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Question 1

what are the macroscopic and microscopic and biochemical changes in alzheimers disease?

Answer 1

macroscopic: widespread cerebral atrophy, particularly involving the cortex and hippocampus
microscopic: cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein. Hyperphosphorylation of the tau protein has been linked to AD
biochemical: there is a deficit of acetylcholine from damage to an ascending forebrain projection

Question 2

what antipsychotic should be avoided in parkinsons?

Answer 2

haloperidol - it is a dopamine antagonist

Question 3

what antidepressant should not be used in those with Alzheimer’s?

Answer 3

. One example of this is the use of tricyclic antidepressants in patients with dementia, due to the risk of worsening cognitive impairment.

Question 4

what levels of drop in BP count as postural hypertension?

Answer 4

a. A drop in systolic BP of 20mmHg or more (with or without symptoms)
b. A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without symptoms)
c. A drop in diastolic BP of 10mmHg with symptoms (although clinically much less significant than a drop in systolic BP).

Question 5

what score is used to assess pressure sores?

Answer 5

waterlow score

Question 6

what is the action of memantine and when is it used?

Answer 6

NMDA receptor antagonist

used in Alzheimer’s

Question 7

what are the features of acute fatty liver of pregnancy?

Answer 7

abdominal pain
nausea & vomiting
headache
jaundice
hypoglycaemia
severe disease may result in pre-eclampsia

Question 8

what are the features of cholestasis of pregnancy?

Answer 8

pruritus, often in the palms and soles
no rash (although skin changes may be seen due to scratching)
raised bilirubin

Question 9

what is the RMI and what are the three components?

Answer 9

RMI is a pre-surgical prognostic criteria

it is based on CA125 levels, menopausal status and US findings

Question 10

what cancers does the combined oral contraceptive pill increase and decrease the risk of?

Answer 10

increases risk of breast and cervical cancer

protective against ovarian and endometrial cancer

Question 11

how are fibroids managed if fertility is wanted?

Answer 11

myomectomy

Question 12

A 19-year-old woman who is 9 weeks into her first pregnancy is seen in the early pregnancy assessment unit with vaginal bleeding. Her ultrasound scan confirms a viable intrauterine pregnancy. However, the high vaginal swab has isolated group B streptococcus (GBS). How should she be managed?

Answer 12

intrapartum IV benzylpenicllin

Question 13

where is an ectopic pregnancy likely to occur?

Answer 13

the isthmus of the fallopisan tube

Question 14

how should you manage a woman who has come into contact with chickenpox for the first time in pregncny?

Answer 14

varicella zoster immunoglobulin

Question 15

what is tranexamic acid used for?

Answer 15

heavy menstrual bleeding

Question 16

how should dysmenorrhoea be managed?

Answer 16

mefenamic acid

Question 17

what is an absolute contraindication to caesarean section?

Answer 17

previous vertical caesarean scar

Question 18

A 35-year-old obese gravida 3 para 2 has developed a swollen and tender left leg; she is currently at 32 weeks of gestation and started on the appropriate treatment regimen. Due to her weight, the clinician decides to monitor her treatment with a specific blood test. Which blood test is this?

Answer 18

Anti-Xa activity

The guidance states that: ‘In clinically suspected DVT or PE, treatment with low-molecular-weight heparin (LMWH) should be commenced immediately until the diagnosis is excluded by objective testing, unless treatment is strongly contraindicated.’

The guidance also states that: ‘Routine measurement of peak anti-Xa activity for patients on LMWH for treatment of acute VTE in pregnancy or postpartum is not recommended except in women at extremes of body weight (less than 50 kg and 90 kg or more) or with other complicating factors (for example, with renal impairment or recurrent VTE).’ and that ‘Routine platelet count monitoring should not be carried out.’

Question 19

how do you medically manage a miscarriage?

Answer 19

misoprostol

Question 20

what is laryngomalacia and how does it present?

Answer 20

Laryngomalacia is a very common, benign cause of noisy breathing in infants
Laryngomalacia should be suspected in an otherwise well infant with noisy breathing. It is caused by a congenital softening of the cartilage of the larynx, causing collapse during inspiration. Laryngomalacia can present at birth, and worsens in the first few weeks of life. It usually self-resolves before 2 years of age.

Question 21

when a child is on Ritalin (Methylphenidate) what do you need to monitor?

Answer 21

Methylphenidate, a stimulant, may suppress appetite and cause growth impairment in children. It is advised to monitor growth as well as blood pressure and pulse in these patients on a regular basis.

Question 22

what score is used to assess the health of a new born baby?

Answer 22

apgar

Question 23

You are working in a busy emergency department. A worried mother brings her 3-year-old boy to see you. He has been crying excessively for the last 12 hours and has had bilious vomiting on multiple occasions. The boy passed one stool around 2 hours ago which contained small amounts of blood.

With the patients likely diagnosis what initial investigation would you do?

Answer 23

Ultrasound is the investigation of choice for intussusception

Question 24

when should you consider pneumonia in children?

Answer 24

Consider a diagnosis of pneumonia if the child has:
high fever (over 39°C) and/or
persistently focal crackles.

Question 25

what is a poor prognostic factor in congenital diaphragmatic hernias?

Answer 25

the presence of the liver in the thoracic cavity

Question 26

where is the most common location for a hypospadias to occur?

Answer 26

distal, ventral surface of the penis

Question 27

what are the major risk factors for sudden infant death syndrome?

Answer 27

prone sleeping
parental smoking
bed-sharing
hyperthermia and head covering
prematurity

Question 28

when do you see a strawberry tongue?

Answer 28

scarlet fever

kawasaki

Question 29

what are the features of pyloric stensosis?

Answer 29

‘projectile’ vomiting, typically 30 minutes after a feed
constipation and dehydration may also be present
a palpable mass may be present in the upper abdomen
hypochloraemic, hypokalaemic alkalosis due to persistent vomiting

Question 30

how is coeliac disease diagnosed?

Answer 30

IgA TTG antibodies

Question 31

what is the emergency treatment of croup?

Answer 31

high-flow oxygen

nebulised adrenaline

Question 32

what are the signs of normal pressure hydrocephalus?

Answer 32

wet wacky and wobbly
urinary incontinence
dementia
gait abnormality - ataxia

Question 33

what is a bartholins cyst and how is it managed?

Answer 33

Bartholin’s glands are a pair of glands located next to the entrance to the vagina. These are normally about the size of a pea, but can become infected and enlarge - forming a Bartholin’s abscess.

This can be treated by antibiotics, by the insertion of a word catheter or by a surgical procedure known as marsupialization.

Question 34

how long should children be excluded from school if they have whooping cough?

Answer 34

A child with whooping cough should be excluded from school for 48 hours following commencement of antibiotics

Question 35

what are the symptoms spontaneous intracranial hypotension?

Answer 35

Spontaneous intracranial hypotension

Spontaneous intracranial hypotension is a very rare cause of headaches that results from a CSF leak. The leak is typically from the thoracic nerve root sleeves.

Risk factors include connective tissue disorders such as Marfan’s syndrome.

Key features
strong postural relationship with the headache generally much worse when upright. Patients may, therefore, be bed-bound

Investigations
MRI with gadolinium: typically shows pachymeningeal enhancement

Management
usually conservative
if this fails an epidural blood patch may be tried