QM/BM Flashcards
1
Q
Which metabolic and endocrine markers are elevated in anorexia?
A
Cortisol, GH, cholesterol, carotinaemia
2
Q
What is Benign Rolandic Epilepsy (BRE)?
A
The most common form of epilepsy in childhood, and children usually outgrow it.
3
Q
How does BRE present?
A
Typically presents in children <12 years of age with brief, focal episodes of seizure activity. The child maintains awareness throughout the episodes, which commonly occurs at night
4
Q
What is West syndrome?
A
Infantile spasms or salaam attacks, is characterised by head, neck and trunk contractions and occurs at around 6 months of age.
5
Q
What is the characteristic finding in West syndrome?
A
Hypsarrhythmia describes a chaotic and disorganised pattern on EEG, which is made up of multiple asynchronous spikes
6
Q
What is the most common cause of obstructive jaundice in the neonate?
A
Biliary atresia, typically occurring around 3 weeks of age
7
Q
Why are neonatal livers less able to conjugate bilirubin as efficiently?
A
Reduced activity of UDP-glucuronosyltransferase (UGT)
8
Q
When would you hear an S2 sound?
A
A split S2 describes when the aortic and pulmonary valves close at different times. Inspiration decreases the intrathoracic pressure, which increases venous return. More blood is then pumped through the pulmonary valve, delaying closure relative to the aortic valve.
9
Q
What is a paradoxical embolus?
A
Occurs when a thrombus crosses an intracardiac defect into the systemic circulation
10
Q
How do we treat cluster headaches long term?
A
Verapamil is a calcium channel blocker. Verapamil 80mg orally TDS is highly effective as long-term prophylaxis and is titrated according to the response. Once the patient has been headache free for at least 2 weeks this is gradually tapered off.
11
Q
Which bacteria does amoxicillin target in meningitis treatment of those under 3 months old?
A
Listeria monocytogenes
12
Q
Why do we use hyperventilation in deteriorating patients with subdural haematoma?
A
Can reduce pCO2 which causes cerebral vasodilatation and increased cerebral perfusion
13
Q
What are the symptoms of encephalitis?
A
Confusion, fever, headache, seizure
14
Q
Most common cause of encephalitis?
A
HSV, confirmed with CSF PCR
15
Q
What is the most common ECG change after antipsychotic commencement?
A
QT prolongation
16
Q
What dose of atorvastatin do we give to pts after stroke or TIA?
A
80mg, in order to reduce non-HDL cholesterol levels by at least 40% within 3 months
17
Q
What is the characteristic neck XR sign of epiglottitis?
A
Thumb sign
18
Q
How do we treat chronic lung disease in children under 9m.o.?
A
Palivizumab
19
Q
Define chronic lung disease of the preterm
A
Preterm and requiring oxygen for at least 28 days from birth
20
Q
What is a salpingoopherectomy?
A
A surgical procedure, which involves removing a woman’s ovaries and fallopian tubes
21
Q
What is the classical finding on chest/neck XR in croup?
A
Normally clinical diagnosis, but steeple sign (tracheal narrowing) seen on XR
22
Q
What is the test of cure for women treated for cervical intraepithelial neoplasia (CIN)?
A
Repeat cytology 6m after tx
23
Q
What are the symptoms of whooping cough?
A
Episodic high pitched coughing followed by post tussive vomiting. Maybe also low-grade pyrexia or coryzal symptoms.
24
Q
If a psych pt has an established diagnosis, do we use section 2 or 3?
A
3 for treatment as already has diagnosis.
25
What are the two key side effects of the progesterone depot injection (e.g. Depo-Provera)?
Weight gain and reduced bone mineral density (osteoporosis)
26
How does PID present?
Lower abdominal pain, usually bilateral, dyspareunia, vaginal discharge, cervical motion tenderness
27
What most commonly causes PID?
Chlamydia trachomatis
28
How does fronto-temporal dementia present?
Parkinsonism, visual hallucinations, REM sleep disorder. Cognitive symptoms precede motor symptoms.
29
What are the cardinal symptoms of parkinsonism?
Bradykinesia, rest tremor and rigidity
30
How do we treat fronto-temporal dementia?
There are medications to help manage symptoms such as anti-depressants or anti-psychotics, but the mainstay is supportive measures such as relaxation techniques and social interaction [1].
31
Which tests do you do for a 39y.o. lady with ? ovarian ca?
CA125 + AFP + hCG if under 40 to screen for ovarian germ cell tumour
Only CA125 if over 40
32
What is rhinorrhoea?
The free discharge of a thin nasal mucus fluid. Commonly known as a runny nose
33
What is mydriasis?
An unusual dilation or widening of the pupils
34
Which allele increases the likelihood of developing Alzheimer's disease?
Apolipoprotein E4, associated with young-onset disease
35
A pregnant lady with painless bright red vaginal bleeding typically has...
Placenta previa
36
How does B12 deficiency affect the spinal cord?
Subacute combined degeneration of the spinal cord affects the dorsal column and corticospinal tracts, hence the impairment of proprioception and upper motor neuron signs.
37
What is the most common cause of cervical cancer?
HPV
38
Which blood tests do you perform to diagnose Coeliac disease?
Anti-TTG and anti-EMA antibodies are IgA. Some patients have an IgA deficiency. When you test for these antibodies, it is important to test for total Immunoglobulin A levels because if total IgA is low because they have an IgA deficiency then the coeliac test will be negative even when they have coeliacs. In this circumstance, you can test for the IgG version of anti-TTG or anti-EMA antibodies or simply do an endoscopy with biopsies.
39
What is Uhthoff's phenomenon?
When the symptoms of MS (or other demyelinating diseases) worsen following a rise in temperature
40
How do we treat whooping cough?
If within 21 days of symptom onset, give macrolide abx (azithromycin/clarithromycin)
41
What environmental factors affect lithium levels?
Increase if dehydrated
42
Give symptoms of lithium toxicity
Coarse tremor, ataxia, dysarthria, nystagmus, convulsions
43
How do we distinguish between mania and hypomania?
Hypomania if less than seven days and no grandiosity
44
Why do we use co-beneldopa in PD?
Carbidopa is added to levodopa to prevent levodopa from being converted into dopamine in the bloodstream
45
When do we admit paed pts with bronchiolitis based on SpO2?
If SpO2 is less than 90% in children 6 weeks and over. In children under 6 weeks, they should be admitted if SpO2 is less than 92%.
46
What is pernicious anaemia?
Autoimmune condition where there is a deficiency of IF, meaning B12 can't be absorbed in the ileum. Most common cause of B12 deficiency in the UK.
47
What is the first line treatment for PID?
IM ceftriaxone (single dose) followed by oral doxycycline and metronidazole for 14 days
48
How do we diagnose delirium?
Confusion assessment method
49
Describe the presentation of placental abruption
Continuous abdo pain, antepartum haemorrhage, abnormalities on the CTG indicating fetal distress,
characteristic “woody” abdomen on palpation (suggesting a large haemorrhage)
50
If the CTG is normal, how do we manage placental abruption?
Corticosteroids should be given to promote lung maturity if under 37 weeks and both the mother and foetus must be monitored
51
What increases the risk of epilepsy after febrile seizure?
If seizure was complex e.g. focal features (one side of body), >15min, recurrence within 24hrs, incomplete recovery within 1 hour
52
What medication do we use as prophylaxis in migraines?
Propanolol
53
How do we manage placenta praevia at 31+1?
If stable, the position of the placenta should be rechecked at 32 weeks gestation by TVUS, if persistently low-lying another TVUS should be performed at 36 weeks gestation. This will be used to confirm the diagnosis of placenta praevia and guide delivery
54
How do we diagnose SAH if CT was inconclusive?
LP to see xanthochromia (12 hours post bleed)
55
How do we treat asthma in children where it affects their sleep?
She should be started on a beta-agonist as a result. As per NICE guidelines, patients who have symptoms ≥3 times a week or night-time waking should be started on an inhaled corticosteroid (ICS) as well [1].
56
What is transient global amnesia?
Anterograde amnesia with no other alteration in consciousness
57
Describe the pathophysiology behind Hirschprung's Disease.
Proteins that assist neural crest migration through the developing digestive tract (e.g. RET) are mutated in this disease. Therefore, these cells do not migrate and fail to differentiate into the ganglion cells that form the plexuses in the colon.
58
How do we diagnose Hirschprung's disease?
Suction renal biopsy
59
Where would you find no Auerbach or Meissner plexuses?
Hirschprung's disease
60
Define placenta praevia
The placenta is < 20mm from the internal cervical os but does not cover it [1].
61
Describe the constituents of a mature teratoma
An ovarian cyst with features suggesting the presence of fat and teeth. Common in younger women.
62
How long are whooping cough pts advised to stay at home?
Until 48 hours after the completion of antibiotic therapy or 21 days after the onset of symptoms if they did not receive antibiotic therapy
63
What usually precedes SAH?
Rupture Berry aneurysm
64
What is the eye opening response scale in GCS?
4 Spontaneously, to speech, to pain, 1 no response
65
What is the verbal response in the GCS scale?
5 oriented to time, person and place; confused; inappropriate words; incomprehensible sounds; no response
66
What is the motor response in GCS scale?
6 Obeys command, moves to localised pain, flex to withdraw from pain, abnormal flexion, abnormal extension, 1 no response
67
Name a vestibulotoxic drug
Gentamycin - will affect balance not hearing
68
What is a first line for migraine prophylaxis which isn't propanolol?
Topiramate
69
How does oesophageal atresia present?
Oesophageal atresia often presents as polyhydraminos. As the oesophagus is blind-ending, fluid cannot pass through the baby to be absorbed. This results in an accumulation of fluid outside the baby – hence the polyhydramnios.
Postnatally the baby has problems with swallowing. The baby will have difficulty feeding and has overflow saliva. There may also be a trachea-oesophageal fistula
70
Which cancer do untreated coeliacs pts have a higher risk of?
Lymphoma
71
A pt at 12+3 asks for amniocentesis due to a family history of Down's syndrome. What are you going to advise?
Before 15 weeks, chorionic villus sampling is the procedure of choice for obtaining a sample of foetal DNA
72
How does parvovirus B19 present in children?
Slapped cheek syndrome: fever, coryza and diarrhoea. Following this, a diffuse 'lace-like' rash develops across the body with a characteristic bright red rash on the cheeks
73
How do we diagnose Meckel's diverticulum?
A technetium scan, using radioactive metastable technetium-99, will highlight ectopic gastric mucosa
74
A pt refuses refeeding treatment for her anorexia. What are the next steps?
Re-feeding is permitted under the MHA as her physical problem is a result of her mental disorder.
75
What is splitting?
Where individuals are considered wholly good or bad
76
Which anti-psychotics have mood stabilising effects?
Olanzapine, haloperidol, risperidone, quetiapine
77
Name the main side effect of ropinirole (dopamine agonist)
Used in PD
| Impulsivity, which can lead to pathological gambling and hypersexuality
78
A pt with Parkinson's disease needs rapid tranquillisation. Which drug do we use?
Lorazepam, as haloperidol is contraindicated due to the fact it promotes the dopamine blockade, resulting in psychosis and a deterioration in motor function
79
How are opiates cleared? Are there any exceptions?
Renally, other than tramadol
80
Name a common cause of microcytic anaemia
Thalassaemia trait
81
What is pseudo-dementia?
Also known as depressive dementia, this is an important differential in the elderly, severe depression can lead to psycho-motor slowing, memory impairment and difficulties in concentration similar to dementia in appearance.
82
A pt who has just recovered from a UTI has a decreased GFR. What are you going to do?
Trimethoprim can reduce creatinine excretion from the kidneys, but doesn’t affect the actual GFR
83
Name a common SE of amitryptiline
Constipation, as it has anticholinergic properties
84
What are the three core features of Lewy Body dementia?
Fluctuating attention and concentration, recurrent well-formed visual hallucinations, spontaneous Parkinsonism
85
What is Charles Bonnet syndrome?
Associated with visual loss, these patients often describe smaller versions of real life objects commonly of faces or cartoons. Importantly, they realise that the hallucinations are not real.
86
Why can't you prescribe nitrates and PDE5 inhibitors together?
Leads to vasodilation of the peripheral vasculature leading to a drop in the blood pressure in a similar way to how nitrates work. When taken together the effect is compounded and has led to several deaths in the 1990s.
87
How do we treat postural hypotension?
Fludrocortisone. A type of corticosteroid, it is mainly used for its mineralocorticoid properties leading to sodium retention and effective blood volume and therefore pressure. Indications include orthostatic intolerance and adrenal insufficiencies.
88
Define uterine hyper-stimulation
Greater than 5 contractions within 10 minutes
89
Why does foetal HR decrease in uterine hyper-stimulation?
Due to increased freq of contractions and thus increased compression on the foetal head
90
How do we treat uterine hyper-stimulation?
Tocolytic agents
91
What is choriocarcinoma?
A rare tumour which is present after evacuation of a hydatidiform mole, where b-hCG levels fail to drop.
92
What is external cephalic version?
usually offered at 36 weeks and involves applying pressure to the maternal abdomen in an attempt to “turn” the baby.
93
What is cyclizine used for?
Reduce N&V
94
What is placenta percreta?
the most severe form of abnormal placental villous adherence. Here the placental villi extend past the normal confines of the uterine myometrium and can even adhere to other abdominal structures such as the bladder.
95
How do we diagnose placenta previa?
TVS
96
How do we treat rhesus-negative pts?
One anti-D dose at 28 weeks of 1500IU
97
How do we terminate pregnancies between 10+1-23+6 weeks?
200mg oral mifepristone followed by 800mcg misoprostol
98
What is the action of mifepristone
a progesterone receptor antagonist and functions to inhibit the action of circulating progesterone, causing endometrial degeneration, cervical softening and increases the uterine sensitivity to prostaglandins.
99
What is the action of misoprostol?
A prostaglandin analogue which causes smooth muscle contractions of the myometrium, resulting in expulsion of uterine contents.
100
When must a gestational diabetes pt deliver by?
40+6 weeks, due to increased risk of stillbirth.
