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phase 3a mine > past paper learnings > Flashcards

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
Q

fibroid degeneration
- when
- sx
- tx

A

pregnancy - it grows with the oestreogen, then degenerates when blood supply isnt enough

“red degeneration”

pain
vomitting
fever

conservative

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26
Q

PID like symptoms following recent coil insertion. you leave in and treat with broad-spectrum abx. when would you take the coil out though?

A

72h no improvement

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27
Q

UTI meds in pregnancy

A

trimeth - bad for 1st trim
nitro - bad for 3rd trim

cephalosporin fine throughout

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28
Q

fibroids
- 1st line
- other meds
- other options

A

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

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29
Q

bHCG
- normal
- ectopic
- miscarriage
- downs

A

over 48h:

  • normal : doubles
  • ectopic : rises but not doubles
  • miscarriage : falls
  • Downs: raised
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30
Q

chlamidya tx

A

Doxycycline 100mg PO BD for 7 days

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31
Q

riluzole for?

A

ALS (MND) - prolongs life by few months

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32
Q

bacterial meningitis most common cause
- neonates
- children

A

neonates: group b strep
children: haem inf, neis men, strep pnuem.

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33
Q

what is given to close contacts of bacterial meningitis

what is given to patitent

A

Oral ciprofloxacin

IV cefotaxime

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34
Q

foot drop nerve

A

L5

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35
Q

postural hypotension criteria

A

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.

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36
Q

pericarditis first line

A

NSAIDs

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37
Q

what reverses heparin (e.g active bleed starts)

too much warfarin?

reverse DOAC?

A

protamine

vit K

Beriplex

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38
Q

rehydration after DKA
1. alert, no vom
2. unconc, vom

A
  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

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39
Q

DKA blood results
- creatine
- na
- k
- glucose
- pH
- ketones
- bicarb

A
  • 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)
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40
Q

JIA tx
- monoarticular
- polyarticular
- screening

A
  • monoarticular: steroid injections
  • polyarticular : methotrexate (steroid injections in interim)
  • screen eyes for anterior uvieits every 3m
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41
Q

JIA is assoc with what disease

JIA effect on puberty?

A

anterior uveitis

can be delayed

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42
Q

stephen johnson syndrome
- causes
- features
- tx

A

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

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43
Q

CSF
- what makes it turbid
- what affects glucose
- what affects protein

what is the appearance of
- bacterial meningitis
- viral meningitis
- encephalitis
- TB meningitis

A

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

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43
Q

wilms tumour
- when
- features

A

5-10y
abdominal mass and painless haematuria.

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44
Q

what are these are

Procyclidine
Protamine sulphate
Pyridostigmine
tertrabenazine

A

Procyclidine - dystonia
Protamine sulphate - heparin reversal
Pyridostigmine - MG
tertrabenazine - tardive dyskinesia

45
Q

opiate overdose
- symptoms
- tx

A
  • rhinorhea - watery nose/ eyes
  • drowsy
  • needle tracks
  • methadone
  • Buprenorphine
46
Q

Clomipramine
- class
- good for

A

TCA

OCD
- used after at least one SSRI

47
Q

clozapine monitoring
- what for
- when

A
  • 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
Q

factor v leiden
- increase or decrease in clotting

A

increase

49
Q

how small is too small to manage a suspected miscarriage (rather than expectant)

A

<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
Q

source of vaginal cancer mostly =

A

metastatic / 2’ from the cervix or endometrium.

51
Q

next step of asymptomatic suspected UTI in preg screening

A

repeat culture (may be contaminated) and treat with sensitive abx from culture

52
Q

definition of oligo and polyhydraminos

A

oligo - <5cm
poly >24cm

53
Q

what is the most important treatable cause of recurrent miscarriage

And so what to look out for

A

antiphospholipid syndrome

which is assoc with SLE - joint pain, (nail fold capillaries)

54
Q

small cell carcinoma of lung can secrete what?

A

ADH/ ACTH

so can cause cushings/ SIADH

55
Q

AKI stages

  • in terms of creatinine compared to baseline
  • in terms of urine output
A

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
Q

CKD stages

A

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
Q

COPD treatment

also: what are these
bromide -
salbutamol -
beclamethsone -
Tiotropium -
salmeterol-

A

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
Q

nephrotic syndrome
- triad
- features
- cause

A

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
Q

henloch shein purpura
- cause
- features
- tx

A

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
Q

ranitidine is a what

A

H2 receptor antagonost

antacid - reduce acid production and stomach content volume

61
Q

omeprazole is a what

A

proton pump inhibitor

62
Q

what is a D2 receptor antagonist +e.g.

A

enhances gastric emptying
- e.g. domperidone

Antiemetic/ anti reflux

63
Q

is someone is resistant to treatment for GORD, what is the surgery called

A

Nissed fundoplication

64
Q

tonsilitis medication (if FeverpAIN is high enough)

A

Phenoxymethylpenicillin

(NB: if tonsilitis is caused by glandular fever, amoxicillin causes widespread rash)

65
Q

port wine stain

strawberry stain

A

port wine - present from birth - naevus flammeus

strawberry - develops after birth <1m - cavernous haemangioma

66
Q
  1. milia
  2. mongolian blue spots
  3. erythema toxicum
A
  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
Q

immune thrombocytopenia tx

A

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
Q

otitis media tx

A

amoxicillin 5d
(clarith if allergic)

— if under 2 and bilateral – otherwise, watch and wait

69
Q

B1
B2
B9
B12

(vitamins)

A

B1 - thiamine
B2 - riboflavin
B9 - folate
B12 - Cobalamin

70
Q

when to use methadone vs naloxone

also naltrexone? benzos?

