Stuff I have got wrong in the past part 2 Flashcards
What are some reasons for taking high dose folic acid (3)?
- Taking AEDs
- BMI > 30
- FHx NTDs
Out of thrombectomy and thrombolysis which treatment should definitely be offered if an MRI shows salvageable tissue?
Thrombectomy always offered, CONSIDER thrombolysis
How should vaginal bleeding be managed in the first 6 weeks of pregnancy?
Send home for expectant management UNLESS abdo/ pelvic pain or cervical motion tenderness present … they then need emergency assessment
How should vaginal bleeding after 6 weeks pregnancy be managed?
Refer to hospital for TVUSS
How should VSDs be managed?
Most can be managed conservatively and monitored closely
What are the criteria for having your tonsils removed due to tonsillitis (3)?
- 7 episodes in 1 year
- 5 episodes per year for 2 years
- 3 episodes per year for 3 years
What criteria should be monitored for methylphenidate (4)?
- BP + pulse
- Psychiatric symptoms
- Appetite
- Weight + height
When should the parameters be measured for people taking methylphenidate (3)?
- Initiation of treatment
- Dose adjustment
- Every 6 months
What is classed as staggered overdose for paracetamol overdose?
First and last dose more than 1 hour apart
What is opisthotonus?
Type of acute dystonia causing involuntary flexing of muscles in back
What is the second line medication for OCD after SSRIs?
Clomipramine
not venlafaxine
What is the first and second line pharmacological treatment for PTSD?
1st = SSRIs/ venlafaxine
2nd = antipsychotics
When can venlafaxine be used first line (although sertraline is usually used first)?
- GAD
- Panic disorder
- PTSD
NOT used for OCD
What migraine medication can cause serotonin syndrome?
Triptans
What two signs indicate meningeal irritation and how do you elicit them?
- Brudzinskis - neck flexed –> involuntary flexion of hips + knees
- Kernigs - hips flexed, then knees straitened –> pain
What are two special signs/ tests are seen in MS?
- Uhtoffs phenomena - worse after hot shower
- Lhermittes sign - neck flexion –> electric shock sensations down spine
What is the most common cause of meningitis in adults?
S. pneumoniae
What tool is used to assess the risk of developing pressure sores for patients?
Waterlow score
What rash is pathological of secondary syphilis?
Condylomata lata - grey discs + rash on hands/ feet
How should antiretroviral drugs for HIV be taken?
Same time every day
How should patient be treated if they refuse a vulvovaginal and endocervical swab?
Order first catch urine, if they refuse this then empirically with Abx
What is the difference between lymphadenopathy in lymphgranuloma vereneum and syphilis?
- Syphilis = non-painful
- Lymphgranuloma vereneum = painful
What are the key explanations for health inequalities according to the black report (4)?
- Artefact
- Social selection
- Materialist/ structural
- Cultural/ behavioural
How long should substance use disorder go on before a diagnosis?
12 months, or 1 month if use is continuous
What is in the censor score (5)?
- Age 3-15
- Exudate/ swollen tonsills
- Swollen LNs
- Temp > 38
- Cough absent
How should anaphylaxis be managed after giving two doses of IM adrenaline?
Fluid bolus + call for help
What is second line for diabetes management?
- Sulfonylureas (e.g. gliclazide)
- Heart disease/ CVD = SGLT-2 inhibitors (e.g. dapagliflozin)
How long should chronic fatigue syndrome last before a diagnosis?
3 months
What is a key side effect of colchicine use?
Diarrhoea
What is first line anticoagulant for AF and what is used in those with poor kidney function?
- 1st line = DOAC (e.g. apixaban)
- CKD = warfarin
What is the definition of postural hypotension in terms of BPs?
- Drop in 20 mmHg systolic
or - Drop in 10 mmHg diastolic
- Within 3 minutes of standing
What two medications can treat postural hypotension?
1st = Midodrine
2nd = Fludrocortisone
What immunoglobulin is raised in hay fever/ asthma/ eczema?
IgE
How is cradle cap (seborrhoeic dermatitis) treated (3)?
- Emollient + brushing
- Topical anti fungal shampoo
- Topical steroids
What is erythema infectiosum?
Slapped cheek
What is a sandal gap associated with?
Downs syndrome
What are the features of potters syndrome (4)?
- Low set ears
- Twisted body/ skeletal malformation
- Flattened nose
- Pulmonary hypoplasia (respiratory distress)
What are some criteria for assisted withdrawal (with chlordiazepoxide) for alcohol use disorder (2)?
