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Finals > Passmed Corrections > Flashcards

Passmed Corrections Flashcards

1
Q

1st line medication management for STRESS incontinence

A

Duloxetine (is an SNRI)
- If asked for conservative Mx: Pelvic floor Muscle Training

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2
Q

Urinary Incontinence causes:

A
  1. Urge(overactive bladder due to detrusor overactivity)
  2. Stress incontinence- leaking small amounts by cough/sneeze
    3.Mixed incontinence (urge and stress)
  3. Overflow incontinence: due to bladder outlet obstruction
  4. Functional Incontinence
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3
Q

Urge Incontinence Management:

A
  • Bladder retraining (1st line)
  • antimuscarinics- Oxybutynin- avoid in older women (immediate release)
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4
Q

Menopause contraception until when:

A

is needed until 12 months after last period if MORE than 50 years and for 24 months if LESS than 50 years

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5
Q

Glucocorticoid(steroid like prednisolone) treatment: what can it cause in a blood result?

A

Can induce Neutrophilia (increased neutrophil count)

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6
Q

Characteristics of Mania vs. Schizophrenia

A

Mania:
- Flight of ideas(there are links to change in topic)

Schizophrenia:
-Knight’s move thinking (no links in conversation)

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7
Q

Thought disorders: types and presentations

A
  • Circumstantiality: tangent that eventually returns back to original point
  • Tangentiality: does not return back to topic
    -Neologism: New word formation/combining of 2 words
    -Clang association: words are related by their similar sound/rhyme
  • Word Salad: completely incoherent speech(nonsense sentences)
  • Knight’s Move thinking: unexpected and illogical leaps from one idea to another= feature of schizophrenia
    -Perseveration: repetition of ideas/words DESPITE attempt to change topic.
  • Echolalia: repetition of someone ELSE’S speech, including the question that was asked.
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8
Q

Tuberculosis:

A

Latent TB: on CXR, can see a calcified Ghon complex(calcified nodule)

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9
Q

Features of Rheumatoid Arthritis:

A

Juxta-Articular osteoporosis/osteopenia-loss of bone density(early feature of R.A)
- Other features: chronic history of swelling and pain in small joints of hand, soft tissue swelling, periarticular erosions, subluxation

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10
Q

X-Ray changes of Osteoarthritis:

A

-Subchondral sclerosis
-Subchrondral cysts
-Osteophytes

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11
Q

Conditions that can be diagnosed prenatally by amniocentesis:

A
  • Alpha1 Antitrypsin deficiency (is located on chromosome 14)
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12
Q

-Meniere’s Disease presentation:

A
  • Recurrent episodes of vertigo, fluctuating sensorineural hearing loss and sensation of fullness/pressure in affected ear, nystagmus
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13
Q

Neonates: transient hypoglycaemia in first hours after birth is normal

A

neonatal hypoglycaemia is less than 2.6mmol/l
- if asymptomatic=encourage normal feeding and monitor blood glucose
-symptomatic/low blood glucose: admit to neonatal unit, IV infusion of 10% dextrose

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14
Q

Ankylosing Spondylitis(Inflammatory Arthritis) features:

A

-Pain improves with exercise
- pain is worse in the morning
- is associated with HLA-B27 gene
- O/E: Schober’s test: reduced forward flexion

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15
Q

Adding progestogen HRT increases risk of which cancer?

A

Breast cancer

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16
Q

Adding oestrogen only HRT increases risk of which cancer?

A

Endometrial cancer- Unopposed oestrogen increases risk

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17
Q

Smoking cessation medication in pregnant women:

A

Nicotine replacement patch therapy
- NB: Bupropion(is contraindicated in pregnancy, breastfeeding and epilepsy) and Varenicline are contraindicated

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18
Q

Dorzolamide(used in the management of Primary Open Angle Glaucoma) drug class:

A
  • Carbonic Anhydrase Inhibitor: works by reducing aqueous humour in eye and therefore reducing intraocular pressure- used in glaucoma
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19
Q

Prophylaxis medical management for oesophageal bleeding:

A

Propanolol: (a non-selective beta blocker can be used- as it reduces portal venous blood flow)

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20
Q

Polymyalgia Rheumatica:

