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passmed Flashcards

1
Q

SHORT STATURE AND AMEONNORHEA”?

A

TURNERS

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2
Q

FSH AND LH levels in amenorrhea

A

both will be raised

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3
Q

Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency?

A

uterine fibroids

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4
Q

cocp are ci with ?

A

migraines with aura

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5
Q

how to differentiate between endometriosis and fibroids

A

endo pain is cyclical - ie before and during period
fibroids can be all the time and more likely to feel a palpable mass

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6
Q

typical history of ectopic pregnancy patient

A

female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding
Shoulder tip pain and cervical excitation may be seen

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7
Q

typical history of UTI patient

A

Dysuria and frequency are common but women may experience suprapubic burning secondary to cystitis

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8
Q

typical history of PID patient

A

Pelvic pain, fever, deep dyspareunia, vaginal discharge, dysuria and menstrual irregularities may occur
Cervical excitation may be found on examination

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9
Q

typical history of ovarian torsion patient

A

Usually sudden onset unilateral lower abdominal pain. Onset may coincide with exercise.
Nausea and vomiting are common
Unilateral, tender adnexal mass on examination

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10
Q

typical history of patient with miscarriage

A

vaginal bleeding and crampy lower abdominal pain following a period of amenorrhoe

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11
Q

Chronic pelvic pain
Dysmenorrhoea - pain often starts days before bleeding
Deep dyspareunia
Subfertility

?

A

endometriosis

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12
Q

typical history of patient with ovarian cyst

A

Unilateral dull ache which may be intermittent or only occur during intercourse. Torsion or rupture may lead to severe abdominal pain
Large cysts may cause abdominal swelling or pressure effects on the bladder

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13
Q

most common side effect of progesterone only pill

A

irregular vaginal bleeding

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14
Q

why is the cocp CI in post natal women

A

in women whoa re breastfeeding increased DVT risk in 6-8 weeks

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15
Q

Stereotypical PCOS results

A

raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low

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16
Q

what happens with mirena coil

A

initially irregular bleeding followed by light menses or amenorrhea

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17
Q

what is first line drug for infertility in PCOS

A

clomifine

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18
Q

what is a common cause of recurrent first trimester miscarriage

A

anti phospholipid syndrome

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19
Q

PCOS should be diagnosed if 2/3 of the following criteria are present:

A

-infrequent or no ovulation (thus oligomenorrhoea is the correct answer in this scenario)
-Clinical or biochemical signs of hyperandrogenism or elevated levels of total or free testosterone (no mention of ‘low levels of oestrogen’)
-Polycystic ovaries on ultrasonography or increased ovarian volume

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20
Q

what is androgen insensitivity

A

genetically XY but are phenotypically female due to reduced/absent testosterone receptors in target tissues.

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21
Q

features of androgen insensitivity

A

‘primary amenorrhoea’
undescended testes causing groin swellings
breast development may occur as a result of conversion of testosterone to oestradiol

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22
Q

management of androgen insensitivity

A

counselling - raise child as female
bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
oestrogen therapy

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23
Q

how to diagnose androgen insensitivity

A

buccal smear or chromosomal analysis to reveal 46XY genotype

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24
Q

effects of the COCP on cancer

A

increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer

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25
Q

two differentiating factors of levy body dementia

A

fluctuating cognition
hallucinations

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26
Q

Urinary incontinence + gait abnormality + dementia

A

normal pressure hydrocephalus

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27
Q

motor neuron disease is associated with that type of dementia

A

front-temporal

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28
Q

how would progressive supra nuclear palsy present

A

postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction

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29
Q

what group of medications to avoid in Lewy body dementia and why

A

neuroleptics
such as haloperidol as it may cause irreversible Parkinsonism

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30
Q

secondary stroke management for pt with af?

A

aspirin for 2 weeks then life long anti coagulant

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31
Q

SE of mirtazipine

A

increased appetite

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32
Q

Obese, young female with headaches / blurred vision?

A

idiopathic intracranial htn

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33
Q

what virus is croup

A

parainfluenza

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34
Q

Ipsilateral oculomotor palsy and contralateral weakness of the upper and lower extremity

A

left posterior cerebral artery

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35
Q

Headaches, amenorrhoea, visual field defects

A

prolactinoma

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36
Q

Posterior inferior cerebellar artery

A

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

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37
Q

basilar artery stroke?

A

locked in syndrome

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38
Q

amaurosis fugal stroke ?

