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Phase 3A > Peer Teaching mock learning points > Flashcards

Peer Teaching mock learning points Flashcards

1
Q

Causes of infectious mononucleosis

A

(glandular fever)
EBV is most common
Also: CMV and HHV-6

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2
Q

Management of infectious mononucleosis?

A

Rest, fluids, avoid alcohol, avoid contact sports for 8 weeks

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3
Q

What happens if you give specific antibiotic (which?) in glandular fever?

A

Amoxicillin= causes a rash in over 99% of patients

Morbilliform eruption

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4
Q

Risk factors for DDH?

A

Breech presentation, high birth weight, female, oligohydramnios, prematurity

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5
Q

Associated conditions of trisomy 21

A

Bowel: Duodenal atresia, oesophageal atresia, hirschpung’s disease, coeliac
Heart: tetralogy of fallot, AVSD, ASD, VSD
Visual: cataracts, strabismus, keratoconus
Malignancy: AML, ALL
Hearing loss, alzheimer’s disease, hypothyroid

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6
Q

Early signs of lithium toxicity?

A

Coarse tremor of extremities and lower jaw, ataxia, seizure, slurred speech, vomiting, diarrhoea, anorexia, choreoathetoid movements, drowsiness, muscle weakness, lethargy, dizziness, blurred vision, tinnitus

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7
Q

Signs of severe lithium toxicity?

A

Hyperreflexia, hyperextension of limbs, syncope, toxic psychosis, seizures, polyuria, renal failure, electrolyte imbalance, dehydration, circulatory failure, coma, occasionally death

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8
Q

Normal lithium levels? Level for severe toxicity?

A

Normal titrated to 0.6-1.0 mmol/L

Severe at over 2.0mmol/L

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9
Q

What monitoring for lithium therapy?

A

Weight, U+Es, eGFR, calcium, TFTs every 6 months (more if needed)

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10
Q

Long term adverse effects of lithium?

A

Hypothyroid, hyperthyroid, hyperparathyroid, nephrotoxicity, renal tumours, rhabdomyolysis

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11
Q

What type of tremor is “normal” when on lithium?

A

Fine

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12
Q

How does neuroleptic malignant syndrome present?

A

Change in mental state, rigidity, fever, autonomic dysfunction (tachycardia and hypertension, sweating)

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13
Q

What is seen on bloods in neuroleptic malignant syndrome?

A

Raised CK, raised WCC, deranged LFTs, acute renal failure with abnormal U+Es, metabolic acidosis

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14
Q

How to manage PID?

A

Mild= start abx immediately before swab results, can leave in recently inserted coil, but if no response by 48-72 hours, remove coil and prescribe any necessary emergency contraceptives

Abx= doxycyline, metronidazole, IM ceftriaxone

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15
Q

What antibiotic safe during whole pregnancy for uti?

A

Cephalosporins eg ceftriaxone

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16
Q

When to avoid nitro and trimethroprim in pregnancy?

A 
Nitro= avoid in 3rd trimester
Trimeth= folate antagonist so avoid in 1st trimester
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17
Q

How long to try pelvic floor muscles for before going 2nd/3rd line for incontinence?

A

3 months

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18
Q

What raises CA125?

A

Adenomyosis, ascites, endometriosis, menstruation, breast cancer, ovarian cancer, endometrial cancer, ovarian torsion, liver disease, metastatic lung cancer

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19
Q

Management of fibroids?

A

1st= mirena coil for under 3cm
Can uses COCP for under 3cm but CI for use before, during and after surgery

Endometrial ablation
Uterine artery embolisation

GnRH agonists used before surgery to reduce size and make them less likely to bleed

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20
Q

How do GnRH agonists work for before fibroid surgery?

A

Induce menopause like state, reduce amount of oestrogen maintaining the fibroid

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21
Q

What tests can show active infection and treatment received for syphilis?

A

VDRL positive = active infection

TPHA positive= received treatment (looking for IgG)

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22
Q

How can congenital syphilis present?

A

Generalised lymphadenopathy, hepatosplenomegaly, rash, skeletal malformations

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23
Q

Tertiary syphilis psych presentation?

A

Similar to psychosis

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24
Q

What causes syphilis?

A

Spirochaete bacterium= treponema pallidum

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25
Q

What counts as orthostatic hypotension?

A

Systolic drop of at least 30 and diastolic drop of at least 15 after 3 minutes of standing

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26
Q

How does N-acetylcysteine work?

A

Replenishes glutathione stores so that NAPQI (intermediary product of paracetamol metabolism) can be converted to less toxic product and prevent hepatocyte damage

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27
Q

How can you reverse heparin?

A

Protamine

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28
Q

How much KCl in management of DKA in children?
How much insulin?
What fluids?

A

KCl: 20mmol/500ml or 40mmol/1000ml

Insulin: 0.1units/kg/hr SC

0.9% NaCl 10ml/kg

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29
Q

What is seen in bloods of a child in DKA?

