Most commonly asked topics Flashcards
What’s placental abruption
(early) separation of placenta from placental bed
Woody uterus on palpation - most likely pathophysiology?
Placental abruption
mx of placental abrupton?
Delivery of placenta
What is placental praevia
low lying placenta
Painless antepartum haemorrhage and soft uterus, indications of what?
Placenta praevia
mx of placental praevia
elective C section
Risk factors for shoulder dystocia
previous hx
macrosomnia
diabetes
maternal high BMI
mx of post partum haemorrhage
fundal massage, syntocin, ergomentine
Investigations for ovarian cancer?
CA125
Presentation of endometrial cancer?
Post menopausal bleeding
What is PCOS?
hyperandrogenism - high LH, Low FSH, High androgens
What are the uses of Magnesium sulfate in pregnancy
prophylaxis for eclampsia seizures
IV form - to terminate an eclampsia seizure
Which antihypertensives are CI in pregnancy?
ramiprill & other Ace-i
Treatment for pre-eclampsia
antihypertensives - labetalol 1st line (CI athsma)
2nd line nifepidine
Risk factors for pre-eclampsia
nulliparity
previous/family hx
increasing maternal age
Hypertension
diabetes
autoimmune disease
multiple pregnancy
features of obstetric cholestasis
itchy hands and feet
mx cholestasis
ursodeoxycholic acid
chlorphenamine (reduce itch)
vit K (reduce risk of haemorrhage)
schedule early labour
indications for induction of labour
> 41 wks
preterm rupture of membranes
intrauterine foetal death
abnormal CTG
pre-eclampsia, diabetes, Obs Chol
CI for induction of labour
previous c section
herpes simplex
placenta praevia
malpresentations
Methods of induction of labour
1st - membrane sweep
2nd - vaginal Pge2
Intrauterian foetal death - misoprostol and miferistone
Most likely causative agent for bartholin’s cyst
E coli
7 stages of delivering baby in normal vaginal delivery
- descent and engagement
- flexion - narrowest diameter
- internal rotation of head into OA
- extension - crowning
- restitution - head aligns with shoulders
- external rotation
- delivery of shoulders
4 causes of failure to progress in labour
power
passage
passenger
position
what are the 7 layers that need to be cut through in a c section
- skin
- Camper’s fascia
- scarpa’s fascia
- rectus sheath
- seperate rectus abdominus
- parietal peritoneum
- uterus
Complications of shoulder dystocia
brachial plexus injury
cerebral palsy
perinatal mortalitiy
PPH
Causes of post-partum haemorrhage - 4T’s
Tone- prolonged labour, twins- macrosomnia
Trauma
Tissue
Thrombin coagulopathy (DIC in pre-eclampsia)
Most common gynae cancer
Endometrial
risk factors for ovarian cancer
BRCA family hx
never used COCP
presentation of ovarian cancer
pelvic mass
ascites
IBS sx
Urinary sx
Risk factors for cervical cancer
HPV infection
Presentation of cervical cancer
symptomatic finding
post coital bleeding
intermenstrual bleeding
abnormal discharge
endometriosis, adenomyosis, fibroids & PID are differentials for what?
Dysmenorrhoea
Presentation of endometriosis
dysmennorrhoea (painful periods)
cyclic period pain
subfertility
Gold standard diagnostic for endometriosis
Laproscopy
What are fibroids
benign neoplasia of uterine smooth muscle
presentation of fibroids
menorrhagia
pelvic pressure
bloating
dysmenorrhoea
mx for fibroids
mirena IUS -normally best option!
COCP
tranexmic acid
Differentials of infrequent periods (oligomennorrhoea)
stress, exercise, weight loss, eating disorders
PCOS
hyperthyroidism
perimenopause
Rotterdam criteria for PCOS
- oligomenorrhoea
- hyperandroginism sx (struggle to lose weight, excess hair)
- polycystic ovaries
Presentation of PCOS
oligomenorrhoea
subfertility
acne
hirsutism
Invx for PCOS
FSH/LH
testerone
TFTs
prolactin
mx of PCOS
COCP
metformin
Clomiphene
Acute lower abdominal pain in a female, what are differentials and what investigations would you do first?
appendicits, ectopic pregnancy, ovarian torsion, PID
- Pregnancy test
- Transvaginal USS/abdo USS
Common site of ectopic pregnancy
ampulla of fallopian tube
Presentation of ectopic pregnancy
normally 6-8wks after fertilisation
acute iliac fossa pain
tenderness
guarding
PV bleed
CI to breastfeeding
TB infection
Uncontrolled HIV
Medications: Amiodarone, lithium, tetracycline, sitagliptin, methotrexate
What medications helps to stop a woman breastfeeding
cabergoline - dopamine receptor agonist
What rhesus status is mum in rhesus isoimmunisation/?
rhesus negative with rhesus positive baby
Indications for rhesus isoimmunisation
28wks or sensitisin event; haemorrhage
prophylaxis anti-D antibodies given
features of haemolytic disease of the newborn
foetal oedema
yellow amniotic fluids
jaundice
features of haemolytic disease of the newborn
foetal oedema
yellow amniotic fluids
jaundice
How resus a neonate
5 rescue breaths followed by 15 chest compressions
differences between placenta accreta, increta and pecreta
accreta- superficial myometrium, does not penetrate muscles
increta - villi invade in but not through
pecreta- invade through to other side
differences between placenta accreta, increta and pecreta
accreta- superficial myometrium, does not penetrate muscles
increta - villi invade in but not through
pecreta - invade through to other organs
Risk factors for placenta accreta
previous TOP
previous C section
advanced maternal age
What investigation used to detect foeto-maternal haemorrhage in rhesus neg mum and rhesus positive baby
Kleinhaur test
What is main causes of anaemia in pregnancy
iron deficient
Freya, a 42-year-old woman, presents to the GP complaining of increasingly frequent,
prolonged and heavy periods. She states she has been passing more clots than usual. Freya
also complains of some constipation which has developed recently, as well as some
discomfort in her lower abdomen. On abdominal examination, there is a palpable, non-tender
mass arising from the pelvis. What is the most likely cause of Freya’s heavy menstrual
bleeding?
fibroids - most common cause heavy menstrual bleeding AND can make uterus palpable
What is the commonest cause of anovulation in women?
PCOS
Genetic causes of infertility
Turner’s syndrome
Kleinfelter’s syndrome
When is an ovarian cyst most likely to erupt?
physical activity - sexual intercourse, exercise
Presentation of an ovarian cyst rupture
asymptomatic sometimes
acute unilateral pain
intra-periotineal haemorrhage with haemodynamic compromise
What is the most common type of ovarian cyst
follicular cyst
Urge incontinence, frequency or noacturia are indicitive of what?
Overactive bladder syndrome
mx for overactive bladder syndrome?
reduce oral fluids/caffeine/alcohol
pelvic floor exercises
anticholinergic: oxybutynin, solifenacin
Presentation of pelvic inflammatory disease
bilateral abdominal pain
discharge
post-coital bleeding
adnexal tenderness, cervical motion tenderness on bi-manual, fever
mx for Pelvic inflammatory disease
ofloxacin + metronidazole
When is a salpingectomy performed?
surgical managment for ectopic pregnancies that have an embryo heartbeat or if the b-hCG is more than 5000
-preferred surgical managment
Use of intramuscular methotrexate for ectopic pregnancy
in ectopic pregnancies where there is no heartbeat and the b-hCG is <1500
What is amniotic fluid embolism and what are the clinical features?
obstetric emergency
amniotic fluid enters maternal circulation
high resp rate
tachycardia
hypotension
hypoxia
disseminated IV coagulaopathy
When in an ectopic pregnancy is surgery over methotrexate prefferred?
