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Pre-exam flashcards > Please > Flashcards

Please Flashcards

1
Q

Pre-eclampsia moderate/high risk aspirin management

A

Take daily from 12 weeks to birth

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2
Q

Threadworm management

A

Mebendazole single dose for child and entire household

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3
Q

What is associated with decreased incidence of hyperemesis gravid arum?

A

Smoking

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4
Q

Main risk of termination of pregnancy and when does it happen?

A

Infection - unlikely to occur soon after the procedure

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5
Q

Iron therapy in pregnancy

A

First trimester 110
Second 105
Post partum 100

Management - oral ferrous sulphate - continue treatment 3 months after iron deficiency is correct to replenish stores

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6
Q

Treating pyrexia in non-haemolytic febrile transfusion reaction

A

Paracetamol

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7
Q

Child coughing at night

A

Whooping cough/ Pertussis

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8
Q

Management of pertussis/whooping cough

A

Clarithromycin

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9
Q

Management of bell’s palsy

A

Prednisolone

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10
Q

Layers of the abdominal wall

A

Skin
Subcutaneous fascia
Abdominal muscles - external oblique, internal oblique, transversus abdominus
Peritoneum
Uterus

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11
Q

Categories of C sections

A

Category 1
an immediate threat to the life of the mother or baby
examples indications include: suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia
delivery of the baby should occur within 30 minutes of making the decision
Category 2
maternal or fetal compromise which is not immediately life-threatening
delivery of the baby should occur within 75 minutes of making the decision
Category 3
delivery is required, but mother and baby are stable
Category 4
elective caesarean

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12
Q

Features of acute sinusitis

A

Facial pain worse on leaning forward
Nasal discharge
Nasal obstruction

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13
Q

Management of acute sinusitis

A

analgesia
intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited
NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
oral antibiotics are not normally required but may be given for severe presentations.
The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’

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14
Q

Management of chronic rhino sinusitis

A

avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution
Red flag: unilateral, epistaxis

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15
Q

Acute sinusitis timeline

A

<12 weeks

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16
Q

Sinuses of the head

A
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17
Q

Mechanism of methotrexate

A

antimetabolite that inhibits dihydrofolate reductase, an enzyme essential for the synthesis of purines and pyrimidines.

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18
Q

Side-effects of methotrexate

A

mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis

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19
Q

Anti-emetic: chemo

A

Ondansetron

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20
Q

Anti-emetic: reduced gastric motility

A

metoclopramide

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21
Q

Anti-emetic: raised intracranial pressure

A

Cyclizine

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22
Q

Discitis: common organisms

A

Staph aureus

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23
Q

Discitis: investigations and management

A

MRI and 6-8 weeks of IV antibiotics

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24
Q

Calculating anion gap

A

(sodium+potassium)-(bicarb+chloride)

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25
Q

Red traffic light: tachypnoea

A

> 60 in any age

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26
Q

Main side effect of nasal decongestants

A

Tachyphylaxis

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27
Q

Hand, foot and mouth disease cause

A

Coxsackie

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28
Q

Peutz-Jegher management

A

Conservative

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29
Q

Palliative care: secretions

A

Hyoscine hydrobromide

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30
Q

Palliative care: hiccups

A

Chlorpromazine

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31
Q

Palliative care prescribing: agitation and confusion

A

first choice: haloperidol

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32
Q

Management of metastatic spinal cord compression

A

Oral dexamethasone

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33
Q

SVCO management

A

dex and endovascular stenting is often the treatment of choice to provide symptom relief

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34
Q

Vincristine

A

Peripheral neuropathy, paralytic ileus, myelosuppression

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35
Q

Cisplatin

A

HOP

Ototoxicity, peripheral neuropathy, hypomagnesaemia

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36
Q

Normal pressure hydrocephalus

A

Can be idiopathic or due to subarachnoid haemorrhage, injury, or meningitis.
Presents with marked mental slowness, apathy, wide-based gait, and urinary incontinence.
Ventriculoatrial shunting only benefits patients with prominent neurological signs and relatively mild dementia but frequently leads to complications.

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37
Q

Breast cancer tumour marker

A

CA153

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38
Q

Neutropenic sepsis

A

Temperature >38oC and neutrophil count <0.5≈109/L.
Treat empirically with piperacillin/tazobactam (see p352).

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39
Q

Frontotemporal dementia:

A

Features: Personality changes, behavioural and language difficulties.

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40
Q

Hypertensive retinopathy features on fundoscopy

A

Keith-Wagener Classification

Stage 1: Mild narrowing of the arterioles
Stage 2: Focal constriction of blood vessels and AV nicking
Stage 3: Cotton-wool patches, exudates and haemorrhages
Stage 4: Papilloedema

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41
Q

Management of intrahepatic cholestasis in pregnancy

A

Ursodeoxycholic acid

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42
Q

When does the anomaly scan happen?

A

18-20+6 weeks

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43
Q

What type of murmur would you hear in pregnancy? Is this pathological?

A

Systolic murmur - it’s normal

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44
Q

Maternal corticosteroids

A

Dexamethasone

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45
Q

Management of a woman with known Group B streptococcus during labour?

A

Intrapartum antibiotics - Benzylpenicillin is antibiotic of choice.

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46
Q

Management of shoulder dystocia

A

Call for help!
McRoberts’ manoeuvre
episiotomy
Suprapubic pressure
Rubin’s manoeuvre
Zavanelli’s manoeuvre

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47
Q

Diagnose please and management

A

Herpes zoster keratitis and oral aciclovir

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48
Q

Diabetic retinopathy findings

A

Brandon Norman Chases Mad Hoes

Blot haemorrhages
Neovascularisation
Cotton wool spots
Microaneurysms
Hard exudate

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49
Q

FRONTAL HEADACHE WHICH HAS DEVELOPED FOLLOWING AN UPPER RESPIRATORY TRACT INFECTION WHICH IS WORSE ON LEARNING FORWARDS!

A

Sinusitis

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50
Q

Management of sinusitis

A

analgesia, intranasal decongestants or nasal saline.
Intranasal corticosteroids if symptoms have been present more than 10 days.
Oral phenoxymethylpenicillin if symptoms are severe.