A

Hyperglycaemia, acidosis, ketonaemia, increased creatinine (mild), decreased bicarb

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30
Q

What do you see in juvenile idiopathic arthritis?

A

Salmon coloured rash at times of fever

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31
Q

Treatment of oligoarticular JIA?

A

Intra-articular steroid injection under USS guidance is first line

Early use of methotrexate reduces joint damage (more effective in polyarthritis)

Paracetamol as antipyretuc

NB/ anti-tnf costly, needs strict supervision

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32
Q

What optical complication highly associated with JIA? What to do about it?

A

Anterior uveitis in up to 1/3 of children with JIA, but commonly silent form

National screening programme for children with JIA to have eyes screened every 3 months

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33
Q

What is stephen johnson syndrome?

A

Multisystemic; start with flu like symptoms then red/purple target like rash spreads and forms blisters. The affected skin eventually dies and peels off
Mucous membranes of mouth, throat, eyes and genital tract can become blistered and ulcerated

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34
Q

Common causes of stephen johnson syndrome?

A

Drugs: allopurinol, lamotrigine, penicillin, phenytoin

Viral: mumps, flu, HSV, EBV

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35
Q

What are EPSEs?

A

Extrapyramidal side effects

parkinsonism, dystonia, tardive dyskinesia, akathisia

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36
Q

What is tardive dyskinesia?

A

Involuntary neurological movement disorder eg lip smacking, facial grimacing, tongue protrusion, excessive eye blinking

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37
Q

What is akathisia?

A

Restlessness leading to compelling need to move/rock/pace

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38
Q

What can be used to reverse sedating effects of benzos?

A

Flumazenil

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39
Q

What is knight’s move thinking? What is it seen in?

A

Seen in schizophrenia and psychosis

Patient’s thoughts move from one topic to another, without any logical connections between them

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40
Q

Management of OCD?

A

Trial combination of SSRI and exposure response prevention CBT for at least 12 weeks

Then try different SSRI or switch the SSRI to clomipramine (TCA)

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41
Q

Signs of hyponatraemia? What drug likely to happen with?

A

Drowsiness, confusion or convulsions

Antidepressants but especially SSRIs

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42
Q

Complications of chickenpox?

A

Bacterial superinfection, cerebellitis, DIC, progressive disseminated disease

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43
Q

CSF for bacterial meningitis?

A

Turbid appearance, raised polymorphs (neutrophils) raised protein, low glucose

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44
Q

CSF for viral meningitis?

A

Clear appearance, raised lymphocytes, normal/raised protein, normal/low glucose

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45
Q

CSF for encephalitis?

A

Clear appearance, normal/raised lymphocytes, normal/raise protein, normal/low glucose

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46
Q

CSF for TB meningitis?

A

Turbid/clear appearance, raised lymphocytes, raised protein, low glucose

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47
Q

Features of fragile X?

A

Learning difficulties, large ears, long thin face, high arched palate, macroorchidism, autism, add, hypotonia, mitral valve prolapse

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48
Q

Features of prader-willi?

A

Hypotonia, faltering growth, developmental delay, learning difficulties, almond shaped eyes, narrow nasal bridge, narrowing of forehead at temples, thin upper lip

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49
Q

Features of noonan syndrome?

A

Mild learning difficulties, short webbed neck, pectus excavatum, short stature, congenital heart disease, broad forehead, drooping eyelids, wide distance between eyes

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50
Q

Features of Down’s syndrome?

A

Learning difficulty, hypotonia, small chin, flat nasal bridge, single palmar crease, protruding tongue, AVSD, tetralogy of fallot

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51
Q

Features of williams syndrome?

A

Short stature, congenital heart disease, mild-mod learning difficulties, broad forehead, short nose, full cheeks, wide mouth

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52
Q

Features of turner’s syndrome?

A

Primary amenorrhoea, short stature, webbed neck, bicuspid aortic valve, coarctation of the aorta, infertility

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53
Q

How is clozapine monitored?

A

1 blood test per week for first 18 weeks
Reduced to fortnightly between 18-52 weeks
Then monthly
All if non concerning results not found

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54
Q

How does placental abruption present?

A

Abdominal pain with mild vaginal bleeding
Shock signs inconsistent with external loss (can be concealed), ,severe pain, often dark bleeding

Woody uterus

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55
Q

Management of placental abruption?

A

If both stable; dexamethasone to promote lung maturation
Any signs of distress under 34 weeks needs C section
If stable and over 34 weeks, can have a vaginal delivery

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56
Q

How does placenta praevia present?

A

Shock consistent with external loss, painless, occasional contractions, red and often profuse bleeding, often has history of small APHs, no uterine tenderness, foetal lie normally high/abnormal, FHR normal usually

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57
Q

Risk factors for placenta praevia?

A

Increased age, IVF, maternal smoking, previous C section

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58
Q

How does vasa praevia present?