A

retinal / ophthalmic artery
ipsilateral - same side
curtain coming down

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39
Q

similarities and differences between PICA and AICA

A

Ataxia, nystagmus
Pain and temperature loss: ipsilateral for face (trochlear nerve), contralateral for limbs (spinothalamic tract)
BOTH HAVE^^

AICA ONLY –Deafness
Facial paralysis (branches can compress the facial nerve)

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40
Q

FIRST LINE TX for croup

A

oral dexamethasone

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41
Q

coco increases risk of what cancer

A

cervical
breast

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42
Q

webers presentation ?

A

down and out
ipsilateral

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43
Q

Fluctuating consciencousness, behaving out of character, confusion would indicate what type of haemorrhage

A

subdural

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44
Q

long term side effect od levodopa

A

at peak dose it can cause chorea, dystonia after pt has been taking it for a few years

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45
Q

Middle-aged, personality changes, involuntary movements?

A

huntingtons

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46
Q

a headache linked to valsalva manouverus would indicate ?

A

raised ICP so a lumbar puncture would be CI

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47
Q

what class of medication can lead to medication overuse headache

A

opioids such as co cocodamol

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48
Q

what class of medications are mostly linked to behaviour changes for patients with Parkinson’s

A

dopamine receptor agonists such as ropinorole

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49
Q

what medication for bipolar can cause , diminished tendon reflexes excess thirst, feeling cold, and weight loss

A

lithium

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50
Q

when are seri’s contraindicated for patient with depression

A

if patient is on warfarin
manic episodes
ischaemic heart disease

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51
Q

what ssris are safe to use during breastfeeding

A

sertraline
paroxetine

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52
Q

first rank symptoms of schizophrenia

A

thought broadcasting, thought withdrawal, delusional perceptions and auditory hallucinations among others.

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53
Q

how can we differentiate between posterior circulation stroke and vestibular neuronotis

A

HinTS exam

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54
Q

is hearing loss in Menderes unilateral or bilateral

A

unilateral
will also causie tinnitus

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55
Q

at what bmi does the use of coco outweighs the benefits

A

bmi over 35

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56
Q

what medication is used in Menieres to prevent attacks

A

betahistine

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57
Q

viral labrynthitis typical history ?

A

recently developed an upper respiratory tract infection presents with vertigo and vomiting. Hearing is also affected. The symptoms came on suddenly
horizontal nystagmus

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58
Q

a patient has a feeling of ‘fullness’ and ‘pressure’ in ears what does this indicate

A

menieres disease

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59
Q

low calcium low phosphate and bone pain and raised alp think ??

A

OSTEOMALACIA

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60
Q

what biochemistry would pagets show

A

raised alp
normal ca and phosphate

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61
Q

what symptom of croup would make you want to admit a child to hospital ?

A

stridor at rest

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62
Q

why should you not examine the throat in croup

A

if stridor is found it can cause further airway obstruction

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63
Q

most common cause of stridor in children

A

laryngomalacia

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64
Q

if mycoplasma pneumonia is found what abx would you give to a child ?

A

erythromycin

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65
Q

what is a common side effect of saba

A

tremor

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66
Q

what would constitute life threatening asthma

A

bradycardia
dysrhythmia
hypotension
92% or lower
silent chest

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67
Q

what would constitute severe asthma

A

can’t complete sentences
rr>25/min
PEFR 33-50

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68
Q

non resp related features of cystic fibrosis

A

short stature
dm
delayed puberty
rectal prolapse
nasal polyps
male infertility

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69
Q

drug contraindications for asthma

A

beta blockers
adenosine

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70
Q

what is the target o2 sat in acute asthma

A

94-98

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71
Q

acute epiglottis is caused by what /

A

Haemophillis influenzai b

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72
Q

next steps for adult suspected asthma after presenting at gp

A

fractional exhaled nitric oxide + spirometry/bronchodilator reversibility test

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73
Q

strongest risk factor for developing a bells palsy?

A

pregnancy

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74
Q

who should be given ipratropium bromide

A

patients with severe or life threatening asthma , or in patients who have not responded to beta agonist and corticosteroid treatment

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75
Q

a normal pco2 of a patient with an asthma attack would indicate ?

A

life threatening as it is a sign of tiring respiratory effort as the high rr driven by hypoxia should result in a low pco2

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76
Q

what is the adult criteria to be met for asthma

A
  • exhaled Reno of 40 parts per billion
    -post bronchodilator improvement of more than 200ml
    -post - bronchodilator improvement in FEV1 of 12 % or more
    -
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77
Q

what monoclonal antibody is used to prevent babies from getting rsv

A

palivizumab

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78
Q

what is eczema herpeticum described as

A

monomorphic punched out erosions usually 1-3cm in diameter

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79
Q

difference of distribution of eczema rash of infants and older children

A

infants- extensor surfaces knees and elbows
older- elbow crease, knee crease , face and neck creases

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80
Q

how does seborrhoea dermatitis present in infants

A

greasy, yellow rash with flaky scales most common on scalp

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81
Q

Oral ulcers + genital ulcers + anterior uveitis

A

Behcets

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82
Q

first line medication for mild urticaria w sleep sx

A

chlorophenamine

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83
Q

severe or resistant urticaria you would give ?

