Mock PassMed Flashcards
What can be used for mx of intractable hiccups in palliative care? (2)
1) Haloperidol
2) Chlorpromazine
What is an example of ‘not envisaged circumstances’ in regards to DNA CPR?
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
What should you avoid cannulating in diabetics?
Feet
Mx of a perforated tympanic membrane caused by barotrauma?
Self-limiting: reassure and follow up
How can long term mechanical ventilation in trauma patients result in tracheo-oesophageal fistula formation?
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.
What is the Z score adjusted for in DEXA scans?
Age, gender and ethnic factors
What does the T score in DEXA scans compare bone density to?
The bone density of a healthy 30 yr old
What should be prescribed alongside allopurinol when starting it for the first time?
‘Cover’ with NSAID or colchicine.
This is because starting allopurinol can in itself trigger and acute flare of gout.
mechanism of allopurinol?
Xanthine oxidase inhibitor –> reduces production of uric acid
When is cervical screening delayed until during pregnancy?
3 months post partum
How can thyroid surgery result in hypocalcaemia?
Due to damage to parathyroid glands
What is the referred surgical management for intertrochanteric (extracapsular) proximal femoral fracture?
Dynamic hip screw
What is d-dimer a product of?
Fibrinogen degradation product
Typical blood picture in DIC?
- low platelets
- low fibrinogen
- raised PT & APTT
- raised fibrinogen degradation products
When prescribing controlled drugs, what should be printed in both figures and words?
The quantity of tablets supplied
1st line treatment for CML?
Tyrosine kinase inhibitors –> imatinib
What class of medication is hyoscine hydrobromide/butylbromide?
Muscarinic receptor antagonist
What can cause a ‘rattling’ sound during breathing in palliative care?
Excessive bronchial and hypopharyngeal secretions.
Driving and schizophrenia?
Patients with schizophrenia must not drive and must notify the DVLA, until stable and well for 3 months and following a suitable psychiatristy report.
What are some key symptoms that differentiate dyskinetic cerebral palsy from other subtypes?
- athetoid movements: slow writhing movements
- oro-motor problems: e.g. drooling
- fluctuating muscle tone: e.g. difficulty in holding objects
What % of women have a successful vaginal delivery following one previous caesarean section?
70-75%
When can referral for surgical excision be made in a fibroadenoma (i.e. what size)?
> 3cm
What treatment can be considered in an acute sickle crisis?
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.
1st line mx step in eclampsia?
IV magnesium sulphate:
- prevent further seizures
- neuroprotection for foetus
What can be used to treat chlamydia in pregnancy? (3)
1) erythromycin
2) azithromycin
3) amoxicillin
Mx of pseudomonas aeruginosa in CF?
Oral ciprofloxacin (combined with inhaled Abx)
If a child lacks capacity, how does it work regarding parents & consent?
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.
What is the imaging modality of choice in osteomyelitis?
MRI
Cause of osteomalacia?
Vitamin D deficiency
Is trimethoprim safe in breastfeeding?
Yes
Mx of all postmenopausal women with atypical endometrial hyperplasia?
A total hysterectomy with bilateral salpingo-oophorectomy, due to the risk of malignant progression.
Mx of Perthe’s disease <6 y/o?
has a good prognosis requiring only observation
Why are patients undergoing chemo at an increased risk of gout?
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.
What cancer can CLL transform into?
Non-Hodgkin’s lymphoma (Richter’s transformation)
This can make patients suddenly unwell
Investigation in children and young people with unexplained bone swelling or pain?
Consider very urgent direct access X-ray to assess for bone sarcoma
How does ovarian cancer initially spread?
Local spread within the pelvic region
What location of ectopic pregnancies are most associated with an increase risk of rupture?
Isthmus
Mx of otitis externa?
Topical antibiotics with or without steroid
E.g. topical gentamicin & hydrocortisone drops
How can NSAIDs in large doses affect the ears?
Aspirin and other NSAIDs taken in high doses can cause tinnitus
What is the most common mechanism of ankle sprain?
Inversion of the foot
If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Doppler, what investigation is next?
Urgent US scan
What can be seen on a blood film in coeliac disease?
Target cells and Howell-Jolly bodies may be seen in coeliac disease → hyposplenism
Mx of whooping cough?
azithromycin or clarithromycin if the onset of cough is within the previous 21 days
If a newborn baby has an abnormal hearing test at birth, what test are they offered next?
Auditory brainstem response
What is given to patients with polycythaemia vera to reduce the risk of thrombotic events?
Aspirin
First line for ITP?
Oral prednisolone
What can be seen on a blood film in DIC?
