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Sheff Phase 4 > Past Qs > Flashcards

Past Qs Flashcards

1
Q

2 key features of early dementia

A 
	Memory lapses
	Forgetting names of people and places
	Difficulty finding words for things
	Inability to remember recent events
	Forgetting appointments
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2
Q

Other than RSV other organisms causing bronchiolitis

A

 Human metapneumovirus (second most common)
 Adenovirus
 Parainfluenza virus

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3
Q

2 auscultation signs of bronchiolitis

A

 Widespread fine inspiratory crackles

 Expiratory wheeze

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4
Q

When cxr On bronchiolitia

A

Should only be performed if there is diagnostic uncertainty or atypical course

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5
Q

2 bits of advice for parent on bringing child back after discharge of bronchiolitis

A

 To return if develops any signs of respiratory distress
 If not tolerating fluids
 If there is any history of apnoea

Worsening

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6
Q

Endocarditis usual valve

A

tricuspid

[Think IVDU -> return of blood to RIGHT side of heart]

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7
Q

Why JVP in IE tricuspid

A

tricuspid regurge -> not able to prevent backflow of blood

-> rise in RA pressure

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8
Q

Why long term abx in IE

A

Neither the heart valves nor the vegetations adherent to them are supplied by blood vessels.

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9
Q

IE develops PE

Mx

A

Drug Heparin
Route Subcutaneous

Oxygen 100%
Route of O2 Non-rebreather mask with reservoir

Analgesia Morphine

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10
Q

Electrolyte abnormalities in DKA

A

hyperK - (overal stores low)

High anion gap

Low Na (if dehydrated) 
-also raised urea / creatinine
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11
Q

Hydrocele
2 causes

Where is fluid

what test for GP

3 things you feel for on scrotal exam

A

 Trauma
 Tumour
 Epididymo-orchitis

tunica vaginalis

transilluminate

Epididymis, testis, vas deferens

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12
Q

3ix and 2 drugs for MS

A

3 Ix
 Evoked potential testing (e.g. visual, auditory, somatosensory)
 MRI scan of brain/spinal cord
 LP for CSF analysis showing oligoclonal bands

Management
Beta-interferon, natalizumab

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13
Q

3 components of bishops score

A

length, position, dilatation, consistency of cervix. Head station

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14
Q

Who can you give PSA

A

over 50 with lower urinary Sx / request

Monitoring of prostate cancer resection

Suspicious PR findings

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15
Q

young guy wants PSA - what Should you do ?

A

Reassure + educate about PSA
PR exam
Urine dip for blood

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16
Q

high Ca - 1st Ix?

A

ECG - Short QT

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17
Q

Initial Mx of hyper Ca - 2nd line?

A 
IV Fluids (+furosemide if volume overload) 
Bisphosphonates

calcitonin

Dialysis

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18
Q

Mx of old post stroke with constipation

A

Improve fibre
Increase fluid intake
Avoid meds which could constipate

Bulk formin lax - Eg Fibrogel

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19
Q

4 meds - > constipaton

A

Opiates
iron tablets
Calcium
Anticholinergics

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20
Q

2 key Ix in pregnant with spotting

A

BHCG

USS

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21
Q

2 drug Mx if incomplete miscarriagre

A

Mifepristone / misoprostol

anti D

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22
Q 
Rheum A pre surg 
2 physical pre for anaethetics 
2 radiological 
2 Anaesthetic techniques 
Which should you do? 
Specific comps post op for RheumA on lots of meds
A

Neck extension
Malapati

CXR - Chest
Neck CT / XR

Spinal, Epidural, volatile gas, Total IV anasthetics

IV - Q she was bleeding (no spinal) dont want haematoma there
-Also RheumA may affect Spine

Infection - immunosuppressed
RA = hypercoagulable - VTE
Steroids - poor healing
Steroids - increased risk of pressure ulcer
Comps with intubation due to neck involvement
-may have fibrosed lungs - resp difficulty

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23
Q

Mx intermittent claudication

A

RF modification
Antiplatelet -clopidogrel 1st line
Supervised exercise
Patient education

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24
Q

How to Ix intermittent claudication ? Levels are significant?