A

oral prednisolone

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84
Q

how would erytheme multiforme present

A

giant non itchy target lesions
target lesions- dark centre with a blister, a ring around this that is pale pinkand raised with bright red outermost ring

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85
Q

what drugs commonly cause urticria

A

aspirin
penicllin
nsaids
opiates

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86
Q

how would lichen sclerosus present

A

itchy white patches on genitals
intense itching
thinning of vulvar skin

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87
Q

first line tx for mild urticaria

A

non sedating anti histamine like loratadine

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88
Q

what is nikolsly sign positive

A

blisters and erosions on gently rubbing the skin

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89
Q

what is pompholyx eczema characterised by

A

acute eruptions of deep seated vesicles in the palms and fingers

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90
Q

what is the main side effect of using topical decongestants for prolonger periods

A

tachyophylaxis

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91
Q

patients feel that their eyes are gritty and sometimes stick in the morning, what is this?

A

blepharitis

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92
Q

what are the first rank symptoms of schizophrenia

A

thought broadcasting
thought withdrawal
delusional perceptions
auditory hallucinations

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93
Q

how to differentiate acute stress disorder vs PTSD

A

Acute stress - first 4 weeks sx
ptsd- after 4 weeks

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94
Q

what should patients be warned about before taking pregablin

A

increased risk of suicidal thinking and self harm
weekly follow up is recommended for the first month

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95
Q

define obsession

A

intrusive, unpleasant and unwanted thought

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95
Q

body dysmorphia ocd medication

A

fluoxetine

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96
Q

define compulsion

A

senseless action taken to reduce the anxiety caused by the obsession

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97
Q

if first line SSRI is ineffttive in GAD what is second line

A

duloxetine or

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98
Q

If patient w ocd feels better with sertraline and wants to stop what is the guideline

A

to continue for 12 months

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99
Q

what part of the brain is involved in the flight or fight response

A

amygdala

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100
Q

what is the system to assess pressure sores

A

Waterlow score

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101
Q

when can orthostatic htn be diagnosed

A

after lying standing bp if the systolic drops below 20mmhg or more
a drop to below 90 even if less than 20

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102
Q

first line management for alzheimers

A

donepzil
acetylcholinesterase inhibitor

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103
Q

what medication/s are CI in patients with parkinsins

A

lorazepam

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104
Q

what is commonly prescribed when patients are in an acute confusional state and become aggressive

A

haloperidol
if Parkinson’s then lorazepam

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105
Q

typical history of a myasthenia graves patient

A

40yr old woman with muscle weakness, affecting her legs , double vision but better with rest

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106
Q

management of myasthenic crisis?

A

iv immunoglobulin + plasmapharesis

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107
Q

what is polymyositis

A

inflammatory disorder causing symmetrical proximal muscle weakness
associated with malignancy

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108
Q

features of polymyositis

A

-proximal muscle weakness +/- tenderness
-raynauds
- rest weakness (COPD hx)

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109
Q

what would investigations show

A

increased CK
AST AND ALT may also be raised

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110
Q

what is Lambert eaton syndrome

A

in association with small cell lung cancer
limb girdle weakness

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111
Q

What are the features of anorexia

A

Reduced bmi
Bradycardia
Hypotension
Enlarged salivary glands

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112
Q

Physiological abnormalities of anorexia ?

A

Hypokalaemia
Low fsh lh oestrogens testosterone
Raised cortisol and growth hormone
Impaired glucose tolerance
Low t3

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113
Q

bullimia vs binge eating disorder ?

A

bullimia = binge eating followed by compensatory mechanisms , vomitting, laxatives

binge eating = binge but no compensation

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114
Q

first line tx for anorexia?

A

anorexia focused family therapy

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115
Q

what are the indications for surgical management of ectopic pregnancy

A
  • ruptured ectopic
    -signs of infection ie fever
  • fatal heartbeat on uss
    -significant pain
    >35mm mass
    -hcg above 5000
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116
Q

expectant management of ectopic is used if ?

A

-unruptured embryo
- <35mm in size
- no heartbeat
- asymptomatic
- hcg <1000

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117
Q

first line medical management of ectopic

A

methotrexate

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118
Q

when should salpingostomy be used instead of salpingectomy in ectopic ?