Schistocytes - due to microangiopathic haemolytic anaemia
Where has damage occurred in dyskinetic cerebral palsy?
Basal ganglia and substantia nigra
What type of c-section is a contraindication to vaginal birth in a subsequent pregnancy?
Classical c-section (vertical scar)
Instead, offer planned c-section at 37 weeks
Why is a classical c section a contraindication to vaginal birth in a subsequent pregnancy?
Due to the increased risk of uterine rupture
1st line mx for non-pregnant women with vaginal thrush?
Oral fluconazole single dose
If a low lying placenta is found at the 20 week scan, what is the next step?
Rescan at 32 weeks to assess
What is the mx of choice for an intracapsular NOF fracture in patients with good pre-morbid status?
Internal fixation
Why should trimethoprim and methotrexate never be prescribed together?
Both inhibit dihydrofolate reductase –> can cause severe myelosuppression,
What 3 organisms most commonly cause post-splenectomy sepsis?
1) Strep. pneumoniae
2) H. influenzae
3) Meningococcus
Ischaemic stroke mx:
a) they present within 4.5 hours
b) they present after 4.5 hours
a) thrombolysis with alteplase, followed by aspirin 300mg 24 hours later
b) no thrombolysis, just aspirin 300mg
How does the Cushing’s reflex (raised ICP) affect HR?
Bradycardia
How does the Cushing’s reflex (raised ICP) affect BP?
HTN
In a patient presenting with fever on alternating days that has returned from abroad, what condition should you consider?
Malaria
When using a salbutamol inhaler, how long between puffs should you wait?
30 secs
Mx of asymptomatic patients bitten by a tick?
Reassurance
Provided the patient is asymptomatic, antibiotics are not recommended for tick bites.
What can be considered in anal fissures that do not respond to conservative mx?
sphincterotomy
What are some conservative mx options in anal fissures?
- laxatives
- lubricants
- topical GTN
What is the key diagnostic test in Guillain-Barre syndrome?
LP –> finding of elevated protein with normal WCC
Mx of human bites if a bite has broken the skin?
Co-amoxiclav
What medications are known for exacerbating plaque psoriasis?
- NSAIDs
- lithium
- antimalarials
- beta blockers
Pharmacological mx of delirium in Parkinson’s disease?
Benzo e.g. lorazepam (give orally if possible)
What is there a risk of when using 0.9% saline for fluid therapy in patients requiring large volumes?
Hyperchloraemic metabolic acidosis
Effect of beta blockers in myasthenia gravis?
Beta blockers WORSEN myasthenia gravis
This affects the breathing muscles and causes a reduced FVC.
Alzheimer’s disease causes widespread cerebral atrophy, mainly involving which areas of the brain?
Cortex & hippocampus
Mx of life threatening C. diff?
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.
Prior to discharge, following an acute asthma attack, what should the peak expiratory flow rate be?
> 75% of best of predicted
How long may finasteride treatment of BPH take before results are seen?
6 months
1st line mx of hypercalcaemia?
IV saline
Then can consider bisphosphonates
What is the investigation of choice in a PE with renal impairment?
V/Q scan
Can a patient with ventricular fibrillation be conscious?
No - the nature of VF means that it is not compatible with a cardiac output.
What investigation is diagnostic for mycoplasma pneumoniae?
Serology
Mx of a unilateral pleural effusion (exudative)?
1) Diagnostic aspiration
then
2) Symptomatic drainage if indicated
Patients who have had an episode of SBP require antibiotic prophylaxis if fluid protein is <15 g/l.
What is prophylaxis with?
Ciprofloxacin
Mx of a myxoedemic coma?
Thyroxine + hydrocortisone
If a patient with Parkinson’s disease cannot take levodopa orally (e.g. NBM), what can they be given?
Dopamine agonist patch as rescue medication to prevent acute dystonia
What are the 3 first line Abx for an infective exacerbation of COPD?
1) Amoxicillin
2) Clarithromycin
3) Doxycycline
What can assist in the diagnosis of Guillain-Barre syndrome?
1) LP –> raised CSF protein
2) Nerve conduction studies –> would be abnormal
What is the gold-standard investigation for assessing drug sensitivities in TB?
Sputum culture
Presentation of hep A?
- flu like symtpoms
- RUQ pain
- tender hepatomegaly
- deranged LFTs (notably raised ALT)
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?
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.
Is warfarin safe in AKI?
Yes
1st line mx of chronic plaque psoriasis?
Topical POTENT steroid (e.g. betamethasone) + topical calcipotriol
What vessel is involved in a 3rd nerve palsy?
posterior communicating artery aneurysm
What can cause SVCO in myasthenia gravis?
