mock paper Q's Flashcards
what are the doses of adrenaline to be given in anaphylaxis for 8 year old boy?
300 micrograms IM adrenaline 1:1000 (0.3ml)
what are the doses of adrenaline to be given for an 18 month old baby?
150 micrograms IM adrenaline 1:1000 (0.15ml)
what are the doses of adrenaline to be given to an adult?
> 12 years - 500 micrograms IM adrenaline 1:1000 (0.5ml)
what us the risk of a patient with foot pain at rest with dusky coloured skin, and absent pulses of needing a lower limb amputation?
25% risk of death in 1 year
33% risk of lower limb amputation
what is the clinic target BP for patient with HTN and T2DM?
140/90 - previous targets have now been superseded by one clinic target of 140/90 for everyone < 80 years old
150/90 > 80 yrs
how do you measure ABPI?
highest recorded systolic BP in the affected leg over the highest recorded systolic pressure in either arm
what are the amber flags for sepsis in children?
not responding normally to social cues - no smile, decreased activity, wakes only with prolonged stimulation
nasal flaring
tachypnoea - > 50 bpm in 6-12 months, > 40 bpm in over 12 months
O2 < 95%, crackles on chest
Tachycardia:
>160 beats/minute, age <12 months
>150 beats/minute, age 12-24 months
>140 beats/minute, age 2-5 years
* Capillary refill time >=3 seconds
* Dry mucous membranes
* Poor feeding in infants
* Reduced urine output
fever > 5 days
age 3-6 months with fever > 40
rigors
swelling of limb or joint
what are some red flag features of sepsis in children?
pale, mottled skin
appears ill to healthcare professional
does not wake on stimulation
weak, high pitched cry
tachypnoea > 60
moderate intercostal/severe recession
reduced skin turgor
< 3 months with > 38 degree temp
- Age <3 months, temperature >=38°C
- Non-blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neurological signs
- Focal seizures
should abx be prescribed to a child with fever with no obvious source?
no - only if suspect meningiococcal sepsis can give IM benpen but no routine abx
what is the dose of IM benpen for suspected meningitis in community for < 1 years old?
IM 300mg
what is the dose of IM benpen for suspected meningitis in community 1-10 years old?
IM 600mg
what is the dose of IM benpen for suspected meningitis for > 10 years old?
1200mg IM
what is the management of one off episode of haematuria in a child with no symptoms?
repeat dipstick in 1 week - one off episode of microscopic haematuria in a child during an illness is common and usually resolves
what temp indicates high risk (red flag) sign for sepsis in 2 month old?
> 38 degrees
what temp indicates high risk (red flag sign) for sepsis in > 3 month old?
no temp indicates red flag
temp > 39 - intermediate (amber) RF for serious illness
what is the management of head lice in children?
Dimeticone 4% lotion and spray, malathion 0.5% lotion and wet combing
what is the honey and mumford questionnaire?
questionnaire used to define the preferred learning style that can help witht he selection of educational experiences that suit that style
what are the learning styles identified in honey and mumford questionnaire?
activists
reflectors
theorists
pragmatists
what is the belbin inventory?
questionnaire which identifies the nine types of personalities that seemed to be important in teams
what is the calgary-cambridge observation guide?
The (enhanced) Calgary–Cambridge guide to the medical interview is a useful guide that can be used when analysing Dr/patient consultations. It considers how we provide structure within the consultation and allows in depth analysis of the following areas within the consultation, expanding on these to enable more effective communication. It describes the five tasks of the consultation as initiating the session, gathering information, building the relationship, giving information – (explaining and planning) and closing the session.
what is collaborative care?
working with the patient and their family to define solutions to problems - collaborative care has shown improvement in MUS and reduced health care utilisation costs
what is reattribution?
technique which tests the thoughts and assumptions of patients by considering alternative causes of events. This particularly helps to challenge beliefs held by people who perceive themselves as the cause of problem events
what is psychodynamic therapy?
