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Peer Teaching Mocks 3a To Learn > Mock 2 > Flashcards

Mock 2 Flashcards

1
Q

What is the initial treatment for DKA in a child with N+V?

A

IV Fluids (0.9% NaCl 10ml/kg) and SC Insulin (0.1units/kg/hr)

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2
Q

Describe bicarbonate levels in DKA

A

Low as the ketones use them all up

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3
Q

Describe creatinine levels in DKA

A

Mildly raised - sign of dehydration

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4
Q

Describe features of Stephen-Johnson Syndrome

A

Rare but serious - affects multiple parts of the body. Begins with flu-like symptoms followed by red/purple target like rash that spreads and forms blisters

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5
Q

Give some common causes of Stephen Johnson syndrome

A 
Allopurinol
Lamotragine
Penicillin
Phenytoin
Viral infection (mumps, flu, HSV, EBV)
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6
Q

What is always the appropriate first step when considering a diagnosis of epilepsy?

A

Request an EEG - Don’t start medication until you know what subtype of epilepsy they have

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7
Q

Give 4 complications of chicken pox

A

Bacterial superinfection
Cerebellitis
DIC
Progressive Disseminated Disease

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8
Q

Describe impetigo rash

A

Small pustules that develop a honey-coloured crusted plaque, usually on face, no surrounding erythema, often not itchy

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9
Q

Give 4 high risks of future suicide after a failed attempt

A

Leaving a note
Taking precautions to avoid discovery
Terminating utility contracts
Using a violent method e.g. jumping/hanging

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10
Q

What class of drugs is used to prevent and treat extra-pyramidal side effects caused by antipsychotics?

A

Anti-cholinergics e.g. procyclidine

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11
Q

What drug is used to treat tardive dyskinesia?

A

Tetrabenazine

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12
Q

Give a drug used to reverse the effects of LMWH

A

Protamine sulphate

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13
Q

Give a drug used for symptomatic management of myasthenia gravis

A

Pyridostigmine

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14
Q

What is the first line treatment for PTSD

A

Trauma focussed CBT

EMDR if ineffective

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15
Q

What class of drug is citalopram?

A

SSRI

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16
Q

What does a PHQ score of 5-9 mean

A

Mild depression

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17
Q

What does a PHQ score of 10-14 mean

A

Moderate depression

18
Q

What does a PHQ score of 15-19 mean

A

Moderately severe depression

19
Q

What does a PHQ score of 20-27 mean

A

Severe depression

20
Q

What is the intervention for mild depression?

A

Watch and wait - consider referral to IAPT for low intensity psychological interventions

21
Q

Are obsessive thoughts usually egosyntonic or egodystonic?

A

Obsessive thoughts are usually egodystonic (very different to the patient’s normal beliefs and values) rather than egosyntonic (in keeping with ones beliefs and values)

22
Q

Give 4 medications associated with delirium?

A

Furosemide
Oxybutinin
Propanolol
Rantidine

23
Q

How often should a patient commenced on clozapine have their blood tested?

A

Every week for 18 weeks

Then fortnightly until 1 year

24
Q

Miss Sahli, a 29-year-old lady, had a positive urinary pregnancy test 6 weeks ago. She presents to your GP surgery complaining of blood coming from her vagina. You suspect she may be having a threatened or inevitable miscarriage. A transvaginal ultrasound is carried out which shows an intrauterine fetal pole with no fetal heartbeat. The crown rump measurement is less than 7mm. What is the next most appropriate step?
A. Inform the mother that she has had a miscarriage
B. Repeat the Ultrasound in 7 days
C. Give IM Methotrexate and monitor beta HCG levels
D. Discharge the patient with no further follow-up as a viable pregnancy is likely
E. Prepare for immediate surgical evacuation of the retained products of conception

A

B is correct as due to the Crown rump length being less than 7mm, it may be too early to tell whether this is viable but very early pregnancy, or a possible non-viable pregnancy (miscarriage). A repeat scan is necessary.

25
Q

If a patient is hrHPV positive and analysis reveals CIN1, what should you do?

A

Do not treat, Discharge and screen again at 12 months in the community. Individuals with CIN 1 have low grade abnormal changes in the transformation zone, they are at lower risk of developing cervical cancer so are often not treated but still need follow up after 12 months and further colposcopy if necessary.

26
Q

What is the most common type of vaginal cancer?

