past paper Q's Flashcards
what are the 3 defining features of a health economic evaluation?
cost both services
benefits both services
comparison of the cost and benefit of the service and alternative service
2 features comprising a QALY?
number of years
quality of life- i.e. utility
what system do health economists use to evaluate disability?
dalys- disability adjusted life years
define healthcare economic ‘efficiency’
getting the max cost/ health benefit outcome from a service
what is the term when treatment is given elsewhere because it gives better benefit on another opportunity?
opportunity cost i.e the money is spent elsewhere because it gives better benefit on another opportunity
what is a SAH?
Bleeding into the subarachnoid space- between arachnoid membrane and pia mater
why does SAH cause a coma?
raised ICP and hydrocephalus
causes of coma?
hypoglycaemia meningococcal septicaemia trauma SAH hypoxaemia seizures
what causes a fixed dilated pupil?
3rd nerve palsy (oculomotor)
immediate management of SAH?
A-E assessment CT scan treat hypertension- nimodipine Intubate and give O2 mannitol-fusion colloid refer for surgery to stem bleed- coiling
4 features of brainstem death?
- no respiratory effort in reaction to turning off ventilator
- fixed pupils unreactive to light
- no corneal reflex
- no cough reflex
- no response to supra orbital pressure
screening by GP for microvascular damage of DM?
Retinal screening
kidney U&E- urine albumin and serum creatinine
Foot care screening- monofilament for sensation
ABPI
causes of increasing floaters?
diabetic retinopathy retinal detachment/tear posterior vitreous detachment trauma recent cataract surgery
Ix of floaters in eye?
1) Fundus photography Schaffer’s sign- positive when you use a thin beam of bright light without a lens and see fine pigment floating in the anterior vitreous
2) ophthalmoscopy
3) ultrasound- flying angel sign
most common cell of bladder cancer?
transitional cell
squamous cell is most common
risk factors for bladder cancer?
FH
smoking
frequent bladder infections
working in a rubber dye factory
which artery supplies the superior and inferior vesical arteries?
internal iliac
what lymph nodes can bladder cancer metastasise to?
external iliac
obturator
internal iliac
common iliac
2 signs of cauda equina in the following areas?
- perianal skin
- lower limb
- anal and urethral sphincters
Perianal skin -paraesthesia, decreased tone
Lower limb -upgoing plantars, pain, altered reflexes
Anal and urethral- decreased tone, incontinence
what abnormal heart sound is heart in pericarditis?
pericardial rub
4 Ix of pericarditis?
USS
CXR
bloods
ECG
2 treatments for pericarditis?
NSAIDS
Steroids
triad of cardiac tamponade?
raised JVP
BP 90/40
tachycardia
causes of pericarditis?
recent viral infection recent bacterial infection e.g. TB recent MI Chest trauma Autoimmune disorders Cancer Uraemic pericarditis
moat common type of lung cancer?
squamous cell adenoma (non- small cell)
common causes of bowel obstruction?
adhesions cancer constipation diverticulitis hernias
common causes of constipation?
drugs
dehydration
autonomic neuropathy
immobility
important things to assess in a fracture?
open/closed
stable/non-stable
neurovascular status
is it displaced
what is the salter harris classification of injury to growth plates?
1- through the growth plate
2- (most common)- through growth plate and metaphysis (proximal)
3- through growth plate and epiphysis (distal)
4- through all 3 elements
5- crush injury of growth plate
how does rivaroxaban work?
inhibits factor 10a
where does the varicella zoster virus reside?
geniculate ganglion
symptoms of ramsey hunt syndrome?
facial palsy
ear: vertigo, ear pain
altered taste, dry mouth, dry eyes
3 actions of PTH?
osteoclast activation
stops loss of ca in the urine
increased absorption from GI
complications of hypercalcaemia?
cardiac arrhythmias
coma
cardiac arrest- short QT and Osborn wave
tx of hypercalcaemia?
fluid
furosemide
bisphosphonates
calcitonin
ix of beta thalassaemia?
FBC- microcytic hypochromic anaemia
Haemoglobin electrophoresis
DNA testing
what is a complication of treatment for B-thalassaemia?
how is this complication prevented?
iron induced oxidative stress
Liver
Heart
Brain
Iron chelation therapy
Ix for rectal bleeding?
