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Clinical > Most commonly asked topics > Flashcards

Most commonly asked topics Flashcards

1
Q

What’s placental abruption

A

(early) separation of placenta from placental bed

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2
Q

Woody uterus on palpation - most likely pathophysiology?

A

Placental abruption

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3
Q

mx of placental abrupton?

A

Delivery of placenta

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4
Q

What is placental praevia

A

low lying placenta

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5
Q

Painless antepartum haemorrhage and soft uterus, indications of what?

A

Placenta praevia

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6
Q

mx of placental praevia

A

elective C section

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7
Q

Risk factors for shoulder dystocia

A

previous hx
macrosomnia
diabetes
maternal high BMI

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8
Q

mx of post partum haemorrhage

A

fundal massage, syntocin, ergomentine

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9
Q

Investigations for ovarian cancer?

A

CA125

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10
Q

Presentation of endometrial cancer?

A

Post menopausal bleeding

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11
Q

What is PCOS?

A

hyperandrogenism - high LH, Low FSH, High androgens

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12
Q

What are the uses of Magnesium sulfate in pregnancy

A

prophylaxis for eclampsia seizures

IV form - to terminate an eclampsia seizure

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13
Q

Which antihypertensives are CI in pregnancy?

A

ramiprill & other Ace-i

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14
Q

Treatment for pre-eclampsia

A

antihypertensives - labetalol 1st line (CI athsma)
2nd line nifepidine

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15
Q

Risk factors for pre-eclampsia

A

nulliparity
previous/family hx
increasing maternal age
Hypertension
diabetes
autoimmune disease
multiple pregnancy

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16
Q

features of obstetric cholestasis

A

itchy hands and feet

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17
Q

mx cholestasis

A

ursodeoxycholic acid

chlorphenamine (reduce itch)
vit K (reduce risk of haemorrhage)
schedule early labour

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18
Q

indications for induction of labour

A

> 41 wks
preterm rupture of membranes
intrauterine foetal death
abnormal CTG
pre-eclampsia, diabetes, Obs Chol

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19
Q

CI for induction of labour

A

previous c section
herpes simplex
placenta praevia
malpresentations

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20
Q

Methods of induction of labour

A

1st - membrane sweep
2nd - vaginal Pge2

Intrauterian foetal death - misoprostol and miferistone

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21
Q

Most likely causative agent for bartholin’s cyst

A

E coli

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22
Q

7 stages of delivering baby in normal vaginal delivery

A
  1. descent and engagement
  2. flexion - narrowest diameter
  3. internal rotation of head into OA
  4. extension - crowning
  5. restitution - head aligns with shoulders
  6. external rotation
  7. delivery of shoulders
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23
Q

4 causes of failure to progress in labour

A

power
passage
passenger
position

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24
Q

what are the 7 layers that need to be cut through in a c section

A
  1. skin
  2. Camper’s fascia
  3. scarpa’s fascia
  4. rectus sheath
  5. seperate rectus abdominus
  6. parietal peritoneum
  7. uterus
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25
Q

Complications of shoulder dystocia

A

brachial plexus injury
cerebral palsy
perinatal mortalitiy
PPH

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26
Q

Causes of post-partum haemorrhage - 4T’s

A

Tone- prolonged labour, twins- macrosomnia
Trauma
Tissue
Thrombin coagulopathy (DIC in pre-eclampsia)

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27
Q

Most common gynae cancer

A

Endometrial

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28
Q

risk factors for ovarian cancer

A

BRCA family hx
never used COCP

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29
Q

presentation of ovarian cancer

A

pelvic mass
ascites
IBS sx
Urinary sx

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30
Q

Risk factors for cervical cancer

A

HPV infection

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31
Q

Presentation of cervical cancer

A

symptomatic finding
post coital bleeding
intermenstrual bleeding
abnormal discharge

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32
Q

endometriosis, adenomyosis, fibroids & PID are differentials for what?

A

Dysmenorrhoea

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33
Q

Presentation of endometriosis

A

dysmennorrhoea (painful periods)
cyclic period pain
subfertility

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34
Q

Gold standard diagnostic for endometriosis

A

Laproscopy

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35
Q

What are fibroids

A

benign neoplasia of uterine smooth muscle

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36
Q

presentation of fibroids

A

menorrhagia
pelvic pressure
bloating
dysmenorrhoea

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37
Q

mx for fibroids

A

mirena IUS -normally best option!
COCP
tranexmic acid

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38
Q

Differentials of infrequent periods (oligomennorrhoea)

A

stress, exercise, weight loss, eating disorders
PCOS
hyperthyroidism
perimenopause

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39
Q

Rotterdam criteria for PCOS

A
  1. oligomenorrhoea
  2. hyperandroginism sx (struggle to lose weight, excess hair)
  3. polycystic ovaries
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40
Q

Presentation of PCOS

A

oligomenorrhoea
subfertility
acne
hirsutism

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41
Q

Invx for PCOS

A

FSH/LH
testerone
TFTs
prolactin

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42
Q

mx of PCOS

A

COCP
metformin
Clomiphene

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43
Q

Acute lower abdominal pain in a female, what are differentials and what investigations would you do first?

A

appendicits, ectopic pregnancy, ovarian torsion, PID

  1. Pregnancy test
  2. Transvaginal USS/abdo USS
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44
Q

Common site of ectopic pregnancy

A

ampulla of fallopian tube

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45
Q

Presentation of ectopic pregnancy

A

normally 6-8wks after fertilisation

acute iliac fossa pain
tenderness
guarding
PV bleed

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46
Q

CI to breastfeeding

A

TB infection
Uncontrolled HIV
Medications: Amiodarone, lithium, tetracycline, sitagliptin, methotrexate

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47
Q

What medications helps to stop a woman breastfeeding

A

cabergoline - dopamine receptor agonist

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48
Q

What rhesus status is mum in rhesus isoimmunisation/?

A

rhesus negative with rhesus positive baby

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49
Q

Indications for rhesus isoimmunisation

A

28wks or sensitisin event; haemorrhage

prophylaxis anti-D antibodies given

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50
Q

features of haemolytic disease of the newborn

A

foetal oedema
yellow amniotic fluids
jaundice

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51
Q

features of haemolytic disease of the newborn

A

foetal oedema
yellow amniotic fluids
jaundice

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52
Q

How resus a neonate

A

5 rescue breaths followed by 15 chest compressions

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53
Q

differences between placenta accreta, increta and pecreta

A

accreta- superficial myometrium, does not penetrate muscles
increta - villi invade in but not through
pecreta- invade through to other side

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54
Q

differences between placenta accreta, increta and pecreta

A

accreta- superficial myometrium, does not penetrate muscles
increta - villi invade in but not through
pecreta - invade through to other organs

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55
Q

Risk factors for placenta accreta

A

previous TOP
previous C section
advanced maternal age

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56
Q

What investigation used to detect foeto-maternal haemorrhage in rhesus neg mum and rhesus positive baby

A

Kleinhaur test

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57
Q

What is main causes of anaemia in pregnancy

A

iron deficient

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58
Q

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?

A

fibroids - most common cause heavy menstrual bleeding AND can make uterus palpable

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59
Q

What is the commonest cause of anovulation in women?

A

PCOS

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60
Q

Genetic causes of infertility

A

Turner’s syndrome
Kleinfelter’s syndrome

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61
Q

When is an ovarian cyst most likely to erupt?

A

physical activity - sexual intercourse, exercise

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62
Q

Presentation of an ovarian cyst rupture

A

asymptomatic sometimes
acute unilateral pain
intra-periotineal haemorrhage with haemodynamic compromise

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63
Q

What is the most common type of ovarian cyst

A

follicular cyst

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64
Q

Urge incontinence, frequency or noacturia are indicitive of what?

A

Overactive bladder syndrome

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65
Q

mx for overactive bladder syndrome?

A

reduce oral fluids/caffeine/alcohol
pelvic floor exercises
anticholinergic: oxybutynin, solifenacin

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66
Q

Presentation of pelvic inflammatory disease

A

bilateral abdominal pain
discharge
post-coital bleeding
adnexal tenderness, cervical motion tenderness on bi-manual, fever

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67
Q

mx for Pelvic inflammatory disease

A

ofloxacin + metronidazole

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68
Q

When is a salpingectomy performed?

A

surgical managment for ectopic pregnancies that have an embryo heartbeat or if the b-hCG is more than 5000

-preferred surgical managment

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69
Q

Use of intramuscular methotrexate for ectopic pregnancy

A

in ectopic pregnancies where there is no heartbeat and the b-hCG is <1500

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70
Q

What is amniotic fluid embolism and what are the clinical features?

