Passmed Mock 1 corrections Flashcards
3 organisms that cause post-splenectomy sepsis;
Haemophilus influenzae
Strep pneumoniae
Meningococci
Small isolated fragments of splenic tissue can implant following splenic rupture in trauma, or be surgically implanted at time of splenectomy. This can cause the sepsis.
What is the standard criteria for stroke thrombolysis, and what is given instead if these criteria are not met?
Exclude haemorrhage (urgent CT)
Within 4.5 hours of symptom onset
Thrombolysis would be alteplase if these criteria are met, and then 24 hours later 300mg aspirin.
If not, they should be treated with aspirin 300mg.
Isolated motor loss ?
Lacunar stroke - e.g. contralateral dense hemiplegia
Which score is used to identify patients at risk of pressure sores?
Waterlow score
A patient has a left homonymous hemianopia. Where would the lesion be?
RIGHT optic tract
How to remember homonymous quadrantanopias?
PITS
Parietal - inferior
Temporal - superior
i.e. surgery to left temporal lobe; RIGHT SUPERIOR homonymous quadrantanopia
A patient presents with sudden PAINLESS loss of vision and severe retinal haemorrhages on fundoscopy. What has happened?
Central retinal vein occlusion.
Optic disc will be swollen
Blot and flame shaped haemorrhages
How would central retinal ARTERY occlusion present?
Sudden painless loss of vision (as in vein occlusion) BUT cherry-red spot on fovea would be present.
Blood flow to retina is obstructed, leading to ischaemia and subsequent infarction of the retina.
Ischaemic optic neuropathy is similar, but would have a pale swollen optic disc instead.
What is the minimum amount of time that a patient should leave between 1st and 2nd puff of an inhaler?
30 seconds
What is first line in mild/moderate cellulitis? And what is the option in cases of allergy?
What is indicated if severe cellulitis is present?
Flucloxacillin
Clarithromycin / erythromycin (pregnancy) / doxycycline
IV ceftriaxone
Which vaccine should MSM be offered?
Which other at-risk groups should be offered this?
Hepatitis A
Close contacts of HAV +ve
Travellers
Chronic liver disease
IVDU
Haemophilia
Occupational exposure e.g. sewage workers, primates
What is the classic presentation of anterior uveitis? What is used to treat it?
Photophobia
Small irregularly shaped pupils
Red eye
Steroids to reduce inflammation
Cycloplegic (mydriatic) eye drops e.g. atropine dilate the pupil and help with pain relief and photophobia
All men with ED should have what checked?
Morning testosterone
What acid-base disturbance does diarrhoea cause, and why?
Metabolic acidosis (low HCO3 and normal CO2) with a NORMAL anion gap.
The anion gap is normal because the GI loss of bicarb causes a reciprocal increase in serum chloride.
(Vomiting causes an alkalosis, as gastric secretions which are acidic are lost, compared to GI contents.)
Give 3 causes of metabolic acidosis with a RAISED anion gap, and discuss why it is raised.
Sepsis
DKA
Methanol poisoning
All of these lead to generation of an anion that is NOT included in the anion gap calculation:
Septic shock = rise in lactic acid
DKA = ketones
Methanol = formic acid
Corticosteroids are indicated in the management of severe alcoholic hepatitis to limit inflammation. What score is used to indicate whether steroids will be of benefit?
Maddrey’s Discriminant Function
What are the conservative management options for anal fissures? What might be considered for cases that do not respond to these?
High fibre diet
Laxatives
Lubricants
Topical GTN
Sphincterotomy might be considered if it is not managed by these methods.
Which type of stoma can be used to defunction the colon after e.g. rectal cancer surgery to protect an anastomosis?
Loop ileostomy
Can be reversed
A child has URTI symptoms and is treated with amoxicillin. They subsequently develop a widespread maculopapular rash. What are you suspicious of, and how should you test for it?
Glandular fever!
Check with a monospot test.
Caused by EBV - heterophil antibodies are detected on the monospot test.
Symptoms include enlarged tonsils, red throat, fever and lymphadenopathy.
What would be seen on a FBC in a patient with glandular fever?
Lymphocytosis
What is the key diagnostic test in GBS?
Lumbar puncture, demonstrating high protein levels and normal WCC.
What is used to prevent vasospasm in aneurysmal SAH?
Nimodipine - given as a 21 day course.
It is a dihydropyridine CCB that targets brain vasculature.
State some triggers that can worsen plaque psoriasis.
Alcohol
Smoking
Stress
Beta blockers
Discontinuing steroids
Initiating NSAIDs
Lithium
Antimalarials
Which lobes are Broca’s and Wernicke’s areas in?
Broca = frontal (nearer to the mouth that produces FLUENT SPEECH)
Wernicke = temporal (near the EAR, where speech is HEARD to comprehend what was said)
What is the difference between Broca’s and Wernicke’s aphasia?
Wernicke’s = cannot comprehend / understand speech, but can produce fluent speech.
Broca’s = cannot form fluent speech, repetition impaired.
