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1
Q

How do we manage biliary colic?

A

Paracetamol
Lifestyle advice for reducing recurrence risk - lower dietary fat intake, pursue weight loss, increase exercise
Elective laparoscopic cholecystectomy within 6 weeks of presentation

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2
Q

Describe the character of the pain in ectopic pregnancy

A

the pain radiates to the patient’s shoulder whilst lying flat. This increases the likelihood of ectopic pregnancy.

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3
Q

What is the difference between visceral and peritoneal pain?

A

Visceral pain, is likely to be vague and difficult to localise
Peritoneal pain is usually felt after visceral pain. Peritoneal pain is easier to localise. This is because it occurs after an inflamed organ comes into contact with the peritoneal peritoneum.

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4
Q

How would you investigate a 40 F presenting with symptoms in line with SBO?

A

Full abdominal examination, bloods (including group and save), venous blood gas, urine dip, pregnancy test, abdominal x-ray, nasogastric tube, IV fluids, discuss with surgical team

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5
Q

When do we perform NIPEs?

A

The examination is performed within the first 72 hours after birth. It is repeated at 6 – 8 weeks by their GP.

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6
Q

What three questions are asked at the start of a NIPE?

A

Has the baby passed meconium?
Is the baby feeding ok?
Is there a family history of congenital heart, eye or hips problems?

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7
Q

How do we assess oxygen saturations in a NIPE?

A

Babies should have their pre-ductal and post-ductal oxygen saturations checked. This measures the oxygen level before and after the ductus arteriosus. Normal saturations are 96% or above. There should not be more than a 2% difference between the pre-ductal and post-ductal saturations. Abnormal saturations require further investigation and potentially admission to the neonatal unit.

Pre-ductal saturations are measured in the baby’s right hand. The right hand receives blood from the right subclavian artery, a branch of the brachiocephalic artery, which branches from the aorta before the ductus arteriosus.

Post-ductal saturations are measured in either foot. The feet receive blood traveling from the descending aorta, which occurs after the ductus arteriosus.

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8
Q

What is the Moro reflex?

A

When rapidly tipped backwards the arms and legs will extend

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9
Q

What is the suckling reflex?

A

placing a finger in the mouth will prompt them to suck

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10
Q

What is the rooting reflex?

A

tickling the cheek will cause them to turn towards the stimulus

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11
Q

What is the grasp reflex?

A

placing a finger in the palm will cause them to grasp

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12
Q

What are talipes?

A

Talipes, also known as clubfoot, is where the ankles are in a supinated position, rolled inwards. It can be positional or structural. Positional talipes is where the muscles are slightly tight around the ankle but the bones are unaffected. The foot can still be moved into the normal position. This requires referral to a physiotherapist for some simple exercises and will resolve with time. Structural talipes involves the bones of the foot and ankle and requires referral to an orthopaedic surgeon.

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13
Q

How do we manage haemangiomas?

A

Haemangiomas near the eyes, mouth or affecting the airway may require referral for treatment with beta blockers (i.e. propranolol). Otherwise they can be monitored and usually resolve with time.

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14
Q

What are port wine stains?

A

Port wine stains are pink patches of skin, often on the face, caused by abnormalities affecting the capillaries. They don’t fade with time and typically turn a darker red or purple colour. Rarely they can be related to a condition called Sturge-Weber syndrome, where there can be visual impairment, learning difficulties, headaches, epilepsy and glaucoma.

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15
Q

When are we concerned about soft systolic murmurs?

A

Soft systolic murmurs of grade 2 or less in otherwise healthy well neonates may be monitored, as these often resolve after 24 – 48 hours. This may be caused by a patent foramen ovale that closes shortly after birth.

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16
Q

How do we manage breech births?

A

External cephalic version at 37w
Then breech vaginal delivery or elective C-section

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17
Q

What are the key obstetric symptoms?

