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AA Y4 Finals cards NE > PassMed/CAP notes > Flashcards

PassMed/CAP notes Flashcards

1
Q

compare the classes of drug that clopidogrel and rivaroxiban and apixiban are?

compare their uses?

A

clopidogrel - anti platelet

rivaroxiban, apixiban- anti coagulant (specifically, DOACs)

clopidogrel is used for arterial diseases (stroke, PE etc)

DOACs are used for venous diseases (atrial fibrillation)

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2
Q

what can concurrent use of trimethoprim and methotrexate cause

A

bone marrow suppression and pancytopenia

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3
Q

what is the length of warfarin treatment in both provoked (surgery) and unprovoked VTEs?

A

provoked: 3 months
unprovoked: 6 months

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4
Q

which skin condition is regarded as a cutaneous manifestation of coeliac disease?

what HLA subtype is it associated with?

A

dermatitis herpetiformis (an itchy, vesicular rash)

HLA-DR3

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5
Q

what form of UV light is used 1st line in secondary care for psoriasis?

A

UVB

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6
Q

what is the 1st line treatment for impetigo in patients who are not systemically unwell or at risk of complications?

A

hydrogen peroxide 1% cream

NICE announced the change in 2020

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7
Q

name the 1st and 2nd line treatments for scabies?

A

1st: permethrin
2nd: malathion

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8
Q

what is the treatment for dermatophyte nail infections?

A

oral terbenafine

“T for Toes!”

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9
Q

what dermatological manifestation may be present in Crohn’s disease and ulcerative colitis?

A

pyoderma gangrenosum

coeliac = dermatitis herpetiformis

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10
Q

describe the later features of pyoderma gangreonsum?

A

a painful, purple ulcer with undetermined borders

the ulcer can be deep and necrotic

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11
Q

which medication class has been implicated in the development and exacerbation of periorificial dermatitis?

A

topical steroids (hydrocortisone)

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12
Q

how can spider naevi be differentiated from telangiectasia?

A

by pressing down on them and watching how they refill…

telangiectasia: fill from the edge

spider naevi: fill from the centre

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13
Q

what is the most common cause of erythema multiforme?

A

herpes simplex virus

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14
Q

how does treatment of flexural psoriasis differ from that of extensor psoriasis?

A

skin in the flexor regions tends to be thinner, so a milder topical steroid should be used

also, there isn’t much evidence that topical vit D treatments are effective in flexural psoriasis

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15
Q

who should tetracyclines be avoided in?

A

pregnant women and kids <12 y/o

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16
Q

which class of drugs are known to precipitate renal failure in patients with multiple myeloma?

A

NSAIDs

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17
Q

in which patient groups are CMV packed red cells recommended for?

A

pregnant patients

neonatal transfusions

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18
Q

which cells are specifically increased in number in chronic myeloid leukemia?

A

high white cell count

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19
Q

which 2 haematological conditions are associated with the JAK2 mutation?

A

myelofibrosis

polycythaemia vera

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20
Q

how is polycythaemia vera treated?

A

aspirin

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21
Q

which cardiovascular drug is known to exacerbate plaque psoriasis?

A

beta blockers

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22
Q

what happens to the reticulocyte count in patients having a sequestration crisis?

A

retic count increases

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23
Q

which haematological condition is defined as an isolated low platelet count with normal bone marrow?

how is it treated?

A

immune (or ideopathic) thrombocytopenic purpura

Tx = oral prednisolone, or if asymptomatic in children and platelet count is >30, then it is self limiting- advice is given to avoid contact sports

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24
Q

how is immune thrombocytopenic purpura treated?

A

oral prednisolone

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25
Q

what haematological conditions cause abdominal pain and neuro symptoms in 20-40 year olds?

A

porphyrias

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26
Q

what is the most useful test to establish if someone has polycythemia rubra vera?

A

JAK 2 mutation

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27
Q

how is the definitive diagnosis made in cases of sickle cell disease?

A

haemoglobin electrophoresis

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28
Q

what are “mirror image nuclei” more commonly known as?

what condition are they found in?

A

reed Sternberg cells

hogkin’s lymphoma

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29
Q

which haematological condition predisposes the RBCs to increased oxidative stress?

A

G6PD deficiency

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30
Q

what condition are bite cells and blister cells typical of on blood film?

A

G6PD deficiency

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31
Q

name the 2 abnormal findings seen on blood film in coeliac disease?

A

target cells

Howell-jolly bodies

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32
Q

which test is diagnostic in hereditary spherocytosis?

A

EMA binding test

sickle cell = Hb electrophoresis

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33
Q

which haematological condition typically presents with abdominal, neuro and psych symptoms?

A

acute intermittent porphyria

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34
Q

when should the COCP be stopped prior to surgery?

A

4 weeks

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35
Q

what is the name of the mutated chromosome seen in chronic myeloid leukaemia?

A

Philadelphia chromasome

t(9;22)

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36
Q

what 3 possible diagnoses do “tear drop” cells on blood film suggest?

A

myelofibrosis

thalassemia

megaloblastic anaemia

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37
Q

what on a blood film would indicate hyposplenism?

A

Howell jolly bodies

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38
Q

what is the most common inherited thrombophillia?

A

factor V leiden (activated protein C resistance)

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39
Q

what is the most common inherited bleeding disorder?

A

von willebrand’s disease

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40
Q

how is antiphospohlipid syndrome managed in pregnant women or those with previous thrombotic events?

A

aspirin and LMWH

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41
Q

how is APS managed in patients thought to be high risk, but never having had a thrombotic event before?

A

aspirin

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42
Q

what is the most likely cause of hair loss in a women who is 10 weeks post partum with no sig PMH?

A

telogen effluvium

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43
Q

what causes asymptomatic, shiny patches on the lower legs of diabetics, with yellow/red discolouration and associated telangiectasia?

