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*Phase 3a Julia > Past papers > Flashcards

Past papers Flashcards

1
Q

DDx depression in 45yo with Down’s syndrome ( 6 mo Hx agitation, incontinence of urine, aggression)

A

Alzheimer’s
Hyperthyroidism
Trauma?

Also: hypothyroidism, cushing’s disease

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2
Q

Ix for depression

A

CT head

TFT

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3
Q

Bowel-related complications of NEC

A

Strictures

? malabsorption

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4
Q

Radiological findings suggestive of NEC

A

Distended bowel loops
Thickened bowel wall
Intramural gas

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5
Q

2 immediate non-surgical interventions for NEC

A

Stop oral feeding

Broad spectrum Abx

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6
Q

Two causes of irregular cycle?

A

PCOS

Excessive weight loss or gain

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7
Q

What two non hormonal interventions to control dysmenorrhoea and menorrhagia?

A

NSAIDs - for dysmenorrhoea (mefenamic acid)

Anti-fibrinolytics- for menorrhagia (tranexamic acid)

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8
Q

Ix PCOS

A

Serum testosterone

USS abdomen

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9
Q

List 6 causes (2 endocrine, 2 neuro, 2 medicated side effects) of failure to ejaculate

A

Endrocrine: low testosterone, low thyroid
Neuro: stroke, neuropathy
Medicated: antidepressants e.g. fluoxetine - SSRI, Beta-blocker - propranolol

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10
Q

Psychosocial reasons for failure to ejaculate

A

Anxiety +/- depression that can –> suppress sexual desire
Cultural or religious taboos
Trauma

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11
Q

Psychological interventions for failure to ejaculate

A

Psychological counselling

Sex therapy

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12
Q

Most common delusions in someone with paranoid schizophrenia?

A

Persecutory delusion

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13
Q

Schizophrenic started on haloperidol and gets contractions in muscles straight away, what is this?

A

Acute dystonic reaction

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14
Q

Rx Acute dystonic reaction

A

IM/IV Benztropine

Alternative: procyclidine

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15
Q

Pt saw a traffic light turn red and then realised he was being followed: what is this?

A

Delusional perception

A 1st rank symptom
others: aud hal, delusions of thought interference, passivity phenomenon/delusions of control

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16
Q

3 neurological signs of lithium toxicity

A

coarse tremor
seizures
coma
hyper-reflexia

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17
Q

Physical signs hypothyroidism

A 
Bradycardia
brittle nails
dry skin
delayed relaxation of deep tendon reflexes
goitre
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18
Q

Why induce labour at 42 weeks?

A

to preven IU fetal death

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19
Q

Methods to induce labour

A

prostaglandin pessary
IV oxytocin
amniotomy (AROM)

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20
Q

What are the elements of the Bishop’s score?

A 
Cervical Position
Cervical Consistency
Cervcial Effacement
Cervical Dilation
Station
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21
Q

Ix for ectopic pregnany (if HCG and ultrasound scan already done)

A

Laparoscopy

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22
Q

3 treatments avaliable for ectopic pregnancy

A

methotrexate
salphinectomy
salphinotomy

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23
Q

Name 3 reassuring features on CTG

A

Fetal HR 110-160
Fetal variability >5bmp
No fetal deceleration

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24
Q

RFs ectopic pregnancy

A 
Submucosal fibroids
IUD
Chlamydia
PID
Previous surgery
Asherman's
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25
Q

what is the incidence of ectopic pregnancy?

A

1%

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26
Q

What is the recurrence rate of an ectopic pregnancy?

A

10%

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27
Q

Parents of a child who has had a febrile convulsion, what should they do if he has another fit?

A
  1. Recovery position

2. Buccal midazolam

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28
Q

Baby jaundiced at day 3 but otherwise well, likely Dx?

A

Physiological jaundice

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29
Q

If baby has jaundice for 3 weeks, what 2 signs would lead you to think underlying pathology?