- the pt is in a large amount of pain
- mass is greater than 35mm
- ultrasound identifies a fetal heartbeat
- serum beta-human chorionic gonadotropin (B-hCG) levels are over 5000
Indications for an elective C-section
abnormal presentation (breech/transverse)
twin pregnancy
maternal HIV
Primary genital herpes in 3rd trimester
placenta praevia
anatomical reasons
Features of premature ovarian insuffiency syndrome
menopause in women aged below 40
- vasomotor: hot flushes, night sweats
- Sexual dysfunction: vaginal dryness, reduced libido
- psychological: depression, anxiety, mood swings, lethargy, reduced concentration
dx and mx of premature ovarian insufficiency
raised FSH levels
HRT
Does smoking increase or decrease the risk of endometrial cancer?
decrease
Features of atrophic vaginitis
inflammation and thinning of genital tissues due to fall in oestrogen levels
thinning of vaginal mucosa
loss of pubic hair
vaginal dryness and itching
dyspareunia
post-coital bleeding
Features of Hyperemesis gravidarum
severe vomiting with onset before 20 weeks gestation
mx of Hyperemesis gravidarum
fluid replacement therapy
potassium chloride replacement (esp if hypokalaemic)
anti-emetics: 1st line = cyclizine, metoclopramide or prochlorperazine.
What is Congenital Toxoplasmosis
caused by protozoan parasite toxoplasma gondii found in cat faeces
abx- spiramycin used in pregnancy
What are tocolytic drugs used in pregnancy and give some examples
used to suppress contractions and labour
nifedipine -1st line
atosiban
indomethacin
terbutaline
Risk factors for ectopic pregnancy
PID
gonorrhoea
pelvic surgery
IUD/IUS in place
IVF
Previous ectopic pregnancy
endometriosis
Clinical features and cause of group B streptococcus infection in pregnancy
bacterium streptococcus agalactiae
sepsis, pneumonia and menigitis of newborn
mx of Group B Streptococcus infection in pregnancy
Intrapartum abx - penicillin
if penicillin allergy - vanomycin
a woman takes 2 b-hCG tests, what does it mean when the 2nd test is more than double than the 1st?
e.g 1st = 24
2nd= 52
viable pregnancy
a woman takes 2 b-hCG tests, what does it mean when the 2nd test is less than the 1st one?
e.g 1st = 100
2nd = 72
ongoing miscarriage
a woman takes 2 b-hCG tests, what does it mean when the 2nd test is more than 1500 and pregnancy not seen on USS
ectopic pregnancy
a woman takes 2 b-hCG tests, what does it mean when the 2nd test is more than 1500
ectopic pregnancy
a woman takes a b-hCG tests, what does it mean when the test is 100,000?
molar pregnancy
Causes of polyhydramnios
excess amniotic fluid
maternal diabetes
foetal renal disorders
foetal anaemia
twin
chromosomal disorders
What is Asherman’s syndrome and what does it cause
intrauterine adhesions causing outflow obsruction (usually after uterine surgery)
secondary amennorhoea
mx for umbilical cord prolapse
emergency c section
get woman on all 4s; knees and elbows
Which type of ovarian tumour may affect younger woman?
germ cell
what is mx of lichen sclerosis
potent topical steroid (dermovate)
What is the most common causative agent for a respiratory tract infection in a pt with Cystic fibrosis?
pseudomonas aeruginosa
Which pathogen is responsible for Roseola Infantum
Human herpes virus 6
Presentation of Roseola Infantum
febrile & lethargic up to 5 days
Fever (up to 40)
blanching, rose-pink macular rash on trunk
What is the most common cause of rectal bleeding in children?
Meckel’s diverticulum
What immune response causes coeliac disease
T cell mediated inflammatory autoimmune
affects the small bowel
produces villous atrophy and malabsorption
Symptoms of coeliac disease in children
steatohorrea
weightloss/failure to thrive
short stature, wasted buttocks
dermatitis herpetiformis (pruritic papulovescular lesions)
gold standard disgnostic investigation for coeliac disease
OGD and duodenal/jejunal biopsy.
shows: sub-total villous atrophy, crypt hyperplasia, intra-epithelial lymphocytes
1st line investigation for coeliac disease
Anti-TTG IgA antibody
What murmur would you hear in ventricular septal defect?
pan-systolic murmur
Presentation of Transient tachypnoea of the newborn
commonly after c section
resp distress: tachypnoea, increased work of breathing, potentially desaturated/cyanotic
What increased risk would a child have with a hydrocele if it didnt resolve within 2 years
inguinal hernia
Presentation of a hydrocele
swollen testes
transiluiminate light
Which vitamin deficiency causes rickets in a child
vitamin D
Presentation of rickets
aching bones
poor growth and development
delayed dentition
weakness
constipation
Presentation of cystic fibrosis in neonates
meconium ileus
Presentation of cystic fibrosis in infants
baby’s sweat is salty
faltering growth
recurrent chest infections
Presentation of cystic fibrosis in toddlers
faltering growth
recurrent chest infections
malabsorption syndromes
Causes of acute epiglottis?
Haemophilus influenza virus B
Presentation of acute epiglottis
fever
ill-looking child
difficulty swallowing/drooling
abx used for acute epiglottitis?
IV cefuroxime
Who is most affected by ALL
children under 6 and adults over 80
Presentation of ALL in child
unexplained bruing
enlarged lymph nodes
hepatosplenomegaly
tired
weightloss
How is leukaemia (ALL) diagnosed?
bone marrow biopsy
What type of reaction is an acute asthma attack?
IgE type 1 hypersensitivity
Presentation of acute asthma attack in a child
breathlessness
audible wheeze bilaterally
chest tightness
Acute asthma attack stepwise approach in children
- inhaled salbutamol
- nebulised salbutamol
- add nebulised ipratropium bromide
- Add magnesium sulfate IF O2 <92%
- oral (1st line) or unable oral, IV steroids
6.. IV salbutamol if no response to other interventions - if severe/life-threatening add aminophylline
What mumur would you hear in an atrial septal defect
low pitched diastolic rumble in tricuspid area
ejection murmur on sternal edge
mx of ADHD
behavioural techniques, support in school
Meds: methylphenidate (1st line)
2nd: lisdexamfetamine (if 1st isn’t helping sx)
3rd: dexamfetamine (if 2nd line side effects aren’t tolerated by pt)
Most common cause of bacterial tracheitis
staphylococcus aureus (most commonly after resp tract infection)
1st line mx for constipation in children
movicol
How is Hirchsprung’s disease diagnosed?
rectal suction biopsy
Presentation of Hirchsprung’s
delay in passsing meconium
distended abdomen
forceful evacuation after DRE
stimulatory cells not present in last segment of bowel (aganglionic colon)
Causes of pathological neonatal jaundice
<24hrs after birth!
haem disorders
G6PD
infection (TORCH screen indicated)
Aetiology of cystic fibrosis
mutations of CFTR protein
What is meconium ileus?
no meconium passed within 48hrs from birth - sign of obstruction
Appearance on xray of meconium ileus
bubbly appearance on abdominal xray
Chest xray appearance to diagnoses neonatal respiratory distress syndrome?
ground glass appearance seen
Presentation of pyloric stenosis in neonates
projectile vomiting ‘hitting walls’
palpable mass o/e - smooth olive mass
Complications of pyloric stenosis in neonate
hypocholoremic, hypokalaemia metabolic acidosis
How is pyloric stenosis diagnosed and what is management
abdominal USS
surgical - pyloromyotomy
fluid resus
Which bacteria causes meningococcal infection?
