Y3 Exam 1 Flashcards
What is the ICD10 classification of mild depression?
What is the ICD10 classification of moderate depression?
What is the ICD10 classification of severe depression?
Mild depression, need 2 of the general criteria PLUS 1 additional sympotms
Moderate depression, need 2 of the general criteria PLUS 3 additional symptoms
Severe depression, need all 3 of the general criteria PLUS 5 additonal symptoms
General criteria for depression:
- Low mood for most of the day almost everyday for 2+ weeks
- Loss of interest or pleasure (anhedonia)
- Decreased energy (fatigue)
Additonal symptoms:
- Loss of confidence
- Feelings of guilt
- Suicidal ideation
- Decreased concentration
- Agitation/ psychomotor retardation
- Sleep disturbance
- Change in appetite
List some symptoms of anorexia (7)
Lanugo hair
Cold intolerance
Blue hands / feet
Amenorrhoea
Dry skin
Hypotension
Weakness / fatigue
List some features of nephrotic syndrome: (4)
List some features of nephritis syndrome: (3)
Nephrotic syndrome:
• proteinuria (+++)
• oedema
• hypoalbuminaemia
• hyperlipidaemia
Nephritic syndrome:
• haematuria
• hypertension
• proteinuira (+)
What is the definition of epilepsy?
State the difference between generalised and partial (focal) seizures:
State whether the following types of epilepsy are generalised or partial:
a) tonic-clonic
b) simple partial
c) complex partial
d) absence seizures
e) myoclonic seizures
f) secondary generalised
g) tonic seizures
h) atonic seizures
i) clonic seizures
Epilepsy - More than 1 unprovoked seizure
Generalised seizures: electrical activity spreads across both hemispheres of brain
Partial (focal) seizures: electrical activity only involves one hemisphere/ lobe
- *a) tonic-clonic:** generalised seizure
- *b) simple partial:** partial seizure
- *c) complex partial:** partial seizure
- *d) absence seizures:** generalised seizure
- *e) myoclonic seizure:** generalised seizure
- *f) secondary generalised:** partial seizure
- *g) tonic seizure:** generalised seizure
- *h) atonic seizure:** generalised seizure
- *i) clonic seizure:** generalised seizure
What are the 7 phases that anaethetists go through to manage a patient?
~ Note which ones are the 4 phases of anaesthesia
1) Pre-operative care/ planning
2) Preparation
* 3) Induction*
* 4) Maintenance*
* 5) Emergence (waking patient up)*
* 6) Recovery*
7) Post-operative care
What are the 2 mechanisms underlying addiction?
~ State whether they underpin physical/ psychological dependence
- Tolerance - physical dependence
- Activation of the reward pathway - psychological dependence
What screening tool is used to assess the likelihood of anorexia nervosa?
A score of what would suggest an eating disorder?
SCOFF questionairre
2+
What is calculated alongside the ASA grade to risk stratify the patient before surgery?
~ a score of what makes them a high risk patient?
How is a patients exercise tolerance graded? (what unit is used?)
~ What score would the following exercise tolerances be given:
a) walking around the house
b) walk 100-200m on flat
c) strenuous exercise
Cardiac risk index - score 2+ = high risk patient!
METs
a) 2 METs
b) 4 METs
c) 9 METs
(Eg, diabetes, renal failure, ischaemic heart disease, congestive heart failure etc)
What is a pleural effusion?
What is the difference between exudate & transudate?
List lung causes of an exudate (3) & transduate (1):
Pleural effusion = fluid in the pleural cavity
Exudate: fluid contains 3g+ of protein - caused by inflammation
• Lung cancer
• Pneumonia
• TB
Transudate: fluid contains less than 3g of protein - caused by fluid shifts
• Congestive heart failure
There are 2 extremes of delirum. What are they called? List some symptoms seen in each: (3, 3)
Hyperactive delirium:
→ Aggression/ aggitation
→ Hallucinations
→ Restlessness
Hypoactive delirium:
→ Sleepiness/ fatigue
→ Withdrawn
→ Memory problems (temporary dementia)
What type of hallucinations are common in lewy body dementia?
