Prep 4 Flashcards
ADHD diagnostic triad
inattention
hyperactivity
impulsivity
MSE
appearance and behaviour speech emotion (mood and affect) perception thought (content, form) insight cognition (MMSE)
cloazapine se
agranulocytosis
cardiomyopathy, weight gain
management of GAD
education and active monitoring
low intensity psychological intervention (self- help, groups)
high intensity psychological intervention (CBT, applied relaxation) or drug treatment (SSRIs - sertraline)
most common psychiatric problem after a CVA?
depression
Management of ADHD?
methylphenidate (monitor growth, psychiatry every 6months) se abdo, nausea, dyspepsia
atomexitine
three components of orientation
time
place
person
What is wernickes encephalopathy and what causes it?
neuropsychiatric disorder due to thiamine (B1) deficiency
seen commonly in alcoholics
triad: ophthalmoplegia, ataxia, confusion
if untreated can develop into korsacoffs (amnesia and confabulation)
step wise dementia
vascular
What is a rumination
focused attention on ones symptoms of stress and the causes and consequences but not solutions
excessive daytime sleepiness and sudden attacks of sleep
narcolepsy
sleep disorder in depression
early wakening
3 core symptoms of depression
anergia, anhedonia, low mood
antideprassant in pregnancy
sertraline
test for chlamydia
NAAT and PCR (endocervical swab or first pass urine)
management of opiod overdose
naloxone
coccaine overdose signs
dilated pupils
hyperstimulation
heroin overdose signs
shallow breaths
pinpoint pupils
man treated with antibiotics for presumed pneumonia, smoker, returns in 6 weeks still hoarse
refer to ENT immediately
bullous pemphigoid
IgG linear at BM no acantholysis
stabbed in neck and then shoulder pain
right axillary nerve
Elbow replacement then tingling in ring finger, positive froments sign
cubital tunnel syndrome (ulnar nerve palsy - weakness of APL, loss of thumb adduction)
abnormal pinch FPL innervated by median nerve compensates and thumb IPJ flexes
posterior hip dislocation
internal rotation
shortening
treatment of a tibial fracture in middle aged
closed fractures with minimal discplacement or stable reduction (long leg cast - delay cast application for 3-5 days to allow swelling to go down)
unstable fractures - operative fixation
DDH screening tests
ortolani (abduct and push thigh anteriorly - trying to relocate)
barlow (adduction of hip and push posteriorly - trying to dislocate)
clicks normal clunks abnormal
AAA screening
abdo USS >5.5cm in males needs repair
back pain, small pupils, red eyes
ank spon
treatment for anterior uveitis
topical prednisolone
treatment for acute angle closed glaucoma
IV acetazolamide
Prevention of pre-eclampsia
aspirin
hydralazine, labetalol, nifedipine
Treatment of eclampsia
mg sulphate
women with TAHBSO age 45 hot flushes and night sweats
oestorgen only hrt
39 year old woman with TAHBSO for endometriosis
sequential hrt
managing squints first step
correct refractive errors first
large for dates pregnancy missing GI tract
polyhydraminos is common in fetal anomoly
duodenal or oesophageal atresia
post menopausal lady with menorrgagia and intermenstrual bleeding
urgent referral to gynae
endometrial Ca, endometrial polyps, atrophy, endometrial hyperplasia, HRT
What is radiotherapy prescribed in?
gray
How are chemotherapy doses calcuated
patient’s calculated surface area
If SVCO is caused by an intrinsic clot which treatment should not be used
stent
what kind of back pain is typical in spinal cord compression
radicular
initial management in a patient with hypercalcemia
iv fluids
what type of lung cancer is most likely to lead to hypercalcemia
squamous cell
what is breakthrough dose for 30mg bd morphine sulphate tablets
10mg oromorph
what virus causes a significant proportion of oropharyngeal cancers
EBV
what 3 screening programmes are there in the uk
breast, bowel, cervical
When can tamoxifen be used in breast cancer
pre-menopausal women
when does ovarian cancers normally present
late
side effects of chemo
alopecia, vomiting, pancytopenia, oedema
Patient is diagnosed with oesophageal cancer, who do you refer to
upper gi and oncology
managment of malignant hyper calcemia
hydration
bisphosphonates
most likely of bilateral internuclear ophthalmoplegia in young
MS
cant adduct affected eye and nystagmus in the other - damage to MLF tract that is heavily myelinated
features of dermatoyositis
symmetrical proximal muscle weakness and characteristic skin lesions (photosensitive rash, helitrope rash, gottrons paupules- roughened surfaces over extensor surfaces of fingers)
What are the 3 main inflammatory myopathies
polymyositis
dermatomositis
inclusion body myositis
What is addisons disease
primary adrenal insufficiency (low cortisol and aldosterone, most commonly AI destruction of adrenal cortex)
why does addisons cause hyperpigmentation
MSH and ACTH have same precursor (increased ACTH results in more of the precursor being produced thus MSH)
function of aldosterone
increases reaborption of Na and excretion of K at distal tubules and collecting duct (works to increase BP)
diagnosis of addisons
short synacthen test (plasma cortisol measured before and after ACTH administration 250mcg im)
features of addisonian crisis
hyperkalemia (more k retained at kidney)
hyponatremia (less Na reabsorption - lack of aldosterone)
hypoglycema (loss of glucocorticoid effect)
metabolic acidosis (H+ retention at kidneys)
acne treatment and contraceptive
dianette (contains cyproterone acetate - antiadrogen and acts as form of progesterone and contains eostrogen)
