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Yr 4 - PassMed Corrections > Mock PassMed > Flashcards

Mock PassMed Flashcards

1
Q

What can be used for mx of intractable hiccups in palliative care? (2)

A

1) Haloperidol

2) Chlorpromazine

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2
Q

What is an example of ‘not envisaged circumstances’ in regards to DNA CPR?

A

Cardiac or respiratory arrest due to a readily reversible cause e.g. choking, blocked tracheal tube, hit by a bus

In these situations, CPR would be appropriate

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3
Q

What should you avoid cannulating in diabetics?

A

Feet

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4
Q

Mx of a perforated tympanic membrane caused by barotrauma?

A

Self-limiting: reassure and follow up

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5
Q

How can long term mechanical ventilation in trauma patients result in tracheo-oesophageal fistula formation?

A

The pressure arising from the ET tube on the posterior membranous wall of the trachea can result in ischaemic necrosis that also involves the anterior wall of the oesophagus.

This results in TOF formation.

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6
Q

What is the Z score adjusted for in DEXA scans?

A

Age, gender and ethnic factors

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7
Q

What does the T score in DEXA scans compare bone density to?

A

The bone density of a healthy 30 yr old

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8
Q

What should be prescribed alongside allopurinol when starting it for the first time?

A

‘Cover’ with NSAID or colchicine.

This is because starting allopurinol can in itself trigger and acute flare of gout.

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9
Q

mechanism of allopurinol?

A

Xanthine oxidase inhibitor –> reduces production of uric acid

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10
Q

When is cervical screening delayed until during pregnancy?

A

3 months post partum

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11
Q

How can thyroid surgery result in hypocalcaemia?

A

Due to damage to parathyroid glands

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12
Q

What is the referred surgical management for intertrochanteric (extracapsular) proximal femoral fracture?

A

Dynamic hip screw

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13
Q

What is d-dimer a product of?

A

Fibrinogen degradation product

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14
Q

Typical blood picture in DIC?

A
  • low platelets
  • low fibrinogen
  • raised PT & APTT
  • raised fibrinogen degradation products
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15
Q

When prescribing controlled drugs, what should be printed in both figures and words?

A

The quantity of tablets supplied

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16
Q

1st line treatment for CML?

A

Tyrosine kinase inhibitors –> imatinib

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17
Q

What class of medication is hyoscine hydrobromide/butylbromide?

A

Muscarinic receptor antagonist

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18
Q

What can cause a ‘rattling’ sound during breathing in palliative care?

A

Excessive bronchial and hypopharyngeal secretions.

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19
Q

Driving and schizophrenia?

A

Patients with schizophrenia must not drive and must notify the DVLA, until stable and well for 3 months and following a suitable psychiatristy report.

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20
Q

What are some key symptoms that differentiate dyskinetic cerebral palsy from other subtypes?

A
  • athetoid movements: slow writhing movements
  • oro-motor problems: e.g. drooling
  • fluctuating muscle tone: e.g. difficulty in holding objects
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21
Q

What % of women have a successful vaginal delivery following one previous caesarean section?

A

70-75%

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22
Q

When can referral for surgical excision be made in a fibroadenoma (i.e. what size)?

A

> 3cm

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23
Q

What treatment can be considered in an acute sickle crisis?

A

Exchange transfusions –> a way of reducing the number of sickle red cells and increasing the number of normal red cells, in order to improve oxygenation.

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24
Q

1st line mx step in eclampsia?

A

IV magnesium sulphate:
- prevent further seizures
- neuroprotection for foetus

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25
Q

What can be used to treat chlamydia in pregnancy? (3)

A

1) erythromycin
2) azithromycin
3) amoxicillin

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26
Q

Mx of pseudomonas aeruginosa in CF?

A

Oral ciprofloxacin (combined with inhaled Abx)

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27
Q

If a child lacks capacity, how does it work regarding parents & consent?

A

When a child lacks capacity, consent from one parent is sufficient to administer treatment as long as it is in the best interests of the child.

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28
Q

What is the imaging modality of choice in osteomyelitis?

A

MRI

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29
Q

Cause of osteomalacia?

A

Vitamin D deficiency

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30
Q

Is trimethoprim safe in breastfeeding?

A

Yes

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31
Q

Mx of all postmenopausal women with atypical endometrial hyperplasia?

A

A total hysterectomy with bilateral salpingo-oophorectomy, due to the risk of malignant progression.

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32
Q

Mx of Perthe’s disease <6 y/o?

A

has a good prognosis requiring only observation

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33
Q

Why are patients undergoing chemo at an increased risk of gout?

A

Cytotoxic drugs cause an increase in the breakdown of cells, releasing products that are degraded into uric acid.

Hyperuricaemia is a known risk factor for gout.

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34
Q

What cancer can CLL transform into?

