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1
Q

What causes brwon sequard syndrome

A

Injury to back -> one side of spinal cord damaged -> hemisection

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2
Q

What is brown sequard syndrome

A

Unilateral spastic paresis
Loss proprioception/vibration sensation with loss pain and temp opp side

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3
Q

Carpal tunnel syndrome management

A

6 weeks wrist splint and steroid injections
Severe - wrist decompression surgery

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4
Q

Idiopathic intracranial HPTN symptoms

A

Diffuse headaches
Pulsatile tinnitus
Blurred vision
Bilateral papilloedema

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5
Q

When treat a person under 80 with stage 1 HPTN

A

Diabetic (ACEi)
Renal disease
QRISK2 >10%
Established coronary vascular disease or end organ damage

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6
Q

Mild falre of UC

A

Fewer than four stools daily with or wothout blood
No systemic disturbance
Normal ESR and CRP

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7
Q

Moderate flare of UC

A

4-6 stools a day w minimal systemic disturbance

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8
Q

Severe flare of UC

A

> 6 stools a day containing blood
Evidence of systemic disturbance eg
Fever
Tachycardia
Abdo tenderness, distension, reduced bowel sounds
Anaemia
Hypoalbuminaemia
Admit to hospital

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9
Q

NIV key indications

A

COPD w reps acidosis pH 7.35-7.35
T2 resp failure secondary to chest wall deformity, Neuromuscular disease or obstructive sleep apnoea
Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation

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10
Q

What glaucomas are myopia vs hypermetropia ass with

A

Hypermetropia - acute angle closure glaucoma
Myopia 0 primary open angle glaucoma

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11
Q

Risk factors for primary open angle glaucoma

A

increasing age
affects < 1’5 in individuals under 55 years of age
but up to 10% over the age of 80 years
genetics
first degree relatives of an open-angle glaucoma patient have a 16% chance of developing the disease
Afro Caribbean ethnicity
myopia
hypertension
diabetes mellitus
corticosteroids

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12
Q

Fundoscopy signs POAG

A
  1. Optic disc cupping - cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen and deepen
  2. Optic disc pallor - indicating optic atrophy
  3. Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base
  4. Additional features - Cup notching (usually inferior where vessels enter disc), Disc haemorrhages
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13
Q

Investigations for POAG

A

automated perimetry to assess visual field
slit lamp examination with pupil dilatation to assess optic nerve and fundus for a baseline
applanation tonometry to measure IOP
central corneal thickness measurement
gonioscopy to assess peripheral anterior chamber configuration and depth
Assess risk of future visual impairment, using risk factors such as IOP, central corneal thickness (CCT), family history, life expectancy

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14
Q

What are glaucomas

A

optic neuropathies ass w raised intraocular pressure
open - iris clear of trabecular meshwork
Closed - iris blocking meshwork

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15
Q

First line investigation sus cauda equina

A

Urgent MRI spine (within 6 hours)

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16
Q

What does concurrent leg pain, new neurological deficit and back pain suggestive of

A

Spinal nerve impingement in spine

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17
Q

What symptoms are suggestive of cauda equina

A

Urinary symptoms with saddle anaesthesia and abnormal rectal examination

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18
Q

Complications of cauda equina

A

New incontinence and paralysis of lower limbs, irreversible within hours

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19
Q

Causes of cauda equina

A

the most common cause is a central disc prolapse
this typically occurs at L4/5 or L5/S1
other causes include:
tumours: primary or metastatic
infection: abscess, discitis
trauma
haematoma

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20
Q

What does erythema migrans suggest

A

Bulls eye shaped rash concentric red rings - lyme disease

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21
Q

Features of erythema migrans

A

Bulls eye shaped rash concentric red rings
painless
1-4 weeks after initial bite

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22
Q

Complications of lyme disease

A

MSK, neuro, cardio
Arthritis, encephalitis, nerve palsies, arrhythmias

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23
Q

What to prescribe for cauda equina syndrome

A

Doxycycline if erythema migrans present and treatment initiated based on presence alone