A

necrobiosis lipoidica diabeticoru

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44
Q

what is the most likely cause of an itchy alopecia measuring 3cm diameter in a 5 y/o?

A

tinea capitis

do skin scrapings to be sure

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45
Q

what is the most appropriate symptomatic treatment for an old man with generalised itch due to severe kidney disease?

A

UVB phototherapy

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46
Q

what would be the main histological feature seen on biopsy of acute dermatitis?

A

spongiosis

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47
Q

what is the most appropriate management for a suspected melanoma?

A

urgent excision with 2mm margins

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48
Q

what is the most likely diagnosis in someone with short lived itchy lesions

A

urticaria

the individual itchy lesions dont last for more than 24 hours usually

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49
Q

in which condition is heliotrope rash seen as a cutaneous feature?

A

dermatomyositis

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50
Q

in which leukaemia is there an increase in granulocytes at different stages of maturation +/- thrombocytosis

A

chronic myeloid leukemia

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51
Q

name the 4 causes of renal impairment in myeloma?

A

AL amyloidosis
bence jones neuropathy
nephrocalcinosis
nephrolithiasis

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52
Q

what are the 2 most common causes of hypercalcemia?

A

malignancy (multiple myeloma)

hyperparathyroidism

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53
Q

In haematology, what does a raised LDH indicate?

A

RBC lysis

indicative of haemolysis

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54
Q

what condition can be diagnosed with a positive Coombs test?

A

haemolytic anaemia

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55
Q

what lymphoma can a stable, chronic lymphocytic leukaemia transform to?

what is the name given to this so called transformation?

A

CLL can transform to a high grade lymphoma

known as richter’s transformation- it makes patients suddenly unwell

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56
Q

what is immune thrombocytopenia ?

A

an immune mediated reduction in the platelet count

1st line tx: oral prednisolone

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57
Q

which cause of leukaemia often presents worth a sense of fullness? why do these patients feel full?

A

chronic myeloid leukaemia

massive splenomegaly causes sense of fullness

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58
Q

in a patient who is deficient in both vit B12 and folic acid, which should be treated 1st? why?

A

treat the vit B12 deficiency 1st

treating the folic acid 1st could result in subacute combined degeneration of the cord

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59
Q

what is the 1st line medication given in PPH?

A

syntocinon/oxytocin
or
ergometrine

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60
Q

what is the treatment of choice for VTE prophylaxis in pregnancy?

what medications should be avoided for VTE prophylaxis in pregnancy?

A

1st line: LMWH

avoid: DOACs and warfarin

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61
Q

what is the 1st line medication given for gestational diabetes?

A

metformin

insulin can be added in if metformin alone does not reduce blood sugars

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62
Q

what is the 1st line medication given in the active management of stage 3 of labour?

A

oxytocin by IM injection

reduces risk of PPH

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63
Q

in labour, a Bishop’s score less than what suggests that labour is unlikely to start spontaneously?

A

Bishop’s score <5

A bishops score >9 suggests labour will occur spontaneously

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64
Q

compare what risks are increased when oestrogen only or combined oestrogen and progesterone are given in HRT?

A

oestrogen: endometrial cancer

Progesterone: breast cancer

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65
Q

what is the investigation of choice for an ectopic pregnancy?

A

transvaginal U/S

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66
Q

where in the Fallopian tube does an ectopic pregancy have the highest risk of rupture?

A

The isthmus

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67
Q

what can be used to treat vasomotor symptoms in menopause?

A

SSRIs

fluoxetine or citalopram

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68
Q

what is the medication of choice for suppressing lactation?

name a drug that has the opposite action to this?

A

cabergoline

it is a dopamine receptor agonist - dopamine inhibits prolactin production

metoclopramide is a dopamine receptor antagonist - it can cause hyperprolactinemia

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69
Q

what condition causes low mood, sleep disturbance and headaches just before the onset of a period? the symptoms resolve just before onset of period…

A

pre menstrual syndrome

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70
Q

how can pre menstrual syndrome be treated?

A

1st line = lifestyle - small, balanced diet in complex carb rich meals

COCP

SSRIs can be taken if severe symptoms

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71
Q

when can the copper IUD be used as emergency contraception?

A

if it is inserted up to 5 days after the UPSI
OR
if it is inserted up to 5 days after the likely ovulation date

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72
Q

what is the most common ovarian cancer?

A

serous carcinoma

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73
Q

which type of ovarian cancer can be referred to as chocolate cysts due to the external appearance?

A

endometriotic cyst

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74
Q

what is the most common type of ovarian CYST?

how are they managed?

A

follicular cyst

they normally regress over several menstrual cycles

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75
Q

what is the investigation of choice for gestational diabetes?

A

oral glucose tolerance test @24-28 weeks

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76
Q

which form of emergency contraception is:

  • safe in severe asthma
  • safe in breastfeeding
  • can begin hormonal contraception immediately after taking it?
A

levonorgestrel

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77
Q

what are the SSRIs of choice in breast-feeding women?

A

sertraline

paroxetine

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78
Q

when is an oral glucose tolerance test carried out in obese pregnant women?

A

24-28 weeks

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79
Q

compare the drug class of mefanamic acid and tranexamic acid?

A

mefanamic acid: NSAID

tranexamic acid: antifibrinolytic

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80
Q

what is the 1st line treatment for primary dysmenorrhoea ?

A

NSAIDs

mefenamic acid, naproxen, ibuprofen

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81
Q

which 2 conditions is cervical excitation found in?

A

ectopic pregancy

pelvic inflammatory disease

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82
Q

which medication is a cause of folic acid deficiency?

A

phenytoin

an anti epileptic

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83
Q

what is the most common identifiable cause of postcoital bleeding?

A

cervical ectropion

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84
Q

what is the causative bacteria in group B streptococcus infections?