Thymoma
What Abs are present in myasthenia gravis?
Abs against acetylcholine receptors
1st line investigation of acromegly?
IGF-1 levels
This can then be confirmed with OGTT and serial GH measurements
OGTT result in acromegaly?
A lack of GH suppression with OGTT
Effect of glucose on GH?
Glucose inhibits GH release
What is used for diagnosis and screening of HIV?
HIV p24 antigen and HIV antibody tests
1st line mx of acute anal fissure?
Soften stool, dietary fibre, analgesia and topical anaesthetic cream if necessary
Mx of a chronic anal fissure?
Topical GTN –> relaxes the musculature and helps expand the blood vessels around the anus, it can be effective at reducing pain.
CSF glucose vs serum glucose in bacterial meningitis?
CSF glucose is typically less than half the serum glucose
What class of medication are associated with a significant increase in mortality in dementia patients?
Antipsychotics
How can loop diuretics affect K+?
Can cause hypokalaemia
UTI in women
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.
CT scan results bronchiectasis?
Abnormal widening and thickening of the bronchi
Confusion in an asthma attack?
Life threatening
What to give as prophylaxis against brain mets in small cell lung cancer?
Prophylactic radiotherapy
What complication of measles most commonly causes death?
Pneumonia
What can be added to syringe driver in end of life care for peope with seizures?
Midazolam
What laxative should you always prescribe alongside opioids?
Senna
Abx for CAP vs HAP?
CAP - amoxicillin
HAP - co-amoxiclav
What laxative should be given to a patient on morphine with constipation (was prescribed senna initially)?
A stimulant (senna) with or without a stool softener (docusate)
or
Daily administration of an osmotic laxative (polyethylene glycol/Movicol)
Treatment for Duke C bowel cancer?
Surgery + adjuvant chemo
Mx of mets in brain and lungs?
Chemotherapy
1st line treatment for haemoptysis in lung cancer?
Palliative radiogtherapy
What Abx to give to a patient with neutropenic sepsis with E. coli infection (but ESBL)?
Carbapenems
Can’t give tazocin as ESBL bacteria is resistant to both piperacillin & tazobactam.
How can immunotherapy affect the thyroid?
Can cause thyroiditis (elevated T4, low TSH)
Long term vs short term side effects of radiotherapy?
Short term: -itis e.g. oesophagitis, dermatitis
Long term: -osis e.g. fibrosis
What is Wernicke’s (receptive) aphasia?
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.
Location of lesion in receptive aphasia?
This is Wernicke’s aphasia.
Location is temporal lobe of the left (dominant) hemisphere of the brain.
What is Broca’s (expressive) aphasia?
Speech is non-fluent, laboured, and halting. Repetition is impaired
Comprehension is NORMAL.
Location of lesion in Broca’s (expressive) aphasia?
Location is frontal lobe of the left (dominant) hemisphere of the brain.
Who must sign a DNA CPR?
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’.
Dose of dex in croup?
150 micrograms/kg for 1 dose
Tapping (percussion) the skull near the junction of the frontal, temporal and parietal bones will produce cracked pot sound in what condition?
Positive test is indication of separated sutures. This is due to raised intracranial tension.
This is called Mcewan sign
Location of lymphadenopathy in rubella?
Posterior & occipital lymphadenopathy
Main mechanism of IUS?
Prevents endometrial proliferation
Mechanism of depolarising (e.g. suxamethonium) vs non-depolarising (e.g. rocuronium) muscle relaxants?
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.
Describe UK bowel cancer screening programme
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)
What 2 drugs are most commonly used for induction in RSI?
Thiopentone + suxamethonium
How soon after paracetamol overdose does jaundice typically appear?
2 to 4 days
How soon after paracetamol overdose does RUQ pain typically appear?
24h
How soon after paracetamol overdose does hepatic encephalopathy pain typically appear?
3-5 days
What are some indications for using the ‘high risk’ treatment line in paracetamol OD?
- malnutrition e.g. AN
- alcoholism
- HIV
- CF
- patients on P450 medications
What class of medication is phenelzine?
MAOI
Boundaries of triangle of safety for chest drain?
Lateral edge of pec major
Base of axilla
Lateral edge of lat dorsi
5th intercostal space
What is used instead of adenosine in SVT in patients with asthma?
Verapamil
Is foetal alcohol syndrome asosicated with TOF?
Yes
Give some ABSOLUTE contraindications to ECV
- Ruptured membranes
- Placenta praevia
- Abnormal CTG
- Uterine malformation
Is placenta praevia a contraindication to ECV?
A relative contraindication
What do Howell-Jolly bodies on a peripheral blood smear indicate?
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.