Foecal calprotectin
bloods
anti-endomysial antibodies and anti-TTG
colonoscopy and biopsy
what is the pathophysiology behind anaphylaxis?
type 1 hypersensitivity reaction- degranulation of mast cells releasing histamine
what are the 5 causes for an association?
bias
chance
confounding
reverse causality
why isn’t there a PSA screening programme in the UK?
length time bias- harmess tumours detected Unnecessary treatment PSA is unreliable Causes undue worry many tumours are slow-growing
when is it appropriate to do a PSA?
Men above age 50
suspicious PR findings
monitoring treatment and remission of prostate cancer
what does an upright CXR exclude in a woman with constipation?
bowel perforation
what do the blood findings raised urea, low creatinine and high Na show?
dehydration
drug treatments of incomplete miscarriage?
anti-D
misoprostol
RFs of intermittent claudication?
smoking diabetes hypertension hyperlipidaemia lack of exercise
how to do ABPI?
A blood pressure cuff is inflated around the lower calf muscle above the ankle joint, and a doppler ultrasound probe placed over the dorsalis pedis artery and the posterior tibial artery
- the max cuff pressure at which the pulse can just be heard with the probe is recorded and related to SBP at brachial artery
- lower BP in the legs is an indicator of PAD
important physical signs in pre-op assessment?
Mallampati- how much of the soft palate in visible on opening of the mouth
Thyromental and sternomental distance
complications seen in RA after routine surgery?
adrenal crisis from stopping prednisolone
RA produces hypercoaguable state- increased VTE risk, infection risk from steroid
Immunosuppression from methotrexate
how to differentiate between testicular torsion and epididymo-orchitis?
Prehn’s sign- scrotal elevation relieves pain in epididymitis but not torsion
Absent cremasteric reflex- torsion
testicle is higher- torsion
differentials of quinsy?
epiglottitis lymphoma tonsillitis pharyngitis craniopharyngioma glandular fever
what is the name of the lymph node affected by quinsy?
jugulodigastric lymph nodes
what hormone is hypersecreted in Conn’s syndrome and where from?
and what hormone is suppressed?
aldosterone (mineralocorticoid) , adrenal cortex
renin, JG apparatus
4 ECG features of hypokalaemia?
U have no POT and no T, but a large PR and a large QT
U waves
small or absent T waves
long PR
long QT
imaging in conn’s syndrome?
CT adrenal gland
where does spironolactone act?
aldosterone antagonist in the cortical collecting duct
used in ascites
2 ECG changes in ischaemia?
ST depression
T wave inversion
how do beta blockers work?
block beta-adrenoreceptors , antagonising the sympathetic NS (reducing NA and adrenaline)
reduces HR and force of contraction
can be cardio-selective or non-cardio selective e.g. propranolol
(can work in sphincters of GI tract- to make them contract)
how do nitrates work?
cause NO release which leads to vasodilation and decreased PVR
why do you do 3 samples of LP in a SAH?
One for virology, one for microbiology and one for biochemistry
what pathological structure causes SAH?
berry aneurysm
what causes headaches pre-SAH?
Sentinel headache due to much smaller lead from the ruptured aneurysm
how does salbutamol work?
beta-2 agonist
relaxation of bronchial smooth muscle, bronchodilation
symptoms of SLE?
malaise, fever, abdo pain, weight loss, fatigue, headache
signs of SLE?
malar rash discoid rash photosensitivity oral ulceration arthritis serositis seizures/psychosis proteinuria anaemia
features of anti-phospholipid syndrome?
CLOTS Coagulation defect Livedo reticularis Obstetric (recurrent miscarriage) Thrombocytopenia SLE
what is amoebiasis?
Amoebiasis is caused by Entamoeba histolytica (an amoeboid protozoan) and spread by the faecal-oral route
features of amoebiasis?
dysentery- bloody diarrhoea
Amoebic liver abscess-mass in R lobe, fever, RUQ pain
what is found on stool microscopy of amoebiasis?
trophozoites, amoebic cysts
tx of amoebiasis?
mentronidazole
how do alpha blockers work?
smooth muscle of blood vessels and GI tract
vasoconstriction of blood vessels and decreased motility in the GI tract
where do beta receptors act?
cause smooth muscle relaxation
GI tract
blood vessels
bronchi
what is adrenaline produced by?