A
  • O/E: no true weakness of limb girdles in this condition; any weakness of muscles is due to myalgia.
    Features: rapid onset less than 1 month, patient is more than 60 yrs old.
    Treatment: - Prednisolone 15mg/once daily (steroids typically help)
    Ddx: could be frozen shoulder- but this is usually unilateral
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21
Q

Rotator Cuff Injury:

A
  • Typically Unilateral, presents with pain on abduction of arm(painful arc)
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22
Q

Febrile seizures considered medication:

A

-Buccal Midazolam or Rectal Diazepam

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23
Q

Vision disorder classical presentation:

A
  • Central field vision loss: Age-related Macular Degeneration
  • Peripheral visual field loss: Primary open-angle Glaucoma
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24
Q

Age-related Macular degeneration:

A
  • Risk factors: advancing age, smoking
  • 2 types: Dry and Wet
    -Fundoscopy: show presence of Drusen
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25
Q

Advanced life support guidelines:

A

-Don’t give atropine in asystole/pulseless electrical activity- only give this for patients with shockable rhythms.

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26
Q

reversible causes of cardiac arrest:

A

Reversible causes of cardiac arrest:

The 4 Hs:
Hypoxia
Hypovolaemia
Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders
Hypothermia
4 T’s:
Thrombosis (coronary or pulmonary)
Tension pneumothorax
Tamponade – cardiac
Toxins

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27
Q

Tetralogy of Fallot Presentation:

A

-may experience episodic tet (hypercyanotic spells)

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28
Q

shaken baby syndrome triad:

A

encephalopthy, SUBdural haematoma, retinal haemorrhage

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29
Q

neonates resp distress syndrome:

A

if can hear tinkling sounds in a resp exam= think diaphragmatic hernia. Manage by: intubation and ventilation

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30
Q

in suspected Lyme disease for Asymptomatic patients:

A

no need to do anything, just reassure patient and give safety-netting advice.
- is caused by spirochaete Borrelia Burgdoferi
- can be diagnosed clinically if erythema migrans(bulls eye ring) is present
- give doxycycline for early symptomatic disease(upto 30 days ish)

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31
Q

PTSD:

A

flashbacks, nightmares
mx: CBT or if medical: Venlafaxine(SNRI)/SSRI

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32
Q

Alcohol(ethanol) why it increases polyuria:

A

Ethanol inhibits ADH secretion

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33
Q

NSTEMI management:

A

NSTEMI (managed conservatively) antiplatelet choice
- Aspirin, plus either:
- Ticagrelor, if not high bleeding risk
- Clopidogrel, if high bleeding risk
= Would perform Coronary Angiography if clinically unstable patient/or do one in 72 hours if GRACE score more than 3%

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34
Q

For potential Tonsillitis/throat infection, use which criteria?

A

Centor criteria= to assess likelihood of bacterial/viral infection and if no points scored on: fever, tonsillar exudate, tender cervical adenopathy, cough=then no need for abx: simple analgesia and rest.
NICE does not recommend taking throat swabs

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35
Q

Bowen’s Disease Mx:

A

Is a type of squamous cell carcinoma in-situ affecting the epidermis.
- presents with red, scaly crusted patch on sun-exposed areas of the body.
Mx: 1st line with topical 5-fluorouracil

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36
Q

Haemochromatosis blood test results:

A
  • Raised Transferritin saturation, Raised ferritin, Low total iron binding capacity
37
Q

Stable Angina 1st line Investigation:

A
  • CT coronary angiography
38
Q

Presentation: Persistent productive cough +/- haemoptysis in a young person with a history of resp problems and no foreign travels+finger clubbing=??