A

N&V
Reduced fetal movements
Vaginal bleeding
Abdo pain
Vaginal discharge or loss of fluid
Headache, visual disturbance, epigastric pain and oedema (pre-eclampsia)
Pruritis (obstetric cholestasis)
Unilateral leg swelling
Chest pain and SOB
Systemic symptoms e.g. fever (chorioamnionitis), fatigue (anaemia) and weight loss (hyperemesis gravidarum)

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18
Q

What would you ask about the current pregnancy?

A

Gestation
Scan results
Screening
Singleton/multiple gestation
Folic acid
Mode of delivery
Any medical illness
Immunisation history
Mental health history

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19
Q

What is important to ask in the gynaecological aspect of an obstetric history?

A

Cervical screening:

Confirm the date and result of the last cervical screening test.
Ask if the patient received any treatment if the cervical screening test was abnormal and check that follow up is in place.
Previous gynaecological conditions and treatments:

Sexually transmitted infections
Endometriosis
Bartholin’s cyst
Cervical ectropion
Malignancy (e.g. cervical, endometrial, ovarian)

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20
Q

How do we investigate fibroids?

A

Hysteroscopy is the initial investigation for submucosal fibroids presenting with heavy menstrual bleeding.

Pelvic ultrasound is the investigation of choice for larger fibroids.

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21
Q

How do we determine if someone needs to go to hospital after two episodes of reasonable haematemesis?

A

Glasgow-Blatchford score

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22
Q

How do we determine mortality risk after endoscopy?

A

Rockall score

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23
Q

How does Mallory-Weiss tear present?

A

This generally occurs due to repetitive retching, vomiting, coughing or straining. It presents with upper gastrointestinal bleeding which is usually self-limiting.

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24
Q

Give four side effects of statins

A

Common side effects to statins include muscle pain, diarrhoea, headaches, and nausea.

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25
Q

What are the important side effects of statins

A

Important side effects include rhabdomyolysis, hepatic disorders, and pancreatitis.

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26
Q

What is contraindicated with statin use?

A

Drinking grapefruit juice

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27
Q

What are the common SEs of steroids?

A
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28
Q

What are the important SEs of steroids?

A
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29
Q

What must we co-prescribe with steroids?

A

concurrent prescription of alendronate to prevent steroid-induced osteoporosis

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30
Q

What is the 5 A’s approach to smoking cessation?

A

Ask - Ask the patient about their tobacco use (as discussed).
Assess - Check the patient’s knowledge about the consequences of smoking, and identify their current motivation to quit. Their motivation may be quantified from 1 (low motivation) to 10 (high motivation).
Advise - Explain the risk caused by smoking and advise them to stop. The patient should be reassured that they will be supported throughout the process.
Assist - Assist the patient in quitting using the STARR method. This involves Setting a date in which the patient will quit (within 2-4 weeks), advising them to Tell their friends and family for extra support, Anticipating any challenges that the patient may face and preparing them to overcome these, Removing all tobacco products, and Recommending counselling and pharmacological options that they may find useful.
Arrange - Arrange a follow-up appointment to provide continued monitoring and support.

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31
Q

What is first-line in smoking cessation therapy?

A

Nicotine replacement therapy - This is normally used as the first-line therapy. It is available in multiple forms, including patches, sprays, and chewing gums. It can increase successful cessation by 1.5x, especially when used in combination with psychological support, and can be bought over the counter.

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32
Q

How do we use bupropion in smoking cessation therapy?

A

Bupropion - This is a dopamine and noradrenaline re-uptake inhibitor, which prevents cravings. The patients should be advised to start the treatment 1-2 weeks before they intend to stop smoking, and then to continue it for an additional 7-12 weeks afterwards.

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33
Q

Give three SEs of bupropion use.

A

However, it can cause some side effects, including nausea, headaches, dizziness, dry mouth, and seizures (1 in 1000).

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34
Q

What is champix? How do we use it?

A

Varenicline (Champix) - This acts as a partial agonist of the nicotine receptors. It is the most effective pharmacological therapy, increasing successful cessation by up to 2x. The patient should be advised to start the treatment 1 week before they intend to stop smoking, and continue it for an additional 11 weeks afterwards.

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35
Q

Give two SEs of champix.

