PassMed Concepts Flashcards
New surroundings can cause what in cognitively impaired patients?
Delirium
Alzheimer’s disease causes what changes in the brain?
Widespread cerebral atrophy mainly involving the cortex and hippocampus
Middle aged adult with insidious onset dementia and personality changes - what condition?
Pick’s disease (frototemporal dementia)
Most important investigation in the elderly who present with falls?
Lying/standing blood pressure
Bone marrow aspirate showing plasma cells
Multiple myeloma
Cancer patients with VTE
6 months of a DOAC
If a 2-level DVT wells score is 2 points what is the next investigation?
Arrange a proximal leg vein ultrasound scan within 4 hours
What are the features of multiple myeloma?
Hypercalcaemia, renal failure, anaemia (and thrombocytopenia) and bone fractures/lytic lesions
Patients over the age of 60 who present with iron deficiency anaemia should be investigated for what condition?
Colorectal cancer
Painless, asymmetrical lymph node swelling in the neck
Hodgkin’s lymphoma
Facial muscle weakness affecting the entire side of the patients face
Bells palsy as it is a lower motor neuron condition
Large artery acute ischaemic stroke - consider what management?
Consider mechanical clot retrieval
What causes should be ruled out in status epilepticus?
Hypoxia and hypoglycaemia
Ptosis can indicate a lesion on what cranial nerve?
CN III
If focal seizures don’t respond to first line drug - what is second line?
try lamotrigine or levetiracetam (i.e. the first-line drug not already
tried) and if neither help then carbamazepine
Unilateral deafness or tinnitus?
Acoustic neuroma
When assessing the GCS, do you take the best or worst response from both sides?
Best
How may patient’s with raised ICP present?
may exhibit Cushing’s triad: - widening pulse pressure - bradycardia - irregular breathing
Management of medication overuse headache?
simple analgesia + triptans: stop abruptly -
opioid analgesia: withdraw gradually
Dominant hemisphere middle cerebral artery strokes cause what?
Aphasia
What seizures feature epigastric aura and automatisms?
Temporal lobe seizures
What nerve supplies the sensory innervation to the palmar and dorsal aspects of 1 and 1/2 fingers medially?
Ulnar nerve
How can you test if clear fluid from the nose or ear is CSF?
Check for glucose
How do anterior cerebral artery strokes present?
causes leg weakness but not face weakness or speech impairment
what is an ataxic gait?
A wide-based gait with loss of heel to toe walking
defective downward gaze and vertical diplopia?
CN IV
What can be a complication of raised ICP?
can cause a third nerve palsy due to herniation
Fever, headache, psychiatric symptoms, seizures, focal features e.g. aphasia can indicate what?
Herpes simplex encephalitis
Headache linked to Valsalva manoeuvres
raised ICP until proven otherwise so LP is contraindicated
First line treatment in patients with early status epilepticus?
IV lorazepam
when do women need to start using contraception post-partum?
21 days from giving birth
When can an IUD or IUS be inserted post partum?
can be inserted within 48 hours of childbirth or after 4 weeks
Both levonorgestrel and ulipristal can be used more than once in the same cycle - True or False?
True
When can postpartum women start the progestogen-only pill?
At any time post partum
If unprotected sex occurred after a missed POP and within 48 hours of restarting the POP - is emergency contraception needed?
Yes
pelvic pain, dysmenorrhoea, dyspareunia and subfertility
endometriosis
Medical abortions
Mifepristone followed by prostaglandins (misoprostol)
What should women having medical management of miscarriage be offered?
antiemetics and pain relief
What is used to shrink uterine fibroids before surgery?
GnRH agonists
first line treatment for endometriosis
NSAIDs and/or paracetamol
What can be used as the progesterone component of HRT for 4 years?
Mirena IUS
How do you confirm ovulation?
Take the serum progesterone level 7 days prior to the expected next period
What medication is a risk factor for endometrial cancer?
Tamoxifen
management of recurrent vaginal candidiasis?
oral fluconazole
What cysts should be biopsied for malignancy?
Complex multi-loculated ovarian cysts
Management for urge incontinence in elderly people
Mirabegron
First line treatment for primary dysmenorrhoea
NSAIDs such as mefenamic acid
How to investigate for suspected PPROM?
if there is no fluid in the posterior vaginal vault then testing the fluid for
PAMG-1 (e.g. AmniSureµ) or IGF binding protein€‘1 may be helpful
Women with uncomplicated, multiple pregnancies should avoid travel by air once they are?