A

Bronchiectasis

39
Q

patients with AAA(Abdominal Aortic Anerysm) Mx:

A
  • With symptoms= immediately refer to vascular surgery so can do emergency repair
    Presenting symptoms:
  • severe, central abdominal pain radiating to the back
    -patients may be shocked
    -pulsatile mass in abdomen
    can only send for a CT scan to confirm diagnosis if patient is stable.
40
Q

Acute mx. of kidney stone (renal colic):

A
  • IM Diclofenac, 2nd line IV paracetamol
  • Presenting features: severe sudden onset loin to groin pain with nausea
41
Q

Obstructive Sleep Apnoea Mx:

A

1st line: CPAP (for moderate/severe) after weight loss

Diagnostic test: Sleep Studies
Also inform DVLA if it is causing daytime sleepiness

42
Q

Diabetic Neuropathy Mx (think neuropathic pain):

A

1st Line:
- Amitriptyline
- Duloxetine
- Gabapentin
- Pregabalin

43
Q

Drug toxicity management:

A

-Opiate(pain): Naloxone
-Benzodiazepine: Flumazenil
-Paracetamol overdose: N-acetyl cysteine, (if ingested less than 1 hour ago, activated charcoal)
- Salicylate(aspirin) and Tricyclic Antidepressants(amitriptyline): IV Bicarbonate, haemodialysis
- Warfarin: Vitamin K
- Heparin: Protamine Sulphate
-Carbon Monoxide: 100% oxygen
-Cyanide: Hydroxycobalamin

44
Q

Association of T2DM: (Axilla)

A

Acanthosis Nigricans: is caused by insulin resistance, (sometimes description as: Hyperpigmentation and Hyperkeratosis in the axilla and groin regions.

45
Q

Most dangerous presentation of breech:

A
  • Footling presentation
46
Q

Unilateral glue ear in an adult Management:

A
  • Need to do 2 week wait referral as needs evaluation for a posterior nasal space tumour.
  • Presentation of glue ear:
47
Q

SSRIs: benefit with PMS and periods?

A

either continuously or during luteal phase helps PMS.

48
Q

Cotton wool spots on eye slit lamp means what?

A

Retinal infarction, and presents in diabetic retinopathy

49
Q

Vitiligo: Dermatological condition association?

A
  • is an autoimmune condition associated with other autoimmune conditions and alopecia areata
  • Koebner phenomenon: trauma may precipitate more reactions.
50
Q

Umbilical cord prolapse is a medical emergency, management?

A
  • Get patient on all 4’s.
51
Q

Congenital Cytomegalovirus presentation in neonates?

A

Presents with:
- Hearing Loss
- Low birth weight
- Petechial rash
- Microcephaly
- Seizures

52
Q

Otitis Externa management:

A

Topical Antibiotics+topical steroid

  • Presents as: external auditory canal infection
  • infection is often caused by: Staph aureus, Pseudomonas Aeruginosa
  • recent swimming is also a trigger
53
Q

Sialadenitis? (salivary glands)

A
  • Is inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct.
54
Q

Missed pill rule:

A
  • If taken COCP in first 7 days of cycle, then if missed a pill a day ago and then resumed to take 2 more pills= Means no emergency contraception will be required.
55
Q

Side effect of long term anti-psychotics?

A

Can lead to the development of diabetes and glucose dysregulation.

Other common side effects of typical antipsychotics (Extra-pyramidal side effects)=
-Parkinsonism
-Acute Dystonia
-akathisia
-tardive dyskinesia

56
Q

Definitive management for acute angle-closure glaucoma?

A
  • Laser iridotomy
  • is an emergency and needs a ophthal referral
57
Q

Postnatal depression screening tool?

A

Edinburgh Scale

58
Q

Management: of primary haemorrhage(bleeding) within hours after tonsillectomy?

A
  • Requires immediate return to theatre
  • if question is phrased like= IV tranexamic acid
59
Q

When can a copped IUD be fitted into the menstrual cycle?

A

Anytime in the cycle, as the IUD is not hormonally linked.

60
Q

missed miscarraige is also known as?

A

delayed miscarraige

61
Q

Surfactant disease in newborn (Respiratory Distress) is a common risk factor in?

A
  • Maternal Diabetes Mellitus
62
Q

Hyperthyroidism (Grave’s disease) mx?

A

Normally Carbimazole but if not in option:
- GP can start: Propanolol for symptom control
- specialist can start: Propylthiouracil to bring thyroid levels under control.

63
Q

Acute angle-closure glaucoma DEFINITIVE mx?

