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PassMed Concepts Flashcards

1
Q

New surroundings can cause what in cognitively impaired patients?

A

Delirium

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2
Q

Alzheimer’s disease causes what changes in the brain?

A

Widespread cerebral atrophy mainly involving the cortex and hippocampus

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3
Q

Middle aged adult with insidious onset dementia and personality changes - what condition?

A

Pick’s disease (frototemporal dementia)

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4
Q

Most important investigation in the elderly who present with falls?

A

Lying/standing blood pressure

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5
Q

Bone marrow aspirate showing plasma cells

A

Multiple myeloma

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6
Q

Cancer patients with VTE

A

6 months of a DOAC

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7
Q

If a 2-level DVT wells score is 2 points what is the next investigation?

A

Arrange a proximal leg vein ultrasound scan within 4 hours

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8
Q

What are the features of multiple myeloma?

A

Hypercalcaemia, renal failure, anaemia (and thrombocytopenia) and bone fractures/lytic lesions

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9
Q

Patients over the age of 60 who present with iron deficiency anaemia should be investigated for what condition?

A

Colorectal cancer

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10
Q

Painless, asymmetrical lymph node swelling in the neck

A

Hodgkin’s lymphoma

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11
Q

Facial muscle weakness affecting the entire side of the patients face

A

Bells palsy as it is a lower motor neuron condition

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12
Q

Large artery acute ischaemic stroke - consider what management?

A

Consider mechanical clot retrieval

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13
Q

What causes should be ruled out in status epilepticus?

A

Hypoxia and hypoglycaemia

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14
Q

Ptosis can indicate a lesion on what cranial nerve?

A

CN III

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15
Q

If focal seizures don’t respond to first line drug - what is second line?

A

try lamotrigine or levetiracetam (i.e. the first-line drug not already
tried) and if neither help then carbamazepine

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16
Q

Unilateral deafness or tinnitus?

A

Acoustic neuroma

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17
Q

When assessing the GCS, do you take the best or worst response from both sides?

A

Best

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18
Q

How may patient’s with raised ICP present?

A

may exhibit Cushing’s triad: - widening pulse pressure - bradycardia - irregular breathing

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19
Q

Management of medication overuse headache?

A

simple analgesia + triptans: stop abruptly -
opioid analgesia: withdraw gradually

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20
Q

Dominant hemisphere middle cerebral artery strokes cause what?

A

Aphasia

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21
Q

What seizures feature epigastric aura and automatisms?

A

Temporal lobe seizures

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22
Q

What nerve supplies the sensory innervation to the palmar and dorsal aspects of 1 and 1/2 fingers medially?

A

Ulnar nerve

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23
Q

How can you test if clear fluid from the nose or ear is CSF?

A

Check for glucose

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24
Q

How do anterior cerebral artery strokes present?

A

causes leg weakness but not face weakness or speech impairment

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25
Q

what is an ataxic gait?

A

A wide-based gait with loss of heel to toe walking

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26
Q

defective downward gaze and vertical diplopia?

A

CN IV

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27
Q

What can be a complication of raised ICP?

A

can cause a third nerve palsy due to herniation

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28
Q

Fever, headache, psychiatric symptoms, seizures, focal features e.g. aphasia can indicate what?

A

Herpes simplex encephalitis

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29
Q

Headache linked to Valsalva manoeuvres

A

raised ICP until proven otherwise so LP is contraindicated

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30
Q

First line treatment in patients with early status epilepticus?

A

IV lorazepam

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31
Q

when do women need to start using contraception post-partum?

A

21 days from giving birth

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32
Q

When can an IUD or IUS be inserted post partum?

A

can be inserted within 48 hours of childbirth or after 4 weeks

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33
Q

Both levonorgestrel and ulipristal can be used more than once in the same cycle - True or False?

A

True

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34
Q

When can postpartum women start the progestogen-only pill?

A

At any time post partum

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35
Q

If unprotected sex occurred after a missed POP and within 48 hours of restarting the POP - is emergency contraception needed?

A

Yes

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36
Q

pelvic pain, dysmenorrhoea, dyspareunia and subfertility

A

endometriosis

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37
Q

Medical abortions

A

Mifepristone followed by prostaglandins (misoprostol)

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38
Q

What should women having medical management of miscarriage be offered?

A

antiemetics and pain relief

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39
Q

What is used to shrink uterine fibroids before surgery?

A

GnRH agonists

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40
Q

first line treatment for endometriosis

A

NSAIDs and/or paracetamol

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41
Q

What can be used as the progesterone component of HRT for 4 years?

A

Mirena IUS

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42
Q

How do you confirm ovulation?