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24
Q

Treatment if disseminated lyme disease

A

IV ceftriaxone

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25
Q

When have to test for antibodies before prescribing antibiotics in lyme disease

A

Symptoms suggestive (tick bite, fever, joint pain) but no erythema migrans

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26
Q

Post op delirium

A
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27
Q

Post operative ileus

A

Intestinal handling in srugery
Anticholinergics
Parkinsons

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28
Q

5 Ws of fever post surgery

A

Wind, water, walking, wound, wonder about drugs

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29
Q

Features of PCOS

A

Raised FSH to LH ratio
Normal or increased testosterone
Normal to low SHBG

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30
Q

1-2 dyas after surgery post op fever

A

Lungs, atelectasis, PE, aspiration

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31
Q

3-5 days post op fever

A

UTI, Catherter UTI

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32
Q

4-76 dyas post op fever

A

veins, DVT, immobility, PE

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33
Q

5-7 days post op

A

infections - superficial, deep, woiuinnd

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34
Q

Adverse drug reactions

A

Augemented - known side effect
B - bizarre 0 not predicted from known, immune mediated
C - chronic - long term
D - delayed - years after stop eg osteo
E - end of treatement eg withdrawal

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35
Q

Diagnosing PCOS

A

Oligo or anovulation
Fetaures or biochemical hyperandrogensim
Polycystic ovaries

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36
Q

Which hip condition is hyperactivity and shprt stature ass with

A

Perthes

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37
Q

What ROM have with a SUFE

A

Normal - limited internal rotation

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38
Q

Xray w SUFE

A

Ice cream falling off cone
Southwick angle for severity
Displaced and inferolaterally falling femoral head

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39
Q

Perthes disease

A

Flattened femoral head -> fragment if untreated
Rest and physio

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40
Q

Treat SUFE

A

Rest - avoid avascular necrosis
Mayneed to pin if severe

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41
Q

What symptoms is long term use of olanzapine most likely to have

A

Polyuria and dypsia - diabetes from atypical antipsychotic s

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42
Q

hat is priaprism

A

RProlonged erection of the penis

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43
Q

What do after a LETZ as follow up

A

Cervical smear in 6 months

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44
Q

hat should Hb levels be in pregnancy

A

first trimester Hb less than 110 g/l
second/third trimester Hb less than 105 g/l
postpartum Hb less than 100 g/l

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45
Q

Lithium side effects

A

Difficuty concentrating, headaches, low mood, constipation

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46
Q

Features ass with increased risk of miscarriage

A

Increased maternal age
Smoking in pregnancy
Consuming alcohol
Recreational drug use
High caffeine intake
Obesity
Infections and food poisoning
Health conditions, e.g. thyroid problems, severe hypertension, uncontrolled diabetes
Medicines, such as ibuprofen, methotrexate and retinoids
Unusual shape or structure of womb
Cervical incompetence

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47
Q

How to treat antidopaminergic side effects

A

Procyclidine

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48
Q

Antidopaminergic side effects

A

Worsning pain and stiff arms
Tremor
Increased agitation, limited responsiveness

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49
Q

How to treat tardive dyskinesia

A

Tetrabenazune or valproate

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50
Q

How to treat NMS

A

Dantrolene

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51
Q

How to treat akathesia

A

Porpanolol or cyproheptadine

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52
Q

Monitoring for APs

A

Cholesterol
HbA1c

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53
Q

What do before commence Antipsychs

A

ECG
baseline bloods

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54
Q

What stage of labour arragnge C section for breech when discovered

A

Before fully dilated - C section
After - all fours

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55
Q

Double bubble on xray paeds

A

Duoenal atresia (presents similarly to intussusception)

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56
Q

How to diagnose premature ovarian insufficiency

A

two sets of FSH levels raised - second after 4-6 weeks

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57
Q

When should babies be able to sit up on own

A

7-8 month old
Refer to paeds after one year

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58
Q

Can u have aspirin in breastfeeding

A

NO

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59
Q

Tranpositinon of great arteries present

A

Cyanosis immediately after birth
loud S2 _ RV impulse
Egg on string X ray

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60
Q

What is alprostdil infusion

A

PGE2 inhibitor

61
Q

Features of temporal seizure

A

focal seizsures - aware in episode, minutes post ictal
smakcing lips
aura - stomach upset
Medial is most common origin