A

Typically occurs with rupture of membranes
Painless bleeding with severe foetal distress

Up to 50% cases detected antenatally and require C section

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59
Q

Difference between placental abruption and placenta praevia?

A 
Painful= abruption
Painless= praevia
Praevia= shock consistent with external loss
Abruption= inconsistent (may be concealed)
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60
Q

Difference between placenta praevia and vasa praevia?

A 
Placenta= FHR normal usually
Vasa= severe foetal distress
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61
Q

How to manage CIN1 from screening?

A

No need for treatment but follow up in 12 months

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62
Q

If treating CIN with lletz, when to screen again?

A

6 months as test of cure

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63
Q

Types of vaginal cancer

A

80% metastatic (mostly from cervix or endometrium)

10% of primary is adenocarcinoma, rest is scc

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64
Q

Who is clear cell adenocarcinoma of vagina associated with?

A

Mothers who took diethylstilbestrol (DES) (synthetic oestrogen) during pregnancy between 1940s and 1971

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65
Q

Mechanism of delivery of foetus?

A

Descent, engagement, flexion, internal rotation, crowning, extension of presenting part, external rotation of head, delivery

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66
Q

Management of asx bacteriuria in pregnancy?

A

Contamination of first culture is positive so second test should be done to confirm
Treat! Risk of pyelonephritis, a/w premature labour and ROM if untreated

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67
Q

Numbers for polyhydramnios? Cause?

A

Most causes=idiopathic
Others= macrosomnia, maternal diabetes, structural deformities of foetus, viral infections
AFI over 24cm (2000ml plus)

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68
Q

Numbers for oligohydramnios?

A

AFI under 5cm (under 200ml)

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69
Q

Criteria for total anterior circulation stroke?

A

All 3 of unilateral weakness of face/arm/leg, high cerebral dysfunction and homonymous hemianopia

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70
Q

Features of Horner’s syndrome?

A

Unilateral anhidrosis, enophthalmos, miosis, ptosis

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71
Q

What does mydriasis mean?

A

Dilated pupil

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72
Q

Causes of horner’s syndrome?

A

Pancoast tumour, MS, brain tumour, large goitre

Anything that can press on the sympathetic chain

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73
Q

Triggers for migraine?

A

CHOCOLATE: chocolate, hangover, orgasm, cheese, oral contraceptive, lie in, alcohol, tumult, exercise

Also: periods, injury, certain sensory triggers, being hungry, smoking

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74
Q

Prophylactics for migraine with CIs for each?

A

Topiramate- teratogenic
Propranolol- asthmatics

If both above are contraindicated can use acupuncture

Botox is last line

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75
Q

Rotterdam criteria?

A

PCOS is at least 2: polycystic ovaries, oligo/anovulation, clinical and/or biochemical signs of hyperandrogenism

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76
Q

What warrants a polycystic ovary?

A

12 or more follicles
or
Increased ovarian volume over 10cm3

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77
Q

How does metformin work in PCOS?

A

decrease appetite, decrease androgen production, decrease LH release, decrease SHBG in liver

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78
Q

Bloods on PCOS?

A

Normal/low FSH
High LH
Decreased SHBG
Raised testosterone

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79
Q

What is HELLP syndrome?

A

Haemolysis, elevated liver enzymes, low platelets

Severe variant of pre-eclampsia, warrants immediate delivery

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80
Q

How does HELLP syndrome present?

A 
Epigastric pain and abnormal clotting (elevated liver enzymes)
Anaemia (due to haemolysis, also raised lactate dehydrogenase)
Low fibrinogen (DIC likely to occur)
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81
Q

How to manage gestational diabetes if fasting glucose is under 7?

A

Trial of diet and exercise, if targets not met within 1-2 weeks, start metformin
Insulin can be used if metformin not tolerated or as an add in if still not controlled

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82
Q

How to manage gestational diabetes if fasting glucose is over 7?

A

Immediate insulin +/- metformin,and diet and exercise

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83
Q

Levels for diagnosis of gestational diabetes?

A

Fasting plasma glucose over 5.6
or
2-hour plasma glucose level over 7.8

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84
Q

What is Conn syndrome?

A

Primary hyperaldosteronism
Aldosterone acts on kidney to increase sodium absorption and thus increase potassium excretion
Hypernatraemia and hypokalaemia

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85
Q

What to treat Conn syndrome with?

A

Spironolactone

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86
Q

investigating renal colic?

A

USS is first line

CTKUB allows a diagnosis

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87
Q

Stage 1 of AKI?

A

Stage 1: creatinine 1.5-1.9 times higher than baseline or urine output under 0.5ml/kg for over 6 consecutive hours

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88
Q

Stage 2 AKI?

A

Creatinine 2-2.9 times higher than baseline or urine output under 0.5ml/kg for over 12 consecutive hours

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89
Q

Stage 3 AKI?

A

Creatinine over 3 times higher than baseline or urine output under 0.5 ml/kg for over 24 consecutive hours or anuria for over 12 hours

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90
Q

Drug causes of AKI?

