Passmed

Question 1

Management of subdural haematoma symptomatic and asymptomatic?

Answer 1

Symptomatic is Burr hole decompression
Asymptomatic is conservative management

SAH is nimodipine

Question 2

Orbital cellulitis. Presentation and Rx?

Answer 2

Painful eye movement, eye swelling, eyelid oedema and erythema, chemosis (swelling of conjunctiva).

Rx: immediate IV abx and admission due to risk of cavernous sinus thrombosis and intracranial spread.

Cavernous sinuses are hollow spaces under brain behind eye socket that drain deoxygenated blood away from brain. If infection spreads to these, blood clot develops to try and stop the spread of the infection but this inadvertently causes damage to brain, eyes and nerves

Question 3

Most common cause of cord prolapse?

Answer 3

Artificial rupture of membranes

Question 4

Cord prolapse management

Answer 4

Push presenting foetus back in
If cord is past vaginal opening (introitus) then minimal handling and it should be kept warm and moist
PATIENT ON ALL FOURS
tocolytics to reduce uterine contraction
Caesarean

Question 5

Pt in VF. After third shock what to give?

Answer 5

IV adrenaline 1mg and IV amiodarone 300mg

Question 6

Provoked PE anticoagulation

Answer 6

DOAC for 3 months

Question 7

COPD pt with low oxygen, high CO2 and respiratory acidosis. Infective exacerbation of COPD. Rx?

Answer 7

Normally we do 15L via rebreathe. But this is enough info to realise we need NIV to deliver positive airway pressure

Question 8

Trigeminal neuralgia first line?

Answer 8

Carbamazepine
Short shock like pains abrupt in onset and termination. Unilateral

Question 9

What heart defect is associated with HOCM?

Answer 9

Wolf Parkinson White

Question 10

Hypernatraemic dehydration in children. Presentation and Rx?

Answer 10

Jittery movements, increased muscle tone, hyper reflexia, convulsions, drowsiness or coma

Rx in dehydrations in children: 50ml/kg oral rehydration solution over 4 hours, continue breastfeeding and supplement with usual fluids

Question 11

Most common cause of neonatal sepsis?

Answer 11

Group B strep

Question 12

Triad of shaken baby syndrome

Answer 12

Retinal haemorrhages, subdural haematoma, encephalopathy

Question 13

Sepsis or transient tachypnoea of the newborn?

Answer 13

TTN is common respiratory distress syndrome caused by delayed resorption of fluid in lungs - common in CS due to fluid not being squeezed out.

Increased RR. CXR shoes hyperinflation and fluid in horizontal fissure.

Rx is observation and supportive care.

Question 14

Stress incontinence Rx?

Answer 14

First pelvic floor exercises and reduced caffeine intake. Then Duoloxetine

Question 15

Urge incontinence Rx

Answer 15

Bladder training.

Stress is pelvic floor exercises

Question 16

What do these organisms cause
Staph epidermis
E. coli
Mycoplasma pneumoniae
Pseudomonas aeruginosa
Strep pyogenes

Answer 16

Staph epidermis found on skin and causes peritonitis in those undergoing peritoneal dialysis

E. coli causes UTIs and spontaneous bacterial peritonitis in those with ascites

Mycoplasma causes atypical pneumonia with bilateral consolidation on CXR

Pseudomonas causes INFRCTIVE EXACERBATIONS OF BRONCHIECTASIS AND CF

Strep pyogenes causes scarlet fever, cellulitis, necrotising fasciitis

Question 17

Commonest long term effect of meningitis?

Answer 17

Sensorineural hearing loss

Question 18

AMA abs associated with which liver condition?

Answer 18

PBC

Question 19

Medical abortions use which drugs?

Answer 19

Mifepristone then prostaglandins

Question 20

Urea:creatinine ratio of >100 is a landmark of what?

Answer 20

Pre renal AKI eg dehydration.

Divide urea by creatinine and divide by 1000