A

strep agalacticae

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85
Q

compare the medications prescribed in stress and urge incontinence ?

A

stress: duloxetine
urge: oxybutynin

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86
Q

which form of HRT does not appear to increase risk of VTE?

A

transdermal HRT

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87
Q

what are the 2 main roles of the booking scan that occurs between 11-13 weeks gestation?

A
  • if there is a viable intrauterine pregancy

- the number of babies

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88
Q

which 3 infectious diseases are screened for at the 12 week booking scan?

A
  • HIV
  • Hep B
  • Syphilis
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89
Q

when is the 1st scan to check the location of the placenta?

A

the 20 week anomaly scan

if it is low, women are offered another scan at 34 weeks

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90
Q

parity refers to the number of deliveries after how many weeks gestation?

A

24 weeks

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91
Q

in a patient with pre-eclampsia, what investigations are done to exclude HELLP syndrome?

A

FBC, LFTs, urine PCR

urinary PCR will help you quantify. the amount of protein in the urine

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92
Q

what is the most accurate measurement for predicting intrauterine growth restrictions?

A

abdominal circumference

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93
Q

what is the chromosome abnormality seen in Edward’s syndrome?

A

trisomy 18

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94
Q

why are patients at risk of hypocalcemia during a massive blood transfusion?

A

due to the citrate preservative

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95
Q

which fetal investigation can detect sickle cell disease in the fetus?

A

chorionic villous sampling at 11-13+6 weeks

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96
Q

which is the only condition that presents with a bisferiens pulse (a double pulse)?

A

HOCM

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97
Q

in AF, what is the CHAzDSz-VASc score used to measure?

A

the risk of stroke in AF

0: no treatment
>2: offer anticoagulation

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98
Q

what are the 1st line anticoagulants offered in AF?

A

DOACs

(apixaban, rivaroxaban, dabigatran)

warfarin is 2nd line, aspirin is not recommended

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99
Q

compare when carotid sinus massage or valsava manoeuvre would be most appropriate in 1st line SVT tx?

A

carotid sinus massage: reserved for younger patients who are at a low risk of stroke

valsava manœuvre: older patients who are haemodynamically stable, but at risk of stroke

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100
Q

how does a valsava manoeuvre work?

A

it aims to increase the blocking at the AV node

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101
Q

what is the next line of tx in SVT if vagal manoeuvres are unsuccessful?

A

IV adenosine

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102
Q

in which patient group is IV adenosine contraindicated?

A

asthmatics

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103
Q

which form of haematoma is most common in elderly people? why?

A

subdural haematoma

cerebral atrophy that occurs with ageing puts more tension on the bridging veins, making them more susceptible to rupture

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104
Q

what is the 1st line treatment for osteoporosis?

what class of drug is this?

A

alendronate

a biphosphonate

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105
Q

what 2 supplements should those with osteoporosis be given?

A

vit D supplementation

calcium supplementation

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106
Q

if alendronate cannot be tolerated, what other 2 biphosphonates can be tried?

A

risedronate or etidronate

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107
Q

what is the method of action of biphosphonates?

A

they inhibit osteoclasts

this reduces demineralisation in bone

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108
Q

name 5 side effects of biphosphonates?

A
  1. oesophageal reactions (oesophagitis or oesophageal ulcers)
  2. increased risk of stress fractures
  3. osteonecrosis of the jaw
  4. acute phase response: fever, myalgia and arthralgia
  5. hypocalcaemia: due to reduced calcium efflux from the bone
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109
Q

when are US indicated in kids with UTIs?

A

if recurrent UTI or a complicated UTI in a child <6mths= US in the acute infection

if it is a UTI that isn’t recurrant and responds well to treatment: no US required in acute infection

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110
Q

in which cases is an US required 6 weeks following a peadiatric UTI?

A

in uncomplicated, non-recurrant UTIs

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111
Q

in which genetic condition are patients short for their age and show no signs of puberty?

A

turner’s syndrome

chromosome 45

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112
Q

what class of drugs cause Parkinsonism?

A

anti psychotics

eg: prochlorperazine (1st generation anti psychotics mostly)

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113
Q

which class of drugs cause Parkinsonism and which have anti-cholinergic side effects ?

A

Parkinsonism: anti psychotics

anti-cholinergic side effects: TCA anti-depressants

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114
Q

what is the most common cause of stridor in infancy?

describe this condition?

A

laryngomalacia

a congenital softening of the tissues of the larynx

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115
Q

when is stridor due to laryngomalacia usually more noticeable?

A

when the baby is sleeping on their back, crying or excited

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116
Q

how is laryngomalacia treated?

A

symptoms usually resolve on their own by 18-24 months of age

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117
Q

which benign laryngeal disease is associated with chronic tobacco abuse and gatrooesophageal reflux disease?

A

reine’s oedema

it causes a long term, deep, hoarse voice but no dysphagia or haemoptysis

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118
Q

what is infectious mononucleosis (glandular fever) caused by?

A

epstein barr virus

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119
Q

what drug should be avoided in cases of infectious mononucleosis?

A

amoxicillin: it causes a maculopapular, puritic rash in 99% of patients

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120
Q

which drug used in heart failure can cause a deterioration in renal functioning?

A

furosemide

it is a powerful loop diuretic which can lead to dehydration and subsequent impaired renal function

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121
Q

what is the “M” rule in primary biliary cholangitis?

A

IgM
M2 subtype
anti-Mitochondrial antibodies
Middle aged women

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122
Q

which condition has swelling over the extensor pollicis breves tendon and the abductor pollicis longus?

A

De Quervain tenosynovitis

Finkelstein’s test is also positive

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123
Q

what use do triptans have in migraine management?

A

triptans = ACUTE phase

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124
Q

name the 2 medications that can be used for migraine prophylaxis?