A

Dark urine
Pale stools

(biliary atresia)

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30
Q

2 nursing strategies for confused agitated patient

A

Reality orientation

Correct sensory impairment

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31
Q

What Rx would you presribe for confused agitation patient for use as required?

A

An antipsychotic e.g. haloperidol

NOT a benzodiazepine as may worsen condition

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32
Q

3 chronic conditions that may lead to erectile dysfunction in 20yr old man

A

DM
MS
Anxiety
PTSD

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33
Q

What is a never event?

A

A significant, largely preventable event that would not occur if the relevant safety guidelines are followed

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34
Q

Give an example of a never event

A

Misidentification

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35
Q

When investigating a never event, what is the personal approach and what is the systems approach. Which should you use?

A

Personal approach: holding 1 person responsible for the event

Systems approach: identifying there are latent errors in the system and that latent + active causes come together to cause error

The latter eliminates blame culture

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36
Q

What is the principle neuroreceptor that anti-psychotics work on?

A

Dopamine D2 receptor (antagonist)

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37
Q

What is characterised by a feeling of inner restlessness and inability to stay still?

A

Akathisia

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38
Q

What antihypertensives for pregnant women with mild–>moderate hypertension?

A

Labetalol

Nifedipine

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39
Q

When should folic acid be taken?

A

From trying to get pregnant up until 12 weeks pregnant

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40
Q

List 2 early pregnancy risks and 3 fetal/neonatal complications with uncontrolled diabetes?

A

Pregnancy risks: miscarriage, stillbirth, preterm delivery

Fetal complications: macrosomia, shoulder dystocia, neonatal hypoglycaemia, congenital defects, SFD, fetal RDS

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41
Q

Routine antenatal Ix to check risk of uncontrolled maternal diabetes?

A 
GTT
BP
Blood glucose
Urinalysis
Uterine Doppler artery
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42
Q

Blood tests for chronic alcoholism

A

GGT (gamma-glutamyl transferase
RBC MCV
AST+ALT
Carbohydrate-deficient transferrin (CDT)

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43
Q

What tests would you do to check someone is ovulating?

A

Day 21 mid-luteral progesterone
(should be 7 days before end of their cycle)

Day 5 FSH

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44
Q

What 2 tests for tubal patency (infertility)

A

Laparoscopy plus dye + HSG (hysterosalphingogram)

HyCoSy

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45
Q

which is the preferred test to test tubal patency and why?

A

HyCoSy - no use of radioactive contrast

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46
Q

In a couple struggling to conceive, what tests can the male undergo?

A

Sperm analysis

FSH/LH levels

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47
Q

45 y/o woman sweaty hands, heart racing. Snappy and irritable. What would make u think hyperthyroidism?

A 
increased appetite
wt loss
diarrhoea
neck swelling
resting tremor
thin hair
palmar erythema
exopthalmos
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48
Q

45 y/o woman sweaty hands, heart racing. Snappy and irritable. What would make u think menopause?

A 
hot flushes 
night sweats
vaginal dryness
skin + breast atrophy
atrophic vaginitis
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49
Q

45 y/o woman sweaty hands, heart racing. Snappy and irritable. What would make u think anxiety disorder?

A

insomnia
feeling of impending doom
anxious feeling across various situations / env
hyperventilation

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50
Q

Treatments for adjustment/ anxiety disorder following grievance?

A 
CBT
SSRI: paroxetine
Mindfulness
Short term BDZ
Beta blocker
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51
Q

What 2 treatments to give child with severe asthma attack?

A

O2

Nebulised salbutamol

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52
Q

If child with acute asthma attack not responding to O2 and nebulised salbutamol, what do you give?

A

IV hydrocortisone
oral prednisolone

?IV salbutamol

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53
Q

6 questions to ask parents to asses how well controlled his asthma is?

A
  1. wake up breathless,
  2. exercise limitations
  3. how often does he use his inhaler
  4. inhaler technique
  5. recent hospital admissions for exacerbations
  6. daytime symptoms
  7. use of oral steroids
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54
Q

3 intestinal signs of IBD?