Visual hallucinations:
→ animals in the house
→ faces in the wallpaper
What is the gold standard investigation for suspected vesico-uteric reflux in children?
What investigation is used to look for any kidney scarring/ function of the kidney?
What investigation is used to look at the structure (size & shape) of the kidney?
MCUG (micturicting urogram)
DMSA
US KUB
What part of the GIT does coeliacs disease affect & what is the main histological finding seen?
List some clinical features seen in coeliac disease: (6)
What condition is closely associated with coeliac disease?
Small bowel (esp jejenum) - villous atrophy
- Failure to thrive (in children)
- Diarrhoea
- Weight loss
- Fatigue
- Dermatitis herpetiformis (itchy rash, usually on abdomen)
- Malabsorption
Type 1 diabetes (as well as other autoimmune conditions)
What condition is indicated if a woman presents with recurrent miscarriages & a history of VTE events?
What is the treatment of this condition? (2)
Antiphospholipid syndrome
Aspirin & LMWH
What is the prophylaxis management of haemophilia?
How is an acute episode of bleeding treated? (3)
Replacement of clotting factors via IV transfusions (VIII - A, IX - B)
1) Infusions of affected clotting factor (VIII or IX)
2) Desmopressin (DDAVP) - to stimulate VWF release
3) Tranexamic acid - reduces the rate of fibrinolysis so that clot remains for longer
What drug class is used for the treatment of Alzheimers disease & Lewy Body dementia?
Give an example of a medication from this class.
Acetylcholinesterase inhibitors
Donepezil
The Philadelphia chromosome is associated with what haematological condition?
The philadelphia chromosome (a mix of 2 chromosomes) results in what oncogenic gene?
~ What is the translocation of the gene?
Chronic myeloid leukaemia
BCR-ABL gene
~ t(9;22)
Regarding sections from the MHA below, state a) how long they are valid for, b) who is able to use them, c) whether they include assessment/ treatment
Emergency detention certificate
Short-term detention certificate
Compulsary treatment order
Emergency detention certificate:
• Valid for 72h
• Fully registered doctor (FY2 onwards) + consent from a MHO (if available)
• ONLY detention
Short-term detention certificate:
• Valid for 28d
• Approved mental health doctor (psychiatrist!!) + MHO consent
• Detention & treatment
Compulsary treatment order:
• Valid for 6m - but can be renewed!
• MHO applies to Tribunal with 2 supporting medical reports from a AMP (psychiatrist) & GP (otherwise 2x AMPs)
• Detention & treatment
Amyotrophic lateral sclerosis is a type of what disease?
List some features of this condition: (4)
What gene mutation is associated with this condition?
What is the treatment of this condition?
What type of penetrance does the disease have? - What does this mean for family members with the gene?
Motor neurone disease
ONLY motor symptoms!!!!!!
• Progressive muscle weakness (LMN)
• Muscle wasting (LMN)
• Hyper-reflexia (UMN)
• Spasticity (UMN)
SOD gene
NO TREATMENT
Incomplete penetrance:
~ People with the gene don’t always develop the disease so offspring may/ may not be affected
~ Environmental factors ‘switch’ the gene on - nobody knows how/ why
What is Immune Thrombocytopenic Purpura (ITP)?
What blood abnormality does it result in?
What is the 1st line treatment for ITP?
If this doesn’t work, what do you add to the treatment?
Autoimmune attack of platelets (antibodies are made against platelets)
Results in thrombocytopenia (low platelet count)
1st line treatment: steroids
If steroids don’t work, add in IV IgG (immunoglobulins)
Give 2 examples of:
a) obstructive lung diseases
b) restrictive lung diseases
Would you expect an FEV1:FVC ratio to be < or > 75% in each?
