mock exam Flashcards
when to give DC cardioversion in context of tachyarrhythmia
systolic BP < 90mmHg
most common cause of infective exacerbations of COPD
Haemophilus influenzae
the equivalent parenteral dose of morphine (subcutaneous, intramuscular, or intravenous) is about _____ of the oral dose.
half
management of seborrhoeic dermatitis
ketoconazole
investigation in suspected endometriosis
laparoscopy
medication given before fibroid surgery
Gonadotrophin-releasing hormone analogue
medical management of large fibroids
ullipristal acetate (progesterone receptor modulator)
treatment of primary dysmenorrhoea
1st line- NSAIDs (mefanamic acid)
charcot’s triad
cholangitis
- fever
- RUQ pain
- jaundice
acute heart failure not responding to treatment
consider CPAP
when is BiPAP used?
T2 respiratory failure
flashers and floaters
vitreous/retinal detachment
why are patients given nimodipine in SAH
prevent vasospasm in aneurysmal subarachnoid haemorrhages
preceding influenza predisposes to ______ pneumonia
staphylococcus aureus
management of whooping cough
if admission is not needed, prescribe an antibiotic if the onset of cough is within the previous 21 days. A macrolide antibiotic is recommended first-line:
> Prescribe clarithromycin for infants less than 1 month of age.
Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
Prescribe erythromycin for pregnant women.
acute migraine management
triptan + NSAID or triptan _ paracetamol
migraine prophylaxis
topiramate or propanolol
features suggestive of steroid responsiveness?
eosinophilia
management of COPD
SABA/SAMA
LABA (salmeterol) + ICS
inguinal hernia in infants
urgent surgery
umbilical hernia in infants
wait and see
potassium per day fluids
1 mmol/kg/day
water requirements per day
25-30ml/kg/day
adjuvant hormonal therapy for ER +ve breast cancer
anastrozole in post-menopausal women
tamoxifen in premenopausal women
how does anastrozole work?
aromatase inhbitor that reduces peripheral oestrogen synthesis
features of wernicke’s encephalopathy
C- onfusion A- ataxia N- ystagmus O- phthalmoplegia PE- ripheral neuropathy N- europathy
managment of symptomatic bradycardia
VI doses of atropine
external pacing
third nerve palsy
pupil down and out and fixed and dilated pupil
causes of third nerve palsy
- trans-tentorial or uncal herniation
- posterior communicating artery aneurysm
- cavernous sinus thrombosis
- webers (contralateral hemiplegia)
- diabetes
- vasculitis
what occurs in cereberllar tonsilar herniation
terminal event- cardio-respiratory arrest
hyper/hypocalcaemia in pancreatitis
hypercalcaemia= can cause pancreatitis
hypocalcaemia= indicator of pancreatitis severity
why do you get hypocalcaemis in pancreatitis
saponification of fats, lipase leaks out of damaged pancreas, breakdown fat into triglycarides and fatty acid. fatty acids combine with calcium to produce soap.
why are ACEi bad in AKI
actively reduce the GFR by causing vasodilation of the efferent arteriole and reducing the glomerular filtration pressure
drugs to continue in AKI
paracetamol Warfarin statins aspirin (at cardioprotective dose of 75mg) clopidogrel beta-blockers
drugs to stop in AKI
NSAIDs aminoglycosides ACEi AR2RB diuretics
drugs that may have to be stopped in AKI as increased risk of toxicity
metformin
lithium
digoxin
Management of hyperkalaemia
Stabilisation of cardiac membrane- IV Ca gluconate
Short-term shift in potassium from extracellular to intracellular fluid department- combined insulin/dextrose infusion, nebulised salbutamol
removal of potassium from the body- calcium resonium (orally or enema),loop diuretics, dialysis
criteria for AAA surgery
- asymptomatic aneurysm larger than 5.5cm in diameter
- asymptomartic aneurysm enlarging by more than 1cm per year
- a symptomatic aneurysm (urgent not elective)
what kind of ileostomy can be used to defunction the colon to protect an anastamosis
loop ileostomy
what distinguishes scleritis from episcleritis
pain
management of TIA in GP
if patient presents within 7 days of a clinically suspected TIA= aspirin 300mg immediately and specialist review within 24hr
similar pain after cholecystectomy
gallstones present in the CBD
presentation of acute lymphoblastic leukaemia
anaemia, neutropenia, thrombocytopenia
management of AHTR
general fluid resuscitation and termination of the transfusion
what cannot be prescribed with methotrexate
trimethoprim
folate antagonist= myelosuppression and pancytopaenia
liver failure
triad
- encephalopathy
- jaundice
- coagulopathy
key differentiating factor between chronic liver disease and acute failure
raised prothrombin time, very high bilirubin, presence of encephalopathy
cause of wernickes
thiamine deficiency
signs of DIC
serious coagulopathy which would cause raised PT time and low platelets
what is hepatorenal syndrome
acute liver failure preceding acute renal failure, high creatinine
caput succedaneum
crossed suture line
where to check pulse paediatric BLS
brachial/femoral artery
women aged >30 with an unexplained breast lump
suspected cancer pathway referral
management of alcohol withdrawal
1st line- long-acting benzo e.g. chlordiazepoxide or diazepam. lorazepam may be preferable in patients with hepatic failure.
