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Phase 3a > NIBBLY BITS > Flashcards

NIBBLY BITS Flashcards

1
Q
A
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2
Q

what is 6CIT

A

a brief cognitive function test which takes less than five minutes and is widely used in primary care settings

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3
Q

what is the treatment of EPSEs

A
  • ESPEs are thought to be due to relatively increased cholinergic transmission so anticholinergics are used
    • procyclidine
  • this works for all but tardive dyskinesia for which tetrabenazine is needed
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4
Q

what is the first line treatment for viral induced wheeze if the child is pretty well

A

salbutamol inhaler given via spacer

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5
Q

summarise childhood limp in ages 1-3, 3-10 and 11-16 differentiating between acute & painful and chronc & intermittent

A
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6
Q

12w vaccines

A

6 in 1 (DTaP, IPV, Hib, Hep B), PCV, Rotavirus.

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7
Q

1y vaccine

A

Hib/Men C, PCV booster, MMR, Men B booster

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8
Q

what is the following PD, what cluster does it belong to?

pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent

A

paranoid

belongs to cluster A (odd or eccentric disorders)

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9
Q

investigations for biliary atresia

A

UCC - double bubble scan

liver histology confirms diagnosis

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10
Q

what is the following PD and what cluster does it belong to?

attention seeking behaviour and excessive emotions

A

histrionic

cluster B (dramatic, emotional or erratic disorders

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11
Q

how do benzos work

A

they facilitate and enhance the binding of GABA to the GABA receptors

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12
Q

what is the threshold for diagnosis of polyhydramnios

A

Polyhydramnios is usually diagnosed at an AFI of >24cm (or 2000ml+). Oligohydramnios is usually diagnosed with an AFI of <5cm (or under 200ml).

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13
Q

typical causes of horners in an exam

A

Pancoast (apical) tumour which is compressing the sympathetic chain. There are other causes of Horner’s syndrome, including central causes like MS or brain tumours, and other things can press on the sympathetic chain such as a large goitre.

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14
Q

3y 4m vaccine

A

DTap/IPV, MMR.

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15
Q

what is flumazenil for

A

reverses benzo overdose

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16
Q

what is the cut off for macrosomia

A

>4.5kg

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17
Q

What are SNRI side effects

A

serotonin syndrome

sexual dysfunction

suicidality

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18
Q

what’s the tremor like in lithium toxicity

A

course

fine tremor is often recorded within therapeutic range so is considered side effect of normal treatment

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19
Q

what is the virus that causes hand foot and mouth

A

coxsackie

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20
Q

what is the following PD and what cluster does it belong to?

grandiosity, need for admiration and a perceived lack of empathy

A

narcissistic

cluster B (dramatic, emotional or erratic disorders)

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21
Q

features of congenital syphilis

A

generalised lymphadenopathy

hepatosplenomegaly

rash

skeletal malformations

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22
Q

what is the management of asymptomatic bacteriuria in pregnant women

A

Asymptomatic bacteriuria in a pregnant woman requires treatment due to risk of pyelonephritis, and association with premature labour and ROM. However contamination of a first culture is possible and so a second test should be performed to confirm.

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23
Q

12-13y vaccine

A

HPV

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24
Q

what is the prophylactic treatment for migrains

A

topirimate or propanolol

propanolol is preferred in female patients of childbearing age as topirimate is teratogenic and can cause hormonal contraceptives to be ineffective

topirimate preferred in asthma

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25
Q

what are the only class of abx that are safe at every stage of pregnancy

A

cephalosporins

e.g. cefotaxime, ceftriaxone, cefuroxime

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26
Q

treatment for normal pressure hydrocephalus

A

LP/lumbar drainage

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27
Q

what is the following PD and what cluster does it belong to?

a pervasice psychological need to be cared for by other people

A

dependent

cluster c (anxious or fearful disorders)

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28
Q

what are made acts, feelings and drives?

A

the experience being carried out by the patient is considered as alien/imposed

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29
Q

what type of drug is venlafaxine

A

SNRI

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30
Q

what is the following PD and what cluster does it belong to?

disregard for the rights of others, lack of empathy, incresed self-image, manipulative and impulsive behaviour

A

dissocial

cluster B (dramatic, emotional or erratic disorders)