62
Q

Jacksonian march where originates

A

Frontal lobe

63
Q

parietal lobe seizure

A

paraestehsia

64
Q

1st line for vaginal candidiasis

A

Clotrimazole pessary
Oral fluconazole one dose

65
Q

Treatment for a intussception - draw legs up to abdomen and mass, pallor, vomitting, crying

A

Reduction via air insufflation

66
Q

US intussception

A

Target sign

67
Q

What is ramsteads pylorotomy a treatment for

A

Pyloric stensosis

68
Q

Which inctontinence is duloxetine for

A

Stress

69
Q

How can acute lymphoblastic leukaemia present

A

Haemorrhagic/thrombotic complications due to DIC

70
Q

What do when admit for bronchiolitis

A

Supportive management only

71
Q

What do to manage

A
72
Q

What CP can be caused by noenatal jaundice

A

Dyskinetic CP - kenicterus 0 basal ganglia eso effected by bilirubin

73
Q

hat suspect in raised FSH and LH and primary amenorrhea

A

Gonadal dysgenesis/Turners syndrome

74
Q

What is the most common complication of Roseola infantum

A

Febrile convulsions

75
Q

hen repeat a smear if HPV + and cytology is normal

A

12 months

76
Q

AntiCCP vs Rf

A

Anti-CCP much more specific for RA
Bpth present in around 70% of RA

77
Q

Hydatiform mole on US

A

mole appears as a solid collection of echoes with numerous small anechoic spaces which resembles a bunch of grapes (also known as ‘snow-storm’ appearanc

77
Q

Hydatiform mole on US

A

mole appears as a solid collection of echoes with numerous small anechoic spaces which resembles a bunch of grapes (also known as ‘snow-storm’ appearanc

78
Q

Within 1 hour CT head injury

A

GCS<12 initial or <15 3hrs post
Open/depressed skull
Basal skull sign
Post traumatic seizure

79
Q

What CCB is contraindicated in heart failyre

A

Verapamil

80
Q

Graves disease most common ab

A

thyroid receptor antibodies

81
Q

Treatment for mennieres

A

Prochlorperazine - 1st line to help in nausea in acute attacks
Betahistine to prevent attacks long term

82
Q

BPPV diagnose and treat

A

Dix halpike test
Epley manouvre treat

83
Q

Mennieres symptoms

A

Fullness/tinnitus in ear
Longer attacks

84
Q

What is features of acuta ngle closure glaucoman

A

Acute painful red eye
Haloes in bright lights
More dilated
Hypermetropia risk factor

85
Q

BCC presentation

A

Pearly rolled edge
Telangiectasia
Raised

86
Q

SCC presentation

A

Flatter
Ulcers
white on it

87
Q

What do if woman less than 6 weeks pregnant presents with bleeding

A

expectant managemnet

88
Q

Infantile spasms

A

classically characterised by repeated flexion of head/arms/trunk followed by extension of arms

89
Q

Investigations if reduced foetal movements with vs without HB

A

with - CTG for 20 mins
WIthout - US scan

90
Q

Chromosome pattern of androgen insensitivity syndrome

A

46XY
Male genotype, female phenotype

91
Q

What is considered reduced foetal movement

A

RCOG considers less than 10 movements within 2 hours (in pregnancies past 28 weeks gestation)

92
Q

Investigations for reduced foetal movements

A

If past 28 weeks gestation:
Initially, handheld Doppler should be used to confirm fetal heartbeat.
If no fetal heartbeat detectable, immediate ultrasound should be offered.
If fetal heartbeat present, CTG should be used for at least 20 minutes to monitor fetal heart rate which can assist in excluding fetal compromise.
If concern remains, despite normal CTG, urgent (within 24 hours) ultrasound can be used. Ultrasound assessment should include abdominal circumference or estimated fetal weight (to exclude SGA), and amniotic fluid volume measurement
If between 24 and 28 weeks gestation, a handheld Doppler should be used to confirm presence of fetal heartbeat.
If below 24 weeks gestation, and fetal movements have previously been felt, a handheld Doppler should be used.
If fetal movements have not yet been felt by 24 weeks, onward referral should be made to a maternal fetal medicine unit