A

when woman has risk factors for tube damage such as PID

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119
Q

How will a threatened miscarriage present

A

painless vaginal bleeding and closed cervical os

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120
Q

management for incomplete miscarriage

A

single dose misoprostol

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121
Q

If bishop score is above 8 what is the management

A

Cervix is ripe or favourable , high chance of spontaneous labour

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122
Q

If bishop score is above 8 what is the management

A

Cervix is ripe or favourable , high chance of spontaneous labour

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123
Q

Management if bishop score is below 6

A

Vaginal prostaglandin or oral misoprostol

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124
Q

First line investigation for PROM

A

Sterile speculum examination

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125
Q

Main complication of induction of Labour ?

A

Uterine hyper stimulation

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126
Q

is respiratory depression occurs in pregnancy with mag sulph what would you give

A

calcium gluconate

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127
Q

what position would woman be in for mcroberts manouvere

A

supine with both hips fully flexed and abducted

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128
Q

correct position for women who have cord prolapse?

A

all four
knees and elbows

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129
Q

how long should magsulphate be given for eclampsia

A

24 hours after delivery/ last seizure

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130
Q

first line medication for eclampsia

A

labetalol

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131
Q

main features of encephalitis

A

fever headache psychiatric symptoms seizures vomitting aphasia

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132
Q

where does encephalitis typically affect

A

temporal and inferior frontal lobes

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133
Q

what are the contraindications of a lumbar puncture

A

focal neurological signs
papilloedema
significant bulging of the fontanelle
disseminated intravascular coagulation
signs of cerebral herniation

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134
Q

what is the most common complication of meningitis

A

sensorineural hearing loss

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135
Q

how would you differentiate between meningitis rash and meninigoccal septicaemia rash

A

meningitis- non blanching rash
meningococcal- purpuric rash - more purple and black

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136
Q

what do you give close contacts of someone infected with meningitis

A

oral ciprofloxacin

137
Q

what is a life threatening effects of clozapine

A

agranulocytosis need to monitor FBC

138
Q

drug used for patients with alcohol withdrawal ?

A

chlorodiazepoxide

139
Q

what test results would you expect t o find in downs syndrome

A

increase in bHCG
decrease in PaPPA
Thick nuchal translucency

140
Q

what are the clinical features of downs ?

A

face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
flat occiput
single palmar crease, pronounced ‘sandal gap’ between big and first toe
hypotonia
congenital heart defects (40-50%, see below)
duodenal atresia
Hirschsprung’s disease

141
Q

weak femoral pulses on a baby in a 6 week check would make you think ?

A

coarctation of the aorta

142
Q

use of indomethacin and prostaglinds post birth for neonates is used for what purpose ?

A

indomethacin- inhibits prostaglandins so will shut things
prostalgandins- to keep things open until corrective surgery can be performed

143
Q

left subclavicular thrill, a heaving apex beat, and a continuous ‘machinery like’ murmur?

A

patent ductus arteriosus

144
Q

what murmur do you hear in tetralogy of fallout?

A

ejection systolic murmur

145
Q

lack of milk production and amenorrhea post birth would indicate ?

A

Sheehans syndrome

ischaemic necrosis of the pititutary gland

146
Q

first line surgical management for pph

A

intrauterine balloon tamponade

147
Q

alternative to oxybutinin in frail old women with dementia ?

A

meragabnon

148
Q

what medication is used to treat alcohol addiction that causes them to violently vomit

A

disulfiram

149
Q

what drug is used for anti craving in alcohol

A

acamprostate

150
Q

what medication commonly caused serotonin syndrome

A

tramadol

151
Q

what can cause necrotising fasciitis in pt with chicken pox

A

beta- haemolytic group a streptococcus

152
Q

what is an indication for high dose aspirin in childrn

A

Kawasaki disease

153
Q

elderly patient with unilateral rash that is macular then vesicular and also painful ?

A

shingles

154
Q

where can shingles be reactivated

A

dorsal root ganglion
cranial nerve ganglion

155
Q

what form of contraception is completely CI in breastfeeding women

A

COcP

156
Q

UKMEC4 for cocp

A

-more than 35 years old and -smoking more than 15 cigarettes/day
-migraine with aura
-history of thromboembolic -disease or thrombogenic -mutation
-history of stroke or –ischaemic heart disease
-breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

157
Q

contraceptives and their time until effectiveness ?