“chromaffin cells” in the adrenal glands
what is phaeochromocytoma
a tumour of the chromaffin cells that secretes unregulated and excessive amounts of adrenaline
caused by MEN 2
features of phaeochromocytoma?
hypertension headaches palpitations sweating anxiety
diagnosis of phaeochromocytoma?
24 hr urinary collection of metanephrines
mx of phaeochromocytoma?
Surgery is the definitive management. The patient must first however be stabilized with medical management:
alpha-blocker (e.g. phenoxybenzamine), given before a
beta-blocker (e.g. propranolol)
what is the pathophysiology of CML?
Philadelphia chromosome- t(9:22) chromosomal translocation= BCR-ABL gene= excess tyrosine kinase activity
tx of CML?
imatinib- tyrosine kinase inhibitor
what is the full name of chlamydia?
chlamydia trachomatis
what is the formula for fluid correction given to a burns patient?
4 x weight x burn percentage
what level of burns is burns with no blistering but reduced pin-prick sensation?
3rd degree, full thickness
electrolyte complication of burns?
hyperkalaemia due to lysis of cells
name some viral and bacterial causes of hospital acquired infections?
viral- norovirus, rotavirus
bacterial- campylobacter, staph aureus, E.coli, C.diff
possible sources of infection in hospital?
resp droplet/airborne
catheter
bloods/cannulas
food
cause of infectious mononucleosis?
EBV
causes of pharyngitis and cervical lymphadenopathy other that EBV?
CMV toxoplasmosis HIV rubella mumps
features of mouth and throat examination of infectious mononucleosis?
sore throat tonsillar enlargement erythema uvula oedema lymphadenopathy palatal petechiae pyrexia
test used to confirm infectious mononucleosis?
Monospot test-hereophil antibody test
FBC, WCC
other features of glandular fever?
splenomegaly- occurs in 50%
hepatitis- transient rise in ALT
lymphocytosis
haemolytic anaemia secondary to cold agglutins
maculopapular pruritic rash common in amoxicillin tx
how does serotonin work?
increases synaptic cleft serotonin level
proven to work with depression
less side effects
what is the most likely cause of mitral stenosis?
rheumatic fever- think in a patient with a new murmur and arthralgia after sore throat
cause of rheumatic fever?
streptococcus pyogenes
why do the following happen in mitral stenosis:
- AF
- RV heave
- Raised JVP
AF- increase of left atrial pressure and dilatation
RV heave- RV hypertrophy
Raised JVP- pulmonary hypertension/ right heart failure
why does mitral stenosis cause dyspnoea?
increased pressure in the atrium due to stenosis, backlog into pulmonary circulation leading to fluid overload leading to INCREASED HYDROSTATIC PRESSURE causing fluid to shift from vascular to interstitial causing oedema and SOB
treatments of COPD after standard medical therapy fails?
LTOT
home nebulisers
pulmonary rehab
CPAP
signs of CO2 retention?
confusion asterixis warm extremities bounding pulse morning headache
what does a low base excess mean? (
there is a lower than normal amount of HCO3- in the blood, suggesting a primary metabolic acidosis or a compensated resp acidosis
how can pancreatitis lead to foul smelling, floaty stools?
pancreatic exocrine dysfunction- lack of faecal elastase
how are spinal cord compression and cauda equina different?
cauda equina- lower back pain and sciatica- bilateral, saddle anaesthesia, loss of anal tone, urinary retention
spinal cord compression- leg weakness and radicular pain, urinary and bowel incontinence, sensory level
treatments of addisons disease?
fludrocortisone
hydrocortisone
causes of addisonian crisis?
- sepsis or surgery causing an acute exacerbation of
- chronic insufficiency (Addison’s, hypopituitarism)
- adrenal haemorrhage
- steroid withdrawal
mx of Addisonian crisis?