A

NSAIDs, ACEi, CCBs, alpha blockers, beta blockers, opioids, diuretics, aciclovir, trimethroprim, lithium

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91
Q

Complications of nephrotic syndrome?

A

Frequent relapses, hypovolaemia, infection, thrombosis, hypercholesterolaemia

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92
Q

How do adults present with nephrotic syndrome?

A

Generalised pitting oedema, heavy proteinuria, hyperlipidaemia

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93
Q

Step wise management of formula fed baby with GORD?

A

Feed thickener eg carobel
Alginate therapy eg gaviscon
H2 receptor anatagonist eg ranitidine
PPI eg omeprazole
Can try d2 antagonists to enhance gastric emptying eg domperidone
Nissen fundoplication is last line surgery option

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94
Q

When do naevus flammeus present?

A

From birth (port wine stain)

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95
Q

When do cavernous haemangioma present?

A

In first month of life, but not from birth (strawberry naevus)

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96
Q

What is ITP?

A

Idiopathic thrombocytopenic purpura (low platelets)= excessive bruising and bleeding
May develop after a viral infection in kids
In adults, a long term condition

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97
Q

Management of ITP?

A

Majority of cases spontaneously resolve within 6-8 weeks and require no further treatment
Advise: avoid NSAIDs, aspirin and contact sports

May require prednisolone if platelet count is too low

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98
Q

When would a splenectomy for ITP be indicated?

A

Life threatening bleeding

Severe chronic and unremitting ITP for 12-24 months with sever symptoms

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99
Q

What surgical procedure for Hirschprungs?

A

Swenson procedure= remove section of affected bowel and anastomose remaining bowel together

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100
Q

What surgical procedure for Meckel’s diverticulum if symptomatic?

A

Wedge excision

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101
Q

Features of tetralogy of fallot?

A

Large VSD, overriding aorta, right ventricular hypertrophy, pulmonary valve stenosis (aka right ventricular outflow obstruction)

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102
Q

VSD murmur and where?

A

pansystolic over lower left sternal edge (tricuspid area)

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103
Q

ASD murmur and where?

A

Ejection systolic murmur over upper left sternal border (pulmonary)

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104
Q

PDA murmur and where?

A

continuous machinery murmur over upper left sternal angle

105
Q

Coarctation of aorta murmur where?

A

On back between scapula

106
Q

Which is trisomy 13?

A

Patau syndrome- remember polydactyly

107
Q

Which is trisomy 18?

A

Edward’s syndrome, remember macrognathia (undersized jaw)

108
Q

How to manage paracetamol od ?

A

If within 1 hour of ingestion= activated charcoal

If within 8 hours= n-acetylcysteine

109
Q

How to give n acetylcysteine?

A

Infusion in 3 divided doses over 21 hours
1st= done over an hour
2nd= over 4 hours straight after
3rd= over 16 hours straight after

110
Q

When do delirium tremens occur?

A

48-72 hours following alcohol withdrawal

111
Q

Describe progression of alcohol withdrawal

A

6-12 hours after withdrawal= tremor, sweating, tachycardia, nausea, headache and anxiety
Seizures peak incidence at 36 hours

112
Q

Phases of cocaine withdrawal?

A

First phase= first 24 hours (increased hunger and cravings)
Second phase can last for up to 10 weeks
Final phase show decrease in most withdrawal symptoms but low mood can persist for 6 months

113
Q

Symptoms of cocaine withdrawal

A

Hunger, cravings, anxiety, fatigue, irritability, lack of motivation, low mood

114
Q

Features of pre-eclampsia?

A

Defining features= hypertension and proteinuria

Epigastric pain, facial oedema, hypertension, hyperreflexia, papilloedema

115
Q

Management of preeclampsia?

A

Labetalol first line

If asthmatic/heart failure/heart block, then nifedipine

116
Q

How to control seizures in eclampsia?

A

Magnesium sulfate

117
Q

RFs for pre-eclampsia?

A

long birth interval (over 10 years), BMI over 31, maternal antiphospholipid syndrome, multiple pregnancy, previous pre-eclampsia

118
Q

What is foetal hydrops?

A

Abnormal accumulation of serous fluid in at least 2 foetal compartments (pleural, pericardial, ascites, skin oedema, polyhydramnios, placental oedema)

119
Q

Causes of foetal hydrops?

A

Immune causes (blood group incompatability)

Non immune causes: severe anaemia (parvovirus B19, alpha thalassaemia major, massive materno-foetal haemorrhage), cardiac abnormalities, twin-twin transfusion syndrome, chromosomal (trisomies, turners), infection (toxoplasmosis, rubella, cmv, varicella), chorionagioma

120
Q

Methods of induction of labour?

A

Membrane sweeping
Vaginal PGE2 is first line pharm
Oxytocin can be used as well (not alone)

121
Q

RFs for obstetric cholestasis?