A

Take the serum progesterone level 7 days prior to the expected next period

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43
Q

What medication is a risk factor for endometrial cancer?

A

Tamoxifen

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44
Q

management of recurrent vaginal candidiasis?

A

oral fluconazole

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45
Q

What cysts should be biopsied for malignancy?

A

Complex multi-loculated ovarian cysts

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46
Q

Management for urge incontinence in elderly people

A

Mirabegron

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47
Q

First line treatment for primary dysmenorrhoea

A

NSAIDs such as mefenamic acid

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48
Q

How to investigate for suspected PPROM?

A

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

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49
Q

Women with uncomplicated, multiple pregnancies should avoid travel by air once they are?

A

> 32 weeks

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50
Q

When should methotrexate be stopped before conception?

A

at least 6 months before conception in both men and women

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51
Q

What further tests are offered to women who have a ‘higher chance’ combined or quadruple tests?

A

offered either further screening (NIPT) or
diagnostic tests (amniocentesis, CVS)

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52
Q

When is induction of labour offered in intrahepatic cholestasis?

A

at 37-38 weeks gestation

53
Q

What is the advice on MMR vaccines in pregnant women?

A

MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant;

54
Q

Which pregnant women should be screened for gestational diabetes?

A

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

55
Q

What is the first line management if a breastfed baby loses >10% of birth weight in first week of life?

A

referral to a midwife-led breastfeeding
clinic may be appropriate

56
Q

Polyhydramnios is a risk factor for what?

A

Placental abruption

57
Q

What is the preferred method of induction of labour if the Bishop score is 6?

A

Vaginal PGE2 or oral misoprostol

58
Q

What is the sensitivity and specificity of NIPT for Downs?

A

> 99%

59
Q

A woman at moderate or high risk of pre-eclampsia should take what medications?

A

aspirin 75-150mg daily from 12 weeks gestation until the birth

60
Q

Management of pregnant women with blood pressure of >160/110 mmHg?

A

likely to be admitted and observed

61
Q

Management of umbilical cord prolapse if the cord is past the level of the introitus?

A

there should be minimal handling and it
should be kept warm and moist to avoid vasospasm

62
Q

What is required for diagnosis of pre-eclampsia?

A

new-onset BP ? 140/90 mmHg after 20 weeks AND ? 1 of proteinuria, organ dysfunction

63
Q

Management of mania/hypomania in patients taking antidepressants?

A

consider stopping the antidepressant and start antipsychotic therapy

64
Q

symptoms seen in SSRI discontinuation syndrome?

A

Gastrointestinal side-effects such as diarrhoea

65
Q

risk of SSRI use in first trimester?

A

small increased chance of congenital heart defects

66
Q

short term side effects of ECT?

A

Cardiac arrhythmias

67
Q

What condition can lithium cause?

A

Diabetes insipidus

68
Q

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

A

Paranoid personality disorder

69
Q

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

A

Antisocial personality disorder

70
Q

negative symptoms suggestive of schizophrenia?

A

Blunting of affect
Anhedonia
Alogia (poverty of speech)
Avolition (poor motivation)
Social withdrawal

71
Q

chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary
choreoathetoid movements in patients on conventional antipsychotics

A

tardive kinesia

72
Q

first line drug treatment in PTSD

A

venlafaxine or a SSRI

73
Q

Useful side effects of mirtazapine?

A

Sedation and increased appetite

73
Q

Anti-psychotic that reduces seizure threshold?

A

Clozapine

74
Q

Management of postpartum thyrotoxic phase

A

propranolol

75
Q

Combined oral contraceptive pill (cancer risks)

A

increased risk of breast and cervical cancer

76
Q

Combined oral contraceptive pill (cancer benefits)

A

protective against ovarian and endometrial cancer

77
Q

Down’s syndrome on combined test

A

↑ HCG, ↓ PAPP-A, thickened nuchal translucency

78
Q

Increased AFP

A

Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy

79
Q

Decreased AFP

A

Down’s syndrome
Trisomy 18
Maternal diabetes mellitus

80
Q

Antenatal screening at 8-12 weeks

A

Booking visit - NP, urine, BMI, bloods, Hep B, Syphilis, HIV tests

81
Q

Antenatal screening at 10-13+ 6 weeks

A

Early scan to confirm dates, exclude multiple pregnancy

82
Q

Antenatal screening at 11-13+ 6 weeks

A

Down’s syndrome screening including nuchal scan

83
Q

Antenatal screening at 16 weeks

A

Information on the anomaly and the blood results. If Hb < 11 g/dl consider iron
Routine care: BP and urine dipstick

84
Q

Antenatal screening at 18-20 + 6 weeks

A

Anomaly scan

85
Q

Antenatal screening at 25 weeks

A

Only if primiparous
Routine care: BP, urine dipstick, symphysis-fundal height (SFH)

