Mocks Flashcards
What other med to add if giving SSRI + NSAID or aspirin?
PPI
Guidelines for imaging after UTI in children - for <6 months? for >6 months?
< 6 months: USS in 6/52
> 6 months: if responded to abx treatment, nil to do unless atypical (e.g. no response to abx 48 hr) or recurrent
6-year-old boy with a limp. His parents report that this has been getting steadily worse over the past few weeks. He complains of pain in the right groin/hip region. An x-ray shows widening of the right hip joint space with flattening of the femoral head.
perthes disease - avascular necrosis of femoral head
Boy, age 4-8
Oral ciprofloxacin or rifampicin is used as prophylaxis for contacts of patients with meningococcal meningitis
0
Unilateral undescended testis at 6 weeks, what to do?
re-examine at 3 months
NICE recommends referral to an appropriate paediatric surgeon if one or both testes are undescended at 3 months of age (ideally to be seen before 6 months of age).
what measures to monitor haemachromatosis tx?
Ferritin and transferrin saturation are used to monitor treatment in haemochromatosis
if eGFR 60-90, what other criteria do you need to diagnose CKD?
also need other kidney tests to be abnormal: e.g. abnormal U&E or proteinuria
otherwise NO CKD
Tx for PID?
1st: IM ceftriaxone, doxy, metronidazole
2nd: ofloxacin, metro
1st line med mx for low back pain?
NSAID
+ PPI if >45 y/o
Biochemical changes in osteomalacia - Ca, Vit D, Pi, PTH, ALP?
low Ca, vit D, low Pi, raised PTH, raised ALP
Maximum lidocaine to give? (mg/kg)
3mg/kg
= 1% = 1g/100ml
what is a likelihood ratio and how to calculate (for +ve and -ve test)?
+ve test: how much the odds of the disease increase if the result is +ve. sensitivity/ (1-specificty)
-ve test: how much the odds of the disease decrease when a test is negative. (1-sensitivity/specificity)
1st line for flexural, facial, genital psoriasis?
mild to mod steroid OD to BD, 2 /52 max
how to calculate standard error of the mean?
Standard deviation / (sq root sample size)
Viruses that cause Hand food and mouth?
coxsackie A16 and enterovirus
chickenpox exposure in pregnancy - what to do?
check varicella abs first
PEP: po aciclovir on days 7, 14 of exposure
after childbirth - when can contraceptive implant be inserted?
anytime after childbirth!
school exclusion for scarlet fever?
24hr after starting Pen V (or azithro)
Tx for croup?
Dexamethasone (0.15mg/kg) regardless of severity
Mx of GORD (w distressing sx): for formula-fed and for breast-fed infant?
formula-fed:
reduce feeds/volumes
trial thickened formula
alginate for 2/52
THEN PPI
breast-fed
DONT reduce feeds
alginate
2ww criteria for lung ca
when to req urgent cxr
have chest x-ray findings that suggest lung cancer
are aged 40 and over with unexplained haemoptysis
age >40 + 2 or more sx OR smoker + 1 sx:
weight loss
SOB
fatigue
CP
weight loss
appetite loss
2ww criteria for breast ca
> 30 y/o w unexplained breast lump w or w/o pain
50 y/o w 1 nipple sx: retraction, discharge
2ww criteria for bladder ca
> 45 y/o w unexplained visible haematuria (no UTI), or visible haematuria that persists (after UTI tx)
> 60 y/o w unexpllained microscopic haematuria + dysuria OR raised wcc
Lithium monitoring:
when to take sample post-dose? then when to monitor?
once established, monitor how often?
once stable, monitor how often?
what tests to do to monitor?
SE?
What ppt toxicity?
12 hr post sample, then sample in 1 week until stable
once established, 3 monthly
once stable, 6 monthly
tests: BMI, U&E (eGFR), TFT, Ca
SE: N&V, fine tremor, nephrotoxicity: diabetes insipidus, weight gain, intracranial HTN
toxicity ppt by: dehydration, renal failure, meds: diuretics, ACE/ARB, NSAID, metronidazole
How long do sx need to be present for, for PTSD?
4 weeks
How long to wait between taking iron/ca tablets & levothyroxine?
Iron / calcium carbonate tablets can reduce the absorption of levothyroxine - should be given 4 hours apart
how to treat perioral dermatitis?
is a type of rosacea
treat w lymecycline/tetracycline
asymptomatic catheterised patients, +ve urine culture - ?
