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Gap deck MSRA > Passmedicine gap deck > Flashcards

Passmedicine gap deck Flashcards

1
Q

How soon after sex should levonorgestrel be taken

A

72 hours post UPSI

  • single dose of levonorgestrel 1.5mg
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2
Q

when should dose of levonorgestrel be doubled

A

BMI >26 or weight over 70kg

dose should also be doubled if taking enzyme-inducing drugs (although a copper IUD as emergency contraception is preferable in this situation)

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3
Q

when should levornogestrel be repeated

A

if vomiting occurs within 3 hours then the dose should be repeated

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4
Q

can you take levonorgestrel multiple times in a menstrual cycle

A

yes

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5
Q

can you start hormonal contraception post levornogestrel

A

hormonal contraception can be started immediately after using levornogestrel (Levonelle) for emergency contraception

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6
Q

MOA ellaOne

A

selective progesterone receptor modulator

The primary mode of action is thought to be inhibition of ovulation

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7
Q

time frame post UPSI of EllaOne

A

120 hours

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8
Q

Ella One and other contraception

A

Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period

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9
Q

caution of ellaone

A

severe asthma

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10
Q

can you use ellaone multiple times in the same cycle

A

yes

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11
Q

when should you insert IUD copper

A

must be inserted within 5 days of UPSI, or
if a woman presents after more than 5 days then an IUD may be fitted up to 5 days after the likely ovulation date

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12
Q

breastfeeding and ellaone

A

breastfeeding should be delayed for one week after taking ulipristal. There are no such restrictions on the use of levonorgestrel

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12
Q

MOA IUD

A

may inhibit fertilisation or implantation

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13
Q

what is somatisation disorder

A

This condition involves multiple physical symptoms that have been present for at least two years, and the patient refuses to accept reassurance or negative test results. The chronic nature of her symptoms (abdominal pain, headaches, joint pain) and the fact that extensive investigations have returned normal results align well with somatisation disorder. Given the chronicity and multiplicity of her unexplained physical symptoms, along with significant distress and impact on functioning, somatisation disorder is the most appropriate diagnosis.

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14
Q

2WW for oesophageal and stomach cancer

A

All patients who’ve got dysphagia

All patients who’ve got an upper abdominal mass consistent with stomach cancer

Patients aged >= 55 years who’ve got weight loss, AND any of the following:
upper abdominal pain
reflux
dyspepsia

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15
Q

non urgent upper GI referral

A

Patients with haematemesis

Patients aged >= 55 years who’ve got:
treatment-resistant dyspepsia or
upper abdominal pain with low haemoglobin levels or
raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain

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16
Q

managing patients who do not meet referral criteria

A
  1. Review medications for possible causes of dyspepsia
  2. Lifestyle advice
  3. Trial of full-dose proton pump inhibitor for one month OR a ‘test and treat’ approach for H. pylori
    if symptoms persist after either of the above approaches then the alternative approach should be tried
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17
Q

testing for h.pylori and test of cure

A

initial diagnosis: NICE recommend using a carbon-13 urea breath test or a stool antigen test, or laboratory-based serology ‘where its performance has been locally validated’

test of cure:
there is no need to check for H. pylori eradication if symptoms have resolved following test and treat
however, if repeat testing is required then a carbon-13 urea breath test should be used

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18
Q

scarlet fever is caused by

A

Group A haemolytic streptococci (usually Streptococcus pyogenes)

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19
Q

presentation and incubation of scarlet fever

A

Scarlet fever is spread via the respiratory route by inhaling or ingesting respiratory droplets or by direct contact with nose and throat discharges, (especially during sneezing and coughing).

fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
‘strawberry’ tongue
rash
fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles
children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures
it is often described as having a rough ‘sandpaper’ texture
desquamination occurs later in the course of the illness, particularly around the fingers and toes

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20
Q

diagnosis of scarlet fever and mx

A

a throat swab is normally taken but antibiotic treatment should be commenced immediately, rather than waiting for the results

oral penicillin V for 10 days
patients who have a penicillin allergy should be given azithromycin
children can return to school 24 hours after commencing antibiotics
scarlet fever is a notifiable disease

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21
Q

scarlet fever complications

A

otitis media: the most common complication

rheumatic fever: typically occurs 20 days after infection

acute glomerulonephritis: typically occurs 10 days after infection

invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness

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22
Q

mx of patient on anticoag w/ TIA sx

A

If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should be admitted immediately for imaging to exclude a haemorrhage

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23
Q

mx of TIA

A

patients with TIA or minor ischaemic stroke should be given antiplatelet therapy provided there is neither a contraindication nor a high risk of bleeding
for patients within 24 hours of onset of TIA or minor ischaemic stroke and with a low risk of bleeding, the following DAPT regimes should be considered:

clopidogrel (initial dose 300 mg followed by 75 mg od) + aspirin (initial dose 300 mg followed by 75 mg od for 21 days) followed by monotherapy with clopidogrel 75 mg od
ticagrelor + clopidogrel is an alternative
if not appropriate for DAPT:
clopidogrel 300 mg loading dose followed by 75 mg od should be given
proton pump inhibitor therapy should be considered for DAPT