Carbamazepine is also effective
neurogenic shock cause
loss of sympathetic outflow resulting in hypotension and bradycardia as well as warm peripheries due to vasodilatation and inability to constrict
complications of thyroid surgery
damage to parathyroid glands= hypocalcaemia
acute reactive arthritis management
NSAIDs
signs of acute reactive arthritis
can’t see, can’t pee, can’t climb a tree/bend the knee’
when can miscarriage not be managed expectantly?
increased risk of bleeding, previous adverse experiences associated with pregnancy, increased risk from the effects of haemorrhage or evidence of infection
medical management of miscarriage
vaginal misoprostol
antiemetics
pain relief
how does misoprostol work?
prostaglandin analogue, binds to myometrial cells to cause strong myometrial contractions leading to the expulsion of tissue
how is TPN given?
through central line- strongly phlebitic and can irritate peripheral veins
symptoms of hypomania in primary care
routine referral to CMHT
cord prolapse positioning
on all fours
management of neoplastic spinal cord compression
> high-dose oral dexamethasone
> urgent oncological assessment for consideration of radiotherapy or surgery
hypercalcaemia ECG change
shortening of QT interval
osborne (J) waves
hyperkalaemia ECG change
Tenting of T waves
wide QRS complexes
hypokalaemia ECG change
prominent U waves
how to step down asthma treatment
25-50% reduction in the dose of ICS
medical indications for circumcision
phimosis
recurrent balanitis
balanitis xerotica obliterans
paraphimosis
what must be excluded before circumcision?
hypospadias
diagnosis of confirmed miscarriage
TVUSS demonstrating a no cardiac activity and
- crown-rump length is greater than 7mm
- gestational sack is greater than 25mm
management for intertrochanteric proximal femoral fracture
DHS
facial pain worse on leaning forward
sinusitis
management of sinusitis
analgesia and decongestants in acute phase
if chronic then intranasal corticosteroids are often beneficial
If C. difficile does not respond to first line metronidazole….
oral vancomycin should be used next, except in life-threatening infections
Management of secondary pneumothorax <1cm
admit and give oxygen for 24 hours and review
scans used to assess the presence of fluid in the abdomen and thorax
FAST
management of myxoedemic coma
Hydrocortisone and Levothyroxine
Thyrotoxic storm treatment
beta blockers, propylthiouracil and hydrocortisone
when are ectopics managed surgically
presence of foetal heart beat
management of IHCP
IOL at 37-38 weeks
causes of drug-induced urinary retention
Opioid analgesia (such as tramadol) alongside anticholinergic
management of DKA
Insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin
What does +ve HBsAG show?
currently infected with HBV
absence of anti-HBcAg IgM
chronic infection
HBV vaccine non-responder
HBsAg = -ve
Anti- HBsAg = -ve
Anti-HBcAg IgM= -ve
Anti-HBcAg IgG= -ve
HBV vaccine responder
HBsAg = -ve
Anti- HBsAg = +ve
Anti-HBcAg IgM= -ve
Anti-HBcAg IgG= -ve
HBV acute infection
HBsAg = +ve
Anti- HBsAg = -ve
Anti-HBcAg IgM= +ve
Anti-HBcAg IgG= +ve/-ve
HBV chronic infection
HBsAg = +ve
Anti- HBsAg = -ve
Anti-HBcAg IgM= -ve
Anti-HBcAg IgG= +ve
previous HBV infection, now immune
HBsAg = -ve
Anti- HBsAg = +ve
Anti-HBcAg IgM= -ve
Anti-HBcAg IgG= +ve
for a diagnosis of PTSD how long should symptoms be present?
one month
what should patients with CD4 count lower than 200/mm3 recieve
prophylaxis against pneumocystis jiroveci= co-trimoxazole
what should all men with ED have checked
testosterone level
A second drug should be added in type 2 diabetes mellitus if the HbA1c is
> 58 mmol/mol
which SSRI is most likely to cause QT prolongation
citalopram
Patient >= 60 years old with new iron-deficiency anaemia →
urgent colorectal cancer pathway
intervention of choice in malignant distal obstructive jaundice
biliary stenting
patients with ascities secondary to liver cirrhosis should get
an aldosterone antagonist= spironolactone
what does a high SAAG suggest?
non-peritoneal cause of ascites = cirrhosis, budd-chiari syndrome, nephrotic syndrome
what does low SAAG suggest?
peritoneal cause of ascites= tuberculous pertonitis, peritoneal mesothelioma
what is SAAG
serum albumin ascites gradient
management of anterior uveitis
steroids drops + cycloplegic (mydriatic) drops
what distinguishes vestibular neuronitis from labyrinthitis
unaffected hearing
Hyponatraemia correction
osmotic demyelination syndrome
Hypernatreamia correction
cerebral oedema
Acute dystonia secondary to antipsychotics is usually managed with
procyclidine
management of bronchiolitis
Supportive measures such as maintaining oxygenation and hydration
treatment of suspected or confirmed shock in children (fluids)
Start IV fluid resuscitation in children or young people with a bolus of 20 ml/kg over less than 10 minutes
what must be done before starting biologics for rheumatoid
CXR- look for TB, can cause reactivation
medications causing hyponatraemia
PPIs
omeprazole
management of human/animal bites
co-amoxiclav
what to do if metformin is not tolerated
try a modified-release formulation before switching to a second-line agent
side effect of aromatase inhibitors
osteoporosis
prescribing in CMPI
Consider prescribing calcium supplements for breastfeeding mothers whose babies have, or are suspected to have, CMPI, to prevent deficiency whilst they exclude dairy from their diet
If investigating a suspected DVT, and either the D-dimer or scan cannot be done within 4 hours, then start a …
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