A

INTESTINAL:
Diarrhoea (more likely to be bloody in UC)
Perianal disease (abscess, fistulae, anal skin tags)
Abdo masses, abdo pain

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55
Q

3 extra intestinal signs of IBD?

A

EXTRA-INTESTINAL: clubbing, mouth ulcers, uveitis, conjunctivitis, arthritis, erythema nodosum, pyoderma, gangrenosum
Diarrhoea (more likely to be bloody in UC) and weight loss

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56
Q

3 histopathological features on biopsy of Crohn’s

A

(inflam in all layers from mucosa to serosa)

*(CAGCGMLflirt)

  1. crypt abscesses
  2. Goblet cell depletion
  3. Microscopic granulomas
  4. Lymphocyte infiltration
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57
Q

Side effects of steroids

A 
Weight gain
osteoporosis
increased chance of infections
thinning of the skin
puffiness around the face
easy bruises
predispose to DM
increased risk of stomach ulcers
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58
Q

What might cause EPSE out of metoclopramide, aspirin, statin, amlopipine?

A

Metoclopramide

It is a Dopamine receptor antagonist

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59
Q

Which neurotransmitter does parkinsons affect?

A

Dopamine D1 and D2

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60
Q

What parkinsons med might cause sleepiness and gambling?

A

Ropinirole

(a dopamine agonist that causes compulsive behaviour)

Rope-in- a- role!!

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61
Q

RFs that predispose to pressure ulcers (not age)

A 
Hx of vascular disease
immobility
poor nutrition and dehydration
bowel incontinuence
medical conditions affecting blood flow (e.g. diabetes, vascular disease)
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62
Q

What 3 actions can be done to stop old immobile lady getting pressure ulcer?

A

Regular turns
Reesablish mobility by strengthening leg/hip muscles
Check and possibly treat cause of incontinence
Adequate nourishment

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63
Q

Treatment that can improve bone health in a lady who has had a hip fracture as a result of reduced bone density?

A

Bisphosphonates
Vitamin D supplements
Calcium supplements

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64
Q

Old lady hip fracture MFFD and mobilising with a zimmer frame, 2 more things you’d ask about before sending home

A

Carers?

Assessment of home situ by OT and rectify any issues, if any

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65
Q

Give 4 qualitative methods for evaluating healthcare

A

Observational
Focus group
Reviewing documents
Interview

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66
Q

Lady having first cervical smear, very anxious. What needs to be done before the examination?

A

Full sexual history
Offer of chaperone
Explain to pt the process of the examination
Enquire if there are any traumatic sexual experiences

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67
Q

4 approaches to psychosocial therapy

A

CBT
Psychodynamic
Systemic
Integrated

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68
Q

Vaginismus treatment options

A 
Indv psychosexual therapy
Integrated CBT
Behaviour interventions:
- breathing control and relaxation
- kegel exercises
- vaginal trainers
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69
Q

Pt has cancer and lots of comorbidities, want to put in place a DNACPR - what is beneficence and how does it relate to this case?

A

Best interest: QoL : S/E > benefits

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70
Q

Pt has cancer and lots of comorbidities, want to put in place a DNACPR - what is non-maleficence and how does it relate to this case?

A

Do no harm - preventing rib fractures from CPR

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71
Q

Who should the trust report a never event to?

A

National Reporting and Learning System (NRLS)

Strategic Executive Information System (STEIS)

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72
Q

Treatment for paracetamol overdose

A

N-acetylcysteine

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73
Q

What treatment is recommended for mild-moderate alzheimer’s disease?

A

Acetylcholinesterase inhibitors:

  • Donepezil, rivastigmine, galantamine
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74
Q

Screening bloods in Alzheimers?

A

FBC, ESR, CRP ; TFT ; serum B12 and folate levels

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75
Q

Pre-eclampsia: high BP, feeling puffy, flashing lights, headache… one additional test for diagnosis?

A

Urine protein measurement (+2)

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76
Q

What are the elements of HELLP syndrome?