A

topiramate or propranolol

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125
Q

what is the medication of choice for migraine prophylaxis in pregancy?

A

propranolol

126
Q

which nerve root radiculopathy would mean patients can’t stand on their toes and depress their ankle jerk?

A

S1 radiculopathy

127
Q

what are the 2 drugs that are recommended as 1st line for hypertension in pregancy?

A
  1. labetalol

2. methyl dopa

128
Q

what virus causes shingles?

A

varicella ZOSTER virus (a type of herpes virus)

not herpes simplex (it is cold sores (HSV-1) and genital herpes (HSV-2))

129
Q

name 2 conditions that varicella zoster virus causes?

A

shingles

chickenpox

130
Q

which type of antibiotics have a B-lactam ring?

A

penicillins

131
Q

which hepatitis is common in developing countries with poor access to hygiene and sanitation?

A

Hep A

132
Q

which medication is used for treatment resistant schizophrenia?

A

clozapine

133
Q

are wide based-gait ataxia and ophthalmoplegia symptoms of wenickie’s encephalopathy or Korsakoff’s syndrome?

A

wernickie’s encephalopathy

134
Q

what is the investigation of choice in a suspected gastric ulcer perforation?

A

erect CXR

135
Q

where is a direct hernia palpable?

A

the swelling is above the pubic tubercle

136
Q

in the inguinal canal, what is the entry point from the abdominal cavity into the canal?

where is this ring anatomically?

A

the deep ring

the deep ring sits at the midpoint of the inguinal canal

137
Q

in the inguinal canal, what is classed as the exit point?

A

the superficial inguinal ring

138
Q

where does the superficial inguinal ring sit anatomically?

A

superior and lateral to the pubic tubercle

139
Q

where can both direct and indirect inguinal hernias exit from?

A

they can both exit from the superficial inguinal ring

but- it is more common for indirect inguinal hernias to exit from here as the path through both anatomical rings has less resistance than piercing through muscle

140
Q

where do direct inguinal hernias pass through to reach the superficial ring?

A

they pierce through the posterior WALL of the inguinal canal

ie-they take a direct approach

141
Q

where do indirect inguinal hernias pass through before reaching the superficial ring?

A

they pass through the deep ring

ie- indirect hernias do not pierce the posterior wall of the inguinal canal

142
Q

compare the causes of direct and indirect inguinal hernias?

A

direct inguinal hernias: caused by age related stress, coughing and weakened muscles in the canal

indirect inguinal hernias: caused by a persistent opening that does not close during fetal development

143
Q

which cardiac condition does VSD increase your risk of?

A

endocarditis

144
Q

in whooping cough, how long should a child be kept off school following commencement of antibiotics?

A

2 days

145
Q

in croup, what is given as a single dose to all patients, regardless of severity?

A

a single dose of oral dexamthasone

146
Q

what is the most common cause of nephrotic syndrome in children?

A

minimal change disease

147
Q

describe the murmur that can be heard in tetralogy of fallot?

A

an ejection systolic murmur at the left sternal edge - due to the pulmonary stenosis

in addition to cyanosis or collapse in the 1st month of life

148
Q

describe how the Ix for DDH are dependant on the age of the patient?

A

<4.5 months: U/S

> 4.5 months: XR

149
Q

in what condition can a pavlik harness be used to treat? what age?

A

pavlik harness used in DDH

used in children < 4-5 months

150
Q

what age are people who present with intussusception?

A

usually affects infants aged between 6-18 months

151
Q

what follow up do all breech babies require following delivery? why?

A

US of pelvis at 6 week baby check

to screen for DDH

152
Q

what is an early sign of LVF?

A

S3 gallop rhythm

153
Q

what is the cut off for the CHA2DS2VASc score that require anti coagulation in atrial fibrillation?

if it is required, what form of anticoagulation is preferred?

A

a score of 2 or more requires lifelong anticoagulation

rivaroxiban (DOAC) is preferred to warfarin

154
Q

which coronary arteries are affected in lateral, anterolateral and inferior MIs?

A

anterolateral: left anterior descending
lateral: left circumflex
inferior: right coronary

155
Q

which combination of drugs should never be used alongside each other, and can cause severe bradycardia and heart failure?

A

BBs and rate limiting CCBs (verapamil or diltiazem)

both can be used as rate limiters in AF, but they should never be used at the same time

156
Q

in paeds, what diagnosis should you always consider in a child with a fever lasting >5 days?

as well as a leukemia ;)

A

Kawasaki disease

especially if there is strawberry tongue and desquamation of the palms

157
Q

what is the most common presentation of a wilm’s tumour in children?

what is a wilm’s tumour?

A

most common feature = abdominal mass

wilm’s tumour is a childhood cancer that starts in the kidneys

158
Q

which condition in premature infants presents with abdominal distension, feeding intolerance and bloody stool?

A

necrotising enterocolitis

159
Q

compare the vomit seen in pyloric stenosis, intussusception and malrotation?

A

pyloric stenosis: milky, non-bilious

intussusception: intermittent, milky, yellow vomit
malrotation: green, bilious vomit

160
Q

compare the stools seen in necrotising colitis and intussusception?

A

necrotising colitis: bloody stool

intussusception: red jelly stool

161
Q

what is the diagnostic Ix for necrotising colitis?

A

Abdominal XR

162
Q

how is pyloric stenosis diagnosed?

A

ultrasound

163
Q

both henoch-schonlein purpura and juvenile idiopathic arthritis cause joint pain and rashes.
compare the rashes they cause

A

HSP: palpable and puritic rash

juvenile ideopathic arthritis: salmon pink

164
Q

what organism accounts for the majority of cases of croup?

A

parainfluenza virus

165
Q

what is the number 1 cause of painless massive GI bleeding requiring a transfusion in kids aged 1-2y/o?

A

Meckel’s diverticulum

166
Q

when does fragile X syndrome typically present?