A

The important side effects to discuss are low mood, sleep disturbances, and nausea.

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36
Q

What dose of naloxone do we give in opiate overdose?

A

400 micrograms IV

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37
Q

How do we investigate AKI?

A

US of the bladder

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38
Q

How do we manage AKI?

A

Strict fluid balance regime, IV fluids if hypotension

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39
Q

Give four signs of chronic liver disease

A

e.g. variceal bleed, cachexia, bruising, clubbing, palmar erythema, gynaecomastia, ascites, jaundice, spider naevi, caput medusa

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40
Q

How would investigate Cushing’s disease?

A

FBC, U&Es, VBG
Overnight dexamethasone suppression test
High dose dexamethasone test
MRI Head
Fasting blood glucose and HbA1C
Lipid profile
DEXA scan for bone density assessment

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41
Q

Give three differentials for Cushing’s syndrome

A

Cushing’s disease (pituitary adenoma secreting ACTH)

Ectopic ACTH production (e.g. small cell lung cancers)

Adrenal adenoma or carcinoma (secreting excess cortisol)

Prolonged glucocorticoid usage

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42
Q

Give three complications of Cushing’s syndrome

A

Metabolic syndrome - 3/5 of the following

Central/abdominal obesity
Hypertension
Hyperglycaemia / T2DM
Hypertriglyceridaemia
Low serum HDL
Osteoporosis

Impaired immunity

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43
Q

How do we perform the dexamethasone suppression test?

A

To perform the test the patient takes a dose of dexamethasone (a synthetic glucocorticoid steroid) at night (i.e. 10pm) and their cortisol and ACTH is measured in the morning (i.e. 9am). The intention is to find out whether the dexamethasone suppresses their normal morning spike of cortisol.

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44
Q

What is a normal result in the low dose dexamethasone test?

A

A normal response is for the dexamethasone to suppress the release of cortisol by effecting negative feedback on the hypothalamus and pituitary. The hypothalamus responds by reducing the CRH output. The pituitary responds by reducing the ACTH output. The lower CRH and ACTH levels result in a low cortisol level. When the cortisol level is not suppressed, this is the abnormal result seen in Cushing’s Syndrome.

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45
Q

What is the result of the high dose dexamethasone test in Cushing’s disease?

A

In Cushing’s Disease (pituitary adenoma) the pituitary still shows some response to negative feedback and 8mg of dexamethasone is enough to suppress cortisol.

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46
Q

What is the result of the high dose dexamethasone test in adrenal adenoma?

A

Where there is an adrenal adenoma, cortisol production is independent from the pituitary. Therefore, cortisone is not suppressed however ACTH is suppressed due to negative feedback on the hypothalamus and pituitary gland.

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47
Q

What is the result of the high dose dexamethasone test in ectopic ACTH?

A

Where there is ectopic ACTH (e.g. from a small cell lung cancer), neither cortisol or ACTH will be suppressed because the ACTH production is independent of the hypothalamus or pituitary gland.

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48
Q

How do we treat Cushings disease?

A

The main treatment is to remove the underlying cause (surgically remove the tumour)

Trans-sphenoidal (through the nose) removal of pituitary adenoma
Surgical removal of adrenal tumour
Surgical removal of tumour producing ectopic ACTH

If surgical removal of the cause is not possible another option is to remove both adrenal glands and give the patient replacement steroid hormones for life.

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49
Q

What is the DWARF mnemonic?

A

Spinal exam:
Deformity, wasting, asymmetry, rashes, fasciculations and swelling

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50
Q

What is Schobers test used for?

A

Schober’s test can be used to identify restricted flexion of the lumbar spine, which may occur in conditions such as ankylosing spondylitis.

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51
Q

How do we perform Schobers test?

A

Identify the location of the posterior superior iliac spine (PSIS) on each side.

  1. Mark the skin in the midline 5cm below the PSIS.
  2. Mark the skin in the midline 10cm above the PSIS.
  3. Ask the patient to touch their toes to assess lumbar flexion.
  4. Measure the distance between the two lines.
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52
Q

What is a normal result in Schobers test?