101
What is the triad of congenital toxoplasmosis?
Hydrocephalus, chorioretinitis
| Usually acquired through exposure to cat faeces.
102
What does a boggy uterus suggest?
Non-contracted, the uterus has failed to contract sufficiently to stem blood from the uterine vessels sheared during delivery.
103
What is the Bishop score used for?
Used to predict whether spontaneous labour will occur. A score of 5 or less suggests labour is unlikely to occur w/o induction.
104
How do prostaglandin pessaries work?
Cause cervical ripening and labour induction.
105
Why does PID increase ectopic pregnancy risk?
Slows the ovum's passage through the fallopian tube to the uterus.
106
What is cervical ectropion?
Happens when cells that line the inside of your cervix grow on the outside. These cells are redder and are more sensitive than the cells typically on the outside, which is why they may cause symptoms, like bleeding and discharge, for some women.
107
How does ectopic pregnancy usually present?
Unilateral cramping pain, amenorrhea for 6 weeks, scant vaginal bleeding of dark brown colour
108
Why can't you do a digital vaginal examination on a woman with placenta praevia?
Performing a digital examination in a woman with placenta praevia can provoke serious haemorrhage.
109
Why do we avoid amiodarone in breastfeeding?
Present in breastmilk in significant amounts and can lead to neonatal hypothyroidism from release of iodine.
110
What is acute fatty liver of pregnancy?
a rare complication of pregnancy. Commonly occurs in the third trimester of immediately following delivery, and is thought to be mroe common in nulliparous women. Presents with general malaise, anorexia, vomiting and jaundice. Tx w/ immediate delivery.
111
Why do we give folic acid?
Folic acid is converted to tetrahydrofolate (THF), which is involved in the synthesis of DNA and RNA. Deficiency in folic acid can cause neural tube defects (NTD).
112
When do we give folic acid?
Until the 12th week of pregnancy.
113
What must you be careful of when there's intractable vomiting in pregnancy?
Thiamine deficiency, leading to Wernicke's
114
A 36+1 lady presents with elevated liver enzymes and low platelets. What is the primary differential?
elevated liver enzymes and low platelets should make you think of HELLP syndrome
115
How do we treat placenta increta?
Hysterectomy
116
How do we use Naegele's rule?
Determine the first day of your last menstrual period, add 9 months and 7 days
117
How does congenital CMV present?
Hearing loss, visual impairment and LD
118
How does placenta accreta present?
Either through US or failure of delivering the placenta, leading to PPH
119
What is amniotic fluid embolism?
severe condition where the amniotic fluid passes into the mother’s blood, usually around delivery. Presents similarly to sepsis.
120
What is congenital toxoplasmosis?
A severe condition typically presenting with hydrocephalus, seizures, visual and hearing impairment. Caused by the parasite toxoplasma gondii, found in cat faeces or contaminated food products
121
Why don't we perform CVS sampling before 11 weeks gestation?
Risk of foetal limb abnomalities
122
What is the first line anti-emetic for hyperemesis gravidarum?
Promethazine
123
Why is classic caesarean section scar an absolute contraindication to VBAC?
Due to a high risk of uterine rupture
124
Where do you find listeria monocytogenes?
Unpasteurized dairy products and soft cheeses
125
How do we treat endometrial hyperplasia and why?
COCP, prevents hyperplasia and can improve acne seen in PCOS
126
A F pt presents with oligomenorrhoea and clinical signs of hyperandrogenism (acne, hirtuism). What is the primary differential?
PCOS
127
What is Cervical intraepithelial neoplasia?
a grading system for the level of dysplasia (premalignant change) in the cells of the cervix. CIN is diagnosed at colposcopy (not with cervical screening). The grades are:
CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated
CIN III: severe dysplasia, very likely to progress to cancer if untreated
128
When is contraception required after delivery?
3 weeks after
129
How do we treat maternal chickenpox?
Aciclovir
130
How does herpes simplex virus present in pregnant women?
Flu-like illness and painful vesicular lesions around vagina
131
What is the difference between the combined and the quadruple test?
Both screening tests. Quadruple after 13 weeks, combined up to 11
132
What does the turtle neck sign indicate?
Macrosomia
133
What is HELLP syndrome?
a variation of severe pre-eclampsia and requires immediate treatment including delivery of the foetus.
HELLP syndrome is managed via urgent delivery of the baby and supportive treatment of organ failure.
134
What three abnormalities do you see in HELLP syndrome?
The three abnormalities found in HELLP syndrome are haemolysis (H), elevated liver enzymes (EL), and low platelets (LP).
135
What is the Kleihauer test?
Used to quantify the dose of Rh-D antigen in maternal circulation. In significant sensitising events (events during which Rh-D antigen enters the maternal Rh-negative circulation), a Kleihauer test can guide the amount of anti-D IG needed to prevent maternal sensitisation
136
How do we reduce psychotic symptoms medically?
Dopamine receptor antagonism, e.g. by olanzapine or risperidone
137
What electrolyte imbalances do you see in refeeding syndrome?
Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces.
138
Which type of vaccines are contraindicated in immunocompromised pts?
Live attenuated vaccines, such as the MMR vaccine
139
A ground glass appearance is seen on CXR. Diagnosis?
Neonatal respiratory distress syndrome.
140
What causes retinopathy of prematurity?
ROP is caused by free radical damage to the retina from high oxygen levels.
141
What is chorioamnionitis?
Infection of the membranes in the uterus.
142
How do we treat recurrent miscarriages due to anti-phospholipid syndromes?
Anti-platelets and anticoagulants
143
How do we treat group B strep in pregnant women?
Penicillin, or vancomycin if contraindicated
144
What does the Coomb test show?
Antiglobulin testing, also known as the Coombs test, is an immunology laboratory procedure used to detect the presence of antibodies against circulating red blood cells (RBCs) in the body, which then induce hemolysis
145
Why do we stop methotrexate use in pregnancy?
It is a folic acid antagonist which can result in anencephaly, hydrocephalus, cleft lip/palate and skull defects
146
How do we manage euthymic pts with diagnoses of hypothyroidism in pregnancy?
NICE recommends increasing levothyroxine by 25 mcg as soon as pregnancy is confirmed despite a euthyroid state. The explanation for this is that in pregnancy there is a physiological increase in serum free thyroxine until the 12th week of pregnancy as the foetus is dependent on mother's circulating thyroxine until the 12th week of development when the foetal thyroid develops. Untreated hypothyroidism can lead to neurodevelopmental delay of the foetus. This surge is not seen in hypothyroid patients. Therefore, levothyroxine should be increased to mimic this surge.
147
What does green tinged liqour during birth show?
Meconium is present. If inhaled by baby, meconium aspiration syndrome can occur.
148
Why is breast feeding preferred in women with epilepsy?
Anticonvulsant medication is present in breast milk in smaller quantities and allows the baby to withdraw slowly
149
What is fetal renal agenesis?
a cause of oligohydramnios because such abnormalities lead to reduced fetal urine production and thus reduced amniotic fluid.
150
What is diabetic amyotrophy?
Asymmetric wasting of the thighs in diabetes
151
What is LEMS?
LEMS is a neuromuscular junction disorder that usually presents with an ascending pattern of weakness that improves upon repetition/usage.
152
What is gastroparesis?
Partial paralysis of the stomach
153
What organism causes Lyme disease?
Borrelia Spp.
154
What is the first line tx for impetigo
Fusidic acid
155
What is the other name for varicella virus?
Human herpes virus 3
156
What effect do macrolides have on the heart?
Lengthen the QT interval
157
What antenatal liver condition can cause CP?
Hepatic ischaemic encephalopathy
158
What does bilious green vomiting a few days after birth suggest?
Malrotation. Perform upper GI contrast study.
159
Describe fibrocystic disease presentation.
bilateral nodularity in a younger patient which worsens in relation to their menstrual cycle.
160
What is the first line tx of infective mastitis
Flucloxacillin
161
What is the difference between tamoxifen and trastuzumab?
Tamoxifen is a selective oestrogen-receptor modulator used in the treatment of oestrogen receptor positive breast cancer.
Trastuzumab (trade name Herceptin) is a monoclonal antibody used in the treatment of HER2 receptor positive breast cancer
162
What is Todd's paresis?
Weakness following a seizure
163
Name SEs of topiramate.
Weight loss, renal stones, cognitive/behavioural changes
164
What is Stevens-Johnson syndrome?
A very severe reaction to medications that causes skin tissue to die and detach
165
What is ovarian hyperstimulation syndrome?
A complication of ovarian stimulation during IVF fertility treatment. It is associated with the use of hCG to mature the follicles during the final steps of of ovarian stimulation.
166
Describe the pathophysiology leading to OHSS
hCG causes an increase in vascular endothelial growth factor (VEGF) released by granulosa cells leads to an increase in vascular permeability, leading to oedema, ascites and hypovolaemia.
167
How do we determine the severity of OHSS
By how raised the renin level is
168
How does haematocrit vary with intravascular fluid volume?
Haematocrit is the concentration of red blood cells in the blood. When the haematocrit goes up, this indicates less fluid in the intravascular space, as the blood is becoming more concentrated. Raised haematocrit can indicate dehydration.
169
What is infectious mononucleosis
Glandular fever, caused by EBV. It is known as the kissing disease as it is found in the saliva of infected individuals.
170
Describe the typical glandular fever presentation.
An adolescent with a sore throat, who develops an itchy rash after taking amoxicillin. Mononucleosis causes an intensely itchy maculopapular rash in response to amoxicillin or cefalosporins
171
What are heterophile antibodies?
In infectious mononucleosis, the body produces something called heterophile antibodies, which are antibodies that are more multipurpose and not specific to the EBV antigens. It takes up to 6 weeks for these antibodies to be produced.
172
How do we test for heterophile antibodies?
Monospot test: this introduces the patient’s blood to red blood cells from horses. Heterophile antibodies (if present) will react to the horse red blood cells and give a positive result.
Paul-Bunnell test: this is similar to the monospot test but uses red blood cells from sheep.
173
How do we manage glandular fever?
Patients are advised to avoid alcohol, as EBV impacts the ability of the liver to process the alcohol. Patients are advised to avoid contact sports due to the risk of splenic rupture.
174
What is Prader-Willi Syndrome?
a genetic condition caused by the loss of functional genes on the proximal arm of the chromosome 15 inherited from the father. This can be due to a deletion of this portion of the chromosome, or when both copies of chromosome 15 are inherited from the mother.
175
What is the main feature of Prader-Willi syndrome?
The key feature everyone remembers for Prader-Willi syndrome is the the insatiable hunger. Feeding can often be a challenge initially due to hypotonia and it is only later that the food seeking and excessive eating occur. It is worth remembering some other key facts about the condition, such as the treatment with growth hormone and the poor muscle tone, so that you know more than just the link with appetite.
176
What is Mittelschmerz?
mid-cycle ovulatory pain and it is common. The pain is due to rupture of the Graafian (dominant) follicle, each month, which results in the release of an ovum into the fallopian tube. The pain can vary from being right-sided to left-sided depending on which ovary is ovulating that month.
177
How do we treat Mittelschmerz?
Duration of pain can vary from minutes up to a few days and it can be controlled using simple analgesics such as paracetamol and NSAIDs.
178
What is the diagnosis criteria for endometrial cancer on TVS?
Endometrial thickness less than 5mm uniformly
179
What is the link between rifampicin and COCP?
Rifampicin decreases the efficacy of the COCP as it is a liver enzyme inducer.
180
Where do 75% of ectopic pregnancies occur?
In the ampulla of the fallopian tube
181
What is mefenamic acid?
A NSAID that is used in the management of menorrhagia, but it can reduce fertility unlike TXA
182
How does BMI relate to endometriosis risk?
Low BMI = higher risk
183
What is the most common cause of postmenopausal bleeding?
Atrophic vaginitis
184
How do we treat endometrial hyperplasia with cellular atypia?
If atypia is present, a total hysterectomy and bilateral salpingo-oophorectomy is indicated in postmenopausal women. In premenopausal women, a total hysterectomy alone is possible.
185
How do we treat endometrial hyperplasia without atypia?
Surveillance +/- progestogens
186
What are ovarian thecomas?
A rare type of ovarian cancer that secrete oestrogen
187
Why do we advise against using the COCP during the first trimester?
Associated with miscarriage
188
What are schistocytes?
fragments of red blood cells seen on blood film
189
What is the red degeneration of a fibroid?
A history of a pregnant patient with abdominal pain, low-grade fever and background of multiple uterine fibroids is classical for “red degeneration” of a fibroid. This describes the rapid growth of a fibroid, leading to outgrowth of its blood supply causing ischaemia and bleeding, due to the surge of sex hormones, particularly during pregnancy
190
What does a large uterus for dates suggest?
? hydatidiform mole
191
How do we manage choriocarcinoma?
Women with low-risk disease are treated with methotrexate. If there is evidence of metastases or high-risk disease, then further agents are added.
192
What is dermatitis herpetiformis?
an itchy, blistering, autoimmune skin condition associated with coeliac disease. It is caused by IgA deposition in the skin, leading to vesicle formation
193
Why do we offer the pneumococcal vaccine to coeliac pts?
Patients with coeliac disease often develop splenic dysfunction, known as functional hyposplenism. This leaves patients susceptible to infection by encapsulated bacteria
194
What type of bacteria is Haemophilus influenzae type B?
Gram -ve, coccobacillary facultative anaerobe
195
How does dehydration affect lactate levels?
Raises
196
What does raised serum tryptase suggest?
Anaphylaxis
197
What type of hypersensitivity reaction is anaphylaxis?
Type I hypersensitivity mediated by IgE
198
What is acanthosis nigricans, and what is it related to?
The hyper-pigmentation and thickening (hyperkeratosis) in these locations is typically of acanthosis nigricans, which is related to insulin resistance.
199
What is the triad for vasa previa?
painless vaginal bleeding, rupture of membranes and fetal bradycardia (fetal heart rate <100bpm)
200
What does a holo-systolic murmur at the lower left sternal edge indicate?