A

Secondary (metastatic) vaginal cancer (80%) - primarily from cervix or endometrium

27
Q

What is the most common type of primary vaginal cancer?

A

Squamous cell carcinoma

28
Q

Describe the correct process of faetal descent through the birth canal

A

Descent, engagement, flexion, internal rotation, crowning, extension of presenting part, external rotation of head, delivery

DEFICEED

29
Q

How should asymptomatic bacteriuria on first culture be managed in pregnant women?

A

Confirm presence of bacteriuria with 2nd culture and then begin culture dependent antibiotic

30
Q

At what amniotic fluid index (AFI) would a pregnancy be diagnosed with polyhydramnios?

A

Greater than 24cm

31
Q

At what amniotic fluid index (AFI) would a pregnancy be diagnosed with oligohydramnios?

A

Less than 5cm

32
Q

What is the most common cause of polyhydromnios?

A

Idiopathic (50-60%)

33
Q

What kind of stroke are personality changes associated with?

A

Anterior cerebral artery stroke

34
Q

What is Horner’s syndrome characterised by?

A
  1. Unilateral anhydrosis (not sweating)
  2. Enophthalmos (inset eye)
  3. Miosis
  4. Ptosis
35
Q

What is a common exam cause of Horner’s syndrome?

A

Pancoast (apical) tumour compressing the sympathetic chain

36
Q

What is the only licensed treatment for MND?

A

Riluzole

37
Q

What are the triggers for migraines?

A 
CHOCOLATE:
Chocolate
Hangover
Orgasm
Cheese
OCP
Lie in 
Alcohol 
Tumult 
Exercise
38
Q

How does ropinirole work?

A

Activates dopamine receptor s to mimic the action of dopamine

39
Q

What should you always give in addition to aspirin?

A

A PPI

40
Q

What should be prescribed for fibroids greater than 3cm whilst definitive treatment is arranged?

A

Tranexamic acid and/or NSAIDs

41
Q
  1. Which of the options below is not a role of metformin in PCOS?
    A. Appetite reduction
    B. Decreases androgen production
    C. Decreases LH from the anterior pituitary
    D. Decreases sex-hormone binding globulin in the liver
    E. GnRH antagonist
A

GnRH antagonist

42
Q
  1. A 6-year-old (20kg) is brought in to the emergency department by his parents. He weighs 20kg, is clinically dehydrated, tachypnoeic, but not shocked. His breath smells like pear drops. You carry out some basic investigations and discover that his blood glucose is 20 mmol/l, arterial pH is 7.2 (assume 5% fluid deficit) and there is ketonaemia. After 200ml of bolus, what is the most appropriate fluid resuscitation in this patient’s current state?
    A. 0.9% NaCl plus KCl 40mmol/L, at a rate of 79ml/hour
    B. 0.9% NaCl plus KCl 40mmol/L, at a rate of 95ml/hour
    C. 0.9% NaCl plus KCl 20mmol/L, at a rate of 79ml/hour
    D. 0.9% NaCl plus KCl 20mmol/L, at a rate of 95ml/hour
    E. 0.9% NaCl plus dextrose, at a rate of 86ml/hour
A

For most paediatric cases 20ml/kg bolus is administered in shock, however in DKA and HF give 10ml/kg bolus due to fluid overload complications, eg. cerebral oedema.
Estimated weight = (age +4)x2.
For non-shocked patients with DKA:
Hourly rate = ({Deficit – initial bolus} / 48hr) + Maintenance per hour
If they were shocked and in DKA then you would not minus the initial bolus. Workings:
- 5% deficit of 20kg:
- 1kg is 1000ml water
- (20x1000) x 0.05=1000ml deficit
- 1000 deficit - 200ml bolus = 800ml to be given over 48h
- 16.67ml/hr for 48h
- Maintenance per 24h:
- 100ml/kg for the first 10kg
- 50ml/kg for the second 10kg
- 20ml/kg for the third 10kg
- 100x10=1000
- 50x10=500
- 1500ml to be given over 24h
- 62.5ml/hr for 24h
- Total:
- 16.7 + 62.5 = 79.2 kg/h for 48 hours Fluid choice:
- “Use 0.9% sodium chloride with 20 mmol potassium chloride in 500 ml (40 mmol per litre) until blood glucose levels are less than 14 mmol/l “
- You would also want to administer IV insulin, but only start this 1-2 hours after administering IV therapy.

Peer Teaching Mocks 3a To Learn (9 decks)

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