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51
Q

DVLA driving rules: first unprovoked/isolated seizure

A

6 months if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG. If these conditions are not met then this is increased to 12 months

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52
Q

DVLA: patients with established epilepsy or those with multiple unprovoked seizures

A

12 months

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53
Q

DVLA: syncope : single episode, explained and treated

A

4 weeks

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54
Q

DVLA: syncope single episode, unexplained:

A

6 months off

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55
Q

DVLA: syncope more than 2 episodes

A

12 months off

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56
Q

DVLA: TIA/Stroke

A

1 month off

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57
Q

DVLA: multiple TIAs over short period of times

A

3 months off

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58
Q

DVLA: craniotomy e.g. For meningioma:

A

1 year off driving

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59
Q

DVLA: craniotomy for pituitary tumour

A

6 months off

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60
Q

DVLA: CABG

A

1 month off

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61
Q

DVLA: ACS

A

1 month off

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62
Q

DVLA: Pacemaker insertion

A

1 week off

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63
Q

DVLA: defirbillator for ventricular arrythmia

A

6 months off

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64
Q

DVLA: defibrillator for prophylaxis

A

1 month off

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65
Q

DVLA: heart transplant

A

6 weeks off

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66
Q

What would you find on LP of MS?

A

Oligoclonal bands

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67
Q

Acute phase treatment of MND

A

High dose steroids IV or Oral methylprednisolone for 5 days.

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68
Q

Parkinson’s drugs and their MOA

A

Levodopa
Carbydopa
MAO-B Inhibitors - sellegiline
COMT inhibitors - tolcapone
Amantadine

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69
Q

Ankle reflexes

A

S1-S2

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70
Q

Knee reflexes

A

L3-L4

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71
Q

Biceps reflexes

A

C5-C6

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72
Q

Triceps reflexes

A

C7-C8

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73
Q

Intrahepatic cholestasis: when should you deliver? and why?

A

37 weeks - due to risk of stillbirth

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74
Q

What are the 5 principles of the mental capacity act?

A

BiQWAS
1. A person must be assumed to have capacity unless it is established that he lacks capacity
2. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
3. A person is not to be treated as unable to make a decision merely because he makes an unwise decision
4. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests
5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action

B - best interst
I - idiot decisions
T - take steps to make sure they dont have capacity
A - assume capacity unless established that they dont
T - take least restrictive option on the patient’s rights and freedom of action.

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75
Q

How would you assess capacity?

A

A person must be able to:
Understand
Retain
Make a decision
Communicate the decision back.

URMC

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76
Q

What is section 2?

A

28 days
AMHP + 2 doctors

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77
Q

What is section 3?

A

6 months
AMHP + 2 doctors

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78
Q

What is Section 4?

A

72 hours
GP and AMHP

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79
Q

What is section 5(2)?

A

A patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

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80
Q

What is section 5(4)?

A

Similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

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81
Q

What is a section 135?

A

A court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety

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82
Q

What is a section 136?

A

Someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
Can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged

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83
Q

Acute bronchitis management

A

Analgesia
Good fluid intake
Abx - doxycycline if systemically unwell.

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84
Q

Most common infective causes of COPD exacerbations (2)

A

Haemophilus influenzae and streptococcus pneumoniae

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85
Q

Management of infective exacerbation of COPD

A

Prednisolone for 5 days
Amoxicillin is antibiotic of choice.
Nebulised SABA and Ipatropium bromide
IV hydrocortisone may be used instead of prendisolone
IV theophylline
NIV or BiPaP if type 2 respiratory failure occurs.

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86
Q

Presentation of ARDS

A

Low oxygen saturations
High respiratory rate
Dyspnoea
Bilateral lung crackles

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87
Q

Presentation and management of allergic bronchopulmonary aspergillosis

A

Presentation: bronchiectasis and eosinophilia.
Management: Oral glucocorticoids

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88
Q

Which areas of the lungs are most affected in aspiration pneumonia?

A

Right middle and lower lung lobes.

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89
Q

Asthma: stepping down treatment

A

Consider every 3 months

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90
Q

Causes of bilateral hilar lymphadenopathy

A

Sarcoidosis and TB.
Lymphoma

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91
Q

What is bronchiectasis?

A

Permanent dilation of the airways due to chronic infection or inflammation

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92
Q

Management of bronchiectasis

A

Physical training - inspiratory muscle training
Antibiotics for exacerbations
Bronchodilators
Surgery for selected cases

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93
Q

Most common organisms in patients with bronchiectasis

A

Haemophilus influenza
Pseudomonas aeruginosa
Klebsiella
Strep pneumoniae

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94
Q

Causes of widened mediastinum

A

Thoracic aortic aneurysm
Lymphoma
Teratoma
Tumours of the thymus

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95
Q

Causes of widened mediastinum

A

Thoracic aortic aneurysm
Lymphoma
Teratoma
Tumours of the thymus

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96
Q

Causes of widened mediastinum

A

Thoracic aortic aneurysm
Lymphoma
Teratoma
Tumours of the thymus

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97
Q

Severity of COPD

A

Stage 1: Mild: >80%
Stage 2: Moderate: 50-79%
Stage 3: Severe: 30-49%
Stage 4: Very severe: <30%

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98
Q

COPD: general management

A

Smoking cessation
Annual influenza vaccine
One-off pneumococcal vaccine
Pulmonary rehabilitation

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99
Q

List 5 causes of haemoptysis

A

Lung cancer
TB
PE
Granulomatosis with polyangitis
Goodpasture’s syndrome
Bronchiectasis

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100
Q

Management of idiopathic pulmonary fibrosis

A

Pulmonary rehabiliation

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101
Q

What condition causes red-current jelly sputum?

A

Klebsiella

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102
Q

In what group of patients is Klebsiella pneumoniae more common in?

A

Diabetics and alcoholics

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103
Q

What complications are common in Klebsiella pneumonia?