> 32 weeks
When should methotrexate be stopped before conception?
at least 6 months before conception in both men and women
What further tests are offered to women who have a ‘higher chance’ combined or quadruple tests?
offered either further screening (NIPT) or
diagnostic tests (amniocentesis, CVS)
When is induction of labour offered in intrahepatic cholestasis?
at 37-38 weeks gestation
What is the advice on MMR vaccines in pregnant women?
MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant;
Which pregnant women should be screened for gestational diabetes?
Pregnant women who have a first degree relative with diabetes should be screened for gestational diabetes with an
oral glucose tolerance test (OGTT) at 24-28 weeks
What is the first line management if a breastfed baby loses >10% of birth weight in first week of life?
referral to a midwife-led breastfeeding
clinic may be appropriate
Polyhydramnios is a risk factor for what?
Placental abruption
What is the preferred method of induction of labour if the Bishop score is 6?
Vaginal PGE2 or oral misoprostol
What is the sensitivity and specificity of NIPT for Downs?
> 99%
A woman at moderate or high risk of pre-eclampsia should take what medications?
aspirin 75-150mg daily from 12 weeks gestation until the birth
Management of pregnant women with blood pressure of >160/110 mmHg?
likely to be admitted and observed
Management of umbilical cord prolapse if the cord is past the level of the introitus?
there should be minimal handling and it
should be kept warm and moist to avoid vasospasm
What is required for diagnosis of pre-eclampsia?
new-onset BP ? 140/90 mmHg after 20 weeks AND ? 1 of proteinuria, organ dysfunction
Management of mania/hypomania in patients taking antidepressants?
consider stopping the antidepressant and start antipsychotic therapy
symptoms seen in SSRI discontinuation syndrome?
Gastrointestinal side-effects such as diarrhoea
risk of SSRI use in first trimester?
small increased chance of congenital heart defects
short term side effects of ECT?
Cardiac arrhythmias
What condition can lithium cause?
Diabetes insipidus
A young woman comes for relationship advice. She is constantly questioning the loyalty of her partner and regularly
accuses him of having affairs for no reason. She also regularly falls out with her female friends as she thinks they
are belittling her
Paranoid personality disorder
A young man is arrested after crashing his car into a pedestrian. He shows little remorse and repeatedly lies to try
and avoid prosecution. He is known to police after being involved in repeated fights
Antisocial personality disorder
negative symptoms suggestive of schizophrenia?
Blunting of affect
Anhedonia
Alogia (poverty of speech)
Avolition (poor motivation)
Social withdrawal
chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary
choreoathetoid movements in patients on conventional antipsychotics
tardive kinesia
first line drug treatment in PTSD
venlafaxine or a SSRI
Useful side effects of mirtazapine?
Sedation and increased appetite
Anti-psychotic that reduces seizure threshold?
Clozapine
Management of postpartum thyrotoxic phase
propranolol
Combined oral contraceptive pill (cancer risks)
increased risk of breast and cervical cancer
Combined oral contraceptive pill (cancer benefits)
protective against ovarian and endometrial cancer
Down’s syndrome on combined test
↑ HCG, ↓ PAPP-A, thickened nuchal translucency
Increased AFP
Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy
Decreased AFP
Down’s syndrome
Trisomy 18
Maternal diabetes mellitus
Antenatal screening at 8-12 weeks
Booking visit - NP, urine, BMI, bloods, Hep B, Syphilis, HIV tests
Antenatal screening at 10-13+ 6 weeks
Early scan to confirm dates, exclude multiple pregnancy
Antenatal screening at 11-13+ 6 weeks
Down’s syndrome screening including nuchal scan
Antenatal screening at 16 weeks
Information on the anomaly and the blood results. If Hb < 11 g/dl consider iron
Routine care: BP and urine dipstick
Antenatal screening at 18-20 + 6 weeks
Anomaly scan
Antenatal screening at 25 weeks
Only if primiparous
Routine care: BP, urine dipstick, symphysis-fundal height (SFH)
Antenatal screening at 28 weeks
Routine care: BP, urine dipstick, SFH
Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