Obstructive lung diseases: FEV1:FVC < 75%
• COPD (permanent airway obstruction)
• Asthma (reversible airway obstruction)
Restrictive lung diseases: FEV1:FVC > 75%
• Pulmonary fibrosis (interstitial lung disease)
• Sarcoidosis
What are the key clinical features in lewy body dementia? (3)
Fluctuating confusion throughout the day
Visual hallucinations
Parkinsonism symptoms (poor mobility, tremor)
List some features of a pleural effusion: (3)
List 2 findings seen on a chest xray:
What other investigation would you do in a pleural effusion to determine the cause?
What is the treatment of a small effusion/ large effusion?
What is the name of an infected pleural effusion?
- SOB
- Reduced breath sounds
- Dullness to prescussion over the effusion
Xray findings:
• Blunting of the costophrenic angles
• Fluid in the lung fissures
Pleural fluid aspirate - to determine exudate VS transudate cause
- *Treatment:**
- Small effusion:* conservative management
- Large effusion:* chest drain
Infected pleural effusion = empyema
What is the definition of psychosis?
What 2 clinical signs fall under pschosis?
The inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality (aka, lack of insight)
Hallucinations
Delusions
List the positive & negative symptoms of schizophrenia: (3, 3)
Having more of which type of symptoms indicates a better prognosis?
How long do symptoms need to be present for an ICD-10 diagnosis?
Positive symptoms: - better prognosis!
• Hallucinations
• Delusions
• Disordered thinking
Negative symptoms:
• Anhedonia
• Lack of emotions (emotional blunting)
• Apathy (lack of motivation)
Schizophrenia = symptoms present for 1 month +
Describe what nociceptive pain is:
Describe what neuropathic pain is:
Note whether they have a protective function or not.
Nociceptive pain = pain when there is tissue injury or illness (eg when you cut yourself)
~ has a protective function (the pain causes you to stop whatever is causing the pain)
Neuropathic pain = pain caused by nervous system damage / abnormality
~ no protective function, often occurs long after there has been trauma!
Regarding fluids, (colloid & crystalloid’s):
1) give an example of each type commonly used in hospital
2) describe the size of the molecules they contain & the consequence of this on fluid compartments within the body
3) state a contraindiction in each type
- *1) Colloid**: fluid containing starch/ gelatin
- *Crystalloid**: plasmalyte/ hartmans/ dextrose/ 0.9%NaCl
- *2) Colloid:** large molecules → more fluid is retained in the blood vessels
- *Crystalloid:** small molecules → some fluid remains in blood vessels & some moves into the tissues/ cells
- *3)** Colloid: the large molecules can cause kidney damage (so cannot be used in patients with renal failure)
- *Crystalloid:** 0.9%NaCl has a high Na conc so can cause hypernatraemia
Germline mutations:
• occur in what cells?
• can mutations be passed on to offspring?
Somatic mutations (non-germline):
• occur in what cells?
• can mutations be passed on to offspring?
Germline:
• mutations occur in egg/ sperm
• mutations are passed to offspring - offspring will have the mutation in every cell within their body!
Somatic:
• mutations occur in any cell of the body except egg/ sperm
• mutations are not passed to offspring
What is the treatment of mild-moderate Alzheimers disease? (Drug & drug class)
~ Name a common S/E of this.
What is the treatment of severe Alzheimers disease/ if previous treatment has failed?
What is the treatment of Vascular dementia?
What is the treatment of Lewy-Body dementia? (Drug & drug class)
~ Name a common S/E of this.
What is the treatment of Fronto-temporal dementia?
Anticholinesterase inhibitors: donepezil
S/E = GI upset (nausea, vomiting, diarrhoea)
Memantine
Management of underlying vascular risk factors
Anticholinesterase inhibitors: donepezil
S/E = GI upset (nausea, vomiting, diarrhoea)
No current treatment..