A

Lung abscesses and empyema

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104
Q

Common causes of klebsiella pneumonia

A

Aspiration

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105
Q

Common organisms causing lung abscesses

A

Staphylococcus aureus, Klebsiella, pseudomonas aeruginosa

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106
Q

First line investigation for lung cancer

A

Chest x-ray

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107
Q

Investigation of choice for lung cancer

A

CT scan

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108
Q

Small cell lung cancer: paraneoplastic syndromes

A

ADH
ACTH
Lambert-Eaton syndrome

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109
Q

Squamous cell lung cancer: paraneoplastic syndromes

A

Parathyroid hormone related protein
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism due to ectopic TSH

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110
Q

Adenocarcinoma of the lung: paraneoplastic syndromes

A

Gynaecomastia
Hypertrophic pulmonary osteoarthropathy

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111
Q

Features of lambert eaton syndrome

A

Diplopia, ptosis, slurred speech

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112
Q

Aortic aneurysm screening

A

One USS at the age of 65 for males only.
<3cm - no follow up
3-4.4 - follow up every year
4.5-5.4 - every 3 months
> 5.5 or >1 cm growth in one year - urgent referral to vascular

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113
Q

Lung cancer referral criteria

A

> 40 and unexplained haemoptysis
or have chest x-ray findings that suggest lung cancer

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114
Q

Causes of upper zone pulmonary fibrosis

A

CHARTS
Coal workers pneumoconiosis
Hypersensitivity pneumonitis
Ankylosing spondylitis
Radiation
TB
Sarcoidosis/silicosis

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115
Q

Causes of lower zone pulmonary fibrosis

A

Methotrexate
Idiopathic
Amiodarone
Asbestosis

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116
Q

List 5 absolute contraindications for thrombolysis

A

Previous intracranial haemorrhage
Pregnancy
Oesophageal varices
Active bleeding
Seizure at onset of stroke

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117
Q

List 5 relative contraindications for thrombolysis

A

Major surgery in past two weeks
Concurrent anticoagulation INR >1.7
Active diabetic haemorrhagic retinopathy

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118
Q

How would you differentiate between a transudative and exudative pleural effusion?

A

Light’s criteria:
Exudate: >30g/L, transudate <30g/L
Exudate: raised pleural LDH, pleural protein/serum protein >0.5

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119
Q

Assessment of pneumonia

A

CURB 65

Confusion
Urea >7
Resp >30
Blood pressure <90 systolic, <60 diastolic
>65 years old

0 - treat at home
1 or 2 - consider hospital assessment
3-4 - urgent admission to hospital

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120
Q

Management of pneumonia

A

Low severity - amoxicillin
Moderate to high severity - amoxicillin and clarithromycin

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121
Q

Pneumonia: after care

A

Repeat chest x-ray at 6 weeks after clinical resolution

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122
Q

Management of primary pneumothorax

A

> 2 cm rim of air -> aspiration
If this fails -> chest drain

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123
Q

Management of secondary pneumothorax

A

<1 cm -> admit for 24 hours and give oxygen
1-2 cm rim of air-> aspiration
>50 years old and >2cm rim of air -> chest drain

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124
Q

Sarcoidosis features

A

Erythema nodosum, bilateral hilar lymphadenopathy, lupus pernio, hypercalcaemia, non-caseating granulomas.

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125
Q

Diagnosis of sarcoidosis

A

ACE levels

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126
Q

Management of sarcoidosis

A

Steroids

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127
Q

Management of tension pneumothorax

A

Needle decompression and chest drain

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128
Q

Shockable rhythms

A

VT/pulseless VF

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129
Q

Non-shockable rhythms

A

Asystole/PEA

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130
Q

When should you defibrilate in shockable rhythms?

A

Single shock by 2 minutes of CPR
If cardiac arrest is witnessed - up to three successive shocks followed by CPR

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131
Q

When should you administer adrenaline?

A

1mg as soon as possible for non-shockable rhythms
After 3rd shock in shockable rhythms and repeat every 3-5 minutes

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132
Q

When should amiodarone be administered?

A

After 3rd shock in VF/pulseless VT and 5th shock

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133
Q

Reversible causes of cardiac arrest

A

4 Hs and 4 Ts

hypoxia
hypothermia
hypo/hyperkalaemia
hypovolaemia

Tension pneumothorax
Toxins
Tamponade
Thrombosis

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133
Q

Reversible causes of cardiac arrest

A

4 Hs and 4 Ts

hypoxia
hypothermia
hypo/hyperkalaemia
hypovolaemia

Tension pneumothorax
Toxins
Tamponade
Thrombosis

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134
Q

Anaphylaxis adrenaline doses

A

<6 months: 100-150 micrograms
6 months - 6 years: 150 micrograms
6-12 years - 300 micrograms
>12 - 500 micrograms

Repeat every 5 minutes

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135
Q

First line investigation for prostate cancer

A

MRI

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136
Q

Management of prostate cancer

A

Surveillance
External beam radiotherapy
Brachytherapy
GnRH agonists (goserelin), androgen receptor blockers, bilateral orchidectomy
Surgery - radical prostatectomy

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137
Q

Management of pericarditis

A

NSAIDs or cholchicine

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138
Q

What’s the management of supraventricular tachycardia?

A

Adenosine - avoid in asthmatics

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139
Q

Side-effects of amiodarone

A

Slate grey appearance
Liver fibrosis
Pulmonary fibrosis
Bradycardia
Peripheral neuropathy

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140
Q

Features of aortic regurgitation

A

Early diastolic murmur
Collapsing pulse
De Musset’s sign

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141
Q

Management of aortic stenosis

A

Asymptomatic - observe
Symptomatic - valve replacement

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142
Q

What is brugada syndrome? And management?

A

Inherited cardiovascular disease - autosomal dominant - common in asians.
Sudden cardiac death
Management - implantable cardiac pacemaker

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143
Q

Cardiac tamponade triad

A

Hypotension
Raised JYP
Muffled heart sounds

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144
Q

How would differentiate cardiac tamponade vs constrictive pericarditis?

A

Pulsus paradoxus - abnormally large drop in BP during inspiration
Not present in constrictive pericarditis

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145
Q

What would you see on ECG in cardiac tamponade

A

Electrical alternans

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146
Q

Chronic heart failure management

A

ACE inhibitor and beta-blocker
Second line - spironolactone

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147
Q

Management of hypertension: diabetes

A

ACE inhibitors or ARBs (first-line)

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148
Q

HOCM: echo findings

A

MR SAM ASH

Mitral regurgitation
Systolic anterior motion
Asymmetrial hypertrophy

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149
Q

What valve is most affected in IE?

