Mixed/Formatives etc Flashcards
1
Q
Low impact tauma in old people, crescent shaped hypodensity on CT
A
Subdural haemorrhage
2
Q
Man falls off horse, lucid interval, hyperdense biconvex on CT
A
Extradural haemorrhage
3
Q
Huntington’s triple repeat of….
A
Glutamate
4
Q
Two year slow onset of Parkinsonism, mainly affecting gait and lower limbs with no autonomic dysfunction
A
Vascular parkinsonism
5
Q
What does LOAF stand for?
A
Lateral two lumbricals
Opponens pollicis
Abductos pollicis brevus
Flexor pollicis brevis
6
Q
Fried egg frontal lobe brain tumour, presents with seizures and headache in a child
A
Oligodendrocytoma
7
Q
Immediate management of TIA 3h ago if symptoms are now resolved
A
Aspirin 300mg
- don’t CT it won’t pick up, wait until spec clinic for MRI)
8
Q
PLS affects which motor neurons
A
UMN
9
Q
PMA affects which motor neurons
A
LMN
10
Q
First synapse in somatosensory pathway of ST tract
A
Lumbar spinal cord
11
Q
Function of vestibulospinal tract
A
Activates the antigravity extensory muscles
- extensor mechanism prevents you falling
12
Q
Fixed dilated pupil, head trauma, unilateral descending tentorial herniation
A
Uncal herniation
13
Q
Management of LEMS
A
3, 4- diaminopyridamine (no steroids involved)
14
Q
Management of absencse seizure
A
Ethosuximide or valproate
15
Q
Name an antidepressant used to block SSRI side effects
A
Mirtazapine
16
Q
Schizophrenic symptoms from childhood, lack of close friends and severe social anxiety
A
Schizotypal personality disoorder
17
Q
Depression, anxiety, irriability, physial health hanges e.g. chest rash
A
Substance misuse (consider if MH symptoms + physical symptoms)
18
Q
Management of psychosis in PD
A
Atypical antipsychotics e.g. olanzapine
19
Q
Management of delirium in PD
A
Lorazepam
20
Q
Investigation for parkinsonism with dementia or LBD
A
CT
- DaT scan them if CT doesn’t show anything
21
Q
Medical management of PTSD
A
Sertraline or venlafaxine
22
Q
Biggest risk factor for puerperal psychosis
A
Bipolar disorder
23
Q
Characteristic sign of SVT on ECG
A
<120ms QRS complexes
24
Q
First line management of ectopic
A
IM methotrexate
25
First line inv of endometriosis
TVUS
26
Management of urge incontinence
Oxybutynin or mirabegron
27
Pain before period, sore pooping, tender nodular mass on pelvic exam
Endmetrial cysts
28
3rd line PET management
Methyldopa
29
First line inv for secondary amennhorroea
Urine beta hCG
30
Management of complete molar pregnancy
Surgical removal and send tissue for pathology
31
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
32
Ovarian tumour with transitional cels, coffee bean nuclei and fibrous stroma
Brenner
- comes from bladder
33
Hormone inhibiting contractility in late pregnancy
Progesterone
34
Hormone increasing contractility in late pregnancy
Oestrogen
35
Hormone increasing contractions and excitabilit and producing prostaglandins in late pregnancy
Oxytocin
36
Where should quinsy pts be treated?
Admit to hospital, risk of airway compromise
37
Imaging choice for kidneys specifically PCKD
US
38
Management of AKI in burns patient
Fluid challenge with crystalloid
39
Components of tetralogy of fallot
Pulmonary stenosis
VSD
Right ventricular hypertrophy
Overriding aorta
40
Can NPH present with tremor as well as triad?
Yes
41
Why do you get pink urine in G6PD?
Intramedullary cause of haemolysis
- therefore you get breakdown products in the urine e.g. haemoglobinuria
42
Prophylactic therapy for polycythemia vera
Aspirin
- due to risk of thrombosis
43
Arterial thrombosis stroke, 3 miscarriages, FHx early death, prolonged PT and APTT
Antiphospholipid
44
Elderly male with uncomplicated UTI who is penicillin allergic
Cotrimoxazole
45
What UTI abx given in 1st and 2nd trimester?
Nitrofurantoin
46
What UTI abx given in 3rd trimester?