A

Haemolysis (low Hb)
Elevated liver enzymes e.g. ALT
Low platelet count

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77
Q

4 further clinical and lab Ix to assess severity of pre-eclampsia, (after HELLP ones) and why?

A
  1. CXR: pulm oedema
  2. Fundoscopy
  3. U&E (renal failure)
  4. CT head - CVS haemorrhage
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78
Q

Complications of pre-eclampsia?

A 
Seizures (eclampsia)
CVA
Renal or liver failure
Pulmonary oedema
DIC
HELLP
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79
Q

29 yo with 6 month history of PCB/IMB. Sexually active, no regular sexual partner, no pain, smoker. 4 DDx? + 2Ix?

A 
Cervical cancer (HPV)
Chlamydia
Cervical ectropian
Vaginitis
Cervical polyps
Uterus: fibroids/cysts

2 Ix: colposcopy
high-vaginal swab and endocervical swab
Blood test: HPV

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80
Q

2 tests/Ix for DVT?

A

Wells’ clinical probability tool
Quantitative D-dimer level
Venous duplex ultrasound (DUS)

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81
Q

3 anticoagulants and their contraindications

A

LMWH - kidney disease
Warfarin - haemorrhagic stroke
Rivaroxaban - significant hepatic impairment

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82
Q

2 likely reasons for bulky uterus / IMB in 58yo female?

A

Fibroids

Adenomyosis

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83
Q

Normal heart rate range at rest?

A

60-100bpm

84
Q

On ECG, whats the space between 2 dark vertical lines, and how long does it represent?

A

5mm = 0.2

85
Q

How to calculate rate on ECG

A

Rate = 60 / (R-R interval)

86
Q

Crying infant 6mo old, apyrexial, petechial rash on neck, immobile left arm, crying when left arm moved. crying throughout assessment. 3 initial Ix?

A

Bloods: CRP, ESR. Blood cultures

Should and elbow Xray

87
Q

6 month old become unresponsive with bulging fontanelle - 3 parts of emergency assessment?

A

A - airway - patent
B - breathing, RR and pattern
C - pulse, CRT, BP

88
Q

CSF features bacterial meningitis?

A

Turbid
Polymorphs (neutrophils)
High protein
Low glucose

89
Q

What can cause respiratory alkalosis?

A

Hyperventilation

90
Q

3 antenatal factors that increase the risk of infection in a baby

A 
PROM
Chorioamnionitis
TORCH infections
Maternal UTI
Group B strep carrier
91
Q

What is PROM?

A

Rupture of membranes AFTER 37 weeks and before the onset of labour

92
Q

Bulging fontanelle and pyrexial, what investigation to do?

A

LP

don’t even have to wait for them to be pyrexial

93
Q

Commonest cause of bacterial meningitis in 0-3mo olds?

A

Group B Streptococcus

Gram +ve cocci in chains

94
Q

Long-term effect of bacterial meningitis?

A

Hearing loss

95
Q

29 year old lady who collapsed while waiting for the bus on a hot day. Also complains of episodes of dejavu, confusion, difficulty speaking and understanding speech, lasting 1 or 2 minutes, 3-4 episodes a month.

Which lobe likely to be abnormal on MRI?

Which hemisphere?

A

Temporal lobe

Dominant

96
Q

Tx for partial/focal seizure (consciousness not lost from the start)

A

Carbamazepine

97
Q

AMT, what is it? And how would drowsiness affect the score?

A

The abbreviated mental test (the 10 quick questions)

Score would be lower

98
Q

4 things to know before discharge planning

A

Care package
OT review
PT review
Social worker, support worker

99
Q

Pt insistent on going home but nurses worried. 3 supportive measure upon discharge

A
  1. Community team

2. OT - modification of housing

100
Q

2 licensed medical / physical treatments rapid ejaculation

A

Topical local anaesthetic e.g. Stud 100 spray

Dapoxetine (short acting SSRI)

Kegel exercises

101
Q

2 behavioural interventions for rapid ejaculation

A

stop-start technique

practice ‘point of inevitability’

102
Q

3 behaviour interventions for weight loss?