A

Mitral valve

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150
Q

Causes of IE

A

Staph aureus
Staph epidermis - in patients with prosthetic heart valves

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151
Q

Criteria for IE

A

Duke’s

Infective endocarditis diagnosed if
pathological criteria positive, or
2 major criteria, or
1 major and 3 minor criteria, or
5 minor criteria

Two positive blood cultures showing organisms consistent with IE
Persistent bacteraemia from two blood cultures taken 12 hours apart

Evidence of endocardial involvement
positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves), or
new valvular regurgitation

Minor criteria
predisposing heart condition or intravenous drug use
microbiological evidence does not meet major criteria
fever > 38ºC
vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots

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152
Q

Complications: MI

A

Cardiac arrest
Cardiogenic shock
Chronic heart failure
Tachyarrythmias
Bradyarrythmias
Pericarditis - Dressler’s syndrome
Left ventricular aneurysm
Left ventricular free wall rupture
VSD
MR

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153
Q

Management of orthostatis hypotension

A

Fludrocortisone

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154
Q

Cause of rheumatic fever

A

Streptococcus pyogenes

155
Q

Diagnosis of rheumatic fever

A

Duke’s criteria - ACCE FRAPP

Diagnosis is based on evidence of recent streptococcal infection accompanied by:
2 major criteria
1 major with 2 minor criteria

Major criteria
erythema marginatum
Sydenham’s chorea: this is often a late feature
polyarthritis
carditis and valvulitis (eg, pancarditis)

Minor criteria
raised ESR or CRP
pyrexia
arthralgia (not if arthritis a major criteria)
prolonged PR interval

156
Q

Management of rheumatic fever

A

Oral Pen V and NSAIDs

157
Q

Management of ventricular tachycardia

A

Amiodarone
Lidocaine (second-line)

158
Q

Wolf-Parkinson-White Syndrome - management

A

Amiodarone, flecanide
Radiofrequency ablation of the accessory pathway

159
Q

Management takayasu’s arteritis

A

Steroids

160
Q

Glue ear management

A

Grommet insertion and adenoidectomy

161
Q

Management of Ramsay-Hunt syndrome

A

Oral aciclovir and steroids

161
Q

ENT referral criteria

A

> 45 and unexplained neck lump or persistent hoarseness of voice

Oral cancer
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either:
unexplained ulceration in the oral cavity lasting for more than 3 weeks or
a persistent and unexplained lump in the neck.
Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:
a lump on the lip or in the oral cavity or
a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia

162
Q

Treatment of vestibular neuronitis

A

Buccal or intramuscular prochlorperazine
Vestibular rehabilitation exercises for patients who experience chronic symptoms.

162
Q

Meniere’s: type of hearing loss

A

Unilateral sensorineural hearing loss

163
Q

How would you differentiate between a posterior cerebellar stroke and vestibular neuronitis?

A

HiNTs exam:

Nystagmus
Vertical skew
Head impulse test

164
Q

Elderly patient - dizziness on head extension

A

Vertebrobasilar ischaemia

165
Q

Acute sensorineural hearing loss management

A

Urgent referal to ENT

166
Q

Most common bacterial cause of otitis media

A

Haemophilus influenza is most common cause of bacterial otitis media.

167
Q

Management of benign paroxysmal positional vertigo

A

Epley
Brant Daroff
Betahistine

168
Q

Risk factors for glue ear

A

Acute otitis media
Barotrauma
Eustachian tube dysfunction
Adenoidal inflammation

169
Q

How would you visualise the vocal cords on examination?

A

Laryngoscopy

170
Q

Where do pharyngeal pouches form?

A

Killian’s dischinence

171
Q

Argyll-Robertson pupil

A

Classically associated with neurosyphilis or diabetes mellitus (which do not apply to this patient), an Argyll-Robertson pupil is typically small, irregular, and unresponsive to light.

172
Q

Holmes- Adie pupil

A

Dilated pupil
Absent ankle/knee reflexes

173
Q

Management of anterior uveitis

A

Steroid eye drops and cycloplegic (mydiatric) drops

174
Q

Management of infective conjunctivitis

A

Chloramphenicol

175
Q

Most common causative organism for bacterial keratitis in contant lense wearers and management

A

Pseudomonas aeruginosa - same day referral to eye specialist in contact lens wearers. Management - topical antibiotics

176
Q

Optic neuritis - features, investigation and management

A

MS, diabetes, syphylis.
Poor discrimination of colours (particulalrly red), pain on eye movement, RAPD and central scotoma.
Ivestigation with MRI brain and orbits with contrast.
Management: high dose steroids.

177
Q

Horner’s syndrome: central lesion causes

A

Stroke
Syringomyelia
Multiple sclerosis
Tumour
Encephalitis

178
Q

Horner’s syndrome: pre-ganglionic lesion causes

A

Pancoast’s tumour
Thyroidectomy
Trauma
Cervical rib

179
Q

Horner’s syndrome: post-ganglionic lesions causes

A

Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

180
Q

Management of acute epiglottitis

A

Ceftriaxone and dexamethasone

181
Q

Status epilepticus managementA

A

ABCDE
Benzo (first-line). Repeat after 10-20 mins.
Phenytoin infusion
Induction with propofol

182
Q

Cerebral palsy: spastic - location of lesion and management

A

Paraventricular white matter - oral diazepam. baclofen

183
Q

Cerebral palsy: dyskinetic - location of lesion

A

Basal ganglia and substantia nigra

184
Q

Cerebral palsy: ataxic - location of lesion

A

Cerebellum

185
Q

What are a small minority of patients likely to develop in chicken pox?

A

Group A strep necrotising fasciitis.

186
Q

What would you find on duodenal biopsy in coeliac’s disease?

A

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

187
Q

Pregnant female presenting with severe abdominal pain, low-grade fever, tachycardia and vomiting with background of fibroids.

A

Red degeneration of fibroids.
Management is supportive, with rest, fluids and analgesia.

188
Q

Management of constipation in children

A

Polyethylene and movicol
Add Senna in addition to movicol if constipation does not resolve in 2 weeks.

189
Q

Emergency treatment of Croup

A

High flow oxygen and nebulised adrenaline

190
Q

Features of cystic fibrosis

A

Meconium ileus, malabsorption, recurrent chest infections, male infertility, female sub fertility, short stature, steatorrhoea.