VSD
201
Describe the rash seen in measles
erythematous, blanching maculopapular rash all over, with grey spots on his buccal mucosa
202
What is the most common cause of proteinuria in children?
Transient proteinuria. It is benign and tends to recede as the precipitant is removed. Precipitants include seizures, strong infections, pregnancy and heavy exercise.
203
What does retinal haemorrhage suggest in children?
can be suggestive of non-accidental injury (commonly known as 'shaken baby syndrome', but seen in older children as well who may have sustained traumatic brain injuries as a result of physical abuse
204
What is the third line treatment for fibroids?
Oral norethisterone
205
What is the Frank breech position?
When the baby's legs are folded flat up against his head and his bottom is closest to the birth canal.
206
What is complete breech?
when both of the baby's knees are bent and his feet and bottom are closest to the birth canal
207
What in incomplete breech?
when one of the baby's knees is bent and his foot and bottom are closest to the birth canal
208
What is Bishop scoring used for?
Determining the chance of spontaneous induction of labour without assistance. 6 or above, 5 or below
209
What causes HIE?
Hypoxic ischaemic encephalopathy (HIE) occurs in neonates as a result of hypoxia during birth
210
Give RFs for HIE.
Events that could lead to hypoxia during the perinatal or intrapartum period,
acidosis (pH < 7) on the umbilical artery blood gas,
poor Apgar scores,
features of mild, moderate or severe HIE (see below)
or evidence of multi organ failure
211
What is Sarnat staging?
HIE grades
212
What is therapeutic hypothermia?
Therapeutic hypothermia involves actively cooling the core temperature of the baby according to a strict protocol. The baby is transferred to neonatal ICU and actively cooled using cooling blankets and a cooling hat. The temperature is carefully monitored with a target of between 33 and 34°C, measured using a rectal probe. This is continued for 72 hours, after which the baby is gradually warmed to a normal temperature over 6 hours.
The intention of therapeutic hypothermia is to reduce the inflammation and neurone loss after the acute hypoxic injury. It reduces the risk of cerebral palsy, developmental delay, learning disability, blindness and death.
213
What is transient tachypnoea of the newborn?
A parenchymal lung disorder characterised by pulmonary oedema resulting from delayed resorption and clearance of foetal alveolar fluid. Commonly occurs after c-section.
214
How do we treat transient tachypnoea of the newborn?
Treatment is with oxygen. TTN should resolve in a couple of days with resorption of lung fluid.
215
What is tuberous sclerosis?
An autosomal-dominant, neurocutaneous, multi-system disorder characterised by cellular hyperplasia, tissue dysplasia, and multiple organ hamartomas.
216
Give features of tuberous sclerosis
Infantile spasms, ash leaf spots, LD/ASD, epilepsy
217
What is Friedreich's ataxia?
a hereditary neurodegenerative disorder affecting the corticospinal tracts, spinocerebellar tracts, dorsal columns, and peripheral nerves
218
How does Friedreich's ataxia present?
Teenage years with lower limb weakness, gait abnormalities, or falls
On physical examination there may be cerebellar signs (due to involvement of the spinocerebellar tracts) or mixed upper and lower motor neuron signs
Involvement of the dorsal columns can lead to impaired joint/vibration sense. Other clues on physical examination include a high-arched palate, pes cavus, and kyphoscoliosis
219
What is Klumpke's palsy?
Involves the C8-T1 nerve roots with corresponding dermatomal sensory loss, and weakness of the intrinsic muscles of the hand. Uncommonly, T1 involvement may also result in an ipsilateral Horner's syndrome.
220
What is Erb's palsy?
Involves the C5-6 nerve roots with corresponding dermatomal sensory loss, and the so-called "waiter's tip" sign with shoulder adduction, elbow extension, forearm pronation and wrist flexion. It is most typically associated with shoulder dystocia and traumatic childbirth.
221
What is ulipristal acetate also known as?
EllaOne
222
How does ulipristal acetate work?
selective progesterone receptor modulator (SPRM). It is used as the ‘morning after pill’ by preventing/delaying ovulation.
223
How does leuprorelin acetate work?
An example of a gonadotropin-releasing hormone (GnRH). These agonists (e.g. leuprorelin acetate) prevent FSH/LH release, used in endometriosis. They shut down the ovaries temporarily and can be useful in treating pain in many women.
224
What is Lynch syndrome?
Also known as hereditary non-polyposis colorectal cancer (HNPCC), is the most common cause of hereditary colorectal (colon) cancer.
225
What is Lynch syndrome associated with?
MLH1 gene defect. Lynch syndrome is associated with a significantly increased risk of endometrial cancer (as well as many other cancers such as colon, breast and ovarian)
226
What is Haemolytic uraemic syndrome?
occurs when there is thrombosis within small blood vessels throughout the body. This is usually triggered by a bacterial toxin called shiga toxin (e-coli 0157).
227
What is the triad in HUS?
Haemolytic anaemia: anaemia caused by red blood cells being destroyed
Acute kidney injury: failure of the kidneys to excrete waste products such as urea
Thrombocytopenia: low platelet count
228
How do we manage HUS?
Medical emergency and has a 10% mortality. Urgent referral to paediatrics. Supportive management.
229
How does orbital cellulitis present?
erythema and oedema around one eye, fever, reduced visual acuity, and painful eye movements
230
Name a common trigger for orbital cellulitis
Bacterial sinusitis (frontal headache, fever, excessive mucous) is a common trigger.
231
What is the classic XR finding for necrotising enterocolitis?
grossly distended bowel loops with air within the bowel wall (pneumointestinalis)
232
Name the triad seen in nephrotic syndrome
Oedema (usually periorbital), proteinuria, hypoalbuminaemia
233
What is the most common cause of nephrotic syndrome in children
Minimal change disease
234
Where do you refer ? osteosarcomas to, and how quickly?
Very urgent (48-hour) referral for an X-ray to assess for bone sarcomas. Osteosarcomas are the most common non-haematological primary malignant neoplasm of the bone in children
235
What is the procalcitonin blood test used for?
Inflammatory markers that could detet bacterial sepsis
236
What is caput succedaneum?
a collection of fluid that collects due to pressure on the head during vaginal delivery. (C)aput (s)uccedaneum (c)rosses (s)uture lines. This will usually spontaneously resolve within days.
237
How do we rule out vesicoureteric reflux?
MCUG: micturating cystourethrogram (MCUG) is a scan that shows how well your child's bladder works
238
What is vesicoureteric reflux?
s a condition in which urine backwashes back up in the ureters/kidneys from the bladder
239
How does roseola infantum present, and what is it caused by?
A 3-5 day fever followed by a maculopapular rash is characteristic of roseola infantum, a condition caused by human herpes virus 6.
240
What is the main complication to be aware of with roseola infantum?
Febrile seizures
241
What is pavilizumab used for?
A monoclonal antibody that minimises the risk of infection by RSV. It is given subcutaneously once a month during bronchiolitis season.
242
What peak flow is indicative of a life-threatening episode of acute asthma?
33%
243
How does fronto-temporal dementia present?
This condition is characterised by a change in personality. Often recognised by the patient’s friends and family, this can include changes in food preference or picking up new, often problematic hobbies like gambling. Memory remains intact until the later stages of the disease. This patient is not exhibiting any of the classical symptoms of Fronto-temporal lobe dementia.
244
What is the triad seen in Lewy Body dementia?
Triad of REM sleep disorder, a history of falls (secondary to motor problems), and hallucinations.
245
What is Munchausen's syndrome?
Where a pt intentionally faking signs and symptoms (i.e. adding blood to urine and complaining of pain) in order to gain attention and play “the patient role”.
246
What is the peak age of onset for FTD?
55-65 years
247
How do we treat the symptoms of menopause?
Monthly, cyclical (sequential) HRT is recommended for women with menopausal symptoms who continue to have regular periods. It consists of taking oestrogen throughout the menstrual cycle, with progesterone taken only in the last 14 days. This combination maintains normal monthly periods which is useful because it is then possible to determine when periods naturally stop. When this occurs, it is an indicator of progression to the last stage of the menopause.
248
How does ovarian torsion present on ultrasound or CT?
Whirlpool sign
249
What causes hand foot and mouth disease?
Coxsackie A virus
250
How does transposition of the great vessels present on CXR?
egg-on-a-string' appearance
251
What will you see on abd US in intussusception?
Target/doughnut sign
252
When do we start worrying about squints?
After 8 weeks
253
What is a common cause of resp tract infections in pts with cystic fibrosis?
Pseudomonas
254
What is the key differential for a child with a barking cough that doesn't resolve with treatment?
Bacterial tracheitis
255
Define aplastic crisis
Reticulocytes <1%
256
How does aplastic crisis in Sickle Cell Disease present?
Tachypnoea, tachycardia in the absence of splenomegaly
257
What is a morbilliform eruption?
A generalised maculopapular rash. Morbilliform reactions are extremely common in patients with infectious mononucleosis taking Amoxicillin.
258
What is the dose of benzylpenicillin in teenage meningitis?
1.2g
259
How does CF present in childhood?
meconium ileus as a neonate, failure to thrive and loose stool as a toddler, short stature and chronic respiratory disease in older childhood
260
What does the heel prick test show for a pt with cystic fibrosis?
High immunoreactive trypsinogen
261
Why can coarctation of the aorta lead to aneurysm formation?
Reduced perfusion pressures distal to stenosis trigger the renin-angiotensin-aldosterone system with limited effect as this won't overcome the stenosis. It however will increase perfusion pressures before the stenosis, including the carotids, resulting in higher cerebral perfusion pressures which can cause aneurysms to form.
262
What causes inguinal hernias in children?
caused by failure of the processus vaginalis to obliterate
263
What is formication, and where is it seen?
Sensation of insects on the skin, seen in delirium tremens
264
What is the main SE of memantine?
Constipation
265
What are neuroleptics?
Neuroleptics, also known as antipsychotic medications, are medications that block dopamine receptors in the nervous system.
266
How does neuroleptic use impact pts with Lewy Body Dementia?
Causes a deterioration in parkinsonism
267
What is neologism?
Coining new words together
268
What is monomania?
The preoccupation with a single subject to a pathological degree
269
What is logoclonia?
Where a pt repeats the last syllable of a word or phrase.
270
What is Lichen sclerosus?
a chronic inflammatory skin condition which affects the anogenital area (specifically the glans penis and prepuce in men). The lesions are white thickened papules and/or plaques. Itch can occur, and there may be pain if there are fissures or erosions.
271
What is Sheehan's syndrome?
post-partum pituitary gland ischemic necrosis due to blood loss and resultant hypovolemic shock in the immediate post-partum period. Presents with hypothyroidism symptoms.
272
What is the cut-off for surgical fibroid treatment?
Symptomatic and 3cm or larger. Treated with myomectomy - removes the fibroids from the uterus
273
What is a cystocele?
A cystocele is the herniation of the bladder into the vagina. There may also be a concurrent urethrocele which is the prolapse of the urethra into the vagina.
274
What is HSP?
Henoch-Schonlein Purpura (HSP). HSP is the most common small vessel vasculitis in children
275
How does HSP present?
a purpuric rash over the legs and buttocks, abdominal pain, arthralgia and haematuria
276
What is the other name for slapped cheek syndrome?
Erythema infectiosum
277
How does foetal alcohol syndrome present?
Microcephaly, short palpebral fissures, hypoplastic upper lip, absent philtrum, reduced IQ, and cardiac abnormalities.
278
What is the most common complication associated with measles infection?
Acute otitis media
279
What is the first line treatment for impetigo?
Hydrogen peroxide 1% cream
280
A child presents with vomiting after being laid flat and crying with arching of the back and drawing up the knees to the chest. Diagnosis?
Reflux
281
What is eczema herpeticum?
A serious infection and a dermatological emergency. Urgent anti-viral therapy with acyclovir is required
282
How does eczema herpeticum present?
Blistering rash over face and high fever. Appears unwell.
283
How do Kwashiorkor and marasmus differ?
Kwashiorkor no protein but good calories, meramus protein and energy malnutrition
284
If clomifene and metformin fail in infertility treatment secondary to PCOS, what is the second line treatment?
Laparoscopic drilling
285
What are the criteria for use of lactational amenorrhoea as an effective contraceptive?
The woman has complete amenorrhoea. The woman is fully, or nearly fully (>85% of feeds are breast milk) breastfeeding. It has been six months or less since the birth of the baby.
286
How does vasa praevia present?
Rupture of membranes followed immediately by vaginal bleeding
287
What is Asherman's syndrome?
Characterised by intrauterine adhesions commonly as a result of previous uterine surgery such as dilation and curettage. It can lead to obstruction to the menstrual outflow tract which presents as secondary amenorrhoea
288
How do we diagnose Asherman's syndrome?
HSG or hysteroscopy might be needed for confirmation.
289
What are reflex anoxic seizures?
Paroxysmal self limited periods of asystole that are triggered by pain, fear or anxiety
290
What is alprostadil?
Prostaglandin E1 - prevent ductus arteriosus from closing
291
How does slapped cheek syndrome effect pregnant women?
asymptomatic in pregnant women but can cause cross the placenta and cause severe anaemia in the fetus due to viral suppression of fetal erythropoiesis. This causes hydrops fetalis and carries a high risk of intrauterine death.
292
How does Prader-Willi syndrome present?
learning difficulties, hyperphagia (insatiable appetite) and obesity with a background of hypotonia, poor feeding and developmental delay
293
What causes congenital adrenal hyperplasia?
90% is caused by 21-hydroxylase deficiency
294
How does CAH present?
There is virilisation of the female external genitalia due to overproduction of ACTH and subsequently adrenal androgens, and a salt wasting crisis caused by deficiency of aldosterone.
295
What is phenylketonuria?
An autosomal recessive disorder from an enzyme mutation that leads to high levels of the amino acid phenylalanine in the blood. Avoid diet pepsi.
296
What is tabes dorsalis?
The progressive degeneration of the dorsal columns seen in late-stage syphilis (tertiary syphilis). Treponemal antibodies will be positive
297
What is the action of triptans?
Selective serotonin receptor agonists with high affinity for the 5HT 1B/D receptors.