Trimethoprim
47
Lumbar puncture in meningitis?
NOOOOO
- due to incr risk of raised ICP and coagulopathy
48
Which hormone gives negative feedback to hypothalamus during follicular phase?
Oestrogen
49
What happens to steady state plasma conc when you double the rate of admin of a FOK drug?
Steady state plasma conc doubles
50
What cells incr membrane resistance in central nervous system?
Oligodendrocytes
51
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
52
Investigation for male breast lump
US
- due to dense breast tissue
- may go on to do biopsy/mammo etc
53
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
54
Contraindication to progesterone only implant
Active breast cancer
55
Wells score >4, what's the first line investigation?
Urgent CTPA
56
Episodes of blacking out with strong family history incl sudden death and ECG changes
Brugada syndrome
57
Best way to analysea 16 gene panel for long QT
Whole genome/exome sequencing
- looking for point mutation in muliple genes
58
What can you detect in chromosomal microarray?
Copy Number Variations (CNV)
59
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
60
What type of stricture is specific to Crohn's?
Ileal stricture
61
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
62
Red jelly sputum pneumonia post-op for bowel obstruction in CF pt
Klebsiella pneumonia
- klebs is a gut commensal
63
Slow progressive bilateral conductive hearing loss, normal ear appearance, 35 yo
Otosclerosis
64
Acute onset painful eye, raised ICP symptoms, optic nerve cupping, red reflex present
Acute closed-angle glaucoma
65
Antipsychotic drug causing withdrawal seizures
Benzodiazepines
66
Mx of AAA <45mm, 45-54mm, >54mm
<45mm yearly US
45-54mm 3 monthly US
>54mm red for surg assessment
67
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
68
Triad of diagnostic criteria for hyperemesis gravidarum
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
69
Creamy or green +/- blood nipple discharge
Duct ectasia
70
First line ER positive breast cancer medical management
Tamoxifen - premeno
Anastrozole - post meno
71
How can you determine if pt will have axillary clearance or SNB?
Pre op axillary US
72
Cut off for metformin treatment in GH
>7 (use insulin)
73
Post menopausal post coital dark red bleeding - most common cause
Vaginal atrophy
- FL oestrogen creams
74
Prevention of vasospasm in SAH
Nimodipine
75
Howell-Jolly bodies and siderocytes on blood film suggest
Hyposplenism or post splenectomy
76
Basophilic stippling and cabot rings on blood film suggest
Lead poisoning
- think lead = metal = ring
77
TRALI vs TACO
Essentially both fluid overloaded butttttttttttt
- TRALI = hypotension (manage with O2)
- TACO = hypertension (manage with diuretics)
78
a benign ovarian tumour
ascites
pleural effusion
Meig's syndrome
79
Which types of miscarriages have open cervical os?
Open your Is
- incomplete and inevitable
80
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
81
Best investigation for fistula e.g. vesicovaginal fistula after prolonged difficult delivery presenting with dribbling incontinence
Urinary dye studies
82
How long should you wait to restart COCP after ullipristal emerg contraception?
5 days
83
What do the antibodies mean in chickenpox exposure pregnancy questions?
IgG: G = Got antibodies
IgM: M = Met someone with the virus (infected)
84
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
85
Med to be taken before fibroid surgery that can help decr size
GnRH agonist e.g. Leuprolide
86
Big risk factor for hyperemesis gravidarum
Trophoblastic disease
87
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
88
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
89
When is AFP raised in pregnancy?
Neural tube defects
90
FL inv vestibular schwannoma
AUdiogram and MRI gadolinium enhanced
91
Medical vs surgical nerve CNIII palsy
Med = down and out
Surg = down and out + dilated
92
How should MND pts be fed?
PEG
93
MoA of hyperventilation in raised ICP pts
Reduce blood carbon dioxide to induce cerebral vasoconstriction
50%
94
ToP meds
Oral Mifepristone followed by Misoprostol vaginally 36-48 hours later
95
Early vs late onset GBS in neonate
Early <1 week
Late >1 week
96
How often should people with PCOS be inducing a withdrawal bleed on COCP?