191
Q

Management of cystic fibrosis

A

Chest physiotherapy, high calorie, high fat diet, pancreatic enzymes.

192
Q

Diagnosis of cystic fibrosis

A

Sweat test

193
Q

Chemical changes seen in diabetic ketoacidosis in children

A

Hyponatraemia, low bicarminate and hypokalaemia

194
Q

Management of cerebral oedema

A

Slow IV fluids, IV mannitol and IV hypertonic saline

195
Q

Unresolved DKA after 24 hours?

A

Refer to paediatric endocrinologist

196
Q

Atopic eczema in children

A

Avoid irritants
Topical emollients
Topical steroids

197
Q

Umbilical hernias management in children

A

Umbilical hernias: Usually self-resolve, but if large or symptomatic perform elective repair at 2-3 years of age. If small and asymptomatic peform elective repair at 4-5 years of age.

198
Q

Meckel’s diverticulum presentation

A

Abdominal pain, rectal bleeding (most common cause of painless GI haemorrhage in children), intestinal obstruction

199
Q

Complications of mumps in children

A

Pancreatitis
Orchitis
SSNHL
Meningitis

200
Q

Complications of perthes disease

A

Osteoarthritis and premature closure of the growth plates

201
Q

Presentation and management of pyloric stenosis

A

Hypochloraemic, hypokalaemic akalosis. Projectile vomiting, dehydeation and constipation.
USS diagnosis.
Ramstedt’s procedure.

202
Q

Features of PDA and management

A

Wide pulse pressure
Collpasing pulse
Continuous machine like murmur

Management: Indomethacin or NSAIDs

203
Q

Management of Group B Strep in neonatal sepsis

A

Benzylpenicilin or gentamicin

204
Q

Group B strep prophylaxis in pregnancy

A

Benzylpenicillin

205
Q

What are koplik’s spots indicative of?

A

Measles

206
Q

Shaken baby syndrome

A

Retinal haemorrhages, subdural haematoma, encephalopathy

207
Q

Breech baby

A

Refer for pelvic USS at 6 weeks to check for DDH

208
Q

Turner’s syndrome

A

SWAB
Primary amenorrhoea
Bicuspid aortic valve
Short stature
Webbed neck

209
Q

Diagnosis of SUFE

A

AP and laternal views - internal fixation

210
Q

Common fractures associated with NAI

A
  • Radial
  • Humeral
  • Femoral
211
Q

When should pregnant women have a whooping cough and influenza vaccine?

A

16-32 weeks

212
Q

Painless abdominal mass in a child with haematuria?

A

Wilm’s tumour

213
Q

What procedure is done for intestinal malrotation?

A

Ladd’s procedure

214
Q

How does intestinal malrotation present?

A

Bile stained vomit

215
Q

T2DM + abnormal liver tests?

A

Non-alcoholic liver disease

216
Q

Investigation for Wilson’s disease

A

Serum ceruloplasmin (reduced)

217
Q

Features of Wilson’s disease and management

A

Kayser-Fleicher rings
Psychiatric problems
Liver cirrhosis/hepatitis
Haemolysis

Management - penicillamine

218
Q

Anti-HbC indicated?

A

Caught - previously or acutely

219
Q

Gene affected in haemachromatosis

A

HFE gene - family testing required

220
Q

Management for haemachromatosis

A

Venesections
Desferioxamine

221
Q

Mesenteric ischaemia vs ischaemic colitis

A

Mesenteric ischaemia due to thrombus and affects small bowel - requires urgent surgery
Ischaemic colitis - multifactorial causes and affects large bowel - conservative management

222
Q

Primary biliary cirrhosis - antibodies and management

A

IgM and Anti-mitochondrial
Ursodeoxycholic acid and cholestyramine for pruritis

223
Q

Management of constipation in patients with IBS

A

Isaghula husk

224
Q

Investigation for alcoholic liver cirrhosis

A

Fibroscan

225
Q

Maximum alcohol units and advise

A

if you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more

226
Q

test recommended for H. pylori post-eradication therapy

A

Urea breath test

227
Q

Management of Crohn’s disease - induction of remission and maintenance regime

A

Induction of remission:
Oral/IV hydrocortisone
Mesalazine
Azathioprine or mercaptopurine/ Methotrexate

Maintenance:
azathioprine or mercaptopurine is used first-line to maintain remission
+TPMT activity should be assessed before starting
methotrexate is used second-line

228
Q

Investigation and management for achalasia

A

Oesophageal monometry, barium swallow
Management: balloon dilation, Heller cardiomyotomy if persistent

229
Q

Management of alcoholic ketoacidosis

A

Saline and thiamine infusion

230
Q

Management of alcoholic hepatitis (Acute)

A

Prednisolone

231
Q

Management of ascites

A

Restrict dietary sodium
Spironolactone
Ciprofloxaclin if ascitic protein >15g/L
TIPS

232
Q

Antibodies found in autoimmune hepatitis and management

A

Anti-nuclear antibodies and/or smooth-muscle antibodies
Management: prednisolone and liver transplantation

233
Q

Change in barrett’s oesophagus and management

A

Squamous -> columnar metaplasia.
Managemnet: High dose PPI, endoscopic surveillance with biopsies.
If any grade of dysplasia is identified endoscopic intervention is offered - ablation is first-line, endoscopic mucosal resection

234
Q

Management of carcinoid tumours

A

Octreotide

235
Q

Management of hepatic encephalopathy

A

Lactulose and rifaximin

236
Q

What is melanosis coli

A

Pigmentation of the bowel wall due to laxative abuse

237
Q

Investigation of primary sclerosing cholangitis

A

MRCP/ERCP
pANCA positive
Increased risk of cholangiocarcinoma and colorectal cancer

238
Q

Small bowel bacterial overgrowth syndrome - risk factors, diagnosis and management

A

Risk factors: diabetes
Diagnosis: hydrogen breath test
Management: rifaximin

239
Q

Diagnosis of helicobacter pylori

A

CLO testing, urea breath test

240
Q

Management of acute pancreatitis

A

IV fluids, Nil by mouth and NG tube

241
Q

Management of Von Willebrand Disease

A

Tranexamic acid for mild bleeding
Desmopressin

242
Q

Investigation for phaechromocytoma

A

Urine metnephrines

243
Q

Diabetes: sick day rules

A

Increase frequency of blood glucose monitoring to four hourly or more frequently
Encourage fluid intake aiming for at least 3 litres in 24hrs
If unable to take struggling to eat may need sugary drinks to maintain carbohydrate intake
If a patient is taking oral hypoglycaemic medication, they should be advised to continue taking their medication even if they are not eating much.
If a patient is on insulin, they must not stop it due to the risk of diabetic ketoacidosis.