A

obstetric emergency
amniotic fluid enters maternal circulation

high resp rate
tachycardia
hypotension
hypoxia
disseminated IV coagulaopathy

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71
Q

When in an ectopic pregnancy is surgery over methotrexate prefferred?

A
  1. the pt is in a large amount of pain
  2. mass is greater than 35mm
  3. ultrasound identifies a fetal heartbeat
  4. serum beta-human chorionic gonadotropin (B-hCG) levels are over 5000
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72
Q

Indications for an elective C-section

A

abnormal presentation (breech/transverse)
twin pregnancy
maternal HIV
Primary genital herpes in 3rd trimester
placenta praevia
anatomical reasons

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73
Q

Features of premature ovarian insuffiency syndrome

A

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
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74
Q

dx and mx of premature ovarian insufficiency

A

raised FSH levels

HRT

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75
Q

Does smoking increase or decrease the risk of endometrial cancer?

A

decrease

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76
Q

Features of atrophic vaginitis

A

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

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77
Q

Features of Hyperemesis gravidarum

A

severe vomiting with onset before 20 weeks gestation

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78
Q

mx of Hyperemesis gravidarum

A

fluid replacement therapy
potassium chloride replacement (esp if hypokalaemic)
anti-emetics: 1st line = cyclizine, metoclopramide or prochlorperazine.

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79
Q

What is Congenital Toxoplasmosis

A

caused by protozoan parasite toxoplasma gondii found in cat faeces

abx- spiramycin used in pregnancy

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80
Q

What are tocolytic drugs used in pregnancy and give some examples

A

used to suppress contractions and labour

nifedipine -1st line
atosiban
indomethacin
terbutaline

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81
Q

Risk factors for ectopic pregnancy

A

PID
gonorrhoea
pelvic surgery
IUD/IUS in place
IVF
Previous ectopic pregnancy
endometriosis

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82
Q

Clinical features and cause of group B streptococcus infection in pregnancy

A

bacterium streptococcus agalactiae

sepsis, pneumonia and menigitis of newborn

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83
Q

mx of Group B Streptococcus infection in pregnancy

A

Intrapartum abx - penicillin

if penicillin allergy - vanomycin

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84
Q

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

A

viable pregnancy

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85
Q

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

A

ongoing miscarriage

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86
Q

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

A

ectopic pregnancy

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87
Q

a woman takes 2 b-hCG tests, what does it mean when the 2nd test is more than 1500

A

ectopic pregnancy

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88
Q

a woman takes a b-hCG tests, what does it mean when the test is 100,000?

A

molar pregnancy

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89
Q

Causes of polyhydramnios

A

excess amniotic fluid

maternal diabetes
foetal renal disorders
foetal anaemia
twin
chromosomal disorders

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90
Q

What is Asherman’s syndrome and what does it cause

A

intrauterine adhesions causing outflow obsruction (usually after uterine surgery)

secondary amennorhoea

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91
Q

mx for umbilical cord prolapse

A

emergency c section
get woman on all 4s; knees and elbows

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92
Q

Which type of ovarian tumour may affect younger woman?

A

germ cell

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93
Q

what is mx of lichen sclerosis

A

potent topical steroid (dermovate)

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94
Q

What is the most common causative agent for a respiratory tract infection in a pt with Cystic fibrosis?

A

pseudomonas aeruginosa

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95
Q

Which pathogen is responsible for Roseola Infantum

A

Human herpes virus 6

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96
Q

Presentation of Roseola Infantum

A

febrile & lethargic up to 5 days
Fever (up to 40)
blanching, rose-pink macular rash on trunk

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97
Q

What is the most common cause of rectal bleeding in children?

A

Meckel’s diverticulum

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98
Q

What immune response causes coeliac disease

A

T cell mediated inflammatory autoimmune
affects the small bowel
produces villous atrophy and malabsorption

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99
Q

Symptoms of coeliac disease in children

A

steatohorrea
weightloss/failure to thrive
short stature, wasted buttocks
dermatitis herpetiformis (pruritic papulovescular lesions)

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100
Q

gold standard disgnostic investigation for coeliac disease

A

OGD and duodenal/jejunal biopsy.

shows: sub-total villous atrophy, crypt hyperplasia, intra-epithelial lymphocytes

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101
Q

1st line investigation for coeliac disease

A

Anti-TTG IgA antibody

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102
Q

What murmur would you hear in ventricular septal defect?

A

pan-systolic murmur

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103
Q

Presentation of Transient tachypnoea of the newborn

A

commonly after c section

resp distress: tachypnoea, increased work of breathing, potentially desaturated/cyanotic

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104
Q

What increased risk would a child have with a hydrocele if it didnt resolve within 2 years

A

inguinal hernia

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105
Q

Presentation of a hydrocele

A

swollen testes
transiluiminate light

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106
Q

Which vitamin deficiency causes rickets in a child

A

vitamin D

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107
Q

Presentation of rickets

A

aching bones
poor growth and development
delayed dentition
weakness
constipation

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108
Q

Presentation of cystic fibrosis in neonates

A

meconium ileus

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109
Q

Presentation of cystic fibrosis in infants

A

baby’s sweat is salty
faltering growth
recurrent chest infections

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110
Q

Presentation of cystic fibrosis in toddlers

A

faltering growth
recurrent chest infections
malabsorption syndromes

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111
Q

Causes of acute epiglottis?

A

Haemophilus influenza virus B

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112
Q

Presentation of acute epiglottis

A

fever
ill-looking child
difficulty swallowing/drooling

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113
Q

abx used for acute epiglottitis?

A

IV cefuroxime

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114
Q

Who is most affected by ALL

A

children under 6 and adults over 80

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115
Q

Presentation of ALL in child

A

unexplained bruing
enlarged lymph nodes

hepatosplenomegaly
tired
weightloss

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116
Q

How is leukaemia (ALL) diagnosed?

A

bone marrow biopsy

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117
Q

What type of reaction is an acute asthma attack?

A

IgE type 1 hypersensitivity

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118
Q

Presentation of acute asthma attack in a child

A

breathlessness
audible wheeze bilaterally
chest tightness

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119
Q

Acute asthma attack stepwise approach in children

A
  1. inhaled salbutamol
  2. nebulised salbutamol
  3. add nebulised ipratropium bromide
  4. Add magnesium sulfate IF O2 <92%
  5. oral (1st line) or unable oral, IV steroids
    6.. IV salbutamol if no response to other interventions
  6. if severe/life-threatening add aminophylline
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120
Q

What mumur would you hear in an atrial septal defect

A

low pitched diastolic rumble in tricuspid area
ejection murmur on sternal edge

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121
Q

mx of ADHD

A

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)

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122
Q

Most common cause of bacterial tracheitis

A

staphylococcus aureus (most commonly after resp tract infection)

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123
Q

1st line mx for constipation in children

A

movicol

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124
Q

How is Hirchsprung’s disease diagnosed?

A

rectal suction biopsy

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125
Q

Presentation of Hirchsprung’s

A

delay in passsing meconium
distended abdomen
forceful evacuation after DRE

stimulatory cells not present in last segment of bowel (aganglionic colon)

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126
Q

Causes of pathological neonatal jaundice

A

<24hrs after birth!

haem disorders
G6PD
infection (TORCH screen indicated)

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127
Q

Aetiology of cystic fibrosis

A

mutations of CFTR protein

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128
Q

What is meconium ileus?

A

no meconium passed within 48hrs from birth - sign of obstruction

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129
Q

Appearance on xray of meconium ileus

A

bubbly appearance on abdominal xray

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130
Q

Chest xray appearance to diagnoses neonatal respiratory distress syndrome?

A

ground glass appearance seen

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131
Q

Presentation of pyloric stenosis in neonates

A

projectile vomiting ‘hitting walls’
palpable mass o/e - smooth olive mass

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132
Q

Complications of pyloric stenosis in neonate

A

hypocholoremic, hypokalaemia metabolic acidosis

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133
Q

How is pyloric stenosis diagnosed and what is management

A

abdominal USS
surgical - pyloromyotomy
fluid resus

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134
Q

Which bacteria causes meningococcal infection?