A

Non-Hodgkin’s lymphoma (Richter’s transformation)

This can make patients suddenly unwell

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35
Q

Investigation in children and young people with unexplained bone swelling or pain?

A

Consider very urgent direct access X-ray to assess for bone sarcoma

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36
Q

How does ovarian cancer initially spread?

A

Local spread within the pelvic region

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37
Q

What location of ectopic pregnancies are most associated with an increase risk of rupture?

A

Isthmus

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38
Q

Mx of otitis externa?

A

Topical antibiotics with or without steroid

E.g. topical gentamicin & hydrocortisone drops

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39
Q

How can NSAIDs in large doses affect the ears?

A

Aspirin and other NSAIDs taken in high doses can cause tinnitus

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40
Q

What is the most common mechanism of ankle sprain?

A

Inversion of the foot

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41
Q

If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Doppler, what investigation is next?

A

Urgent US scan

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42
Q

What can be seen on a blood film in coeliac disease?

A

Target cells and Howell-Jolly bodies may be seen in coeliac disease → hyposplenism

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43
Q

Mx of whooping cough?

A

azithromycin or clarithromycin if the onset of cough is within the previous 21 days

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44
Q

If a newborn baby has an abnormal hearing test at birth, what test are they offered next?

A

Auditory brainstem response

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45
Q

What is given to patients with polycythaemia vera to reduce the risk of thrombotic events?

A

Aspirin

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46
Q

First line for ITP?

A

Oral prednisolone

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47
Q

What can be seen on a blood film in DIC?

A

Schistocytes - due to microangiopathic haemolytic anaemia

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48
Q

Where has damage occurred in dyskinetic cerebral palsy?

A

Basal ganglia and substantia nigra

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49
Q

What type of c-section is a contraindication to vaginal birth in a subsequent pregnancy?

A

Classical c-section (vertical scar)

Instead, offer planned c-section at 37 weeks

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50
Q

Why is a classical c section a contraindication to vaginal birth in a subsequent pregnancy?

A

Due to the increased risk of uterine rupture

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51
Q

1st line mx for non-pregnant women with vaginal thrush?

A

Oral fluconazole single dose

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52
Q

If a low lying placenta is found at the 20 week scan, what is the next step?

A

Rescan at 32 weeks to assess

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53
Q

What is the mx of choice for an intracapsular NOF fracture in patients with good pre-morbid status?

A

Internal fixation

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54
Q

Why should trimethoprim and methotrexate never be prescribed together?

A

Both inhibit dihydrofolate reductase –> can cause severe myelosuppression,

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55
Q

What 3 organisms most commonly cause post-splenectomy sepsis?

A

1) Strep. pneumoniae

2) H. influenzae

3) Meningococcus

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56
Q

Ischaemic stroke mx:

a) they present within 4.5 hours

b) they present after 4.5 hours

A

a) thrombolysis with alteplase, followed by aspirin 300mg 24 hours later

b) no thrombolysis, just aspirin 300mg

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57
Q

How does the Cushing’s reflex (raised ICP) affect HR?

A

Bradycardia

58
Q

How does the Cushing’s reflex (raised ICP) affect BP?

A

HTN

59
Q

In a patient presenting with fever on alternating days that has returned from abroad, what condition should you consider?

A

Malaria

60
Q

When using a salbutamol inhaler, how long between puffs should you wait?

A

30 secs

61
Q

Mx of asymptomatic patients bitten by a tick?

A

Reassurance

Provided the patient is asymptomatic, antibiotics are not recommended for tick bites.

62
Q

What can be considered in anal fissures that do not respond to conservative mx?

A

sphincterotomy

63
Q

What are some conservative mx options in anal fissures?

A
  • laxatives
  • lubricants
  • topical GTN
64
Q

What is the key diagnostic test in Guillain-Barre syndrome?

A

LP –> finding of elevated protein with normal WCC

65
Q

Mx of human bites if a bite has broken the skin?

A

Co-amoxiclav

66
Q

What medications are known for exacerbating plaque psoriasis?

A
  • NSAIDs
  • lithium
  • antimalarials
  • beta blockers
67
Q

Pharmacological mx of delirium in Parkinson’s disease?

A

Benzo e.g. lorazepam (give orally if possible)

68
Q

What is there a risk of when using 0.9% saline for fluid therapy in patients requiring large volumes?

A

Hyperchloraemic metabolic acidosis

69
Q

Effect of beta blockers in myasthenia gravis?

A

Beta blockers WORSEN myasthenia gravis

This affects the breathing muscles and causes a reduced FVC.

70
Q

Alzheimer’s disease causes widespread cerebral atrophy, mainly involving which areas of the brain?

A

Cortex & hippocampus

71
Q

Mx of life threatening C. diff?