244
Q

Campylobacter jejuni management

A

Clarithromycin

245
Q

Signs of digoxin toxicity and management

A

Anorexia, confusion, nausea/vomiting, gynaecomastia
Management: digibind

246
Q

Features of hypothyroidism

A

BRADYCARDIC

Bradycardia
Reflexes slowed
Ataxia
Dru skin/thin hair
Yawning
Coma
Ascites
Round puffy eyes
Defeated demeanor
Immobile
Congestive heart failure

247
Q

Management of myoedema coma

A

Thyroxine and IV hydrocortisone
Correct hypoglycaemia
Rehydrate and oxygen if needed

248
Q

Management of thyroid storm

A

IV fluids
Beta blocker
Digoxin
Carbimazole + iodine
Hydrocortisone
Infection - Abx

249
Q

Most common thyroid cancer in young patients and management

A

Papillary - thyroidectomy + node excision +/- radio

250
Q

What thyroid cancer is associated with MEN2

A

Medullary
Test for phaechromocytoma

251
Q

What is MODY?

A

T2DM in young patients

252
Q

LADA?

A

Autoimmune diabetes developing later in life

253
Q

Differentiating between T1DM and T2DM

A

C-peptide

254
Q

Diagnosis of diabetes

A

Fasting >7
Random >11
HbA1C >48

Symptomatic - one test
Asymptomatic - two seperate occasion

255
Q

Diagnosing pre-diabetes

A

6.1-6.9
42-47

256
Q

Antibodies for hashimoto’s

A

Anti-TPO and anti-thyroglobulin

257
Q

Management of myoedema coma and thyrotoxicosis

A
258
Q

DPP4

A

Sitagliptin
GI upset
Pancreatitis

259
Q

Pioglitazone

A

Thiazolidinedoine
Weight gain
fluid retention
CONTRAINDICATED IN HEART FAILURE
INCREASED RISK OF BLADDER CANCER

260
Q

Sulfonylurea

A

Gliclazide
Weight gain
Hypoglycaemia

261
Q

SGLT2 inhibitors

A

Empagliflozin
Weight loss
urinary and genital infections
Normoglycaemic ketoacidosis

262
Q

GLP1 mimetics

A

Exenatide
GI upset
Weight loss
Risk of hypoglycaemia

263
Q

Investigation of cushings

A

Dexamethasone suppresion test
In pituitary adenoma - ACTH and cortisol will be suppressed

264
Q

Signs and symptoms of adrenal insufficiency

A

Salt craving
Hyperpigmentation of palmar creases
Nausea
Vomiting
Anorexia
Hypotension

265
Q

Investigating Addisons

A

Short synacthin test

266
Q

Management of Addison’s

A

IV hydrocortisone and flurdocortisone

267
Q

Conn’s syndrome features

A

Hypertension
Hypokalaemia
Metabolic alkalosis

268
Q

Prolactinomas features

A

Male: galactorrhoea, impotence
Female: Amenorrhoea, infertility, galactorrhea

269
Q

Prolactinoma investigation and management

A

MRI

Bromocriptine
Transphenoidal surgery

270
Q

Paediatric inguinal hernia

A

<1 year - high risk of strangulation - refer for urgent surgery
over 1 year of age are at lower risk and surgery may be performed electively

271
Q

Peripheral arterial disease

A

Clopidogrel and statin

272
Q

Ventricular tachycardia: management

A

Haemodynamically unstable: DC cardioversion
Stable: Amiodarone

273
Q

Management of peripheral arterial disease

A

Statin and clopidogril
Exercise

274
Q

PTSD vs acute stress disorder

A

PTSD >1 month

275
Q

PTSD management

A

trauma focused CBT and SSRI

276
Q

Acute stress disorder

A

Trauma focused CBT

277
Q

Management of anorexia nervosa

A

individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
specialist supportive clinical management (SSCM).

Family therapy in children. CBT second line

278
Q

Bipolar disorder: management

A

Lithium remains the mood stabilizer of choice. An alternative is valproate
management of mania/hypomania
consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol
management of depression
talking therapies (see above); fluoxetine is the antidepressant of choice

279
Q

calluses on the knuckles or back of the hand due to repeated self-induced vomiting

A

Russell’s sign

280
Q

De Clerambault’s

A

Erotomania - patient believes a famous person is in love with them

281
Q

Cotard syndrome

A

Patient believes that they or parts of their body are dead or non-existent

282
Q

S/E of ECT

A

Short term memory loss
Cardiac arrhythmias
Nausea
Headache
memory loss of events prior to ECT

283
Q

Indications and contraindications for ECT

A

severe depression refractory to medication (e.g. catatonia) those with psychotic symptoms

Contraindicated in raised intracranial pressure

284
Q

Meningitis and raised intracranial pressure

A

Do CT head first

285
Q

Management of Generalised anxiety disorder

A

NICE suggest a step-wise approach:
step 1: education about GAD + active monitoring
step 2: low-intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
step 3: high-intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment. See drug treatment below for more information
step 4: highly specialist input e.g. Multi agency teams

Drug treatment
NICE suggest sertraline should be considered the first-line SSRI
if sertraline is ineffective, offer an alternative SSRI or a serotonin–noradrenaline reuptake inhibitor (SNRI)

286
Q

What are the five stages of grief

A

Denial: this may include a feeling of numbness and also pseudohallucinations of the deceased, both auditory and visual. Occasionally people may focus on physical objects that remind them of their loved one or even prepare meals for them
Anger:
Bargaining
Depression
Acceptance

DABDA

287
Q

S/E of lithium

A

nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia

288
Q

Lithium monitoring

A

Check lithium levels 12 hours post dose. weekly until concentrations stable and then every 3 months
Thyroid and renal function every 6 months