A

Exercise
Healthy Diet
Cut down alcohol

103
Q

Libertarian principle for resource allocation, and give an example

A

Each is responsible for their own health, wellbeing and fulfilment of life plan e.g. the German Health Incentive Scheme

104
Q

What is the rule of rescue? and who made it up?

A

Jonsen: The perceived duty to save an endangered life where possible

105
Q

Weekly alcohol unit limit men and women?

A

14 units

106
Q

Define the swiss cheese model

A

The swiss cheese model of adverse events

  • Each slice of cheese is a barrier to propagation (of an adverse event)
  • Holes represent failures in the barriers
107
Q

Criteria for negligence

A
  1. There was a DUTY of care
  2. This was BREACHED
  3. The pt came to HARM
  4. The harm was CAUSED by the breach in duty of care
108
Q

8 endocrine tests for female orgasmic disorder?

A
  1. testosterone,
  2. sex hormone binding globulin,
  3. dihydrotestosterone,
  4. LH,
  5. FSH,
  6. estradiol,
  7. progesterone,
  8. prolactin,
  9. TSH
109
Q

Four types of couples therapy ?

A

CBT
Psychodynamic
Systemic
Integrated

(Also stuff like sensate-focused, new sexual routines)

110
Q

Behavioural interventions for female orgasmic disorder?

A

Kegel exercises

Guided mastrubation

111
Q

Causative organism Toxic Shock Syndrome and Scalded skin syndrome

A

Gram positive coccus: staphylococcus aureus

112
Q

What CFs for TSS?

A

Fever >39
Hypotension
Diffuse, erythematous, macular rash

(if no fever, its staphylococcal scalded skin syndrome)

113
Q

Mx TSS

A

ITU for support for shock
Surgical debridement of areas of infection
IV immunoglobulin

114
Q

What is Juvenile Idiopathic Arthritis?

A

Persistent joint swelling (of >6 wks duration) without infection or any other cause

115
Q

Histopathological features Coeliac disease

A
  • villous atrophy
  • crypt hyperplasia
  • increase in intraepithelial lymphocytes
  • lamina propria infiltration with lymphocytes
116
Q

ICD-10 OCD?

A

Obsessive thoughts

Compulsive acts

117
Q

What are 3 themes in obsessional ideas in OCD?

A

Often unpleasant
Repetitive
Intrusive
Irrational

Recognised as patients own thoughts

118
Q

Alcoholic pt went from drinking wine, whisky and Beer to only drinking Wine, what symptom
of dependence Is this?

A

Narrowed repetoire

119
Q

What blood tests do you do for alcohol dependence?

A

FBC, MCV

Gamma-glutamyl transferase

Carbohydrate Deficient Transferrin

120
Q

Pt withdrawing gets delirium tremons, name 2 key CFs that would make you think it had developed to Wernicke’s ecephalopathy

A

Confusion

Opthalmoplegia (paralysis of the muscles within or surrounding the eye)

121
Q

Define Korsakoff syndrome

A

A chronic memory disorder caused by severe deficiency of thiamine (Vitamin B-1)

122
Q

Whats in the combined test?

A

Nucheal Translucency
PAPP-A
bHCG

123
Q

Whats in the quadruple test?

A

Inhibin A
Alpha-fetoprotein
hCG (human chorionic gonadotropin)
Estriol

124
Q

4 risks amniocentesis

A

Miscarriage
Infection
Perforation of placenta
Rhesus D sensitisation

125
Q

What drug do you give before amniocentesis?

A

Anti-D immunoglobulin

126
Q

Apart from Down’s, name 3 chromosomal abnormalities you can test for antenatally and their name

A

Patau’s - Chromosome 13
Edwards- ch 18

Angelman syndrome - chr 15

127
Q

65 year old woman comes in with abdominal mass, GP examines her. What 4 features would you find on ultrasound that would indicate a malignant lesion rather than a benign one?