298
What do we combine IM haloperidol with for de-escalation?
IM promethazine
299
What would be monitor with lithium use?
Renal/thyroid disfunction
300
How do we treat multiple viral-induced wheeze admissions?
Inhaled corticosteroid or montelukast
301
What is the action of leukotrienes?
Inflammatory mediators which cause bronchoconstriction, inflammation, microvascular permeability and mucus secretion
302
What is the difference between diffuse and focal crackles on paediatric resp examination?
With pneumonia, localising signs on chest examination would be expected, such as focal rather than diffuse crackles
303
How do we rehydrate children first-line?
Nasogastric or orogastric fluids
304
What is a tet spell?
cyanosis following exertion (e.g. feeds or crying). Seen in tetralogy of fallot
305
What are the five features of tetralogy of fallot?
Pulmonary stenosis Right ventricular hypertrophy Overriding aorta Ventricular septal defect (VSD) Ejection systolic murmur (pulmonary stenosis)
306
Where would you see the "Coeur-en-sabot" finding?
In ToF, which is a characteristic boot-like appearance associated with RVH. Not a common finding.
307
What is a Blalock-Taussig shunt?
A surgical shunt between the subclavian and pulmonary artery. The pulmonary circulation does not receive enough blood from the right ventricle due to outflow obstruction. The shunt allows for perfusion of the pulmonary circuit, thereby improving oxygenation. It is used only as a temporary holding measure until surgery
308
How do we treat severe croup with impending airway obstruction that hasn't responded to steroids?
Nebulised adrenaline can provide temporary relief of airway obstruction
309
What is the Westley score?
Used to quantify croup severity
310
What imaging must all myasthenia gravis pts have?
Thymus imaging, usually through a CT chest. 10% will have a thymoma, whilst 70% have thymic hyperplasia
311
What is pyridostigmine used for?
Acetylcholinesterase inhibitor. Inhibition of acetylcholinesterase causes a reduced breakdown of acetylcholine and an increased concentration of acetylcholine in the synaptic cleft, resulting in symptomatic relief of weakness
312
Which abx are avoided in myasthenia gravis?
Aminoglycosides, polymyxins, macrolides, quinolones, and tetracyclines should be avoided if possible [6]. Aminoglycosides and polymyxins are particularly thought to interfere with neuromuscular junction transmission and exacerbate weakness.
313
How does scarlet fever present?
initially presents with non-specific features such as headache, fever, sore throat. The characteristic rash is described as ‘sandpaper’ texture and children can develop ‘strawberry tongue’, named as the tongue appears bright red
314
How do we treat scarlet fever?
Abx
315
What is the most common finding at paediatric cardiac arrests?
Asystole
316
What is scissor walking, and where is it found?
Periventricular damage (due to a hypoxic ischaemic event during a prolonged delivery due to the baby getting stuck) is the aetiology behind spastic diplegia.
317
How do we treat persistent ductus arteriosis?
If symptomatic, this can be managed medically with a prostaglandin synthesis inhibitor (NSAID) like indomethacin, causing vasoconstriction to close the duct.
318
What murmur is found in PDA?
Continuous machine-like murmur
319
What are Koplik's spots?
Koplik’s spots (grey) on his buccal mucosa which supports the diagnosis of measles.
320
This child has presented with fever, chest pain and shortness of breath on a background of sickle cell disease which makes the most likely diagnosis...
acute chest syndrome
321
How do we treat uterine inversion?
Immediate replacement of the uterus is the best first step as the greater the delay in attempting this, the greater the likelihood the manoeuvre will fail. General resuscitation measures should also be taken and tocolytic drugs can be used to aid replacement of the uterus if a first attempt fails.
322
What is polymorphic eruption of pregnancy?
also known as pruritic urticarial papules and plaques of pregnancy (PUPPP) typically present in the third trimester. It occurs as itchy red patches and often first appears on the abdomen, particularly over striae.
323
How does congenital rubella syndrome present?
Eye defects, congenital heart disease and sensorineural deafness. These features are implicated in the history by the loss of red reflex, patent ductus arteriosus (continuous “machine-like” murmur) and abnormal newborn hearing test. The purpuric skin rash often referred to as “blueberry muffin” rash is also a common finding in CRS. Pregnant mothers are often asymptomatic.
324
What is an msk SE of statins?
Cramps. Measure CK.
325
How do we treat symptoms of leg cramps?
Quinine
326
How do we calculate earliest possible ovulation date?
Earliest possible ovulation date is worked out by length of cycle - 14 days
327
What contraception can be used in active breast cancer?
Non-hormonal methods such as the IUD
328
What is the rule of thirds in POP?
1/3rd of women stop having periods, 1/3rd continue and 1/3rd experience irregular bleeding in the form of irregular bleeds, light bleeding between periods or bleeding throughout the cycle (termed ‘spotting').
329
What is an effective tx for heavy periods?
Mirena coil
330
What is the difference between desogestrel and norethisterone POPs?
Desogestrel POPs are considered missed after 12 hours of being late to take them, whilst norethisterone POPs are missed after 3 hours - this patient is four hours late, therefore has missed a pill and needs added protection
331
Why can rubella lead to hydrocephalus?
Rubella can cause aqueductal stenosis leading to congenital hydrocephalus
332
How does congenital HSV present?
Congenital herpes simplex infection include vesicular herpetic lesions on the skin, eye, oral mucosa, encephalitis and sepsis. Transmission from the mother can occur during delivery if the mother has an active primary infection within 6 weeks of birth. In these cases, elective caesarean section may be advised to avoid contact with the lesions. If this is declined, intra-partum IV acyclovir can be given to reduce transmission.
333
What is the latent phase of the first stage of labour?
The latent phase of the first stage of labour is dilation of the cervix from 0cm to 3cm.
334
What is the active phase of the first stage of labour?
The active phase of the first stage of labour is described as cervical dilation from 3cm to 10cm.
335
What is the second stage of labour?
The second stage involves the descent of the fetal head into the pelvis so that the presenting part is at the level of the ischial spines (station = 0). This is known as engagement.
336
What is restitution?
Restitution describes the external rotation of the fetus following delivery of the fetal head to bring the shoulders into an antero-posterior (AP) position. This facilitates subsequent delivery of the anterior shoulder.
337
How do we determine if there is a complete or partial molar pregnancy on ultrasound?
As there is fetal tissue present in the uterus then this is a partial molar pregnancy. fetal tissue present in the uterus on the ultrasound this excludes a complete molar pregnancy.
338
How do we manage women with previous group B strep infection in pregnancy?
maternal antibiotic prophylaxis is to be offered to women with a previous baby with a GBS infection. Usually penicillin.
339
What does the quadruple test consist of?
It includes a dating scan and blood tests measuring oestriol, hCG, AFP and inhibin A
340
What does the combined test consist of?
Nuchal scan plus blood tests measuring PAPP-A and hCG
341
Describe the C-section journey.
Skin - subcutaneous fat - rectus sheath - rectus abdominus muscle - peritoneum - uterine myometrium - amniotic sac
342
How does ITP present?
Can commonly follow a viral infection or vaccination. It presents with an isolated thrombocytopenia and causes a petechial rash. In children it is a self-limiting disease and the majority of cases resolve spontaneously within 3-6 months.
343
Why are kids with T1DM more like to suffer from vitiligo?
In vitiligo, auto-immune destruction of melanocytes causes patchy areas of complete depigmentation.
344
What is the most common form of partial seizure, and how does it present?
(TLE) is the most common type of partial seizure. The patient’s subjective abdominal symptoms, and then staring, followed by lip smacking and a period of disorientation, are in keeping with a description of temporal lobe seizures. Inter-ictal EEGs are abnormal in one third of individuals with TLE. MRI is the imaging modality of choice, looking for an underling cause, such a hippocampal or temporal sclerosis, temporal lobe dysplasia or tumour. This patient is exhibiting focal symptoms relating to the temporal lobe - automatisms.
345
How do we treat fatigue in MS
There are no licensed drugs for treatment of patients with fatigue. However there are existing medications that are used for other conditions that have been found to show improvement in fatigue symptoms in MS such as Modafinil and also Amantadine
346
How do we manage benign essential tremor medically?
Propranolol and primidone are both effective in managing essential tremor
347
What is multiple system atrophy?
MSA is a Parkinson-plus syndrome, including the Parkinsonian triad of tremor, hypertonia, and bradykinesia, but does not include vertical gaze palsy. Characteristically, it involves early autonomic clinical features such as: postural hypotension (>20/10), incontinence, and impotence.
348
What is rotigotine?
Dopamine agonist
349
Why do myasthenia gravis pts become nasally in speech?
The condition may cause weakness in bulbar muscles resulting in nasal speech or dysarthria. The bulbar signs also show fatigability (e.g. speech becomes quieter on counting to 50).
350
When does cataplexy occur?
They are usually caused by strong emotions or laughter
351
What is cortico-basal degeneration?
a Parkinson-plus syndrome, including the Parkinsonian triad of tremor, hypertonia, and bradykinesia. Characteristically, it involves spontaneous activity by an affected limb, or akinetic rigidity of that limb.
352
What is the initial management in expected cord compression?
8mg dexamethasone BD
353
What is the difference between Charcot-Marie-Tooth syndrome type 1 and 2?
Type 1 is a demyelinating syndrome. Type 2 is an axonal syndrome.
354
Which back pain is unusual?
Thoracic
355
What is Ramsey-Hunt syndrome?
Ramsay-Hunt syndrome is a very popular presentation in your MCQ exams. Look out for that patient with a vesicular rash around their ear and a facial nerve palsy.
356
How do we treat Ramsey-Hunt Syndrome?
Prednisolone
Aciclovir
Patients also require lubricating eye drops.
357
What is Knight's move thinking?
named after the way the knight moves in chess, this thought disorder is characterised by illogical leaps between unconnected ideas. It is also known as loosening of associations.
358
What is pellagra?
Vitamin B3 (niacin) deficiency and is characterised by Dementia, Dermatitis and Diarrhoea
359
Give two RFs for pellagra.
Alcoholism and Crohn's disease are both risk factors for Pellagra due to malnutrition/malabsorption.
360
What is Cotard's delusion?
The belief that a patient is dead, non-existent or ‘rotting'.
361
How do we treat Wernicke's encephalopathy?
Acutely, it is important to start intravenous Pabrinex which provides a mixture of B vitamins (including B1 which is thiamine)
362
How would a posterior cerebral artery infarct affect one's vision?
Posterior cerebral artery supplies the corresponding occipital cortex. That occipital cortex encodes the contralateral visual field. Lesions here will cause this specific field of vision deficit. Macular sparing occurs because fibres representing the macula of vision are bilaterally represented
363
What is hemiparesis?
Hemiparesis is weakness or the inability to move on one side of the body
364
What is writer's cramp?
the most common form of occupational focal dystonia. It typically only occurs with a specific action. Dystonia is a sustained muscle contraction often with slow, twisting or repetitive movements or abnormal postures
365
How does encephalitis present on MRI?
Bilateral medial temporal lobe involvement
366
Define idiopathic intracranial HTN
a syndrome of unknown aetiology that results in raised intracranial pressure (opening pressure >25 cmH2O)
367
Who does idiopathic intracranial htn typically present in?
most commonly in young and obese women
368
How do we manage idiopathic intracranial HTN?
First line management of idiopathic intracranial hypertension (and the only intervention supported by good evidence) is weight loss. Failing this, patients often try carbonic anhydrase inhibitors, such as acetazolamide, but its extensive profile of side effects (peripheral paraesthesia, anorexia and metallic dysgeusia) mean that it is poorly tolerated.
369
When should a migraine sufferer take sumatriptan?
once the headache starts, but not during the aura phase
370
How does cervical myelopathy present?
The patient presents with an Upper motor neurone pattern of weakness at the C7 level as evidenced by spasticity on extension of his arms, weakness and bilateral brisk triceps reflexes. There is a sensory level at C7 over the middle fingers.
371
How do we surgically manage SAH?
Surgical clipping and endovascular coiling (1o)
372
How do we surgically manage extradural haemorrhage?
Ligation of the bleeding artery
373
How do we treat acute MS?
Methylprednisolone
374
How does Meniere's disease present?
Recurrent attacks of vertigo, hearing loss, tinnitus, and the sensation of aural fullness.
375
What causes Meniere's disease?
Meniere's disease is caused by the dilatation of the endolymphatic spaces of the membranous labyrinth causing episodes of vertigo lasting for 12-24 hours
376
How do we manage Meniere's disease?
Management relies on prophylactic use of betahistine to reduce the frequency of attacks, and the acute use of prochlorperazine.
377
What is the difference between acute labyrinthitis and vestibular neuritis?
Inflammation of the vestibular nerve causes an acute severe vertigo, which may be associated with vomiting. Acute labyrinthitis can present with hearing loss and tinnitus, whereas vestibular neuritis does not - it only affects the vestibular nerve.
378
How does an acoustic neuroma present?
Unilateral hearing loss first, and later vertigo. It may also progress to involve several cranial nerve deficits. It does not, however, present with recurrent attacks of vertigo with hearing loss, tinnitus, and aural fullness
379
What is the most common cause of intracerebral haemorrhage?
Htn
380
What causes Ramsey-Hunt Syndrome?
Caused by infection of the geniculate ganglion of the facial nerve, together with invasion of the VIIIth nerve ganglia, by the herpes zoster virus
381
What is the most common cause of early onset sepsis in babies?
Group B strep
382
Give the most important potential complication of glandular fever
Splenomegaly from white blood cell sequestration. The enlarged spleen is at risk of rupture in severe cases
383
What is Galleazi's test?
Used to indicate whether the shortening is femoral or tibial in DDH
384
What is Lachman's test?
a test for the integrity of the anterior cruciate ligament of the knee
385
Abdominal XR shows distended loops of bowel with thin black lines within the white bowel walls. Diagnosis?
necrotising enterocolitis (air in the bowel wall)
386
Give two RFs for TGA
Male; diabetic mothers
387
How does the presentation of TGA and TOF differ?
TGA presents very early on, TOF around 1-2m
388
What is the characteristic sign on XR/US of duodenal atresia?