289
Q

Reversal of opioids

A

Naloxone

290
Q

Reversal of benzodiazepines

A

Flumazenil

291
Q

Reversal of TCAs

A

IV bicarbonate

292
Q

Reversal of lithium

A

Mild to moderate - IV fluids
Severe - haemodialysis

293
Q

TCA S/E

A

Dry mouth
Blurred vision
Constipation
Urinary retention

294
Q

Features of Addisonian crisis

A

Hyponatraemia
Hyperkalaemia
Hypoglycaemia

295
Q

Most common cause of Addison’s disease

A

Autoimmune

296
Q

Causes of SIADH

A

S - small cell lung cancer
I - infection (meningitis, pneumonia)
A - abscess (cerebral oedema)
D - drugs (carbemazepine, SSRIs
H - haemorrhage (subarachnoid)

297
Q

Confirmation of ovulation in investigating infertility

A

To confirm ovulation: Take the serum progesterone level 7 days prior to the expected next period if menstrual cycle is not 28 days
If 28 days - day 21 progesterone

298
Q

Booking visit

A

8 - 12 weeks (ideally < 10 weeks)
Booking bloods/urine
FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
hepatitis B, syphilis
HIV test is offered to all women
urine culture to detect asymptomatic bacteriuria

299
Q

Early scan

A

11 - 13+6 weeks
Early scan to confirm dates, exclude multiple pregnancy
Down’s syndrome screening including nuchal scan

300
Q

Anomaly scan

A

18 - 20+6 weeks

301
Q

First dose of Anti-D injection

A

28 weeks

302
Q

Baby in transverse lie

A

External cephalic version

303
Q

Amniocentesis time

A

15 weeks

304
Q

Chorion villus sampling

A

11-13+6 weeks
Transabdominally or transvaginally

305
Q

Idiopathic intracranial hypertension - population and management

A

Obese females
Weight loss
Acetazolamide

306
Q

Monochorionic diamniotic management and delivery

A

scan every 2 weeks
36-37+6

307
Q

Diamniotic dichorionic management and delivery

A

Scan every 4 weeks
37-38/40

308
Q

Gestational diabetes screening

A

24-28 weeks OGTT

309
Q

Neonatal hypoglycaemia

A

Babies need close monitoring for neonatal hypoglycaemia, with regular blood glucose checks and frequent feeds. The aim is to maintain their blood sugar above 2 mmol/l, and if it falls below this, they may need IV dextrose of nasogastric feeding.

310
Q

Gestational hypertension

A

> 20 weeks
No proteinuria

311
Q

Folic acid dose and timing

A

Normal 400mcg - before contraception to 12 weeks
>30 BMI, high risk NTD - 5mg before contraception to 12 weeks

312
Q

Signs of labour

A

Show (mucus plug from the cervix)
Rupture of membranes
Regular, painful contractions
Dilating cervix on examination

313
Q

Di-George Syndrome

A

CATCH-22 mnemonic:

C – Congenital heart disease
A – Abnormal facies (characteristic facial appearance)
T – Thymus gland incompletely developed
C – Cleft palate
H – Hypoparathyroidism and resulting Hypocalcaemia
22nd chromosome affected

314
Q

Reactive arthritis

A

Urethritis
Arthritis
Conjunctivitis

Aseptic joint aspiration with raised WBC

315
Q

How would you manage hyperacute graft rejection

A

Remove the ting

316
Q

Prophylaxis for contacts of meningitis

A

Rifampicin or ciprofloxacin

317
Q

Syphillis organism

A

Trepanema pallidum

318
Q

Bilateral upper and lower motor limb weakness

A

Rule out hypoglycaemia before doing CT head

319
Q

Treatment of Conn’s syndrome due to bilateral adrenal hyperplasia

A

Spironolactone

320
Q

Treatment of Conn’s syndrome due to adrenal adenoma

A

Surgery

321
Q

Side-effects of antipsychotics

A

Parkinsonism (procyclidine)
Tardative diskinesia (tetrabenazine)
Acute dystonia (procyclidine)
Akisthesia (bisoprolol)
Weight gain
Reduced seizure threshold
Impaired glucose tolerance
Increased stroke and VTE
Neuroleptic malignant syndrome

322
Q

Treatment of colorectal cancer: sigmoid colon

A

High anterior resection

323
Q

Treatment of colorectal cancer: low/high rectum

A

Anterior resection

324
Q

Treatment of colorectal cancer: anal verge

A

Abdomino-peroneal excision of the rectum

325
Q

Treatment of colorectal cancer: Descending colon

A

Left hemicolectomy

326
Q

Treatment of colorectal cancer: Caecal, ascending or transverse colon

A

Right hemicolectomy

327
Q

What is Hartmann’s procedure?

A

Used in emerency situations, where there is bowel perforation and the risk of failure of the colon-to-colon anastamosis is high, a temporary end colostomy is created and reversed at a later date.

328
Q

Most common type of bladder cancer

A

Transitional cell carcinoma

329
Q

Bladder cancer referral criteria

A

Aged over 45 with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI
Aged over 60 with microscopic haematuria (not visible but positive on a urine dipstick) PLUS:
Dysuria or;
Raised white blood cells on a full blood count

330
Q

Diagnosis of bladder cancer

A

Cystoscopy

331
Q

Management of bladder cancer

A

Transurethral resection of bladder tumour (TURBT)
Radical cystectomy
Chemo
Radio

332
Q

Successful wide local excision of breast cancer with normal margins and no lymph node metastasis, next step

A

Radiotherapy to prevent recurrence

333
Q

Bronchiolitis: immediate transfer to hospital if:

A

Apnoea
Grunting
Central cyanosis
O2 <92
>70 RR

334
Q

Management of intertrochanteric fracture

A

Dynamic hip screw

335
Q

Management of subtrochanteric fractures

A

Intramedullary device

336
Q

Management CKD induced proteinuria

A

ACE inhibitors

337
Q

Triad of infectious mononucleosis and diagnosis

A

Sore throat, pyrexia and lymphadenopathy

Monospot test

338
Q

Management of infectious mononucleiosis

A

Rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
consensus guidance in the UK is to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