A

Oral vancomycin and IV metronidazole

Tip - Vancomycin is given orally as it is poorly absorbed by the GI tract, allowing it to reach the site of infection and take effect.

72
Q

Prior to discharge, following an acute asthma attack, what should the peak expiratory flow rate be?

A

> 75% of best of predicted

73
Q

How long may finasteride treatment of BPH take before results are seen?

A

6 months

74
Q

1st line mx of hypercalcaemia?

A

IV saline

Then can consider bisphosphonates

75
Q

What is the investigation of choice in a PE with renal impairment?

A

V/Q scan

76
Q

Can a patient with ventricular fibrillation be conscious?

A

No - the nature of VF means that it is not compatible with a cardiac output.

77
Q

What investigation is diagnostic for mycoplasma pneumoniae?

A

Serology

78
Q

Mx of a unilateral pleural effusion (exudative)?

A

1) Diagnostic aspiration

then

2) Symptomatic drainage if indicated

79
Q

Patients who have had an episode of SBP require antibiotic prophylaxis if fluid protein is <15 g/l.

What is prophylaxis with?

A

Ciprofloxacin

80
Q

Mx of a myxoedemic coma?

A

Thyroxine + hydrocortisone

81
Q

If a patient with Parkinson’s disease cannot take levodopa orally (e.g. NBM), what can they be given?

A

Dopamine agonist patch as rescue medication to prevent acute dystonia

82
Q

What are the 3 first line Abx for an infective exacerbation of COPD?

A

1) Amoxicillin
2) Clarithromycin
3) Doxycycline

82
Q

What can assist in the diagnosis of Guillain-Barre syndrome?

A

1) LP –> raised CSF protein

2) Nerve conduction studies –> would be abnormal

83
Q

What is the gold-standard investigation for assessing drug sensitivities in TB?

A

Sputum culture

84
Q

Presentation of hep A?

A
  • flu like symtpoms
  • RUQ pain
  • tender hepatomegaly
  • deranged LFTs (notably raised ALT)
84
Q

If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago, do they require treatment for a tetanus prone wound?

A

If a patient has had 5 doses of tetanus vaccine, with the last dose <10 years ago, they don’t require a booster vaccine nor immunoglobulins, regardless of how severe the wound is.

85
Q

Is warfarin safe in AKI?

A

Yes

86
Q

1st line mx of chronic plaque psoriasis?

A

Topical POTENT steroid (e.g. betamethasone) + topical calcipotriol

87
Q

What vessel is involved in a 3rd nerve palsy?

A

posterior communicating artery aneurysm

88
Q

What can cause SVCO in myasthenia gravis?

A

Thymoma

89
Q

What Abs are present in myasthenia gravis?

A

Abs against acetylcholine receptors

90
Q

1st line investigation of acromegly?

A

IGF-1 levels

This can then be confirmed with OGTT and serial GH measurements

91
Q

OGTT result in acromegaly?

A

A lack of GH suppression with OGTT

92
Q

Effect of glucose on GH?

A

Glucose inhibits GH release

93
Q

What is used for diagnosis and screening of HIV?

A

HIV p24 antigen and HIV antibody tests

94
Q

1st line mx of acute anal fissure?

A

Soften stool, dietary fibre, analgesia and topical anaesthetic cream if necessary

95
Q

Mx of a chronic anal fissure?

A

Topical GTN –> relaxes the musculature and helps expand the blood vessels around the anus, it can be effective at reducing pain.

96
Q

CSF glucose vs serum glucose in bacterial meningitis?

A

CSF glucose is typically less than half the serum glucose

97
Q

What class of medication are associated with a significant increase in mortality in dementia patients?

A

Antipsychotics

98
Q

How can loop diuretics affect K+?

A

Can cause hypokalaemia

99
Q

UTI in women

A

Send an MSU for all women with a suspected UTI if associated with visible or non-visible haematuria.

This is because haematuria raises the possibility of an atypical organism.

100
Q

CT scan results bronchiectasis?

A

Abnormal widening and thickening of the bronchi

101
Q

Confusion in an asthma attack?

A

Life threatening

102
Q

What to give as prophylaxis against brain mets in small cell lung cancer?

A

Prophylactic radiotherapy

103
Q

What complication of measles most commonly causes death?

A

Pneumonia

104
Q

What can be added to syringe driver in end of life care for peope with seizures?

A

Midazolam

105
Q

What laxative should you always prescribe alongside opioids?

A

Senna

106
Q

Abx for CAP vs HAP?

A

CAP - amoxicillin

HAP - co-amoxiclav

107
Q

What laxative should be given to a patient on morphine with constipation (was prescribed senna initially)?

A

A stimulant (senna) with or without a stool softener (docusate)

or

Daily administration of an osmotic laxative (polyethylene glycol/Movicol)

108
Q

Treatment for Duke C bowel cancer?