A

Laser peripheral iridotomy

NB: 1st line) Latanoprost eye drops

64
Q

Associations of: Acute angle closure glaucoma AND Primary open-angle glaucoma

A

-Acute angle: Hypermetropia (long-sightedness)
-Primary open angle: Myopia (near-sightedness)

65
Q

Main risk factor for retinal detachment?

A
  • Myopia
66
Q

Mx. of OESTROGEN receptor positive breast cancer in pre-menopausal women?

A

Tamoxifen

  • Although examples of aromatase inhibitors is: Anastrozole and letrozole: reduces peripheral oestrogen, however could cause Osteoporosis.
67
Q

For asthma diagnosis in children:

A
  • Even if spirometry is negative, still need to check Fractional exhaled nitric oxide testing (FeNO) to confirm asthma diagnosis.
68
Q

Pulmonary Fibrosis investigation required for definitively diagnosing the condition?

A
  • CT (high resolution): also hear Bilateral Fine Crepitations and finger clubbing can be seen.
  • Spirometry: classically shows a restrictive picture (ratio increased FEV1/FVC: decreased)
  • Poor prognosis, life expectancy is around 3-4 years.
69
Q

Most common organism: in young adults with septic arthritis?

A

Neisseria Gonorrhoeae

70
Q

Renal colic: acute management based on guidelines?

A
  • IM Diclofenac (NSAID)
  • Imaging: Non contrast CT kidney, ureter and bladder.
71
Q

Example of a nephrotoxic disease that needs to be stopped if patient has a AKI?

A

Ibuprofen

72
Q

New-onset AF management: if Pharmacological cardioversion is agreed

A
  • If evidence of structural/ischaemic heart disease: give Flecainide or Amiodarone
  • If yes: evidence of structural heart disease= Amiodarone
73
Q

Rate control medication for AF:

A
  • Atenolol (beta blockers)
  • Digoxin therapy: only if patient is presenting with non-paraoxysmal AF+sedentary
74
Q

What medications should patients be prescribed for a STEMI= that needs Fibrinolysis?

A
  • Alteplase
    AND
  • Fondaparinux (is an antithrombin drug)
75
Q

how to manage: IRREGULAR broad complex tachycardia?

A
  • this is a rare condition: therefore= seek specialist cardio input
76
Q

What is typically spared in Motor neuron Disease?

A
  • Ophthalmoplegia: eye movements (as extraocular eye muscles are preserved)
77
Q

What would point towards a diagnosis of Motor Neuron Disease?

A
  • Fasciculations
  • Asymmetric limb weakness is most common presentation of ALS (amyotrophic lateral sclerosis)
  • wasting of small muscle hands
    NB: doesn’t affect eye muscles, has no cerebellar signs
78
Q

Osteomalacia blood results?

A
  • Low calcium
  • low vitamin d
  • low phosphate
  • usually high alkaline phosphatase
79
Q

In Diabetes when should you add another medication to monotherapy?

A
  • If Hba1c rises to more than 58mmol/mol
  • Hba1c should be checked every 3-6 months until stable, then 6 monthly
80
Q

Diabetes and then get MI: what to prescribe?

A

D for diabetes
D for Dapagliflozin

81
Q

Presentation of Ileus (post-operative= same as bowel obstruction)?

A
  • Abdominal pain
  • Bloating
  • Vomiting
    (following bowel surgery)
82
Q

Optic Neuritis mx?

A
  • IM corticosteroids (high dose steroids) + MRI of brain and orbit of eye
83
Q

Presentation of Optic Neuritis?

A
  • Subacute unilateral vision loss
  • Eye pain worse on movements
84
Q

Anterior Uveitis Mx?

A
  • Steroid and Cycloplegic eyedrops
85
Q

Eczema Herpeticum: most likely diagnosis?

A
  • Very severe emergency presentation: is a painful red rash, occurs when HSV(Herpes Simplex Virus) infects an area that is infected by eczema
  • is a life-threatening condition and should be admitted for IV aciclovir
86
Q

Side effects of beta blockers?

A

Sleep disturbances: Insomnia

87
Q

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

A

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

88
Q

Associated condition to think of: Mitral stenosis and what condition?

A

Rheumatic fever (past history)

Mitral Stenosis murmur: loud S1, opening snap.

Finals (38 decks)

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