A

IUD- instant
POP- 2 days
COC, IUS,Injection, implant - 7 days

158
Q

what contraception is safe in breastfeeding women

A

progesterone only pill

159
Q

which form of contraception has a proven link to weight gain

A

depo injection

160
Q

what is the guideline regarding going back to school with Scarlett fever

A

can return 24 hrs after the first dose of ABX which is oral penicillin

161
Q

most common complaint in crohns, adult vs child

A

adult = bloody diarhhoea
child= abdominal pain

162
Q

first Line medication for spasticity in multiple sclerosis

A

gabapentin
baclofen

163
Q

typical MS history

A

30-40 YO woman with visual issues, tingling, relapsing and remitting

164
Q

typical history of child w intusuccesption

A

inconsolable crying child, currant / red stools/ knees to chest , billions vomitting

165
Q

first line management of hirschprungs

A

bowel irrigation/ wash out

166
Q

A 6-week-old baby boy presents with ‘projectle’ vomiting 30 minutes after feeding. On examination he is mildy dehydrated and has a small palpable mass in the upper abdomen is a stereotypical history of

A

pyloric stenosis

167
Q

necrotising enterocolitis typical history ?

A

1 week old with feeding intolerance , dark urine and pale stools

x ray shows gas cysts/ bubbles

168
Q

a patient comes into the ER with acute chest pain, fever, dyspnoea and cough with px admission of joint pains what are you thinking

A

sickle cell crisis

169
Q

long term management of sickle cell

A

hydroxyurea - increases hbf levels

170
Q

Isolated rise in GGT in the context of a macrocytic anaemia should suggest

A

alcohol excess

171
Q

blood film for megaloblastic anaemia would show ?

A

hyper - segmented neutrophil polymorphs

172
Q

psych patient believes they are dead what is this phenomenon

A

cotard syndrome

173
Q

psych patient repeating questions back to you

A

echolalia

174
Q

capgras syndrome

A

irrational delusion of misidentification where patients believe that a relative has been replaced by an identical imposter

175
Q

Charles bonnet syndrome?

A

patients with significant vision loss have vivid, often recurrent visual hallucinations

176
Q

endocrine disorder linked to chronic lithium toxicity

A

hypothyroidism

177
Q

what SSRI is most likely to lead to qt prolongation

A

citalopram

178
Q

how long should antidepressants be taken once patients wants to stop

A

6 months

179
Q

what examinations must you do before starting lithium

A

ecg- prolongeg QT syndrome
U and E
TFT

180
Q

what are some effects of lithium toxicity

A

seizures
coma
tremor
convulsions

181
Q

mechanism of tamsulosin

A

a-antagonist

182
Q

mechanism of finasteride

A

5 alpha reductase inhibitor

183
Q

mediation for UTi in non pregnant women and men

A

non pregnant women - nitrofurantoin or trimethoroim for 3 days

men- same but for 7 days

184
Q

for what reason would you send a urine culture in suspected UTI

A

-OVER 65 female
-pregnany
-visible or non visible haematuria
-men

185
Q

common side effect of tamsulosin

A

dizziness and postural hypotension

186
Q

uti treatment for pregnant woman

A

nitrofurantoin for 7 days

187
Q

what would a blood film show in myeloma

A

rouleax formation

188
Q

burrkits lymphoma is associated with what mutation

A

translocation of c myc gene

189
Q

characteristic blood film finding of CLL

A

SMEAR/ SMUDGE CELLS

190
Q

Where would you find auer rods

A

acute myeloid leukaemia

191
Q

common causative organism for Haemolytic uraemic syndrome and its sx

A

E coli 0157
bloody diarrhoea preceding gastroenteritis

192
Q

what is hypospadias

A

ventral urethral meatus
a hooded prepuce
chordee (ventral curvature of the penis) in more severe forms

193
Q

nephrotic syndrome is associated with a hyper coagulable state due to ?

A

loss of antithrombin 3 and plasminogen via the kidneys

194
Q

Membranous glomerulonephritis histology:

A

basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2

195
Q

causes of acute interstitial nephritis

A

penicillin
rifampicin
NSAIDs
allopurinol
furosemide
systemic disease: SLE, sarcoidosis, and Sjogren’s syndrome
infection: Hanta virus , staphylococci