bilateral red eye in child
chlamydial conjunctivitis (a - c serological group)
what is a dermatofibroma
benign fibrous nodule that commonly arises on lower leg
firm and tethered to skin surface move over underneath tissue
when can graduated compression be used on leg ulcers
ABPI >0.8 indicating venous cuase
ABPI 0.4
refer to vascular surgeon
histology in psoriasis
absent granular layer
hyperproliferation of keratinocytes
What drugs interact macrolide abx (clarithromycin etc)
statins
theophylline
(potent inhibitors of P450 enzymes involved in metabolising these drugs, increased levels of statin and theophylline in the blood and se more likely)
What does the combination of ACEi, NSAID and diuretic increase the liklihood of
high risk of AKI
physiological change in elderly
increased heterogenity
benzodiazepines causing memory loss
idiosyncratic effect
first order drug kinetics
rate of administration = rate of elimination (elimination is proportional to drug concentration)
when are patches preferred to oral/iv morphine
CKD
side effect of calcium
gi upset
what drugs commonly cause tremor
caffeine salbutamol lithium neuroleptics cyclosporine
when is metformin CI
renal impairment
exudate vs transudate
transudate protein <25 (HF, cirrohosis, hypoproteinaemia)
exudate protein >25 (malignancy, infection and inflammation)
Empyeme findings
pH <7.2
low glucose
raised LDH
walking up stairs and losing consciousness
vertebrobasilar insuffieciency
difference between alpha blockers (tamulosin, doxasosin) and 5-alpha reductast inhibitors (finasteride)
alpha blockers relax smooth muscle of prostate and bladder affect acheived in days and se postural hypotension
5-aloha reductase inhibitors reduce prostatic metabolism of testosterone take several months until effect se loos of libido and erectile dysfunction
tolteridone
antimuscarinic used in urge incontinence
bisphosphonate mechanism
increase apoptosis of osteoclasts
what combination is ueful in reducing fracture risk
bisphosphonate, calcium, vit d
mycobacterium tb features
acid fast bacilli
strict aerobe
stains ZN bright red
caseated granuloma
tb
ghon focus
tb
dka
metabolic acidosis
how can cushings cause infertility
pituitary adenoma with over secretion of ACTH
other pituitary hormones affected reduces FSH & LH production
23 year old para 0+0 woman is currently at 20 weeks gestation. She is currently well. Her sister had severe early onset pre-eclampsia and delivered a growth-restricted infant at 28 weeks. Which test should be performed to further assess this patient’s risk of developing pre-eclampsia
urinalysis for proteinurea
BP
Maternal artery doppler (in pre-eclampsia there is a pathological increase in placental vascular resistance - absent end diastolic flow or reversed end diastolic flow)
GORD in pregnancy
antacids (maalox)
alginates (gaviscon)
what should women at high risk of pre-eclampsia take
aspirin 75mg from week 12 until birth (previous htn, ckd, AI disorders, DM)
management and prophylaxis of seizures in pre-eclampsia
mg sulphate 4g IV
hrt in endometriosis
combined hrt (even if TAH BSO)
active 3rd stage of labour drug
syntocinon
definition of hypertension in pregnancy
> 140/90 or DBP>110 or >30/15 from booking visit
treat with labetalol, nifidepin or hydralazine
drugs in urge incontinance after bladder drills (at least 6 weeks)
oxybutinin (avoid in frail elderly)
tolteridone (antimuscarincs relax the over active detrusor)
treatment of stress incontinence
pelvic floor excerises for at least 3 months then consider surgery
what can cause polyhydraminos
monchorionic twins
anomolys (GI atresias, anencephaly, downs and edwards) maternal diabetes
hydrops fetalis
management of persistent eclamptic seizure
diazepam 10mg iv
Post menopausal lady with menorrhagia and intermenstrual bleed
urgent gynaereferral
first line hormonal treatment of menorrhagia
IUS
non hormonal tranexamic acid or mefanamic acid
contraception for pcos
COCP (increases ABG) or
diannete (co cyprindiol) has antiadonergics effects
pcos management for fertility
clomifine (anti-oestorgen)
+/- metformin
contraception if BMI >35
POP
what drug should be used for hyperthyroidism in pregnancy
propylthiouracil
PCOS criteria
> 2 of:
clinical or biochemical raised androgens
oligo/amenorrhea
polycystic ovaries on USS
flagellae under microscope
trachomonas
G-ve diploccoi
gonorrhoae
painful ulcers on labia
HSV
40ish woman, still having periods, but mood swings and hot flushes, what HRT?
oestrogen and mirena
51 year old Woman with hot flushes, night sweats, 18 months since last period
continous combined
Younger woman, still having irregular periods
sequential HRT
what cancer does tamoxifen increase risk of
endometrial (is a oestrogen receptor antagonist at breast but not at endometrium)
How long is tamoxifen used for after removal of oestrogen sensitive breast ca
5 years
management of vault prolapse
sacrospinous fixation
best treatment for a urethrocele no other medical problems
pelvic floor exercises
tx endometrial polyps
myomectomy
what is term
38-42weeks
presentation
part presenting into pelvis
postion
baby facing OA OP
lie
foetal axis to maternal axis
inducing ovulation in pituitary adenomas
GnRH
dopamine agonists
what does imperforate hymen increase risk of
endometriosis (retrograde menses)
tests to confirm menopause
FSH and LH levels
next investigation after increased endometrial thickness
endometrial biopsy
maagement of PID
IM ceftrioxone
metronidizole
doxycycline
deep dyspareunia fixed retroverted uterus
endometriosis