A

Neiseria meningitidis (gram neg intracellular diplococcus)

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135
Q

Presentation of meningococcal infection in children

A

septicaemia
meningitis
purpuric skin rash
cold peripheries
poor cap refill time
tachycardia
decreased urine output

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136
Q

Presentation of parvovirus B19 (slapped cheek syndrome)

A

fever, coryza, diarrhoea
‘lace like’ rash across body
red rash on cheeks

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137
Q

Specific values to diagnoses DKA

A

ketones: 3mmol/L and over
Blood glucose: >11mmol/L
Bicarbonate: <15mmol/L or venous pH <7.3

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138
Q

Presentation of diabetic ketoacidosis (DKA)

A

acetone on breath (fruity)
vomiting
dehydration
abdominal pain
hypovalaemic shock
coma

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139
Q

Mx of DKA

A

IV fluids (0.9% NaCl, insulin infusion 0.1 units/kg)

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140
Q

What causes whooping cough? (pertussis)

A

boredetella pertussis (gram negative coccobacillis

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141
Q

Presentation of whooping cough

A

prolonged coughing followed by gasping for air
inspiratory stridor
post-tussive vomiting

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142
Q

Mx of whooping cough

A

notifiable disease

1st line: erythromycin, azithromycin or clarithromycin

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143
Q

What causes rubella?

A

rubella togavirus

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144
Q

Presentation of rubella

A

fever, coryza, arthralgia
rash (starts on face, moves down to trunk, spares arms and legs)
post auricular lymphadenopathy

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145
Q

clinical features of encephalitis

A

altered mental state
fever/flu-like symptoms
early seizures

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146
Q

Most common cause of encephalitis

A

herpes simplex virus 1

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147
Q

Mx for encephalitis

A

broad spec abx + 2g IV ceftriaxone BD + 10mg/kg acyclovir TDS 3 weeks

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148
Q

What causes impetigo?

A

staphylococcal and streptococcal

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149
Q

Clinical features of impetigo

A

prurtic rash
discrete patches golden crusting

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150
Q

mx of impetigo

A

fusidic acid or oral flucloxacillin

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151
Q

What causes scarlet fever

A

streptococcus

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152
Q

Presentation of scarlet fever

A

coarse red rash on cheeks
sore throat
fever
headache
‘sandpaper’ rash
bright red tongue

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153
Q

Mx for scarelt fever

A

phenoxymethylpenicillin for 10days

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154
Q

Presentation of hand, foot, mouth disease

A

blisters on hands and feet
ulcerations in buccal cavity
usually preceded by 1/7 hx of fever and lethargy

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155
Q

Common cause of hand foot mouth disease

A

coxsackie virus A16

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156
Q

Presentation of measels

A

erythematous blanching maculopapular rash all over body
preceded by fever, cough, runny nose or conjuntivitis
koplik spots in mouth

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157
Q

Presentation of chicken pox

A

maculopapular vesicular rash that crusts over to form blisters
itchy

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158
Q

cause of chicken pox

A

varicella zoster virus (human herpes virus 3 (HHV3))

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159
Q

Presentation of septicaemia

A

rapidly developing non-blanching purpuric rash
lethargy
fever
headache
rigors
vomiting

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160
Q

if pt is seen in community with suspected meningitis alongside septiceamia, what should you do?

A

immediate IM benzylopenicillin
send to hospital

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161
Q

What causes infectious mononucleosis (glandular fever)

A

epstein Barr virus

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162
Q

Presentation of infectious mononucleosis (glandular fever)

A

fever
sore throat
fatigue
hepatosplenomegaly

rash that forms all over body if amoxicilin has been prescribed (morbiliform eruption - generalised maculopapular rash)

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163
Q

Paeds: perianal/vulval itching, worse at night, unremarkable examination. What is the disease and what is the treatment?

A

threadworm

1st line: oral mebandazole

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164
Q

Features of otitis media

A

pain
fever
vomiting
often occurs after viral resp infection

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165
Q

Presentation of intussusception (paeds)

A

severe colicky pain
child draws legs up
refuse feeds
bilious vomiting
red-jelly stool
sausage shape mass palpated

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166
Q

What signs would be shown on abdominal ultrasound for intussception

A

target sign (cocentric echogenic and hypoechogenic bands)
free abdominal air
presence of gangrene

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167
Q

Presentation of Juvenile idiopathic athritis (JIV)

A

joint pain
fevers
malaise
salmon pink rash

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168
Q

1st line mx for juvenile idiopathic arthritis where less than 4 joints affected?

A

intra-auricular steroid injections: methylprednisolone acetate

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169
Q

Presentation of GORD in children

A

milky vomit after feed
crying /irritability
drawing up knees to chest

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170
Q

Features of nephrotic syndrome

A

proteinuria
oedema
hypoalbuminaemia
hyperlipideamia
lipiduria

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171
Q

Most common cause of nephrotic syndrome in children

A

minimal change disease

tx: steroids

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172
Q

What is Henoch Schonlein purpura (HSP)

A

small vessel vasculitis in children

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173
Q

Presentation of Henoch schonlein purpura (HSP)

A

purpura or petechiae on buttocks or lower limbs
start urticarial - maculopapular
trunk is spared
abdo pain
arthralgia
fever

preceded by viral upper resp infection

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174
Q

What is naevus flammeus

A

port-wine stain birthmark
present from birth, grows with infant

laser therapy can be used in future

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175
Q

What is 1st and 2nd line tx for acute otitis media in under 2yrs

A

1st: amoxicillin

2nd: clarithromycin

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176
Q

Is tetraology of fallot cyanotic or non-cyanotic

A

cyanotic
congenital cardiac disease

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177
Q

Presentation of tetraology of fallot

A

detection of murmur (pan-systolic (VSD))
cyanosis

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178
Q

What are the features of Patau’s syndrome

A

trisomy 13

holoprosencephaly
cleft lip and palate
microcephaly
polydactyll
congenital heart disease

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179
Q

Presentation of Turner’s syndrome

A

short stature
webbed neck
wide spaced nipples
bicuspid aortic valve defect
delayed puberty

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180
Q

Which clotting factor is deficient in haemophilia A

A

VIII

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181
Q

Presentation of haemophilia A

A

bleeding into soft tissue, joints and muscles - bruising

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182
Q

mx of haemophilia A

A

desmopressin

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183
Q

Which clotting factor if deficient in haemophilia B

A

factor IX

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184
Q

Features of Von Willibrand disease

A

excess or prolonged bleeding
easy bruising
menorrhagia
GI bleeding

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185
Q

Investigation results for Von Willebrand disease

A

decreased factor VIII activity
PT normal
APTT prolonged
bleeding time prolonged

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186
Q

Presentation of Wilm’s tumour (paeds)

A

abdominal mass that doesn’t cross midline
abdominal distension
haematuria
hypertension

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187
Q

Presentation of retinoblastoma in children

A

white eye reflex (loss of normal red reflex)

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188
Q

Features of Edward’s syndrome

A

trisomy 18
low set ears
microcephaly

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189
Q

What is Fragile X syndrome and presentation

A

CGG repeat X chromosome

long face
large protruding ears
large testes
autistic spectrum features

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190
Q

Presentation of Prader Willi syndrome

A

hypotonia and poor feeding infancy
developmental delay
short stature
obesity in older childhood

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191
Q

What defect is associated with Noonan syndrome

A

pulmonary stenosis

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192
Q

What defect is associated with down syndrome

A

AVSD (atrioventricular septal defects)

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193
Q

What defect is associated with foetal alcohol syndrome

A

venticular septal defect

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194
Q

What defect is associated with DiGeorge syndrome

A

aortic arch defects

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195
Q

What defect is associated with Turner syndrome

A

bicuspid aortic valve

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196
Q

What defect is associated with Edwards syndrome

A

septal defects

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197
Q

Cause of septic arthritis in children

A

staphylococcus auerus

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198
Q

Presentation of septic arthritis

A

fever pain
swelling
redness of sight
unable to weight bear

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199
Q

mx for septic arthritis in children

A

flucloacilin + fusidic acid / rafampcin
if penicillin allergy: clindamycin

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200
Q

Presentation of Perthes disease

A

gradual onset limp & hip pain
persists over 4 weeks

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201
Q

mx of UTIs in children

A

Lower UTIs: nitrofurantoin
Upper UTIs: cephalosporin

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202
Q

What is on the DSM-V 6 criteria for ADHD?

A
  • answers questions prematurely
  • always on the go, spontaneously moving around
  • losing important things, forgetful
  • cannot play quietly
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203
Q

1st line management for viral induced wheeze?

A

inhaled salbutamol

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204
Q

common signs/symptoms of necrotising enterocolitis (NEC)

A

abdominal distension
vomiting
visible intestine loops
rectal bleeding
lethargy
feeding intolerance

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205
Q

Most appropriate diagnostic for necrotising enterocolitis (NEC) and what would you see?

