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past paper learnings Flashcards

1
Q

haemolytic uraemic syndrome
- rf
- presentation
- tx

A

kids
exposure to farm animals

  1. AKI
  2. normocytic anaemia - microangiopathic haemolytic anaemia
  3. thrombocytopenia

often diarrhea (inc bloody)
abdo pain
fever
vom

supportive tx

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2
Q

glandular fever (infectious mononucleoisis)

  • pathogen (normally)
  • tx
  • what happens when treated with amoxicillin
A

EBV

rest, avoid contact sports/ alcohol

rash! widespread, itchy, maculopapular, pruritic rash

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3
Q

allergic reaction vs anaphylaxis

A

anaphylaxis is like whole body stuff, like shock

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4
Q

immunisation schedule
- 8w/ 2m
- 12w/ 3m
- 16w/ 4m
- 1y
- 3y4m
- 12-13y
- 14y
- extra one?

A

8w = 6 in 1 (DTaP, IPV, Hib, Hep B), Men B, Rotavirus.
- 12w = 6 in 1 (DTaP, IPV, Hib, Hep B), PCV, Rotavirus.
- 16w = 6 in 1 (DTaP, IPV, Hib, Hep B), Men B.
- 1y = Hib/Men C, PCV, MMR, Men B.
- 3y 4m = ‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio), MMR.
- 12-13y = HPV.
- 14y = 3 in 1 (Tetanus, diphtheria, polio). Men ACWY.

Influenza vaccine is also offered to all children of primary school age and those in Y7. It is also
offered from 6m to those at high risk.

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5
Q

6 in 1
4 in 1
3 in 1

whats in them and when are they

A

6 in 1
diptheria, tetanus, polio, Hib, hepB, whooping cough, polio
2m, 3m, 4m,

4 in 1
tetanus, diptheria, whooping, polio
3y4m

3 in 1
tetanus, diptheria, polio
12-13y

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6
Q

congential adrenal hyperplasia
- what is it
- features
- presents when

A

too little cortisol and aldosterone

so less K excreted and less sodium reabsorbed

hyperkalemia
hyponatraemia
metabolic acidosis

when older - early puberty for boys, and under/unusally developed genetalia for girls

often 1-3w old

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7
Q

Roseola Infantum

  • cause
  • symptoms
  • tx
A

HHV-6 (human herpes) (or7)

fever (sometimes febrile convulsions)
THEN
maculopapular rash
“Nagayama” spots on uvula/ roof of mouth

supportive

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8
Q

where does chemo not go

A

CNS (brain blood barrier)
testes

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9
Q

what does penicillamine do

A

chelates copper in wilsons disease

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10
Q

patient demographic way to distinguish haemophilia a/b and von willebrand disease

A

haemophilia a/b is x linked recessive so only boys
willebrand = woman too

both bleeding disorders

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11
Q

haemophilia a
- defiency of what

haemophilia b
- deficiency of what

A

A- clotting factor VIII

B = clotting factor IX

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12
Q

investigation to diagnose
- hodgkin lymphoma
- Leukaemia

A
  • hodgkin lymphoma - PET scan
  • Leukaemia - blood film
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13
Q

lymphomas: common when
- hodg and non hodg

what are the b symptoms

other symptoms

A

hodg- teenagers
non hodg - children

unexplained weight loss
unexplained fever
drenching sweats - esp at night

fatigue
prurits
enlarged lymph nodes

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14
Q

developmental dysplasia of hip risk factors

A

breech
heavy baby
oligohydraminos
prematurity
female

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15
Q

duodenal atresia x ray sign

A

double bubble

assoc with downs

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16
Q

ankastic personality disorder

A

personality with set rules and ideals that the person believes everyone should
follow

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17
Q

cheese effect
- with what drug - egs
- results in what

A

MAOi - phenlezine, Isocarboxazid, selegiline, tranylcypromine

HTN

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18
Q

acute tx in bipolar
- manic episode
- depressive episode

long term managmenet

A

atypical antipsychotic

SSRI+ atypical - fluoxetine and olanzapine

lithium (if no work - valporate)