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24
Q

triptan contraindications

A

patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease

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25
Q

undescended testis management

A

Unilateral undescended testis
referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age
orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age

Bilateral undescended testes
Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation

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26
Q

mx of prostatitis

A

ciprofloxacin

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27
Q

Management of NSTEMI

A

fondaparinux should be offered to patients who are not at a high risk of bleeding and who are not having angiography immediately

if immediate angiography is planned or a patients creatinine is > 265 µmol/L then unfractionated heparin should be given

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28
Q

what does the GRACE score take into consideration

A

age
heart rate, blood pressure
cardiac (Killip class) and renal function (serum creatinine)
cardiac arrest on presentation
ECG findings
troponin levels

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29
Q

Which patients with NSTEMI/unstable angina should have coronary angiography (with follow-on PCI if necessary)?

A

immediate: patient who are clinically unstable (e.g. hypotensive)
within 72 hours: patients with a GRACE score > 3% i.e. those at intermediate, high or highest risk
coronary angiography should also be considered for patients if ischaemia is subsequently experienced after admission

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30
Q

Percutaneous coronary intervention for patients with NSTEMI/unstable angina

A

unfractionated heparin should be given regardless of whether the patient has had fondaparinux or not
further antiplatelet (‘dual antiplatelet therapy’, i.e. aspirin + another drug) prior to PCI
if the patient is not taking an oral anticoagulant: prasugrel or ticagrelor
if taking an oral anticoagulant: clopidogrel

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31
Q

A 74-year-old man with symptomatic aortic stenosis is reviewed in the cardiology clinic. He is otherwise fit and well and keen for intervention if possible. What type of intervention is he most likely to be offered?

A

Bioprosthetic aortic valve replacement. This patient with symptomatic aortic stenosis who is fit for surgery would most likely be offered a bioprosthetic aortic valve replacement. According to UK guidelines, this intervention is recommended for patients aged >65 years or younger patients not wishing to take lifelong anticoagulation. Bioprosthetic valves have the advantage of not requiring long-term anticoagulation, unlike mechanical valves, and are generally preferred in older patients due to their better hemodynamic properties and lower risk of thromboembolic complications.

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32
Q

when do you need to refer molloscum to specialties

A

Molluscum contagiosum with eyelid or ocular involvement and red eye requires urgent ophthalmology review

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33
Q

what can cause myasthenic crisis

A

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

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34
Q

is azathioprine safe in pregnancy

A

yes

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35
Q

what to do if on clopidogrel 75mg post stroke and want to change

A

clopidogrel 75 mg daily should be the standard antithrombotic treatment;

aspirin 75 mg daily should be used for those who are unable to tolerate clopidogrel;

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36
Q

port wine stains

A

Port wine stains are vascular birthmarks that tend to be unilateral. They are deep red or purple in colour. Unlike other vascular birthmarks such as salmon patches and strawberry haemangiomas, they do not spontaneously resolve, and in fact often darken and become raised over time. Treatment is with cosmetic camouflage or laser therapy (multiple sessions are required).

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37
Q

what causes hand foot and mouth disease

A

coxsackie or enterovirus

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38
Q

first line for delirium in agitated palliative patients

A

oral haloperidol

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39
Q

pregnancy and antiepileptics

A

aim for monotherapy

there is no indication to monitor antiepileptic drug levels

sodium valproate: associated with neural tube defects - DO NOT USE IN PREGNANCY

carbamazepine: often considered the least teratogenic of the older antiepileptics

phenytoin: associated with cleft palate

lamotrigine: studies to date suggest the rate of congenital malformations may be low.
The dose of lamotrigine may need to be increased in pregnancy

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40
Q

breast feeding and antiepileptics

A

Breast feeding is generally considered safe for mothers taking antiepileptics with the possible exception of the barbiturates

It is advised that pregnant women taking phenytoin are given vitamin K in the last month of pregnancy to prevent clotting disorders in the newborn

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41
Q

mx of CURB 65 patients

A

0: low risk (less than 1% mortality risk)
NICE recommend that treatment at home should be considered (alongside clinical judgement)

1 or 2: intermediate risk (1-10% mortality risk)
NICE recommend that ‘ hospital assessment should be considered (particularly for people with a score of 2)’

3 or 4: high risk (more than 10% mortality risk)

NICE recommend urgent admission to hospital

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42
Q

mx of CAP

A

Management of low-severity community acquired pneumonia
amoxicillin is first-line
if penicillin allergic then use a macrolide or tetracycline

NICE now recommend a 5 day course of antibiotics for patients with low severity community acquired pneumonia

Management of moderate and high-severity community acquired pneumonia
dual antibiotic therapy is recommended with amoxicillin and a macrolide
a 7-10 day course is recommended

NICE recommend considering a beta-lactamase stable penicillin such as co-amoxiclav, ceftriaxone or piperacillin with tazobactam and a macrolide in high-severity community acquired pneumonia

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43
Q

things that hinder discharge with a CAP

A

NICE recommend that patients are not routinely discharged if in the past 24 hours they have had 2 or more of the following findings:
temperature higher than 37.5°C
respiratory rate 24 breaths per minute or more
heart rate over 100 beats per minute
systolic blood pressure 90 mmHg or less
oxygen saturation under 90% on room air
abnormal mental status
inability to eat without assistance.