Double bubble sign, caused by a distended and air filled stomach and small bowel
389
How does neuroblastoma present?
Typically crosses the midline presents with symptoms of fever, fatigue, weight loss, diarrhoea and vomiting.
390
What is the first line treatment for absence seizures?
Sodium Valproate or Ethosuximide
391
How does fibromuscular dysplasia present on MRI angiography?
characteristic ‘string of beads’ appearance
392
How does common peroneal nerve palsy present? What can cause it?
Plaster cast compression at the fibula neck is a risk factor for common peroneal nerve palsy. This results in weak dorsiflexion and eversion of the affected foot without any implications for movements of the hip.
393
How does diabetic mononeuritis multiplex present?
Pupil-sparing third nerve palsy, associated with foot drop (likely due to a common peroneal nerve palsy) in the context of poorly controlled diabetes mellitus
394
How does mixed urge and stress incontinence present?
present as a sudden sensation to relieve oneself and inadvertently passing small amounts of urine in response to a rise in intra-abdominal pressure (coughing, sneezing, laughing, etc)
395
What do you measure when serum acetylcholine receptor antibodies are negative in ? myasthenia?
anti-muscle-specific tyrosine kinase antibodies should be measured. These are positive in up to 70% with acetylcholine receptor sero-negative generalised myasthenia gravis.
396
What imaging can diagnose early ischaemic stroke?
Diffusion-weighted MRI can confirm early ischaemic stroke, which appears bright; as CT scan can be normal in first few hours.
397
What is cubital tunnel syndrome and how does it present?
it affects the ulnar nerve, which results in weakness and changes to sensation over the medial one and a half digits. This commonly occurs in people who lean on their elbow, sleep with their arm hanging off the bed, or with impact over the "funny bone”.
398
What is the most common cause of encephalitis?
HSV
399
Give a long term side effect of levodopa
development of drug induced dyskinesias. This is most likely due to the non-physiological effects exogenous levodopa on a deteriorating extrapyramidal system.
400
A pt presents with hyponaetraemia and a peripheral coin-shaped lesion on CXR. Differential?
Small cell lung cancer
401
How does subdural haemorrhage present on CT?
Crescent-shaped haematoma
402
Give two RFs for subdural haemorrhage.
Old age and alcoholism
403
What is myotonic dystrophy?
Myotonic dystrophy is a trinucleotide repeat disorder in the DMPK or ZNF9 gene.
404
What does cachectic mean?
Having cachexia, physical wasting with loss of weight and muscle mass due to disease.
405
How does L5 radiculopathy present?
A unilateral foot drop with weak foot dorsiflexion, inversion and eversion as well as toe extension. Furthermore, weakness of hip abduction and weakness of foot inversion are both findings that help to differentiate L5 radiculopathy from peroneal nerve neuropathy.
406
What is opthalmoplegia?
Paralysis or weakness of the eye muscles
407
What is the first line treatment of myoclonic seizures?
Sodium valproate. Carbamazepine makes worse
408
How does cortico-basal degeneration present?
Parkinson-plus: involves spontaneous activity by an affected limb, or akinetic rigidity of that limb.
409
What is a reflex anoxic seizure?
Caused by overactivity of the vagus nerve, causing vasodilation and a collapse from a temporary reduction in cerebral perfusion.
410
Where should you check for a pulse emergently in a child?
In the neck (carotid pulse) in children over 1 year, or in the inner aspect of the upper arm (brachial pulse) in an infant.
411
What is the first line therapy for relapsing-remitting MS?
Despite its side effect profile, injectable beta interferon. Natalizumab second line as expensive and high SE profile.
412
What do we use in lieu of mannitol?
IV hypertonic saline will help to reduce the intracranial pressure in the short term while definitive management (where possible) is sought. Mannitol used to be used, but appears to carry no benefit over hypertonic saline, and carries with it a high risk of significant SEs
413
What is neostigmine?
Like pyridostigmine, a cholinesterase inhibitor
414
Which consequence of artificial ventilation is routinely screened for?
Retinopathy of prematurity, caused by the uncontrolled proliferation of blood vessels within the retina due to over oxygenation
415
In status epilepticus, what should be trialled after two unsuccessful doses of benzodiazepines?
IV Phenytoin should be initiated
416
What must you monitor with IV phenytoin use?
Phenytoin can cause bradycardia and hypotension so you must monitor the blood pressure and ECG.
417
How does roseola infantum present?
6th disease, caused by HHV6, is generally a benign illness characterised by several days of high temperatures followed by a widespread rash that starts on the torso/neck. These children tend to be well and do not require intervention.
418
Where would you find GM1 ganglioside antibodies?
May be positive in Guillain-Barré syndrome
419
How does Huntington's disease present on MRI?
Atrophy of the caudate nucleus and putamen.
420
How does extradural haemorrhage present on CT?
Biconvex haematoma
421
How does extradural haemorrhage typically present?
History of head trauma and contralateral hemiplegia
422
What is Henoch-Schonlein purpura, and how does it present?
The most common vasculitis of childhood and affects the small vessels. The condition presents with a tetrad of rash, abdominal pain, arthralgia and glomerulonephritis.
423
What is Jacksonian march?
Jacksonian seizures are also known as a Jacksonian march. This is because the tingling or twitching begins in a small area and then "marches" or spreads to a larger area of the body.
424
How does internuclear opthalmoplegia present?
failure to adduct on the affected side and nystagmus on the contralateral side. It is most likely vascular in origin.
425
What is the other term for a Wilms tumour?
Nephroblastoma
426
How does vestibular neuritis present?
Vertigo and unsteadiness. Commonly occurs after a upper respiratory tract infection and presents with short bursts of dizziness
427
What is the most common bone cancer in children and adolescents?
Osteosarcoma is the most common non-haematological primary malignant neoplasm of bone in children and adolescents. Pain and swelling with a prolonged onset are characteristic.
428
How do osteosarcomas present on XR?
The x-ray findings of new bony growth and a periosteal reaction causing a sunburnt appearance are typical of osteosarcoma.
429
What is papilloedema?
Bilateral swollen discs in the presence of raised intracranial pressure
430
What would the CXR show in TTN?
The chest x-ray would show hyperinflated lungs and importantly, a fluid level. This is because there is a delayed resorption of lung fluid.
431
What is meralgia paraesthetica?
A syndrome that includes numbness, paraesthesiae and pain in the anterolateral thigh, which may result from either an entrapment neuropathy or a neuroma of the lateral femoral cutaneous nerve. Obesity or weight gain is a risk factor for this as it predisposes to nerve compression.
432
What are the features of cerebellar syndrome?
DANISH (dysdiadochokinesis, ataxia, nystagmus, intention tremor, slurred speech, and hypotonia)
433
What is the link between epilepsy and cerebellar syndrome?
The patient is epileptic so the cerebellar syndrome may be secondary to anti-epileptic medication (such as carbamazepine or phenytoin)
434
What must you rule out in cases of HSP?
It is important to establish whether there is any renal involvement as IgA immune complexes can deposit in the kidneys and cause haematuria and proteinuria.
435
Which TB medication can cause polyneuropathy?
Isoniazid causes B6 deficiency
436
How do we calculate the APGAR score?
Appearance: fully pink, pink body blue extrem, blue/pale
Pulse: >100, <100, absent
Grimace: Cry, weak grimace, no response
Activity: Full movement and flexion of extrem, some flexion of extrem, limp
Respiration: full cry/good resp effort, poor resp effort, no resp effort
437
What is the most common complication seen with measles?
Otitis media
438
When can kids with measles go back to school?
4 days after the rash has cleared up
439
How do we treat measles?
Self-limiting
440
Which organism causes chicken pox?
Varicella zoster
441
When can kids with chickenpox go back to school?
The virus is contagious until all vesicular lesions have crusted over
442
When can a kid with scarlet fever go back to school?
Infectious until 24 hours after the first dose of antibiotics and should not return to school until then
443
What murmur do you hear with an ASD?
Pulmonary ejection murmur and a fixed split second heart sound
444
How does mitral stenosis present?
A blowing holo-systolic murmur at the 5th intercostal space in the midaxillary line
445
Give a complication of lamotrigine
Stevens-Johnson syndrome, which is a large blistering rash throughout the body. It is more common in children that adults, more common with co-administration of Valproate, higher doses and rapid titration
446
Give two SEs of sodium valproate
Hair thinning and weight gain
447
How do we treat midgut volvulus?
a Ladd's operation for definitive management. This is performed, either open or laparoscopically, by untwisting the midgut volvulus, fixing the malrotated bowel in the correct location, removing Ladd's bands (congenital adhesions) and performing an appendicectomy.
448
What are sympathomimetic drugs?
Such as cocaine and amphetamines
449
What is the triad seen in Miller-Fisher syndrome?
Ataxia, areflexia and opthalmoplegia
450
What is Miller-Fisher syndrome?
A rare, acquired nerve disease that is considered to be a variant of Guillain-Barré syndrome. It is characterized by abnormal muscle coordination, paralysis of the eye muscles, and absence of the tendon reflexes. Like Guillain-Barré syndrome, symptoms may be preceded by a viral illness.
451
How do you distinguish between GBS and Miller-Fisher syndrome?
Remember that Guillain-Barre starts distally (polyneuropathy) and makes it way up. Miller-Fisher starts proximally i.e. with the eyes.
452
Name the chronic form of GBS
Chronic inflammatory demyelinating polyradiculopathy
453
What scoring system do we use to recognise stroke in an ED?
ROSIER score
454
What is hereditary spastic paraparesis, and how does it present?
Clinical features that are necessary for the diagnosis are: family history, progressive gait disturbance, spasticity of lower limbs, hyper-reflexia of lower limbs, and extensor plantar responses. The condition can be inherited in an autosomal dominant, autosomal recessive, or X-linked pattern. Genetic testing of known genetic mutations (such as L1CAM or PLP) is diagnostic.
455
What is Reye's syndrome?
acute liver failure and non-inflammatory hepatic encephalopathy which occurs in children under 12 who are given aspirin during the acute phase of a viral infection. Liver biopsies show microvesicular steatosis and venous collapse. Treatment is supportive, and often requires ITU admission.
456
How can we lower ammonia levels in someone suffering from Reye's syndrome?
Lactulose can be used to lower ammonia levels.
457
How would Ewing's sarcoma present on XR?
Ewing's sarcoma typically presented with the lamellated (onion skinning) periosteal reaction which is visible on x-ray.
458
How would Ewing's sarcoma present on MRI?
MRI typically shows a large mass with evidence of necrosis and on histology small blue round cells are visible with clear cytoplasms on haematoxylin and eosin staining.
459
Where would you see SOD1 mutations?
The most common genetic cause of familial ALS as described in this young patient with a family history
460
What is the most common cause of febrile convulsions in children?
Human Herpes Virus 6 or Roseola Infantum
461
Give a SE that furosemide and vancomycin share.
Ototoxicity
462
What is the first thing you do in a child who has become unconscious after choking?
5 rescue breaths
463
What is the first line treatment for trigeminal neuralgia?
Carbamazepine
464
How do we diagnose pertussis?
PCR
465
What is bronchiolitis obliterans, and what usually causes it?
In bronchiolitis obliterans, there is permanent damage to the small breathing tubes, caused by inflammation and scarring. Often associated with adenovirus.
466
What is the most common cause of third nerve palsy?
Diabetes
467
What is the difference between a surgical and non-surgical third nerve palsy?
A surgical third nerve palsy can be differentiated from a medical third nerve palsy as it is painful and causes a fixed dilated pupil.
468
What is a cause of surgical third nerve palsy?
Posterior communicating artery aneurysm, within the Circle of Willis
469
What is a broad spectrum used in UTI tx?
Cephalexin
470
How do we confirm delayed puberty?
This is confirmed with a hand/wrist x-ray to assess bone age, which will be delayed in constitutional growth delay.
471
What gait do you see in PD?
Festinating and shuffling gait
472
What is the gold standard for diagnosing vascular abnormalities, e.g. after SAH?
Digital subtraction catheter angiography (DSA) remains the gold standard for diagnosis and characterisation of vascular abnormalities. Done after CT angiogram in SAH, which is done after confirmed SAH.
473
How does L5 radiculopathy present?
L5 supplies the dorsiflexion of the big toe. Weakness in power of dorsiflexion of the big toe is suggestive of damage to the L5 nerve root.
474
How might bronchiolitis affect U&Es?
Hyponaetraemia
475
Give a potential long term complication of measles
Subacute sclerosing panencephalitis
475
Give a potential long term complication of measles
Subacute sclerosing panencephalitis
476
How does Wallenburg's syndrome present?
The presentation can be summarised by the mnemonic "DANVAH" - Dysphagia, ipsilateral Ataxia, ipsilateral Nystagmus, Vertigo, Anaesthesia (Ipsilateral facial numbness and contralateral pain loss on the body) and ipsilateral Horner's syndrome.
477
What causes Wallenberg's syndrome
Caused by the occlusion of the posterior inferior cerebellar artery
478
What is agnosia?
A rare disorder whereby a patient is unable to recognize and identify objects, persons, or sounds using one or more of their senses despite otherwise normally functioning senses
479
How do we perform chest compressions in infants?
Chest compressions should be one finger’s breadth above the xiphisternum, 4-5cm deep, at a rate of 100-120 per minute, ensuring there is full recoil of the chest. In infants, chest compressions should be performed with both thumbs, whereas in children aged over 1 year, chest compressions should be performed with the heel of one hand, or both hands with fingers interlocked for larger children
480
What is Gowers' sign?
Gowers' sign describes a patient that has to use their hands and arms to 'walk' up their own body in order to stand up from a supine position. This is classically seen in Duchenne muscular dystrophy (DMD) due to proximal muscle weakness.
481
How do we initially investigate DMD?
Measure creatinine levels
482
What is Ebstein's anomaly?
This is characterised by a large right atrium and small right ventricle, usually due to low insertion of the tricuspid valve, which also causes tricuspid incompetence.
483
What causes Ebstein's anomaly?
Can be caused by Lithium monotherapy
484
Give a common complication of parvovirus B19.