A 
Irregular, 
Ascites, 
Multi-occular cyst, 
Solid area, 
Metastasis, 
Bilateral lesions
128
Q

~ What 4 blood tests would you do pre-operatively and why? ~

A 
FBC- Hb, 
platelets- cross match,
group and save, 
clotting screen- coagulation- risk of thrombosis/bleed, 
?? not sure
129
Q

Operation for early stage ovarian cancer?

A

Bilateral hysterosalpingectomy

130
Q

What intraoperative investigation would you do to determine if an ovarian mass is malignant?

A

biopsy the malignant tissue

131
Q

How does the organism in Staphylococcal Scalded Skin Syndrome cause skin to peel?

A

Exfoliative Staphylococcus epidermolytic exotoxin

132
Q

Kid becomes unresponsive, what three things would you do on initial management?

A

Airway- patent, head tilt and chin lift- if not- intubate, Breathing- decreased- Oxygen,
Circulation- IV
Fluids

133
Q

Ix JIA

A

ANA may be +ve, esp in oligoarticular JIA

Rheumatoid factor is usually negative

FBC: microcytic anaemia in chronic disease
XR/USS to define inflammation

134
Q

Mx JIA?

A

NSAIDs
Steroid injections
DMARDs e.g. methotrexate
Biological agents - infliximab

135
Q

What antibodies are present in most of pts with Grave’s disease?

A

TSH receptor antibodies

136
Q

What drugs to treat symptoms of thyrotoxicosis?

A

Carbimazole: blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production

Propanolol: for tremor

Diarrhoea: immodium

137
Q

Symptoms of thyroid storm?

And what should GP do?

A

Fever of 38.9, palpitations, increased heart rate,
sweating.

Refer to hospital urgently

138
Q

Describe the pathophysiology of parkinson’s disease including the histological changes, neurotransmitter and part of the brain affected

A

Neurological disease characterised by the loss of dopaminergic neurons in the substantia nigra of the basal ganglia. Lewy bodies also develop

139
Q

Treatment for PD

A

Levodopa + carbidopa

Ropinirole (dopamine agonist) / bromocriptine

Selegiline (MOA-B inhibitors)

Tolcapone (COMT inhibitor)

140
Q

Drugs contraindicated in PD

A

Typical antipsychotics e.g. haloperidol

Some anti-emetics e.g. metoclopramide

141
Q

What is a reversible cause of dementia?

A

Normal pressure hydrocephalus

142
Q

Classical triad of features seen in normal pressure hydrocephalus?

A

a. urinary incontinence
b. dementia and bradyphrenia (slowness of thought)
c. gait abnormality (may be similar to Parkinson’s disease)

143
Q

If joint sense and vibration are spared in a spinal cord lesion, what column has been spared?

A

Dorsal column

144
Q

3 histopathological features on biopsy of UC

A

Similar to Crohns,
No inflammation beyond submucosa
Inflammatory cells infiltrate in lamina propria
- and granulomas are infrequent

145
Q

Ix for TB

A 
Sputum
Tissue
X-ray
Mantoux
IFN gamma blood tests
146
Q

3 signs on CXR Tb

A
  1. Consolidation
  2. Cavities
  3. Pleural effusion
  4. Hilar or mediastinal lymphadenopathy
147
Q

Causative organism TB

A

Mycobacterium tuberculosis

148
Q

Rx TB:

A

RIPE

  • rifampicin
  • isoniazid
  • pyrazinamide
  • ethambutol
149
Q

How to calculate relative risk

A

Probability of outcome in exposed group
/
Probability of outcome in unexposed group

(very similar to odds ratio, but is using % instead of ratios)

150
Q

An example of a non-causal variable (not confounding)

A

Number of churches in a town and number of deaths from cancer

(its actually cause larger towns have more people- decreasing number of churches in town won’t reduce the number of cancer deaths)

151
Q

6 symptoms of depression (not including anergia or social WD)

A 
Anhedonia
Loss of libido
Poor appetite
Weight loss
Early morning waking
Loss of concentration

(guilt, hopelessness)

152
Q

3 cognitive symptoms of depresion

A 
Memory loss
Difficulty concentrating
Negative thinking
Distractibility
Indecisiveness
153
Q

Depression screening tool

A

the Patient Health Questionnaire (PHQ-9)

Hospital Anxiety and Depression (HAD) scale

154
Q

3 management strategies depression

A

SSRI

CBT, interpersonal therapy

155
Q

Signs of preterm labour

A

Before 37 weeks

  1. Contractions >4 per hour
  2. Low cramps
  3. Change in quantity or quality of vaginal discharge, esp gush or leak of fluid
156
Q

Tender uterus, bleed and pain - Dx?