A

around the time of puberty

unlike many other genetic conditions, which can be diagnosed much earlier

167
Q

what is the 1st line treatment for all children with pneumonia?

A

amoxicillin

168
Q

describe the pulse in PDA?

A

large volume, bounding, collapsing pulse

169
Q

what is the 1st line Tx for threadworms in children?

A

mebendazole

170
Q

what is the most common complication of measles?

A

otitis media

171
Q

how can hand, foot and mouth disease be differentiated from chickenpox?

A

hand foot and mouth disease is isolated to the palms, soles and mouth and heals without crusting

172
Q

what drugs are the most common cause of drug induced angioedema?

A

ACEi

173
Q

compare the 1st line therapies for HF, angina and hypertension?

A

HF: ACEi +/- BB

angina: BB+/- CCB

HT: ACEi +/- CCB

174
Q

what investigation does the NICE guidance state must be carried out prior to a CTPA or V/Q in suspected cases of PE?

A

CXR

175
Q

which cardiac medication causes ‘scooped’ ST depression?

A

digoxin therapy

176
Q

how can VF and VT be differentiated from each other just by looking at the patient?

A

if patient is conscious, it has to be VT

VF is not compatible with cardiac output, which means patients are always unconscious

177
Q

which paediatric condition presents with a high fever, later followed by a maculopapular rash?

A

roseola infantosum

caused by human herpes virus 6

178
Q

what is the 1st line treatment for menorrhagia?

A

IUS (mirena)

179
Q

what is pathognmomic on ECG of hypokalaemia?

A

U waves

long PR and long QT

180
Q

what hormone deficiency causes hot flushes and vaginal dryness?

how can this be treated?

A

caused by oestrogen deficiency

treat with estradiol

in patients with a uterus, must also treat with progesterone therapy - unopposed oestrogen can cause endometrial cancer

181
Q

which transporter is blocked by thiazide-like diuretics?

what electrolyte abnormality can they cause?

A

blocks the Na-Cl transporter

can cause hypercalcaemia

182
Q

describe the effect that ACEi’s have on both AKI and CKD?

A

ACEi cause renal efferent arteriole dilatation

in AKI - this is bad… there is already a loss of renal functioning and causing arteriole dilatation will only reduce the pressure gradient further - this will worsen AKI

in CKD… the actual filtration mechanism is shot- patients are pissing out all sorts of proteins etc… giving someone with CKD an ACEi will reduce the filtration pressure, so loss of important blood components is reduced - a good thing

183
Q

which cardiac drug reduces bone health? how come?

A

loop diuretics (furosemide)

causes hypocalcemia

184
Q

what does medical management of a miscarriage involve?

A

giving vaginal misoprostol alone

185
Q

what is the relevance of “5,6,7,8 in gestational diabetes?

A

the glucose cut off levels to diagnose it…

fasting glucose level = 5.6mmol/l

2-hour glucose = 7.8mmol/l

186
Q

when should the 6 in 1 DTAP immunisation be administered?

A

2,3 and 4 months old

187
Q

when is the men B immunisation given?

A

2,4 and 12 months

188
Q

when is the oral rotavirus vaccine given?

A

2 months and 3 months

189
Q

in biliary atresia, describe the bilirubin content?

A

total bilirubin may be normal, whereas conjugated bilirubin is abnormally high

the problem is obstruction, not conjugation- the liver is working fine

190
Q

what is the most common presentation of neonatal sepsis?

A

respiratory distress (grunting)

occurs in approx 85% of cases

191
Q

what is the investigation of choice for reflux nephropathy?

A

micturating cystourethrogram (MCUG)

192
Q

what is 1st line treatment for ADHD?

A

methylphenidate (ritalin)

193
Q

how should a women with confirmed group B strep during pregancy be managed?

A

intrapartum IV benzylpenicillin

194
Q

what is asherman’s syndrome and when may it occur?

A

an acquired condition whereby scar tissues form

can occur following a dilatation and curettage

may prevent the endometrium from responding to oestrogen as it normally would (no periods)

195
Q

what inheritance pattern do mitochondrial diseases follow?

A

mitochondrial inheritance pattern

sperm contributes no cytoplasm to the zygote

therefore, all of the children of an affected mother will inherit a mitochondrial condition, but none of an affected father

196
Q

which class of antibiotic are 1st line in mycoplasma pneumonia is suspected?

A

Macrolides for Mycoplasma and listeria

(ie- erythromycin is 1st line)

for any other pneumonia causative, amoxicillin is 1st line

197
Q

name 5 symptoms of Kawasaki disease?

A
  • persistent fever lasting >5 days
  • injected conjunctivitis
  • red, dry, cracked lips
  • red, swollen hands and feet
  • cervical lymphadenopathy
198
Q

scarlet fever and Kawasaki disease both cause a red rash after a fever and affect the oral cavity.
how can they be differentiated?

A

Kawasaki disease: also causes red, dry, cracked lips and injected conjunctiva

scarlet fever: causes a red strawberry tongue but does not affect the lips or the eyes

199
Q

name the main complication of Kawasaki disease?

A

coronary artery aneurysm

must do an ECHO to exclude

200
Q

compare henoch Schönlein and ITP in their presentations?

A

HSP: post bacterial infection, palpable purpuric rash, polyarthralgia

ITP: post viral infection, flat petechial rash, isolated low platelets

201
Q

describe the transmission of X linked recessive conditions from father to son?

A

there is no male-male transmission of X linked recessive conditions

202
Q

which genetic condition is neonatal hypotonia most associated with?

A

prader willi syndrome (floppy willi)

neonatal hypotonia also associated with neonatal sepsis, spinal muscular atrophy and hypothyroidism

203
Q

how can cephalhaematoma and caput succedaneum be differentiated?