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19
Q

lithium tremor

A

lithium in range - fine tremor
lithium toxicity - coarse tremor

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20
Q

lithium toxicity

sx

tx

A

normally 1.5 and above:

coarse tremor
ataxia
slurred speech
vomitting
seizure
polyuria
hyperreflexia

fluids

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21
Q

alcohol detox drugs

A

Chlordiazepoxide (a benzo)

thiamine

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22
Q

delerium tremens tx

A

IV Pabrinex (vit b..) and high dose Benzodiazepine

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23
Q

serotonin syndrome sx

A

triad of neuromuscular excitability, autonomic dysfunction (hypo or hypertension), and
altered mental state

neuromuscular excitation
- hyperreflexia
- myoclonus
- rigidity

autonomic nervous system excitation
- hyperthermia
- sweating
- flushed skin
- BP change/ HR change

altered mental state
- confusion
- agitation

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24
Q

neuroleptic malignant syndrome

A

a change in mental state,
rigidity, (causes raised creatinine kinase)
fever, (raised wbc)
autonomic dysfunction

metabolic acidosis
odd U/E + LFTs

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25
fibroid degeneration - when - sx - tx
pregnancy - it grows with the oestreogen, then degenerates when blood supply isnt enough "red degeneration" pain vomitting fever conservative
26
PID like symptoms following recent coil insertion. you leave in and treat with broad-spectrum abx. when would you take the coil out though?
72h no improvement
27
UTI meds in pregnancy
trimeth - bad for 1st trim nitro - bad for 3rd trim cephalosporin fine throughout
28
fibroids - 1st line - other meds - other options
mirena coil COCP (not near surgery though) mefanamic acid transexamic acid oral / injectable progesterone surgery - take GnRH agonists before to shrink + reduce chance of bleed - myomectomy - endometrial ablation - uterine artery embolisation - hysterectomy
29
bHCG - normal - ectopic - miscarriage - downs
over 48h: - normal : doubles - ectopic : rises but not doubles - miscarriage : falls - Downs: raised
30
chlamidya tx
Doxycycline 100mg PO BD for 7 days
31
riluzole for?
ALS (MND) - prolongs life by few months
32
bacterial meningitis most common cause - neonates - children
neonates: group b strep children: haem inf, neis men, strep pnuem.
33
what is given to close contacts of bacterial meningitis what is given to patitent
Oral ciprofloxacin IV cefotaxime
34
foot drop nerve
L5
35
postural hypotension criteria
systolic drop >20mmHg when going from sitting/lying to standing. Patient should be lying or sitting still for 5 minutes and then their baseline measured. Get them to stand and measure their BP at 1 minute and 3 minutes. If there is a drop >20mmHg at either 1 min or 3 mins then they have postural (orthostatic) hypotension.
36
pericarditis first line
NSAIDs
37
what reverses heparin (e.g active bleed starts) too much warfarin? reverse DOAC?
protamine vit K Beriplex
38
rehydration after DKA 1. alert, no vom 2. unconc, vom
1. PO fluids + SC insulin (0.1units/kg/hr) 2. IV fluids (0.9% NaCl 10ml/kg) + SC insulin (0.1units/kg/hr) over 48h to prevent cerebral oedema
39
DKA blood results - creatine - na - k - glucose - pH - ketones - bicarb
- creatine = mildly raised (dehydration) - na = normal/ mildly raised (dehydration) - k = high (acidosis, low insulin) - glucose = high - pH = acidosis - ketones = high - bicarb = low (used up by bicarb)
40
JIA tx - monoarticular - polyarticular - screening
- monoarticular: steroid injections - polyarticular : methotrexate (steroid injections in interim) - screen eyes for anterior uvieits every 3m
41
