passmed

Question 1

What medication should be avoided in patients taking a selective serotonin reuptake inhibitor (SSRI)?

Answer 1

NSAIDs eg sumatriptan

Question 2

Treatment for PTSD?

Answer 2

SSRI sertraline or paroxetine or venlafaxine

Question 3

What are some key signs of Osgood-Schlatter disease?

Answer 3

Common in adolescents and typically, pain is:
Unilateral (but may be bilateral in up to 30% of people).
Gradual in onset and initially mild and intermittent, but may progress to become severe and continuous.
Relieved by rest and made worse by kneeling and activity, such as running or jumping.

Question 4

Is it nephritic or nephrotic syndrome: Minimal Change Disease

Answer 4

Nephrotic: proteinuria (> 1 g/m^2 per 24 hours)
hypoalbuminaemia (< 25 g/l)
oedema

Question 5

What is the presentation of malrotation with volvulus and what should be done immediately. what treatment

Answer 5

A distended abdomen and bilious vomiting is highly suggestive of intestinal malrotation and volvulus. An urgent upper GI contrast study and ultrasound is required. treated with Ladd’s procedure

Question 6

How is pyloric stenosis diagnosed?

Answer 6

M>F
5-10% Family history in parents
Projectile non bile stained vomiting at 4-6 weeks of life
Diagnosis is made by test feed or USS
Treatment: Ramstedt pyloromyotomy (open or laparoscopic)

Question 7

Intussusception treatment

Answer 7

Telescoping bowel
Proximal to or at the level of, ileocaecal valve
6-9 months of age
Colicky pain, diarrhoea and vomiting, sausage-shaped mass, red jelly stool.
Treatment: reduction with air insufflation

Question 8

necrotising enterocolitis

Answer 8

Prematurity is the main risk factor
Early features include abdominal distension and passage of bloody stools
X-Rays may show pneumatosis intestinalis and evidence of free air
Increased risk when empirical antibiotics are given to infants beyond 5 days
Treatment is with total gut rest and TPN, babies with perforations will require laparotomy

Question 9

what procedure should be done for biliary atresia?

Answer 9

Jaundice > 14 days
Increased conjugated bilirubin
Urgent Kasai procedure

Question 10

Which condition of the liver is associated with very itchy skin?

Answer 10

Intrahepatic cholestasis of pregnancy

Question 11

What is the main side effect of clozapine? What condition is it administered to?

Answer 11

agranulocytosis, atypical antipsychotic

Question 12

Atypical antipsychotics what are the main s.e.?

Answer 12

Atypical: weight gain, hyperprolactinaemia.

Typical: Akathisia, dystonia, parkinsonism, tardive dyskinesia (facial)

Question 13

What are the 3 main symptoms of PTSD?

Answer 13

hypervigilance, avoidance and intrusive memories

Question 14

COCP increases the risk of which cancers and decreases the risk of which cancers?

Answer 14

Increases risk of breast and cervical
Protective against ovarian and endometrial

Question 15

Define these:
Euthymia
Reactive affect
Congruent affect:

Answer 15

Euthymia- steady state happy calm, content
Reactive affect: responds appropriately to the subject of conversation
Congruent affect: emotions match the situation

Question 16

What drug classes:
Tolterodine
Teriparatide
Toremifene
Finasteride
Tamsculosin
Oxybutunin

Answer 16

Tolterodine: antimuscarinic
Teriparatide: bisphosphonates for osteoporosis
Toremifene: nonsteroidal antiestrogens
Finasteride: 5-alpha reductase
Tamsculosin: alpha blocker
Oxybutunin: antimuscarinic

Question 17

MAOIs- monamine oxidase inhibitors (isocarboxazid, moclobemide) why is it so bad

Answer 17

Can cause hypertensive crisis, tyrosine kinase reaction associated with cheese/wine/marmite!!!!!!!!!!

Question 18

A patient with lung cancer has PET scan to evaluate mets. What does this type of scan demonstrate?
A) Cellular proliferation
B) apoptotic activity
C) glucose uptake
D) Vascular supply
E) tyrosine kinase activity

Answer 18

C) glucose update

Question 19

Fever persisting for more than 5 days, rash, strawberry tongue, lymphadenopathy, conjunctivitis

Answer 19

Kawasaki Disease

Question 20

Which anaesthetic can cause malignant hyperthermia and what do you give for management?

Answer 20

Suxamethonium, and give Dantrolene prevents Ca2+ release from the sarcoplasmic reticulum

Question 21

A 2-week-old infant with a small chin, posterior displacement of the tongue and cleft palate

Answer 21

Pierre-Robin syndrome

Question 22

Supravalvular aortic stenosis is found in a 3-year-old boy with learning difficulties

Answer 22

Williams syndrome

Question 23

A 9-week-old is noted to have a small chin and rocker-bottom feet

Answer 23

Edward’s syndrome

Question 24

Which drug can cause similar symptoms to schizophrenia?

Answer 24

Amphetamine as it is a dopamine agonist

Question 25

What are poor prognosis factors for schizophrenia?

Answer 25

Factors associated with poor prognosis
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

Question 26

A 26 year-old woman presents to her GP with a 3 month history of inter-menstrual bleeding and occasional post-coital bleeding. She is sexually active and takes Microgynon (a combined oral contraceptive pill). Her last cervical smear was normal.