A

cephalahematoma: it does NOT extend across the suture lines of the skull

caput succedaneum: it does extend across the suture lines of the skull

204
Q

how should Pityriasis versicolour be managed?

A

ketoconazole 2% shampoo

205
Q

compare the 1st line Tx’s of pityriasis versicolour and Pityriasis rosea?

A

pityriasis versicolour - ketoconazole 2% shampoo

Pityriasis rosea - self limiting within 12 weeks

206
Q

what is the most common cause of meningitis in neonatal to 3 months?

A

group B streptococcus

207
Q

which type of neck cyst is soft and transilluminates?

A

cystic hygroma

208
Q

which type of neck cyst is most often located laterally and near to the angle of the mandible?

A

branchial cyst

209
Q

which type of neck cyst has a heterogenous appearance on imaging?

A

dermoid cysts

they are usually multiloculated and heterogenous

210
Q

what investigation is now used 1st line to diagnose Duchenne muscular dystrophy?

A

genetic analysis

proximal muscle biopsy is no longer the guild standard

211
Q

compare what the major risk factors for neonatal respiratory distress syndrome and tachypnoea of the newborn are?

A

NRDS: prematurity

TTN: caesarean section

212
Q

what is the mechanism of action of metformin in PCOS?

A

increases peripheral insulin sensitivity

213
Q

what stage is ovarian cancer that is confined to the pelvis?

A

stage 2

214
Q

what stage is ovarian cancer spread outwith the pelvis but still within the abdomen?

A

stage 3

215
Q

what does the ABC in irritable bowel stand for?

A

Abdominal pain
Bloating
Change in bowel habit

216
Q

what is the most common side effect of the POP contraception?

A

irregular vaginal bleeding

217
Q

in which cases of miscarriage is dilation and curettage mandatory?

A

whenever the patient is haemodynamically unstable (systolic <90mmHg)

218
Q

what gynae condition causes an enlarged uterus that is “boggy” on imaging with subendometrial linear striations?

A

adenomyosis

diagnosed on an MRI pelvis

219
Q

what score should be assessed in all women prior to induction of labour?

A

bishop score

score <5 - indicates labour is unlikely to start without induction

220
Q

what is the likely effect on periods of the IUS?

A

initially irregular bleeding followed by light menses or amenorrhoea

221
Q

what is the most common type of ovarian epithelial cell tumour?

A

serous cystadenoma

222
Q

what is the most favourable option for inducing labour?

A

membrane sweep

it should be considered as an adjunct to labour rather than an actual method of induction

AROM is associated with more risks so isn’t as favourable

223
Q

what is the best imaging to diagnose adenomyosis?

A

MRI pelvis

224
Q

why is cervical ectropion more common in those on the COCP?

A

due to higher oestrogen levels

225
Q

what is 1st line tx for faecal impaction in kids?

A

polyethylene glycol 3350 + electrolytes

add a stimulant laxative (Senna) if no response

226
Q

describe the prodromal features seen in measles?

A
  • fever
  • irritability
  • conjunctivitis
227
Q

compare what the 1st signs of puberty are in boys and girls?

A

boys: increase in testicular volume
girls: breast development

228
Q

compare the initial empirical therapy for meningitis if < 3months old and >3 months old?

A

<3 months old: cefotaxime and amoxicillin

> 3 months old: ceftriaxone

229
Q

which condition causes a 2 day history of fever and tonsillitis in a 4 year old. he has a furred tongue and enlarged papillae. there is a blanching punctate rash that spares the face?

A

scarlet fever

the rash spares the face

230
Q

in which childhood condition are suboccipital lymph nodes palpable?

A

rubella

231
Q

what is the one main risk of progesterone in HRT that should be mentioned to patients?

A

slightly increased risk of breast cancer

232
Q

when should a salpingectomy/otomy be offered in ectopic pregnancies?

A
  • if the ectopic is >35mm
  • causing severe pain
  • B-hCG level is >1500

otherwise, methotrexate should be used

233
Q

what is the most common cause of hyperparathyroidism?

A

a parathyroid adenoma

234
Q

what is the most common cause of vertebral wedge compression fractures and focal sclerotic bony lesions in an old man?

A

metastatic prostate cancer

prostate cancer mets typically have a sclerotic appearance on XR

235
Q

which 2 conditions account for 90% of cases of hypercalcemia?

A
  1. primary hyperparathyroidism - commonest cause in non-hospitalised patients
  2. malignancy- commonest cause in hospitalised patients
236
Q

coeliac disease increases the risk of developing which haematological malignancy?

A

T cell lymphoma

237
Q

what is the single greatest risk of developing necrotising enterocolitis?

A

formula feeding during the neonatal period

238
Q

which ECG feature is seen in hypokalaemia?

A

U waves

also, prolonged QT interval

239
Q

what is the causative in rheumatic fever?

A

strep pyogenes

often present initially with a sore throat

240
Q

in neonatal bilious vomitingg with a double bubble sign on AXR, what is the diagnosis?

A

duodenal atresia

absence of the duodenum or complete closure of a part of the lumen

241
Q

which genetic condition is duodenal atresia closely linked with?

A

Down’s syndrome

1/3 of downs patients have duodenal atresia

242
Q

why should inguinal hernia repair take place ASAP in kids?

A

they have the highest rate of strangulation

243
Q

what is bilious vomiting within 24 hours of birth most commonly caused by?

A

intestinal atresia

244
Q

which endocrine disorder is a risk factor for pseudogout?

A

hyperparathyroidism

raised calcium, low phosphate and raised parathyroid hormone

245
Q

compare the treatment for temporal arteritis depending on if there is evolving visual loss or not?

A

no visual loss: oral prednisolone

evolving visual loss: IV methylprednisolone

246
Q

which extreme of BMI is at highest risk of developing osteoporosis?