Explain the difference in absorption of drugs between younger & geriatric patients:
• amount of absorption
• rate of absorption
Name the exception (drug) to this!!!
- Amount of drug absorption is the SAME
- Rate of drug absorption is SLOWER in geriatric patients compared with younger people → time of onset of drug action is delayed
LEVODOPA is absorbed quicker in older people!!!
List some features of Crohn’s: (NESTS) +2
→ NO blood/ mucus (uncommon)
→ Entire GI tract
→ Skip lesions on endoscopy
→ Terminal ileum most affected & Transmural thickness of inflammation
→ Smoking = risk factor
→ Weight loss
→ Structures/ fistulas
What is the mode of inheritance of Myotonic dystrophy?
~ What is the repeated gene?
Explain what anticipation is:
List some symptoms/ signs of Myotonic dystophy: (6)
Autosomal dominant
~ CTG repeats
Anticipation: Successive generations inherit more CTG repeats in the gene → earlier onset & increased severity of the disease
• Distal muscle weakness/ stiffness (diaphragm/ face)
• Saggy face (due to muscle weakness)
• Bilateral ptosis
• Bilateral cataracts
• Frontal balding
• Difficulty letting go after shaking someones hand
What are the 1st rank symptoms of Schizophrenia? (ABCD)
A - Auditory Hallucinations
B - Broadcasting of Thought
C - Controlled Thought (delusions of control)
D - Delusional Perception
Having a H.pylori infection increases the risk of what condition?
How is H.pylori infection treated & how long for?
What is Barretts oesophagus & what causes it?
Barretts oesophagus increases the risk of what?
What is the a) prevention & b) treatment of Barretts oesophagus?
Stomach cancer (MALT)
Triple therapy for 7 days:
~ PPI (eg omeprazole)
~ 2x antibiotics
A premalignant change from squamous to columnar epithelium in the lower oesophagus - caused by persistent reflux (GORD)
Adenocarcinoma
Prevention: PPI’s (eg omeprazole)
Treatment: ablation of dysplastic cells
What immunological mechanism is responsible for type 2 hypersensitivity reactions?
Give 2 examples of conditions that this occurs in:
Auto-antibody mediated receptor activation
Haemolytic disease of the newborn
Transfusion reactions
If a woman is *Rh- and is carrying a Rh+ baby and there is no intervention, what will happen during delivery/ when there is mixing of blood?
Why does this happen?
When should this be checked for during pregnancy?
What can be given as prophylaxis for this?
*Rh = rhesus
The women will start developing anti-D antibodies after any sensitising event (commonly giving birth)
If someone is rhesus negative, they don’t have the D antigen on their RBC’s so if their blood comes into contact with someone that is rhesus positive then their blood will start producing antibodies against the foreign antigens.
Rh status of mother & baby is checked at the booking appointment (week 10)
If mother is negative & baby is positive, prophylaxis = anti D injection at 28 weeks gestation PLUS immediately after any sensitising events (eg birth/ trauma)
Name the condition described:
“Episodes of binge eating with a sense of loss of control, followed by purging behaviour” - BMI less than 17.5
Anorexia nervosa: binge purge subtype
A 19 year old student presents to his GP with a three month history of hearing a voice commenting on what he is doing and making derogatory comments about him. It has recently started telling him to do things. He has started to believe that his flatmates are against him and wish to harm him. He uses no illicit drugs.
What is the most likely diagnosis?
Schizophrenia
Anti-CCP is specific for what condition?
Rheumatoid arthritis
An extradural haemorrhage is commonly caused by a tear in which artery?
A # in which part of the skull usually causes this tear?
Middle meningeal artery
A # of the pterion - the pterion is weakest part of the skull & lies above the middle meningeal artery
What are the 3 core symptoms of depression?
- Low mood (for more than half of the day, 2+ weeks)
- Anhedonia
- Low energy levels
List some common symptoms of asthma: (3)
List some common symptoms of COPD: (5)
~ state the biggest risk factor!!