They also recommend delaying discharge if the temperature is higher than 37.5°C.

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44
Q

when should you have a CXR post pneumonia

A

CXR @ 6 weeks

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45
Q

when can a child crawl

A

9 months old

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46
Q

which diabetic meds can cause cholestasis

A

gliclazide

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47
Q

murmur and signs in aortic regurg

A

early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre
collapsing pulse
wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)
mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams

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48
Q

criteria for USS for DDH

A

All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery

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49
Q

what type of fever in bronchiolitis

A

low grade
Consider a diagnosis of pneumonia if the child has:
high fever (over 39°C) and/or
persistently focal crackles.

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50
Q

mx of keloid scar

A

The most appropriate management for this patient with a keloid scar is to refer for intralesional triamcinolone. Intralesional corticosteroids, such as triamcinolone, are the first-line treatment for keloids according to UK guidelines. They work by reducing inflammation, collagen synthesis, and fibroblast proliferation, ultimately leading to a reduction in the size and appearance of the keloid. Multiple injections may be required at 4-6 week intervals.

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51
Q

COCP UKMEC 3

A

more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease

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52
Q

COCP UKMEC 4

A

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

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53
Q

how long does finasteride treatment of BPH take to be effective

A

may take 6 months before results are seen

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54
Q

what is spider naevi associated with

A

liver disease
pregnancy
combined oral contraceptive pill

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55
Q

COCP MOA

A

Inhibits ovulation

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56
Q

Progestogen-only pill (excluding desogestrel) MOA

A

Thickens cervical mucus

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57
Q

Desogestrel-only pill MOA

A

Primary: Inhibits ovulation
Also: thickens cervical mucus

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58
Q

Injectable contraceptive (medroxyprogesterone acetate) MOA

A

Primary: Inhibits ovulation
Also: thickens cervical mucus

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59
Q

Implantable contraceptive (etonogestrel) MOA

A

Primary: Inhibits ovulation
Also: thickens cervical mucus

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60
Q

Intrauterine contraceptive device MOA

A

Decreases sperm motility and survival

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61
Q

Intrauterine system (levonorgestrel)

A

Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus

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62
Q

methods of emergency contraception and mechanism of action

A

Levonorgestrel Inhibits ovulation
Ulipristal Inhibits ovulation
Intrauterine contraceptive device Primary: Toxic to sperm and ovum
Also: Inhibits implantation

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63
Q

T1DM HbA1C targets

A

In type 1 diabetics, a general HbA1c target of 48 mmol/mol (6.5%) should be used

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64
Q

holmes adie pupil facts

A

unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light
association of Holmes-Adie pupil with absent ankle/knee reflexes

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65
Q

meningitis in neonatal to 3 months

A

Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes
E. coli and other Gram -ve organisms
Listeria monocytogenes

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66
Q

meningitis bacteria in 1 month to 6 years

A

Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae

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67
Q

meningitis in >6 years

A

Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)

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68
Q

eczema herpeticum

A

caused by superimposed herpes simplex 1

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69
Q

management of prophylaxis of oesophageal bleeding

A

propanolol (NSBB)

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70
Q

blood test deranged in APS

A

prolonged APTT and low platelets

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71
Q

s.aureus incubation time

A

short - severe vomiting, no diarrhoea

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72
Q

management of small fibroadenomas that have no concerning features

A

<3cm on imaging –> first line is watchful waiting without biopsy

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73
Q

when do you give oral abx in acute COPD

A

if there is purulent sputum / signs of pneumonia

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74
Q

glaucoma ocular pressure

A

normal IOP –> normal tension glaucoma

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75
Q

mumps school avoidance guidelines

A

kept off school for 5 days from the onset of the swollen glands

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76
Q

red flags paeds

A

child <3 months with a fever >38 –> ED

RR > 60

moderate or severe chest indrawing

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77
Q

chickenpox exposure in pregnancy:

A

antivirals or VZIG (if available) should be given at 7-14 days post exposure if not immediately

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78
Q

maintatining remission in crohns

A

azathioprine / mercatopurine

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79
Q

section 4

A

GPs can use section 4 of MHA (alongside an AMHP or NR) to transfer a patietn for an emergency psychiatric assessment