Neiseria meningitidis (gram neg intracellular diplococcus)
Presentation of meningococcal infection in children
septicaemia
meningitis
purpuric skin rash
cold peripheries
poor cap refill time
tachycardia
decreased urine output
Presentation of parvovirus B19 (slapped cheek syndrome)
fever, coryza, diarrhoea
‘lace like’ rash across body
red rash on cheeks
Specific values to diagnoses DKA
ketones: 3mmol/L and over
Blood glucose: >11mmol/L
Bicarbonate: <15mmol/L or venous pH <7.3
Presentation of diabetic ketoacidosis (DKA)
acetone on breath (fruity)
vomiting
dehydration
abdominal pain
hypovalaemic shock
coma
Mx of DKA
IV fluids (0.9% NaCl, insulin infusion 0.1 units/kg)
What causes whooping cough? (pertussis)
boredetella pertussis (gram negative coccobacillis
Presentation of whooping cough
prolonged coughing followed by gasping for air
inspiratory stridor
post-tussive vomiting
Mx of whooping cough
notifiable disease
1st line: erythromycin, azithromycin or clarithromycin
What causes rubella?
rubella togavirus
Presentation of rubella
fever, coryza, arthralgia
rash (starts on face, moves down to trunk, spares arms and legs)
post auricular lymphadenopathy
clinical features of encephalitis
altered mental state
fever/flu-like symptoms
early seizures
Most common cause of encephalitis
herpes simplex virus 1
Mx for encephalitis
broad spec abx + 2g IV ceftriaxone BD + 10mg/kg acyclovir TDS 3 weeks
What causes impetigo?
staphylococcal and streptococcal
Clinical features of impetigo
prurtic rash
discrete patches golden crusting
mx of impetigo
fusidic acid or oral flucloxacillin
What causes scarlet fever
streptococcus
Presentation of scarlet fever
coarse red rash on cheeks
sore throat
fever
headache
‘sandpaper’ rash
bright red tongue
Mx for scarelt fever
phenoxymethylpenicillin for 10days
Presentation of hand, foot, mouth disease
blisters on hands and feet
ulcerations in buccal cavity
usually preceded by 1/7 hx of fever and lethargy
Common cause of hand foot mouth disease
coxsackie virus A16
Presentation of measels
erythematous blanching maculopapular rash all over body
preceded by fever, cough, runny nose or conjuntivitis
koplik spots in mouth
Presentation of chicken pox
maculopapular vesicular rash that crusts over to form blisters
itchy
cause of chicken pox
varicella zoster virus (human herpes virus 3 (HHV3))
Presentation of septicaemia
rapidly developing non-blanching purpuric rash
lethargy
fever
headache
rigors
vomiting
if pt is seen in community with suspected meningitis alongside septiceamia, what should you do?
immediate IM benzylopenicillin
send to hospital
What causes infectious mononucleosis (glandular fever)
epstein Barr virus
Presentation of infectious mononucleosis (glandular fever)
fever
sore throat
fatigue
hepatosplenomegaly
rash that forms all over body if amoxicilin has been prescribed (morbiliform eruption - generalised maculopapular rash)
Paeds: perianal/vulval itching, worse at night, unremarkable examination. What is the disease and what is the treatment?
threadworm
1st line: oral mebandazole
Features of otitis media
pain
fever
vomiting
often occurs after viral resp infection
Presentation of intussusception (paeds)
severe colicky pain
child draws legs up
refuse feeds
bilious vomiting
red-jelly stool
sausage shape mass palpated
What signs would be shown on abdominal ultrasound for intussception
target sign (cocentric echogenic and hypoechogenic bands)
free abdominal air
presence of gangrene
Presentation of Juvenile idiopathic athritis (JIV)
joint pain
fevers
malaise
salmon pink rash
1st line mx for juvenile idiopathic arthritis where less than 4 joints affected?
intra-auricular steroid injections: methylprednisolone acetate
Presentation of GORD in children
milky vomit after feed
crying /irritability
drawing up knees to chest
Features of nephrotic syndrome
proteinuria
oedema
hypoalbuminaemia
hyperlipideamia
lipiduria
Most common cause of nephrotic syndrome in children
minimal change disease
tx: steroids
What is Henoch Schonlein purpura (HSP)
small vessel vasculitis in children
Presentation of Henoch schonlein purpura (HSP)
purpura or petechiae on buttocks or lower limbs
start urticarial - maculopapular
trunk is spared
abdo pain
arthralgia
fever
preceded by viral upper resp infection
What is naevus flammeus
port-wine stain birthmark
present from birth, grows with infant
laser therapy can be used in future
What is 1st and 2nd line tx for acute otitis media in under 2yrs
1st: amoxicillin
2nd: clarithromycin
Is tetraology of fallot cyanotic or non-cyanotic
cyanotic
congenital cardiac disease
Presentation of tetraology of fallot
detection of murmur (pan-systolic (VSD))
cyanosis
What are the features of Patau’s syndrome
trisomy 13
holoprosencephaly
cleft lip and palate
microcephaly
polydactyll
congenital heart disease
Presentation of Turner’s syndrome
short stature
webbed neck
wide spaced nipples
bicuspid aortic valve defect
delayed puberty
Which clotting factor is deficient in haemophilia A
VIII
Presentation of haemophilia A
bleeding into soft tissue, joints and muscles - bruising
mx of haemophilia A
desmopressin
Which clotting factor if deficient in haemophilia B
factor IX
Features of Von Willibrand disease
excess or prolonged bleeding
easy bruising
menorrhagia
GI bleeding
Investigation results for Von Willebrand disease
decreased factor VIII activity
PT normal
APTT prolonged
bleeding time prolonged
Presentation of Wilm’s tumour (paeds)
abdominal mass that doesn’t cross midline
abdominal distension
haematuria
hypertension
Presentation of retinoblastoma in children
white eye reflex (loss of normal red reflex)
Features of Edward’s syndrome
trisomy 18
low set ears
microcephaly
What is Fragile X syndrome and presentation
CGG repeat X chromosome
long face
large protruding ears
large testes
autistic spectrum features
Presentation of Prader Willi syndrome
hypotonia and poor feeding infancy
developmental delay
short stature
obesity in older childhood
What defect is associated with Noonan syndrome
pulmonary stenosis
What defect is associated with down syndrome
AVSD (atrioventricular septal defects)
What defect is associated with foetal alcohol syndrome
venticular septal defect
What defect is associated with DiGeorge syndrome
aortic arch defects
What defect is associated with Turner syndrome
bicuspid aortic valve
What defect is associated with Edwards syndrome
septal defects
Cause of septic arthritis in children
staphylococcus auerus
Presentation of septic arthritis
fever pain
swelling
redness of sight
unable to weight bear
mx for septic arthritis in children
flucloacilin + fusidic acid / rafampcin
if penicillin allergy: clindamycin
Presentation of Perthes disease
gradual onset limp & hip pain
persists over 4 weeks
mx of UTIs in children
Lower UTIs: nitrofurantoin
Upper UTIs: cephalosporin
What is on the DSM-V 6 criteria for ADHD?
- answers questions prematurely
- always on the go, spontaneously moving around
- losing important things, forgetful
- cannot play quietly
1st line management for viral induced wheeze?
inhaled salbutamol
common signs/symptoms of necrotising enterocolitis (NEC)
abdominal distension
vomiting
visible intestine loops
rectal bleeding
lethargy
feeding intolerance
Most appropriate diagnostic for necrotising enterocolitis (NEC) and what would you see?
Abdominal xray
- dilated bowel loops
- bowel wall oedema
- pneumotitis intestinalis
what are the 3 cyanotic heart disease in paeds?