Asthma:
• Wheeze
• Cough (worse at night)
• SOB
COPD:
• Progressive SOB
• Cough
• Sputum production
• Wheeze
• Recurrent resp infections
Risk factor: SMOKING
Anti-CCP is specific for what condition?
Rheumatoid arthritis
What are the 2 main joints affected in ankylosing spondylitis?
What gene is associated with the condition?
What is the main presenting symptom?
~ Describe this
List 2 common xray findings seen in ankylosing spondylitis:
What is the 1st line medical treatment? - what is used in acute flares?
- Sacroiliac joint
- vertebrae
HLA B27
Lower back pain & stiffness
~ gradual onset (months)
~ worse at rest & in the morning/ night
~ improves with movement
Bamboo spine, squaring of the vertebral bodies
1st line treatment: NSAIDs (no known drugs modify disease course!)
• flares: steroids
Germline mutations:
• occur in what cells?
• can mutations be passed on to offspring?
Somatic mutations (non-germline):
• occur in what cells?
• can mutations be passed on to offspring?
Germline:
• mutations occur in egg/ sperm
• mutations are passed to offspring - offspring will have the mutation in every cell within their body!
Somatic:
• mutations occur in any cell of the body except egg/ sperm
• mutations are not passed to offspring
There are 2 types of immunity: innate & adaptive:
1) Which one is activated in a primary/ secondary infection?
2) Which one is rapid & non-specific/ slow onset & very specific?
3) Which one provides ‘short’/ ‘long’ term immunity?
4) Which one involves phagocytes & the complement system?
5) Which one invovles antibodies and cellular immunity (provided by T cells)?
1) Primary infection = innate
* *Secondary** infection = adaptive
2) Rapid & non specific = innate
* *Slow & very specific** = adaptive
3) Short term immunity = innate
* *Long term immunity** = adaptive
4) Phagocytes & complement = innate
5) Antibody production & cellular immunity = adaptive
What is the mode of inheritance of Huntington’s Disease?
~ What is the repeated gene?
Explain what anticipation is:
List some symptoms/ signs of huntingtons: (4)
What type of penetrance does the disease have? - What does this mean for family members with the gene?
Autosomal dominant
~ CAG gene repeats
Anticipation: Successive generations inherit more CAG repeats in the gene → earlier onset & increased severity of the disease
- Chorea (involuntary, abnormal movements)
- Dementia (poor memory/ cognitive function)
- Personality change
- Depression/ psychosis etc
Full penetrant - all family members with the gene will develop the disease at some point
What does SCID stand for?
Which immune cells are affected in SCID?
What are the 2 treatment options for SCID?
Severe combined immunodeficiency
Development of B cells & T cells is affected producing dysfunctional B & T cells
1st line = stem cell transplant
If not available: gene therapy
Explain urge incontinence:
• state the commonest cause
What are the treatments of urge incontinence?
• Non-pharmacolgical
• Pharmacological
The sudden need to urinate without warning
• overactive/ irritated bladder (detrusor muscle is over stimulated!)
- *Non-pharmacolgical:** Bladder retraining
- *Pharmacological:** Antimuscarinics** (eg Oxybutinin)
Antimuscarinics act to block activation of the detrusor muscle
List some clinical features seen in haemophilia: (5)
Haemarthrosis (bleeding into the joints)
Muscle haematoma
CNS bleeding
Prolonged bleeding after surgery/ trauma
Menorrhagia
List 3 screening tools used to identify an alcohol problem:
CAGE - score of 2+ indicates alcohol problem
AUDIT
FAST
Explain the effects that the below changes in body composition in the elderly have on the drug effects:
a) increased adipose tissue
→ volume of distribution
→ duration of action/ half life
b) reduced body water
→ volume of distribution
→ serum concentration
→ duration of action
c) reduced albumin
→ serum concentration
→ effect of drug
a) Increased adipose tissue
→ increased volume of distribution of fat soluble drugs
→ fat soluble drugs will have longer 1/2 life & duration of action!
b) Reduced body water
→ lower volume of distribution of water soluble drugs
→ higher serum concentration
→ reduced duration of action
c) Reduced albumin
→ reduced amount of drug will be bound to albumin (as there is less of it)
→ higher serum concentration of active drug
→ bigger (stronger) effect of drug produced
Between which meningeal layers does a subarachnoid haemorrhage occur?