196
Q

features of acute interstitial nephritis

A

-fever,
-rash,
-arthralgia
-eosinophilia
-mild renal impairment
-hypertension

197
Q

psgn vs iga nephropathy timeframe

A

psgn- 1-2 weeks after strep infection
iga- 1-2 days after iga ifection

198
Q

tetracyclines for acne management should be avoided in what patient population

A

breastfeeding
under 12
pregnant

199
Q

what is first line for moderate acne

A

tetracycline + retinoid/ benzyl peroxide

doxycycline

200
Q

safe medication for acne in pregnancy

A

oral erythromycin

201
Q

what medication needs a dermatologist referral and what warrants it

A

topical isotretinoin
scarring , pitting severe acne

202
Q

first line mx for non bullous impetigo

A

1% hydrogen peroxide cream

203
Q

second line mx for impetigo

A

topical fusidic acid

204
Q

what syndrome must you look out for with olanzapine/clozapine

A

acute dystonic reaction

205
Q

how long does a section 2 last

A

28 dasy

206
Q

how long Is a section 3

A

6 months

207
Q

how long is a section 136

A

72hrs to take a person to a place of safety

208
Q

what murmur would you expect in turners

A

ejection systolic murmur due to bicupsid aortic valvw

209
Q

potential complication of fragile x

A

mitral valve prolapse

210
Q

long term cardiac complication of turners

A

aortic dissection and dilatation n

211
Q

common cardiac pathology with Duchenne muscular dystrophy

A

dilated cardiomyopathy

212
Q

diet advice for cystic fibrosus

A

high fat high calorie with pancreatic enzymes with every meal

213
Q

presenting features of cystic fibrosis

A

neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice
recurrent chest infections (40%)
malabsorption (30%): steatorrhoea, failure to thrive
other features (10%): liver disease

214
Q

what is used for peri and pre menopausal woman in breast cancer

A

tamoxifen

215
Q

what is used for post menopausal women in breast cancer

A

anastrozole

216
Q

side effects of tamoxifen

A

vte
endometrial cancer

217
Q

when is excision of fibroadenoma indicated

A

more than 3cm

218
Q

hormone levels and management for patient with subclinical hypothyroidsim

A

normal t4 but low raised tsh
give thyroxine

219
Q

what is tangentiality

A

Tangentiality refers to wandering from a topic without returning to it.

220
Q

what is circumstantiality

A

Circumstantiality is the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.

221
Q

young obese boy with groin pain and limp?
management?

A

slipped capital femoral epiphysis
in situ fixation with cannulated screw

222
Q

blood test results for osteogenesis imperfecta

A

normal path, calcium, calcitril, calcidiol

223
Q

most common benign ovarian tumour in women under 25

A

dermoid cyst - teratoma

224
Q

Most common type of ovarian pathology associated with Meigs’ syndrome

A

fibroma

225
Q

ovarian torsion would show what on ultrasound?

A

whirlpool sign

226
Q

why should metaclopramide not be used for more than 5 days in hyperemesis gravid arum

A

risk of extra pyramidical effects such as tremor

227
Q

how would you confirm ovulation

A

take progesterone levels 7 days before next period

228
Q

most common cause of post coital bleeding

A

cervical ectropion

229
Q

first line menorrhagia tx?

A

mirena ius

230
Q

first line tx for gonorrhoea

A

1g im ceftriaxone

231
Q

first line tx for bv and tv

A

ORAL METRONIDAZOLE

232
Q

how to diagnose premature ovarian insufficiency and tx

A

raised fish on two account
HRT till 51 or combined oral contraceptive till 51

233
Q

how to diagnose complete miscarriage on us

A

-The crown-rump length is greater than 7mm OR
-The gestational sack is greater than 25mm

234
Q

thrush first line mx

A

oral fluconazole - not pregnant

pregnant - clomitrazole pessary

235
Q

most common se of ivf

A

ovarian hyperstimulation syndrome

236
Q

what does adding progesterone to HRT do

A

increase risk of breast cancer

237
Q

most common cause of post menopausal bleeding

A

vaginal atrophy

238
Q

prophylaxis for infantile spasms

A

buccal midazolam
rectal diazepam

239
Q

most common cause of horners

A

pan coast tumir

240
Q

pregnant woman with jaundice and itchy skin would indicate ?

A

obstetric cholestasis

241
Q

presentation of molar pregnancy

A

painless vaginal bleeding
excessive morning sickness
SOB

242
Q

BY what week should mother feel feral movements at the latest ?

A

24 weeks if not then refer to FMU

243
Q

Immediate management if pregnant women has confirmed DVT

A

LMWH

244
Q

first line management for reduced fetal movements ?