A

low BMIs

247
Q

a common side effect of clopidogrel is diarrhoea. if it is not tolerated in patients for secondary prevention following stroke, what can be given instead?

A

aspirin 75mg + modified release dipyridamole

248
Q

compare which nerve root is responsible for plantar flexion and which for dorsiflexion?

A

dorsiflexion: L5
plantarflexion: S1

249
Q

what is the most common type of cancer to metastasise to the brain?

A

lung cancer

250
Q

what is the 1st line Ix for narcolepsy?

A

multiple sleep latency EEG

251
Q

compare when ondansetron, haloperidol and metoclopramide are used for anti emetics?

A

depends on the location causing the nausea:

GI: metoclopramide

chemotherapy induced nausea: ondansetron

raised ICP: haloperidol

252
Q

what tool is recommended by NICE to assess a patient with a suspected stroke?

A

ROSIER

a stroke is likely if score >0

253
Q

which form of dementia is most associated with MND?

A

frontotemporal dementia

Lewy body dementia is most associated with Parkinson’s disease

254
Q

describe how eye movements are affected in motor neurone disease?

A

they’re typically not affected

MND tends to spare the external ocular muscles

there is also no cerebellar features of MND

255
Q

What is the medical management in an acute myasthenic crisis?

A

plasmapheresis and IV Ig

256
Q

what is a positive Hoffmans sign in neurology a sign of?

A

a sign of UMN dysfunction and points to a disease of the CNS

Ie- degenerative cervical myelopathy

257
Q

what 2 medications are 1st line for spasticity in multiple sclerosis?

A

baclofen

gabapentin

258
Q

is a bilateral or unilateral tremor most commonly seen in ideopathic Parkinson’s disease?

A

unilateral tremor

if the tremor is bilateral, the Parkinson’s disease is more likely drug induced Parkinson’s

259
Q

what pattern of deficits are found in subacute combined degeneration of the cord?

A

the dorsal column and lateral corticospinal tracts are affected

patient will present with loss of proprioception and vibration, muscle weakness and hyporeflexia

DC pathway= proprioception and vibration

corticospinal = movement

260
Q

in a painful 3rd nerve palsy, where is the most likely location of the lesion?

A

posterior communicating artery

261
Q

compare when clopidogrel and DOACs would be used?

A

clopidogrel (anti-platelet): ACS (dual anti platelet therapy), 1st line following ischaemic stroke and PAD

DOACs (rivaroxiban): atrial fibrillation (stroke prevention), VTE prevention (following knee/hip surgery), Tx of DVT and PE

262
Q

what is the most important blood test to assess response to levothyroxine?

A

TSH

aiming to “normalise” the TSH value

263
Q

in which thyroid condition is there patchy, ill defined uptake of iodine on nuclear scintigraphy?

A

toxic multinodular goitre

264
Q

when would a patient with T1DM need to surrender their drivers licence?

A

if they have more than one hypoglycaemic episodes that require help

265
Q

which diabetic medication has been associated with necrotising fasciitis of the genitalia?

A

SGLT-2 inhibitors

eg - dapahliflozin

the same class that cause recurrent UTIs

266
Q

what causes Kallman’s syndrome?

A

failure of GnRH secreting neurones

results in hypogonadotrophic hypogonadism

hormone profile will show a low testosterone and low LH and FSH

in kleinfelter’s, men are generally taller than average and have elevated FSH and LH

267
Q

which treatment is best for symptomatic control of hyperthyroidism whilst awaiting more definitive treatment?

A

propranolol

carbimazole is 1st line Tx for grave’s, but can take time to take effect

propranolol can therefore be used in the short term

268
Q

define subclinical hyperthyroidism?

A

TSH raised, but T3, T4 normal

269
Q

compare if there is pain associated with the goitre graves disease and sub acute thyroiditis?

A

graves disease: no pain associated with goitre

sub acute thyroiditis: pain associated with goitre

270
Q

name the 3 drugs given to treat thyrotoxic storm?

A

BBs, Propylthiouracil and hydrocortisone

hydrocortisone prevents the conversion of T4 to T3

271
Q

what drug is 1st line for all diabetics with hypertension?

A

ACEi or ARB if black

272
Q

compare the diagnostic investigation in primary and secondary hypothyroidism?

A

primary: anti TPO antibodies
secondary: MRI pituitary gland

273
Q

what is used to manage primary hyperaldosteronism?

A

spironolactone

274
Q

name the only 2 diabetic drugs other than metformin that cause weight loss?

which one can only be used as triple therapy with metformin?

A

SGLT-2 inhibitors (empagliflozin) and GLP-1 analogues

GLP-1 analogues are injected, and can only be used as part of triple therapy with metformin

therefore, if you’re looking for a diabetic drug that causes weight loss, SGLT-2 inhibitors are always the choice

275
Q

which thyroid condition is suggested by tender goitre, initially hyperthyroidism, raised ESR with globally reduced uptake on technetium thyroid scan?

A

subacute thyroiditis

276
Q

what is the single most useful test for determining the cause of hypercalcemia?

A

parathyroid hormone

277
Q

what is the 1st line imaging choice when investigating thyroid nodules?

A

ultrasonography

278
Q

name the 1st and 2nd line Mx for a patient with hypercalcemia due to cancer?

A

1st line: IV 0.9% saline

2nd line: biphosphonates

279
Q

describe subclinical hypothyroidism?

A

TSH raised

T3 and T4 normal

no obvious symptoms

280
Q

how often should patients with insulin dependant diabetes check their blood sugars when unwell?

A

at least 4 hourly during the day

also increase fluid intake and have mobile phone handy

281
Q

which diabetic medication increases insulin sensitivity?

in which conditions are they C/I’d?

A

glitazones (TZDs)

they reduce peripheral insulin resistance

C/I’d in heart failure and bladder cancer

282
Q

which type of cancer often secrete calcitonin?

