Mock 4 Flashcards
What are the 1st and second line medications in ADHD?
- Methylphenidate
2. Lisdexamfetamine
What is the 1st line treatment in viral induced wheeze?
Inhaled salbutamol via a spacer
What is used to diagnose Necrotising Enterocolitis?
Abdominal X-ray
What is the treatment for glue ear?
Usually resolves by itself (can take up to 3 months)
If treatment is required, grommets or temporary hearing aids can be given
Which side are inguinal hernias more common on?
The right side - due to patency of the processes vaginalis
What heart defect is William’s syndrome associated with?
Supravalvular Aortic Stenosis
What can be given after 1st line management in asthma exacerbation if the patient is not responding?
IV Salbutamol
IV aminophylline
IV magnesium
What does gram negative diplococci in CSF suggest?
N. meningitidis
Why is amoxicillin added to children under 3 months treatment for meningitis?
To cover for listeria
What is cryptorchidism?
Undescended testes
What are the 3 types of cryptorchidism?
- Retractile
- Palpable
- Impalpable
What is retractile cryptorchidism?
the testis is not present in the scrotum but can be manipulated into the scrotum before retracting again
What is palpable cryptorchidism?
the testis can be palpated in the groin but cannot be manipulated into the scrotum
What is impalpable cryptorchidism?
no testis can be felt, and may lie in the inguinal canal, intra-abdominally, or be absent
What is orchidopexy?
Surgical placement of the testis in the scrotum
What type of hypersensitivity reaction is anaphylaxis ?
Type 1
How should adrenaline be given in anaphylaxis?
IM - If there is no change administer again
What is the most common cause of intestinal obstruction in infants after the neonatal period ?
Intussusception
What is the investigation of choice in intussusception?
Abdo USS - Target sign or donut sign seen
Why are fluids crucial in intussusception?
Fluid pools in the abdomen due to obstruction - leading to shock
What is the treatment of choice in intussusception?
Air insufflation
What happens to reflexes in lithium toxicity?
They become hyper-reflexic
Give 4 examples of drugs that can be used as a mood stabiliser in long term bipolar?
Lithium
Carbamazepine
Olanzapine
Sodium valproate
What is more common, hypoactive or hyperactive delirium?
Hypoactive - but its much easier to miss
Give 7 causes of delirium
PINCH ME Pain Infection Nutrition Constipation Hydration Medication Electrolytes
What is a GI side effect of oxybutinin?
Constipation
What are the 3 main areas of serotonin syndrome?
Neuromuscular hyperactivity
Autonomic dysfunction
Altered mental state
How long should benzodiazepines be used for (maximum)?
No more than 2-4 weeks due to risk of addiction and side effects such as drowsiness
What class of drug is duloxetine?
SNRI
What are Lilliputian hallucinations?
This is characterised by seeing lots of small people. The name comes from Gulliver’s Travels
What kind of hallucinations are seen in delirium tremens?
Lilliputian hallucinations
What are extracampine hallucinations? What are they seen in?
Hallucinations outside the realm of physical possibility
Schizophrenia and other psychotic illnesses
What are the 2 most common heart defects seen in Turner’s syndrome?
- Bicuspid aortic valve
2. Coarctation of the aorta
Damage to which nerves causes Erb’s Palsy?
C5-C6
What is Klumpke’s palsy?
Damage to C8-T1 after birth - less common than Erb’s palsy
What is given in preterm labour before 24 weeks with a TVUS cervical length of <25mm and no previous preterm birth/trauma?
Vaginal progesterone - decreases activity of myometrium and prevents cervix remodelling
What is given in preterm labour if the patient had a previous preterm birth or any cervical trauma (for example cone biopsy to take out abnormal cells or if TVUS cervical length is 25mm+?
Cervical cerclage - stitch in the cervix
Give 5 features of ovarian neoplasm
- Hirsutism due to testosterone secretion
- Acute abdomen due to ovarian torsion
- Rupture or haemorrhage
- Thyrotoxicosis as in struma ovarii
- Amenorrhea
What is haematocolpos?
An accumulation of blood in the vagina - usually die to an imperforate hymen
What is ovarian hyperthecosis?
The presence of luteinised theca call nests in the ovarian stroma - it accounts for most of the cases of hyperandrogenaemia in POSTMENOPAUSAL women
What is the most likely cause of hyperandrogegism in postmenopausal women?
Ovarian hyperthecosis
What would LH, FSH, Oestradiol and TSH look like in anorexia nervosa?
LH - Low
FSH - Low
Oestrodial - Low
TSH - Low
What is the management of puerperal psychosis?
Hospital admission for psychiatric evaluation
What are the radiological findings in heart failure?
Alveolar oedema Kerley B lines Cardiomegaly Dilated upper lobe veins Pleural effusion
What are bat wing opacities?
Seen on CXR - representing alveolar oedema
What do Koplik spots look like?
Red spots with white centres on the buccal mucosa
What is an AUDIT score?
Alcohol Use Disorders Identification Test
What is AUDIT-C?
The shortened version of AUDIT. It comprises of the following 3 questions. If the patient scores more than 3, you must complete the full questionnaire.
1. How often do you have a drink containing alcohol?
2. How many units of alcohol do you drink on a typical day when you are drinking?
3. How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in
the last year?
How would you manage somebody who has come in with possible symptoms of alcohol withdrawal but are unsure whether it s alcohol related?
Assess their AUDIT score
When is sumatriptan contraindicated?
Coronary artery disease
What can be used second line in a premenopausal woman with focal seizures that is intolerant to carbamazepine?
Lamotragine
What is the explanation for a large mediastinal mass on CT CAP in myasthenia gravis patients?
Thymic hyperplasia (75% of pts) Thyoma (15% of pts)
What is the GCS score?
What is Uhthoff’s phenomenon?
Heat sensitivity in MS
What is Lhermitte’s sign?
A transient sensory symptom described as an electric shock radiating down the spine or into the limbs most often after flexion of the neck.
What are the symptoms of primary biliary cholangitis?
Fatigue
Jaundice
Pruritis
PBC is related with other autoimmune diseases
What antibodies are detected in primary biliary cholangitis?
Antimitochondrial antibodies
What is 1st line In delirium tremens?
Lorazepam
What is the causative organism in syphilis?
Treponema pallidum
What kind of bacteria is treponema pallidum?
Spirochaete bacterium
What is the 1st line treatment in acute flare up in ulcerative colitis?
Severe: IV Steroids i.e. hydrocortisone or methylprednisolone
Moderate: Oral steroids e.g. prednisolone
What are used to induce remission into mild disease in UC?
5-ASAs e.g. Mesalazine
What does gram positive cocci in CSF suggest?
Streptococcus Pneumoniae
What is used to relieve pain in IBS?
Buscopan - antispasmodic medication
What is 1st and 2nd line for prevention of migraines?
- Propanolol
2. Topiramate
Where might patients suffering from biliary colic feel pain?
- RUQ pain in waves
2. Referred intrascapular pain
What is charcot’s triad?
Characteristic of cholangitis:
- Fever
- RUQ pain
- Jaundice
What sign is seen in cholecystitis?
Positive Murphy’s sign
How do you differentiate cholangitis and cholecystitis?
Jaundice is present in cholangitis. It is not present in cholecystitis.