A

Hepatitis C, multiple pregnancy, obstetric cholestasis in previous pregnancy, presence of gallstones

122
Q

When can you offer external cephalic version?

A

From 36 weeks in nulliparous

From 37 weeks in multiparous

123
Q

What is QRISK? what is in it?

A

Risk of having a stroke or heart attack in the next 10 years

Fxs: age, sex, smoking, diabetes, angina, ckd, AF, BP treatment, migraines, SLE, mental illness, steroids, erectile dysfunction

124
Q

What is error of over attachment?

A

Conduction of tests to confirm what we expect/want to see and not ruling out other causes

125
Q

What is error due to failure to consider the alternative?

A

One abnormality found that fits particular diagnosis so stop searching for other potential clues that could change diagnosis

126
Q

What is error of bravado?

A

Working above competence

127
Q

What is error of inheriting thinking?

A

When working diagnosis handed over and accepted without pause for consideration and determining whether it has been substantially proved

128
Q

What is error of ignorance?

A

Unconscious incompetence

129
Q

2 ethical frameworks to assess ethical dilemmas?

A

Four quadrants

Seedhouse ethical grid

130
Q

Describe the four quadrants to assess ethical dilemmas?

A 
Medical indications (beneficence and non maleficence)
Patient preferences (autonomy)
Quality of life (beneficence and nonmaleficence)
Contextual features (loyalty and fairness)
131
Q

Describe seedhouse ethical grid

A

Central conditions, key principles (deontology), consequences then external considerations

132
Q

Presentation of gastric cancer?

A

Palpable mass in abdomen, ascites, dysphagia, weight loss

133
Q

Medications for ADHD?

A

Methylphenidate first line
Lisdexamfetamine second line
Dexamfetamine if patient intolerant to side effects of lisdexamfetamine

134
Q

How can necrotising enterocolitis present?

A

Abdominal distension, vomiting, visible intestine loops lacking peristalsis, rectal bleeding, lethargy, feeding intolerance

135
Q

What can be seen in advanced NEC?

A

Metabolic acidosis

136
Q

How to diagnose NEC?

A

Abdominal Xray shows dilated bowel loops, bowel wall oedema, pneumonitis intestinalis

Abdo USS can be used if XRay inconclusive

137
Q

Management of NEC?

A

Broad spectrum antibiotics

138
Q

Asthma management pathway?

A

Regular ICS and PRN short acting b2 agonist
If uncontrolled add a leukotriene receptor antagonist eg montelukast
If montelukast not working, increase ICS

LABA can be added if child is over 5 years

139
Q

How does intussuscpetion present?

A

Paroxysmal episodes of colicky abdo pain, inconsolable, drawing legs up to abdomen, features of intestinal obstruction

Distension of abdomen, vomiting, constipation, redcurrant jelly stool (late sign)

140
Q

Who is intussusception most common in?

A

Between 3 months and 2 years

141
Q

Where is the most common site for intussusception?

A

Ileum telescoping into caecum

142
Q

Investigating intussusception?

A

USS abdomen, look for target sign or doughnut sign

143
Q

How to manage intussusception?

A

IV fluids and rectal air insufflation

Only need operative reduction if peritonitis or rectal air insufflation failed

144
Q

Prophylactics in bipolar affective disorder?

A

Lithium (first line)
Valproate
Olanzapine (if responsive to this in previous manic phase)
Carbamazepine (if patients unresponsive to combination of other prophylactic drugs, used inpatients with rapid cycling disease)

145
Q

Organic causes of GAD?

A 
Anaemia
Hyperthyroid
Pheochromocytoma 
Temporal lobe epilepsy 
Hypoglycaemia
Tachycardia
146
Q

Hallucination seen in delirium tremens?

A

Lilliputian (seeing lots of tiny people)

147
Q

Hallucination type seen in psychosis?

A

Extracampine (beyond the realm of physical possibility)

148
Q

What combination of drugs makes serotonin syndrome most likely?

A

SSRI and MAOI eg phenelzine

149
Q

When does it count as premature ovarian insufficiency?

A

Menopausal symptoms and secondary ammenorrhoea under 40 years old
No negative feedback from ovaries so FSH and LH levels very high

150
Q

What is a first degree tear?

A

Into perineal skin only

151
Q

What is a second degree tear?

A

Fascia and muscles of perineum affected

152
Q

What is third degree (A) tear?

A

fascia and muscles of perineum, and <50% of external anal sphincter involved

153
Q

What is a third degree (B) tear?

A

fascia and muscles of perineum and over 50% of external anal sphincter involved

154
Q

What is a third degree (C) tear?

A

fascia and muscles of perineum and both external and internal anal sphincters involved

155
Q

What is a fourth degree tear?

A

Both external and internal anal sphincters completely torn and anal epithelium involved

156
Q

What is Erbs palsy?