A

ABPI
Lie pt flat
Use doppler probe to test bracial and medial maleola arteries
Extringuish with cuff

<0.9 = some arterial disease 
<0.5 = critical ischemia
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25
Q

Why trismus in quinsy

A

muscle spasm caused by abscess

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26
Q

Mx of quinsy

A

IV fluids - probs dehydrated
Analgesia
ABx - clindamycin / metronidazole
Drain pus

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27
Q

Lymph node in quinsy

A

jugulodigastric node

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28
Q

Signs to differentiate torsion and eppididimoorchiditis. Initial Ix

A

Torsion - red, swollen, transverse lie, vomiting / nausea
Absent cremaster

Epi - Prehn’s sign [lift testi and -> eases pain]
Retrotesticular pain

USS - see if torsion

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29
Q

CURB65 points

A 
Confusion 
Urea >7
Respiratory rate of 30 or more
Blood pressure less than 90 mmHg systolic or diastolic 60 mmHg or less
Age 65 or older
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30
Q

When to transfer pneumonia -> ITU

A

Uraemic - Kidney failure / ureamic encephalopathy
septic shock
Resp failure - requirement for mechanical ventilation
Multi organ support needed

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31
Q

CAP levels of Mx

A

Mx in community - Amox
Mx in hosp - Amox + macrolide Eg erythromycin
Severe in cost - CoAmox + macrolide

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32
Q

Young sporty - develops clicking and pain in hip

3DDx

A

OA, Trochanitc bursitis, femoroacetablar impringement

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33
Q

Pyelonephritis initial mx

A
  • adequate fluid intake and analgesia

- Start empirical Abx eg Cipro while waiting MC+S

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34
Q

Name 3 viral causes of meningitis

A

HIV, Mumps, HSV, ebv

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35
Q

How to NSAIDs / Acei cause kidney failure

A

nsaids - inhibit prostaglandin -> constrict aferent arteriole - hypoperfusion

ACEI - reduce angiotensin 2 -> less tone of efferent arteriole -> more blood flows out

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36
Q

Signs an infant is sick

A

pale/mottled/ashen/blue skin, lips or tongue

no response to social cues[3]

appearing ill to a healthcare professional

does not wake or if roused does not stay awake

weak, high-pitched or continuous cry

grunting

respiratory rate greater than 60 breaths per minute

moderate or severe chest indrawing

reduced skin turgor

bulging fontanelle

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37
Q

2 key ways to monitor Renal function in hosp

A

Urine output

u+e

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38
Q

4 ways to have successful consultation with interpreter

A 
Speak to pt not interpreter 
Avoid jargon 
Short simple sentances 
Not multiple Questions 
clarify 
Allow plenty of time
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39
Q

Bar capcity 2 things needed for consent

A

 Free from coercion/voluntary participation
 Use understandable terms
 Give sufficient time for careful decision-making
 Give thorough information
 Allow questions and comments

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40
Q

Mx asthma emergency?

If life threatening ?

A

 Sit up and give 15L of O2 via non-rebreathing bag
 Salbutamol 5mg + ipratropium bromide 0.5mg nebulised with O2.
 Hydrocortisone IV or prednisolone PO
 CXR to exclude pneumothorax

If life-threatening: o	Inform ITU o	Add iv magnesium sulphate o	IV salbutamol
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41
Q

Immediate actions in PEA ?

Drug and route?

A 
Ensure airway is patent 
Call crash team
Commence CPR
Gain IV access
Attach defibrillator

1mL adrenaline 1:10,000 IV

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42
Q

Why might asthma get VT/VF

A

VT – salbutamol – long QT

Hypoxia

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43
Q

Why do you get acanthrosis nigricans

A

Increased circulating insulin.
This activates keratinocyte ILG-F 1receptors

. Increased circulating IGF may lead to keratinocyte and dermal fibroblast proliferation.

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44
Q

Pathophys of sickle cell veno-occlusive

A

Deoxygenated HbS molecules are insoluble and polymerize.

RBCs become rigid and take up their characteristic sickle appearance.

Sickling leads to

1) decreased red cell survival and
2) impaired passage of cells through the microcirculation, leading to obstruction of small vessels and tissue infarction.