A

Surgery + adjuvant chemo

109
Q

Mx of mets in brain and lungs?

A

Chemotherapy

110
Q

1st line treatment for haemoptysis in lung cancer?

A

Palliative radiogtherapy

111
Q

What Abx to give to a patient with neutropenic sepsis with E. coli infection (but ESBL)?

A

Carbapenems

Can’t give tazocin as ESBL bacteria is resistant to both piperacillin & tazobactam.

112
Q

How can immunotherapy affect the thyroid?

A

Can cause thyroiditis (elevated T4, low TSH)

113
Q

Long term vs short term side effects of radiotherapy?

A

Short term: -itis e.g. oesophagitis, dermatitis

Long term: -osis e.g. fibrosis

114
Q

What is Wernicke’s (receptive) aphasia?

A

This area ‘forms’ the speech before ‘sending it’ to Broca’s area. Lesions result in sentences that make no sense, word substitution and neologisms but speech remains fluent - ‘word salad’

Comprehension is IMPAIRED.

115
Q

Location of lesion in receptive aphasia?

A

This is Wernicke’s aphasia.

Location is temporal lobe of the left (dominant) hemisphere of the brain.

116
Q

What is Broca’s (expressive) aphasia?

A

Speech is non-fluent, laboured, and halting. Repetition is impaired

Comprehension is NORMAL.

117
Q

Location of lesion in Broca’s (expressive) aphasia?

A

Location is frontal lobe of the left (dominant) hemisphere of the brain.

118
Q

Who must sign a DNA CPR?

A

Consultant

‘Where a patient has not appointed a welfare attorney or made an advance decision, the treatment decision rests with the most senior clinician responsible for the patient’s care’.

119
Q
A
120
Q

Dose of dex in croup?

A

150 micrograms/kg for 1 dose

121
Q

Tapping (percussion) the skull near the junction of the frontal, temporal and parietal bones will produce cracked pot sound in what condition?

A

Positive test is indication of separated sutures. This is due to raised intracranial tension.

This is called Mcewan sign

122
Q

Location of lymphadenopathy in rubella?

A

Posterior & occipital lymphadenopathy

123
Q

Main mechanism of IUS?

A

Prevents endometrial proliferation

124
Q

Mechanism of depolarising (e.g. suxamethonium) vs non-depolarising (e.g. rocuronium) muscle relaxants?

A

Depolarising:
- Bind to Nicotinic receptors but they DO cause an action potential (AP).
- Acetylcholinesterase can’t break it down as well as normal ACh so the suxamethonium stays put, constantly triggering an AP.
- This eventually causes the muscle to fatigue and relax as it can’t repolarise.
- Therefore you get contractions causing potential muscle damage, pain and hyperkalaemia before relaxation, also fasciculations.
- Process is FASTER (hence used for RSI).

Non-depolarising:
- Competitively bind to Nicotinic receptors.
- This stops ACh from binding to the same Nicotinic receptors so they can’t trigger APs.

125
Q

Describe UK bowel cancer screening programme

A

Every 2 years FIT test between 60 and 74 y/o

55 y/o - invited for one off bowel scope screening test (if available in area)

126
Q

What 2 drugs are most commonly used for induction in RSI?

A

Thiopentone + suxamethonium

127
Q

How soon after paracetamol overdose does jaundice typically appear?

A

2 to 4 days

128
Q

How soon after paracetamol overdose does RUQ pain typically appear?

A

24h

129
Q

How soon after paracetamol overdose does hepatic encephalopathy pain typically appear?

A

3-5 days

130
Q

What are some indications for using the ‘high risk’ treatment line in paracetamol OD?

A
  • malnutrition e.g. AN
  • alcoholism
  • HIV
  • CF
  • patients on P450 medications
131
Q

What class of medication is phenelzine?

A

MAOI

132
Q

Boundaries of triangle of safety for chest drain?

A

Lateral edge of pec major

Base of axilla

Lateral edge of lat dorsi

5th intercostal space

133
Q

What is used instead of adenosine in SVT in patients with asthma?

A

Verapamil

134
Q

Is foetal alcohol syndrome asosicated with TOF?

A

Yes

135
Q

Give some ABSOLUTE contraindications to ECV

A
  • Ruptured membranes
  • Placenta praevia
  • Abnormal CTG
  • Uterine malformation
136
Q

Is placenta praevia a contraindication to ECV?

A

A relative contraindication

137
Q

What do Howell-Jolly bodies on a peripheral blood smear indicate?

A

Absent or deficient spleen function.

They are pathognomonic for splenic dysfunction but can be found in a long list of disorders e.g. post-splenectomy, sepsis, Coeliac disease.

138
Q
A

Yr 4 - PassMed Corrections (36 decks)

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