A

c5-c6 injury
Arm paralysis or weakness after birth trauma, typically shoulder dystocia
Can resolve by itself or need physio or surgery

157
Q

What is Klumpke’s palsy

A

Injury of C8-T1

Generally from difficult birth

158
Q

Termination of pregnancy options

A

For gestation under 7 weeks use medical methods: mifepristone first then misoprostol 36-48 hours later

Dilatation and evacuation performed above 13 weeks, but would still prefer medical mx

Suction curettage between 7 and 13 weeks

159
Q

What can ovarian neoplasms cause

A

hirsutism (testosterone secretion), acute abdomen (torsion), rupture or haemorrhage, thyrotoxicosis, amenorrhoea

160
Q

Cervical cancer management options

A

Fertility preserving= cone biopsy
CIN= laser ablation
Non fertility preserving= radical trachelectomy, hysterectomy with lymph node clearance
Cisplatin and radio used for later staged cancers

161
Q

What is ovarian hyperthecosis?

A

Luteinised theca cell nests in ovarian stroma

Closely related to PCOS but a/w more severe hyperandrogenism and virilisation

Accounts for most cases of hyperandrogenaemia in postmenopausal women, but prevalence much lower in younger women

162
Q

Signs of heart failure on CXR?

A 
ABCDE
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe veins
Pleural effusion
163
Q

Presentation of cluster headaches?

A

Sudden unilateral severe headache, ptosis, miosis, conjunctival infection, excessive lacrimation

Headaches in clusters of 6-12 weeks then period of remission

164
Q

How to manage cluster headaches?

A

Acute attack= sumatriptan and high flow oxygen

Verapamil for prophylaxis

165
Q

Who is sumatriptan contraindicated in?

A

Those with history of coronary artery disease

166
Q

how can normal pressure hydrocephalus present?

A

Urinary incontinence, dementia, gait disturbance

167
Q

Path of flow for CSF

A

Two lateral ventricles, foramina of monro, third ventricle, cerebral aqueduct, fourth ventricle, formaina of luschka and magendie, subarachnoid space

168
Q

How does C diff infection present?

A

Soft abdomen, epigastric tenderness, diarrhoea

169
Q

Management of c diff?

A

Take stool cultures
Rehydration
Metronidazole or vancomycin

170
Q

What is primary biliary cholangitis?

A

Inflammation of bile ducts, related to autoimmune conditions, antimitochondrial antibodies in up to 98% of cases

Px: fatigue, jaundice, pruritus

171
Q

Diagnosis of acromegaly?

A

Oral glucose tolerance test

172
Q

Why do we not use GH in testing for acromegaly?

A

GH released in a pulsatile manner, non specific, raised in stress, anorexia, sleep, puberty, pregnancy

173
Q

What are the sick day rules for someone on hydrocortisone and fludrocortisone for primary adrenal insufficiency?

A

Double hydrocortisone in febrile illness, breaking bone, bodily stressors eg cold/diarrhoea

Don’t need to do anything to fludrocortisone

174
Q

RFs for subarachnoid haemorrhage?

A

Ehler danlos syndrome, smoking, excessive alcohol intake, PKD, coarctation of aorta, cocaine use

175
Q

Presentation of varicocele

A

Most asx
Some patients may have dull ache
15% of boys around puberty and more likely to be left testicle

176
Q

What part of management of DKA in adults which may be considered is never used in children?

A

IV sodium bicarb if pH were uner 6.9

177
Q

How does scarlet fever present?

A

Sandpaper rash, strawberry tongue

178
Q

Biggest cause of scarlet fever?

A

Strep pyogenes

179
Q

How to manage scarlet fever?

A

PO phenoxymethylpenicillin for 10 days

Notify PHE

180
Q

How does acamprosate work?

A

Enhances GABA transmission and reduces cravings

181
Q

How does clomethiazole work?

A

Enhances GABA transmission, but cannot be used if continuing to drink

182
Q

How does disulfiram work?

A

Causes build up of acetaldehyde on consumption of alcohol causing unpleasant symptoms like flushing, headache and anxiety

183
Q

How does naltrexone work?

A

Reduces pleasurable effect of alcohol by acting as opioid antagonist

184
Q

Absolute contraindication to ECT?

A

Raised intracranial pressure

185
Q

Relative contraindications to ECT?

A

Cerebral tumour/aneurysm, phaeochromocytoma, pregnancy, recent MI

186
Q

5 causes of drug induced psychosis?

A

Alcohol, cocaine, amphetamine, MDMA, cannabis, mephedrone, LSD, ketamine, anti-malarail, bromocriptine, levodopa, steroids

187
Q

What is the edinburgh scale used for?

A

Screening for postnatal depression

188
Q

What is the beck depression inventory used for?

A

To measure severity of depression

189
Q

What is the hamilton depression rating scale?

A

indication of depression and guide to evaluate recovery

190
Q

What is the PHQ4 for?

A

Brief screening tool for anxiety and depression

191
Q

What is the PHQ9 for?