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31
Q

what type of drug is paroxetine

A

SSRI

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32
Q

what is first and second line intervention for anxiety

A

talking therapies

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33
Q

common side effects of antipsychotic drugs

A
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34
Q

management of nephrotic syndrome

A

prednisolone

penicillin prophylaxis

pneumococcal vaccination

consider albumin infusion

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35
Q

causes of neonatal hepatitis syndrome

A

idiopathic

congenital infection

CF

alpha anti-trypsin deficienct

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36
Q

what types of drugs can cause a manic switch in depression

A

TCAs like amitryptyline

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37
Q

what are the COPD steps of management

A
  • Step 1: SABA or SAMA
    • if no asthmatic features or features suggesting steroid responsiveness
      • Step 2: Add LABA + LAMA
      • Step 3: LABA + LAMA + ICS
    • if they have asthmatic features or features suggesting steroid responsiveness
      • Step 2: LABA + ICS
      • Step 3: LABA +LAMA + ICS
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38
Q

alzheimers meds

A

donepezil

memantine

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39
Q

what are the kocher criteria for and what do they include

A

septic arthritis

fever >38.5

non weight bearing

raised ESR

raised CRP

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40
Q

how long does in an interpregnancy interval need to be to increase risk of IUGR

A

120 months

(10 yrs)

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41
Q

difference between cicumstantiality and tangential speech

A

circumstantiality - talking at great length around the subject but returns to the topic

tangenital: does not return to the topic

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42
Q

what is meningococcal meningitis prophylaxis antibiotic

A

oral ciprofloxacin

or

oral rifampicin

or

im ceftriaxone

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43
Q

what is the antibiotic prophylaxis of choice in preterm prelabour ROM

A

PO erythromycin

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44
Q

prerequisites for instrumental delivery

A
  • cervix fully effaced and dilated
  • head position known to be deeply engaged in mid cavity or below
  • valid indicaton
  • empty bladder
  • adequate analgesia
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45
Q

what happens if you have amoxicillin with infectious mononucleosis

A

maculopapular pruritic rash

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46
Q

what are the 5 Ms of geriatric medicine

A

mind

mobility

medications

multi-complexity

matters most - i.e. holistic patient centred approach

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47
Q

treatment for fibroids <3cm

A

cocp

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48
Q

what type of drug is duloxetine

A

SNRI

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49
Q

what is the surgery for biliary atresia and what is an important consideration

A

kasai procedure

success rate diminishes with age

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50
Q

4 complications of prematurity

A

retinopathy of prematurity

NEC

intraventricular haemorrhage

chronic lung disease

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51
Q

where is the rash normally in HSP

A

on the bum and extensor surfaces usually symmetrical

trunk usually spared

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52
Q

what is perseveration

A

repetition of a word or phrase (usually associated with an organic/frontal disorder)

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53
Q

what timings for emergency contraception

A

ullipristal acetate (ellaone) and copper coil: up to 120 hrs

levonelle: up to 72hrs

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54
Q

difference between stereotype and mannerism

A

Stereotype: A repetitive and bizarre movement which is not goal-directed (in contrast to mannerism). The action may have delusional significance to the patient. Seen in schizophrenia.

Mannerism: Abnormal and occasionally bizarre performance of a voluntary, goal directed activity (e.g. a conspicuously dramatic manner of walking.

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55
Q

buttock wasting – think:

A

coeliac

56
Q

what would you give before fibroid surgery and why

A

GnRH agonists - fibroids are oestrogen dependent so temporary menopause will reduce their size and make them less likely to bleed during surgery

57
Q

how do antipsychotics work

A

they block dopamine D2 receptors

58
Q

what do you give someone with cuada equina before surgery

A

high dose dexamethasone to try and halt progression of compression before surgery

59
Q

what is horner’s syndrome

A

unilateral anhidrosis (absence of sweating of the face), enophthalmos (inset eye), miosis (constricted pupil) and ptosis (drooping eyelid)

60
Q

how long should a woman with premature preterm rupture of membranes be given antibiotics for

A

10 days or until she is in established labour - whichever is sooner

61
Q

what are TCA side effects

A

sedation

anti-cholinergic

cardic arrhythmias

62
Q

what is the following PD and what cluster does it belong to?

rigid conformity to rules, perfectionism and control to the point of satisfaction and excluson of leisurely activities and friendship

A

anankastic (obsessive compulsive)

cluster C (anxious or fearful disorders)

63
Q
A
64
Q

explain the two syphilis tests

A

VDRL - indicate active syphilis and become negative after treatment

TPHA - look for IgG which remains after treatment to confer immunity

65
Q

what does egosyntonic mean

A

very different to the patient’s normal beliefs and values

66
Q

what investigation is used to monitor treatment response in hodgkin lymphoma?