A

If a patient has normal lumbar flexion the distance between the two marks should increase from the initial 15cm to more than 20cm.

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53
Q

What is the sciatic stretch test used for?

A

The sciatic stretch test is considered positive if the patient experiences pain in the posterior thigh or buttock region.

A positive test is suggestive of sciatic nerve irritation (e.g. secondary to lumbar disc prolapse).

54
Q

What does SPIKES stand for?

A

Situation
Perception
Invite
Knowledge
Emotions and empathy
Strategy and next Steps

55
Q

How do we prepare patients for endoscopy?

A

Fast

56
Q

How might a patient feel after an endoscopy?

A

After the procedure you might feel sleepy, and might have a bit of a sore throat

57
Q

What are the risks of endoscopy?

A

Bleeding
Perforation of the oesophagus
Infection

58
Q

What is the pathophysiology in atrial fibrillation?

A

The regular heartbeat we all have is regulated by a certain parts of your heart called the pacemakers. They also ensure that the heart beats in a co-ordinated manner and hence pumps out blood effectively.
In atrial fibrillation, one of the pacemakers has lost its ability to provide control and this results in an irregular heart beat which can affect the heart’s effectiveness in pumping blood. This can leave you with palpitations, feeling lightheaded, and dangerously low blood pressure if left unchecked.
Often the underlying trigger for this condition cannot be pinpointed.
The diagnosis is made by looking at your heart rhythm trace and the unsuccessful attempts at reverting your heart back to normal rhythm.
If left untreated, it carries a risk of blood clot formation which itself can lead to stroke.

59
Q

What must we do before starting DOACs?

A

It will require a one off test of kidney function before starting the medication.

60
Q

How do we safety net DOAC prescribing?

A

It does carry a small risk of serious bleeding events.
There are no specific dietary or lifestyle alterations needed.
Seeking medical advice is recommended if any unexpected bleeding occurs.
Seeking medical advice is recommended if any injuries to the head are sustained, or following any significant falls, as scans will be required to evaluate for internal bleeds.

61
Q

What is the purpose of a smear test?

A

Screening test
Takes a small sample of the cells of the cervix
Aims to detect early signs that may increase your risk of developing cervical cancer
Does not test for “cancer”

62
Q

What does a smear test look for?

A

Tests the cells to see if you have a “high risk” HPV infection or not
If you do have a high-risk HPV infection, the sample will be sent for cytology (looking at the cells under a microscope) to see if there are changes to the cells

63
Q

What does moderate dyskaryosis mean?

A

“Your cells under the microscope show moderate dyskaryosis”
This means there are some precancerous changes to the cells that may become cancerous if left untreated
This does not mean you have cancer

64
Q

What does moderate dyskaryosis mean?

A

“Your cells under the microscope show moderate dyskaryosis”
This means there are some precancerous changes to the cells that may become cancerous if left untreated
This does not mean you have cancer

65
Q

What is LLETZ?

A

Large loop excision of the transformation zone (LLETZ)
Performed with local anaesthetic
A thin wire used to cut away the abnormal cells

66
Q

What are the possible outcomes from colposcopy?

A

Explain possible outcomes from colposcopy
Large loop excision of the transformation zone (LLETZ)
Performed with local anaesthetic
A thin wire used to cut away the abnormal cells
Cold coagulation
Abnormal tissue burned away
Will likely be invited for a follow up appointment to make sure cells have been removed and not returned

67
Q

What do DNAR forms relate to?

A

Candidates should be able to reassure the patient that DNAR forms only relate to resuscitation, they do not mean that other treatment will be withheld. They will emphasise this point to the patient.

68
Q

What makes up a gynaecological history?

A

LMP and start of menstruation, any current bleeding
Gynae surgery
Sexually active
Contraception
Any discharge
Smears and results

69
Q

What is a benefit of HRT that isn’t symptom relief?

A

Reduced risk of osteoporosis
Reduced risk of cvs disease

70
Q

Why do we give oestrogen and progesterone in HRT?

