Stuff I have got wrong in the past Flashcards
What two bacteria are most significant for those with CF and are the reasons they should not interact?
- Pseudomonas aeruginosa
- Burkholderia cepacia (contraindication to lung transplant in CF)
When should infantile colic resolve by?
6 months
What is the triad of features seen in shaken baby syndrome?
- Retinal haemorrhage
- Subdural haematoma
- Encephalopathy
When can a child legally consent to sex and the doctor is not required to contact safeguarding?
13
What medications can be used to close a PDA (3)?
- Indomethacin
- Ibruprofen
- Paracetamol
What must be done before giving indomethacin to a neonate for PDA?
Echo to rule out duct dependant CHD
PPROM definition?
(preterm premature rupture of the membranes) - rupture of membranes before 37 weeks and before labour
does not have to be a specific time period before labour
Prolonged = rupture more than 18 hours before labour
What is prolonged rupture of membranes?
Amniotic sac ruptured more than 18 hours before labour
note prelabour rupture of membranes simply means before labour
What are the sepsis six?
- Blood cultures
- Urine output
- Fluids
- Antibiotics
- Lactate
-
Oxygen
consider inotropic support e.g. epinephrine
What is pituitary apoplexy and how does it present (3)?
Sudden enlargement of a pituitary tumour:
* Sudden onset headache
* Visual field defects
* Evidence of pituitary insufficiency (e.g. hypotension)
What time period after going to hospital should deaths be reported to the coroner?
If death occurs within 24 hours
What law allows treatment of a patient for emergency treatment?
Common law
this supersedes MCA/ MHA in an emergency
What sort of memory loss does depression cause?
Global memory loss
How should neuropathic pain be managed (3)?
- Try one of amitriptyline, gabapentin/ pregabalin, duloxetine
- Stop original drug, try another
How should MS be diagnosed?
MRI WITH contrast
When should bleeding whilst taking a progesterone only pill be investigated?
If it lasts beyond 3 months
How is measles diagnosed (2)?
- If rash began within 3 days = PCR
- If rash began more than 3 days ago = serology
How should a sickle cell crisis be managed (4)?
- Fluid
- Analgesia
- Oxygen
- Abx
What are the different types of perineal tears (6)?
- 1 = superficial, no muscle involvement
- 2 = injury to perineal muscle, not sphincter
- 3a = <50% external anal sphincter
- 3b = >50% external anal sphincter
- 3c = internal anal sphincter
- 4 = rectal mucosa
How should perineal tears be managed (3)?
- Nothing = 1st
- Suture on ward by midwife = 2nd
- Repair in theatre = 3/4th
What medication can improve the success of ECV?
Terbutaline
What nerve is often injured in a neck of fibular fracture?
Common fibular nerve
What drug can be given for the active management of the third stage of labour?
Oxytocin
ergometrine sometimes used as an alternative
When should urine cultures be sent in adults as opposed to relying on urine dipstick (4)?
- Over 65
- Visible/ non visible haematuria
- Men
- Pregnant women
What is jugular foramen syndrome?
Paralysis of CN 9, 10 and 11
What does a fluctuant breast mass suggest (2)?
- Cyst
- Abscess - refer to surgeons to drain
How should PID be managed with antibiotics (3)?
- Ceftriaxone
- Metronidazole
- Doxycycline
What are the signs/ symptoms of rickets (5)?
- Bowed legs (genuflects varum)
- Stunted growth
- Bone pain
- Frontal bossing
- Harrisons sulcus - indentation roughly along line of 6th rib (also seen in asthma)
What is Cushing’s reflex (3)?
- Bradycardia
- Hypertension
- Irregular breathing
What is variance?
Standard deviation ^ 2
What is likelihood ratio for a positive test?
sensitivity/ (1 - specificity)
What is the likelihood ratio for a negative test?
(1 - sensitivity)/ specificity
Hazard ratio vs incidence rate ratio?
- Hazard ratio compares the risk over time periods
- Incidence rate ratio simply compares the incidence at different time points
Should patients with cystic fibrosis be allowed to interact with PPE?
No they should never be allowed to interact under NO circumstances
What is the hawthorne effect?
Change in behaviour due to the knowledge that it is being studied
What nerves are affected in vestibular schwannomas?
5, 7, 8
What medication is used for delirium tremens in those with liver failure?
Lorazepam
What is raised in the newborn blood spot test in children with cystic fibrosis?