A

methadone (+ naltrexone) - opioid dependance

naloxone - opioid toxicity / OD

benzos also used?

71
Q

activated charcoal

A

use for poisoning / paracetemol overdose as reduces absorption - but need to get it in quick

72
Q

cocaine withdrawal
Symptoms

A

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
Q

fetal hydrops = ?

causes

A

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
Q

uterine leiomyoma =?

are they tender on palpation?

A

fibroid silly!

nontender (unlike adenomyosis, endometriosis

75
Q

most common cause of childhood squint

tx

A

hypermetropia (long-sighted –> excessive accomodation)

treated q successfully with convex lenses

76
Q

ADHD
1st and 2nd line

A

1st - Methylphenidate
2nd - Lisdexamfetamine
3rd - Dexamfetamine (if benefited from lisdexam .. but could not tolerate it)

77
Q

age of asthma/ viral induced wheeze / bronchitis

A

asthma = 4/5y +
viral induced wheeze = 2- 4/5y
bronchiolitis= <1y

78
Q

viral induced wheeze tx

A

1) SABA - nebulised salbutamol
2) LTRA, (ICS)

79
Q

what should be monitored in lithium

A

TFTs
U/E
eGFR

lithium can cause hypo and hyperthyroidism, hyperPTH (calcium), kidney issues ..

80
Q

Haematocolpos = ?

A

accumulation of blood like cos of imperforate hymen

81
Q

what do bat wing opacities represent?

A

alveolar oedema

82
Q

what does AUDIT score do

A

assesses alcohol abuse

83
Q

when are triptans a no no

A

SSRI
coronary artery disease

84
Q

status epilepticus tx in hospital

A

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
Q

normal pressure hydrocephalus symtpoms

A

gait
incontinence
dementia

86
Q

hyperthyroidism tx

A

symptoms – propanolol

disease course – carbimazole

87
Q

ulcerative collitis
- flare up
- remission

A

hydrocortisone

messalazine
prednisolone

88
Q

acromegaly inv

A

OGTT

(not growth hormone as it is pulsatile)

89
Q

Atrial fib vs atrial flut
rhythym

A

AF = irregularly irreg

flut = regularly irreg

90
Q

effects and mode of action of
-acomprosate
- disulferide
- naltrexone

A

acomprosate - alleviates cravings - enhances GABA

disulferide - makes feel ill after alcohol - build up of acetaldeyde

naltrexone - reduces pleasure of drinking - opiate antagonist

91
Q

what s/e of mitrazapine can be used to advantage

A

sedation (insomnia) - take at night
weight gain (low appetite / weight loss)

(SNRI)

92
Q

ECT absolute and relative contraindications

A

absolute
- raised ICP

relative
- pregnancy
- cerebral tumour
- cerebral aneurysm
- phreatochroma
- recent MI /stroke
- active bleeding
- liver disease
- retinal detachment

93
Q

ECT s/e

A

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
Q

first line delerium tx (pharmacological ) inc dose and route

A

haloperidol 0.5 mg PO / IM

(lorazepam can be used too, but not first line, can be added)

95
Q

prem ROM –> what Abx

A

erythromycin PO

unless fever/ previous group B strep –> benzylpenicillin

96
Q

genital warts features

A

itch
no pain
bleed

97
Q

discharge - pH

A

BV and TV has pH >4.5

all else <4.5 - acidic

98
Q

cauda equina tx

A

high dose dexamethason (decompresses)

consider surgical decompression (above in the meantime)

consider inv into cancer as a cause

99
Q

how to take bisphosphonate (alendronic acid)

A

sat/ stood upright for 30 mins
empty stomach (eg 30 mins before breakfast)

100
Q

alcoholic liver disease LFTs

A

↑AST +↑ALT with an AST/ALT ratio of 2:1

101
Q
  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
A
  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
Q

indapamide =?

A

thiazide like diuretic

103
Q

febrile seizure - normal vs concerning
- length
- further seizure
- type

A

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
Q

idiopathic ICP tx

A

Acetazolamide to reduce eye pressure

then shunts etc later

105
Q

65y+ and on long term steroids …. they should start a ?

A

alendronic acid = bisphosphonate (regardless of DEXA)

106
Q

rhabdomyolysis features

A

dark brown urine following long lie (eg fell and wasnt found)

107
Q

meningitis + mengicocal rash = what organism?

A

neiseria meningitis = causative organism

108
Q

ebstein anomaly
- cause
-effect

A

lithium
low tricuspid valve insertion

109
Q

impetigo tx

A
  1. hydrogen peroxide 1% cream
  2. topical fusidic acid
  3. oral flucoxacillin (eryth if allergic)
110
Q

initial LOC with clinical improvement then sudden
deterioration

A

extradural

phase 3a mine (16 decks)

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