A

Explains the purpose of the oestrogen is to relieve menopausal symptoms

Explains the purpose of the progestogen is to prevent oestrogen-induced endometrial thickening

71
Q

What are the symptoms in menopause?

A

Vasomotor symptoms (hot flushes, night sweats)
Mood changes (depression, sleep problems, anxiety, irritability)
Sexual dysfunction (reduced libido, dyspareunia)
Cognitive changes (reduced concentration, poor memory)
Urogenital changes (vaginal dryness, vulval itch, dysuria, increased urinary frequency, frequent urinary tract infection)
Menstrual changes (menstrual irregularity, shorter or longer cycles)
Weight gain

72
Q

What are the risks of HRT?

A

Increased risk of venous thromboembolism with oral therapy (2-3x risk)

Increased risk of stroke with oral therapy

Slightly increased risk of breast cancer

Increased risk of endometrial cancer with oestrogen-only HRT

73
Q

What are the oestrogen-related SEs of HRT?

A

Breast tenderness, nausea, fluid retention, bloating, headaches, leg cramps, dyspepsia

74
Q

What are the progestogen-related SEs of HRT?

A

Fluid retention, breast tenderness, headaches, mood swings, premenstrual syndrome-like symptoms, depression, acne, lower abdominal pain, back pain

75
Q

Give alternatives for vasomotor symptoms of HRT

A

selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), clonidine

76
Q

Give alternatives for urogenital symptoms of HRT

A

lubricants, vaginal moisturisers

77
Q

Give alternatives for mood symptoms of HRT

A

cognitive behavioural therapy, antidepressant medication

78
Q

What are the contraindications of HRT

A

Known or suspected oestrogen-sensitive cancer

Current, past or suspected breast cancer

Undiagnosed unusual vaginal bleeding

Untreated endometrial hyperplasia (“thickening of the lining of the womb”)

Previous or current venous thromboembolism

Current or recent arterial disease (e.g. angina, myocardial infarction)

Untreated hypertension

Acute liver disease

Pregnancy or breastfeeding

79
Q

Define menopause

A

Defined as amenorrhoea >1 year if over 50 or amenorrhoea >2 years if under 50

80
Q

What are the risks of receiving antibiotics?

A

May not work
Anaphylaxis
Infection
Pain

81
Q

How do we assess capacity?

A

“Does that make sense?” “Do you understand that?”
“Can you tell me what we just spoke about in your own words, I want to make sure you can remember it”
Do you remember the benefits of receiving antibiotics?”
“Do you remember the risks and consequences of not receiving antibiotics?”
“Can you tell me if you consent to receiving antibiotics?”

82
Q

How do we classify a severe asthma attack?

A

A CHEST 92:

Altered consciousness
Cyanosis
Hypotension
Exhaustion
Silent Chest
Threatening Peak Flow: <33% best or predicted
Oxygen saturations <92%

83
Q

How do we manage thyrotoxic storm?

A

PO Propylthiouracil is the first-line treatment for a thyrotoxic storm and is also the preferred antithyroid medication during pregnancy.

84
Q

Give a neurology systems enquiry

A

No visual disturbance, headache, weakness, dizziness or fainting

85
Q

What might trigger a headache?

A

diet, stress, dehydration, sleep deprivation

86
Q

How do we manage SAH?

A

Nimodipine - ca channel blocker that reduces bleeding

87
Q

What do you need to ask when it comes to memory loss?

A

Asks for specific examples of memory loss, eg. misplacing items, getting lost, forgetting to eat/wash
Asks specifically about safety: door locking, blowing out candles, turning off the oven

88
Q

What might you ask in the PMH in a memory loss hx?

A

Asks specifically about history of depression

Asks specifically about history of head injury

Asks specifically about history of malignancy

89
Q

How would we investigate long-term confusion?

A

Collateral history
Cognitive assessment eg. MoCA or MMSE
Physical examination, particularly neurological and gait
Bloods:
FBC (full blood count)
U&Es (urea and electrolytes)
LFTs (liver-function tests)
B12
Thyroid function tests
Imaging:
CT
MRI if CT inconclusive

90
Q

A patient presents with hearing voices. What do you need to ask about them?