339
Q

Blood transfusion threshold in ACS

A

80

340
Q

Platelet transfusion threshold

A

10

341
Q

Herpes and pregnancy

A

Oral aciclovir until delivery and then c-section

342
Q

Newly diagnosed grave’s in primary care

A

Propranolol

343
Q

Sickle cell crisis

A

Analgesia
Abx
Blood transfusion

344
Q

Acute graft failure

A

Acute graft failure (< 6 months)
usually due to mismatched HLA. Cell-mediated (cytotoxic T cells)
usually asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria
other causes include cytomegalovirus infection
may be reversible with steroids and immunosuppressants

345
Q

Concomitant oral opioids should not be prescribed whilst a patient is using an opioid PCA

A

:)

346
Q

ASA Grade: Healthy, non-smoking, no or minimal alcohol use

A

ASA 1

347
Q

ASA Grade: current smoker, social alcohol drinker, pregnancy, obesity (BMI 30 - 40), well-controlled Diabetes Mellitus/Hypertension

A

ASA 2

348
Q

ASA grade: poorly controlled Diabetes Mellitus/Hypertension, COPD, morbid obesity (BMI > 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, End-Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis, history (>3 months) of Myocardial infarction, Cerebrovascular accidents

A

ASA 3

349
Q

ASA grade: recent (< 3 months) of Myocardial infarction, Cerebrovascular accidents, ongoing cardiac ischaemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis

A

ASA 4

350
Q

ASA grade: ruptured abdominal/thoracic aneurysm, massive trauma, intra-cranial bleed with mass effect, ischaemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

A

ASA 5

351
Q

ASA grade: A declared brain-dead patient whose organs are being removed for donor purposes

A

ASA 6

352
Q

When do you fix undescended testis?

A

1 year old

353
Q

Fluid resuscitation in burns

A

Parkland formula
(Crystalloid only e.g. Hartman’s solution/Ringers’ lactate)
Total fluid requirement in 24 hours =
4 ml x (total burn surface area (%)) x (body weight (kg))
50% given in first 8 hours
50% given in next 16 hours

354
Q

Maintenance fluids in adults

A

25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis

355
Q

Risk of fluid overload in 0.9% sodium chloride

A

Hyperchloraemic metabolic acidosis

356
Q

What is cyclothymia?

A

Milder form of bipolar - hypomania rather than mania and more frequent highs and lows

357
Q

Management of Alzheimer’s

A

Neostigmine
Memantine (second-line)

358
Q

Treatment of MRSA

A

Vancomycin
Teicoplanin
Linezolid

359
Q

Limited cutaneous systemic sclerosis

A

CREST syndrome: Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
Anti-centromere antibodies

360
Q

Diffuse cutaneous systemic sclerosis

A

SCL-70
scleroderma affects trunk and proximal limbs predominately
Renal complications - ACE inhibitor

361
Q

Management of gout in renal impairement

A

Colchicine or intra-articular steroids

362
Q

Abx with risk of tendon ruptures

A

Quinolones - ciprofloxacin

363
Q

Management of reactive arthritis

A

NSAIDs

364
Q

Refeeding syndrome

A

Hypokalaemia
Hypophosphotaemia
Hypomagnasaemia

365
Q

Types of febrile convulsions

A

<15 minutes, generalised, no recurrence and complete recovery within an hour.
Complex: 15-30 minutes, focal seizure, may repeat within 24 hours
Febrile status epilepticus: >30 minutes

366
Q

What is the difference between congenital adrenal hyperplasia and androgen insensitivity syndrome?

A

Congenital adrenal hyperplasia - lack of 21 hydroxylase enzyme which causes underproduction of cortisol and aldosterone and overproduction of androgens from birth. Abnormal genitalia seen in children. Female features: tall, facial hair, absent periods, deep voice, early puberty.
Male features: tall, deep voice, large penis, small testicles, early puberty.
Management: cortisol replacement (hydrocortisone and fludrocortisone.
Androgen insensitivity syndrome - XY but externally female. Amenorrhoea, Raised LH
Normal or raised FSH
Normal or raised testosterone levels (for a male)
Raised oestrogen levels (for a male)
Management: bilateral orchidectomy, oestrogen therapy.

367
Q

Management for crohn’s

A

Inducing: Oral pred
Mesalazine
Azathio or mercapto/ methotrexate
Maintaning: aza/mercapto

368
Q

Management for UC

A

UC management: inducing remission.
Mesalazine (first-line) (oral or rectal)
Prednisolone (second line)
Maintaining remission:
Mesalazine (oral or rectal)
Azathioprine or mercaptopurine

369
Q

Meningitis in children <3months

A

Group B strep
E.coli

370
Q

Mumps complications

A

Orchitis
Pancreatitis
Parotitis
SSNHL
Meningitis

371
Q

Scarlet fever management

A

Pen V for 10 days

372
Q

Neonatal hypoglycaemia management

A

Management depends on the severity of the hypoglycaemia and if the newborn is symptomatic
* asymptomatic
o encourage normal feeding (breast or bottle)
o monitor blood glucose
* symptomatic or very low blood glucose
o admit to the neonatal unit
o intravenous infusion of 10% dextrose

373
Q

Kawasaki’s management

A

High dose aspirin and IV immunoglobulins

374
Q

Myasthenic crisis management

A

Plasmaphoresis and IV Immunoglobulins

375
Q

Gullian- barre management

A

IV immunoglobulins

376
Q

Wernicke’s encephalopathy

A

CAN OPEN
Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral
Neuropathy

377
Q

IgA vs post-streptococcus

A

IgA= three letters= 3 days
Post-streptococcal = 17 letter = (2-3 weeks)

378
Q

> 1 cm growth aneurysm asymptomatic management

A

Elective vascular surgery not urgent

379
Q

HIV - lung infection and prophylaxis

A

Pneumocistic jirovecii - co-trimoxazole

380
Q

At what point should a second drug (in combination with metformin) be added to lower this patient’s HbA1c?

A

> 58

381
Q

Side effect of anastrazole

A

Osteoporosis

382
Q

Haemodynamically unstable AF >48 hours

A

DC cardioversion

383
Q

Seborrhoeic dermatitis - features and management

A

Features
eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop
Face and body management
topical antifungals: e.g. ketoconazole
topical steroids: best used for short periods

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