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80
Q

APKD screening

A

USS abdo

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81
Q

alcohol withdrawal

A

symptoms 6-12 hours
seizures 36 hours
DT 72 hours

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82
Q

most common cause of cushings syndrome

A

pituitary adenoma

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83
Q

most common headache in children

A

migrainesi

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84
Q

what to do if starting SGLT-2 as initial therapy for T2DM

A

ensure metformin is uptitrated first

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85
Q

most common cardiac defect downs

A

AVSD

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86
Q

APER vs high anterior resection

A

APER removes anal canal –> therefore if there is anal verge involvement need an APER > resection

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87
Q

Latent TB management

A

3 months of isoniazid (with pyridoxine) and rifampicin OR
6 months of isoniazid with pyridoxine

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88
Q

inducing remission for UC that extends past the left side

A

oral aminosalicylate and rectal

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89
Q

opthamia neonatorum

A

infection of the newborn eye
chlamydia and neisseria
refer for same day assessment

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90
Q

children with squint

A

refer to opthalmology

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91
Q

bow legs in child <3

A

normal variant and usually resolves by the age of 4

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92
Q

what will the kidney be like in diabetic nephrologist

A

bilaterally enlarged kidneys

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93
Q

most common cause of orbital cellulitis in children

A

ethmoidal cellulitis

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94
Q

decreasing vision over months with metamorphosia and central scotoma

A

wet age related macular

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95
Q

lyme disease rash

A

eyrthema migrans

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96
Q

is hyperacusis seen in bells palsy

A

yes

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97
Q

what wosense plaque psoriasis

A

beta blockers

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98
Q

dermatophyte nail infection

A

oral terbinafine

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99
Q

live attenuated vaccines

A

BCG
MMR
oral polio
yellow fever
oral typhoid

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100
Q

difference between MCUG and DMSA

A

MCUG for reflux

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101
Q

when can women have pertussis vaciner

A

16-32 weeksw

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102
Q

hearing test in school entry

A

pure tone audiometry

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103
Q

lfts testing statin

A

lfts at baseline, 3, 12 months

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104
Q

pagets disease of bone presents with

A

bowing of legs
managed with nbisphosohonates

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105
Q

what should you avoid in HOCM

A

ramipril

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106
Q

children under the age of five with enuresis

A

reassurance and advice

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107
Q

A 4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a blanching punctate rash sparing the face

A

rubella

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108
Q

A 3-year-old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted

A

Rubella

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109
Q

Measles

A

Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

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110
Q

Lacunar stroke

A

unilateral motor disturbance affecting the face, arm or leg or all 3.
complete one sided sensory loss.
ataxia hemiparesis.

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111
Q

management of PBC

A

ursodeoxychlocic acid

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112
Q

what precipitates gout

A

furosemide

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113
Q

patients having cocaine induced MI should be given what as part of acute management

A

diazepam

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114
Q

actinic keratosis management

A

topical fluoracil

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115
Q

is digoxin monitored

A

no

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116
Q

monitoring of haemochromatosis

A

ferritin and transferrin saturation

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117
Q

diclofenac and cardiovascular disease

A

CI

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118
Q

most common site affected in UC

A

rectum

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119
Q

BV tx alternative to metronidazole

A

topical clindamycin

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120
Q

when in thrombolysis indicated

A

if a stroke is confirmed occlusive proximal

121
Q

most common symptoms of posterior circulation stroke

A

dizziness

122
Q

If a patient with AF has a stroke or TIA, the anticoagulant choice…

A

he anticoagulant of choice should be warfarin or a direct thrombin or factor Xa inhibitor

123
Q

which PD meds causes hallucinations

A

ropinirole

124
Q

calcium level in rhabdomyolysis

A

calcium is usually low

125
Q

medical cardioversion if evidence of structural heart disease

A

amiodarone

126
Q

what do you need to monitor when on magnesium sulfate

A

monitor reflexes and respiratory rate

127
Q

what can ramipril do to BNP

A

cause it to be low

128
Q

RAST test

A

Determines the amount of IgE that reacts specifically with suspected or known allergens, for example IgE to egg protein. Results are given in grades from 0 (negative) to 6 (strongly positive)

Useful for food allergies, inhaled allergens (e.g. Pollen) and wasp/bee venom

Blood tests may be used when skin prick tests are not suitable, for example if there is extensive eczema or if the patient is taking antihistamines

129
Q

review of sertraline

A

<25 - review in 1 week
>25 - review in 2 weeks time

130
Q

difference betwween polymorphic eruption of pregnancy and pemphigoid

A

Polymorphic eruption of pregnancy is not associated with blistering

131
Q

what is GABA

A

inhibitory neurotransmitter

benzos increase GAB A

132
Q

treatment of chronic rhinosinusitis

A

nasal irrigation with saline solution

133
Q

PCV

A

there is overproduction of platelets, neutrophils and Hb

134
Q

what to avoid in BPH

A

amitriptyline –> risk of urinary retention

135
Q

level of PSA post prostastectomy

A

should be less than 0.2 = undetectable

136
Q

what should you avoid with SSRIs

A

patients prescribed warfarin

137
Q

radial tunnel syndrome

A

Radial tunnel syndrome presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation

138
Q

management of labial adhesions if recurrent UTIs

A

oestrogen cream

139
Q
A
140
Q

when do you take progesterone levels in women

A

7 days before next expected period

141
Q

what to do if you pick up a simple ovarian cyst on the scan

A

repeat USS in 12 weeks time

142
Q

rhesus negative women when do you give first dose of anti D

A

28 weeks

143
Q

FAST questionnaire

A

4 item questionnaire
minimum score = 0, maximum score = 16
the score for hazardous drinking is 3 or more
with relation to the first question 1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits
if the answer to the first question is ‘never’ then the patient is not misusing alcohol
if the response to the first question is ‘Weekly’ or ‘Daily or almost daily’ then the patient is a hazardous, harmful or dependent drinker. Over 50% of people will be classified using just this one question

144
Q

skin manifestations of tuberous sclerosis

A

adenoma sebaceum

145
Q

severity of COPD scores

A
146
Q

is blepharitis associated with acne rosacea

A

yes

147
Q

when is meningitis B vaccine given

A

2 months, 4 months, 12-13 months

148
Q

what causes angular chelitis in anorexia

A

zinc deficiency

149
Q

does gliclazide cause weight gain/loss

A

causes weight gain - This occurs due to increased insulin levels leading to increased glucose uptake and storage as glycogen or fat.

150
Q

difference between PVD, RD, vitreous haemorrhage

A

PVD: Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision

RD: Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss

VH: Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters

151
Q

MMR vaccine contraindication

A

allergy to neomycin

152
Q

gap between most recent live attenuated virus and MMR vaccine

A

4 weeks

153
Q

what does newborn blood spot screening test for

A

congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)

154
Q

isoniazid side effects

A

b6 deficiency causing peripheral neuropathy

155
Q

which antimalarial is taken weekly

A

mefloquin

156
Q

doxycycline s/e

A

photosensitivity

157
Q

webers syndrome

A

Weber’s syndrome is a form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

158
Q

investigations for sarcoidosis

A

serum ACE, sputum culture and CXR

159
Q

what investigation do you do pre-herceptin

A

echo as it is cardiotoxic

160
Q

which conditions do not require school exclusion

A

Conjunctivitis
Fifth disease (slapped cheek)
Roseola
Infectious mononucleosis
Head lice
Threadworms
Hand, foot and mouth

161
Q

scarlet fever exclusion

A

24 hours after commencing antibiotics

162
Q

Whooping cough exclusion

A

2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

163
Q

measles school exclusion

A

4 days from rash onset

164
Q

rubella school exclusion

A

5 days rash onset

165
Q

chickenpox school exclusion

A

all lesions crusted over

166
Q

mumps exclusion

A

5 days from onset of swollen glands

167
Q

impetigo exclusion

A

until lesions are crusted and healed / 48 hours post commencement of abx treatment

168
Q

scabies exclusion

A

until treated

169
Q

infleunza excluion

A

until recovered

170
Q

blurring of vision years post cataract suregry

A

posterior cataract opacificationc

171
Q

caput succadenum vs cephalohaematoma

A

caput secadaneum is scalp oedema that crosses suture lines
cephalohaematoma does not cross suture lines

172
Q

post MI SSRI choice

A

setraline

173
Q

hypolcaemia and cataracts

A

hypocalcaemia is a risk factor for cataracts

174
Q

suspected laryngeal cancer guidelines

A

A suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over with:
persistent unexplained hoarseness or
An unexplained lump in the neck.

175
Q

ENT referral ear ache

A

Unexplained, unilateral ear ache for more than 4 weeks with unremarkable otoscopy should be referred under the 2 week wait

176
Q

difference between labrynthitis and vestibular neuronitis

A

there is hearing loss with labrynthitis

177
Q

constipation in IBS what drug

A

ispaghula husk

178
Q

migraine anti sickness

A

metoclopramide

179
Q

somatisation disorder

A

multiple physical symptoms for at least 2 years, patient refuses to accept reassurance or negative test results

180
Q

triptans and SSRIs

A

increase risk of serotonin syndrome

181
Q

FIT testing programme

A

Faecal immunochemical tests (FIT) are used to screen for colorectal cancer. Screening kits are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland. If the results of these are abnormal then the patient is offered a colonoscopy.

182
Q

PSA timings

A

6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation

183
Q

TIA rules driving

A

can start driving if symptom free after 1 month - no need to inform the DVLA

184
Q

CFS - how long should you have symptoms for

A

3 months

185
Q

difference between erysipelas and nec fasc

A

erysipelas only affects the upper dermis

186
Q

VZV babies look lije

A

scarring of the skin, limb hypoplasia, microcephaly and eye defect

187
Q

rubella in babies symptons

A

congenital cataracts, sensorineural deafness and pulmonary artery stenosisr

188
Q

rules for acei

A

he BNF recommends the angiotensin-converting enzyme inhibitors should only be stopped if the creatinine increases by 30% or eGFR falls by 25% or greater.