Arthralgia
485
Describe the pathophysiology behind ADHD
Studies have shown that in patients with ADHD, there is reduced function of the frontal lobe, which controls executive function. The theory is that, as executive function controls the ability to focus attention and inhibit impulsive behaviours, a reduced function of the frontal lobe results in inattention and impulsivity.
486
How does Brown Sequard syndrome present?
There is ipsilateral paralysis, loss of vibration and position sense and hyperreflexia below the level of the lesion. Contralateral loss of pain and temperature sensation, usually beginning about two to three segments below the level of the lesion, is also seen. In the clinical situation, a mix of these signs is usually seen as hemi-section is rarely complete.
487
What does DMSA look for?
Renal scarring
488
What chromosomal abnormality causes Turner's syndrome?
XO karyotype
489
What INR is an absolute contraindication to giving thrombolysis
>1.7
490
What causes rickets?
VitD deficiency
491
What causes rickets?
VitD deficiency
492
How does ischaemia present on CT?
Loss of grey-white matter differentiation in the left temporal region with hypodensity of the cortex in this region
493
Hand preference <18m indicates...
Cerebral palsy or spastic hemiplegia
494
What is Cushing's triad?
Hypertension, bradycardia and labile breathing. Seen in pts with raised intracranial pressure.
495
How does transient synovitis present?
Well-appearing child with acute onset non-weight bearing limp and low-grade fever following a recent viral infection. The underlying trigger for the inflammation of the synovial membrane in transient synovitis is a preceding viral infection.
496
From when is scarlet fever no longer infectious?
He will be infectious until 24 hours after the first dose of antibiotics and should not return to school until then.
497
How do we treat threadworm?
Oral Mebendazole, and hygiene measures for all members of the household.
498
What is the Potter sequence?
It arises from a common sequence of events caused by oligohydramnios. The lack of amniotic fluid means there is a lack of 'cushioning' of the foetus, resulting in it getting squashed by the surrounding maternal organs - resulting in their characteristic appearance.
499
How do we confirm transient synovitis? How do we treat it?
It is confirmed using a hip x-ray and ultrasound, which shows synovitis. It is treated using NSAIDs and bedrest for up to 6 weeks.
500
Which demographic is MS more common in?
Caucasian
501
What is meralgia paresthetica
A syndrome caused by compression of the lateral cutaneous nerve of the thigh underneath the inguinal ligament. It is characterised by shooting pains along the outer aspect of the upper leg.
502
Who is topiramate relatively contraindicated in?
A woman of child bearing age. 1st line = Beta-blocker or Amitriptyline, 2nd line = Topiromate/valproate
503
How does metoclopramide work?
Thought of mostly as a dopamine antagonist, it also has some 5HT3 antagonist activity too at the chemoreceptor trigger zone in the brain. It is also a prokinetic and induces gastric contractions. A commonly used anti-emetic, it is very effective however in parkinsonian patients can make their symptoms significantly worse.
504
What is ondansetron used for/
A serotonin 5HT3 antagonist, it is often used as an adjunct with chemotherapy to reduce nausea. Importantly, it can be given PO/IM/IV making it useful when a patient is unable to keep oral foods down.
505
Give a complication of ondansetron use
One should note that ondansetron can increase QT interval and put a patient at risk of torsades de pointes.
506
What is a pseudobulbar palsy?
an 'upper motor neurone' lesion affecting the muscles of speech and swallowing. The lesion occurs at the cortico-bulbar tracts, above the level of the mid-pons.
507
How does Wilsons disease present?
Combination of cerebellar signs, tremor and rhythm abnormalities in a young patient
508
What must we co-prescribe with isoniazid and why?
It must be co-prescribed with Pyridoxine to avert a peripheral neuropathy.
509
What vaccines at 8, 12 and 16 weeks?
8w - 6 in 1, MenB, rotavirus
12w - 6 in 1, PCV, rotavirus
16w - 6 in 1, MenB
510
What vaccines at given at 1y?
Hib/MenC, PCV booster, MMR, MenB booster
511
What vaccines are given at 3y4m?
DTap/IPV, MMR
512
What vaccine is given at 12-13y?
HPV
513
What vaccines are given at 14y?
Tetanus, diphtheria, polio, Men ACWY
514
Who is offered the influenza vaccine?
All children of primary school age and those in y&. Also offered to high risk children from 6m.
515
What is given in a clotting screen?
Prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen. Tells you if there is a problem with the way the blood is clotting.
516
What anaemia is seen in HIE?
Normocytic (microangiopathic haemolytic anaemia)
517
Where would you see hyponaetraemia, hyperkalaemia and metabolic acidosis?
Congenital adrenal hyperplasia (aldosterone effects)
518
What are the two sanctuary sites of the body in ALL tx?
Testes and CNS
519
How do we monitor treatment response for Hodgkin's lymphoma?
Positron emission tomography (PET)
520
What is emotionally unstable personality disorder?
It is also known as borderline personality disorder. It usually causes you to experience intense and fluctuating emotions, which can last for anywhere between a few hours and several days at a time
521
What is schizotypal personality disorder?
People with schizotypal personality disorder are loners who prefer to keep their distance from others and are uncomfortable being in relationships. They sometimes exhibit odd speech or behavior, and they have a limited or flat range of emotions.
522
What is an alternative to lithium for long term bipolar affective disorder control?
Valproate
523
What is agoraphobia?
A fear of being in situations where escape might be difficult or that help wouldn't be available if things go wrong
524
What is the mechanism of action of benzodiazepines?
GABAA is the main inhibitory neurotransmitter in the brain. Benzos facilitate and enhance the binding of GABA to the GABAA receptors, thus resulting in anxiolytic effect
525
What would you see in neuroleptic malignant syndrome?
Raised CK due to muscle rigidity, raised WCC, deranged LFTs, acute renal failure, metabolic acidosis
526
Which abx for UTIs are safe throughout the pregnancy?
Cephalosporins. Nitrofurantoin should be avoided in final trimester.
527
How does duloxetine work in stress incontinence?
This medication is thought to increases the activity of the nerve that stimulates the urethral sphincter, improving its function.
528
Why do we give GnRH agonists before fibroid surgery?
AHA
529
How long does pelvic pain need to be present before endometriosis is considered?
6 months
530
How long should abx be given for following PROM?
10 days or until the woman is in established labour, whichever is sooner.
531
How do we investigate delay in puberty in girls?
FSH/LH, and then oestrogen to determine whether the problem is pituitary or ovarian
532
Which conditions can lead to delayed puberty?
PCOS, Turner's syndrome, and primary ovarian insufficiency
533
What is androgen insensitivity syndrome?
Where a person is phenotypically female but genetically male. High levels of testosterone.
534
Why do we use first catch urine sample for NAAT in chlamydia diagnosis?
Chlamydia infection is in the urethra, urine will wash out organisms residing in the urethra
535
What is the tx for gonorrhoea
Ceftriaxone 1g single IM dose
| Purulent discharge and no bleeding seen
536
What is the tx for trichomoniasis?
Metronidazole 200mg PO TDS for seven days
537
How do we treat thrush?
Clotrimazole 500mg single pessary, at night
538
What is hypoactive sexual desire disorder?
Lower than normal interest in sex, but arousal is normal
539
How do we diagnose syphyilis
VRDL negative, TPHA positive
540
What is first line for pericarditis?
NSAID
541
How does N-acetylcysteine work?
Replenishes body stores of glutathione, needed to detoxify a toxic intermediary product of paracetamol metabolism (NAPQI)
542
What do we use to reverse heparin?
Protamine
543
What is kolionychia?
Thin, spoon-shaped nail
544
What is leukonychia?
White streaks on the nails
545
What is onycholysis?
Lifting of the distal nail plate
546
Describe the structure of urate crystals seen in gout
Negatively birefringent needles (everything negative)
547
Describe the structure of calcium pyrophosphate crystals seen in pseudogout
Positively birefringent crystals
548
What is the main differential for caput succedaneum?
Cephalohaematoma, but these don't cross the suture lines
549
What is rhesus haemolytic disease?
Occurs when the mum is rhesus negative, and the baby is rhesus positive
If the baby's blood is exposed to the mothers (via a sensitising event) e.g., trauma/abruption then the mother develops antibodies against the baby's blood
This results in a haemolytic anaemia producing a lot of unconjugated bilirubin
550
Give a cause of hypothyroidism diagnosed with TSH levels.
Congenital hypothyroidism; it slows everything down causing impaired bilirubin excretion
551
What is kernicterus
A type of brain damage that can result from high levels of bilirubin in a baby's blood. It can cause athetoid cerebral palsy and hearing loss
552
How do we differentiate between direct and indirect hernias?
Ring occlusion test
553
Give a late sign of intussuception
Red currant jelly stool due to bowel ischaemia
554
Give an important potential side effect of using indomethacin for PDA
Causes bowel ischaemia as it causes vasoconstriction of the mesenteric arteries
555
How do we treat minor cases of GORD?
advise smaller more frequent feeds, sit upright straight after feeds
Thickening agents e.g. carobel for bottles
556
How does movicol work?
Osmotic laxative/macrogol
557
How does senna work?
Stimulant laxative
558
How long should you stay off after mumps infection?
7 days, self-limiting
559
Give four clinical features of measles.
Cough, cranky, coryzal, conjunctivitis
560
How does rubella present?
Coryzal, pink maculopapular rash, lymphadenopathy, arthralgia
561
What causes scarlet fever?
Caused by endotoxins released by GABHS
562
How do we treat scarlet fever?
Sames as tonsilitis
563
When do we treat chicken pox?
If signs of infection, flucloxacillin
| If immunocompromised, acyclovir
564
When can you go back to school after impetigo infection?
48hrs after abx or until the lesions have crusted over
565
What are theca cells sensitive to, and what do they make?
LH, synthesise progesterone and testosterone
566
What are granulosa cells sensitive to, and what do they make?
FSH, convert testosterone to oestrogen
567
Describe the pathophysiology behind androgen insensitivity
X-linked recessive, due to resistance of biological effects of testosterone
568
How do we treat infertility in PCOS?
Letrozle 1st line ovulation induced, second line clomifine
569
What is a myomectomy?
Surgical removal of fibroids
570
What is the gold standard investigation for endometriosis?
Laparoscopic visualisation of the pelvis + biopsy
571
How do we manage endometriosis?
NSAIDs/paracetamol first line, hormone treatment second line
572
Define miscarriage
Spontaneous loss of a pregnancy before 24 weeks of gestation
573
Give four causes of primary PPH
Tone - uterine atony,
Tissue - retained placenta,
Trauma - c-sect, episiotomy
Thrombin - clotting disorder, DIC
574
What must you be aware of when giving oxytocin?
Uterine rupture
575
Which is more serious, viral or bacterial meningitis?
Bacterial
576
How does fragile X syndrome present?
Learning difficulties, large ears, long thin face, high-arched palate, marcroorchidism, autism, ADHD, hypotonia, mitral valve prolapse
577
How does Williams syndrome present?
Short stature, congenital heart disease, learning difficulties, facies - broad forehead, short nose, full cheeks, wide mouth
578
Aside from hyperglycaemia, acidosis and ketonaemia, what other abnormality may be seen on blood ix of DKA prior to treatment?
Mildly raised creatinine
579
What cardiac feature is seen in Turner syndrome?
Coarc of aorta
580
How does Kallmann syndrome present?
Delayed puberty, reduced sense of smell, poor balance, LD
581
Where is DBT used?
EUPD
582
What is circumstantiality?
s circuitous and non-direct thinking or speech that digresses from the main point of a conversation
583
What is the difference between knight's move thinking and circumstantiality?
Knight’s move thinking is the correct answer, as this describes a phenomenon where a patient’s thoughts
move from one topic to another, without any logical connection between them. It is a feature that is
common in schizophrenia
Flight of ideas (B) is similar to knight’s move thinking. However, there is increased rate of thought and
there is at least some logical links between the frequent changes of topics that a patient is talking about.
584
What is clomipramine?
Tri-cyclic antidepressant
585
What is serotonin syndrome?
Serotonin syndrome occurs when the levels of a chemical called serotonin in your brain become too high. It's usually triggered when you take an SSRI or SNRI in combination with another medicine (or substance) that also raises serotonin levels, such as another antidepressant or St John's wort.
586
What is egosystonia?
Obsessive thoughts are usually egodystonic (very different to the patient’s normal beliefs and values)
rather than egosyntonic (in keeping with ones beliefs and values)
587
How often must bloods be taken for clozapine use?
Any patient commenced on Clozapine needs to have a minimum of 1 blood test per week for the first 18
weeks. This is reduced to fortnightly until 1 year. After this monthly blood tests are needed. (This is only
if no abnormalities are found on blood tests - if monitoring shows concerning results, then monitoring
may not step down).
588
A surge in which hormone causes ovulation?
LH
589
Other than miosis, ptosis and anhidrosis; what is seen in Horner's syndrome?
Enopthalmos
590
What is the action of ropinirole?
Activates dopamine receptors to mimic the action of dopamine
591
How do we treat gestational diabetes?
Fasting glucose <7mmol/L: trial of diet and exercise. However if targets are not met within 1-2
weeks, start metformin. Offer insulin if metformin CI or not tolerated. Add insulin to metformin if
glucose is still not controlled.
- Fasting glucose of 7mmol/L or above: immediate insulin +/- metformin, and diet and exercise
592
How do we manage Conn's syndrome?
Spironolactone
593
How do we treat COPD in pts who haven't responded to salbutamol?
Add LAMA + LABA
594
How long must symptoms of GAD be present before diagnosis?
6 months
595
How do we treat panic disorder?
SSRIS > TCA, CBT and self help methods
596
What are the extra-pyramidal SEs seen with typical antidepressant use?
Akathisia, tardive dyskinesia, dystonia, NMS
597
What is the purpose of a section 5?
Patient is in hospital but wants to leave
598
What is a section 135?
36hrs, police allowed to enter pt's home to move to a place of safety
599
What is a section 136?
Police can move pt with mental disorder in a public place to a place of safety
600
What causes neuroleptic malignant syndrome, and how do we manage it?