First dose of anti-D prophylaxis to rhesus negative women
Antenatal screening at 34 weeks
Routine care as above
Second dose of anti-D prophylaxis to rhesus negative women*
Information on labour and birth plan
Antenatal screening at 36/38 weeks
Routine care as above
Check presentation - offer external cephalic version if indicated
Information on breast feeding, vitamin K, ‘baby-blues’
McRobert’s manoeuvre
this manoeuvre entails flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen
Management of acute asthma
Oxygen 15L via non-rebreathe mask
Bronchodilation with SABA e.g., high dose salbutamol
Corticosteroids (40-50mg prednisolone orally daily for 5 days)
IF SEVERE - ipratropium bromide
most common cause of acute exacerbation of COPD
Haemophilus influenzae
Steps of asthma management
Step 1 - SABA
Step 2 - SABA + ICS
Step 3 - SABA + ICS + leukotriene receptor antagonist
Step 4 - SABA + ICS + LABA
Step 5 - SABA +/- LTRA + Stronger ICS
permanent dilatation of the airways secondary to chronic infection or inflammation
Bronchiectasis
COPD Pharmacological management
SABA or SAMA first line
if no asthmatic features + still breathless - add LABA + LAMA
If asthmatic features + still breathless - LABA + ICS or LAMA + LABA + ICS
Most common lung cancer
Adenocarcinoma
Lung cancer seen in non-smokers
Adenocarcinoma
Cavitating lesions in lung cancer
Squamous lung cancer
Lung cancer associated with hyponatraemia and Cushing’s syndrome
Small cell lung cancer
lung cancer associated with pleural effusions
mesothelioma
CURB 65 criteria
Confusion
Urea >7
Respiratory Rate >= 30/min
Blood pressure (systolic <=90 and/or diastolic <= 60)
65 - Aged >=65
Causes of respiratory acidosis
COPD
decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema
neuromuscular disease
obesity hypoventilation syndrome
sedative drugs: benzodiazepines, opiate overdose
Causes of respiratory alkalosis
anxiety leading to hyperventilation
pulmonary embolism
salicylate poisoning*
CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
altitude
pregnancy
management of sarcoidosis
steroids
management of tension pneumothorax
needle decompression - 2nd intercostal space in midclavicular line
Then placement of a chest drain
large volume of fresh blood being vomited or brought up
Oesophageal varices
Small volume of fresh blood, often streaking vomit
Oesophagitis
Small volume of vomited blood with associated symptoms of dysphagia and weight loss
Oesophageal cancer
Brisk small to moderate volume of bright red blood following bout of repeated vomiting
Mallory Weiss Tear
Pain in abdomen several hours after eating which may present with haematemesis and melena
Duodenal ulcer
Pain when eating in upper abdomen, small low volume bleeds, iron deficiency anaemia
Gastric ulcer
immediate Management of upper GI bleeding
ABCDE - wide bore IV access x2
Platelet transfusion if <50
FFP if elevated PT or APTT
Endoscopy
Management of non-variceal bleeding
PPIs
Interventional radiology
Surgery
Management of variceal bleeding
Band ligation and injections of N-butyl-2-cyanoacrylate
Crohns management
Glucocorticoids
5-ASA drugs second line
Azathioprine or mercaptopurine add on therapy
areas affected by Crohn’s
terminal ileum and colon but can be seen anywhere from mouth to anus
h.pylori eradication
a proton pump inhibitor + amoxicillin + (clarithromycin OR metronidazole)
if penicillin-allergic: a proton pump inhibitor + metronidazole + clarithromycin
test for h.pylori
urea breath test
RUQ pain, intermittent, usually begins abruptly and subsides gradually. Attacks often occur after eating.
Female, forties, fat and fair
Biliary colic
Pain similar to biliary colic but more severe and persistent. The pain may radiate to the back or right shoulder.
Murphy’s sign positive
Acute cholecystitis
Classically presents with a triad of:
fever (rigors are common)
RUQ pain
jaundice
Ascending cholangitis
Usually due to alcohol or gallstones
Severe epigastric pain
Vomiting is common
Acute pancreatitis
Painless jaundice is the classical presentation of pancreatic cancer. Anorexia and weight loss
Pancreatic cancer
Bloody diarrhoea more common
Abdominal pain in the left lower quadrant
Tenesmus
Ulcerative colitis
Inflammation always starts at rectum and never spreads beyond ileocaecal valve
ulcerative colitis