- transposition of the great arteries
- tetralogy of fallot
- tricuspid atresia
Treatment for glue ear
Grommets
What is an indication for an emergency surgical operation when it comes to an inguinal hernia?
hernia has become strangulated
Pathway for non-acute asthma control
- regular inhaled corticosteroid (beclomethasone) + short acting B2 agonist (salbutamol)
- oral leukotriene receptor antagonist (montelukast)
Description of a meningococcal septicaemia rash?
non-blanching, flat, purpuric rash
What is crptochidism?
undescended testes
mx of anaphylaxis
Intramuscular adrenaline
Signs of lithium toxicity
diarrhoea, vomiting
anorexia
muscle weakness
lethargy
dizziness
ataxia
coarse tremor
hyperreflexia
Mx of bipolar disorder
lithium 1st line
olanzapine
barbamazepine
What results on CSF would you see in bacterial meningitis?
cloudy, raised proteins, low glucose, presence of neutrophil polymorphs
diagnostic investigation for Necrotising enterocolitis and what would you see?
Abdominal xray
dilated bowel loops
pnumatosis intesinalis
Features of necrotising enterocolitis
first 3 weeks of life
vomiting - bile streaked
bloody stools
abdominal distension
absent bowel sounds
Features of William’s syndrome
Smiley
small stature
small or missing teeth
aortic/pulomonary stenosis
Features of Angelman syndrome
delayed development signs
ataxia
frequent laughing/smiling
easily excitable
hyperactive
short attention span
Most common metabolic abnormality you would see in pyloric stenosis
hypocholaemic metabolic alkalosis
Presentation of Kawasaki disease
fever>5 days
CREAM features
conjuntivits
rash
red hands and feet
strawberry tongue
important to do an echo as follow up - risk of coronary artery aneurysm
Side effects of clozapine (atypical anti-psychotic)
agranulocytosis - reduced neutrophils
cardiomyopathy
side effects of risperidone (atypical anti-psychotic)
hyperprolactaemia
What are the 3 cluster A personality disorders
paranoid - suspicious, sensitive, unforgiving of others
schizoid - emotionally cold, detached, lack of interest in others, sexual drive low
Schizotypical - interpersonal discomfort with pecular ideas, perceptions, inability to maintain friendships
What are the 4 cluster B personality disorders?
Antisocial - lack of concern for others, disreguard rules and responsibilities, aggression
EUPD - impulsive, self harm, feelings of emptiness, attachment in relationship issues
Histrionic - self discrimisation, shallow affect, craves attention, manipulative behaviour
narcissitic - grandiosity, lack of empathy, need for admiration
What are the 3 cluster C personality disorders
avoidant - tension, self consciousness, fear of negative thoughts from others, social inhibition
Dependent - reaussurance required, lack of self confidence, fear of abandoment
OCD / anankastic - doubt, indesiveness, caution, perfectionism
What is delusion of guilt?/
belief self needs to be punished
common in severe depression
What is delusion of persecution?
paranoid
being followed or spied on
commonly seen in schizophrenia
grandiose delusion?
exaggerated beliefs one pts self and worth
think they are best
Delusion of thought posession?
thought insertion/withdrawal/ broadcasting
seen commonly in schizophrenia
What is cotards syndrome
believe you’re dead or decaying
side effects of typical anti-psychotics
parkinsonism
1st line mx for EUPD
DBT
What is treatment for opioid overdose
naloxone
Whats tx for opioid dependence (not overdose)
detox - methodone
relieve withdrawal sx - lofexidine
prevent relapse - naltrexone
Smoking cessation tx
stop - NRT (nicotine replacement therapy)
reduce craving - varenicline
reduce pleasure - bupropion
tx for alcohol withdrawal?
PO chlordiazepoxide
+ IV thiamine (B1)
symptoms of neuroleptic syndrome and what causes it
confused
hyperthermic
tachycardic
hypertension or hypo
adverse reaction to anti-psychotics
symptoms of serotonin syndrome and what causes it
antidepressants SSRI/SNRI most common
hallucinations, confusion
tremor,
hyperreflexia
HTN
tachycardia
hyperthermia
Presentation and treatment of acute dystonic reaction
from typical antipsychotics
contraction of eyes, neck, jaw
tx: procyclidine
Presentation of Wernicke’s encephalopathy and treatment - DAHN
delerium,
ataxia
hypothermia
nystagmus
IV thiamine (pabrinex)
symptoms and treatment for Korsakoff’s psychosis
irreversible short term memory loss, disorientation to time
tx: IV thiamine
Presentation of delierium tremens
72hrs after alcohol withdrawal
cognitive impairment
hallucinations
tremor
fever
dehydration
treatment for delerium tremens
IV thiamine and lorazepam
What biochemical changes would you expect to see in someone with anorexia nervosa
hypercortisolaemia
what is bipolar 1
episodes of depression and mainia or mixed states separated by periods of normal mood
what is bipolar 2
don’t experience mania
may have hypomania, depression or mixed states
1st line management for a manic episode
olanzapine or aripiprazole
maintenance management of bipolar
lithium 1st line
which class of antidepressant is CI in previous heart disease
tricyclic
What are 1st rank symptoms in psychosis
thought alienation
passivity phenomena
3rd person auditory hallucinations
delusion perception
What is used for maintenance management of alcohol withdrawal
naltrexone
What is dissocial personality disorder
lack of remorse, easily angered, impulsivity, callous, tendency to blame others
A 26-year-old woman presents with a 2-month history of amenorrhoea. She previously had regular menstrual cycles. She is sexually active and uses barrier contraception but admits that she has reduced libido. She has gained over 3 kg in weight over the past 3 months. She was diagnosed with bipolar affective disorder 3 months ago and is taking risperidone. She denies having symptoms of mania or depression. Her urine pregnancy test is negative.
Which is the most appropriate investigation to confirm the diagnosis?
prolactin - hyperprolactamia side effect of risperidone
Treatment of refeeding syndrome
phosphate replacement
What section can be used by the police to detain somebody for being violent in public due to a suspected mental disorder
136
What is an Ekbom syndrome delusion?
pt believes infested by parasite
crawling sensation on skin
psychological or B12 deficiency
What metabolic change will be seen in someone with purge-type bulimia?
hypokalaemia with metabolic alkalosis
Acute management of migraines
NSAIDs
Sumitriptan
Prophylactic management of migraines
Propanolol 1st line (CI in asthma)
topiramate
amitryptiline
management of cluster headaches
acute: high flow oxygen
nasal triptan
prophylactic:
varepamil
Presentation of cluster headaches
recurrent attacks
sudden unilateral periorbital pain
water eyes, nose, blood shot eye
pt may bang head to relieve pain
What tumours are myasthenia gravis linked to?
thymomas - thyroid
presentation of myasthenia gravis
weakness of limbs, facial muscle, eye lids
worse in evening/after activity better in morning/with rest
Investigations for myasthenia gravis
bloods:
1st: serum acetylcholine receptor antibody
2nd: muscle-specific tyrosine kinase antibodies
CT chest/neck - tumours of thymus
An elderly pt fell and hit their head, what should be an immediate differential regarding their head
subdural haemorrhage
Presentation of sub-dural haemorrhage
sub acute
typically following trauma
headache
nausea/vomiting
confusion
first line treatment for optic neuritis?