Adverse reaction to dopamine receptor agonists - anti-psychotics
or abrupt withdrawal of dopaminergic medication.
Withdraw medication and supportive treatment
601
What causes serotonin syndrome?
Increased intrasynaptic serotonin concentration
602
How do we manage serotonin syndrome?
Withdraw offending medication
Supportive treatment
If recent overdose – activated charcoal
603
What is the difference between cluster A, cluster B and cluster C patients?
Cluster A patients are likely to appear ‘odd’ or eccentric
Cluster B includes patients often appear dramatic, emotional or erratic
Cluster C patient tend to appear anxious or fearful
604
What is schizoid personality disorder?
Emotionally cold, detached affect, lack of interest in others, indifferent to praise/criticism, tasks done alone, sexual drive low
605
What is schizotypal PD?
Interpersonal discomfort with peculiar ideas, perceptions, appearance, eccentric behaviour, speech and beliefs are odd, inability to maintain friendships, lack of companionship, emotionally cold
606
What is histrionic PD?
a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive desire for approval.
607
What is narcissistic PD?
Grandiosity, lack of empathy and need for admiration
608
What is avoidant PD?
Grandiosity, lack of empathy and need for admiration
609
What is a section 4?
72hrs, non-renewable, to hold pt until assessment by S12 doctor. Done by one doctor and one AMHP.
610
What is the alcohol screening tool?
AUDIT-C score
611
What is first line for opioid detoxification?
Buprenorphine
612
How does androgen insensitivity syndrome present?
People with this condition are genetically male, with one X chromosome and one Y chromosome in each cell. Because their bodies are unable to respond to certain male sex hormones (called androgens), they may have mostly female external sex characteristics or signs of both male and female sexual development.
613
What is internuclear opthalmoplegia?
a disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction. When an attempt is made to gaze contralaterally (relative to the affected eye), the affected eye adducts minimally, if at all. The contralateral eye abducts, however with nystagmus. Presents with double vision.
614
What is the dose of IV lorazepam in status epilepticus?
4mg
615
What causes narcolepsy?
Hypocretin deficiency
616
What is shingles?
Following re-infection with varicella zoster (chickenpox), a unilateral painful rash can develop. Manage within 72h with acyclovir
617
What causes leprosy?
An infectious disease caused by an obligate intracellular bacillus Mycobacterium leprae. Although rarely seen in the UK, leprosy is one of the most common causes of peripheral neuropathy worldwide.
618
What is the pathophysiology behind leprosy infection?
The intracellular mycobacteria act on the Schwann cells producing a chronic granulomatous reaction resulting in the destruction of both myelin and the underlying nerve cells.The damage to nerves and their protective outer layers leads to permanent neurological damage.
619
Do you see hyper or hyporeflexia in GBS?
Hypo
620
Where would you test for anti-ganglioside antibodies?
Anti-ganglioside antibodies: can be used to differentiate GBS variants, e.g. anti-GQ1b antibody in Miller-Fisher syndrome
621
What causes subdural haemorrhage?
Rupture of the bridging veins in the outermost meningeal layer, causing a bleed between the dura and arachnoid mater.
622
How do subdural haemorrhages present on CT?
Crescent shape and cross over the sutures
623
Who are subdural haemorrhages more likely to occur in?
Subdural haemorrhages occur more frequently in elderly or alcoholic patients. These patients have more atrophy in their brains making vessels more likely to rupture.
624
What causes extradural haemorrhage?
Usually caused by rupture of the middle meningeal artery in the temporo-parietal region. Can be associated with a fracture of the temporal bone. Occurs between skull and dura mater.
625
How do extradural haemorrhages present on CT?
A bi-convex shape and are limited by the cranial sutures (they can’t cross over the sutures).
626
How do intracerebral haemorrhages present?
Intracerebral haemorrhage involves bleeding into the brain tissue. It presents similarly to an ischaemic stroke.
627
What is letrazole?
Aromatase inhibitor
628
What can congenital hypothyroidism cause if not treated?
Can cause long term irreversible neurological deficit
629
How do we treat cataplexy?
Sodium oxybate
630
What is tuberous sclerosis?
A genetic condition that causes features in multiple systems. The characteristic feature is the development of hamartomas. These are benign neoplastic growths of the tissue that they origin from. Hamartomas cause problems based on the location of the lesion.
631
Name three sites that hamartomas can affect.
Skin, brain, lungs, heart, kidneys, eyes
632
Which mutations can cause tuberous sclerosis?
TSC1 gene on chromosome 9, which codes for hamartin
TSC2 gene on chromosome 16, which codes for tuberin
Hamartin and tuberin interact with each other to control the size and growth of cells. Abnormalities in one of these proteins leads to abnormal cell size and growth.
633
Give three skin signs of tuberous sclerosis.
Ash leaf spots, shagreen patches, cafe-au-lait spots, angiofibromas, poliosis
634
What is the classical presentation of tuberous sclerosis? How is it managed?
The classical presentation is a child presenting with epilepsy found to have skin features of tuberous sclerosis. It can also present in adulthood. Supportive management.
635
What is choreoathetosis? Where is it seen?
Huntington's. Choreoathetosis is a movement disorder that is usually a symptom of another underlying cause. It causes involuntary movements throughout the body.
636
How do we treat Huntingtons chorea?
Tetrabenazine/amantadine
637
How do we diagnose Horner's syndrome?
Cocaine drops usually dilate pupils but no response in Horner’s
638
How does anterior cord syndrome present?
As there is a single anterior spinal artery running down the midline of the spinal cord (in the anterior median fissure), blockage causes loss of pain, temperature, motor and autonomic function below that level.
Dorsal column function is preserved.
639
What is a category 1 c-section?
There is an immediate threat to the life of the mother or baby. Decision to delivery time is 30 minutes.
640
What is a category 2 section?
There is not an imminent threat to life, but caesarean is required urgently due to compromise of the mother or baby. Decision to delivery time is 75 minutes.
641
What is a category 3 section?
Delivery is required, but mother and baby are stable.
642
What is a category 4 section?
This is an elective caesarean
643
What is a Pfannenstiel incision?
a curved incision two fingers width above the pubic symphysis
644
What is a Joel-cohen incision?
a straight incision that is slightly higher (this is the recommended incision)
645
Why is oxytocin given during a c-section?
To reduce the risk of PPH
646
What is the uterine rupture risk in VBAC?
0.5%
647
What is Potter syndrome?
Potter syndrome is a rare condition characterized by the physical characteristics of a fetus that develop when there is too little amniotic fluid in the uterus (in utero) during pregnancy
648
What is the Chandler classification used for?
Chandler classification is the most commonly used system for dividing the different types of orbital cellulitis.
649
Give the four types of CP.
Spastic, dyskinetic, ataxic, mixed
650
What is spastic cerebral palsy?
Hypertonia and reduced function resulting from damage to UMNs
651
What is dyskinetic CP
Problems controlling muscle tone, with hyper and hypotonia, causing athetoid movements and oro-motor problems. Result from basal ganglia damage.
652
What is ataxic CP
Problems with coordinated movement resulting from damage to the cerebellum
653
What does hemiplegic/diplegic gait show?
UMN lesion
654
What does high stepping gait show?
Foot drop or LMN lesion
655
What does waddling gait show?
Pelvic muscle weakness due to myopathy
656
What is antalgic gait?
Limp
657
What is baclofen?
Muscle relaxant
658
Name a thiazide-like diuretic
Indapamide, Chlorothiazide
659
How does Turner's present?
Primary amenorrhoea and short height
660
What is the health belief model?
The health belief model is a psychological model that attempts to explain and predict health behaviors by focusing on the attitudes and beliefs of individuals.
661
What components make up the health belief model?
Degree of perceived risk of a disease.
Perceived benefits of diet adherence.
Perceived barriers to diet adherence.
Cues to action. Events that motivate people to take action in changing their dietary habits are crucial determinants of change.
Self-efficacy. A very important variable is the belief in being able to successfully execute the dietary behavior required to produce the desired outcomes
662
Give a long term complication of lithium treatment.
Hypothyroidism, nephrogenic diabetes insipidus (NDI) (causing resultant increased lithium levels), hyperparathyroidism (inc ca levels)
663
When do you diagnose metabolic alkalosis on ABG?
When the bicarbonate is raised
664
When do we give mothers 5mg of folic acid until 12w instead of 400mcg?
If on an anti-epileptic drug, coeliac disease, diabetes, BMI >30, neural tube defect risk
665
What is the difference between specificity and sensitivity?
Sensitivity (True Positive Rate) refers to the proportion of those who have the condition that received a positive result on this test.
Specificity (True Negative Rate) refers to the proportion of those who do not have the condition that received a negative result on this test.
666
What pressure score do we use to screen for pressure ulcers?
Waterlow score
667
What is Chvostek's sign?
In hypocalcaemia, if you tap the facial nerve the face will start to twitch
668
What is hoover's sign?
When you place your hand under the pts right leg and ask them to raise their left leg, you feel pressure against your hand
669
What is a section 136?
allows the police to take you to (or keep you at) a place of safety from a public place
670
What is a section 135?
Section 135 allows the police to enter your home and take you to (or keep you at) a place of safety so that a mental health assessment can be done.
671
What are Maxwell's Dimensions of Quality?
Maxwell (34) identified six dimensions of quality: effectiveness, acceptability, efficiency, access, equity and relevance
672
A 76y.o. pt is started on steroids for polymyalgia rheumatica. What would you also prescribe?
Alendronic acid (bisphosphonate)
673
What is polymyalgia rheumatica?
Polymyalgia rheumatica (PMR) is an inflammatory condition of unknown cause which is characterised by severe bilateral pain and morning stiffness of the shoulder, neck and pelvic girdle. There is ongoing debate as to whether or not PMR represents a form of giant cell arteritis (GCA), or whether they are distinct conditions, as they often co-exist, they share many common features and both respond to corticosteroids
674
What is green nipple discharge characteristic of?
Duct ectasia
675
What is a health behaviour aimed to seek remedy?
Illness behaviour
676
How does alcohol impact tremor in PD?
No effect.
677
You see a 18y.o. M with a fever, headache and purpuric rash on his abdomen. What is the diagnosis?
Meningococcal septicaemia, typically caused by Neisseria meningitidis
678
What effect does disulfiram have?
Drinking alcohol and disulfiram gives terrible SEs like making you viciously sick if consuming alcohol with it.
679
What is acamprosate used for?
Acamprosate works by helping the brains of people who have drunk large amounts of alcohol to work normally again. Acamprosate does not prevent the withdrawal symptoms that people may experience when they stop drinking alcohol. Acamprosate has not been shown to work in people who have not stopped drinking alcohol or in people who drink large amounts of alcohol and also overuse or abuse other substances such as street drugs or prescription medications.
680
What is Ebstein's anomaly, and what is it associated with?
Lithium use, large RA and small RV as tricuspid valves attach lower down on RV
681
When can you diagnose PTSD?
After 4 weeks of symptoms
682
How would you diagnose ? PTSD at 2wks?
Acute stress reaction
683
What are the normal ranges for fasting plasma glucose and the oral glucose tolerance test after 2h?
Normal: 3.9 to 5.4 mmols/l, pre 5.5 to 6.9 mmol/l
Normal: under 7.8 mmol/L, pre 7.9 to 11.0 mmol/L
684
What is antisocial personality disorder?
Criminal behaviour with no remorse
685
What is the management for meningitis in a 4m.o. F?
IV ceftriaxone and dexamethasone (if <3m amoxicllin)
686
Describe the features of Edward's syndrome
Overlapping fingers and rocker-bottom feet are key characteristics in Edward’s syndrome
687
How do we manage meconium ileus?
Rectal washouts initially, and then anorectal pullthrough if not effective
688
How does Osgood-Schlatter's disease present?
Anterior knee pain and palpable swelling at tibial tuberosity
689
A pt with obstetric cholestasis should give birth at... because...
Induction of labour at 37–38 weeks – risk of stillbirth in intrahepatic cholestasis
of pregnancy
690
How do we manage symptomatic hypoglycaemia/very low glucose?
Administer IV 10% dextrose
691
What is an acute dystonic reaction?
Acute dystonic reaction is an acute neurological condition, commonly seen in the emergency department that is characterized by involuntary muscle contractions that may manifest as torticollis, opisthotonus, dysarthria and/or oculogyric crisis [1]. Typically starts after starting on anti-psychotics
692
How do we manage acute dystonic reaction?
IV procyclidine
693
What is the most common cause of hypothyroidism?
Hashimoto’s thyroiditis with anti-TPO antibodies
694
What is naevus flammeus?
Port-wine stain
695
Where is the rash found in HSP?
The trunk is spared
696
What type of diuretic is movicol?
A macrogol. If not tolerated, an osmotic laxative like lactulose can be used instead.
697
What is Sandifer syndrome?
Sandifer syndrome a rare disorder that usually affects children up to the ages of 18 to 24 months. It causes unusual movements in a child’s neck and back that sometimes make it look like they’re having a seizure. However, these symptoms are usually caused by severe acid reflux, or gastroesophageal reflux disease (GERD).
698
When is immediate prescription of abx indicated for acute otitis media?
AOM in only hearing ear, cochlear implant present,
| AOM in both ears in children <2 and perforated TM
699
What is the name of the surgical procedure used to treat Hirschsprung's disease?
Swenson procedure
700
Give one feature of Patau syndrome
Polydactyly
701
How does fragile X syndrome present
Macrocephaly, the definition of which is the circumference of a person’s head being more than 2 standard deviations above the average for their age.
702
What is micrognathia a sign of?
Micrognathia is a feature of Edwards syndrome (Trisomy 18). The patient will have an undersized
lower jaw.
703
What is a sign of Noonan syndrome?
Pectus excavatum is a feature of Noonan syndrome. It is a congenital deformity of the chest wall
where several ribs and the sternum will grow inwards.
704
Would dementia pts be worried about their memory?
Typically lack insight, so no
705
What is the action of memantine?
MDMA antagonist
706
How long do we infuse N-acetylcysteine for?