- Audit > 20
- Drink more than 15 units per day
What is the most common cause of a painful third nerve palsy?
Posterior communicating artery aneurysm
If a woman is using lactational amenorrhoea as a form of contraception is it recommended for her to take the POP or not?
Yes POP is recommended even with lactational amenorrhoea
If a preterm woman is in labour and she is 4cm dilated what medications should she be given (2)?
- Betamethasone (mature lungs)
- Benzylpenicllin (indicated in preterm births)
How would GBS appear under the microscope?
Positive coccus
How should labour be managed after 3 pulls using an instrumental delivery?
Convert to LSCS
Can you take amiodarone whilst breastfeeding?
No, and not during pregnancy either
What is Galeazzis test?
Used to indicate whether leg length shortening is due to tibia or femur
What medication other than SSRIs can be helpful in treating those with anorexia nervosa?
Mirtazapine
What are some normal laboratory findings/ changes from normal in pregnancy (3)?
- Increased urinary protein
- Reduced serum creatinine
- Reduced serum urea
How long should symptoms of PTSD go on before a diagnosis can be made?
1 month
What is the second line medication for ADHD after methylphenidate?
Lisdexamfetamine
What heart defect is associated with Williams syndrome?
Supravalvular aortic stenosis
How is meningitis treated in those over and under 3 months?
- Over = ceftriaxone + dexamethasone
- Under = cefotaxime + amoxicillin
Is a meningococcal septicaemia rash raised?
No it is flat on skin
When does volvulus usually present?
Before 1 month
What are the signs/ symptoms of lithium toxicity (5)?
- Corse tremor
- Hyper-reflexia
- Acute confusion
- Polyuria
- Seizures
What are the 3 drugs used for alcohol dependance and what do they do?
- Disulfiram - unpleasant symptoms if alcohol consumed
- Acamprosate - reduces desire
- Naltrexone - reduces pleasure
What are the important blood tests to do in those taking lithium (4)?
- TFTs
- eGFR
- U&Es
- Lithium level
What is a lilliputian hallucination?
Seeing lots of small people
What is the most common type of hallucination in delirium tremens?
Tactile hallucinations
What is the most common type of hallucination in delirium?
Visual
Which nerves are affected in erbs palsy?
C5-6
When are cervical cerclage and vaginal progesterone used in preterm labour?
- Cerclage = when cervical length < 25mm AND previous preterm birth
- Vaginal progesterone = ONLY when cervical length < 25mm
When should serum progesterone be measured in those having trouble conceiving?
7 days before end of cycle
What are the criteria for prescribing antibiotics in mastitis (2)?
- Symptoms do not improve after 12-24 hours of breastfeeding
- Nipple fissure present
fluclox first line
What is a haematoclopos?
Accumulation of blood in the vagina usually due to imperforate hymen
What is the most common cause of hyperandrogegism in postmenopausal women?
Ovarian hyperthecosis - luteinised theca cell nests in ovaries
What are the 5 signs of heart failure on X-ray?
- Alveolar bat wing oedema
- Kerley B lines
- Cardiomegally
- Dilated upper lobe vessels
- Pleural effusion
What is the flow of CSF through to the subarachnoid space?
Lateral ventricles –> foramen on monro –> third ventricle –> cerebral aqueduct –> fourth ventricle –> foramina of luschka & magendie –> SAS
What autoantibodies are found in primary biliary cholangitis?
Anti mitochondrial antibodies
What two drugs are important in hyperthyroidism?
- Carbimazole - reduce thyroid levels
- Propanolol - symptomatic relief
What medication can be used to provide relief from stomach cramps of those with IBS?
Buscopan
How is DKA managed in the emergency setting?
- IV bolus 0.9% NaCl 10ml/kg given over 15 minutes
- Insulin at 0.1 units/kg/h
What causes molluscum contagiosum?
Poxvirus
What is conduct disorder?
Persistent behaviours that violate the right of others in people under 18
What is oppositional defiant disorder?
Angry, irritable mood and argumentative, but without the severe aggression seen in conduct disorder
What are some contraindications for donepezil (2)?
- Pelvic ulcers
- Bradycardia
What features suggest a worse prognosis for MS (3)?
- Male
- Older
- Motor signs at onset
How is a missed miscarriage managed medically?
- Mifepristone
- Misoprostol (48 hours later)
How is an incomplete miscarriage managed medically?
Misoprostol
How should a bishop score of more than 6 be managed?
Amniotomy AND IV oxytocin
How should a bishops score of 6 or less be managed?
Vaginal prostaglandin E2 OR oral misoprostol