
AUdiogram and MRI gadolinium enhanced
Medical vs surgical nerve CNIII palsy
Med = down and out
Surg = down and out + dilated
How should MND pts be fed?
PEG
MoA of hyperventilation in raised ICP pts
Reduce blood carbon dioxide to induce cerebral vasoconstriction
50%
ToP meds
Oral Mifepristone followed by Misoprostol vaginally 36-48 hours later
Early vs late onset GBS in neonate
Early <1 week
Late >1 week
How often should people with PCOS be inducing a withdrawal bleed on COCP?
Every 3 months
Inheritance of CMT
Auto dominant
FL prevention of tumour lysis
Aggressive hydration and allopurinol
- if high risk add rasburicase
Management of PMDD
FL COCP
SSRI e.g. sertraline or fluox
Empiric treatment of coag negative staph
Vancomycin
FL inv in pt with low plates
Examine for signs of bleeding
- if plates <50 and signs of bleeding -> platelet transfusion
When would prothrombin or FFP be given in bleeding on warfarin?
Only in major bleeding e.g. haemorrhage post-trauma
- give FFP if prothrombin not available
How strong should breakthrough meds be in relation to sustained release?
1/6
Clotting factor affected by VWF
VIII looks like VW
Thrombotic risk factors + lupus and gradual onset headache and focal neuro
Venous sinus thrombosis
Quadruple test is done from…..
13 weeks
Most common cause of meningitis in young adults
Neisseria
How to rmember most common meningitis organisms?
Explaining Big, Hot Neck Stiffness
E. coli, Group B strep (neonates)
Haemophilius influenzae (older infants/children)
Neisseria meningitis (adults <50)
Streptococcus pneumoniae (>50yo)
Chandelier sign
Eponymous name for cervical excitation
FL management in acute stress reaction
Trama focussed CBT
Smoking affects neutrophls in what way……
Neutrophilia
Raised protein and lymphocytes with polymorphonuclear cells on LP
Tubercular or cryptococcal meningitis
Lymphocyte = viral
polymorph = bacterial
mixed = TB
What pneumonia is assoc with cold IgM haemolytic anaemia?
Mycoplasma
Management of cervical ectropion
Unconercned - reassure and follow uo
Concerned - colposcopy
bHCG >1500 and no evidence yet of IUP
Presume ectopic
Palliative management of breathlessness at EOL
Morphine sulphate 2.5-5mg
Soft and high uterus with PPH and lots of clots
Uterine atony
- RFs include uterine overstretch with twins
Klumpke’s palsy
Dermatomal sensory loss in the C8-T1 distribution
Weakness of the intrinsic muscles of the hand
Potential ipsilateral Horner’s syndrome if T1 involvement occurs
How often should severe PET pts be getting bloods?
U&E, FBC, transaminases and bilirubin three times per week
Mangeement of drug induced parkinsonism
Procycline
FL management of pt with cord compression
Dexamethasone
95% of extradural bleeds are…
Supratentorial
Lentiform-shaped heterogenous hyper-dense extra-axial collection
Extradural haemorrhagge
Acute cord compression in the context of anticoagulation…..
Think epidural haematoma
How is SAH managed?
Endovascular coiling
- can’t suck it out bc mixed with CSF
- can;t ligate artery
Second inv after CT to diagnose SAH
LP 12 after symptom onset
- CTA is used to guide management and is gold standard
Acute subdural haemorrhage management
Craniotomy
Managment of extradural haemorrhage
Ligation of bleeding vessel
Severe back pain followed by four-limb flaccid weakness
Spinal cord infarction
- cauda equina = HAPPENS AT BOTTOM OF CORD SO ONLY LEGS
Head CT in 1 hour
Clinical evidence of skull fracture.
30 minutes retrograde amnesia.
Focal neuro or seizure.
GCS <13 at any time (or <15 2 hours after injury).
Vomiting.
LOC and amnesia in:
- Are >65 years
- Suffered a dangerous mechanism of injury
- Coagulopathy
Head CT in 8 hours
If pt on warfarin
Management of intracranial venous sinus thrombosis
LMWH
Contraception to be stopped after 50
COCP and depo
Anti D is given in TOPs and miscarruages after….
10 weeks
When can you start COCP after levonogestrel?
Immediate
- 5 days if ullipristal
When are forceps allowed?
o Fully dilated cervix (10cm)
o One-fifth or nil palpable abdominally (-2 station)
o Ruptured membranes
o Contractions present
o Empty bladder
o Presentation (Cephalic) and position (OA – OP possible with rotational)
o Satifactory analgesia – Vaccuum/low forceps (Perineal block), Mid-forceps (Epidural)
Fluids given in HG
Normal saline with added potassium IV
PP only need emergency contraception at how many days ……
21§
For how long after TOP is a pos pregnancy test normal finding
4 weeks
Staging of endo cancer
- Confined to uterus
- Spread to cervical stroma
- Spread to adnexal structures
- Spread to bowel, bladder or more distant’§
FL for ITP plates <30
Prednisolone oral
Fl for ITP plates >30
Observation
Is graft-host tranasfusion disease assoc with B or T cells?
T cells
Which type of HRT is incr risk of breast cancer?
Combiend
Anastrozole incr risk of ……
Osteoporosis
What inv next for reduced foetal movement if you can’t find heartbeat on doppler?
Ultrasound
- won’t find it on CTG if it’s not on doppler, US will be more sensitive
What happens if you find late decels on CTG that midwife is concerned about?
Fetal blood sampling
- if <7.2 then C section
- more likely just do urgent C section bc FBS might take too long and risk baby
Painful 3rd nerve palsy is ……. until proven otherwise
Post comm artery aneurysm
Blood pressure problems in pregnancy don’t present until…..
20 weeks
- any HT before that is pre-existing
Hb threshold for iron tabs in pregnancy
110
Contralateral homonymous hemianopia with macular sparing and visual agnosia
Posterior cerebral artery
Normal endo thickness
- During menstruation: 2-4mm
- Early proliferative phase (day 6-14): 5-7mm
- Late proliferative: up to 11 mm
- Secretory phase: 7-16 mm
Urine turns red on standing
Acute intermittent porphyria
- assoc with abdo pain, vomiting, HT, tachycardia, seizures, psych symptoms
Biochem findings in myeloma
High calcium. Normal phosphate. Normal alkaline phosphate
Mx APS in pregnancy
Dalteparin (LMWH) and aspirin