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45
Q

Sickle long term Mx

A

Hydroxycarbamide (hydroxyurea)

Antibiotic prophylaxis / vaccines due to hyposplenism

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46
Q

Name 2 lymph nodes around bladder

A 
Primary lymphatic drainage of BCa extends into the
	internal iliac LNs
	external iliac LNs
	obturator LNs
	presacral LNs
Secondary drainage progresses into the
	common iliac LNs
	para-aortic LNs
	interaortocaval LNs
	paracaval LNs
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47
Q

Bloood supply to bladder

A

Superior and inferior vesical arteries which arise form the iternal iliac artery

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48
Q

Key observation I forget in TURP

A

temperature (hypothermia)

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49
Q

4 things that could cause shock post TURP

A 
	TUR syndrome (absorption of washout causing hyponatraemia)
	Sepsis
	Bleeding
	Clot retention
	Pulmonary embolism
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50
Q

1st rank Sx of schitz

A

 Delusions of thought interference: thought withdrawal, insertion, or blocking
 Delusional perception
 Auditory hallucinations (commentary, made in third person)
 Delusion of control (passivity of affect, passivity of impulse, passivity of volitions, somatic passivity)

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51
Q

Gallstones -> pancreatitis mx

A

 NBM
 NG tube
 Set up IVI
 Analgesia: pethidine or morphine

 ERCP + gallstone removal may be needed if there is progressive jaundice

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52
Q

2 Psych Mx for eating disorders

A

 Cognitive behavioural therapy (CBT)

 Family-based treatment (FBT)

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53
Q

2 eye Sx of optic neuritis

A

 Decreased visual acuity
 Painful eye movements
 Blurred vision on having a hot bath (Uhtoff’s phenomenon)
 Decrease in colour vision

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54
Q

MS - weak legs

4 other signs

A

 Hypertonia (spasticity)
 Increased reflexes
 Upgoing plantars
 Clonus

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55
Q

3 signs of pailloedema on opthalmoscope

A

venous engorgement - usually first
 hemorrhages over and / or adjacent to the optic disc
 blurring of optic margins
 elevation of optic disc

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56
Q

Where does klebsiella live normally

A

Nose, mouth, GI tract.

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57
Q

Which Valve most common in IE and why

A

Tricuspid valve – most commonly infected valve in IVDU as first valve that bugs come into contact with

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58
Q

Most common IE bug? if IVDU?

A

Alpha haemolytic streptococcus – Streptococcus viridans

Staph aureus is commonest in IVDU

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59
Q

puritis due to liver failure mx?>

A

 Cholestyramine

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60
Q

2 esrly signs dementia

A

amnesia, decreased cognitive function, constructional apraxia, Aphasia

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61
Q

2 reasons you would surgically drain SUBDURAL

Comps of this?

A

Focal neurology
Riased ICP
Seizures

Infection, haemorrhage, brain tissue injury, brain oedema, seizures

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62
Q

Endocarditis

What valve lesion would you see on ECHO?

Raised JVP - what abnormality in the wave would you see?

A

vegetation on the valve

Raised V wave

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63
Q

Erectile dysfunction 22 male

4 chronic causes
3 Blood tests

3 mx performance anxiety

A

Diabetes, hypertension, depression, MS

Prolactin, testosterone, FSH, LH, SHBG

CBT, Sex therapy, Sildenafil

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64
Q

Bony landmark on top of scrotum

A

pubic tubercle

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65
Q

Hydrocoele comes from

A

Processus vaginalis

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66
Q

SEVERE UC remission

Initial Mx drug and route

If failing

Remission if Mild?

A

IV hydrocortisone

Cyclosporin / infliximab

Sulphasalazine Oral

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67
Q

Drug in SAH

A

nimodipine

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68
Q

4 features of brainstem death

A

No respiratory effort in reaction to turning off ventilator

  1. Fixed Pupils unreactive to light
  2. No corneal reflex
  3. No cough reflex
  4. No response to supra orbital pressure.
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69
Q

Pericarditis auscultation?