Psychodynamic therapy draws on theories and practices of analytical psychology and psychoanalysis. It is a therapeutic process which helps patients understand and resolve their problems, helping individuals to unravel, experience and understand their true, deep-rooted feelings in order to resolve them.
at how many weeks from the onset of symptoms would you investigate fatigue with no other symptoms?
approx 4 weeks
how long can you safely use a potent corticosteroid in one area of skin in plaque psoriasis?
8 weeks continuously
what is the management of chronic plaque psoriasis?
first line - potent corticosteroid + vit D OR vit D analogue for 4 weeks, can be extended to 8 weeks max.
second line - if no suitable clearance after 8 weeks, offter vit D analogue or a vit D analogue alone applied twice daily
for how long should very potent corticosteroids be applied in psoriasis?
for 4 weeks and only with specialist input
how long should you have breaks between treatment of potent or very potent corticosteroids in plaque psorasis?
4 weeks between courses of treatment
how long can potent steroids be used on the scalp?
8 weeks
how long and what type of steroids can be used for psoraisis affecting the face, flexues or genitals?
only a mild-moderate steroid can be used for no more than 2 weeks
which is the most common type of BCC?
Nodular BCC - accounts for 60-80% of all cases, commonly found on the face and neck, nodular with pearly rolled edges, with a central depressed/ulcerated area
which virus increases the risk of laryngeal cancer?
HPV
what is the paradise criteria?
criteria for tonsillectomy in recurrent tonsillitis -
more than 7 yearly
more than 5 yearly over 2 consecutive years
more than 3 years over 3 successive years
what is the most common pathogen in otitis externa?
aspergillus
which treatment for ear wax is NOT licensed by NICE?
manual syringing
what is the standardised mortality ratio?
SMR - ratio of observed deaths to expected deaths, multipled by 100. I.e. AN SMR of 100 means the number of deaths is the same as expected for the general population. A number higher than 100 implies an excess mortality rate.
what would the SMR rate be if it is ten times that of the general population?
10 x 100 = 1000
what is relative afferent pupillary defect?
If afferent impulses on the right side are delayed (due to, for instance, optic neuritis) as light is swung into the affected eye the consensual dilation from the (normal) left eye is more powerful than the light reflex in the affected eye. Therefore, paroxysmal dilatation is seen on the swinging light test in the affected (i.e., the right) eye. This phenomenon is best demonstrated with the light shone into the eyes alternately for 2–3 seconds with approximately one second in between.
what is the serious eye complication in classical GCA?
ischaemic optic neuropathy - caused by occlusion of the short psoterios ciliary arteries
what is the percentage cure rate for patients with Hep C antiviral treatment?
95%
which is the most common muscular dystrophy?
myotonic dystrophy
what is the inheritance of myotonic dystrophy?
autosomal dominant
what are the symptoms of myotonic dystophy?
The disease is slowly progressive and is characterised by cataract formation, hypogonadism, frontal balding and cardiac disorders. As well as weakness, there is myotonia of involved muscles, the latter resulting in an inability of the patient to let go of the examiner’s hand.
when does duchennes muscular dystrophy present?
aggressive disease that presents in first 5 years of life and usually leads to death by 20 years .
how is duchennes muscular dystrophy inherited?
x-linked
what is the most significant prognostic indicator for breast cancer prognosis?
axillary LN positivity
which medication should be avoided in methotrexate?
the most serious complication of methotrexate therapy is bone marrow suppression, hence the need for regular blood monitoring with a full blood count. The concomitant use of an anti-folate drug (e.g. trimethoprim) increases the risk of bone marrow suppression, and should therefore be avoided, especially for prolonged treatment courses.
which is the most common testicular neoplasm in over 50 years?
non hodgkins lymphoma
what is the most common testicular neoplasm in 20-60 years?
leydig cell tumours
what age can sertoli tumours present in the testes?
any age including infants
what are the conditions which should be reported to the Injuries, Disease and Dangerous Occurances Regulations 2013?