93
Q

What is the only suitable UPSI after 5 days of ovulation

A

Offer to fit IUD

94
Q

How many times do you repeat smear if HPV positive and normal cytology before colposcopy

A

3

95
Q

Age ranges for smears

A

25 - every 3 years
50 - every 5 years
Stop over 64

96
Q

Salmon pink rash and sore joints

A

JIA/Stills disease

97
Q

HIV positive when offered HPV smear

A

Annually

98
Q

reatment for whooping cough

A

azithromycin or clarithromycin if the onset of cough is within the previous 21 days

99
Q

Presentation of tetralogty of fallot

A

Cyanosis or collapse in first month of life, hypercyanotic spells. Ejection systolic murmur at left sternal edge

100
Q

Target BP in pregnancy

A

135/85
blood pressure falls in the first trimester (particularly the diastolic), and continues to fall until 20-24 weeks
after this time the blood pressure usually increases to pre-pregnancy levels by term

101
Q

HPTN in pregnancy

A

systolic > 140 mmHg or diastolic > 90 mmHg
or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic

102
Q

Most common cause of PPH

A

Uterine atony

103
Q

When do urgent delivery after foetal blood smaple

A

Foetal acidosis

104
Q

What do it late decelerations on ECG

A

Foetal blood sampling - pathological sign

105
Q

Biggest risk factor for Bella’s palsy

A

Pregnancy

106
Q

What diuretic causes hypercalcemia

A

Thiazide like

107
Q

What diuretic causes hypercalcemia

A

Thiazide like

108
Q

What two conditions cause 90% of hypercalcemia?

A

Primary hyperparathytoidism
Malignancy - PTHrP secreting tumour, bone mets, myeloma (increased osteoclast activity)

109
Q

What’s the most appropriate medical
Management for PE with hypotension

A

Alteplase - thrombolysis

110
Q

Alteplase MOA

A

Recombinant tissue plasminogen activator - activates plasminogen -> plasmin
More aggressive than anticoagulant, higher bleeding risk

111
Q

PE no haemodynamic instability treatment

A

DOAC first line
LMWH if unavailable or unsuitable

112
Q

Management of major bleed on warfarin

A

Stop warfarin
IV vitamin K 5mg
Prothrombin complex concentrate
Above regardless of INR immediately

Repeat dose vit K in 24 hours if INR still high

113
Q

Management of INR >8 vs 5-8 and minor bleed warfarin

A

Stop warfarin
IV vit K 1-3mg
if INR>8 repeat in 24 hours if INR still too high
For both Restart warfarin when INR <5

114
Q

When use oral vit K warfarin reversal

A

INR >8 but no bleeding
Otherwise same management as >8 and minor bleeding

115
Q

When withold warfarin

A

When INR 5-8
Withold 1 or 2 doses and reduce subsequent maintenance dose

116
Q

What condition could present as painful red bumps on legs, non productive cough and recent joint pains, bilateral hilar lymphadenopathy

A

Sarcoidosis

117
Q

First line treatment for broad complex tachycardia dw no adverse effects

A

IV amiodarone

118
Q

MOA of amiodarone

A

Improves cardiac polarisation and depolarisation by blocking potassium channels
Helps in broad complex tachy - heart struggling to pump

119
Q

What tahcycardia is adenosine used in

A

SVTs w narrow complexes

120
Q

MOA adenosine

A

Stimulates A1recptors on cardiac cells inducing adenosine sensitive potassium channels and cAMP production -> prolonged conduction through AV node -> AV blockade -> sinus rhythm

121
Q

What is atropine used for

A

Bradycardias

122
Q

What does atropine act on

A

The vagus nerve
Remove PNS input on heart

123
Q

When can alpha anti trypsin 1 deficiency be diagnosed and where is it made

A

Prenatal
Liver

124
Q

First line forCML

A

Imatinib

125
Q

Neuropathic pain medical management

A

Amitruptilline, duloxetine, gabapentin or pregabalin first line
If doesn’t work swap to another
Tramadol as rescue medication
Topical capsaicin if localised

126
Q

What would urinary incontinence, gait instability and new dementia suggest in an elderly patient?