4Ix

2mx

A

pericardial rub

 Chest x ray
 Bloods esr/crp/WBC
 ECG
echo
biopsy

NSAIDS - colchicine
steroids

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70
Q

Cancer in right hilum smoker =

How to biopsy

A

Squamous cell

CT guided

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71
Q

Lung Ca features of types

A

Squamous

  • Smokers, Hilum
  • PTH

Adeno
-Periphery

Small cell - bronchus

  • ADH
  • ACTH
  • LEM
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72
Q

2 causes and 4 mechanisms for abdo distension

A

a. bowel obstruction
i. adhesions/ recent surgery – most common
ii. cancer
iii. constipation
iv. diverticulitis
v. autonomic dysfunction bowel control
vi. hernias

b. Ascities
-Cardiac / liver failure
meigs
-hypoalbuminaemia

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73
Q

3 slit lamp findings anterior uveitis

A

Keratic Precipitates, Hypopyon, strange shaped pupil

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74
Q

Anterior uveitis rare infective cause

A

HSV

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75
Q

Advice when given GTN to pt

A

headache, call 999 if not relieved after 3 goes

76
Q

Small bowel obstruction XR

A

Multiple loops
central
coniventes (full thickness muscular rings)
No gas in large bowel

77
Q

Large bowel obstruction

A

peripheral
larger than small bowel
presence of haustra

78
Q

Obstruction following surgery top 3 ddx

A

Adhesions = most likely
Hernia
Volvulus

79
Q

IBD 2 AXR findings

A

thumb printing

lead pipe colon

80
Q

2 enzyme inducers (decrease effect of other drugs)

A

phenytoin
rifampicin
carbamazepine
alcohol

[CARP]- Carbamazepine also has CAR at start

81
Q

2 enzyme inhibitors (increase effect of other drugs)

A 
SSRIs
ciprofloxacin 
amiodarone 
diltazem / verapamil 
Smoking

[Can Andy Stop Smoking] -

82
Q

Ipatropium class

A

SAMA

83
Q

Reversal of heparin

A

protamine

84
Q

Stroke vessles and Sx

A

MCA - hemiplegia (especially face/arm)
-Can getoptic involvement too

Anterior - Weak leg

  • Siminar / mild arm
  • SPARES FACE

Posterior - Homonymous hemaniopia with macular sparing

85
Q

1 year bleeding risk

A

H Hypertension: (uncontrolled, >160 mmHg systolic)

A Abnormal renal function: Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L
Abnormal liver function: Cirrhosis or Bilirubin >2x Normal or AST/ALT/AP >3x Normal

S Stroke: Prior history of stroke

B Bleeding: Prior Major Bleeding or Predisposition to Bleeding

L Labile INR: (Unstable/high INR), Time in Therapeutic Range 65 years

D Prior Alcohol or Drug Usage History (≥ 8 drinks/week)
Medication Usage Predisposing to Bleeding: (Antiplatelet agents, NSAIDs)

86
Q

-Hypokalaemia – 1x symptom and 1x sign o/e

A

weakness

hypOrelfexia / hypotonia

87
Q

Score post TIA

A 
ABCD² 
age >60
BP > 140/90
Cliical features - speech / unilateral weakness(2)
Duration >10mins >1hr (2)
Diabetes
88
Q

Score for stroke post AF

A

C Congestive heart failure (or Left ventricular systolic dysfunction)

H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)

A2 Age ≥75 years

D Diabetes Mellitus

S2 Prior Stroke or TIA or thromboembolism

V Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)

A Age 65–74 years

Sc Sex category (i.e. female sex)

89
Q

Dx of thalassaemia

A

Microcytic hypochromic anaemia- FBC
Haemoglobin electrophoresis
DNA testing

90
Q

Most common lung cancer

A

squamous (in smokers)

91
Q

Allergy physiology

A

type 1 hypersensitivity- degranulation of mast cells releasing histamine.
IgE medicated

92
Q

4 things to check before heparin

A

U&E, FBC ( platlet count), LFT, accurate weight
, HASBLED

93
Q

melanoma tumor marker

A

s-100 


94
Q

vit d metabolism

A

VIT D skin -> Hydroxylated by liver 25 hydroxy vit D

-> Hydroxylated by kidney 1,25 hydroxy vit D

95
Q

What PTH binds to for bone resorption

A

RANK-L

96
Q

Why vit D lack -> osteomalacia

A

lack of Vit D -> reduces Ca

-> Increases PTH which increases osteoclastic activity and bones become undermineralised- i.e osteo malacia