A

How many voices are there?
Do they recognise the voices?
What is their gender?
What do the voices say?
Do they instruct him?
Do they tell him to harm himself or others?
How long has he had the voices?

91
Q

What might you ask about a patients thoughts?

A

Asks about delusions

Asks about thought insertion

Asks about thought removal

Asks about thought interruption

Asks about thought broadcasting

92
Q

What are the first-rank symptoms of schizophrenia?

A

Hallucinations, either auditory or somatic
Thought disorders
Delusions
A lack of insight.

93
Q

What is the atopic triad?

A

Asthma, eczema and hayfever

94
Q

How often should you apply emollient?

A

You should also be aware that E45 is an emollient and that a single application of a thin layer of any emollient each day is not going to be enough. Excellent candidates will be able to take the time to advise the mother that she needs to be applying the cream at least 4 or 5 times a day and that she should be using liberal amounts.

95
Q

What do you ask about in the PMH of a paediatric hx?

A

PMH
Birth history
Immx history
Breast or bottle fed

96
Q

What must you ask in a obstetric history?

A

0 Clarify the current gestational age of the pregnancy (if not done already)
21 Ask about recent scan results
22 Ask about screening (ultrasound scans)
23 Ask about immunisations
24 Ask about maternal mental health
25 Clarify other details of the current pregnancy (e.g. singleton vs multiple gestation, use of folic
acid, mode of delivery, medical illness during pregnancy)
Clarify the patient’s gravidity and parity (if not done already)
27 For term pregnancies (>24 weeks) clarify: gestation at delivery, birth weight, mode of
delivery, complications, stillbirths, use of assisted reproductive techniques
28 Ask sensitively about miscarriages, termination of pregnancy and ectopic pregnancy

97
Q

What must you ask in a gynae history?

A

Ask about recent and previous cervical screening results
Ask about previous gynaecological conditions and treatments

98
Q

Give four symptoms of pre-eclampsia

A

headache, visual disturbance, epigastric pain, oedema

99
Q

When do we expect to feel foetal movements?

A

16-20 weeks

100
Q

When should you go to hospital in asthma exacerbation?

A

Advises the need to go to the hospital if peak flow less than 50% of normal or if no relief after four puffs

101
Q

When should we be worried about asthma control?

A

Advises the need to see the GP/asthma team if using blue inhaler more than 3 times a week

102
Q

What is the psychiatric screen?

A

Thought disorder, auditory hallucinations, delusions, passivity…

Mood
Motivation
Sleep
Appetite
Anxiety

103
Q

When can you have intercourse after starting the COCP?

A

Explains if start on first five days of menstrual cycle, contraceptive cover immediate

Explains if start on any other day of the menstrual cycle, must use additional precautions (e.g. condoms) for 7 days

104
Q

What is a missed pill?

A

Explains if it’s been more than 48 hours since last took a pill this counts as a “missed pill”

105
Q

How does the COCP work?

A

stops the ovaries from producing an egg
also thickens the mucus around the neck of the womb, making it more difficult for sperm to enter
also makes the lining of the womb less likely to accept a fertilised egg

106
Q

What are the advantages of the COCP?

A

Explain can make periods more regular, lighter and less painful
Explain can give choice not to have a monthly bleed
Explain to “skip” a bleed, simply continue straight onto the next pack without taking a break
Explain may help with premenstrual symptoms
Explain may help improve acne

107
Q

What are the disadvantages of the COCP?

A

Explain that you have to remember it daily for it to be effective as a contraceptive
Explain that some people do get side effects
Most common in the first 3-6 months of use and often settle down
Explain may increase blood pressure
Will need to have blood pressure checked at initiation and at least once per year
Explain does not protect from sexually transmitted infections (STI)
Explain only condoms protect against STI

108
Q

What should you do if you’ve missed one COCP pill?

A

Take missed pill as soon as remember and continue pill-taking as normal
Usually no need for additional precautions

109
Q

What should you do if you’ve missed two COCP pills?