A

Abdominal xray

  • dilated bowel loops
  • bowel wall oedema
  • pneumotitis intestinalis
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206
Q

what are the 3 cyanotic heart disease in paeds?

A
  • transposition of the great arteries
  • tetralogy of fallot
  • tricuspid atresia
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207
Q

Treatment for glue ear

A

Grommets

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208
Q

What is an indication for an emergency surgical operation when it comes to an inguinal hernia?

A

hernia has become strangulated

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209
Q

Pathway for non-acute asthma control

A
  1. regular inhaled corticosteroid (beclomethasone) + short acting B2 agonist (salbutamol)
  2. oral leukotriene receptor antagonist (montelukast)
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210
Q

Description of a meningococcal septicaemia rash?

A

non-blanching, flat, purpuric rash

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211
Q

What is crptochidism?

A

undescended testes

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212
Q

mx of anaphylaxis

A

Intramuscular adrenaline

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213
Q

Signs of lithium toxicity

A

diarrhoea, vomiting
anorexia
muscle weakness
lethargy
dizziness
ataxia
coarse tremor
hyperreflexia

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214
Q

Mx of bipolar disorder

A

lithium 1st line
olanzapine
barbamazepine

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215
Q

What results on CSF would you see in bacterial meningitis?

A

cloudy, raised proteins, low glucose, presence of neutrophil polymorphs

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216
Q

diagnostic investigation for Necrotising enterocolitis and what would you see?

A

Abdominal xray

dilated bowel loops
pnumatosis intesinalis

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217
Q

Features of necrotising enterocolitis

A

first 3 weeks of life
vomiting - bile streaked
bloody stools
abdominal distension
absent bowel sounds

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218
Q

Features of William’s syndrome

A

Smiley
small stature
small or missing teeth

aortic/pulomonary stenosis

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219
Q

Features of Angelman syndrome

A

delayed development signs
ataxia
frequent laughing/smiling
easily excitable
hyperactive
short attention span

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220
Q

Most common metabolic abnormality you would see in pyloric stenosis

A

hypocholaemic metabolic alkalosis

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221
Q

Presentation of Kawasaki disease

A

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

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222
Q

Side effects of clozapine (atypical anti-psychotic)

A

agranulocytosis - reduced neutrophils
cardiomyopathy

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223
Q

side effects of risperidone (atypical anti-psychotic)

A

hyperprolactaemia

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224
Q

What are the 3 cluster A personality disorders

A

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

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225
Q

What are the 4 cluster B personality disorders?

A

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

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226
Q

What are the 3 cluster C personality disorders

A

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

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227
Q

What is delusion of guilt?/

A

belief self needs to be punished
common in severe depression

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228
Q

What is delusion of persecution?

A

paranoid
being followed or spied on
commonly seen in schizophrenia

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229
Q

grandiose delusion?

A

exaggerated beliefs one pts self and worth
think they are best

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230
Q

Delusion of thought posession?

A

thought insertion/withdrawal/ broadcasting
seen commonly in schizophrenia

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231
Q

What is cotards syndrome

A

believe you’re dead or decaying

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232
Q

side effects of typical anti-psychotics

A

parkinsonism

233
Q

1st line mx for EUPD

A

DBT

234
Q

What is treatment for opioid overdose

A

naloxone

235
Q

Whats tx for opioid dependence (not overdose)

A

detox - methodone
relieve withdrawal sx - lofexidine
prevent relapse - naltrexone

236
Q

Smoking cessation tx

A

stop - NRT (nicotine replacement therapy)
reduce craving - varenicline
reduce pleasure - bupropion

237
Q

tx for alcohol withdrawal?

A

PO chlordiazepoxide
+ IV thiamine (B1)

238
Q

symptoms of neuroleptic syndrome and what causes it

A

confused
hyperthermic
tachycardic
hypertension or hypo

adverse reaction to anti-psychotics

239
Q

symptoms of serotonin syndrome and what causes it

A

antidepressants SSRI/SNRI most common

hallucinations, confusion
tremor,
hyperreflexia
HTN
tachycardia
hyperthermia

240
Q

Presentation and treatment of acute dystonic reaction

A

from typical antipsychotics

contraction of eyes, neck, jaw

tx: procyclidine

241
Q

Presentation of Wernicke’s encephalopathy and treatment - DAHN

A

delerium,
ataxia
hypothermia
nystagmus

IV thiamine (pabrinex)

242
Q

symptoms and treatment for Korsakoff’s psychosis

A

irreversible short term memory loss, disorientation to time

tx: IV thiamine

243
Q

Presentation of delierium tremens

A

72hrs after alcohol withdrawal

cognitive impairment
hallucinations
tremor
fever
dehydration

244
Q

treatment for delerium tremens

A

IV thiamine and lorazepam

245
Q

What biochemical changes would you expect to see in someone with anorexia nervosa

A

hypercortisolaemia

246
Q

what is bipolar 1

A

episodes of depression and mainia or mixed states separated by periods of normal mood

247
Q

what is bipolar 2

A

don’t experience mania
may have hypomania, depression or mixed states

248
Q

1st line management for a manic episode

A

olanzapine or aripiprazole

249
Q

maintenance management of bipolar

A

lithium 1st line

250
Q

which class of antidepressant is CI in previous heart disease

A

tricyclic

251
Q

What are 1st rank symptoms in psychosis

A

thought alienation
passivity phenomena
3rd person auditory hallucinations
delusion perception

252
Q

What is used for maintenance management of alcohol withdrawal

A

naltrexone

253
Q

What is dissocial personality disorder

A

lack of remorse, easily angered, impulsivity, callous, tendency to blame others

254
Q

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?

A

prolactin - hyperprolactamia side effect of risperidone

255
Q

Treatment of refeeding syndrome

A

phosphate replacement

256
Q

What section can be used by the police to detain somebody for being violent in public due to a suspected mental disorder

A

136

257
Q

What is an Ekbom syndrome delusion?

A

pt believes infested by parasite
crawling sensation on skin
psychological or B12 deficiency

258
Q

What metabolic change will be seen in someone with purge-type bulimia?

A

hypokalaemia with metabolic alkalosis

259
Q

Acute management of migraines

A

NSAIDs
Sumitriptan

260
Q

Prophylactic management of migraines

A

Propanolol 1st line (CI in asthma)
topiramate
amitryptiline

261
Q

management of cluster headaches

A

acute: high flow oxygen
nasal triptan

prophylactic:
varepamil

262
Q

Presentation of cluster headaches

A

recurrent attacks
sudden unilateral periorbital pain
water eyes, nose, blood shot eye
pt may bang head to relieve pain

263
Q

What tumours are myasthenia gravis linked to?

A

thymomas - thyroid

264
Q

presentation of myasthenia gravis

A

weakness of limbs, facial muscle, eye lids
worse in evening/after activity better in morning/with rest

265
Q

Investigations for myasthenia gravis

A

bloods:
1st: serum acetylcholine receptor antibody
2nd: muscle-specific tyrosine kinase antibodies

CT chest/neck - tumours of thymus

266
Q

An elderly pt fell and hit their head, what should be an immediate differential regarding their head

A

subdural haemorrhage

267
Q

Presentation of sub-dural haemorrhage

A

sub acute
typically following trauma

headache
nausea/vomiting
confusion

268
Q

first line treatment for optic neuritis?

A

IV methylprednisolone

269
Q

features of cerebellar syndrome - DANISH

A

dysiadochokinesia
ataxia (broad based unsteady gait)
nystagmus
intention tremor
slurred speech
hypotonia

270
Q

What is horner’s syndrome and what is most common cause

A

interruption of sympathetic nervous supply to the eye
pancoast tumour

271
Q

Causes of encephalitis

A

herpes simplex virus 1

272
Q

What is difference between simple focal seizures and complex focal seizures

A

simple - no loss of consciousness, no post-ictal symptoms
complex - is both of above

273
Q

features of temporal - lobe specific focal seizure

A

lip smacking, sudden terror, hallucinations

274
Q

features of frontal-lobe specific focal seizure

A

motor features

275
Q

features of parietal lobe specific focal seizures

A

sensory symptoms

276
Q

treatment for absent seizures

A

sodium valporate or erthosuximide 1st line

AVOID CARBAMAZAPINE

277
Q

treatment for tonic clonic seizures

A

sodium valporate or lamotrigine

278
Q

treatment for myoclonic seizures (sudden jerk of a limb)

A

sodium valporate 1st line
(if woman child bearing age then- levetiracetam or topiramate)

AVOID CARBAMAZAPINE

279
Q

treatment for atonic seizures - sudden loss of muscle tone, pt fall whilst retaining conciousness