JIA is assoc with what disease JIA effect on puberty?
anterior uveitis can be delayed
42
stephen johnson syndrome - causes - features - tx
medication - Allopurinol - Lamotrigine - Penicillin - Phenytoin viral - mumps - flu - HSV - EBV - flu-like symptoms - followed by a red/purple target-like rash that spreads and forms blisters. The affected skin eventually dies and peels off. - The mucous membranes of the mouth, throat, eyes and genital tract may also become blistered and ulcerated fluids analgesia opthalmology treat 2' infections
43
CSF - what makes it turbid - what affects glucose - what affects protein what is the appearance of - bacterial meningitis - viral meningitis - encephalitis - TB meningitis
turbid - wbc/ rbc (bacterial) glucose - low = bacterial/ fungal protein - raised = bacterial Bacterial meningitis - turbid appearance, raised polymorphs, raised protein, low glucose Viral meningitis/ encephalitis - clear appearance, raised lymphocytes, normal/raised protein, normal/low glucose TB meningiti- turbid/clear appearance, raised lymphocytes, raised protein, low glucose
43
wilms tumour - when - features
5-10y abdominal mass and painless haematuria.
44
what are these are Procyclidine Protamine sulphate Pyridostigmine tertrabenazine
Procyclidine - dystonia Protamine sulphate - heparin reversal Pyridostigmine - MG tertrabenazine - tardive dyskinesia
45
opiate overdose - symptoms - tx
- rhinorhea - watery nose/ eyes - drowsy - needle tracks - methadone - Buprenorphine
46
Clomipramine - class - good for
TCA OCD - used after at least one SSRI
47
clozapine monitoring - what for - when
- WBC (neutropaenia and agranulocytosis) - 1 blood test / week for 18w, then fortnightly until 1y, then monthly (if all fine, otherwise may stay more highly monitored)
48
factor v leiden - increase or decrease in clotting
increase
49
how small is too small to manage a suspected miscarriage (rather than expectant)
<7mm repeat US in 7days although most are managed by waiting to see if miscarries spontaneously. only after 7-14d would you consider medical/surgical mx
50
source of vaginal cancer mostly =
metastatic / 2' from the cervix or endometrium.
51
next step of asymptomatic suspected UTI in preg screening
repeat culture (may be contaminated) and treat with sensitive abx from culture
52
definition of oligo and polyhydraminos
oligo - <5cm poly >24cm
53
what is the most important treatable cause of recurrent miscarriage And so what to look out for
antiphospholipid syndrome which is assoc with SLE - joint pain, (nail fold capillaries)
54
small cell carcinoma of lung can secrete what?
ADH/ ACTH so can cause cushings/ SIADH
55
AKI stages - in terms of creatinine compared to baseline - in terms of urine output
1: 1-1.9x 2: 2-2.9x 3: 3+x urine output <0.5ml/h for 1: 6h 2: 12h 3: 24h // anuria for 12+h
56
CKD stages
Stage 1: > 90 mL/min/ 1.73m Stage 2: 60-89 mL/min/ 1.73m Stage 3A: 45-59 mL/min/ 1.73m Stage 3B: 30-44 mL/min/ 1.73m Stage 4: 15-29 mL/min/ 1.73m Stage 5/ESRF: <15mL/min/ 1.73m
57
COPD treatment also: what are these bromide - salbutamol - beclamethsone - Tiotropium - salmeterol-
work out if steroid- responsive: - steroid responsive = FEV1 variation, atopic asthmatic features - non-steroid responsive = no FEV1 variation, no atopic/ asthmatic features steroid responsive: ● Step 1: SABA or SAMA ● Step 2: SABA + LABA + ICS (if they were originally on SAMA, discontinue and start SABA) ● Step 3: SABA + LABA + ICS + LAMA non-steroid responsive: ● Step 1: SABA or SAMA ● Step 2: SABA + LABA + LAMA (if they were originally on SAMA, discontinue and start SABA) bromide - SAMA salbutamol - SABA beclamethsone - ICS Tiotropium - LAMA salmeterol - LABA
58
nephrotic syndrome - triad - features - cause