- hydrocortisone 100mg IM or IV
- 1L normal saline infused over 30-60 mins or with dextrose if hypoglycaemic
- continue hydrocortisone 6-hourly until the patient is stable. No fludrocortisone in required because high cortisol exerts weak mineralocorticoid action
- oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
signs/symptoms of Addisonian crisis?
shock, confusion, N&V, fever, acute abdo pain, tachycardia
causes of confusion in a patient with myeloma?
hypercalcaemia
uraemia
what does a technicium bone scan look at and why is it not suitable in myeloma?
looks at osteoblastic activity
myeloma causes plasma cells to secrete IL-6 which inhibits osteoblast and stimulates osteoclastic activity
Name 2 methods in which patient could get funding for cancer treatments not
recommended by NICE in the NHS
1) individual funding through PCT
2) cancer drug fund (charity)
3) private funding
consultants can apply for funding through NICE if they feel it is appropriate
classic clinical features of plague psoriasis skin lesion?
well-dermarcated
silver scaly plaque
erythematous rash
hyperproliferation (thickened)
differences between psoriatic and rheumatoid arthritis?
psoriatic arthritis affects distal interphalangeal joints and has nail changes
what does COX stand for?
cyclooxygenase
what substances do NSAIDs prevent from forming?
thromboxane A2
prostaglandin
mechanism of steroid action in the nucleus and cytoplasm?
steroids are lipid-soluble so pass through cell membrane. They bind to steroid receptors in the cytoplasm where they combine and travel into the nucleus. There they bind to DNA receptors and control protein synthesis and enzymes that regulate vital cell activity.
AEs of methotrexate?
mucositis myelosuppression pneumonitis pulmonary fibrosis liver fibrosis teratogenic- need to be on contraception
ECG features of hypokalaemia?
flat inverted T waves, u waves, depressed ST, long QT
what are the actions of aldosterone?
Increase sodium reabsorption from the distal tubule
Increase potassium secretion from the distal tubule
Increase hydrogen secretion from the collecting ducts
diagnosis of COPD on spirometry?
FEV1 <80%
FEV1/FVC <0.7
RFs for osteoporosis?
Steroids, hyperparathyroidism, alcohol, low testosterone, low BMI, early
menopause, renal failure, erosive, dietary, female sex, Asian/causasian, increasing age,
smoking, non- weight bearing
what is a vertebral compression fracture in the spine called?
wedge fracture
signs of lower motor neurone disease?
Muscle wasting
Reduced tone
Fasciculations (twitches in the muscles)
Reduced reflexes
signs of upper motor neurone disease?
Increased tone or spasticity
Brisk reflexes
Upgoing plantar responses
symptoms of bulbar or pseudobulbar palsy?
slurred speech Dysphagia, labile mood, nasal regurgitation, weak wasted fasciculating tongue. Loss of gag reflex. Jaw jerk affected.
what will happen to sensitivity and PPV if the prevalence of a disease increases?
sensitivity will stay the same
PPV will increase as there are less false positives (NPV will decrease as there are more false negatives for every true negative
Ix for suspected crohn’s
high foecal calprotectin
colonoscopy
ESR/CRP
rectal biopst
inducing remission drugs and maintaining remission drugs in crohns?
inducing remission- glucocorticoids e.g. prednisolone, budesonide, 5-ASA drugs (e.g. mesalazine) 2nd line
maintaining remission- azathioprine or mercaptopurine
mx of erythema nodosum?
best rest analgesia NSAIDs venous compression therapy steroids if malignancy and infection ruled out
If there is hearing loss + facial weakness, where is the acoustic neuroma located
intracranially?
cerebellopontine angle
what are the features of an acoustic neuroma?
cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
name some biochemical abnormalities of nephrotic syndrome/
hypoalbuminaemia
hyperlipidaemia- a consequence of increased synthesis of lipoproteins as a direct
consequence of low plasma albumin.
pathological change of basement membrane in diabetic nephropathy?
basement membrane thickening
name some risk factors for PE and how they increase risk?
Virchow’s triad= stasis, hypercoagulability, endothelial damage
immobility= increased stasis
malignancy= pro-thrombotic state
prev DVT= increased risk of embolus
COCP- oestrogen increases pro-thrombotic state
name some thromboprophylaxis methods?
TED stockings encourage mobilisation dalteparin DC leg elevation flowtron- intermittent compression device
how does LMWH work?
activates antithrombin which prevents conversion of prothrombin to thrombin
how does clopidogrel work?