A

handheld doppler to confirm heartbeat

245
Q

how does blood pressure change throughout pregnancy

A

blood pressure falls in the first trimester
till 24 weeks then begins to increase till term

246
Q

define pregnancy induced htn

A

hypertension post 20 weeks gestation
no proteinuria or oedema

140/90 +

247
Q

most common cause of fever/ infection of post partum woman

A

endometriosis with c section

248
Q

biggest risk factor for PPH

A

placenta accreta

249
Q

guidance on folic acid during pregnancy

A

women should take 4mg before conception
women with raised BMI, epilepsy , fh of neural tube defect to take 5

250
Q

management for acute pulmonary oedema

A

iv furosemide

251
Q

what vaccine should all heart failure have

A

annual influenza

252
Q

what combination therapy is not recommended in heart failure patients

A

ace inhibitor and arb
use spironolactone instead

253
Q

women collapses after PROM? what is the most likely diagnosis

A

Amniotic fluid embolism

254
Q

first line management for mastitis

A

oral flucoxacillin for 10-14 days
continue breastfeeding and expressing

255
Q

what drugs should be avoided in breastfeeding ?

A

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

256
Q

medication of choice to suppress breast feeding

A

cabergoline

257
Q

how would you assess SGA

A

Symphysis fundal height should correlate to gestation by 1-2cm

258
Q

what is HELPP syndrome and how does it present

A

severe pre eclampsia
presents as malaise, headaches, vomiting

259
Q

most important prognostic factor in paracetamol overdose

A

arterial blood gas ph

260
Q

main point for liver transplant in paracetamol overdose

A

ph less than 7.3

261
Q

typical MS patient history

A

young person with relapsing remitting sx

balance issues, increased tone and clonus
pupillary defect

262
Q

what is the alternative to clopidogrel in stroke treatment if it is CI

A

ASPIRIN AND DIPYRIDAMOLE

263
Q

mechanism of ondansetron

A

5 HT3 ANTAGONIST

264
Q

vision worse going down stairs ?

A

4th nerve palsy

265
Q

MANAGEMENT Of brain abscess

A

cephalosporin + metronidazole

266
Q

what blood test will differentiate between true seizure and pseudoseizue

A

prolactin

267
Q

what obstetric condition would cause painless vaginal bleeding

A

placenta previa-
placenta completely or partially covers the cervix

268
Q

chorionic villi invade the myometrium but not the perimetrium

A

placenta accrete

269
Q

timeframe for cat 1 c section

A

30 mins

270
Q

presentation of chorioamnionitis

A

uterine tenderness and foul smelling discharge

271
Q

scale for post natal depression

A

Edinburgh scale

272
Q

what would variable decelerations indicate

A

cord compression

273
Q

what would early decelerations indicate

A

head compression

274
Q

what would late declarations indicate

A

placental insufficiency

275
Q

adrenaline doses for anaphylaxis

A

under 6 months - 100-150mcg
6m-6yrs- 150mcg
6-12- 300mcg
12+ -500mcg

276
Q

most useful test to establish anaphylaxis

A

serum tryptase

277
Q

define threatened miscarriage

A

painless vaginal bleeding , cervical os is closed

278
Q

define missed miscarriage

A

gestational sac contains a dead foetus but remaining utero

279
Q

define inevitable miscarriage

A

cervix is dilated, heavy bleeding , clots and pain

280
Q

define incomplete miscarriage

A

not all products have been expelled , pain and vaginal bleeding

281
Q

ectopic pregnancy RF

A

damage to tubes- pID
previous ectopic
IUCD
progesterone pill
IVF

282
Q

wha measurement would make you consider hydratiform mole

A

excess bhcg 300,000

283
Q

typical px of hand foot and mouth

A

fever then ulcers in mouth
red spots on hands and feet

284
Q

what is hand foot and mouth caused by

A

coxsackie a16
more rare enterovirus 71

285
Q

biggest risk factor for toxic shock syndrome

A

use of tampons

286
Q

hormone findings in kallman syndrome

A

low fhs/lh
low testoerone

287
Q

key unique finding of pt with kallman syndrome

A

taller than average
anosmia - no smell

288
Q

post MI drugs

A

Ace inhibitor
Beta blocker
statin
aspirin
ticagrelor

289
Q

reasons for PCI with NSTEMI/ UNSTABLE ANGINA

A

IMMEDIATE- patient is hypotensive or clinically unstable
within 72 hrs- if GRACE score is above 3%

290
Q

a patient develops acute HF 5 days post MI ? what is this and what is heard

A

Ventricular septal defect
new pan systolic murmur
raised JVP
bi basal crackles

291
Q

characteristics of acute epiglottis and its cause

A

tripod position - neck extended
haemophillus influenzae

292
Q

main points about polymyalgia rheumatica

A

ESR is raised
shoulder and neck pain
difficulty getting out of chair
morning stiffness
ORAL PREDNOSOLONE

293
Q

management of stroke if pt presents within 4.5hrs and no evidence of haemorrhagic stroke

A

aspirin 300mg
thrombolysis with alteplase within 4.5h and thrombectomy within 6h

294
Q

does amaurosis fugax cause ipsilateral or contralateral vision problems

A

ipsilateral

295
Q

After what period of time would continued lochia warrant further investigation with ultrasound?