proteinuria oedema hypoalbuminaemia swelling- facial, eyes, ankles, groin 2-5y hyperlipidaemia (increase in cholesterol) hypercoagulable (decrease in antithrombin) prone to infection (decrease in immunoglob) hypovolemia (due to oedema) hypocalcaemia (loss of vit D) mostly minimal change glopmerulonephritis (can also be secondary to allergens, henloch-shein purpura, infections and SLE)
59
henloch shein purpura - cause - features - tx
cause= valsculitis of small vessels rash - trunk spared! - buttocks, limbs- extensor - symetrical - uritcarial --> mac pap + purpuric, palpable - may have localised oedema joint pain abdo pain ig nepropathy - haematuria, renal failure treatment = supportive + treat joint pain. maybe steroids/ Immuunosup mostly self-limiting monitor BP and urine re kidneys
60
ranitidine is a what
H2 receptor antagonost antacid - reduce acid production and stomach content volume
61
omeprazole is a what
proton pump inhibitor
62
what is a D2 receptor antagonist +e.g.
enhances gastric emptying - e.g. domperidone Antiemetic/ anti reflux
63
is someone is resistant to treatment for GORD, what is the surgery called
Nissed fundoplication
64
tonsilitis medication (if FeverpAIN is high enough)
Phenoxymethylpenicillin (NB: if tonsilitis is caused by glandular fever, amoxicillin causes widespread rash)
65
port wine stain strawberry stain
port wine - present from birth - naevus flammeus strawberry - develops after birth <1m - cavernous haemangioma
66
1. milia 2. mongolian blue spots 3. erythema toxicum
1. milia - white spots on nose/ cheeks 2. mongolian blue spots - lower back /bum (look like bruises) 3. erythema toxicum - (neonatal urticaria) is a common rash appearing at 2-3 days of age, consisting of white pinpoint papules at the §centre of an erythematous base, concentrated on the trunk
67
immune thrombocytopenia tx
prednisolone to increase platelet numbers but normally self-resolves so no tx needed splenectomy for life-threatening bleeds advice to avoid contact sports/ bleeding triggers
68
otitis media tx
amoxicillin 5d (clarith if allergic) --- if under 2 and bilateral -- otherwise, watch and wait
69
B1 B2 B9 B12 (vitamins)
B1 - thiamine B2 - riboflavin B9 - folate B12 - Cobalamin
70
when to use methadone vs naloxone also naltrexone? benzos?
methadone (+ naltrexone) - opioid dependance naloxone - opioid toxicity / OD benzos also used?
71
activated charcoal
use for poisoning / paracetemol overdose as reduces absorption - but need to get it in quick
72
cocaine withdrawal Symptoms
first 24 h - most intense - increased hunger - fatigue - anxiety - irritable - reduced motivation next 10 weeks - above but less intense next 6 months - milder above but - low mood
73
fetal hydrops = ? causes
Fetal hydrops is the abnormal accumulation of serous fluid in 2+ fetal compartments due to fetal anaemia immune - rhesus incompat non immune ● Severe anaemia – congenital parvovirus B19 infection, alpha thalassaemia major (not beta), massive materno-feto haemorrhage ● Cardiac abnormalities ● Chromosomal – Trisomy 13, 18, 21, or Turners ● Infection – toxoplasmosis, rubella, CMV, varicella ● Twin- Twin transfusion syndrome (in the recipient twin) ● Chorioangioma
74
uterine leiomyoma =? are they tender on palpation?
fibroid silly! nontender (unlike adenomyosis, endometriosis
75
most common cause of childhood squint tx
hypermetropia (long-sighted --> excessive accomodation) treated q successfully with convex lenses
76
ADHD 1st and 2nd line
1st - Methylphenidate 2nd - Lisdexamfetamine 3rd - Dexamfetamine (if benefited from lisdexam .. but could not tolerate it)
77
age of asthma/ viral induced wheeze / bronchitis
asthma = 4/5y + viral induced wheeze = 2- 4/5y bronchiolitis= <1y
78
viral induced wheeze tx
1) SABA - nebulised salbutamol 2) LTRA, (ICS)
79
what should be monitored in lithium