Between the arachnoid mater & pia mater
What is the acute management of a manic episode? - give an example
What is the chronic management of bipolar disorder?
Antipsychotic (eg, Olanzapine)
Lithium (or sodium valproate)
+ antipsychotic (eg olanzapine) - if uncontrolled with lithium
A patient with delirium does not have capacity. - T/F
Capacity is decision specific. - T/F
False, some patients may still have capacity
True, a patient may not have capacity for more complex decisions but may retain capacity for basic decisions
What are 2 serious side effects of MAOI’s? - How can these be avoided?
1) Hypertensive crisis (cheese reaction)
~ avoid tyramine rich foods as they cause huge increase in BP
~ eg, beer, wine, cheese
2) Serotonin syndrome
~ occurs when MAOI’s are taken alongisde drugs that increase serotonin (eg SSRI’s)
~ wait 2 weeks after stopping SSRI before starting MAOI
What are the 2 main joints affected in ankylosing spondylitis?
What gene is associated with the condition?
What is the main presenting symptom?
~ Describe this
List 2 common xray findings seen in ankylosing spondylitis:
What is the 1st line medical treatment? - what is used in acute flares?
- Sacroiliac joint
- vertebrae
HLA B27
Lower back pain & stiffness
~ gradual onset (months)
~ worse at rest & in the morning/ night
~ improves with movement
Bamboo spine, squaring of the vertebral bodies
1st line treatment: NSAIDs (no known drugs modify disease course!)
• flares: steroids
What is the management of tension headaches?
Simple analgesia: NSAIDs / paracetemol
An elderly man has been admitted to hospital with acute onset disorientation, visual hallucinations and agitation. He has no psychiatric history and lives alone and requires no support.
What is the most likely diagnosis?
Delirium
What type of dementia is most common in the under 65’s age group?
Alcohol related brain damage (ARBD)
The body compostion changes with age. In regards to the following, state what you would expect in older people, compared to young:
a) muscle mass
b) adipose tissue (fat)
c) % body water
d) albumin
e) permeability of the BBB
a) Reduced muscle mass
b) Increased adipose tissue
c) Reduced body water %
d) Reduced albumin
e) Increased permeability of BBB
What is the difference between mania and hypomania?
For a diagnosis of either, how long do symptoms need to be present for?
Mania: Elated/ irritable mood PLUS:
• psychotic features (halluctination/ delusions)
• impacts on ADL
Hypomania: Elated/ irritable mood PLUS:
• NO psychotic features
• NO impact on ADL
Diagnosis requires symptoms for 1 week+
Now-a-days most medications aren’t stopped before surgery, even if patients are NBM…!
List 3 medications that would never be stopped before a surgery:
List 2 medications that may be stopped before a surgery:
Never stop:
• Inhalers
• Anti-anginals (GTN)
• Anti-epileptics
Sometimes may stop:
• Diabetic meds
• Anti-coagulants
What is the ASA grading system used for in anaesthetics?
Describe each ASA grade 1-6:
ASA used to identify how healthy the patient is in order to stratify the risk of surgery on the patient
ASA1: Healthy patient, non-smoker
ASA2: Mild systemic disturbance/ smoker/ obesity (eg, well controlled diabetes/ hypertension)
ASA3: Severe systemic disturbance (eg, poorly controlled diabetes/ hypertension)
ASA4: Life threatening disease (eg, recent MI/ sepsis)
ASA5: Moribund patient (unlikely to survive the surgery)
ASA6: Organ retrieval (patient is brain dead)
What are the cancerous cells in chronic lymphocytic leukaemia?