A

Normal pressure hydrocephalus
Wet wobbly and wacky

127
Q

What can contribute to normal pressure hydrocephalus and what does it look like on imaging

A

Meningitis
Subarachnoid haemorrhage
Head injury

Looks like hydrocephalus with ventriculomegy +/- ducal enlargement

128
Q

Management of normal pressure hydrocephalus

A

Ventriculoperitone shunt
10% she complications eg seizures, infection, haemorrhage

129
Q

Why don’t cardiovert AF if >48 hours and when can you

A

May have a clot build up and DC cardioversion could dislodge and cause a stroke
Can cardiovert for long term after been on anti coagulation for 3 weeks

130
Q

What does acute management of AF depend on

A

How acute it is
<48 hours = rate off rhythm control
>48 hours or uncertain = rate control beta blocker, CCB, digoxin

131
Q

Who should rate control not be first line in for AF?

A

Reversible cause
Heart failure from AF
New onset <48 hours
Atrial flutter who can have ablation
Rhythm control better from clinical judgement

132
Q

Does catheter ablation reduce risk of stroke in AF?

A

No - still need to CHAVASC HASBLED to decide if need to anticoagulste

133
Q

Anticoagulation in catheter ablation

A

4 weeks prior
CHADVASC HASBLED
0 = 2 months of anticoagulstion
>1 = life long anticoagulant

134
Q

Complications of catheter ablation

A

Cardiac tamponade
Stroke
Pulmonary vein stenosis

135
Q

NSTEMI low GRACE score management low vs high bleeding risk

A

Low = ticagrelor (+apsirin + fondaparinux)
High = clopidogrel (+ above)

136
Q

What is atelactasis

A

Post op complication where basal alveolar collapse -> respiratory difficulty due to AWs blocked w bronchial secretions

137
Q

Features and treatment of atelectasis

A

Hypoxaemia and Dyspnoea up to 72 hours post op
Treat w chest physiotherapy and breathing exercises to clear secretions

138
Q

c-ANCA vs p-ANCA

A

c-ANCA PR3 - grnaulomatosis with polyangitis - proteinase
p-ANCA - microscopic polyangitis

139
Q

Histology in rapidly progressive glomerulinephritis

A

Crescenteric glomerulonephritis

140
Q

What difference is there in results between secondary and tertiary hyperparathyroidsim?

A

Low to normal phosphate in tertiary
High in secondary

141
Q

Sinus vs fistula

A

Fistula = abnormal passage between two epithelial surfaces
Sinus = blind channel lined with granulation tissue

142
Q

What GI condition causes severe epigastric pain relieved on leaning forwards

A

Pancreatitis

143
Q

Drugs causing pancreatitis

A

Azathipprine
Mesalazine
Didanosine
Bendeoflumethiazide
Furosemide
Pentamidine
Steroids
Sodium valproate

144
Q

Typical presentation of primary hyperthyroidism

A

Tired
Polyuria
High calcium normal PTH
Low mood

145
Q

Causes of primary hyperparathyroidisl form most to least likely

A

Solitary parathyroid adenoma (85%)
Hyperplasia 10%
Multiple adenoma 4%
Carcinoma 1%

146
Q

How to remember hyperparathyroidsim symptoms

A

Bones, stones, abdo moans and psychic groans

147
Q

Features of hyperparathryodism

A

Polydypsia, polyuria
Depression
Anorexia, nausea, constipation
Peptic ulcer
Pancreatitis
Connect pain/fracture
Renal stones
HPTN

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