TFTs U/E eGFR lithium can cause hypo and hyperthyroidism, hyperPTH (calcium), kidney issues ..
80
Haematocolpos = ?
accumulation of blood like cos of imperforate hymen
81
what do bat wing opacities represent?
alveolar oedema
82
what does AUDIT score do
assesses alcohol abuse
83
when are triptans a no no
SSRI coronary artery disease
84
status epilepticus tx in hospital
IV benzo. eg IV lorazepam - can repeat dose if ineffective after 10-20mins - if not in hosp - PR diazepam or buccal midazolam ongoing--> phenytoin still ongoing --> general anaesthetic
85
normal pressure hydrocephalus symtpoms
gait incontinence dementia
86
hyperthyroidism tx
symptoms -- propanolol disease course -- carbimazole
87
ulcerative collitis - flare up - remission
hydrocortisone messalazine prednisolone
88
acromegaly inv
OGTT (not growth hormone as it is pulsatile)
89
Atrial fib vs atrial flut rhythym
AF = irregularly irreg flut = regularly irreg
90
effects and mode of action of -acomprosate - disulferide - naltrexone
acomprosate - alleviates cravings - enhances GABA disulferide - makes feel ill after alcohol - build up of acetaldeyde naltrexone - reduces pleasure of drinking - opiate antagonist
91
what s/e of mitrazapine can be used to advantage
sedation (insomnia) - take at night weight gain (low appetite / weight loss) (SNRI)
92
ECT absolute and relative contraindications
absolute - raised ICP relative - pregnancy - cerebral tumour - cerebral aneurysm - phreatochroma - recent MI /stroke - active bleeding - liver disease - retinal detachment
93
ECT s/e
Short-term side-effects - headache - nausea - short term memory impairment - memory loss of events prior to ECT - cardiac arrhythmia Long-term side-effects - some patients report impaired memory
94
first line delerium tx (pharmacological ) inc dose and route
haloperidol 0.5 mg PO / IM (lorazepam can be used too, but not first line, can be added)
95
prem ROM --> what Abx
erythromycin PO unless fever/ previous group B strep --> benzylpenicillin
96
genital warts features
itch no pain bleed
97
discharge - pH
BV and TV has pH >4.5 all else <4.5 - acidic
98
cauda equina tx
high dose dexamethason (decompresses) consider surgical decompression (above in the meantime) consider inv into cancer as a cause
99
how to take bisphosphonate (alendronic acid)
sat/ stood upright for 30 mins empty stomach (eg 30 mins before breakfast)
100
alcoholic liver disease LFTs
↑AST +↑ALT with an AST/ALT ratio of 2:1
101
1. ↑AST +↑ALT with an AST/ALT ratio of 2:1 2. ↑AST +↑ALT with an AST/ALT ratio of 1:2 3. isolated ↑ALT 4. predominate ↑ALT 5. isolated ↑Bilirubin
1. alcohlic liver disease 2. viral hepatitis or possibly non-alcoholic fatty liver diseasey in alcoholic patients 3. breakdown of bone e.g bony metastases 4. cholestatic 5. gillberts
102
indapamide =?
thiazide like diuretic
103
febrile seizure - normal vs concerning - length - further seizure - type
up to 15 min fine, longer = concerning. further seizure within 24 h = concerning further seizures more than 5min = concerning tonic clonic fine, focial = concerning
104
idiopathic ICP tx
Acetazolamide to reduce eye pressure then shunts etc later
105
65y+ and on long term steroids .... they should start a ?
alendronic acid = bisphosphonate (regardless of DEXA)
106
rhabdomyolysis features
dark brown urine following long lie (eg fell and wasnt found)
107
meningitis + mengicocal rash = what organism?
neiseria meningitis = causative organism
108
ebstein anomaly - cause -effect
lithium low tricuspid valve insertion
109
impetigo tx
1. hydrogen peroxide 1% cream 2. topical fusidic acid 3. oral flucoxacillin (eryth if allergic)
110
initial LOC with clinical improvement then sudden deterioration
extradural

phase 3a mine (16 decks)

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