Every 3 months
97
Inheritance of CMT
Auto dominant
98
FL prevention of tumour lysis
Aggressive hydration and allopurinol
- if high risk add rasburicase
99
Management of PMDD
FL COCP
SSRI e.g. sertraline or fluox
100
Empiric treatment of coag negative staph
Vancomycin
101
FL inv in pt with low plates
Examine for signs of bleeding
- if plates <50 and signs of bleeding -> platelet transfusion
102
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
103
How strong should breakthrough meds be in relation to sustained release?
1/6
104
Clotting factor affected by VWF
VIII looks like VW
105
Thrombotic risk factors + lupus and gradual onset headache and focal neuro
Venous sinus thrombosis
106
Quadruple test is done from.....
13 weeks
107
Most common cause of meningitis in young adults
Neisseria
108
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)
109
Chandelier sign
Eponymous name for cervical excitation
110
FL management in acute stress reaction
Trama focussed CBT
111
Smoking affects neutrophls in what way......
Neutrophilia
112
Raised protein and lymphocytes with polymorphonuclear cells on LP
Tubercular or cryptococcal meningitis
Lymphocyte = viral
polymorph = bacterial
mixed = TB
113
What pneumonia is assoc with cold IgM haemolytic anaemia?
Mycoplasma
114
Management of cervical ectropion
Unconercned - reassure and follow uo
Concerned - colposcopy
115
bHCG >1500 and no evidence yet of IUP
Presume ectopic
116
Palliative management of breathlessness at EOL
Morphine sulphate 2.5-5mg
117
Soft and high uterus with PPH and lots of clots
Uterine atony
- RFs include uterine overstretch with twins
118
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
119
How often should severe PET pts be getting bloods?
U&E, FBC, transaminases and bilirubin three times per week
120
Mangeement of drug induced parkinsonism
Procycline
121
FL management of pt with cord compression
Dexamethasone
122
95% of extradural bleeds are...
Supratentorial
123
Lentiform-shaped heterogenous hyper-dense extra-axial collection
Extradural haemorrhagge
124
Acute cord compression in the context of anticoagulation.....
Think epidural haematoma
125
How is SAH managed?
Endovascular coiling
- can't suck it out bc mixed with CSF
- can;t ligate artery
126
Second inv after CT to diagnose SAH
LP 12 after symptom onset
- CTA is used to guide management and is gold standard
127
Acute subdural haemorrhage management
Craniotomy
128
Managment of extradural haemorrhage
Ligation of bleeding vessel
129
Severe back pain followed by four-limb flaccid weakness
Spinal cord infarction
- cauda equina = HAPPENS AT BOTTOM OF CORD SO ONLY LEGS
130
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
131
Head CT in 8 hours
If pt on warfarin
132
Management of intracranial venous sinus thrombosis
LMWH
133
Contraception to be stopped after 50
COCP and depo
134
Anti D is given in TOPs and miscarruages after....
10 weeks
135
When can you start COCP after levonogestrel?
Immediate
- 5 days if ullipristal
136
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)
137
Fluids given in HG
Normal saline with added potassium IV
138
PP only need emergency contraception at how many days ......
21§
139
For how long after TOP is a pos pregnancy test normal finding
4 weeks
140
Staging of endo cancer
1. Confined to uterus
2. Spread to cervical stroma
3. Spread to adnexal structures
4. Spread to bowel, bladder or more distant'§
141
FL for ITP plates <30
Prednisolone oral
142
Fl for ITP plates >30
Observation
143
Is graft-host tranasfusion disease assoc with B or T cells?
T cells
144
Which type of HRT is incr risk of breast cancer?
Combiend
145
Anastrozole incr risk of ......
Osteoporosis
146
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
147
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
148
Painful 3rd nerve palsy is ....... until proven otherwise
Post comm artery aneurysm
149
Blood pressure problems in pregnancy don't present until.....
20 weeks
- any HT before that is pre-existing
150
Hb threshold for iron tabs in pregnancy
110
151
Contralateral homonymous hemianopia with macular sparing and visual agnosia
Posterior cerebral artery
152
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
153
Urine turns red on standing
Acute intermittent porphyria
- assoc with abdo pain, vomiting, HT, tachycardia, seizures, psych symptoms
154
Biochem findings in myeloma
High calcium. Normal phosphate. Normal alkaline phosphate
155
Mx APS in pregnancy
Dalteparin (LMWH) and aspirin
156