P2Y12 inhibitor- stops ADP binding to platelet receptor= platelets can’t aggregate
how do DOACs work?
rivaroxaban= factor Xa inhibitor
signs of down’s syndrome?
single palmar crease sandal gap flat nasal bridge small, low set ears upsloping palpebral fissures epicanthic folds protruding tongue brush field spots in eyes
what is the most important risk factors for down’s syndrome?
maternal age for non-disjunction
prev down’s baby
translocation carrier
2 genetic mutations for down’s syndrome?
non-disjunction/translocation/mosaic- trisomy 21
2 GI malformations for down’s syndrome?
hirschsprungs disease
duodenal atresia
risks to child with down’s syndrome?
low IQ early onset alzheimers epilepsy cataracts leukaemia
RFs for melanoma?
UV exposure
multiple moles
family history
pale skin
which lymph nodes are melanoma of the lower leg likely to spread to?
superficial inguinal
external/internal iliac
RFs for lack of vitamin D?
dietary protective clothing housebound renal/liver disease malabsorption e.g. coeliac
how is vitamin D absorbed?
through the intestine to liver to become 25(OH)D to go to the kidney
- increases calcium and phosphate from the intestine
- increases bone resorption
how does PTH work?
BONE- works on bone to increase osteoclastic activity so there is more calcium in the bloodstream
KIDNEY- increases vit D activation and calcium resorption from the distal convoluted tubule and increased phosphate excretion
why does lack of vitamin D cause demineralisation of bone?
lack of Vit , reduces calcium, and increasing PTH which increases osteoclastic activity
4 things to do for Vitamin D deficiency?
Vit D + calcium supplements (Adcal), increase sunlight exposure, avoid using sunblock, avoid covering, diet (fish and milk), bisphosphonate (prevents osteoclastic activity)
triggers of gout?
chemo acute illness alcohol surgery diuretics
what type of drug is
- colchicine
- allopurinol
- plant alkaloid
- xanthine oxidase inhibitor- reduces serum uric acid levels (can precipitate an acute attack so don’t start straight away)
why does gout favour small distal joints?
distal blood supply is cooler so crystals more likely to precipitate i.e. uric acid
where are transitional cells found?
renal pelvis, ureter, urethra, bladder
blood supply for bladder and nodal clearance?
internal iliac -> superior and inferior vesicle arteries
nodes- external iliac, common iliac
coeliac antibodies?
anti-TTG
anti- endomysial
anti-gliadin
advice before coeliac biopsy?
eat a gluten diet
histology of coeliac?
crypt hyperplasia, villous atrophy, intraepithelial lymphocytes
what do vitamin A and E deficiencies cause?
A- night blindness
E- peripheral neuropathy
cancer risk of coeliac?
T call lymphoma of small bowel
skin rash of coeliac?
dermatitis herpetiformis
define economic evaluation?
Assessment of cost effectiveness - comparative study of the costs and benefits of a health care intervention. Costs and benefits need to be compared to at least two other interventions
define efficiency
Allocation of resources between activities on order to maximise benefit
what is opportunity cost?
to spend resources on one activity means a sacrifice in terms of lost opportunity elsewhere – benefits foregone from not allocating resources to the next best activity
prophylaxis and protective measures for malaria?
malarone
doxycycline
wearing protective clothing, DEET spray
3 reasons for malaria prophylaxis failure?
- non compliance
- resistance to meds
- inappropriate med for species
diagnosis of malaria?
thick and thin blood film – need to take 3 films on 3 subsequent occasions
thick – detection of parasite
thin – detection of species
Rapid diagnostic test to look for antigen/enzymes of parasite
symptoms of cerebral malaria?
Confusion, coma, seizures, encephalopathy
symptoms of severe malaria?
seizures, AKI, ARDS, DIC, sepsis,
hypoglycemia
treatment of malaria?
ACT – artemisinin combination
therapy
treatment of complicated malaria?
IV artesunate
2 things to regularly test in lithium treatment?
eGFR- renal function
TFTs
signs of lithium toxicity?
tremor, confusion, ataxia, restlessness, hypertonicity, myoclonic jerks
what is an apical lung tumour called?
Pancoast Tumor
3 features of horner’s syndrome?
ptosis
miosis
anhydrosis
caused by sympathetic fibres
why do people with lung cancer get shoulder and scapula involvement?
involvement of brachial plexus
when nerve root causes wasting of thenar eminence?
supplied by median nerve- C8-T1
what nerve causes a hoarse voice?
recurrent laryngeal nerve
different features of hypertensive retinopathy on fundoscopy?