A

loch

296
Q

what is bhcg secreted by

A

syncitiotrophoblasts

297
Q

guidance regarding methotrexate in conception

A

both men and women should stop for 6 months

298
Q

classic triad of sx for vasa previa

A

painless vaginal bleeding
rupture of membranes
bradycardia

299
Q

normal pregnancy lab findings

A

Reduced urea, reduced creatinine, increased urinary protein loss

300
Q

A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers is typical for ?

A

edwards

301
Q

most common fracture in childhood abuse

A

humeral fracture

302
Q

neonatal causes for jaundice

A

rubella
syhphillis
G6PD def
haematome

303
Q

possible complication If biliary atresia is not sorted

A

kernicketerus

304
Q

treatment for neonatal jaundice

A

phototherapy
exchange transfusion

305
Q

signs of cyanotic heart disease

A

poor feeding, dyspnoea, tachycardia, weak pulse, engorged neck veins, sweating, gallop

306
Q

risk factors for respiratory distress syndrome

A

maternial diabetes
c section
second twins
males
hypothermia
perinatal asphyxia

307
Q

what cells produce surfactant

A

type 2 pneumocytes

308
Q

patient loses conciosunes sbrifefly regains then loses again is what type of stroke

A

SUBDURAL HAEMATOMA

309
Q

what medication commonly causes Steven Johnson syndrome

A

carbamezapine

used in epilepsy, trigeminal neuralgia

310
Q

DVLA rules on epilepsy

A

6months no driving with first unprovoked sezure
12 months seizure free for epileptics

311
Q

nerve root for biceps reflex

A

c5-c6

312
Q

cushings triad ?

A

widening pulse pressure
hypertension
bradycardia

313
Q

how would a pontine haemorrhage present

A

reduced GCS
paralysis
pinpoint pupils

314
Q

medications for neuropathic pain

A

amitryptyline
duloxetine
gabapentin
pregablin

315
Q

what is de clerambaults syndrome

A

erotomania - delusion that someone famous is in love w th them

316
Q

what is de fregoli syndrome

A

delusion that identifying a familiar person in various people they encounter

317
Q

indications for catatonia

A

treatment resistant severe depression
manic episodes
life threatening catatonia

318
Q

what is conversion disorder

A

functional neurological disorder

319
Q

what is somatosisation disorder

A

patient feels multiple sx but ni tests can provide any answer

320
Q

what is a common SE of nexplanon and how can it be treated

A

irregular menstrual bleeding
three month course of COCP

321
Q

what are the common extra pyramidal se of typical antipsychotics

A

Parkinsonism
acute dystonia
tardily dyskinesia
akathisia

322
Q

what is tardive dyskinesia

A

repetitive involuntary movement such as pouting mouth

323
Q

what are the feature of acute dystonia

A

torticollis
oculogyric crisis
mouth open
pain and distress

324
Q

what is neologism

A

making up new words

325
Q

what is perseveration

A

repeating the same words/ answers

326
Q

what is catatonia

A

Stopping of voluntary movement or staying still in an unusual position

327
Q

drug related Parkinson would present how?

A

with a bilateral resting tremor

328
Q

management for acute dystonia

A

IM PROCYCLIDINE

329
Q

management for tardike dyskinesia

A

tetrabenezine

330
Q

what is akathisia and management

A

restlessness
propranolol

331
Q

what is a section 2

A

admission for up to 28 days
APHM on the recommendation of two doctors
tx can be given without wishes

332
Q

what is a section 3

A

6 months - can be renewed
pt must have been seen within past 24hrs
tx can be given against wishes

333
Q

what is a section 4

A

72hr assessment
used as an emergency
often changed to a section 2 once at hospital

334
Q

what is a section 5

A

voluntary patient can be legally detained by a doctor for 72hrs

335
Q

section 136

A

24hrs
someone found in public space can be taken to a place of safety by the police

336
Q

what do you give to a pt who presents with confusion agitation with liver cirrhosis/ without

A

with liver cirrhosis-lorazepam

without- chlordiazepoxide

337
Q

most common cause of IE within 2 months of valve replacement and after 2 months

A

within 2 months - s epidermis
after2 months - s aureus

338
Q

mc location site of infective endocarditis

A

IVDU- tricupsid
MITRAL FOR EVERYONE ELSE

339
Q
A

passmed 3a (3 decks)

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