Do not treat asymptomatic bacteria in catheterised patients
Monitor for sx
subclinical hypothyroidism - what to check next?
anti-TPO
Check thyroid peroxidase antibodies in patients who have subclinical hypothyroidism as this can indicate patients who are more likely to progress to overt hypothyroidism
what abs seen in: Graves disease, and in Hashimoto’s thyroiditis generally?
Graves: anti-TSH
Hashimoto’s: anti-TPO
ECG findings in digoxin toxicity?
AV nodal block is pathognomonic of digoxin toxicity.
flat T waves
define stage 1,2,3,4 of COPD
FEV1 >80%: 1
50-80: 2
30-50: 3
<30: 4
when to consider prophylactic abx for COPD pts?
> =4 exacerbations/ year w sputum production
prolonged exacerbations with sputum production exacerbations resulting in hospitalisation
NOT for smoker
WHen to refer asthma for poor control?
> =2 courses of systemic steroids in yr
repeated emergency care visits or hospital admissions
when to refer copd for poor control?
> =2 mod or 1 severe exacerbation requiring hospitalisation in 1 yr
severe breathlessness MRC 4/5 impacting daily life despite tx
define delayed puberty in boys & girls
girls: no breast dev by age 13 OR breast dev but primary amenorrhoea age 15
boys: no testicular enlargement by age 14
define precocious puberty in boys & girls
girls: dev of secondary sexual characteristics before age 8
boys: as above, before age 9
define “recurrent UTI” in children
in children, recurrent UTI is defined as three or more episodes of UTI within 12 months or two or more episodes within six months.
unexplained petechiae or hepatosplenomegaly in a child - what to do?
same day admission, need to exclude leukaemia
how much weight loss (%) is acceptable in the first week of life?
Anything up to 10% is considered acceptable weight loss in the first week of life
1st line tx for constipation& disimpaction in children?
movicol/macrogol
How to measure temp in:
children <4/52
children 4/52 - 5 yrs
electronic thermometer in axilla
as above
chemical dot thermometer in axilla
infrared tympanic thermometer
child w UC - stable. how often for routine height/weight?
yearly
child w signs/sx of UTI but -ve culture, sterile pyuria. Mx?
Treat w abx
how to dx CKD - criteria
eGFR<60 on 2 occasions, 3 months apart
ACR>=3
structural kidney disease
any one of the above
what is the STOP BANG questionnaire for?
The STOP-Bang questionnaire is an eight-item tool that assesses snoring, sleepiness, apnoeas, hypertension, obesity, neck circumference, age, and sex. It is sensitive but not specific
3x common meds that cause hyponatraemia?
Diuretics, SSRIs and antipsychotics
Pts w CKD & ACR>70 - BP aim?
130/80
HTN w CKD
CKD + ACR >30: what med?
CKD + ACR< 30: what med?
ACEi
follow HTN guidelines
Meds that can cause oesophagitis?
NSAID
bisphosphonates
tetracyclines e.g. doxycycline
Tx ladder for anal fissure
for haemorrhoids?
anal fissure: laxatives, to panaesthetic, top GTN (BD 8/52), refer: botox, diltiazem
haemohrroid: laxatives, excision
MS - neuropathic pain, ladder
neuropathic pain: pregab/gabapentin…
tramadol
morphine
to diagnose delirium, NICE recommends which test?
4ATs
fracture risk can be raised in patients taking SSRIs
x
what classes of drugs can cause ototoxicity?
diuretics (furosemide), anti-inflammatory agents, antineoplastic agents and aminoglycoside antibiotics.
Tx for vulvovaginal-candidiasis?
- fluconazole single dose
- clotrimazole pessary
Constipation starting in early life (less than 1 month old) is a red flag
Refer
what meds/conditions trigger gout?
BB, diuretics, ACEi, aspirin
CKD, lead toxicity
severe psoriasis, cytotoxic trugs, myeloproliferative disorder
A 28-year-old woman has developed dysuria, frequency and a slight vaginal discharge over the past three days. Sterile pyuria on culture. What dx to consider?
chlamydia trachomatis
vaginal infections
non culturable: TB, renal pathology
BP aim for pts w CKD & T2DM:
- ACR<70
- ACR>70
140/90
130/80
Pt: HTN & DM. 1st line Mx for HTN?
ACEi
REGARDLESS OF RACE/AGE
Sudden onset vertigo/uncontrolled vestibular sx + tinnitus. ?Dx
?stroke
send to ED