Answer 26

Cervical ectropion

Question 27

Which opioid should be given for severe kidney failure in palliative care?

Answer 27

Buprenorphine or fentanyl are the opioids of choice for pain relief in palliative care patients with severe renal impairment

Question 28

Gynaecomastia, loss of libido and erectile dysfunction what causes this in antipsychotic meds?

Answer 28

Gynaecomastia, loss of libido and erectile dysfunction, which are defining features of hyperprolactinaemia

Question 29

How long do you have to continue antidepressants for after starting to feel better on them before you start tapering down?

Answer 29

Antidepressants should be continued for at least 6 months after remission of symptoms to decrease risk of relapse

Question 30

A risk factor for developing Ebstein’s anomaly is the mother taking ……..?

Answer 30

A risk factor for developing Ebstein’s anomaly is the mother taking lithium during the first trimester of pregnancy.

Systolic heart murmur is heard. An echocardiogram shows right atrial hypertrophy and the septal and posterior leaflet of the tricuspid valve attached to the right ventricle

Question 31

Which atypical antipsychotic should you give for hyperprolactinaemia?

Answer 31

Aripiprazole has the most tolerable side effect profile of the atypical antispsychotics, particularly for prolactin elevation

Question 32

conjunctivitis, slapped cheek, roseola, infectious mononucleosis, head lice, threadworms and hand, foot and mouth.

whooping cough.

measles.

rubella.

All lesions crusted over is incorrect and instead appropriate for a diagnosis of chickenpox.

5 days from onset of swollen glands is incorrect and instead appropriate for a diagnosis of mumps.

Until symptoms have settled for 48 hours is incorrect and instead appropriate for a diagnosis of infectious gastroenteritis.

Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment is incorrect and instead appropriate for a diagnosis of impetigo.

Answer 32

No exclusion is incorrect and instead appropriate for the following diagnoses: conjunctivitis, slapped cheek, roseola, infectious mononucleosis, head lice, threadworms and hand, foot and mouth.

2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics) is incorrect and instead appropriate for a diagnosis of whooping cough.

4 days from onset of rash is incorrect and instead appropriate for a diagnosis of measles.

5 days from onset of rash is incorrect and instead appropriate for a diagnosis of rubella.

All lesions crusted over is incorrect and instead appropriate for a diagnosis of chickenpox.

5 days from onset of swollen glands is incorrect and instead appropriate for a diagnosis of mumps.

Until symptoms have settled for 48 hours is incorrect and instead appropriate for a diagnosis of infectious gastroenteritis.

Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment is incorrect and instead appropriate for a diagnosis of impetigo.

Question 33

Which atypical antipsychotic is given for drug management for challenging behaviours with dementia? short-term treatment (up to six weeks) ​

Only medicine licensed ​

Moderate to severe Alzheimer’s disease ​

Where risk of harm to Self or Others

Answer 33

Risperidone

Question 34

What are some causes of delirium?
PINCH ME

Answer 34

pain, infection, neoplasm, constipation, hydration, medication, environment

Question 35

In males what epilepsy meds for generalised seizure and what for focal seizure?

Answer 35

Epilepsy medication for males:
generalised seizure: sodium valproate
focal seizure: lamotrigine or levetiracetam

Question 36

Main things to remember in medical emergencies:
-Acute exarcebation of COPD ( what meds and what is the scoring system called for in patient mortality score)
-Anaphylaxis (what blood is important to take)
-PE (management)
-

Answer 36

COPD: DECAF score, salbutamol, ipratroprium, hydrocortisone/prednisolone
Anaphylaxis: lie patient flat, raise legs, call for help, administer IM adrenaline and remove antigen causing attack. do mast cell trypstase!! give chlorphenamine and hydrocortisone!!!!! and repeat mast cell tryptase 2 hours post event
PE: furosemide IV, do troponin and BNP!! catheterise patient, consider CPAP potentially, do ECHO

Question 37

Alcohol withdrawal what to expect after
6-12 hours?
24 hours?
36 hours?
3-4 days?

Answer 37

6-12 hours → tremor
24 hours → anxiety, agitation, muscle pain, sweating, nausea, insomnia
36 hours → seizures
3-4 days → delirium tremens

Question 38

What is the mechanism of action of benzos?

Answer 38

GABA agonist!!! targets GABA, allowing chloride to flow into cells. Advise patient they should not drive or operate machinery after taking the drug. Avoid daily use or no longer than 4 weeks.

Question 39

Which illegal drug is an Monoamine reuptake inhibitor?

Answer 39

Cocaine

Question 40

Cocaine, LSD, MDMA/ ectasy, canabis amphetamine(meth/speed), ketamine, mushrooms, heroin, benzos

Answer 40

Canabis: Class B
Ketamine: Class B
Cocaine: Class A
LSD: Class A
Mushrooms: Class A
Amphetamine: Class B
MDMA/ectasy: Class A
Heroin: Class A (pinpoint pupils) give naloxone and methadone
Benzos: Class C (flumazenil)

Question 41

In MHA how long does section 2 and section 3 lasts?

Answer 41

Section 2 for assessment is up to 28 days
Section 3 is for medical treatment and is up to 6 months

Question 42

Haloperidol administered due to patient being aggressive. What medication is important to also have prepared in the case the patient suffers a dystonic reaction?

Answer 42

Acute dystonia secondary to antipsychotics is usually managed with procyclidine