Discuss smoking cessation options in pregnancy.
Nicotine replacement patches are an option, but should be removed at night.
Varenicline (partial agonist of nicotinic ach receptors) and bupropion (selective inhibition of noradrenaline and dopamine r) are contraindicated.
How should you adjust a steroid maintenance regime for Addison’s during intercurrent illness, and why?
Double the dose of the glucocorticoid e.g. hydrocortisone.
Keep mineralocorticoid the same e.g. fludrocortisone.
This mimics the body’s natural response to illness, where glucocorticoid secretion is increased but mineralocorticoid stays the same.
Increased goblet cells are found in …
Crohn’s disease
Crypt abscesses are found in …
Ulcerative colitis
A patient has had severe diarrhoea and then been given excess normal saline. Discuss what may happen to their acid base balance and why.
Severe diarrhoea can cause excess bicarbonate loss.
NaCl 0.9% contains 154mmol/L of Na and Cl - large volume resuscitation with normal saline leads to an overload of chloride ions into the blood. This forces bicarbonate into the cells, and reduces the available bicarbonate for the pH buffering system, therefore resulting in HYPERCHLORAEMIC METABOLIC ACIDOSIS.
What is the initial investigation / management for a patient who is on anticoagulants or has a bleeding disorder in a suspected TIA?
Admit and arrange CT head to see if it was an ischaemic or haemorrhagic cause of the TIA.
What is the management of a TIA in patients who don’t have a bleeding disorder or are not on anticoagulants?
300mg aspirin
What does forehead sparing indicate in a focal neurological deficit?
An upper motor neuron sign - more likely to be a haemorrhagic cause?
What medication class can cause worsening of myasthenia and potential for urgent neurology / ITU input and why?
Beta blockers ; causes worsening of myasthenia.
FVC can drop, which requires serious senior input.
Which antibiotics can cause exacerbations of myasthenia?
Aminoglycosides e.g. gentamicin and amikacin
Why can you get hyponatraemia post SAH?
Hypophyseal irritation from the SAH can cause SIADH.
Management of SIADH:
Euvolaemic and hypervolaemic hyponatraemia = fluid restrict 500-1000mls / day
Hypovolaemic hyponatraemia = consider NaCl 0.9%
Severe hyponatraemia e.g. <120mmol/L or symptomatic = hypertonic saline.
Discuss 2 scores used in upper GI bleeding and the timeline in which they should be used.
Glasgow-Blatchford score (B = BEFORE) = decides before a procedure to determine whether a patient will need to be admitted or not.
Rockall score = after endoscopy to determine % risk of rebleeding and mortality in patients with upper GI bleeding.
The AIMS65 score is used to calculate the risk of in-hospital mortality in patients with an upper GI bleed. Often before, as is based on albumin levels, coag results and altered mental status.
Give 2 conservative and 2 drug options for an overactive bladder, as well as symptoms of an overactive bladder.
Storage symptoms = overactive bladder e.g. URGENCY and FREQUENCY. No voiding issues.
Lifestyle measures
Bladder training
- Oxybutynin = antimuscarinic agent; antagonise contractions of the detrusor muscle.
- Mirabegron = beta-3 agonist, causes relaxation of the detrusor muscle, increasing the bladders storage capacity.
If a patient has hypertension, and is found to have a raised ACR ratio, what range is it relevant and what medication would this prompt?
Ramipril e.g. ACEi or an ARB.
Following an ACS, patients are offered 5 different drugs. What are they?
DAPT - aspirin + one other e.g. prasugrel
ACE inhibitor
BB
Statin
First and second line treatments for acute onset of AF if >48 hours, or if patient uncertain of when it started:
- Bisoprolol
- Amiodarone
Which areas of the brain does Alzheimer’s mainly involve?
Cortex
Hippocampus
(widespread cerebral atrophy)
Which 2 medication classes can be used first line to prevent angina attacks?
BB or CCB (rate limiting e.g. verapamil / diltiazem)
2nd line = isosorbide mononitrate / nicorandil
Treatment of VT with no adverse features?
Loading dose of amiodarone then 24-hour infusion
Treatment of VT with adverse features?
Sedate if conscious and give synchronised 1 DC shock.
Adverse features inc shock, syncope, heart failure, myocardial ischaemia.
In a patient with hypercalcaemia, what would the normal response be? What would the response in primary hyperparathyroidism be?
Normal = low PTH
Primary hyperparathyroidism = high or normal PTH
PEA is a non-shockable rhythm - what drug should be given immediately?
IV adrenaline
The management of renal stones depends on whether there are signs of obstruction and infection. What is the first line investigation? What is the management of obstruction? What is the management of infective symptoms?
NON-CONTRAST CT-KUB
Nephrostomy tube insertion is required in obstruction e.g. evidence of hydronephrosis for immediate renal decompression to reduce the risk of permanent renal damage.
Why is prothrombin time a better measure of ACUTE liver failure than albumin?
Shorter half life
How long before a patient undergoing investigations for coeliac disease should they have gluten in their diet?
6 weeks