IV methylprednisolone
features of cerebellar syndrome - DANISH
dysiadochokinesia
ataxia (broad based unsteady gait)
nystagmus
intention tremor
slurred speech
hypotonia
What is horner’s syndrome and what is most common cause
interruption of sympathetic nervous supply to the eye
pancoast tumour
Causes of encephalitis
herpes simplex virus 1
What is difference between simple focal seizures and complex focal seizures
simple - no loss of consciousness, no post-ictal symptoms
complex - is both of above
features of temporal - lobe specific focal seizure
lip smacking, sudden terror, hallucinations
features of frontal-lobe specific focal seizure
motor features
features of parietal lobe specific focal seizures
sensory symptoms
treatment for absent seizures
sodium valporate or erthosuximide 1st line
AVOID CARBAMAZAPINE
treatment for tonic clonic seizures
sodium valporate or lamotrigine
treatment for myoclonic seizures (sudden jerk of a limb)
sodium valporate 1st line
(if woman child bearing age then- levetiracetam or topiramate)
AVOID CARBAMAZAPINE
treatment for atonic seizures - sudden loss of muscle tone, pt fall whilst retaining conciousness
sodium valporate or lamotrigine
treatment for status eplicticus
IV lorazepam/buccal midazolam
then phenytoin
treatment for focal seizures
carbamazepine, gabapentin, phenytoin
Presentation of giant cell arteritis/temporal arteritis
headache side of head
jaw claudication- pain while chewing
amaurosis fugax
scalp tenderness
definitive investigation for giant cell arteritis
temporal artery biopsy
treatment for giant cell arteritis
60mg OD prednisolone
high dose steroid
Cause of cauda equina
lumbar disc herniation at L4/5 L5/s1
presentation of Guillain-barre syndrome
ascending symmetrical limb weakness
few weeks after diarrhoea/infection
management of guillain-barre syndrome
IV immunoglobulins
if doesnt work - plasma exchange
FVC needs to be monitored - high risk resp failure
Causes of guillain barre syndrome
campylobacter jejuni infection
management of TIA
300mg aspirin
review within 24hrs
what are the 4 types of multiple sclerosis
relapsing-remitting
secondary progressive
primary progressive
progressive relapsing
What is presentation of multiple sclerosis
ACUTE progressive weakness
brisk reflexes
patchy sensory disturbances
white matter plaques brain MRI
optic neuritis
oligoclonal bands CSF
periventricular plaques
management of acute attack multiple sclerosis
IV methylprednisolone
- doesnt work - plasma exchange
chronic management of multiple sclerosis
injectable beta interferon
Presentation of normal pressure hydrocephalus
urinary incontinence
dementia
gait abnormality
How would you de-escalate an elderly man who is having hallucinations and trying to hit you with a magazine
stepwise approach
de-esculation techniques first
PO lorezapam
IV lorezapam
Features of Lewy-body dementia
fluctuating cognition
parkinsonism
visual hallucinations
What is side effect of Ropinirole used for parkinson’s disease
dopamine agonist
impulsivity
gambling, hypersexuality
Which antibiotic reduces the seizure threshold?
ciprofloxacin
management for mild-moderate alzheimer’s
1st line - donepezil
2nd line- memantine
what medications can be used to raise BP
fludrocortisone
Presentation of Alzheimer’s disease
short term memory loss (progressive + persistent)
global cognitive impairment
irritable, mood swings, apathy
management for lewy body dementia
levodopa
symptoms of fronto-temporal dementia
impulsive
irritable
crying
overweight
akinesia
hallucinations
Presentation of vascular dementia
sudden onset
stepwise deterioration
motor disorders
behavioural changes
cognitive impairment
What is the ratio change from oral morphine to subcutaneous morphine
2:1
so if oral 300mg
would be 150mg subcutaneous
what pain relief medication can be used in patients on dialysis
tramadol or oxycodone
How do you treat paracetamol overdose above 4 hrs?
acetylcysteine
Presentation of Parkison’s disease
tremor
bradykinesia
rigidity (lead pipe, cogwheel)
management of parkison’s
L-dopa
What scoring tool is used to calculate risk of developing a stroke in next few days in a pt with TIA
ABCD2
What scoring tools is used to asses someone’s risk of stroke with AF?
CHADS-Vasc
presentation of hypercalcaemia - bones, stones, groans and moans
bones, stones, groans and moans
bone pain
renal stones
poor concentration
GI discomfort
What are the features of the mental capacity act?
assume capacity
maximise decision making
freedom to make seemingly unwise decisions
best interests
least restrictive options
What is section 2 and 3 of the MHA used for?
section 2 - 28days, not renewable. Detain someone with mental disorder
section 3: similar but for treatment, for 6 months, can be renewed
What is section 4 of the MHA used for?
72hr assessment order
used in emergencies
What is section 5 of the MHA used for?
5(2): pt voluntary in hospital can legally be detained by a doctor for 72hrs
5(4): pt voluntarily in hosp, can be detained by a nurse for 6 hrs
What is section 135 MHA used for
allow police to break into a property to remove a person to a place of safety - court order
What is section 136 of the MHA used for
someone found in public place, expected to have a mental disorder can be taken by police to place of safety
Presentation of Huntington’s disease
dominant inheritance (family hx)
choeroathetosis
dementia
What are the 3 main categories of behaviours related to health
health behaviour - aimed to prevent disease (eating healthy)
illness behaviour - aimed to seek remedy (see a dr)
sick role behaviour - aim to get better (taking medications)
What is unrealistic optimism in public health
people continue health damaging behaviours due to inaccurate perceptions of risk
What is health belief model - Becker 1974
people will change if
- believe susceptible to condition
- believe it has serious consequences
- believe that taking action reduces susceptibility
- believe that benefits of taking action outweigh the costs
What is theory of planned behaviour - Ajzen 1988
best predictor of behaviour is intention
person’s attitude
social pressure/social norm
Transtheoretical model of health behaviour steps
precontemplation
contemplation
preparation
action
maintenance
What is sensitivity mean in public health
proportion of those with disease who are correctly identified by screening test
What is felt need in the sociological perspective in the health needs model
individual perceptions of variation from normal health
What is expressed need in the sociological perspective in the health needs model
individual seeks help to overcome variation in normal health (demand)
What is normative need in the sociological perspective in the health needs model
professional defines intervention appropriate for the expressed need
What is comparative need in the sociological perspective in the health needs model
comparison between severity, range of interventions and cost
What are the 3 approaches in the health needs assessment
epidemiological
comparative
corporate
What type of reaction is anaphylaxis?
IgE type 1 hypersensitivity reaction
management for anaphylaxis
remove trigger
ABCDE
O2
Adrenaline IM (adult 500mg)
chlorophenamine & hydrocortisone
IV fluids
Mechanism of action of donepezil and rivastigmine
acetylcholinesterase inhibitor
What is the mechanism of action of memantine? (used for severe alzheimer’s)
Glutamate receptor antagonist
Which form of dementia is seen frequently in motor neurone disease?
fronto-temporal dementia
Sedation is most strongly associated with which type of antipsychotic, typical or atypical?
typical
What is pernicious anaemia
caused by lack of B12 vitamin
Haematological features of pernicious anaemia
low hB, high MCV, normal MCHC
management of pernicious anaemia
life long replacement with cobalamin
Presentation of pernicious anaemia
lethargy
fatigue
chronic condition
red beefy tongue
ulcers in mouth
Which type of anaemia is anaemia of chronic disease?