- Arteriolar narrowing
- AV nipping
- Flame haemorrhages, blot haemorrhages, cotton wool spots, exudates
- Papilloedema
findings on slit lamp examination of anterior uveitis?
Cell and Flare (turbidity in aqueous humour), Keratic Precipitates, Hypopyon
cause of eczema herpeticum?
HSV 1 and 2
pathophysiology of lupus nephritis?
immune complex deposition on basement membrane.
name some SLE treatments and class of drug?
Methotrexate – immunosuppressant
Corticosteroid – prednisolone
NSAID – naproxen
Hydroxychloroquine
signs of examination on ascites?
Shifting dullness, fluid thrill
signs in hands of chronic liver disease?
Palmar erythema, spider naevi, clubbing, leukonychia (white spots on nails), dupuytrens contracture,
asterixis/liver flap. Other – jaundice, gynaecomastia
complications of chronic liver disease?
varices cirrhosis liver failure hepatocellular carcinoma hepatic encephalopathy – raised ammonia itching bruising – decreased production of clotting factors
pathophysiology of pleural effusion?
increased vascular permeability causes fluid to move into pleural space
is a pleural fluid protein of 55 a transudate or exudate?
exudate a >30g/L
how to diagnose TB?
microscopy – acid-fast bacilli on Ziehl-Neelson stain,
why does an AKI cause tachypnoea?
metabolic acidosis caused by raised urea
trying to blow off C02 to compensate
risk factors for T2DM?
Overweight age FH ethnicity hypertension gestational diabetes heart disease or stroke depression PCOS
signs of inflammatory arthritis?
Pain in the morning
Systemic features
Raised inflammatory markers
signs of hyperthyroidism?
Irregularly, irregular pulse
pretibial myoedema
thyroid acropatchy- clubbing
inappropriate dressing
signs of psoriatic arthritis?
nail pitting
alopecia
which 2 places to ask to check in psoriatic arthritis?
behind ears
base of spine
tx of PVD?
Stents
bypass surgery
causes of poor ulcer healing?
poor perfusion
decreased mobility
malnutrition
what is insertion of tendon to bone called?
enthesis
symptoms of T2DM?
polydipsia polyuria abdo pain ED recurrent UTI thrush
RFs for angina?
smoking DM hypertension age FH obesity hyperlipidaemia
secondary care ix of angina?
CT coronary angiography
exercise tolerance test with ECG
drugs for angina?
everyone has GTN, statin and aspirin
BB e.g. bisoprolol or CCB nifedipine (if combined with BB)
indicators for legionella pneumonia?
low sodium
travel history
bradycardia
dry cough
6 Ix for haematuria?
urine dipstick urine culture bloods- clotting, FBC, LFT flexible cystoscopy CT KUB? XR/ CT
most common type of renal cell cancer?
clear cell
inherited risk factor for RCC?
Von- Hippel Lindau
4 side effects of chemotherapy?
alopecia
nausea
constipation
peripheral neuropathy
tx of neutropenic sepsis?
tazocin IV- penicillin (piperacillin) with beta-lactamase inhibitor (tazobactam)
complications of chemo?
immunosuppression
cardiomyopathy
renal failure
complications of MI
heart failure pericarditis dressler's syndrome mitral regurgitation LVH
immediate management of HF
Loop diuretics
O2
Opiates
Nitrates
drugs of glaucoma
BB- timolol
prostaglandin analogue- lantoprost
carbonic anhydrase inhibitors- dorzolamide
oral/iv acetazolamide
pilocarpine drips (mydriatic)- constrict pupil
prevent recurrence- laser iridotomy
why can asthma cause cushings syndrome?
exogenous steroids
what is a confounder?
when an apparent association between an exposure and an outcome is actually the result of another factor e.g. office workers seem to be more likely to get lung cancer, but in fact more of them smoke
features on a DRE that could point to prostate disease?
tender, boggy= prostatis
smooth, enlarged= BPH
craggy, irregular, enlarged= prostate cancer
diagnosis of prostate cancer?