A

Placental Abruption

157
Q

Ix placental abruption

A

Cardiotocography
FBC
clotting
USS (to exclude vasa praevia)

158
Q

Mx placental abruption

A

IV fluids

Consider blood transfusion

159
Q

What is agoraphobia?

A

Fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong

160
Q

Two treatments for panic disorder

A

SSRIs

CBT

161
Q

Endocrine disorder that also makes ppl feel like they’re about to die

A

Pheochromocytoma

162
Q

Define depersonalisation

A

An unpleaseant subjective experience where the patient feels as if they have become ‘unreal’

163
Q

Define derealisation

A

An unpleaseant subjective experience where the patient feels as if the whole world has become unreal

164
Q

List 3 features of dependence syndrome

A
  1. Strong desire or compulsion to use
  2. Difficulties in controlling substance-taking behaviour (onset, termination, or level)
  3. Physiological withdrawal state when reduce use (or substitution to avoid withdrawal )
  4. Tolerance (more for same effect)
  5. Progressive neglect of pleasures/interests, increased time spent using
  6. Persistent use despite evidence of harmful consequences (physical health, mood, cognition
165
Q

2 treatments for detox from opiates

A

Buprenorphine

Methadone

166
Q

One investigation before treating opiate addiction

A

Urine or oral fluid drug test

167
Q

What is the name given for when the eyes roll back into the head on antipsychotics?

A

Oculogyric crisis

168
Q

What is the name given for when the neck painfully twists and tilts on antipsychotics?

A

Torticollic crsis

169
Q

Name 2 other atypical antipsychotics (other than clozapine and risperidone)

A

Olanzapine

Quetiapine

170
Q

What drug classes can cause delirium?

A

Sedative hypnotics (e.g. benzodiazepines).

Anticonvulsants (e.g. barbiturates).

Antiparkinsonian agents (e.g. the anticholinergic, benztropine)

171
Q

6 Cardiovascular risk factors for a TIA

A
  • smoking
  • HTN
  • DM
  • hypercholesterolaemia
  • AF
  • Thrombophilia
172
Q

2 Ex for TIA (other than take BP)

A

CN examination

UL and LL neuro exam

173
Q

2 Ix for TIA

A
  1. Serum FBC, U&E, fasting lipids and glucose, ESR, LFT &TSH
  2. ECG
174
Q

TIA pt: scans carried out show no abnormalities and pt is discharged. What treatment, if any, would you provide?

A
  1. Calculate ABCD2 score
  2. Control CV risk factors
  3. 2 weeks 300mg aspirin
  4. Clopidogrel 75mg
  5. Simvastatin 40mg

Advise not to drive for at least 4 weeks following a TIA

175
Q

What happens to sensitivity and PPV if the prevalence increases?

A

Sensitivity stays the same

PPV increases

176
Q

How does increased prevalence impact NPV?

A

It decreases NPV

177
Q

Give 3 psychosexual and 2 medical causes of rapid ejaculation

A

Psychosexual:

  1. Anxiety
  2. Relationship issues
  3. Lack of sexual experience

Med:

  1. Penile hypersensitivity
  2. Hypothyroidism
178
Q

3 non-ogranic causes for female dyspareunia

A
  1. previous experience of pain
  2. insufficient relaxation
  3. fear of intimacy
179
Q

4 possible treatments for rapid ejaculation

A
  1. Stud 100 spray (topical anaesthetic)
  2. Dapoxetine (short acting SSRI)
  3. Couples psychosexual therapy
  4. Practice ‘point of inevitability’
180
Q

Questions to ask to assess if there is pressure in the pelvis?