A

sodium valporate or lamotrigine

280
Q

treatment for status eplicticus

A

IV lorazepam/buccal midazolam
then phenytoin

281
Q

treatment for focal seizures

A

carbamazepine, gabapentin, phenytoin

282
Q

Presentation of giant cell arteritis/temporal arteritis

A

headache side of head
jaw claudication- pain while chewing
amaurosis fugax
scalp tenderness

283
Q

definitive investigation for giant cell arteritis

A

temporal artery biopsy

284
Q

treatment for giant cell arteritis

A

60mg OD prednisolone
high dose steroid

285
Q

Cause of cauda equina

A

lumbar disc herniation at L4/5 L5/s1

286
Q

presentation of Guillain-barre syndrome

A

ascending symmetrical limb weakness
few weeks after diarrhoea/infection

287
Q

management of guillain-barre syndrome

A

IV immunoglobulins
if doesnt work - plasma exchange

FVC needs to be monitored - high risk resp failure

288
Q

Causes of guillain barre syndrome

A

campylobacter jejuni infection

289
Q

management of TIA

A

300mg aspirin
review within 24hrs

290
Q

what are the 4 types of multiple sclerosis

A

relapsing-remitting
secondary progressive
primary progressive
progressive relapsing

291
Q

What is presentation of multiple sclerosis

A

ACUTE progressive weakness
brisk reflexes
patchy sensory disturbances
white matter plaques brain MRI
optic neuritis
oligoclonal bands CSF
periventricular plaques

292
Q

management of acute attack multiple sclerosis

A

IV methylprednisolone
- doesnt work - plasma exchange

293
Q

chronic management of multiple sclerosis

A

injectable beta interferon

294
Q

Presentation of normal pressure hydrocephalus

A

urinary incontinence
dementia
gait abnormality

295
Q

How would you de-escalate an elderly man who is having hallucinations and trying to hit you with a magazine

A

stepwise approach
de-esculation techniques first
PO lorezapam
IV lorezapam

296
Q

Features of Lewy-body dementia

A

fluctuating cognition
parkinsonism
visual hallucinations

297
Q

What is side effect of Ropinirole used for parkinson’s disease

A

dopamine agonist

impulsivity
gambling, hypersexuality

298
Q

Which antibiotic reduces the seizure threshold?

A

ciprofloxacin

299
Q

management for mild-moderate alzheimer’s

A

1st line - donepezil

2nd line- memantine

300
Q

what medications can be used to raise BP

A

fludrocortisone

301
Q

Presentation of Alzheimer’s disease

A

short term memory loss (progressive + persistent)
global cognitive impairment
irritable, mood swings, apathy

302
Q

management for lewy body dementia

A

levodopa

303
Q

symptoms of fronto-temporal dementia

A

impulsive
irritable
crying
overweight
akinesia
hallucinations

304
Q

Presentation of vascular dementia

A

sudden onset
stepwise deterioration
motor disorders
behavioural changes
cognitive impairment

305
Q

What is the ratio change from oral morphine to subcutaneous morphine

A

2:1

so if oral 300mg
would be 150mg subcutaneous

306
Q

what pain relief medication can be used in patients on dialysis

A

tramadol or oxycodone

307
Q

How do you treat paracetamol overdose above 4 hrs?

A

acetylcysteine

308
Q

Presentation of Parkison’s disease

A

tremor
bradykinesia
rigidity (lead pipe, cogwheel)

309
Q

management of parkison’s

A

L-dopa

310
Q

What scoring tool is used to calculate risk of developing a stroke in next few days in a pt with TIA

A

ABCD2

311
Q

What scoring tools is used to asses someone’s risk of stroke with AF?

A

CHADS-Vasc

312
Q

presentation of hypercalcaemia - bones, stones, groans and moans

A

bones, stones, groans and moans

bone pain
renal stones
poor concentration
GI discomfort

313
Q

What are the features of the mental capacity act?

A

assume capacity
maximise decision making
freedom to make seemingly unwise decisions
best interests
least restrictive options

314
Q

What is section 2 and 3 of the MHA used for?

A

section 2 - 28days, not renewable. Detain someone with mental disorder

section 3: similar but for treatment, for 6 months, can be renewed

315
Q

What is section 4 of the MHA used for?

A

72hr assessment order
used in emergencies

316
Q

What is section 5 of the MHA used for?

A

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

317
Q

What is section 135 MHA used for

A

allow police to break into a property to remove a person to a place of safety - court order

318
Q

What is section 136 of the MHA used for

A

someone found in public place, expected to have a mental disorder can be taken by police to place of safety

319
Q

Presentation of Huntington’s disease

A

dominant inheritance (family hx)
choeroathetosis
dementia

320
Q

What are the 3 main categories of behaviours related to health

A

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)

321
Q

What is unrealistic optimism in public health

A

people continue health damaging behaviours due to inaccurate perceptions of risk

322
Q

What is health belief model - Becker 1974

A

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

323
Q

What is theory of planned behaviour - Ajzen 1988

A

best predictor of behaviour is intention
person’s attitude
social pressure/social norm

324
Q

Transtheoretical model of health behaviour steps

A

precontemplation
contemplation
preparation
action
maintenance

325
Q

What is sensitivity mean in public health

A

proportion of those with disease who are correctly identified by screening test

326
Q

What is felt need in the sociological perspective in the health needs model

A

individual perceptions of variation from normal health

327
Q

What is expressed need in the sociological perspective in the health needs model

A

individual seeks help to overcome variation in normal health (demand)

328
Q

What is normative need in the sociological perspective in the health needs model

A

professional defines intervention appropriate for the expressed need

329
Q

What is comparative need in the sociological perspective in the health needs model

A

comparison between severity, range of interventions and cost

330
Q

What are the 3 approaches in the health needs assessment

A

epidemiological
comparative
corporate

331
Q

What type of reaction is anaphylaxis?

A

IgE type 1 hypersensitivity reaction

332
Q

management for anaphylaxis

A

remove trigger
ABCDE
O2
Adrenaline IM (adult 500mg)
chlorophenamine & hydrocortisone
IV fluids

333
Q

Mechanism of action of donepezil and rivastigmine

A

acetylcholinesterase inhibitor

334
Q

What is the mechanism of action of memantine? (used for severe alzheimer’s)

A

Glutamate receptor antagonist

335
Q

Which form of dementia is seen frequently in motor neurone disease?

A

fronto-temporal dementia

336
Q

Sedation is most strongly associated with which type of antipsychotic, typical or atypical?

A

typical

337
Q

What is pernicious anaemia

A

caused by lack of B12 vitamin

338
Q

Haematological features of pernicious anaemia

A

low hB, high MCV, normal MCHC

339
Q

management of pernicious anaemia

A

life long replacement with cobalamin

340
Q

Presentation of pernicious anaemia

A

lethargy
fatigue
chronic condition
red beefy tongue
ulcers in mouth

341
Q

Which type of anaemia is anaemia of chronic disease?

A

normocytic type

342
Q

Features of alpha thalassaemia

A

jaundice
fatigue
facial bone deformities

343
Q

Presentation of beta thalassaemia minor

A

mild anaemia
isolated microcytosis
pt usually aysmptomatic

344
Q

Presentation of beta thalassaemia major

A

severe symptomatic anaemia (3-9 months old)
frontal bossing
maxillary overgrowth

345
Q

Presentation of haemorrhoids

A

bright red PR bleed associated with defecation
no pain
itching

346
Q

Presentation of GORD

A

dyspepsia
sensation of acid
regurgitation of food

347
Q

RED FLAGS for GORD like symptoms

A

weight loss
anaemia
dysphagia
haematemesis

348
Q

What are the stages of chronic kidney disease (CKD)

A

1: eGFR >90
2. eGFR 60-89
3. eGFR 30-59
4. eGFR 15-30
5. eGFR<15

349
Q

Presentation of COPD

A

chronic productive cough
purulent sputum production
hypoxia
hypercapnia
exertional dyspnoea
cyanosis
peripheral oedema
wheeze

350
Q

Stages of spirometry for COPD

A
  1. FEV1>80%
  2. FEV1 50-79%
  3. FEV1 30-49%
  4. FEV1 <30%
351
Q

management of acute COPD

A

O2 88-92%
nebulised salbutamol, ipratropium
steroids: oral prednisolone
IV hydrocortisone (if severe)

352
Q

Management of COPD (chronic management)

A
  1. SABA/ SAMA
  2. LABA and LAMA
  3. LAMA and LABA and ICS (steroids)
  4. specialist referral
353
Q

