Passmed 2

Question 1

Side effects of ECT

Answer 1

Immediate side effects
-Drowsiness
-Confusion
-Headache
-Nausea
-Aching muscles
-Loss of appetite

Long term side effects
-Apathy
-Anhedonia
-Difficulty concentrating
-Loss of emotional responses
-Difficulty learning new information

Question 2

Retrograde amnesia is

Answer 2

difficulty remembering events prior to injury

Question 3

Anterograde amnesia is

Answer 3

loss of ability to form new memories after the insult

Question 4

Anaesthetic drug that can cause rise in intraocular pressure

Answer 4

Suxamethonium, Oxybutinin

Question 5

Orbital swellings are classified based on what classification system

Answer 5

Chandler classification
I. Pre-septal cellulitis
II. Orbital cellulitis without abscess
III. Orbital cellulitis with subperiosteal abscess
IV. Intra-orbital abscess
V. Cavernous sinus thrombosis

Question 6

Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for oesophageal cancer in people with dysphagia, or aged 55 and over with weight loss and any of the following:

Answer 6

Upper abdominal pain

Reflux

Dyspepsia

Question 7

Marfans syndrome
- mode of inheritance
- caused by

Answer 7

autosomal dominant

caused by defect in the FBN1 gene on chromosome 15
- codes for protein fibrillin-1

Question 8

Referral criteria for nausea and vomiting in pregnancy

Answer 8

Admission if:
1. Continued N+V and unable to keep down fluids or oral antiemetics

2. Continued N+V w/ ketonuria and/or weight loss (greater than 5% of body weight) despite tx with oral Abx
3. Confirmed or suspected comorbidity (for example unable to tolerate oral abx for UTI)

Treatment = IV Saline with added potassium

Question 9

3 day old male admitted with bilious vomiting and reduced feeding.
Born 30 weeks gestation via uncomplicated delivery.

Abdo X-ray is requested that shows intramural gas.

Oral feeding stopped and started on broad spec Abx.

likely diagnosis:

Answer 9

Necrotising enterocolitis
- pneumatosis intestinalis is a hallmark feature

Question 10

Causes of euvolaemic hyponatraemia

Answer 10

1. SIADH (retention of pure water dilutes sodium further)
2. Hypothyroidism

Question 11

Categorising asthma into moderate, severe and life-threatening

Answer 11

Moderate
- 50-75% best or predicted
- Speech normal
- RR < 25 / min
- Pulse < 110 bpm

Severe
- 33-50% best or predicted
- can’t complete sentences
- RR > 25/min
- Pulse > 110 bpm

Life-threatening
- < 33% best or predicted
- oxygen sats < 92%
- silent chest, cyanosis or feeble respiratory effort
- bradycardia, dysrhythmia or hypotension
- exhaustion, confusion or coma

Question 12

Development of rash (erythema marginatum) combined with arthritis and pan systolic murmur following recent sore throat is indicative of what condition

Answer 12

Rheumatic fever

Question 13

first line treatment for rheumatic fever

Answer 13

one of dose of IM BENZYLPENICILLIN

oral pen v can be given too

Question 14

1st line tx for lichen planus

Answer 14

topical betamethasone

Question 15

what ECG changes are associated with Wolff-Parkinson White syndrome?

Answer 15

Short PR interval

W: Waves -> delta waves;
P: PR interval shortened;
W: Wide QRS

Question 16

4 Ts of PPH

Answer 16

Tone - uterine atony

Trauma (perineal tear)

Tissue (Retained placenta)

Thrombin (e.g. clotting / bleeding disorder)

Question 17

Management of PPH

Answer 17

ABCDE
- two peripheral large bore 14 gauge cannula
- lie woman flat
- bloods –> group and save
- commence warmed crystalloid infusion

Mechanical
- palpate uterine fundus to stimulate contractions
- catheterisation to prevent bladder distention and monitor urine output

Medical
- IV oxytocin: slow IV injection followed by an IV infusion
- Ergometrine slow IV or IM (unless HTN pmh)
- Carboprost IM (unless asthma)
- misoprostol sublingual
- tranexamic acid

Surgical
-1st line intrauterine balloon tamponade
- B lynch suture
- ligation of uterine arteries or internal iliac arteries

Question 18

Investigation of choice for vesicouteric reflux

Answer 18

Normally diagnosed following a micturating cystourethrogram

DMSA scan may also be performed to look for renal scarring

Question 19

How might you diagnose primary ovarian insufficency

Answer 19

Raished FSH, LH levels

FSH > 40

Elevated FSH should be shown on two blood samples taken 4-6 weeks apart

Question 20

Acute epiglottitis pathogen

Answer 20

Haemophilus influenza type B

Question 21

This is a condition in which scar tissue adhesions form within the uterus (often following uterine surgeries), causing amenorrhoea.

Answer 21

ashermans syndrome

Question 22

32 F

pc: sudden onset dizziness, describes it as the room spinning.

No hearing loss or tinnitus.

Can occur at rest + during activity

No specific movements exacerbate the symptoms, apart from feeling slightly run down a week prior.

Likely diagnosis

Answer 22

Vestibular neuritis

Notes
- not positional, unlikely to be BPPV
- no signs of infection: unlikely to be otitis media
- no hearing loss: labyrinthitis associated with hearing loss which she denies

Question 23

What test is performed on symptomatic patients to differentiate between peripheral and central causes of vertigo?

Answer 23

Head impulse test

Question 24

infective conjunctivitis management

Answer 24

• normally self limiting 1-2 weeks
• topical abx therapy often given
• chloramphenicol drops or ointment
• Fusidic acid if pregnant women BD

If contact lens wearer
- identify any corneal staining with topical fluoresceins
- treat as above

Don’t share towels

No school exlcusion

Question 25

1st line for spasticity in multiple sclerosis

Answer 25

Baclofen and gabapentin

Question 26

contraception contraindicated post partum

Answer 26

COCP
- absolute contraindication less than 6 weeks post partum

• combined hormonal contraceptives reduce breast milk volume

Mirena and IUD can be used 4 weeks post partum,

POP can be started 21 days post partum.

Progestogen implant can be inserted at any tine.

Question 27

Sign associated with shingles

Answer 27

Hutchinson’s sign
- vesicles extending to the tip of the nose
- strongly associated with ocular involvement in shingles