List some symptoms/ signs of CLL: (4)
What autoimmune condition is associated with CLL?
What cell would be seen on a blood film?
What is the management of CLL? - is it curable?
Differentiated lymphoid cells (B & T lypmhocytes)
- COMMONLY ASYMPTOMATIC !!!!
- Non-tender lymphadenopathy
- Hepatosplenomegaly
- B symptoms
Warm autoimmune haemolytic anaemia
Smudge cells
NOT CURABLE - if no symptoms, don’t treat!
(Otherwise chemotherapy)
List some extrinsic causes of urinary incontinence: (5)
- Immobility issues - unable to get to toilet
- Diuretics - increase volume of urine
- Constipation
- Confusion - may be unaware of needing toilet
- Painkillers - can cause constipation
A bacterial growth of what suggests a UTI?
105
In the RAT approach to pain management, what does R, A, T stand for?
How would a patient describe nociceptive pain?
How would a patient describe neuropathic pain?
- *R** - recognise pain
- *A** - assess pain type/ severity
- *T** - treat pain
Nociceptive pain:
• Sharp/ dull pain
• Well localised (patient can point to location of pain)
Neuropathic pain:
• Burning/ shooting pain
• Pins & needles
• Numbnesss
Describe what you might see in the following seizures:
a) Tonic-clonic seizure
b) Myoclonic seizure
c) Absence seizure
d) Atonic seizure
Tonic-clonic seizure: Muscles stiffen (go rigid = tonic) before generalised jerking of limbs (clonic)
Myoclonic seizure: Sudden jerking of one limb - patient may be conscious!
Absence seizure: Patient ‘pauses’ for a few seconds before restarting activity - patient often has no recollection
Atonic seizure: Muscles suddenly loose all tone - patient falls over
What is a common presentation of a cluster headache? (6)
Male with sudden onset, severe pain, behind one eye
Associated with:
~ watery, bloodshot eye
~ lacrimation
~ ptosis
~ miosis
~ runny nose (rhinorrhea)
What type of pain will the WHO pain ladder be successful at helping?
What is the treatment for the other type of pain? (name 2 examples of drugs used)
Nociceptive pain = use WHO pain ladder
Neuropathic pain - WHO pain ladder doesn’t work
~ amitriptylline
~ gabapentin
~ duloxetine
What type of headache is associated with autonomic symptoms? (Ptosis, miosis, lacrimation, nasal congestion)
Cluster headache
What immunological mechanism is responsible for type 3 hypersensitivity reactions?
Give an example of a disease that is caused by type 3 hypersensitivity.
Immune complex deposition
SLE
What are the 3 main criteria of PTSD according to ICD-10? - list some symptoms that fall under each one
What is the management of sub-clinical PTSD?
What is the management of moderate+ PTSD?
~ if this doesn’t work, what medication can be used?
1) Hyper-arousal
~ persistent anxiety
~ poor concentration
~ emotional numbing
2) Flashbacks
~ intense flashbacks at night/ during day
3) Avoidance
~ activities that remind patient of trauma are avoided
Subclinical: Watch & wait approach
Moderate: Trauma focused CBT - SSRI’s
When should an ADR be reported to the yellow card scheme? (3)
- Any ADR seen in a new drug
- Any ADR in children
- Any serious ADR, even if the ADR is already known about (eg neutropenia/ agranulocytosis etc)
What is the treatment of von Willebrand disease?
List 2 contraindictations to the use of DDAVP:
There is no day-to-day treatment. Treatment is given after a bleed or in preparation for surgery
1) VWF concentrate IV
2) Desmopressin - stimulates the release of VWF
3) Tranexamic acid - inhibits fibrinolysis (clot breakdown)
Contraindictations: young children, people with high cardiovascular risk
What chromosome is associated with chronic myeloid leukaemia? - what are the consequences of this?