A

Take last missed pill as soon as remember and continue pill-taking as normal
Ongoing contraceptive cover may be affected
This is also applicable if starting new pack more than 2 days late
If less than 7 pills left in pack, continue to new pack without taking a break
If missed 2 or more pills in the first week of a new pack, and have had unprotected sex in previous week, may need emergency contraception

110
Q

What are the Fraser guidelines?

A

They cannot be persuaded to inform their parents about the consultation, or allow the doctor to inform their parents/carers
They understand the content of the consultation
Their physical and/or mental health are likely to suffer unless they receive advice or treatment
It is in their best interests to receive advice without their parents/carers knowledge
They are likely to continue to have sex despite the outcome of the consultation

111
Q

How does atorvastatin work?

A

Statins can help to reduce the level of ‘bad’ cholesterol in the blood by reducing the production of it within the liver.

112
Q

What is a rare but serious complication of statin use?

A

Rhabdomyolysis - attend A&E if severe muscle aches

113
Q

How do we monitor statin use?

A

lipid profile, TSH, LFTs, creatine kinase, and U&Es

114
Q

What is an important SE of methotrexate use?

A

symptoms of infection like fevers, sore throat, or a new productive cough, or unexpected bruising or bleeding (sign of myelosuppression)

115
Q

What is contraindicated with methotrexate use?

A

Trying to conceive

116
Q

What are key complications of methotrexate use?

A

Infections due to too much immune suppression - take fevers, sore throats, or other infective symptoms very seriously and attend A&E
Liver toxicity - to minimise this risk, try and drink as little alcohol as possible
Lung toxicity - take any periods of unexplained breathlessness seriously and seek an assessment from your specialist
Risk to embryos - conceiving whilst on this drug is absolutely recommended against so ensure adequate use of contraception or speak to your specialist about alternative medications if you wish to start planning a family
Risk of stomach lining bleeds - avoid using over the counter NSAIDs or aspirin

117
Q

When is a DOAC dose late?

A

Explains that if a dose is missed this can be taken up to 12 hours late
Explains not to double dose or take a dose more than 12 hours late (wait until next dose due)

118
Q

Which medications can you not take with DOACs?

A

NSAIDS e.g. ibuprofen

119
Q

Which bloods do we do before starting a DOAC?

A

baseline FBC, U+Es, LFTs and coagulation screen

120
Q

What are the risks with blood transfusion?

A

You know the risks and consequences of not receiving a blood transfusion: ongoing fatigue, dizziness, breathlessness that may take many months to resolve

121
Q

How do we investigate hypercalcaemia?

A

Blood test to measure parathyroid hormone and thyroid function
Urine Bence Jones protein
Protein electrophoresis
Imaging, including: CT CAP to look for evidence of malignancy
Referral to endocrinology

122
Q

What is the most important thing to think about in elderly patients?

A

What is their baseline function?

123
Q

How do we assess cognition?

A

Time, person and place

124
Q

How might you ask about grandiose delusions?

A

You seem to have special powers, why do you think this is?

125
Q

How might you ask about pressured speech?

A

You seem to talk very quickly, is this normal for you?”

126
Q

How might you ask about flight of ideas?

A

“You seem to have lots of ideas, is this new or have you always been very creative?”

127
Q

Give an autoimmune screen

A

Dry mouth, mouth ulcers, nail changes, visual disturbances,

128
Q

How do we investigate ankylosing spondylitis?

A

(Inflammatory markers such as ESR or CRP, plain X-rays of the sacroiliac joints and spine, chest X-ray, exercise, physiotherapy, NSAIDs with Protein Pump Inhibitor cover, DMARDs, steroid injections

129
Q

How does posterior stroke present?

A

Posterior stroke is the most likely differential due to the fact that the symptoms all came on suddenly. The patient is suffering from vertigo type symptoms, as well as unsteadiness and diplopia. This diplopia sounded as if it was due to ophthalmoplegia.

130
Q

What might you ask in a dizziness hx?

A

Ear pain, ear lesions, ear discharge, tinnitus, hearing loss, problems with balance, problems with coordination

phase 4 (10 decks)

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