97
Q

Gout 1st line acute ? Long term and class

A

Naproxen
(colchicine if CI)

Allopurinol - xanthine oxidase inhibitor
-> reduces serum uric acid

98
Q

coealiac rash? tumour risk

A

dermatitis herpetiformis 


MALT Lymphoma

99
Q

Define economic evaluation


A

Assessment of efficiency, in other words it’s the comparative study of the cost and effectiveness/benefits of a health care intervention 


100
Q

What makes a QALY

A

Quality and Quanity (age) of life lived 


101
Q

2 things which make an economic evaluation

A

Cost and effectiveness

102
Q

2 types of economic evaluation

A

cost benefit analysis, cost utility analysis, cost effectiveness 
analysis, cost minimization analysis

103
Q

Define efficiency 


A

When resources are allocated between activates in such a way as to maximize benefits for a given budget. 


104
Q

Identify opportunity cost

A

to spend resources on one activity means a sacrifice in terms of 
lost opportunity elsewhere 


105
Q

Identify equity

A

fairness and justice in distribution of cost and benefits

106
Q

3 reasons for prophlyaxis failure

A

Compliance, resistance,
Interactions
D+V

107
Q

Malaria Dx Ix

A

GIEMSA thick and thin blood film

108
Q

Malaria drug

A

artesunate

109
Q

3 neuro signs lithium

A

coarse tremor, hyperreflexia, coma, ataxia, decreased conciousness, seizures

110
Q

lithium teratogenicity

A

ebsteins - Cardiac

111
Q

what is an advabced directive

A

An advance directive is a document by which a person makes provision for health care decisions in the event that, in the future, he/she becomes unable to make those decisions. 


112
Q

Present with obstruction 4 immediate Mx IF STABLE(ish). 2 other to consdier

A

IV fluids
NG tube + suction
Catheter for urine output
Analgesia

Consider:
Antibiotics
Antiemetics (if vomiting)

113
Q
  1. Lady falls off her horse lands on left flank, now has blood in urine
    a. 4 immediate management ?
    b Imaging -?
    c. 3 other non-renal injuries to look out for?
    d. She is found to have grade 2 renal laceration, state what you would monitor and what is your management
    e. She is later discharged to GP, what advice would you give to GP on follow-up
A

U+E (Cr baseline), Analgesia, Lower limb neuro, clotting

CT KUB

Fracture – spine / pelvis, Ruptured spleen, Cord compression eg haematoma -> Cauda equina, pneumothorax

all grade 1 and 2 and most grade 3 and 4 injuries, can be safely treated without active intervention.
Monitor - Monitor U+E(Cr especially) , Urine output, BP / signs of shock

Monitor renal function – if persists / gets worse to re admit

114
Q

What is compartnemnt syndrome

b. What is the most important symptom and most important sign that will make you suspect compartment syndrome

What happens if left untreated ?

A

Bleeding into a closed space
Increased pressure within one of the body’s anatomical compartments – leading to decreased blood supply of those tissues

Sx - Pain out of proportion
Sign - Pain on passive stretch

ischemia, necrosis of muscle -> renal failure / amputation

115
Q

4 mx of fracture

A

Conservative - Cast
Internal fixation - intramedullary nail
Open reduction internal fixation with plate
Externa fixation

116
Q
  1. 50 year old man with viral conjunctivitis
    a. 4 symptoms that would aid in your diagnosis of viral conjunctivitis
    B 4 signs
A

Red eye, watery discharge, slight discomfort, burning senation

Pre-auricular lymph nodes, conjunctival follicles, Lid oedema, acuity unaffected, normal pupil reponse

117
Q
  1. Some guy found in the park, he appears to be breathing, GCS of 9/15. No evidence of alcohol or dug use
    a. What are 4 initial management steps on taking over care of patient?
    b - Deteriorates to GCS 7/15 4 Mx now
A

