Past Exam Q's Flashcards
Amoxicillin dose in infective COPD exacerbation?
Amoxicillin 500 mg TDS for 5 days.
How long must patient be on metformin for before considering increasing dose?
At least 1 week
500mg OD for at least one week
500mg BD for at least one week
500mg TDS for at least one week
Max 2g daily
Initial and max dose of ramipril?
Initial: 2.5 mg once a day
Max: 5 mg twice a day or 10 mg once a day
What is checked before the induction of anaesthesia in the WHO surgical safety checklist?
1) Has the patient confirmed his/her identity, site, procedure and consent?
2) Is the site marked?
3) Is the anaesthesia machine and medication check complete?
4) Is the pulse ox on the patient and functioning?
5) Allergy status of patient
6) Difficult airway or aspiration risk?
7) Risk of >500ml blood loss (7ml/kg in children?
What is checked before skin incision in the WHO surgical safety checklist?
1) Confirm all team members have introduced themselves by name and role
2) Confirm patient’s name, procedure, and where the incision will be made
3) Has abx prophylaxis been given within the last 60 mins?
4) Anticipated critical concerns e.g. any anaesthetic concerns?
5) Is essential imaging displayed?
Before the patient is put to sleep in the anaesthetic room, who confirms the patient’s identity and the procedure they have been consented +/- marked for?
The anaesthetist
In a patient with septic shock with hypotension, what is given after fluids to raise BP?
Vasopressors
What is the most common type of SVT?
AVNRT
What assessment is done to assess acute delirium?
4AT
Mx of different foetal blood sampling results:
1) ≤7.20
2) 7.21-7.24
3) 7.25
1) Abnormal - Inform consultant with the aim of expediting delivery
2) Borderline - Repeat in 30 mins
3) Normal - Repeat in 60 mins
When is foetal blood sampling indicated?
In abnormal CTG
Give some contraindications to the MMR
1) severe immunosuppression e.g. high dose steroids
2) allergy to neomycin
3) children who have received another live vaccine by injection within 4 weeks
4) pregnancy should be avoided for at least 1 month following vaccination
5) immunoglobulin therapy within the past 3 months (there may be no immune response to the measles vaccine if antibodies are present)
What is a pica a significant cause of?
1) Anaemia
2) Lead poisoning
What 8 conditions are screened for on the newborn blood spot?
1) congenital hypothyroidism
2) cystic fibrosis
3) sickle cell disease
4) phenylketonuria
5) medium chain acyl-CoA dehydrogenase deficiency (MCADD)
6) maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
7) glutaric aciduria type 1 (GA1)
8) homocystinuria (pyridoxine unresponsive) (HCU)
What is raised on newborn blood spot test in patients with CF?
IRT - immunoreactive trypsinogen
How are pre and post-ductal sats measured in babies?
The saturation probe is applied to the baby’s right hand (pre-ductal reading) and either foot (post-ductal reading).
What pre & post ductal sats result is normal?
Both readings of ≥ 95% and difference less than 3% normal (test negative) and constitutes no concerns.
Next step if Barlow & Ortolani tests are positive?
US both hips at 6 weeks
What questionnaire for depression can be used in 1ary care?
PHQ-9
What test is used to assess if treatment is working in colorectal cancer?
CEA
At what aortic valve gradient should aortic valve replacement be considered?
≥50mmHg
+ symptoms, or
+ reduced LV EF (<50%)
is there a role of medications in aortic stenosis?
No - only surgery
Typical creatine kinase levels in rhabdo?
> 10,000
Duloxetine vs amitriptyline for neuropathic pain in renal impairment?
Amitriptyline > duloxetine
What can be used to reduce oral candidiasis with steroid inhaler?
Use a large volume spacer - reduces drug deposition in mouth.
What are anticardiolipin antibodies?
A type of antiphospholipid antibody –> antiphospholipid syndrome.
They are associated with an increased risk of stroke.
What are the 3 key antiphospholipid antibodies?
1) Anticardiolipin antibodies
2) Anti-beta-2-glycoprotein-I antibodies
3) Lupus anticoagulants
What organism can cause bilateral pneumonia and meningitis?
Strep. pneumoniae
What feature of C. diff makes it particularly difficult to destroy?
Spore formation
1st line treatment for acute severe mania?
Antipsychotic
Stepwise mx of urogenital prolapse?
1) If asymptomatic/mild –> none
2) Conservative –> weight loss, pelvic floor exercises
3) Ring/pessary
4) Surgery
What can be given for breathlessness in end stage HF (if furosemide has already been given)?
Morphine
Mechanism of neostigmine?
A cholinesterase inhibitor –> reduces the breakdown of ACh at the NMJ, increasing it’s availability to bind to the ACh receptor and trigger muscle contraction.
Role –> reversal agent for non-depolarising muscle relaxants.
What can be used for palliation of dysphagia in patients with oesophageal cancer?
Placement of an oesophageal stent.
This involves the placement of a metal or plastic stent into the oesophagus to hold it open, allowing
food and liquid to pass through.
What is the most appropriate initial investigation to confirm the diagnosis of myeloma?
Serum free light chains testing
This will detect the presence of Bence-Jones protein, characteristic of myeloma.
Describe histology of a fibroadenoma
Duct-like structures lined by regular, low columnar cells separated by loose fibrous tissue, with well defined margins.
At what hCG are you likely to see an intrauterine pregnancy on an US?
1500-2000
Getting pregnant after methotrexate use?
Avoid getting pregnant for 3 months if ONE methotrexate dose
Avoid getting pregnant for 6 months if ≥TWO doses
hCG levels in different mx options for ectopic?
<1000 - expectant
<1500 - medical
> 5000 - surgical
What is the PCR threshold for significant proteinuria in pregnancy?
≥30
When does BP peak after birth?
Day 4 postpartum
What is the biggest risk factor for uterine rupture?
Trial of labour after previous c-section
Is postpartum endometritis more commonly following c-section or vaginal delivery?
C-section
2 most common organisms causing postpartum endometritis?
GBS
Staph. epidermis
GAS
How soon before onset of labour do membranes rupture in PROM?
At least 1 hour prior to onset of labour
Note - PROM occurs ≥37 weeks gestation
Role of riluzole?
Glutamate antagonist - used to treat amyotrophic lateral sclerosis (prolong survival).
Define orthostatic hypotension
Systolic drop >20mmHg at 1 min or 3 mins
When is colchicine indicated in pericarditis?
May be given alone or alongside NSAIDs for patients with RECURRENT or continued symptoms.
Mechanism of N-acetylcysteine?
Replenishes body’s stores of glutathione
How long to give PEP for?
Within 72h for 4 weeks
ET tube vs tracheostomy for long term ventilation?
Tracheostomy recommended for ventilation >14 days.