189
Q

AKI stages

A
190
Q

osgood schlatter disease

A

This condition is a common cause of knee pain in growing adolescents, typically aged between 10 and 15 years old. It is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia). The symptoms usually include pain and swelling over the tibial tubercle, which can be exacerbated by physical activity such as hockey. The condition tends to resolve itself with time, once the child has stopped growing.

191
Q

painful diabetic neuropathy tx

A

duloxetine

192
Q

first line otitis externa management

A

topical corticosteroid and aminoglycoside

193
Q

keratoderma blennorhagica

A

seen in reactive arthritis

194
Q

management of invaive diarrhoea (causes bloody diarrhoea and fever)

A

ciprofloxacin

195
Q

what medication can cause TEN and other complications that it can cause and mx

A

phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs

can cause AKI on bloods

mx: IVIG / supportive care

196
Q

which contraception types are not affected by enzyme inducing drugs

A

copper IUD
progesterone injection
mirena

197
Q

incubation period of b.cereus

A

6-15 hours

198
Q

varenciclone drug class

A

nicotinic receptor partial agonist

199
Q

what is the best measurement to assess for response to treatment for hashimotos

A

TSH

200
Q

mechanism of action of bupropion

A

norepinephrine and dopamine reuptake inhibitor and nitotinic antagonist

201
Q

side effects of colchicine

A

diarrhoea

202
Q

what is a risk factor for respiratory distress syndrome

A

maternal diabetes mellitus

203
Q

tamsulosin side effects

A

dizziness and postural Hypotension

204
Q

when do you avoid amitriptyline. what can you use alternatively

A

if there is BPH –> can cause urinary retention

pregablin

205
Q

patients on allopurinol already

A

they should take it at the same dose during acute episodes, but new patients should not be started on allupurinol until an acute attack has settled

206
Q

what are traditional POPs and the rules with these

A

micronor
noriday
nogeston
femulen

if less than 3 hours late no action required, continue as normal

if more than 3 hours late
take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
continue with rest of pack
extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours

207
Q

what criteria in salicylate overdose –> haemodialysis

A

pulmonary oedema and metabolic acidosis

208
Q

what is used in managing tremor in drug induced parkinsonism

A

procyclidine

209
Q

focal seizure drug management

A

lamotrigine / levetiracetam

210
Q

generalised TC seizures management

A

males: sodium valproate
females: lamotrigine or levetiracetam
girls aged under 10 years and who are unlikely to need treatment when they are old enough to have children or women who are unable to have children may be offered sodium valproate first-line

211
Q

absence seizures management

A

first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures

212
Q

myoclonic seizures management

A

males: sodium valproate
females: levetiracetam

213
Q

tonic or atonic seizures management

A

males: sodium valproate
females: lamotrigine

214
Q

primary open angle glaucoma visual loss

A

unilateral peripheral visual loss

215
Q

patient who has an extensive stroke with right sided hemiplegia what side will the homonymous hemianopia be

A

right sided

216
Q

femeroacetabular impingement

A

caused by anterior groin pain
one of the most common causes of persistent hip pain in active young adults
pain worse on prolonged sitting and assocaited with snapping, clicking or locking of the hip

217
Q

management of menieres

A

referaral to ENT

218
Q

when can children combine two words by

A

2 years old

219
Q

parkland fluid resuscitation formula

A

Total fluid requirement in 24 hours =
4 ml x (total burn surface area (%)) x (body weight (kg))
50% given in first 8 hours
50% given in next 16 hours

ensure it is crystalloid only = hartmanns/ringers lactate

220
Q

management of first episode genital herpes during third trimester

A

managed with daily suppressive oral aciclovir 400mg until delviery
C/S

221
Q

how to remember where brocas and wenickes areas are

A

Spoken word is heard at the ear. This passes to Wernicke’s area in the temporal lobe (near the ear) to comprehend what was said. Once understood, the signal passes along the arcuate fasciculus, before reaching Broca’s area. The Broca’s area in the frontal lobe (near the mouth) then generates a signal to coordinate the mouth to speak what is thought (fluent speech).

222
Q

what would you see on bloods in hyposplenis m

A

target cells and howell jolly bodies

223
Q

management of otitis externa depending of severity

A

Mild - mild cases (mild discomfort and/or pruritus; no deafness or discharge), consider prescribing topical acetic acid 2% spray.

More severe - 7 days of a topical abx with or without topical steroid

224
Q

degenerative cervical myelopathy symptoms

A

Pain (affecting the neck, upper or lower limbs)
Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and imbalance
Loss of sensory function causing numbness
Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition
Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.