ABCDE, Glucose, ECG, Examine for head injury

Contact ICU, Secure Airway / provide O2, CT head, ABG

118
Q
  1. 20 year old girl has central abdominal pain, which then migrates to right iliac fossa, you suspect acute appendicitis. Her last period ended 3 days ago.
    a. What 2 physical signs would help you in your diagnosis
    b. What 2 common laboratory investigations would help you in your diagnosis

c - 2 other Dx

d. She then complains that pain is now widespread across abdomen and looks unwell, what 2 immediate actions would you take

A

Rosvigs, the psoas test, rebound tenderness

CRP, WCC

Renal colic, ovarian torsion, ovarian cyst

Contact theatres, group and save
(Antibiotics and fluid)

119
Q

What is selction bias

A

Systematic error either: in the selection of participants; or, In the allocation of participants to different study groups

120
Q

8 blood tests for dementia

A

FBC, ESR, U&E, TFTs, Glucose, Lipids, Calcium & B12, syphilis

121
Q

3 aspects of initial management of dementia

A

[Higher functioning, cognition, memory ]

refer to a memory assessment service

treat any risk factors for cognitive impairment

Patient education

122
Q

2 causes for acute deteriation in dementia

A

Vascular - stepwise

Delerium - UTI / other causes

123
Q

Mallory weiss mech

A

Excessive wretching / vomiting -> laceration of mucosa at junction of stomach / oesophagus

124
Q

Stressed - over use meds and tension headaches
Make a 4 point management plan to ensure holistic care

organisational changes?

A

IAPT
Address stress, relaxation techniques
Exercise
When / how much to use meds - don’t overdo -> overuse headache

Increased GP follow up
Shorter prescription time

125
Q

4 features of Delerium tremens

A

seizures, agitation, sweating, fever, hallucinations, tremor

126
Q

2 questions to ask self for capacity assessment

A

Is there an impairment in their cognition

Is the patient unable to make a decision
Understand, retain, weigh up, communicate

127
Q

Anaphylaxis antihistamine you can never quite get right

A

chlorphenamine

128
Q

1 blood test for anaphylaxis Dx

A

Mast cell triptase

129
Q

Anaphylaxis pathophys

A

histamine mediated T1 HS reaction with mast cell degranulation

130
Q

4 locations of endometriosis

A

lungs, ovaries, pouch of douglas, umbilicus

131
Q

Management of endometreosis

A

COCP mirena
tranexamic acid + mefanamic acid

Gosrelin
Ablation
Hysterectomy

132
Q

2 Mx acromegaly

A

Transphenoidal surgery – removal

Octreotide – somatostatin analogue

133
Q

Surgical safety
4x pre-procedure checks

2x post-procedure checks

2x actions on incorrect swab count

2x DVT prophylaxis

A

Patient identifying features, consent form, do you have your own teeth? Patient knows purpose of operation? Site of operations/specifics, previous exposure to anaesthetics, allergies, anticipated blood loss, GS + crossmatch completed

fluid balance, specimens for culture, equipment check – retained products, completion of anaesthetic chart, pain relief prescribed, anti-emetics prescribed

re-count, re-open patient as never event (check floor, check operating table etc

TED, LMWH, early mobilisation, good hydration

134
Q

diagnose DIC from blood results

A

low plts, low fibrinogen, high aPTT, high PT, high thrombin time, high D dimer

135
Q

DIC blood products to transfuse (no RBCs)

A

platelets
cryoprecipitate - fibrinogen
FFP - clotting factors

136
Q

Bone marrow aspirate of AML

A

blast cells of myeloid precursors >20%
Hypercellularity
Auer rods

137
Q

When not to give bulk-forming laxatives

A

in opioid constipation

[lactulose - like post hernia]

138
Q

2 drugs for miss carriage

A

Anti-D, misoprostol

139
Q

Abx for pyelonephritis , length?