Carpal tunnel syndrome
Cramp of the hand or forearm
Occupational dermatitis
Hand arm vibration syndrome
Occupational asthma
Tendonitis or tenosynovitis
Occupational cancer
Exposure to a biological agent
what is the Carr-Hill formula?
the Carr-Hill allocation formula
used to adjust the global sum total for a number of local demographic and other factors which may affect Practice workload.
for example, a Practice with a large number of elderly patients may have a higher workload than one which primarily cares for commuters.
what is the time limit for a practice to acknowledge a complaint?
3 working days
when is the most appropriate day of a womans cycle to take a mid-luteal phase serum progesterone?
Ovulation can be confirmed retrospectively by measurement of serum progesterone in the mid-luteal phase, approximately day 21 of a 28-day cycle. Women with fertility problems and prolonged regular menstrual cycles should be offered a later serum progesterone measurement e.g. day 28 of a 35-day cycle.
when can a mirena coil be inserted after delivery of baby?
Levonorgestrel-intrauterine device (LNG-IUD) can be inserted within 48h of delivery, or after four weeks post-partum, given the risk of ascending bacterial infection and uterine perforation. Risk is deemed to be higher in breast feeding so sexual health clinics may wait up to 3 months.
what are the fitness to fly rules in pregnancy?
most airlines do not allow travel after 36 weeks for a single pregnancy and after 32 weeks for a multiple pregnancy
what is the only licensed antidepressant for PTSD?
sertraline
what is the antidepressant of choice in patients on warfarin, heparin or NSAID’s?
mirtazapine - lowest bleeding risk
which medications are contraindicated in lithium?
NSAID’s - reduce the excretion of lithium and increase the risk of toxicity
what is the target HBA1c in patients with T2DM?
if managing with lifestyle only - 48
if managing with medications - 53
first line antiemetic in EOL care of patient with bowel obstruction?
hyoscine butylbromide
in a child who has survived a primarycancer, which is the single most common site of a subsequent primary cancer?
brain + thyroid
what are the classes of BMI?
Overweight: BMI greater than 25 kg/m2
Obesity class 1: BMI of 30–34.9kg/m2
Obesity class 2: BMI 35 kg/m2 to 39.9 kg/m2
Obesity class 3: BMI 40 kg/m2 or more.
what is the criteria for ref to genetic services in patient with breast cancer?
Bilateral breast cancer
Male breast cancer
Ovarian cancer
Jewish ancestry
Sarcoma in a relative younger than age 45 years
Glioma or childhood adrenal cortical carcinomas
Complicated patterns of multiple cancers at a young age
Paternal history of breast cancer (two or more relatives on the father’s side of the family)
what is the MRC dyspnoea scale?
The modified Medical Research Council (mMRC) dyspnoea scale:
- Not troubled by breathless except on strenuous exercise
- Short of breath when hurrying on a level or when walking up a slight hill
- Walks slower than most people on the level, stops after a mile or so, or stops after 15 min walking at own pace
- Stops for breath after walking 100 yards, or after a few minutes on level ground
- Too breathless to leave the house, or breathless when dressing/undressing
what urine specimen is considered gold standard for chlamydia testing?
first catch urine
vulvovaginal swab is the specimen of choice in women are most sensitive
when should a repeat test be offered to young people under the age of 25 years with chlamydia?
after 3 months -This guidance is based on evidence that young adults who test positive for chlamydia are 2–6-times more likely to have a subsequent positive test, and that repeated chlamydia infection is associated with an increased risk of complications such as pelvic inflammatory disease and tubal infertility. A test-of-cure, however, is not routinely recommended for uncomplicated genital chlamydia infection.
how long an ulipristal acetate be used for emergency contraception?
up to 120 hours after unprotected sex