normocytic type
Features of alpha thalassaemia
jaundice
fatigue
facial bone deformities
Presentation of beta thalassaemia minor
mild anaemia
isolated microcytosis
pt usually aysmptomatic
Presentation of beta thalassaemia major
severe symptomatic anaemia (3-9 months old)
frontal bossing
maxillary overgrowth
Presentation of haemorrhoids
bright red PR bleed associated with defecation
no pain
itching
Presentation of GORD
dyspepsia
sensation of acid
regurgitation of food
RED FLAGS for GORD like symptoms
weight loss
anaemia
dysphagia
haematemesis
What are the stages of chronic kidney disease (CKD)
1: eGFR >90
2. eGFR 60-89
3. eGFR 30-59
4. eGFR 15-30
5. eGFR<15
Presentation of COPD
chronic productive cough
purulent sputum production
hypoxia
hypercapnia
exertional dyspnoea
cyanosis
peripheral oedema
wheeze
Stages of spirometry for COPD
- FEV1>80%
- FEV1 50-79%
- FEV1 30-49%
- FEV1 <30%
management of acute COPD
O2 88-92%
nebulised salbutamol, ipratropium
steroids: oral prednisolone
IV hydrocortisone (if severe)
Management of COPD (chronic management)
- SABA/ SAMA
- LABA and LAMA
- LAMA and LABA and ICS (steroids)
- specialist referral
Management of cellulitis
blood tests and culture
skin swab
oral or IV abx (fluxocilin)
Osteoarthritis vs rheumatoid arthritis
OA - worse with movement, and end of day. Morning stiffness under 20 mins
RA - improves with movement, morning stiffness >30
What are the xray features of osteoarthritis - LOSS
Loss of joint space
osteophytes
subchondral cysts
subarticular sclerosis
Causes of folliclitis
staphylococcus aureus
gram negative
Presentation of hypothyroidism
dry, thick skin, brittle hair
puffy face
loss of lateral third eyebrow
goitre
bradycardia
cardiomegaly
Auto immune cause of hypothyroidism
hashimoto’s
management of hypothyroidism
levothyroxine
Most common cause of hypothyroidism
idoine deficiency
Cause of trichomoniasis infection
trichomonas vaginalis
Presentation of trichomoniasis infection
women: yellow, frothy discharge, vulval irritation
strawberry cervix
management of trichomoniasis infection
oral metronidazole
Causes of chlamydia
chlamydia trachomatis
Presentation of chlamydia
discharge, dysuria, intermenstrual bleeding
Management for chlamydia
oral doxycycline
Presentation of bacterial vaginosis
increased vaginal discharge
fishy smell
management of bacterial vaginosis
metronidazole or clindamycin
Presentation of vaginal thrush
itchy, cottage cheese discharge
itching
redness
management for genital thrush
fluconazole
topical clotrimazole cream for itch relief
Cause of genital herpes
herpes simplex virus 1
causes of gonorrhoea
neiseeria gonorrhoea
gram negative diplococcus
Presentation of gonorrhoea
discharge, dysuria, abnormal bleeding
management of gonorrhoea
ceftriaxone
What is ‘error of overthinking’
when a working diagnosis is handed over and accepted without pause for consideration and determination whether its been substantially proven
What is error of overattachment
conducting tests to confirm what we expect or want to see and not ruling out other causes
What is error of bravado
typically working above competence in a show of over confidence
what is error of ignorance
unconscious imcompetence
What is QRISK used for
work out risk of developing heart attack or stroke in next 10 years
Cause of shingles and management
varicellar zoster virus
oral aciclovir
What is 1st line investigation with suspected ischaemic stroke?
CT head
What is neologism
making up of new words that only the patient understands
What is genetic cause Edward’s syndrome
Trisomy 18
What is genetic cause of Turner’s syndrome
45XO
What is genetic cause of Patau’s syndrome
Trisomy 13
What is genetic cause of sickle cell anaemia
single mutation on chromosome 11
Cause of Scarlet fever
streptococcus pyogenes
managment of croup
oral dexomethasone
if not responding: O2 + nebulised adrenaline
what are the 4 key drives for failure to thrive
inadequate intake
inadequate retention (vomiting)
malabsorption (coeliac)
increased requirements (congenital heart disease, malignancy)
best SNRI 1st line for someone with depression and insomnia
mirtazapine
What is contraindication for ECT (electroconvulsive therapy)
increased intracranial pressure
Which scoring system is used for post natal depression
Edniburgh scale
what is 1st line management for delerium (medically)
0.5mg PO haloperidol
When is the copper iud CI
chylamdia and pregnancy
What inheritance type is Marfan’s syndrome and what is the risk of it
autosomal dominant
aortic dissection/rupture
1st line SURGICAL management of post partum haemorrhage
intrauterine balloon tamponade
Which SNRI does not cause drug reaction with methylphenimate
venlafaxine
What is abx used in preterm rupture of membranes
oral eyrthromycin
When is IV penicillin used intrapartum?
mother’s with previous strep B
used in labour
Is hypertension a risk factor for endometriosis?
no
What is antenatal screening NOT used for
cytomegalovirus
What investigation should be 1st line after raised Ca125 for ovarian cancer
US abdomen pelvis
What is the antenatal combined screening for down syndrome compromised of
nuchal translucency measurement, serum beta hCG, PAPP-A
Pt has symptoms of STI, before swab results come back, what can be given to treat infection?
azichromycin 1g
treats both gonorrhoea and chlamydia
vaginal ph 5, indicative of what?
bacterial vaginosis
What information should be given to a pt regarding depo injections
fertility can take up to a year to return to normal
cauda equina managment?
1st line medical - dexamethasone 16mg
1st line definitive surgical decompression
‘down and out’ eye symptoms, which cranial nerve affected
CNIII
Symptoms of Brown-sequard syndrome
hemisection of cord on R side:
- paralysis, loss of propioception and vibration on R side (same side)
- loss of pain and temp on opposite side (L side)
(vice versa on L side)
Symptoms of benign essential tremor and management
tremor that is worse on stretching but better on rest
usually better with alcohol
management propanlol (CI in asthma)
what should be co-prescribed with NSAID
PPI e.g omeprazole
chest xray, cyanotic heart disease, ‘boot shaped heart’ (upturned apex)
tetraology of fallot
which tumour causes hyperprolactinaemia
pituitary
gout management
1st line: allopurinol
2nd: febuxostat
1st line treatment for biliary colic (gall stones)
laproscopy cholecystectomy
What is a complication of acute prostatitis
urinary retention
presentation of acute prostatitis
diminishing urinary stream, dysuria, and urinary frequency
tender, boggy, and slightly enlarged prostate
fever
what is the most common cause of infective exacerbation of COPD
moraxella cararrhalis
haemophilius influenza
streptococcus penumoniae
What pattern in LFTs would defend your diagnosis of alcoholic liver disease?
↑AST +↑ALT with an AST/ALT ratio of 2:1
What information should be given about taking alendroic acid for osteoporosis
stay standing or sitting upright for at least 30 mins before taking tablets
should be taken 30 minutes BEFORE breakfast on an EMPTY stomach
can be given IV once a year (in specialist clinic)
Cause of croup
parainfluenza virus
What is contraindicated in treatment of chickenpox in children
ibuprofen
management of whooping cough
erythromycin
symptoms of orbital cellulitis
unilateral
reduced visual acuity
eyelids red and swollen
hurts when move
when is the MMR vaccine given in children
1st dose - 1 year
2nd dose - 3yrs 4 months
Which infection causes this presentation on a nipe:
microcephaly, sensorineural deafness, cataracts
rubella
management for stress incontinence
pelvic floor exercises
duloxetine
management of urge incontinence
lifestyle mx
pelvic floor
oxybutynin, tolterodine, fesoterodine, solifenacin
Management of motor neuron disease
riluzole
Upper signs of motor neuron disease
spasticity
hyperreflexia
downwards plantars
Lower signs of motor nueron disease
fasiculations
later - atrophy
What genetic repeat is cause of Huntington’s
CAG trinucleotide
Exam presentation of Huntington’s
uncontrollable, purposeless + fitting movements (laughing)
family history
MRI&CT: increased size frontal horns, lateral ventricles
dx and mx of Hirchsprung’s disease
rectal bowel biopsy- absence of ganglionic cells
mx: definitive: surgical removal of aganglionic bowel segment
What effect does metaclopramide (anti-emetic) have on Parkinsons
counteracts parkinson’s medication
pts symptoms parkinson’s may seem worse
what is circumstantiality (talking symptom)
irrelevant wandering in conversation/going around the point
What is tangentiality in conversation?