Often they are incorrectly diagnosed with carpal tunnel syndrome

225
Q

itching in scabies

A

can persist for 4 weeks post infection

226
Q

haemolytic uraemic syndrome treatment

A

supportive measurement

227
Q

when is downs syndrome screening done

A

11-13+6 weeks

228
Q

measles symptoms

A

koplik spots, macpap rash behind the ears and conjunctivitis

229
Q

causes of cranial diabetes insipidus

A

idiopathic
post head injury
pituitary surgery
craniopharyngiomas
infiltrative
histiocytosis X
sarcoidosis
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)
haemochromatosis

230
Q

causes of nephrogenic DI

A

genetic:
more common form affects the vasopression (ADH) receptor
less common form results from a mutation in the gene that encodes the aquaporin 2 channel
electrolytes
hypercalcaemia
hypokalaemia
lithium
lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts
demeclocycline
tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

231
Q

invesigations for diabetes insipidus

A

high plasma osmolality, low urine osmolality
a urine osmolality of >700 mOsm/kg excludes diabetes insipidus
water deprivation test

232
Q

management of diabetes insipidus

A

nephrogenic diabetes insipidus
thiazides
low salt/protein diet
central diabetes insipidus can be treated with desmopressin

233
Q

trinucloetide repeat disorders

A

Fragile X (CGG)
Huntington’s (CAG)
myotonic dystrophy (CTG)
Friedreich’s ataxia* (GAA)
spinocerebellar ataxia
spinobulbar muscular atrophy
dentatorubral pallidoluysian atrophy

234
Q

shaken baby syndrome type of haemorrhage

A

subdural

235
Q

dental abscess abx

A

amoxicillin

236
Q

what precipitates dupuytrens

A

manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand

237
Q

azathioprine adverse affects

A

bone marrow depression - consider a full blood count if infection/bleeding occurs
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer

238
Q

shadow in red reflect

A

cataract

239
Q

sildenafill side effects

A

headaches

240
Q

positive straight leg test means

A

sciatic nerve irritation

241
Q

what to do next in endometriosis if analgesia doesnt work

A

COCP and progesterone

242
Q

how long can nexplanon stay in situ

A

3 years

243
Q

tetanus rules with exposure

A

if a patient had 5 doses of tetanus with the last dose <10 years ago they do not require a booster vaccine nor immunoglobulins

244
Q

what to avoid NSAIDs with

A

warfarin

245
Q

first line for trigeminal neuralgia

A

carbamazepine

246
Q

difference between VWD and haemophilia A

A

haemophilia A APTT is a lot more prolonged

247
Q

PET management

A

Delivery should not be offered to women before 34 weeks unless:
severe hypertension remains refractory to treatment
maternal or fetal indications develop as specified in the consultant plan

At 34 weeks delivery should be offered to women with pre-eclampsia once a course of corticosteroids has been completed.

248
Q

transient tachypnoea of the newborn

A

there are no CXR changes

249
Q

management of chickenpox in pregancy

A

You should ask pregnant women exposed to chickenpox if they have had the infection before. If they say no or are unsure, varicella antibodies should be checked. If it is confirmed they are not immune, varicella immunoglobulin should be considered. It can be given at any point in pregnancy and is effective up to 10 days after exposure.

250
Q

what should you investigate prior to anti-tuberculous therapy

A

LFTs

251
Q

what is a risk of combining sodium valrpoate and lamotrigine

A

steven johnsons syndrome

252
Q

what causes xanthelasma

A

hypercholesterolaemia

253
Q

when would you do a renal biopsy in minimal change disease

A

if the response to steroids is poor

254
Q

CI to the pneumococcal vaccine

A

current febrile illness

255
Q

MMR vaccination if missed

A

give MMR with repeat dose in 3 months

256
Q

glue ear

A

Also known as otitis media with effusion

peaks at 2 years of age
hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)
secondary problems such as speech and language delay, behavioural or balance problems may also be seen

257
Q

antifreeze antidote

A

fomepizole

258
Q

what to do after a 5 year period on bisphosphonates

A

After a five year period for oral bisphosphonates (three years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.

This guidance separates patients into high and low risk groups. To fall into the high risk group, one of the following must be true:
Age >75
Glucocorticoid therapy
Previous hip/vertebral fractures
Further fractures on treatment
High risk on FRAX scoring
T score <-2.5 after treatment

If any of the high risk criteria apply, treatment should be continued indefinitely, or until the criteria no longer apply. If they are in the low risk group however, treatment may be discontinued and re-assessed after two years, or if a further fracture occurs.