Management of cellulitis

A

blood tests and culture
skin swab
oral or IV abx (fluxocilin)

354
Q

Osteoarthritis vs rheumatoid arthritis

A

OA - worse with movement, and end of day. Morning stiffness under 20 mins

RA - improves with movement, morning stiffness >30

355
Q

What are the xray features of osteoarthritis - LOSS

A

Loss of joint space
osteophytes
subchondral cysts
subarticular sclerosis

356
Q

Causes of folliclitis

A

staphylococcus aureus

gram negative

357
Q

Presentation of hypothyroidism

A

dry, thick skin, brittle hair
puffy face
loss of lateral third eyebrow
goitre
bradycardia
cardiomegaly

358
Q

Auto immune cause of hypothyroidism

A

hashimoto’s

359
Q

management of hypothyroidism

A

levothyroxine

360
Q

Most common cause of hypothyroidism

A

idoine deficiency

361
Q

Cause of trichomoniasis infection

A

trichomonas vaginalis

362
Q

Presentation of trichomoniasis infection

A

women: yellow, frothy discharge, vulval irritation
strawberry cervix

363
Q

management of trichomoniasis infection

A

oral metronidazole

364
Q

Causes of chlamydia

A

chlamydia trachomatis

365
Q

Presentation of chlamydia

A

discharge, dysuria, intermenstrual bleeding

366
Q

Management for chlamydia

A

oral doxycycline

367
Q

Presentation of bacterial vaginosis

A

increased vaginal discharge
fishy smell

368
Q

management of bacterial vaginosis

A

metronidazole or clindamycin

369
Q

Presentation of vaginal thrush

A

itchy, cottage cheese discharge
itching
redness

370
Q

management for genital thrush

A

fluconazole

topical clotrimazole cream for itch relief

371
Q

Cause of genital herpes

A

herpes simplex virus 1

372
Q

causes of gonorrhoea

A

neiseeria gonorrhoea

gram negative diplococcus

373
Q

Presentation of gonorrhoea

A

discharge, dysuria, abnormal bleeding

374
Q

management of gonorrhoea

A

ceftriaxone

375
Q

What is ‘error of overthinking’

A

when a working diagnosis is handed over and accepted without pause for consideration and determination whether its been substantially proven

376
Q

What is error of overattachment

A

conducting tests to confirm what we expect or want to see and not ruling out other causes

377
Q

What is error of bravado

A

typically working above competence in a show of over confidence

378
Q

what is error of ignorance

A

unconscious imcompetence

379
Q

What is QRISK used for

A

work out risk of developing heart attack or stroke in next 10 years

380
Q

Cause of shingles and management

A

varicellar zoster virus

oral aciclovir

381
Q

What is 1st line investigation with suspected ischaemic stroke?

A

CT head

382
Q

What is neologism

A

making up of new words that only the patient understands

383
Q

What is genetic cause Edward’s syndrome

A

Trisomy 18

384
Q

What is genetic cause of Turner’s syndrome

A

45XO

385
Q

What is genetic cause of Patau’s syndrome

A

Trisomy 13

386
Q

What is genetic cause of sickle cell anaemia

A

single mutation on chromosome 11

387
Q

Cause of Scarlet fever

A

streptococcus pyogenes

388
Q

managment of croup

A

oral dexomethasone

if not responding: O2 + nebulised adrenaline

389
Q

what are the 4 key drives for failure to thrive

A

inadequate intake
inadequate retention (vomiting)
malabsorption (coeliac)
increased requirements (congenital heart disease, malignancy)

390
Q

best SNRI 1st line for someone with depression and insomnia

A

mirtazapine

391
Q

What is contraindication for ECT (electroconvulsive therapy)

A

increased intracranial pressure

392
Q

Which scoring system is used for post natal depression

A

Edniburgh scale

393
Q

what is 1st line management for delerium (medically)

A

0.5mg PO haloperidol

394
Q

When is the copper iud CI

A

chylamdia and pregnancy

395
Q

What inheritance type is Marfan’s syndrome and what is the risk of it

A

autosomal dominant

aortic dissection/rupture

396
Q

1st line SURGICAL management of post partum haemorrhage

A

intrauterine balloon tamponade

397
Q

Which SNRI does not cause drug reaction with methylphenimate

A

venlafaxine

398
Q

What is abx used in preterm rupture of membranes

A

oral eyrthromycin

399
Q

When is IV penicillin used intrapartum?

A

mother’s with previous strep B

used in labour

400
Q

Is hypertension a risk factor for endometriosis?

A

no

401
Q

What is antenatal screening NOT used for

A

cytomegalovirus

402
Q

What investigation should be 1st line after raised Ca125 for ovarian cancer

A

US abdomen pelvis

403
Q

What is the antenatal combined screening for down syndrome compromised of

A

nuchal translucency measurement, serum beta hCG, PAPP-A

404
Q

Pt has symptoms of STI, before swab results come back, what can be given to treat infection?

A

azichromycin 1g

treats both gonorrhoea and chlamydia

405
Q

vaginal ph 5, indicative of what?

A

bacterial vaginosis

406
Q

What information should be given to a pt regarding depo injections

A

fertility can take up to a year to return to normal

407
Q

cauda equina managment?

A

1st line medical - dexamethasone 16mg

1st line definitive surgical decompression

408
Q

‘down and out’ eye symptoms, which cranial nerve affected

A

CNIII

409
Q

Symptoms of Brown-sequard syndrome

A

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)

410
Q

Symptoms of benign essential tremor and management

A

tremor that is worse on stretching but better on rest
usually better with alcohol
management propanlol (CI in asthma)

411
Q

what should be co-prescribed with NSAID

A

PPI e.g omeprazole

412
Q

chest xray, cyanotic heart disease, ‘boot shaped heart’ (upturned apex)

A

tetraology of fallot

413
Q

which tumour causes hyperprolactinaemia

A

pituitary

414
Q

gout management

A

1st line: allopurinol
2nd: febuxostat

415
Q

1st line treatment for biliary colic (gall stones)

A

laproscopy cholecystectomy

416
Q

What is a complication of acute prostatitis

A

urinary retention

417
Q

presentation of acute prostatitis

A

diminishing urinary stream, dysuria, and urinary frequency
tender, boggy, and slightly enlarged prostate
fever

418
Q

what is the most common cause of infective exacerbation of COPD

A

moraxella cararrhalis
haemophilius influenza
streptococcus penumoniae

419
Q

What pattern in LFTs would defend your diagnosis of alcoholic liver disease?

A

↑AST +↑ALT with an AST/ALT ratio of 2:1

420
Q

What information should be given about taking alendroic acid for osteoporosis

A

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)

421
Q

Cause of croup

A

parainfluenza virus

422
Q

What is contraindicated in treatment of chickenpox in children

A

ibuprofen

423
Q

management of whooping cough

A

erythromycin

424
Q

symptoms of orbital cellulitis

A

unilateral
reduced visual acuity
eyelids red and swollen
hurts when move

425
Q

when is the MMR vaccine given in children

A

1st dose - 1 year
2nd dose - 3yrs 4 months

426
Q

Which infection causes this presentation on a nipe:
microcephaly, sensorineural deafness, cataracts

A

rubella

427
Q

management for stress incontinence

A

pelvic floor exercises
duloxetine

428
Q

management of urge incontinence

A

lifestyle mx
pelvic floor
oxybutynin, tolterodine, fesoterodine, solifenacin

429
Q

Management of motor neuron disease

A

riluzole

430
Q

Upper signs of motor neuron disease

A

spasticity
hyperreflexia
downwards plantars

431
Q

Lower signs of motor nueron disease

A

fasiculations
later - atrophy

432
Q

What genetic repeat is cause of Huntington’s

A

CAG trinucleotide

433
Q

Exam presentation of Huntington’s

A

uncontrollable, purposeless + fitting movements (laughing)
family history

MRI&CT: increased size frontal horns, lateral ventricles

434
Q

dx and mx of Hirchsprung’s disease

A

rectal bowel biopsy- absence of ganglionic cells

mx: definitive: surgical removal of aganglionic bowel segment

435
Q

What effect does metaclopramide (anti-emetic) have on Parkinsons

A

counteracts parkinson’s medication
pts symptoms parkinson’s may seem worse

436
Q

what is circumstantiality (talking symptom)

A

irrelevant wandering in conversation/going around the point

437
Q

What is tangentiality in conversation?