A
  • Urinary symptoms Urgency + Freq
  • Early satiety
  • Diarrhoea
181
Q

Abdominal mass, low Hb, menorrhagia, afro-caribbean descent. What is Dx?

A

Uterine fibroid

182
Q

Pressure effects of uterine fibroids

A

Freq/urg (bladder)
Hydronephrosis (swelling of kidney if ureter blocked)
Infertility (tubal ostia)

183
Q

Dx uterine fibroids

A

TVUSS

184
Q

Mx uterine fibroids

A
  1. IUS / COCP
  2. tranexamic acid
  3. GnRH analogues
  4. Surgery (hysterectomy, myomectomy
  5. Uterine artery embolization
185
Q

2 routinely administered childhood vaccines which help prevent meningitis?

A

Meningococcal C

Haemophilis Influenza B

186
Q

2 Abx for prophylactic treatment of meningitis patient’s close contacts?

A

Rifampicin

Ciprofloxacin

187
Q

most common malignant neoplasm to affect the breast?

A

Invasive ductal carcinoma in situ

188
Q

2 genes responsible for familial causes of breast cancer

A

BRCA 1

BRCA 2

189
Q

Which 5 common tumours typically metastasise to bone?

A 
Breast
Prostate
Lung
Kidney
Thyroid
190
Q

2 special laboratory tests which should be carried out on

the originally excised tissue in breast Ca in order to plan the patient’s therapy.

A

HER-2 status (+ve status is bad)

Oestrogen receptor status (-ve is bad)

191
Q

MOA of fluoextine, what neurotransmitter does it affect to lessen depression and in what part of brain does this occur predominantly

A

Blockade of re-uptake of serotonin (5-HT)
Downregulate the number of 5-HT receptors
Pre-frontal cortex

192
Q

How long to take SSRIs before benefit is felt usually?

A

2-4 weeks

speak to gp if no benefit after 6-8wks

Should continue for at least 6 months as relapse is high in this time

193
Q

How to stop an SSRI

A

Dose gradually reduced over 4 weeks (not the case with fluoxetine- has a longer half-life)

194
Q

What receptors do tricyclic antidepressants also unfortunately block (as well as inhibiting the reuptake of seratonin and noradrenaline?

A

Muscarinic Acetylcholine Receptors (AChR) are blocked

SE: dry mouth, constipation, urinary retention, blurred vision

195
Q

Early features of tricyclic overdose

A

Relate to anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.

196
Q

Features of severe tricyclic poisoning:

A

arrhythmias
seizures
metabolic acidosis
coma

197
Q

Inheritence pattern in early onset alzheimer’s disease (before age 65)

A

15% increased chance if have a parent with it
AD
APOE E4 gene

198
Q

Diuretics that cause postural hypotension

A 
Thiazide diuretic (chlorothiazide)
Loop diuretic (furosemide)
199
Q

Causes of postural hypotension

A
  1. hypovolaemia
  2. autonomic dysfunction: diabetes, Parkinson’s
  3. drugs: diuretics, antihypertensives, L-dopa, phenothiazines, antidepressants, sedatives
  4. alcohol
200
Q

Behavioural ways to lessen dizziness when getting out of bed in elderly lady w postural hypotension

A

Sit still for a bit

Raise and lower arms 5 times before standing

201
Q

A non-pharmacological measure to imrpvoe dizzy episodes throughout day on standing in elderly lady w postural hypotension

A

Stockings

202
Q

How to increased chance of eliciting cog-wheel rigidity?

A

Reinforcement

203
Q

Likely RBC abnormality in alcoholic? And reason why

A

Macrocytosis

Folate deficiency

204
Q

Causes of haematemesis in alcoholic

A

Mallory Weiss tear
Bleeding varices
Gastritis
PUD

205
Q

Rx seizures in delirium tremens

A

IV diazepam

*Phase 3a Julia (8 decks)

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