A

Diagnoses depression and grades severity of symptoms

192
Q

Which type of benzos are likely to cause behavioural disinhibition?

A

Short acting

193
Q

What’s a good alternative to short acting benzos?

A

Hydroxyzine (sedating antihistamine)

194
Q

Which class of antidepressants should be used with caution in benzo use and why?

A

SSRIs increase the plasma concentration of benzos

195
Q

First line pharm option for delirium?

Repeat options?

A

Haloperidol 0.5mg PO or IM
If PO, dosing can be repeated every 4 hours
0.5mg IM can be repeated hourly

196
Q

What is second line pharm option for delirium?

A

Lorazepam

197
Q

Carbamazepine interactions with methylphenidate?

A

Decreases levels of methylphenidate

198
Q

Isocarboxazid class, and how does it interact with methylphenidate?

A

MAOI

Increases risk of a hypertensive crisis

199
Q

Risperidone interactions with methylphenidate?

A

Increased risk of dyskinesias

200
Q

How does linezolid (which class?) interact with methylphenidate?

A

Antibiotic

Increases risk of elevated blood pressure

201
Q

Emergency contraception options and time limits?

A

Within 72 hours: levonelle (levonorgestrel 1.5mg)

Within 120 hour: ellaone (ulipristal acetate 30mg) and copper coil IUD

202
Q

When should you not use copper coil as emergency contraception?

A

Copper allergy or Wilsons disease

Untreated STI or pelvic infection

203
Q

Complications of gestational diabetes?

A

Polyhydramnios, high birth weight, preterm delivery, stillbirth, shoulder dystocia, high blood pressure, preeclampsia

204
Q

Teratogenic effects of sodium valproate, in order of occurrence?

A 
Hypospadias most likely
Spina bifida
ASD
Cleft palate
Polydactyly
205
Q

Inheritance of marfans syndrome? Main risk of this condition?

A

Autosomal dominant

Aortic dissection and rupture

206
Q

Management of PPH due to uterine atony?

A

Meds first: oxytocin, ergometrine, carboprost, misoprostol
Then intrauterine balloon tamponade
Then haemostatic suturing (B lynch)
Then hysterectomy as last resort

207
Q

What antibiotic for preterm PROM?

A

Oral erythromycin, continue for maximum of 10 days or until woman is in established labour (whichever comes first)

208
Q

What antibiotic for women in labour with a fever or have had previous GBS infection in pregnancy?

A

IV benyzlpenicillin

209
Q

Risk factors for ectopic pregnancy?

A

Anything slowing down passage of ovum

POP, IVF, endometriosis, adhesions

210
Q

What is first line management for confirmed miscarriage?

A

Expectant management for 7 to 14 days

211
Q

When do you consider alternative management options for confirmed miscarriage?

A

Woman at increased risk of haemorrhage eg late in first trimester, coagulopathies, can not have blood transfusion
Woman has had previous adverse/traumatic experience in pregnancy eg stillbirth, miscarriage, APH
Evidence of infection

212
Q

What is the combined test, when conducted?

A

Between 11 and 13+6 weeks, standard screening test for Down syndrome

Nuchal translucency measurement, serum beta hcg, pregnancy associated plasma protein A (PAPP-A)

213
Q

What combined test result would suggest down syndrome?

A

Raised hcg, low PAPP-A and thickened nuchal translucency

214
Q

What tests can be offered instead in woman past the threshold of combined test?

A

Triple or quadruple test

215
Q

What does triple test look at?

A

AFP (alpha fetoprotein), unconjugated oestradiol, hcg

216
Q

What does quadruple test look at?

A

AFP, unconjugated oestriol, hcg, inhibin A

217
Q

What are risk factors for endometriosis?

A

Anything prolonging amount of bleeding a woman has
Early menarche, late menopause, delayed childbearing, nulliparity

Also, family history, vaginal outflow obstruction, white ethnicity, low BMI, autoimmune disease

218
Q

How to manage cauda equina?

A

Medical decompression first with high dose dexamethasone

Surgeon review and surgical decompression

219
Q

How does brown sequard syndrome present?

A

Hemisection of cord on one side

Paralysis, loss of proprioception and vibration on ipsilateral side of lesion
Contralateral side= lack of pain and temperature sensation

220
Q

What shape can the heart have on CXR in tetralogy of fallot?

A

Boot shaped (upturned cardiac apex) due to RVH and flat/concave pulmonary trunk (due to pulmonary stenosis)

221
Q

Contraindications to joint aspiration?

A 
Relative= joint prosthesis (only done by ortho surgeon in theatre due to risk of infection)
Others= bacteraemia, inaccessible joints, overlying infection in soft tissue
222
Q

Absolute vs relative contraindication?

A

Absolute- event or substance could cause life threatening situation

Relative- caution should be used, acceptable if benefits outweigh risks

223
Q

Bloods indicative of alcoholic liver disease?