A

speak about topics unrelated to the question/topic at hand
don’t circle back to answer question

438
Q

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

A
  1. Ace-i (-pril’ rampiril) OR ARB ( -artan e.g candesartan)
  2. ACEi or ARB + CCB (-‘pine’ e.g amlodipine) OR thiazide-like diuretic (-‘ide’ e.g furesomide)
  3. ACEi OR ARB + CCB + diuretic
  4. specialist
439
Q

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

A
  1. CCB (-‘pine’ e.g amlodipine)
  2. CCB + ACEi (‘pril e.g ramipril) Or ARB (-artan e.g candesartan) OR diuretic (-‘ide’ e.g furesomide)
  3. ACEi OR ARB + CCB + diuretic
  4. specialist
440
Q

Presentation of otitis media

A

common in children
bulging and erythamatous tympanic membrane
no discharge (usually)

441
Q

How to check for agranulocytosis in pt on clozapine

A

FBC - check WBC / neutrophil count

442
Q

How to work out units of alcohol

A

units = Vol (L) x % ABV

443
Q

Presentation of vasa pravea

A

painless vaginal bleeding
rupture of membranes
foetal bradycardia

444
Q

What can be caused by lithium treatment in a pt with bipolar disorder

A

hypothyroidism

445
Q

Common blood gas presentation of pyloric stenosis in neonate

A

metabolic alkalosis with partial compensation

low K and cl

446
Q

What course of abx required in man with UTI pt allergic to penicillin

A

nitrofurantoin for 7 days (men need 7 day course)

447
Q

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

A

5mg folic acid until 12 weeks (instead of 400mcg)

448
Q

What scoring system is used for pts at risk of developing pressure ulcers

A

Waterlow

449
Q

1st line medical management for idiopathic intracranial hypertension

A

acetazolamide

1st line conservative - weight loss

450
Q

Presentation for idiopathic intracranial hypertension

A

non-pulsatile
bilateral
worse in morning, after lying down or bending forward
blurred vision
common in obese

451
Q

Presentation of threatened miscarriage

A

painless PV bleeding
closed os
viable pregnancy

452
Q

What is 1st line control of AF

A

bisoprolol

or rate-limiting CCB

453
Q

Features of Maxwell’s Dimensions of quality - 3A’s, 2E’s

A

acceptability
accessibility
appropriateness
effectiveness
equity

454
Q

Example of secondary prevention

A

breast cancer screening

455
Q

pt is >65 and on long term steroids, what other medication should she be started on?

A

alendronic acid

456
Q

management of a vasospasm

A

nimodipine 21d course

457
Q

Features of Bradford-Hill criteria

A

Biological plausibility
consistency of results
dose-response
strength of association

458
Q

What is reverse causality

A

don’t know association between exposure and outcome

459
Q

managment of absence sezirues

A

sodium valporate or ethosuximide

460
Q

Signs of duct ectasia

A

green nipple discharge

461
Q

Is tremor in parkinson’s symmetrical or asymmetrical

A

asymmetrical

462
Q

what is rhabdomyolysis

A

dark urine following long lie

463
Q

Test for suspected coeliac

A

anti-tissue transglutaminase levels (Anti-TT)

464
Q

test for intussusception

A

abdominal uss - target sign

465
Q

Diagnosis of NEC

A

abdominal xray

466
Q

How long after a traumatic event can PTSD be diagnosed

A

4 weeks

before 4 weeks = acute stress reaction

467
Q

if systemically well , what is 1st line for impetigo

A

hydrogen peroxide 1% cream

468
Q

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

A

give varicella-zoster immunoglobulin ASAP as <20 weeks

469
Q

management of croup

A

dexamethasone

470
Q

Child with menigococcal septicaemia, what is management

A

IV ceftriaxone and dexamethasone if over 3 months,
if under 3 months IV cefotixime + amoxicillin

471
Q

Presentation of Edward’s syndrome

A

overlapping fingers
rocker-bottom feet

472
Q

Presentation of extradural haematoma

A

trauma to head
initial loss of consciousness but recovered
but then sudden deterioration

473
Q

Pregnant lady has obs cholestasis, what is plans for delivery

A

induction of labour 37-38 weeks

474
Q

When can you xray a baby?

A

over 3 months age

475
Q

Features of tetrology of fallot (cyanotic)

A

overriding aorta
pulmonary stenosis
right ventricular hypertrophy
ventricular septal defect

476
Q

Management of acute dystonic reaction

A

IV procyclidine

477
Q

Presentation of gonadal dysgenesis

A

high FSH
high LH
primary amenorrhoea

478
Q

1st line mx for focal seizures

A

carbamazepine

479
Q

presentation of hypothyroidism

A

HIGH TSH
LOW free T3/4
ANTI- TPO antibodies

cause? Hashimoto’s

480
Q

Presentation of ovarian hyperstimulation syndrome

A

ascites
vomiting
diarrhoea
high haematocrit

associated with gonadotrophin therapy

481
Q

Managment of neonatal hypoglycaemia

A

if asymptomatic encourage feeding & monitor blood glucose

if symptomatic: admit to neonatal unit, Iv infusion of 10% dextrose

482
Q

Features of anorexia nervosa

A

lanugo hair
delayed / absent puberty

bradycardia
hypotension
hypokalaemia
hypercholesterolaemia
hypercarotinaemia
low T3

483
Q

Triad of shaken baby syndrome

A

subdural haematoma
retinal haemorrhages
encephalopathy

484
Q

Most common presentation of neonatal sepsis

A

respiratory distress; grunting

485
Q

Most common cause of neonatal sepsis

A

GBS: group B strept in mum

486
Q

metabolic signs of pyloric stenosis

A

hypocholraemia
hypokalaemia
alkalosis

487
Q

Presentation of slipped capital femoral epiphysis

A

loss of internal rotation of leg in flexion
more common in adolescents
groin pain radiating to thigh and knee

488
Q

Differences between schizoid and schizotypical personality disorder

A

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

489
Q

Characteristics of an innocent murmur

A

soft blowing pulmonary area
short buzzing aortic area
no diastolic component
no thrill or added sounds
asymptomatic child

490
Q

Presentation of transposition of the great arteries

A

cyanosis
tachypnoea
loud single S2
right ventricular impulse
‘egg on side’ appearance chest xray

491
Q

management of transposition of the great arteries

A

1st: prostaglandins

definitive: surgery

492
Q

medical treatments for post-partum haemorrhage

A

IV oxytocin, ergometrine, carboprost (CI asthma), misoprostol

493
Q

most common cause of post menopausal bleeding

A

vaginal atrophy

494
Q

Difference between onset of cyanotic heart disease

A

Transposition of great arteries - 1st few days of life
tetralogy of fallot - 1-2 months of life

495
Q

Feeding intolerance, bloody stools, abdominal distension. Which is diagnostic investigation?

A

Necrotising enterocolitis

abdominal xray - pneumoatosis intestinalis

496
Q

Features of cow’s milk protein allergy

A

regurgitation and vomiting
diarrhoea
eczema
colic sx: irritability and crying

497
Q

A pregnant lady infected with cytomegalovirus for the first time, what is risk to foetus

A

hearing loss
visual impairment
learning difficulty

498
Q

What maternal conditions can result in congenital heart disease

A

Type 1 and 2 diabetes
Rubella infection
thalidomide, isotretinoin, lithium
alcohol

499
Q

What is immaging likely to show in normal pressure hydrocephalus

A

ventriculomegaly in the absence of sulcal enlargment

500
Q

What initial management should be done in a person with suspected dementia

A

FBC, U&Es, LFTs, ESR.CRP. vit B12, TFTs
- look for reversible organic causes

501
Q

Which class of antidepressants may cause urinary retention

A

tricyclic

502
Q

What would results be on a quadruple test for a positive down syndrome

A

decreased AFP
Decreased oestriol
increased hCG
increased inhibin A

503
Q

1st line management for cow’s milk protein allergy in neonates

A

extensively hydrolysed formula

504
Q

features of an atypical UTI in children

A

seriously ill
poor urine flow
abdo or bladder mass
raised creatinine
septicaemia
infection of non e coli

505
Q

Presentation of henoch schonlein puroura

A

purpura/ petechiae on butt or lower limbs
abdo pain
arthralgia
preceded by viral upper resp infection

506
Q

management of henoch schonlein purpura

A

NSAIDs
anti hypertensives
regular urine dips 12 months after

507
Q

Presentation of Wernicke’s encephalopathy - triad

A

ataxia
confusion
ocular abnormalities ; nystagmus

508
Q

What is Wernicke’s encephalopathy due from

A

thiamine (B1 ) deficiency

tx: IV pabrinex

509
Q

What is ‘flight of ideas’

A

stream accelerated thoughts
jumps randomly from topic to topic
no clear direction

510
Q

What is ‘word salad’

A

pt uses words nonsenically e.g “purple monkey dishwasher? Thursday!”