speak about topics unrelated to the question/topic at hand
don’t circle back to answer question
What is the stepwise approach to hypertensive management if the patient has type 2 diabetes or is under 55 and not of black African descent
- Ace-i (-pril’ rampiril) OR ARB ( -artan e.g candesartan)
- ACEi or ARB + CCB (-‘pine’ e.g amlodipine) OR thiazide-like diuretic (-‘ide’ e.g furesomide)
- ACEi OR ARB + CCB + diuretic
- specialist
What is stepwise approach to hypertensive management if the patient is over 55, doesn’t have type 2 diabetes or is from black-African origin
- CCB (-‘pine’ e.g amlodipine)
- CCB + ACEi (‘pril e.g ramipril) Or ARB (-artan e.g candesartan) OR diuretic (-‘ide’ e.g furesomide)
- ACEi OR ARB + CCB + diuretic
- specialist
Presentation of otitis media
common in children
bulging and erythamatous tympanic membrane
no discharge (usually)
How to check for agranulocytosis in pt on clozapine
FBC - check WBC / neutrophil count
How to work out units of alcohol
units = Vol (L) x % ABV
Presentation of vasa pravea
painless vaginal bleeding
rupture of membranes
foetal bradycardia
What can be caused by lithium treatment in a pt with bipolar disorder
hypothyroidism
Common blood gas presentation of pyloric stenosis in neonate
metabolic alkalosis with partial compensation
low K and cl
What course of abx required in man with UTI pt allergic to penicillin
nitrofurantoin for 7 days (men need 7 day course)
If pregnant lady on anti-epileptic medication or has coeliac disease or diabetes or BMI >30, what advice should be given about folic acid supplement
5mg folic acid until 12 weeks (instead of 400mcg)
What scoring system is used for pts at risk of developing pressure ulcers
Waterlow
1st line medical management for idiopathic intracranial hypertension
acetazolamide
1st line conservative - weight loss
Presentation for idiopathic intracranial hypertension
non-pulsatile
bilateral
worse in morning, after lying down or bending forward
blurred vision
common in obese
Presentation of threatened miscarriage
painless PV bleeding
closed os
viable pregnancy
What is 1st line control of AF
bisoprolol
or rate-limiting CCB
Features of Maxwell’s Dimensions of quality - 3A’s, 2E’s
acceptability
accessibility
appropriateness
effectiveness
equity
Example of secondary prevention
breast cancer screening
pt is >65 and on long term steroids, what other medication should she be started on?
alendronic acid
management of a vasospasm
nimodipine 21d course
Features of Bradford-Hill criteria
Biological plausibility
consistency of results
dose-response
strength of association
What is reverse causality
don’t know association between exposure and outcome
managment of absence sezirues
sodium valporate or ethosuximide
Signs of duct ectasia
green nipple discharge
Is tremor in parkinson’s symmetrical or asymmetrical
asymmetrical
what is rhabdomyolysis
dark urine following long lie
Test for suspected coeliac
anti-tissue transglutaminase levels (Anti-TT)
test for intussusception
abdominal uss - target sign
Diagnosis of NEC
abdominal xray
How long after a traumatic event can PTSD be diagnosed
4 weeks
before 4 weeks = acute stress reaction
if systemically well , what is 1st line for impetigo
hydrogen peroxide 1% cream
pregnant lady came in contact with child with chicken pox, never had chicken pox as a child. What do you do? she is <20wks pregnant
give varicella-zoster immunoglobulin ASAP as <20 weeks
management of croup
dexamethasone
Child with menigococcal septicaemia, what is management
IV ceftriaxone and dexamethasone if over 3 months,
if under 3 months IV cefotixime + amoxicillin
Presentation of Edward’s syndrome
overlapping fingers
rocker-bottom feet
Presentation of extradural haematoma
trauma to head
initial loss of consciousness but recovered
but then sudden deterioration
Pregnant lady has obs cholestasis, what is plans for delivery
induction of labour 37-38 weeks
When can you xray a baby?
over 3 months age
Features of tetrology of fallot (cyanotic)
overriding aorta
pulmonary stenosis
right ventricular hypertrophy
ventricular septal defect
Management of acute dystonic reaction
IV procyclidine
Presentation of gonadal dysgenesis
high FSH
high LH
primary amenorrhoea
1st line mx for focal seizures
carbamazepine
presentation of hypothyroidism
HIGH TSH
LOW free T3/4
ANTI- TPO antibodies
cause? Hashimoto’s
Presentation of ovarian hyperstimulation syndrome
ascites
vomiting
diarrhoea
high haematocrit
associated with gonadotrophin therapy
Managment of neonatal hypoglycaemia
if asymptomatic encourage feeding & monitor blood glucose
if symptomatic: admit to neonatal unit, Iv infusion of 10% dextrose
Features of anorexia nervosa
lanugo hair
delayed / absent puberty
bradycardia
hypotension
hypokalaemia
hypercholesterolaemia
hypercarotinaemia
low T3
Triad of shaken baby syndrome
subdural haematoma
retinal haemorrhages
encephalopathy
Most common presentation of neonatal sepsis
respiratory distress; grunting
Most common cause of neonatal sepsis
GBS: group B strept in mum
metabolic signs of pyloric stenosis
hypocholraemia
hypokalaemia
alkalosis
Presentation of slipped capital femoral epiphysis
loss of internal rotation of leg in flexion
more common in adolescents
groin pain radiating to thigh and knee
Differences between schizoid and schizotypical personality disorder
schizoid: indifference to paise, preference for solitary activities, lack of desire companionship, few friends, emotional coldness
schizotypical: odd beliefs, unusual perception, paranoid, lack of close friends, odd, eccentric behaviour
Characteristics of an innocent murmur
soft blowing pulmonary area
short buzzing aortic area
no diastolic component
no thrill or added sounds
asymptomatic child
Presentation of transposition of the great arteries
cyanosis
tachypnoea
loud single S2
right ventricular impulse
‘egg on side’ appearance chest xray
management of transposition of the great arteries
1st: prostaglandins
definitive: surgery
medical treatments for post-partum haemorrhage
IV oxytocin, ergometrine, carboprost (CI asthma), misoprostol
most common cause of post menopausal bleeding
vaginal atrophy
Difference between onset of cyanotic heart disease
Transposition of great arteries - 1st few days of life
tetralogy of fallot - 1-2 months of life
Feeding intolerance, bloody stools, abdominal distension. Which is diagnostic investigation?
Necrotising enterocolitis
abdominal xray - pneumoatosis intestinalis
Features of cow’s milk protein allergy
regurgitation and vomiting
diarrhoea
eczema
colic sx: irritability and crying
A pregnant lady infected with cytomegalovirus for the first time, what is risk to foetus
hearing loss
visual impairment
learning difficulty
What maternal conditions can result in congenital heart disease
Type 1 and 2 diabetes
Rubella infection
thalidomide, isotretinoin, lithium
alcohol
What is immaging likely to show in normal pressure hydrocephalus
ventriculomegaly in the absence of sulcal enlargment
What initial management should be done in a person with suspected dementia
FBC, U&Es, LFTs, ESR.CRP. vit B12, TFTs
- look for reversible organic causes
Which class of antidepressants may cause urinary retention
tricyclic
What would results be on a quadruple test for a positive down syndrome
decreased AFP
Decreased oestriol
increased hCG
increased inhibin A
1st line management for cow’s milk protein allergy in neonates
extensively hydrolysed formula
features of an atypical UTI in children
seriously ill
poor urine flow
abdo or bladder mass
raised creatinine
septicaemia
infection of non e coli
Presentation of henoch schonlein puroura
purpura/ petechiae on butt or lower limbs
abdo pain
arthralgia
preceded by viral upper resp infection
management of henoch schonlein purpura
NSAIDs
anti hypertensives
regular urine dips 12 months after
Presentation of Wernicke’s encephalopathy - triad
ataxia
confusion
ocular abnormalities ; nystagmus
What is Wernicke’s encephalopathy due from
thiamine (B1 ) deficiency
tx: IV pabrinex
What is ‘flight of ideas’
stream accelerated thoughts
jumps randomly from topic to topic
no clear direction
What is ‘word salad’
pt uses words nonsenically e.g “purple monkey dishwasher? Thursday!”