A

positron emission tomography PET

67
Q

which nerve roots are affected by erb’s palsy

A

c5-c6

68
Q

what are the geriatric giants

A

immobility

instability

incontinence

impaired intellect

69
Q

What is the initial blood monitoring for clozapine

A

minimum of 1 blood test per week for the first 18 weeks

then fortnightly for 1 year

after one year it’s monthly

70
Q

Haemophilus influenzae type b disease: prevention of secondary cases

A

rifampicin

71
Q

what are the schneiderian 1st rank symotoms

A
  • 3rd person auditory hallucinations
  • passivity phenomena
  • thought alienation
    • insertion
    • withdrawal
    • broadcast
  • delusional perception
72
Q

what is the most common cause of meningitis in neonates

A

GBS

73
Q

8w vaccines

A

6 in 1 (DTaP, IPV, Hib, Hep B), Men B, Rotavirus

74
Q

what type of drug is fluvoxamine

A

SSRI

75
Q

what is the first line treatment for faecal impaction in children

A

macrogol laxative e.g. polyethylene glycol and electrolytes (movicol paediatric plain)

76
Q

what checks should be done with lithium and how often

A

Thyroid and renal function should be checked every 6 months, as lithium can cause hypothyroidism and is nephrotoxic

Lithium has a narrow therapeutic index. Lithium levels are therefore checked every 3 months

remember that a fine tremor is fine and a course tremor indicates toxicity

77
Q

what is the nephrotic syndrome triad

A

proteinuria >1g/m2/24hrs

serum albumin <25

peripheral oedema

78
Q

what’s the first line medical treatment for delirium if it is required

A

haloperidol 0.5mg PO

or

haloperidol 0.5mg IM

79
Q

if a child is in 10% fluid deficit (shocked) what would you give them

A

maintenance + extra 100ml/kg/day

80
Q

NSAID for heavy menstrual bleeding

A

mefanemic acid

81
Q

what is a liver biopsy with giant cell hepatitis and rosette formation in a neonate indicative of

A

neonatal hepatitis syndrome

82
Q

what is the following PD and what cluster does it belong to?

mood swings, insability in relationships, self-image/identity, behaviour and affect, often leading to self harm and impulsivity

A

EUPD

cluster B (dramatic, eomotional or erratic disorders)

83
Q

if a child is in 5% fluid deficit what would you give them

A

maintenance + extra 50ml/kg/day

84
Q
A
85
Q

what is methylphenidate

A

ritalin

used for adhd

86
Q

what is the following PD and what cluster does it belong to?

social inhibition and inadequacy, extreme sensitivity to negative evaluation

A

anxious avoidant

cluster C (anxious or fearful disorders)

87
Q

what is thought echo

A

it is a form or auditory hallucination where a patient hears their thoughts spoken aloud

88
Q

what is protamine sulphate

A

treats heparin overdose

89
Q

5 drugs that cause falls in the elderly and how they do it

A
  • senna: urgency to go to toilet
  • painkillers (co-codamol or amitryptyline) : cause confusion
  • diuretics: postural hypotension
  • sertraline: low sodium
  • benzos: sedation
90
Q

managment of DDH

A

pavlik harness if <5 months

if 6 months or older then closed reduction and fixation

91
Q

what is the delirium screen

A

calcium

TFT

B12

infection (CRP, WCC and MSU)

exclude strokes

exclude constipation

identify and treat pain

92
Q

some causes of stephen johnson syndrome

A
  • drugs
    • allopurinol
    • penicillin
    • phenytoin
    • lamotrigine
  • infections
    • mumps
    • flu
    • HSV
    • EBV
93
Q

what is becks questionaire for

A

depression

94
Q

what medication for stress incontinence

A

1st line is 3 months of pelvic floor training

then duloxetine or surgery

95
Q
A
96
Q

which drugs typically cause extrapyramidal side effects

A

1st generation (typical) antipsychotics such as haloperidol

97
Q

what is natrexone

A

long-acting opioid receptor antagonist that can be used in opioid and alcohol maintenance regimes, but is not considered first line

98
Q

describe extrapyramidal side effects and their treatment

A
  • acute dystonic reaction
    • Rx: benzos
  • akanthasia - extreme restlessness
    • Rx: beta blockers or benzos
  • pseudoparkinsonism
  • tardive dyskinesia
    • associated with chronic antipsychotic use
    • lip smacking and tongue protrusion
    • Rx: switch antipsychotic
99
Q

what is the 1 yr mortality of a NOF fracture

A

30%

30 day mortality is 7%

100
Q

name four 2nd generation antipsychotics

A

clozapine

olanxapine

risperidone

quetiapine

101
Q

what is clozapine and what can it cause

A

2nd generation antipsychotic

can cause neutropenia

102
Q

14y vaccine

A

Tetanus, diphtheria, polio. Men ACWY

103
Q
A
104
Q

16w vaccines

A

6 in 1 (DTaP, IPV, Hib, Hep B), Men B

105
Q

what are the sanctuary sites for chemo

A

testes and CNS

106
Q

what is the only absolute contraindication for ECT

A

raised ICP

107
Q

which drugs can cause parkinsonism

A

Typical antipsychotics (e.g. haloperidol) are known to be dopamine antagonists and can cause parkinsonism. The atypical antipsychotics (e.g. clozapine, olanzapine, quetiapine, risperidone) often do not have extrapyramidal side effects including parkinsonism.