511
Q

What is ‘logoclonia’

A

pt repeats last syllable of a word or phrase

512
Q

what is ‘derailment’

A

speech consists of series of unrelated or remotely related ideas

513
Q

What is ‘knight’s move thinking’

A

illogical leaps between unconnected ideas
loosening of association

514
Q

what term is used to describe when a patient is fascinated with repetitive mechanical tasks or with the ordering of objects

A

Punding

515
Q

Presentation and management of candidiasis (thrush)

A

itching, white curdy discharge, sour milk odour, superficial dyspareunia
o/e: redness, thick white discharge

mx: fluconazole

516
Q

Presentation and management of bacterial vaginosis

A

fish odour, pH >4.5, grey discharge

mx: metronidazole or clindamycin
metronidazole in pregnancy

517
Q

Presentation and management of trichomoniasis

A

frothy yellow discharge, vulva irritation
strawberry cervix

mx: metronidazole

518
Q

Presentation and management of chlamydia

A

discharge, dysurina, inter menstrual bleeding

mx: doxycycline (or azithromycin)

519
Q

Presentation and management of gonorrhoea

A

discharge, dysuria, tender inguinal nodes, abnormal bleeding

mx: ceftriaxone and Azithromycin

520
Q

Primary amenorrhoea (inability to establish menstruation by 15), no axillary or pubic hair, elevated testosterone. What is most likely dx?

A

androgen insensitivity syndrome

X linked recessive

521
Q

what is usually 1st line in ectopic pregnancy

A

salpinectomy

522
Q

What are the risk factors for the different female cancers (endometrial, cervical, breast. ovarian)

A

Endometrial: PCOS
Cervical: COCP, early 1st intercourse
breast: COCP, BRCA2

523
Q

defective downward gaze and vertical diplopia may indicate a lesion in which cranial nerve?

A

CN IV

524
Q

What is 1st line mx of acute sezirues

A

Benzodiazepine (chlordiazepoxide, loreazepam))

525
Q

Bicuspid aortic valve associated with which genetic condition

A

Turner’s syndrome

526
Q

a woman suddenly falls to the ground then lays motionless. Which type of seizure does this sound like? & mx of this type of seizure

A

atonic seizure
mx: Sodium Valproate or Lamotrigine is first-line.

527
Q

Transient unilateral loss of vision described as a ‘curtain descending’ is typically caused by a lesion affecting the:

A

ophthalmic artery

typical for TIA

528
Q

Which drugs could reduce seizure threshold

A

antipsychotics
ciprofloxacin

529
Q

Strawberry tongue - characteristic of which paeds disease? (scarlet fever, roseola infantum, slapped cheek syndrome or measels)

A

Scarlet fever

530
Q

what kind of rash appears in roseola infantum and when does it appear

A

48hrs after fever
maculopapular rash

531
Q

Presentation of trigeminal euralgia

A

electric shock (trigeminal nerve regions)
light touch, eating may trigger pain

532
Q

1st line management for trigeminal neuralgia

A

carbamazepine

533
Q

Contralateral hemiparesis and sensory loss with the lower extremity being more affected than the upper is typically caused by a lesion affecting the:

A

anterior cerebral artery

534
Q

Contralateral homonymous hemianopia with macular sparing and visual agnosia is typically caused by a lesion affecting the:

A

posterior cerebral artery

535
Q

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:

A

rubella

536
Q

Acyanotic congenital heart disease

A

coarction of aorta
ventricular septal defect
aortic valve stenosis
atrial septal defect

537
Q

Which drugs can cause ataxia

A

carbamazepine
phenytoin
sodium valproate

(think epilepsy meds)

538
Q

Which drugs can cause nephrotoxicity

A

lithium
aminoglycosides
ciclosporins
amphotericin b

539
Q

When is BCG (vaccine against TB) offered to babies up to 1 year recommended?

A
  • born in ares of uk with high rates TB
  • have parent or grandparent who was born in country with high rates TB
540
Q

Presentation of Wilm’s tumour

A

abdominal mass doesn’t cross midline
haematuria
hypertension
abdominal distension

541
Q

Presentation of transient synovitis

A

3-8yrs old

acute hip pain
associated with viral infection
pain, reluctant to weight bear
still normal range of movement

542
Q

Presentation of Perthes’ disease

A

4-8yrs
chronic degenerative - avascular necrosis femoral head

hip pain that progressive over weeks
limp
stiffness, reduced ROM

dx: xray

543
Q

What investigations should be done in infants younger than 3 months presenting with a fever

A

FBC
Blood culture
C-reactive protein (CRP )
Urine test
chest imaging only if resp sx
stool culture if diarrhoea present

544
Q

What is a risk associated with zopiclone use in the elderly

A

increased risk of falls

545
Q

A woman struggling with depression, low appetite and sleep problems. Best drug to prescribe

A

mirtazapine - helps insomnia and increases appetite

546
Q

1st line management in acute stress reaction

A

CBT

547
Q

Advise about SSRIs in pregnancy

A

avoided unless the benefits outweigh the risk, can lead to increased risk of congenital malformations (esp paroxetine)

548
Q

What are elderly pts at an increased risk of when they take atypical antipsychotics (clozapine, risperidone, olanzapine)

A

increased risk of stroke and VTE

549
Q

When is vaginal delivery recommended in a woman with HIV

A

if viral load is less then 50 at 36weeks

550
Q

What antibiotic is given to women with pre-term rupture of membranes

A

10 days erythromycin

551
Q

When is the down syndrome screening done during pregnancy

A

11-13+6 weekss

552
Q

Which form of HRT (treatment for menopause) pose lowest risk of VTE

A

transdermal HRT

553
Q

treatment for moderate/severe tardive dyskinesia (common from long term antipyschotic use)

A

tetrabenazine

554
Q

What is akathisia

A

sense of inner restlessness and inability to keep still

can be sx from long term antipsychotic use

555
Q

which type of urinary incontinence is associated with amitriptyline

A

overflow incontinence

556
Q

What does SNRI stand for/ mechanism of action

A

serotonin and noradrenalin reuptake inhibitor

557
Q

features of Bradford Hill criteria (causality) - 9

A

strength of association
consistency of results
dose response
temporality
plausibility
reversibility
coherence
analogy
specificity

558
Q

Disadvantages of screening - 3

A

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

559
Q

definition of specificity

A

proportion of people without the disease who are correctly excluded by the screening test

560
Q

definition of positive predictive value

A

proportion of people with a positive test result who actually have the disease

561
Q

Definition of negative predictive value

A

proportion of people with a negative test result who do not have the disease

562
Q

What is lead time bias

A

screening identifies outcome earlier that it would apparent increase in survival time even if screening had no effect on this outcome

563
Q

what is length time bias

A

results from differences in the length of time taken for a condition to progress to severe effects that may affect efficacy of screening methods

564
Q

what should be initiated immediately in cases of suspected encephalitis

A

aciclovir

565
Q

What is 1st line drug management for ocular myasthenia gravis

A

pyridostigmine

566
Q

chronic progressive weakness in legs, tednency to tripover,. fasciculations, reduced power bilaterally. hyperreflexia and upgoing plantars. What it diagnosis?

A

motor neuron disease - ALS

567
Q

7month history of fatigable weakness, double vision, worsens throughtout the day, improves on rest. What is likely dx?>

A

myasthenia gravis - fatiguable weakness better with rest

568
Q

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?

A

myasthenia gravis

569
Q

What medications worsen myasthenia gravis symptoms

A

beta blockers
lithium
antimalarias

570
Q

What type of drug is pyridostigmine (for myasthenia gravis)

A

cholinesterase inhibitor

571
Q

What is a poor prognostic for schizophrenia

A

gradual onset

572
Q

What is uterus atony

A

failure of adequate contractions

573
Q

Features of acute fatty liver of pregnancy

A

abdo pain
nasuea+vomiting
jaundice
ALT elevated

574
Q

Features of acute fatty liver of pregnancy

A

abdo pain
nasuea+vomiting
jaundice
ALT elevated

575
Q

Features of HELLP

A

haemolysis
elevated liver enzymes
low platelets

576
Q

if woman has 2 cervical smears both resulting in HPV +, cytology normal, what is next step

A

colposcopy

577
Q

Presentation of vasa praevia

A

rupture of membranes followed by immediate vaginal bleeding
fetal bradycardia

578
Q

What Hb in pregnancy is cut off for treatment with supplements

A

haemoglbuin less than 110

Clinical (12 decks)

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