What is ‘logoclonia’
pt repeats last syllable of a word or phrase
what is ‘derailment’
speech consists of series of unrelated or remotely related ideas
What is ‘knight’s move thinking’
illogical leaps between unconnected ideas
loosening of association
what term is used to describe when a patient is fascinated with repetitive mechanical tasks or with the ordering of objects
Punding
Presentation and management of candidiasis (thrush)
itching, white curdy discharge, sour milk odour, superficial dyspareunia
o/e: redness, thick white discharge
mx: fluconazole
Presentation and management of bacterial vaginosis
fish odour, pH >4.5, grey discharge
mx: metronidazole or clindamycin
metronidazole in pregnancy
Presentation and management of trichomoniasis
frothy yellow discharge, vulva irritation
strawberry cervix
mx: metronidazole
Presentation and management of chlamydia
discharge, dysurina, inter menstrual bleeding
mx: doxycycline (or azithromycin)
Presentation and management of gonorrhoea
discharge, dysuria, tender inguinal nodes, abnormal bleeding
mx: ceftriaxone and Azithromycin
Primary amenorrhoea (inability to establish menstruation by 15), no axillary or pubic hair, elevated testosterone. What is most likely dx?
androgen insensitivity syndrome
X linked recessive
what is usually 1st line in ectopic pregnancy
salpinectomy
What are the risk factors for the different female cancers (endometrial, cervical, breast. ovarian)
Endometrial: PCOS
Cervical: COCP, early 1st intercourse
breast: COCP, BRCA2
defective downward gaze and vertical diplopia may indicate a lesion in which cranial nerve?
CN IV
What is 1st line mx of acute sezirues
Benzodiazepine (chlordiazepoxide, loreazepam))
Bicuspid aortic valve associated with which genetic condition
Turner’s syndrome
a woman suddenly falls to the ground then lays motionless. Which type of seizure does this sound like? & mx of this type of seizure
atonic seizure
mx: Sodium Valproate or Lamotrigine is first-line.
Transient unilateral loss of vision described as a ‘curtain descending’ is typically caused by a lesion affecting the:
ophthalmic artery
typical for TIA
Which drugs could reduce seizure threshold
antipsychotics
ciprofloxacin
Strawberry tongue - characteristic of which paeds disease? (scarlet fever, roseola infantum, slapped cheek syndrome or measels)
Scarlet fever
what kind of rash appears in roseola infantum and when does it appear
48hrs after fever
maculopapular rash
Presentation of trigeminal euralgia
electric shock (trigeminal nerve regions)
light touch, eating may trigger pain
1st line management for trigeminal neuralgia
carbamazepine
Contralateral hemiparesis and sensory loss with the lower extremity being more affected than the upper is typically caused by a lesion affecting the:
anterior cerebral artery
Contralateral homonymous hemianopia with macular sparing and visual agnosia is typically caused by a lesion affecting the:
posterior cerebral artery
A child develops a pink maculopapular rash, initially on the face before spreading to the whole body. Suboccipital and postauricular lymphadenopathy is present is a stereotypical history of:
rubella
Acyanotic congenital heart disease
coarction of aorta
ventricular septal defect
aortic valve stenosis
atrial septal defect
Which drugs can cause ataxia
carbamazepine
phenytoin
sodium valproate
(think epilepsy meds)
Which drugs can cause nephrotoxicity
lithium
aminoglycosides
ciclosporins
amphotericin b
When is BCG (vaccine against TB) offered to babies up to 1 year recommended?
- born in ares of uk with high rates TB
- have parent or grandparent who was born in country with high rates TB
Presentation of Wilm’s tumour
abdominal mass doesn’t cross midline
haematuria
hypertension
abdominal distension
Presentation of transient synovitis
3-8yrs old
acute hip pain
associated with viral infection
pain, reluctant to weight bear
still normal range of movement
Presentation of Perthes’ disease
4-8yrs
chronic degenerative - avascular necrosis femoral head
hip pain that progressive over weeks
limp
stiffness, reduced ROM
dx: xray
What investigations should be done in infants younger than 3 months presenting with a fever
FBC
Blood culture
C-reactive protein (CRP )
Urine test
chest imaging only if resp sx
stool culture if diarrhoea present
What is a risk associated with zopiclone use in the elderly
increased risk of falls
A woman struggling with depression, low appetite and sleep problems. Best drug to prescribe
mirtazapine - helps insomnia and increases appetite
1st line management in acute stress reaction
CBT
Advise about SSRIs in pregnancy
avoided unless the benefits outweigh the risk, can lead to increased risk of congenital malformations (esp paroxetine)
What are elderly pts at an increased risk of when they take atypical antipsychotics (clozapine, risperidone, olanzapine)
increased risk of stroke and VTE
When is vaginal delivery recommended in a woman with HIV
if viral load is less then 50 at 36weeks
What antibiotic is given to women with pre-term rupture of membranes
10 days erythromycin
When is the down syndrome screening done during pregnancy
11-13+6 weekss
Which form of HRT (treatment for menopause) pose lowest risk of VTE
transdermal HRT
treatment for moderate/severe tardive dyskinesia (common from long term antipyschotic use)
tetrabenazine
What is akathisia
sense of inner restlessness and inability to keep still
can be sx from long term antipsychotic use
which type of urinary incontinence is associated with amitriptyline
overflow incontinence
What does SNRI stand for/ mechanism of action
serotonin and noradrenalin reuptake inhibitor
features of Bradford Hill criteria (causality) - 9
strength of association
consistency of results
dose response
temporality
plausibility
reversibility
coherence
analogy
specificity
Disadvantages of screening - 3
exposure of well individuals to harmful diagnostic tests
detection and treatment of sub clinical disease that would never have caused problems
preventative interventions that may cause harm to indivudal or population
definition of specificity
proportion of people without the disease who are correctly excluded by the screening test
definition of positive predictive value
proportion of people with a positive test result who actually have the disease
Definition of negative predictive value
proportion of people with a negative test result who do not have the disease
What is lead time bias
screening identifies outcome earlier that it would apparent increase in survival time even if screening had no effect on this outcome
what is length time bias
results from differences in the length of time taken for a condition to progress to severe effects that may affect efficacy of screening methods
what should be initiated immediately in cases of suspected encephalitis
aciclovir
What is 1st line drug management for ocular myasthenia gravis
pyridostigmine
chronic progressive weakness in legs, tednency to tripover,. fasciculations, reduced power bilaterally. hyperreflexia and upgoing plantars. What it diagnosis?
motor neuron disease - ALS
7month history of fatigable weakness, double vision, worsens throughtout the day, improves on rest. What is likely dx?>
myasthenia gravis - fatiguable weakness better with rest
A 30 year old female is referred to the neurology clinic with a 2 month history of weakness, which she reports is better in the morning than in the evening.
On physical examination there is proximal limb weakness and mild bilateral ptosis, exacerbated by prolonged upgaze. Reflexes and sensation are intact.
What is most likely dx?
myasthenia gravis
What medications worsen myasthenia gravis symptoms
beta blockers
lithium
antimalarias
What type of drug is pyridostigmine (for myasthenia gravis)
cholinesterase inhibitor
What is a poor prognostic for schizophrenia
gradual onset
What is uterus atony
failure of adequate contractions
Features of acute fatty liver of pregnancy
abdo pain
nasuea+vomiting
jaundice
ALT elevated
Features of acute fatty liver of pregnancy
abdo pain
nasuea+vomiting
jaundice
ALT elevated
Features of HELLP
haemolysis
elevated liver enzymes
low platelets
if woman has 2 cervical smears both resulting in HPV +, cytology normal, what is next step
colposcopy
Presentation of vasa praevia
rupture of membranes followed by immediate vaginal bleeding
fetal bradycardia
What Hb in pregnancy is cut off for treatment with supplements
haemoglbuin less than 110