TRUSS biopsy
what is passivity
were someone feels they are controlled by another person e.g. commanding a mother to kill their baby
mx of puerperal psychosis?
atypical antipsychotic- risperidone, olanzapine
CBT
talking therapy
immediate treatments for liver failure?
lactulose- prevent hepatic encephalopathy
vitamin K/ beriplex- to increase clotting factors
hormone blood tests done in a sexual health disorder?
testosterone and SHBG and albumin LH/FSH oestrogen day 21 progesterone free androgen index prolactin TFTs semen analysis
four complications you might see in this RA patient after a routine surgical procedure?
adrenal crisis from stopping prednisolone
infection from steroid
hypercoagulable state- increased VTE risk
immune suppression from methotrexate
what is included in PESI score?
30 day outcome in PE male malignancy heart failure chronic lung disease tachycardia hypotension etc
what causes compartment syndrome?
increased pressure in the tissue in an anatomical area leads to necrosis and compression of structures
due to an increase in fluid building up pressure so tissue pressure is higher than capillary pressure
drugs that contraindicate with warfarin?
any drug that prolongs QT
e.g. amiodarone, haloperidol, bendroflumethazide
what is serotonin syndrome?
cognitive impairment
autonomic dysfunction
neuromuscular hyperactivity
tx= benzodiazepine
mx of status epilepticus
buccal midazolam-> IV lorazepam -> contact anaesthetist -> phenytoin, sodium valproate, phenobarbitol
remember to do a blood glucose to exclude hypoglycaemia
drug for alcohol withdrawal?
chlordiazepoxide
Ix in addisons
Short synacthen test- cortisol doesn’t increase in problem with adrenals
CT adrenals
adrenal auto-antibody
mx of addisonian crisis?
stress-dose hydrocortisone -> saline -> dextrose (and normal dose hydrocortisone)
how to prevent addisonian crisis?
steroid sick days
increase in exercise
compliance
medical alert bracelet
signs of a deteriorating baby?
firm fontanelle dry mucous membranes no response cyanosed tachycardia floppy reduced urine output not feeding properly
bloods of paediatric sepsis?
FBC CRP Coagulation screen blood cultures ABG BG lactate
paediatric sepsis 6?
O2 IV or IV Abx IV fluids get senior help inotropes e.g. DA
what class of drug is cyclophosphamide?
alkylating agent
well’s score for PE?
signs and symptoms of DVT alternative diagnosis less likely tachycardia immobilisation prev DVT/PE haemoptysis maligancy
signs of PE?
haemoptyis dyspnoea tachycardia fever crackles chest pain
differentials for dysphagia?
cancer
pharyngeal pouch
MND
achalasia
side effects of over treating with levothyroxine?
thyrotoxicosis AF worsening of angina palpitations altered mental state tremor
mx of leg injury in ambulance?
IV access gas and air morphine immobilise ice and elevate to prevent compartment syndrome
surgical mx of burns?
escarotomy
fasciotomy
why do sickle cell pts have increased risk of gallstones?
haemolysis causes increased bilirubin-> stones
prophylactic surgery of sickle cell?
splenectomy
drug mx of sickle cell?
hydroxycarbamide (increases foetal Hb)
its an anti-metabolite
signs of opioid withdrawal?
restlessness, pupil dilatation, insomnia, sweating, N&V, diarrhoea
signs of opioid toxicity?
hypotensive tachycardia pupil constriction resp depression constipation
mx of IVDU addict?
sexual health screen
needle exchange
immunisation
causes of intra-abdominal sepsis?
staph aureus- anaerobe
E.Coli- gram-negative
Enterococcus
why does lactate go up in intra-abdominal sepsis?
hypoxia causes anaerobic respiration which causes lactate production
sign of increased mortality
2 features of cauda equina in perianal area?
anal wink, saddle anaesthesia
features of quinsy?
deviated uvula, purulent tonsils, trismus, painful swallowing
UMN signs? (L1 and above)
upgoing plantars hypertonia brisk reflexes weakness retention
what is efficiency?
max benefit from resource allocation
cerebral complications of malaria?
confusion, coma, seizures
severe complications of malaria?
seizures, AKI, DIC, sepsis, hypoglycaemia
2 things to test before lithium
eGFR, TFT
what causes horner’s syndrome?
sympathetic nerve fibres
features of bulbar palsy?
LMN
dysarthria, dysphagia, drooling, absent gag reflex, fasciculating tongue
differentials of facial nerve palsy?
bells palsy, ramsey-hunt syndrome, parotid tumour