Immunoreactive trypsinogen
How should pre-elampsia be managed by a GP?
Emergency secondary care assessment
What causes webers syndrome?
Occlusion in the branches of the posterior cerebral artery that supply the midbrain
How does webers syndrome (branches of posterior cerebral artery that supply the midbrain) present (2)?
- Ipsilateral CN 3 palsy
- Contralateral weakness of upper + lower extremities
What causes Wallenberg syndrome (lateral medullary syndrome)?
Posterior inferior cerebellar artery occlusion
What causes lateral pontine syndrome?
Anterior inferior cerebellar artery occlusion
How does Wallenbergs (PICA) present (4)?
- Ipsilateral facial pain + temp loss
- Contralateral limb pain + temp loss
- Ataxia
- Nystagmus
How does lateral pontine syndrome present (AICA) (3)?
- Same as Wallenbergs +++
- Ipsilateral facial droop
- Deafness
What neurological condition can cause fluctuating levels of consciousness?
Subdural haemorrhage
What is the presentation of a hydrocele?
Fluctuant mass in groin area
fluctuant differentiates it from hernia
What is the most common cause of painless massive GI bleed in 1-2 year olds?
Meckles diverticulum
What is the most common cause of mesenteric adenitis?
Yersinia enterocolitica
How is CJD definitively diagnosed?
Brain biopsy
What should indicate the need for antibiotics in women breastfeeding who have mastitis (3)?
- No improvement after 12-24 hours of expressing/ breastfeeding
- Nipple fissure
- Systemically unwell
How is whooping cough investigated (2)?
- Nasal swab + culture = first line
- Nasal swab + PCR = more sensitive
What medication is used to suppress breastfeeding?
Cabergoline (dopamine receptor agonist)
What is often the most significant sign of congestive heart failure in infants?
Hepatomegaly
What is a radial scar?
Benign breast condition causing scaring of the breast in a star shaped pattern (due to sclerosis of breast ducts)
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
What is confabulation?
Memory gaps are filled with false fabricated memories
How should abnormal vaginal bleeding be investigated in postmenopausal women (3)?
- TVUSS
- Hysteroscopy
- Biopsy
How should premenopausal women be investigated for abnormal vaginal bleeding (4)?
- TVUSS
- Chlamydia test
- Colposcopy
- Biopsy
What is cataplexy?
Sudden and transient loss of muscle tone caused by strong emotions e.g. laughing
How is spasticity due to MS treated (2)?
Baclofen or gabapentin
What is the bone marrow finding in those with ALL?
Blast cell predominance
note ALL causes pancytopenia - even WCC can be low
What are the combined test results for downs?
- Raised BhCG
- Increased NT
- Decreased PAPP-A
What are the quadruple test results for Downs?
- Raised BhCG
- Raised inhibit A
- Decreased AFP
- Decreased E3
How does a bartholins cyst present and what is the management?
Painless fluctuant lump on labia major
manage with warm salt water baths
What is usually the most significant risk factor for candidasis?
COCP
also DM, recent Abx
When is spinal stenosis pain/weakness usually worse?
Walking downhill
What type of biopsy should be used for most breast lumps?
Core needle biopsy
fine is not used very frequently nowadays
Which antipsychotic has the highest rate of prolactinaemia?
Risperidone
What tool is used to assess whether medications should be discontinued?
STOPP tool
Can aspirin be taken whilst breastfeeding?
NOOOOO
What are the ranges for a diabetes diagnosis (3)?
- FBG > 7.0
- HbA1C > 48 (or equal to)
- RPG > 11.1
How does gliclazide (sulfonylurea) cause hypoglycaemia?
Increases pancreatic beta cell insulin production + release independent of blood glucose level
What legislation allows patients who lack capacity to be made to do something/ not allowed to do what they want??
Deprivation of liberties safeguard
What are the 3 most common presentations of OCD (3)?
- Hand washing
- Fear of harm
- Perfectionism/ arranging things
How does lymphogranuloma vereneum present?
Small PAINLESS ulcer in genital area
doxycyline = first line
What is a differential for croup if symptoms do not improve with treatment?
Bacterial tracheitis
How is chorea in huntingtons treated?
Tetrabenazine
What is baclofen?
Muscle relaxant often used for MS and muscle spasms in palliative care
What bloods should be done before starting lithium (5)?
- FBC
- U&Es
- Ca2+
- eGFR
- TFTs