1hr
707
When is activated charcoal most effective?
If given within 1 hr of presentation
708
When does peak incidence of delirium tremens occur?
48-72hrs following alcohol withdrawal
709
What is schizoaffective disorder?
Features of both schizophrenia and
| affective disorder
710
How does histrionic personality disorder present?
Patient over-dramatising her weight gain, trying to change her body weight for a boyfriend of 2 weeks (relationship considered to be more intimate than it is), trying to touch the GP (inappropriate sexual seductiveness), needing to be the centre of attention (trying to surprise her boyfriend for his mum’s birthday)
711
What is the first line tx of borderline personality disorder?
Dialectical behavioural therapy
712
What are the recommendations for contraception when on HRT?
Many women take HRT to reduce the symptoms they are getting from menopause. However women
start getting symptoms when they are peri-menopausal. Therefore it is recommended that you use
contraception for 2 years after your last period if you are under 50, and 1 year after if you are over 50.
This is because you can still get pregnant whilst on HRT
713
Who can unopposed oestrogen therapy be used for as HRT?
HRT containing unopposed oestrogen can only be used in women who have had a hysterectomy. This is
because unopposed oestrogen can increase your risk of endometrial cancer.
714
What is Gilbert's syndrome?
is an inherited (genetic) liver disorder that affects the body's ability to process bilirubin. Bilirubin is yellow liquid waste that occurs naturally as the body breaks down old red blood cells. People with Gilbert's syndrome don't produce enough liver enzymes to keep bilirubin at a normal level. No tx necessary.
715
When should external cephalic version be offered?
From 37 weeks if multiparous, from 36 weeks if nulliparous
716
What is the other word for fibroids?
Uterine leiomyoma, most common cause of heavy menstrual bleeding.
717
What is the difference between placenta accreta, increta and percreta?
Placenta accreta: chorionic villi penetrate the decidua basalis to attach to the myometrium.
Placenta increta: the villi penetrate deeply into the myometrium.
Placenta percreta: the villi breech the myometrium into the peritoneum.
718
Why is placenta praevia a RF for abnormal foetal lie?
it prevents engagement of the head.
719
When is the administration of anti-D prophylaxis indicated in women undergoing a TOP?
Rhesus -ve and after 10 weeks
720
What is an error of inheriting thinking?
g is when a working diagnosis is handed over and accepted without pause for
consideration and determining whether it has been substantially proven or whether it matches the
overall clinical picture
721
What is an error of bravado?
Error of bravado is typically working above competence in a show of
over confidence that is not safe.
722
What is an error of ignorance?
unconscious incompetence
723
What are the four layers of Seedhouse's ethical grid?
Core rationale, deontological layer, consequential layer, external considerations
724
What is the four pillar approach to medical ethics
Beneficence (doing good)
Non-maleficence (to do no harm)
Autonomy (giving the patient the freedom to choose freely, where they are able)
Justice (ensuring fairness)
725
What does amaurosis fugax of the eye causing visual loss suggest?
Temporal arteritis
726
What disease has a strong association to temporal arteritis?
Polymyalgia rheumatica
727
What is the commonest cause of a convergent squint?
A convergent squint is the commonest form of childhood quint. Hypermetropia or long sightedness
causes the image to focus behind the retina when the eye is at rest. excessive accommodation can bring the image into focus but also causes a convergent squint in children.
728
What are the calcium levels like in hyperparathyroidism?
Raised
729
Where do you see the Swan-Neck deformity?
RA
730
What is the action of salmeterol?
A long acting beta agonist, stimulation of G protein-coupled receptors causing smooth
muscle relaxation and hence bronchodilation
731
Second line for ADHD? Third line?
lisdexamfetamine, dexamfetamine
732
How do we treat viral-induced wheeze?
Salbutamol inhaler via a nebuliser
733
What does DELIRIUM stand for?
```
Causes of delirium
Dehydration
Electrolyte abnormality
Liver/withdrawal
Infection
Renal/liver
Ischaemia
UTI/constipation
Medications
```
734
Which medications are associated with delirium?
Opiates, benzos, zopiclone, anticholinergic-type meds, dopaminergic drugs such as those in PD
735
First line for trigeminal neuralgia?
Carbamazepine
736
In the Bamford classification, how do we diagnosed total anterior circulation syndrome?
Contralateral weakness of face, arm & leg
Homonymous hemianopia
Higher dysfunction e.g. dysphasia, visuospatial disorder
ALL THREE
737
Using the Bamford classification, how do we diagnose partial anterior circulation infarct?
2 of:
Contralateral weakness of face, arm & leg
Homonymous hemianopia
Higher dysfunction e.g. dysphasia, visuospatial disorder
738
How do we diagnose posterior circulation syndrome?
1 of:
Cerebellar/brainstem syndrome - e.g. quadriplegia, locked in syndrome
LoC
Isolated homonymous hemianopia
Cranial nerve palsy and contralateral motor-sensory deficity
739
What is lacunar syndrome?
Subcortical stroke due to small vessel disease
740
How do we diagnose lacunar syndrome?
```
Pure motor stroke (contralateral weakness of face, arm, leg or all three)
Ataxic hemiparesis
Pure sensory stroke
Mixed sensorimotor stroke
Clumsy hand dysarthria
```
741
When can a thrombectomy be performed?
Within 6 hours if proximal anterior circulation thrombus proven by CTA/MRI
742
How do parietal strokes present?
Sensory disturbances e.g. tingling, numbness
743
How do we treat absence seizures?
Sodium valproate or ethosuximide
744
How do we treat myoclonic seizures?
Sodium valproate or leviteracetam
745
How do we treat community status epilepticus?
Buccal midazolam or rectal diazepam
746
What do we use after two doses of lorazepam in status epilepticus?
IV phenytoin
747
How does chlorpromazine work in huntington's?
D2 antagonism may help control movements
748
What is Pick's disease?
Fronto-temporal dementia
749
What is the pathophysiology of MS?
Discrete plaques of demyelination in CNS disseminated in time and space due to T cell mediated schwann cell destruction
750
How does progressive muscular atrophy present?
An MND, wasting begins in the small muscles of the hand. Fasciculation is common, cramps may occur.
751
How does trigeminal nerve palsy present?
pTerygoids and Tongue go Towards the lesion.
752
What antibodies do you see in LEMS?
Anti-VGCC
753
What is a radiculopathy?
Mechanical compression of a nerve as it leaves the spinal cord.
754
What is a myelopathy?
Trauma or compression of the spinal cord
755
What is the first line investigation for NEC?
AXR
756
Which heart defect is associated with Williams syndrome?
William’s Syndrome is generally associated with Supravalvular Aortic Stenosis, which is not a cause of cyanotic heart disease.
757
Do we see hyper or hyporeflexia in lithium toxicity?
Hyper-reflexia
758
Which U&E abnormality can be seen with SSRI use?
Hyponaetraemia
759
How does tertiary syphilis present psychiatrically?
Psychosis
760
What is the type of hallucination delirium tremens?
Lilliputian
761
What is phenelzine, and what is complication is it associated with?
MAOI, used in depression, when paired with SSRI can cause serotonin syndrome
762
What cardiac defect is seen in Turner's syndrome?
Bicuspid aortic valve
763
Describe the types of O&G tears.
First degree tear – perineal skin only
Second degree tear – fascia and muscles of perineum
Third degree (A) tear – fascia and muscles of perineum, and <50% of external anal sphincter involved Third degree (B) tear – fascia and muscles of perineum, and >50% of external anal sphincter involved Third degree (C) tear – fascia and muscles of perineum, and both external and internal anal sphincters involved
Fourth degree tear – both external and internal anal sphincters completely torn, and anal epithelium involved
764
What is Erb's palsy?
C5-C6, This is where there is arm paralysis or weakness after birth trauma, typically shoulder dystocia. It may resolve on its own, need physio or need surgery.
765
When do we give steroids to premature babies?
After 24 weeks
766
When does the progesterone level peak?
The serum progesterone level will peak 7 days after ovulation has occurred. Therefore cycle - 14 (=ovulation) + 7
767
How do we manage mastitis?
Management of mastitis focuses on relieving pain with simple analgesia and warm compresses and encouraging complete emptying of the breast after feeding.
The woman should be encouraged to continue breastfeeding as this improves milk removal and prevent nipple damage. If pain prevents her from breastfeeding, she should be encouraged to express breast milk by hand or pump until breastfeeding can be resumed.
768
What is galactorrhoea?
is a milky nipple discharge unrelated to the normal milk production of breast-feeding.
769
How do we treat squamous cell carcinomas of the cervix?
Cone biopsy if want kids, a hysterectomy with lymph node clearance if doesn't want kids
770
What is haematocolpos?
An accumulation of the blood in the vagina, usually due to an imperforate hymen. Presents with cyclical pelvic pain, without having started menstruating.
771
Where do you see suppressed gonadotrophins in the present of low oestradiol?
Anorexia nervosa
772
What do we use the audit score for?
Assessing the patient’s AUDIT score will help you decide whether he has been abusing alcohol and whether he can be managed in the community. Admitting him for inpatient care without first assessing his AUDIT score would not be appropriate.
773
Describe CSF flow through the ventricles.
The CSF flows from the two lateral ventricles --> foramina of Monro --> third ventricle --> cerebral aqueduct --> fourth ventricle --> foramina of Luschka & Magendie --> subarachnoid space.
774
How do we calculate GCS?
Motor out of 6, verbal out of 5, speech out of 4
775
How does primary biliary cholangitis present?
Inflammation of the bile ducts. Fatigue is one of the commonest presenting symptoms, accompanied by jaundice and pruritus.
776
What autoantibodies do you see in primary biliary cholangitis?
Anti-mitochondrial
777
What is the difference between nephrotic and nephritic syndrome?
Nephrotic syndrome is characterised by severe proteinuria, i.e. high amounts of protein, including albumin, in the urine, while nephritic syndrome's major feature is inflammation.
The definition of nephrotic syndrome includes both massive proteinuria (≥3.5 g/day) and hypoalbuminaemia (serum albumin ≤30 g/L).
778
What is first line for thyrotoxicosis?
Propanolol, followed by carbimazole
779
How do we manage acute flare of UC?
The first-line treatment in an acute severe flare-up is IV steroids i.e. hydrocortisone or methylprednisolone.
780
What biochemical abnormality is seen with PCOS?
Raised LH. Hypersecretion of LH results in increased testosterone levels which results in reduced production of sex hormone binding globulin.
781
Where might you see pain in cholecystitis?
Referred to intrascapular
782
What is the difference between cholecystitis and cholangitis?
The presence of jaundice (D) would form Charcot’s triad (fever, RUQ pain, jaundice) which is characteristic of cholangitis. It is the presence of jaundice that separates cholangitis from cholecystitis.
Cholangitis - inflammation of biliary tree
Cholecystitis - inflammation of gallbladder
783
Triad in congenital rubella syndrome?
Triad of deafness, blindness and congenital heart disease.
784
Give three common SEs of topical corticosteroids
Striae, thinning of skin, acne
| NOT oedema
785
How high does an infants RR need to be to be concerning?
>70
786
Where do you see the cobblestone appearance on duodenal biopsy?
Crohn's disease
787
What is Toddler's diarrhoea?
Toddler's diarrhoea is a common cause of persistent (chronic) diarrhoea in young children. It mainly affects children between the ages of 1 and 5 years and is more common in boys. Toddler's diarrhoea is not serious and the child is well. The diarrhoea will go as the child becomes older. The diet of young children is often not ideal and is thought to contribute to the cause.
788
How does acamprosate work?
Reduces craving by inhibiting GABA transmission
789
What is the only absolute contraindication for ECT?
Raised intracranial pressure
790
What is mirtazapine? Where do we use it?
Mirtazapine is an SNRI that could be used in older patients who struggle with insomnia and weight loss due to its side effect of drowsiness (therefore should be taken at night) and weight gain.
791
What is dyspraxia?
Dyspraxia (E) affects a person's motor skills. Motor skills help us with movement and coordination. A young child with dyspraxia may bump into things or have trouble holding a spoon or tying their shoelaces. Later, they may struggle with things like writing and typing
792
What is the Edinburgh scale for?
Screening for postnatal depression
793
What is agomelatine?
An atypical antidepressant used to treat major depressive disorder.
794
What would you see on TFT in hyperemesis gravidarum?
Thyroid function tests are not helpful for diagnosis because they are often transiently abnormal in women with this condition.
795
What is the most common congenital abnormality seen with sodium valproate use?
Hypospadias
796
What kind of inheritance pattern is Marfan's syndrome?
Autosomal dominant
797
What is the antibiotic prophylaxis of choice for preterm prelabour rupture of the membranes?
Oral erythromycin is the antibiotic prophylaxis of choice for preterm prelabour rupture of the membranes.
798
What can be used for both the treatment of gonorrhoea & chlamydia?
Azithromycin can be used for both the treatment of gonorrhoea & chlamydia
799
Where do you see a positive Dix-Hallpike Maneuver?
Pathognomonic of Benign Paroxysmal Positional Vertiligo
800
How does vestibular neuritis present?
a continuous vertigo, which doesn’t fit the episodic nature here. It is also worsened by head position and there is likely to be a recent history of URTI. It is called Labyrinthitis if hearing is also affected i.e. Deafness or Tinnitus
801
How does posterior circulation stroke present?
PCS can present in a variety of ways, including CN palsy, Eye movement disorders, and Locked in syndrome
802
What is Lhermitte's sign?
Lhermitte's sign (also known as Lhermitte's phenomenon also referred to as the barber chair phenomenon is the name which describes an electric shock-like sensation that occurs on flexion of the neck
803
When should alendronic acid be taken?
Alendronic acid should be taken at least 30 minutes before food to maximise absorption, so (D) is correct.
804
What drug can be prescribed as an alternative to allopurinol in gout prevention?
Febuxostat
805
What is tamsulosin?
Alpha blocker used in BPH
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What are the most common causes of COPD exacerbations?
Moraxella catarrhalis (A) is one of the common bacteria causing COPD exacerbations, along with Haemophilus influenzae and Streptococcus pneumoniae.