259
Q

what to do if the person does not have any of the high risk criteria

A

The best option would therefore be to re-scan her now, and consider a two year break if her T score is >-2.5

260
Q

what is used to prevent migraine

A

propanolon

261
Q

what is used to prevent cluster headaches

A

verapamil

262
Q

retinitis pifmentosa

A

night blindness and tunnel vision

263
Q

first line seborrhoeic dermatitis

A

topical ketoconazole

264
Q

what is seborrhoeic dermatitis associated with

A

HIV and PD

265
Q

COCP cancer risks

A

increased risk of breast and cervical. protective against ovarian and endometrial

266
Q

thiazides side effect

A

hypercalcaemia

267
Q

high risk factor for PET in pregnancy

A

hypertensive disease in a previous pregnancy
chronic kidney disease
autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
type 1 or type 2 diabetes
chronic hypertension

268
Q

moderate risk factors for PET

A

first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m² or more at first visit
family history of pre-eclampsia
multiple pregnancy

269
Q

who should take aspirin 75-150mg daily from 12 weeks gestation until birth

A

1 or more high risk factor
2 or more moderate risk factors

270
Q

Wells score for DVT

A

if 2 or more you would do a leg USS

271
Q

side effects of TB drugs

A

Ethabutol - eye
isoniazid - i cant feel my feet
pyrazinamide - uric acid
rimpicins - P450 inducer
red/orange

272
Q

criteria of anti-D

A

delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma

273
Q

management of impetigo

A

hydrogen peroxide, fusidic acid

extensive -oral fluclox

274
Q

transient tachypnoea of the newborn vs RDS on CXR

A

hyperinflation and fluid in the horizontal fissure

ground glass

275
Q

iodine uptake findings

A

graves disease - increased homogenous uptake
subacute thyroiditis - faint diffuse uptake
no uptake - subacute thyroiditis
single hot nodule with the rest of the gland suppressed - toxic adenoma

276
Q

raised AFP and BHCG

A

non seminomatous testicular cancer
as a raised AFP excludes a seminoma

277
Q

kallmans syndrome bloods

A

LH and FSH low - normal but testosterone is low

278
Q

what are the causes of scarring alopecia

A

lichen planus

279
Q

what are causes of non scarring alopecia

A

trauma/burns, radiotherapy, lichen planus, discoid lupus, tine acpaitis

280
Q

what size fibroadenoma would you excise

A

you would surgically excise if >3cm

281
Q

what is the most common ocular manifestation of rhuematoid arthritis

A

keratoconjunctivitis sicca

282
Q

optic neuritis

A

central scotoma
RAPD
decreased colour vision and pain on momevement

283
Q

croup age group

A

6 months - 3 years old

284
Q

types of conjunctivitis

A

herpes simplex - there will be cold sores or fluorescein uptake showing dendritic ulcers

bacteiral conjunctivitis - purulent discharge

adenoviral - this is the most common infectious type

285
Q

L3 nerve root compression symptoms

A

Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

286
Q

L4 nerve root compression symptoms

A

Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

287
Q

L5 nerve root compression symptoms

A

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

288
Q

S1 nerve root compression symptoms

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

289
Q

Management of prolapsed disc

A

similar to that of other musculoskeletal lower back pain: analgesia, physiotherapy, exercises
NICE recommend using the same drugs as for back pain without sciatica symptoms i.e. first-line is NSAIDs +/- proton pump inhibitors rather than using neuropathic analgesia (e.g. duloxetine)
if symptoms persist e.g. after 4-6 weeks) then referral for consideration of MRI is appropriate

290
Q

organophosphate poisoning symptoms

A

DUMBELS
D: defaecation & diaphoresis.
U: urinary incontinence.
M: miosis (pupil constriction).
B: bradycardia
E: emesis.
L: lacrimation.
S: salivation.

291
Q

management of glue ear

A

children should be observed for 6-12 weeks as symptoms are self-limiting and referral should be reserved if sx persist beyond this point

However, referral should be earlier if:
Symptoms are significantly affecting hearing, development or education
Immediate referral in children with Downs syndrome or cleft palate

292
Q

causes of mydriasis

A

third nerve palsy
Holmes-Adie pupil
traumatic iridoplegia
phaeochromocytoma
congenital

293
Q

first line in priapism in a child

A

cavernosal blood gas

294
Q

when should you refer for infertility

A

early referral

Female Male
Age above 35 Previous surgery on genitalia
Amenorrhoea Previous STI
Previous pelvic surgery Varicocele
Previous STI Significant systemic illness
Abnormal genital examination Abnormal genital examination

295
Q

PHQ-9 interpretation

A

‘less severe’ depression: encompasses what was previously termed subthreshold and mild depression
a PHQ-9 score of < 16
‘more severe’ depression: encompasses what was previously termed moderate and severe depression
a PHQ-9 score of ≥ 16

296
Q

what is internuclear opthalmoplegia

A

Internuclear ophthalmoplegia (INO) occurs due to a lesion of the medial longitudinal fasciculus (MLF), a tract that allows conjugate eye movement.

297
Q

first rank sx of schizophrenia

A

auditory hallucinations
thought disorders
passivity phenomena
delusional perceptions

298
Q

when can you get gestational HTN

A

> 20 weeks

299
Q

what are the bloods like in beta thalassaemia trait

A

there is a mild hypochromic microcytic anaemia
and the HBA2 is raised

300
Q

what happens if you are outside the window of the oral rotavirus vaccine

A

it should not be given after 15 weeks

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