A

medullary thyroid cancers

monitoring the levels of serum calcitonin is useful in detecting sub clinical recurrence

283
Q

what condition is most likely to be causing poor blood glucose control, bloating and vomiting in a T1DM?

A

gastroparesis

can occur in diabetics due to neuropathy of the vagus nerve, causing abnormal gout movement

284
Q

how do non-functioning pituitary adenomas cause hypopituitarism?

A

the growth of the adenoma compresses the normal functioning pituitary gland, causing hypopituitarism

also usually causes compression of the optic chasm, causing bitemporal hemianopia

285
Q

which osmotic diuretic is used to treat raised ICP following head trauma?

A

IV mannitol

IV dexamethasone is used to treat raised ICP due to CNS infections or neoplasms

286
Q

what is the immediate, 1st line Tx of Stevens-johnson syndrome?

A

stop all medications, obtain IV access and begin fluid rehydration

287
Q

how does motor neurone disease affect sensory innervation?

A

it doesnt affect it in the slightest - it is a disease of the motor pathway only

288
Q

what is lateral medullary syndrome?

A

ipsilateral facial pain and temperature loss, with

contralateral limb pain and temperature loss. w/ ataxia and nystagmus also

due to occlusion of the posterior inferior cerebellar artery

289
Q

what is 1st line Tx for trigeminal neuralgia?

A

carbamazepine

290
Q

which CNs are affected in vestibular schwannomas?

how does this present?

A

CNs 5, 7, 8

  • vertigo and unilateral hearing loss (CN8)
  • absent corneal reflex (CN5)
  • unilateral facial numbness (CN7)
291
Q

what are the most common triggers of autonomic dysreflexia?

A

urinary retention and faecal impaction

292
Q

what is primary hyperparathyroidism most commonly due to?

A

a solitary adenoma

293
Q

which Alpha blocker should be given before the beta blocker in phaeochromocytoma?

A

PHenoxybenzamine for PHaechromocytoma

it is a non-selective alpha blocker whereas doxazosin (used in BPH) is a selective Alpha blocker

294
Q

describe whipple’s triad for insulinomas?

A
  1. hypoglycaemia with fasting or exercise
  2. reversal of symptoms with glucose
  3. recoded low BMs at the time of symptoms

insulinoma associated with MEN 1

295
Q

what does the pneumonic “EXPLAIN” stand for to help you remember the causes of hypoglycaemia?

A 
EXogenous drugs (sulfonylureas or insulin) 
Pituitary insufficiency 
Liver failure 
Addison's disease 
Islet cell tumours (insulinomas) 
Non-pancreatic neoplasms
296
Q

name the 3 endocrine parameters reduced in stress response?

A

insulin

testosterone

oestrogen

297
Q

patients with CKD should be started on an ACEi if their albumin:creatinine ratio is over what value?

A

start them on ACEi if ACR >30 and they have hypertension

298
Q

in mineral bone disease, occurring due to CKD, what should be treated 1st?

the high phosphate or the low calcium?

A

the high phosphate is Tx’d first

1st line: low phosphate diet

2nd line: phosphate binders

the low calcium is contributed to by the high phosphate - treat it 1st and that should improve calcium

299
Q

what testicular manifestation is associated with RCC?

A

varicocele

“a bag of worms”

300
Q

describe the response to a fluid challenge in acute tubular necrosis?

A

poor response to fluid challenge

in cases of pre-renal uraemia, there is an increase in urine output following fluid challenge

301
Q

name the 3 criteria that can be used to diagnose AKI?

A
  1. creatinine > by 26umol/l in 48 hours
  2. creatinine > by 50% in 7 days
  3. urine output < 0.5ml/kg/hr for more than 6 hours
302
Q

compare post strep glomerulonephritis and minimal change disease?
which is nephrotic and which is nephritic?

A

post strep glomerulonephritis = nephritic (blood in pee)

minimal change disease = nephrotic (no blood in pee)

303
Q

name 3 conditions that cause nephrotic syndrome?

A

minimal change disease

focal segmental glomerulosclerosis

membranous glomerulonephritis

304
Q

name the drugs used to a) induce remission and b) maintain remission in Crohn’s disease?

A

induce remission: glucocorticoids

maintain remission: azathioprine

305
Q

does mesalazine have a role in crohns?

A

no - it is used in ulcerative colitis, for both inducing and retaining remission

can be given rectally or orally depending on the extent of disease

306
Q

compare the initial Mx of an inguinal hernia in a 6mth old boy with an 18mth old boy?

A

6months old- immediate surgical repair

18 months old - elective repair

children under 1y/o with inguinal hernia are at increased risk of strangulation

307
Q

what is Brugada syndrome characterised by on EGC?

A

“coved” ST segment elevation followed by T wave inversion in V1-3

coved = having a concave arch or arches - its arched shaped ST elevation

308
Q

what is the Ix of choice in suspected cases of Brugada syndrome?

A

administer flecainide

this makes the ECG changes more apparent

(ST segment elevation and T wave inversion in V1-3)

309
Q

how should a pregnant women with a fasting plasma glucose of <7mmol/l be managed initially?

A

trial of diet and exercise for 1-2 weeks

if this doesn’t work, patient should then be started on metformin

if metformin doesnt bring it down, start her on insulin

310
Q

what is the main risk of progesterone in HRT that women should be counselled on?

A

increased risk of breast cancer

although, the risk is very minimal

311
Q

why should urinanalysis be carried out in a women in her 60’s with urinary incontinence, where you think the diagnosis is stress incontinence?

A

carry out urinalysis to rule out a UTI and diabetes mellitus

312
Q

name the 3 components seen in HELLP syndrome?

A
  1. haemolysis
  2. elevated liver enzymes
  3. low platelets

AA Y4 Finals cards NE (40 decks)

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