86
Q

Antenatal screening at 28 weeks

A

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

87
Q

Antenatal screening at 34 weeks

A

Routine care as above
Second dose of anti-D prophylaxis to rhesus negative women*
Information on labour and birth plan

88
Q

Antenatal screening at 36/38 weeks

A

Routine care as above
Check presentation - offer external cephalic version if indicated
Information on breast feeding, vitamin K, ‘baby-blues’

89
Q

McRobert’s manoeuvre

A

this manoeuvre entails flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen

90
Q

Management of acute asthma

A

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

91
Q

most common cause of acute exacerbation of COPD

A

Haemophilus influenzae

92
Q

Steps of asthma management

A

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

93
Q

permanent dilatation of the airways secondary to chronic infection or inflammation

A

Bronchiectasis

94
Q

COPD Pharmacological management

A

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

95
Q

Most common lung cancer

A

Adenocarcinoma

96
Q

Lung cancer seen in non-smokers

A

Adenocarcinoma

97
Q

Cavitating lesions in lung cancer

A

Squamous lung cancer

98
Q

Lung cancer associated with hyponatraemia and Cushing’s syndrome

A

Small cell lung cancer

99
Q

lung cancer associated with pleural effusions

A

mesothelioma

100
Q

CURB 65 criteria

A

Confusion
Urea >7
Respiratory Rate >= 30/min
Blood pressure (systolic <=90 and/or diastolic <= 60)
65 - Aged >=65

101
Q

Causes of respiratory acidosis

A

COPD
decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema
neuromuscular disease
obesity hypoventilation syndrome
sedative drugs: benzodiazepines, opiate overdose

102
Q

Causes of respiratory alkalosis

A

anxiety leading to hyperventilation
pulmonary embolism
salicylate poisoning*
CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
altitude
pregnancy

103
Q

management of sarcoidosis

A

steroids

104
Q

management of tension pneumothorax

A

needle decompression - 2nd intercostal space in midclavicular line
Then placement of a chest drain

105
Q

large volume of fresh blood being vomited or brought up

A

Oesophageal varices

106
Q

Small volume of fresh blood, often streaking vomit

A

Oesophagitis

107
Q

Small volume of vomited blood with associated symptoms of dysphagia and weight loss

A

Oesophageal cancer

108
Q

Brisk small to moderate volume of bright red blood following bout of repeated vomiting

A

Mallory Weiss Tear

109
Q

Pain in abdomen several hours after eating which may present with haematemesis and melena

A

Duodenal ulcer

110
Q

Pain when eating in upper abdomen, small low volume bleeds, iron deficiency anaemia

A

Gastric ulcer

111
Q

immediate Management of upper GI bleeding

A

ABCDE - wide bore IV access x2
Platelet transfusion if <50
FFP if elevated PT or APTT
Endoscopy

112
Q

Management of non-variceal bleeding

A

PPIs
Interventional radiology
Surgery

113
Q

Management of variceal bleeding

A

Band ligation and injections of N-butyl-2-cyanoacrylate

114
Q

Crohns management

A

Glucocorticoids
5-ASA drugs second line
Azathioprine or mercaptopurine add on therapy

115
Q

areas affected by Crohn’s

A

terminal ileum and colon but can be seen anywhere from mouth to anus

116
Q

h.pylori eradication

A

a proton pump inhibitor + amoxicillin + (clarithromycin OR metronidazole)
if penicillin-allergic: a proton pump inhibitor + metronidazole + clarithromycin

117
Q
A
118
Q
A
119
Q
A
120
Q
A
121
Q

test for h.pylori

A

urea breath test

121
Q

RUQ pain, intermittent, usually begins abruptly and subsides gradually. Attacks often occur after eating.
Female, forties, fat and fair

A

Biliary colic

122
Q

Pain similar to biliary colic but more severe and persistent. The pain may radiate to the back or right shoulder.
Murphy’s sign positive

A

Acute cholecystitis

123
Q

Classically presents with a triad of:
fever (rigors are common)
RUQ pain
jaundice

A

Ascending cholangitis

124
Q

Usually due to alcohol or gallstones
Severe epigastric pain
Vomiting is common

A

Acute pancreatitis

125
Q

Painless jaundice is the classical presentation of pancreatic cancer. Anorexia and weight loss

A

Pancreatic cancer

126
Q

Bloody diarrhoea more common
Abdominal pain in the left lower quadrant
Tenesmus

A

Ulcerative colitis

127
Q

Inflammation always starts at rectum and never spreads beyond ileocaecal valve

A

ulcerative colitis

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