A

AST levels elevated, normally above ALT level

AST:ALT ratio above 2:1 in about 70% of cases

224
Q

Main causative organisms of COPD exacerbations?

A

Moraxella catarrhalis, Hameophilus influenzae, S. pneumoniae

225
Q

Class of drug of indapamide?

A

Thiazide like diuretic

226
Q

How to calculate units in an alcoholic drink?

A

Units= volume (L) x %ABV

227
Q

Concerning feature of a febrile seizure?

A

Focal seizure lasting over 15 minutes= complex febrile convulsion

228
Q

UTI in men management?

A

7 days nitrofurantoin bd
or
7 days trimethroprim bd

229
Q

Normal folic acid recommendation for pregnancy?

A

400 ug daily before pregnancy and throughout first 12 weeks

230
Q

When are folic acid requirements different? How much to advise?

A

5 mg a day before and throughout first 12 weeks

If: on anti-epileptic drug, coeliac, diabetes, BMI over 30 or has neural tube defect risk

231
Q

Score used to stratify upper GI bleeding patients who are low risk and candidates for outpatient management?

A

Glasgow-Blatchford bleeding score

232
Q

What is the PERC score?

A

Used to rule out pulmonary embolism

233
Q

What is the STOPP criteria?

A

Used to review medication regimes in elderly people

234
Q

What is the waterlow score?

A

Estimates risk for development of a pressure sore

235
Q

What is chvostek’s sign?

A

Seen in hypocalcaemia

Tapping of facial nerve on cheek causes twitching of face

236
Q

What is Hoffman’s sign?

A

UMN sign

Involuntary flexion of index finger and adduction of thumb on flicking finger

237
Q

What is Hoover’s sign?

A

Patient supine, hand under patients heel, patient to press heels onto table

Examiner feels pressure on non-paretic limb

Patient raises non paretic limb against resistance, shouldn’t feel pressure under paretic leg on table

Hoover’s sign= pressure felt on paretic leg when non paretic leg raised and no pressure vice versa

238
Q

Frontotemporal dementia features?

A

Disinhibition, personality change with memory relatively intact

239
Q

Management of idiopathic intracranial hypertension?

A

Initially: acetazolamide or other diuretics

Other options: serial lumbar puncture, weight reduction

Surgery: optic nerve sheath fenestration, CSF diversion (lumboperitoneal or ventriculoperitoneal shunt)

240
Q

Bone protection for those on long term steroids over 65?

A

Start alendronic acid or other bisphophonate, no need for DEXA scan

241
Q

What drug to use to prevent vasospasm in cerebral vasculature after SAH?

A

Nimodipine for 21 days qds, start within 4 days of SAH

242
Q

What is the bradford hill criteria used for?

A

9 principles used to establish epidemiologic evidence of a causal relationship

243
Q

What are the bradford criteria?

A

Strength (effect size), consistency, specificity, temporality, dose-response relationship, plausibility, coherence, experiment, analogy

244
Q

How will rhabdomyolysis present?

A

Myalgia, weakness, red-brown urine, elevated muscle enzymes (incl raised CK), might be asx

245
Q

Bishop score low, how to induce labour?

A

Need to use vaginal prostaglandin E2 first line

246
Q

Time cut off for acute stress reaction and PTSD?

A

PTSD can only be diagnosed after 4 weeks

247
Q

Pregnant woman come into contact with chickenpox, never had it herself, what to do?

A

Give varicella-zoster immunoglobulin ASAP if under 20 weeks pregnant

248
Q

Pregnant woman with chickenpox if presenting within 24 hours of rash onset, management?

A

If after 20 weeks, oral aciclovir

249
Q

Normal OGTT result?

A

Less than 7.8 mmol/L

250
Q

What sections don’t apply in A&E?

A

5(2) and 5(4)

251
Q

What is always going to be initial management with preterm labour?

A

Steroids

Then the emergency Cs

252
Q

Status epilepticus management?

A

Lorazepam IV 4mg, then repeat dose after 10 minutes if no response

Then move onto IV phenytoin

253
Q

Hirschprung’s management?

A

Rectal washouts/bowel irrigation initially

Definitive= anorectal pullthrough

254
Q

How does extradural haematoma present?

A

Initial LOC then clinical improvement then sudden deterioration

255
Q

Timecourse of subdural haematoma presentation?

A

Can have a latent period before symptoms appear

256
Q

Labour management of obstetric cholestasis?

A

Induction of labour at 37-38 weeks (risk of stillbirth)

257
Q

How to manage threadworm?

A

Mebendazole for household

258
Q

What medication for acute dystonia?

A

IV procyclidine

259
Q

Key causes of drug induced gynaecomastia?

A 
Hormones (oestrogen, anabolic steroids)
Anti-androgens (finasteride)
Spironolactone
Antibiotics (metronidazole)
Antihypertensives (amlodipine, verapamil)
GI (omeprazole)
Psych drugs (diazepam, haloperidol, TCAs)
Statins

Phase 3A (8 decks)

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