108
Q

what is pyridostigmine for

A

it is a long-acting acetylcholinesterase inhibitor for myasthenia gravis

109
Q

how is the diagnosis of necrotising enterocolitis made

A

colonoscopy

110
Q

describe neuroleptic malignant syndrome

A
111
Q

what is the management for acute otitis media

A
  • watch and wait is suitable for majority of children as it will resolve within 4 days
    • treat if:
      • AOM in only hearing ear
      • cochlear implant
      • perforated TM
      • both ears if they’re <2yrs
  • first line treatment for a patient you need to treat is 5 days of amoxicillin
112
Q

how should sfh correlate with gestation

A
  • fundus not obvious before 12 wks
  • at 16wks it’s half way beteen symphysis and umbilicus
  • 16-26wks height in cm = gestational age
  • 26-36wks height in cm +/- 2cm = gestational age
  • from 36 wks you’re allowed +/- 3cm
113
Q

what is somatic passivity

A

delusional belief that the bodily sensations are from an external agency

114
Q

name 5 1st generation antipsychotics

A

sulpiride

haloperidol

flupentixol

zuclopennthixol

chlorpromazine

115
Q

investigation results that would diagnose gestational diabtes

A

OGTT: 2hr plasma glucose >7.8mmol/l

fasting glucose >5.6mmol/l

116
Q

difference between dissociation, derealisation and depersonalisation

A
  • depersonalisation: pt. feels that they are unreal
  • derealisation: pt. feels that the world has become unreal
  • dossociation: The separation of unpleasant emotions and memories from consciousness awareness with subsequent disruption to the normal integrated function of consciousness and memory.
    • dissociative fugue
117
Q

can lithium be used in pregnancy

A

Lithium is teratogenic and is therefore contraindicated in pregnancy. It is associated with Ebstein’s anomaly, a congenital heart defect characterised by an enlarged right atrium, shrunken right ventricle, and a pansystolic murmur caused by a defective tricuspid valve

118
Q

why do you get raised CK in NMS

A

because of muscle rigidity

119
Q

what is the following PD and what cluster does it belong to?

lack of interest and detachment from social relationships, apathy and restricted emotional expression

A

schizoid

cluster A (odd or eccentric disorders)

120
Q

what are the safest anti-epileptics in pregnancy

A

carbemazepine and lamotragine

121
Q

what can you add if lithium alone isn’t working for BPD

A

valproate

122
Q

what type of drug is trazodone

A

TCA

123
Q

phenlazine side effects

A

hypertensive crises associated with cheese and wine

124
Q

summarise the pregnancy appt timeline

A

booking: 8-12 wks

dating scan 12-14 wks

anomaly scan 18-20wks

fortnightly midwifery checks from 34wks

125
Q

what type of drugs must you avoid eating cheese with and why

A

MAO inhibitor antidepressants such as phenelzine

tyramine rich foods such as cheese and wine can lead to a build up of tyramine and hypertension

126
Q

what is loosening of association

A

lack of association between thoughts

127
Q

what are anticholinergic side effects

A

urinary retention

constipation

dry mouth

dry eyes

blurred vision

dizziness

unsteadiness

confusion

128
Q

what is carbimazole switched to in pregnancy

A

propylthiouracil

129
Q

lewy body dementia meds

A

rivastigmine

130
Q

three most common causes of neonatal bacterial meningitis

A

GBS
E.coli

listeria monocytogenes

131
Q

SSRIs side effects

A

abdo upset

suicidality

sexual dysfunction

132
Q

when does peak incidence of delerium tremens occur

A

48-72hrs following alcohol withdrawal

133
Q

what is belle indifference

A

an apparent lack of concern at symptoms/disability

134
Q

compare gilbert and crigler nijjar syndrome

A
135
Q

3 things screened for at dating scan

A

down’s

edward’s

patau’s

136
Q

first second and third line antipsychotics

A
  • first line: 2nd gen
  • second line: 1st or 2nd gen
  • third line: clozapine
    • has increased efficacy but more hazardous side effect profile

Phase 3a (5 decks)

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