A

Cipro IV 48hrs - review to step down for oral to complete 7 days

140
Q

Grading of liver failure

A

child pugh

[Album
encephalopathy
bilirubin
ascites
INR ]
141
Q

AKI stages

A

compare to Cr baseline:
x1.5 - stage 1
x 2 - stage 2
x 3 - stage 3 (or over 354)

142
Q

eGFR when not to use

A

doesn’t work for extremes of age or weight

Not applicable to AKI
Cr clearance is more specific

143
Q

bullus pemphigoid
describe rash

2 comps

Dx

Mx

A

tense fluid-filled blisters on the trunk and limbs
Erythematous - some burst?
Size

Antigens in epidermis

Infection
Complications of treatment

Skin biopsy
Serum autoantibodies

High dose steroids, immunosuppression

144
Q

Pemphigus vulgaris describe

A

Rash with flaccid eaisy ruptured blistered with erosions and crusts
MUCOSAL involvement

145
Q

Transfer co-efficient in asthma

A

normal / Increase

146
Q

Decrease cause of transfer coefficient

A 
Affects alveolar surface area 
COPD 
Anaemia 
Heart failure 
PE 
Fibrosis
147
Q

Increase transfe coeffecicent

A

polycythemia

Asthma - maybe

148
Q

2 interventions for food debis in oesophagus

A

capsule of Creon dissolved in 30 mL coke

Endoscopic retreval

149
Q

Addisons crisis 2 cat ions and 1 wcc

Q2: 3 initial management points

A

hyperK, HypoNa,
Eosinophilia

ABCDE, IV fluid, IV hydrocortisone, O2
Don’t need fludrocortisone as high doses hydrocorsitone have mineralcorticoid effects

150
Q

synacth test explain

A

Initial cortisol / give synacth IM – wait 30 mins – if cortisol rises = exclude addisons

151
Q

Full term baby which deteriorated gradually over a few months. Turns out that she has an a severe genetic disorder. Parents want her to try on an experimental treatment. Her medical team has applied to the family division of the high court to withdraw life support.

Q1: What 3 things would you like to ask the medical team and/or family about the patient’s condition and treatment before deciding on a course of action?

Q2: 2 ethical principles when the medical team and the family disagree over the treatment of an infant.

Q3: If the patient was an adult who wanted to try out a novel treatment and the medical team was supporting him, would you grant him wish? Use an ethical principle/existing legislation to explain your answer.

Q4: Using deontology, explain the doctors decision to withdraw care for this baby

A

Suffering with treatment ?
Benefits / evidence base of treatment?
Cost of treatment ?

Beneficence
Non maleficicence

Yes capacity and autonomy

Based on action itself not consequences
If give treatment – prolong unnecessary suffering

152
Q

What is utalitarism ?

A

Ultaritarism – outcome (term is near enough synonymous with consequentialism)

153
Q
  1. Young gentleman injuries his right leg while playing football. It is painful and he has already received gas and air while in the ambulance. Leg deformed, but no open wound
    Q1: How else can you control his pain?
A

Boxplint

IV morphone

154
Q

3 other benefits of a ‘box splint’.

A

less pain
immobilise injury
decrease swelling
Helps maintain neurovascular status

155
Q

Post cast compartment - 2 ways to have prevented

A

backslab instead of cast

reduce early

156
Q

Q1: Genetic inheritance of sickle cell disease

Q2: Symptoms of chest crisis. What is your initial management

Q3: Why does he get gallstones

Q4: What are other treatment would you offer alongside a routine cholecystectomy to reduce the likelihood of post op crisis.

Q5: Has lots of painful crises What medications do you give and mechanism

A

AR HbS

O2, iv fluids, pain relief, warmth, Abx

Increeased haemolysis -> increased bilirubin -> gallstones

RBC transfusion

Hydroxycarbamide -> increases foetal Hb / less HbS production / less platlet
Penicillin -> less infection -> less crisis

157
Q

MCA

A 
Assume capacity 
help them make decisions 
allow to make unwise decision 
Best interests 
Least restrictive option

[assume helping interesting, restricted, unwise decisions]

158
Q

Why measure lactate in sepsis

A

Prognostic indicator and marker of anaerobic resp

monitor improvement

159
Q

Chronic HF mx

A

Acei, Bblocker
Furosemide - Sx
Spirolactolone

160
Q

Q1: 4 questions to assess the general fitness of a patient for surgery/anaesthetic

A

Weight, CVD, exercise tolerance, lung disease

161
Q

ASA scores

A 
1 – healthy 
2 – mild disease (doesn’t impact )
3 – disease severe -/ impacts =====this is her 
4 – incapacitating disease 
5 – not expected to survive
162
Q

Q3: How do you predict a difficult intubation? (3)

A

anaesthetic record
Lack of neck extension
Lack of jaw opening
Malampati score

163
Q

Q4: What from the WHO checklist do you do once the patient has arrived for surgery before anaesthetic (4)

A 
Confirm patient 
Confirm procedure 
Any allergies 
Team brief 
Recovery location 
Equipment check 
Confirm consent 
Medications taken this morning / NBM
Are you diabetic
164
Q

Venous occlusion in eye what do you see

A

Flame hemorrages
cotton wool spots
Tortuous veins

165
Q

MRSA Mx

A

Vanc

166
Q

3 mechanisms of shoulder injury and how to manage

A

Rotator cuff tear – immobilise
Dislocation – reduce and XR to make sure in right place
Fracture – reduce and immobilise

167
Q

Q3. 2 blood tests for someone with palpitations + what are you looking for?

A

TFT - hyper
U+E – CA / K
FBC - anaemia
Catecholamines – phaeo

168
Q

SVT Mx steps

A 
vagal manoeuvres 
Adenosine 
Bblockers 
amiodarone 
shock

[can go adenosine -> shock if unstable]

169
Q

Why hyperacusis in facial nerve palsy

A

Paralysis of stapedius

170
Q

4 routes and drug for analgesia

A

i) Oral – paracetamol
ii) IV – morphine
iii) Inhaled -nos
iv) Intranasal - fentanyl
Sub cut - fentanyl

171
Q

Parkland formula

A

4 x kg x %burn

½ in first 8hrs ½ over next 16hr

172
Q

How thick should endometrium be post menopausal

mx if CT Pelvis - stage 3 disease
Q4. Which treatment / combination of treatments is best?

A

in post menopausal <5mm (or <8mm if receiving HRT)

TAH + BSO + LN clearance + chemo if stage 3

173
Q

Nephrotic syndrome Dx?

In children?

A

3.5g protein / 24 hrs [in children is 1g]
Oedema
Hypoalbumin <30g/dL [<25 in children]

174
Q

Lymphoma classification? staging?

A

WHO

Ann arbour

175
Q

5 tests for haematuria

A

Dip, u+E, urinalysis, PSA, Autoantibodies, clotting

US KUB, MC + S

176
Q

Leigonella mx

A

fluoroquinolone + clarithromycin

177
Q

4 ways to gilick competency

A

he young person will understand the professional’s advice;

the young person cannot be persuaded to inform their parents;

the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment;

unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer;

the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent.

178
Q

2 classes of drug to improve prognosis angina

A

statin – simvastatin,

Aspirin- Antiplatelet - cox 2 inhibitor

179
Q

d) What is the area that connects a tendon/ligament to a bone?
e) What is the name given to inflammation of an entire digit?

A

Enthesis

Dactylitis

180
Q

f) What anatomical area is inflamed in the joints of an inflammatory arthritis?

A

Synovium

181
Q

ann arbour staging

A

1 – 1 node, 2 -2 nodes same side of diaphragm, 3 both sides, 4 wide spread and other organs

182
Q

Mx of lymphoma in remission who have relapse

A

Peripheral stem cell transplant

183
Q

Cushings
b. GP sends her to endocrinologist - which 2 tests would confirm suspicion of Cushing’s syndrome

c. Which test would tell you location of lesion?[not imaging]

The above test comes back with low levels of analyte, what is your next choice of investigation

Imaging to confirm

A

24hr urinary cortisol, dexamethasone suppression test

Plasma - ACTH

High dose dexamethasone still
If high ACTH still - lung, low = pit –

Chest/abdo CT
Pit MRI

184
Q

2 ECG Angina

A

ST depression and T wave inversion/flattening

185
Q

3 Areas of HELLP mX

A

Deliver baby
MgSO4 - prevent seizures
IV steroids
Mange BP if raised

186
Q

How is audiogram carried out

A

sound proof room, headphones, sounds of variable vol and pitch in one ear, press button when hear it

187
Q

What is a tympanogram

A

graphic representation of the relationship between the air pressure in the ear canal and the movement of the eardrum,

Sheff Phase 4 (26 decks)

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