What is the gene translocation?
What is the 1st line management of CML?
Philadelphia chromosome ⇒ BCR-ABL gene (oncogene)
t (9;22)
Tyrosine kinase inhibitors (inhibit BCR-ABL!)
~ eg Imatinib
What is often the first clinical feature seen in vascular dementia?
Aphasia (problems with communication)
* Memory is often spared until advanced disease
TRUE/ FALSE:
- Blood pressure normally goes up under anaesthesia.
- End tidal CO2 measures how much CO2 the patient breathes in.
- There are 5 pieces of monitoring that must be present before a GA is given.
- Only some patients require airway management whilst under anaesthesia.
False - anaesthetics commonly make BP fall
False - the amount of CO2 breathed out
True - BP, SATs, ECG, end tidal CO2, airway pressure
False - every patient will require some degree of airway management
A bacterial growth of what suggests a UTI?
105
What is Osteoarthritis - what does it usually present with?
~ what makes it worse/ better?
List the 4 commonest joints affected:
List 2 common signs that are seen in the hands:
What things are used in the management?
Mechanical wear & tear - presents with joint pain & stiffness
~ worse at night & upon activity, better with rest
- Hips
- Knee
- DIPs (of hands)
- MCP joint at base of thumb
- Haberdens nodes (DIP joints)
- Bouchards nodes (PIP joints)
- Physiotherapy (mobilising joint)
- Weight loss
- Paracetemol & topical NSAIDs ⇒ oral NSAIDs
- Intra-articular steroid injections
What is the management of mild- moderate depression?
What is the management of moderate- severe depression?
What do you do next if the 1st medical managent of severe depression fails?
~ If this fails, then what?
~ What do you add in next?
What is the management of severe treatment resistant depression?
~ If patient doesn’t want this, what medical management is available?
Mild-moderate: • Group CBT
Moderate-severe: • CBT PLUS SSRI (sertraline)
Add in a 2nd SSRI
~ Swap one of the SSRI’s for an SNRI
~ Use these along with lithium
** Review after 2 weeks
ECT (electro convulsive therapy)
~ Monoamine oxidase inhibitors (MAOIs)
What is a tension pneumothorax?
~ what is the cause?
List some signs of a tension pneumothorax: (4)
What is the initial management?
What is the definitive management?
Tension pneumothorax: air enters the pleural space through a one way valve - during inspiration, air moves into pleural space, during expiration air cannot leave
~ Caused by trauma to the chest
- SOB
- Tracheal deviation away from side of pneumorthorax
- Reduced air entry on affected side
- Resonant to percussion on affected side
- *Management:**
- Initial*: insert a large bore cannula into the 2nd intercostal space in the midclavicular line
- Definitive*: Chest drain
Joint pain/ stiffness that is worse in the morning & improves with exercise indicates:
a) mechanical cause
b) inflammatory cause
Inflammatory cause
Which electrolyte imbalance is seen in anorexia nervosa?
Hypokalaemia (low K)
What cells are cancerous in myeloproliferative disorders? - where in the body are these cancerous cells found? (before mets)
List some clinical signs/ symptoms of chronic myeloid leukaemia (a myeloproliferative disorder) (4) - what is the cancerous cell?
What chromosome is associated with CML? - what are the consequences of this?
What is the 1st line management of CML?
Differentiated cells of myeloid origin
~ found in bone marrow
• Anaemia (→ pancytopenia)
• Massive splenomegaly
• HIGH WCC
• Gout
~ Cancerous cell = neutrophils
Philadelphia chromosome ⇒ BCR-ABL gene (oncogene)
Tyrosine kinase inhibitors (inhibit BCR-ABL!)
What condition is indicated if a woman presents with recurrent miscarriages & a history of VTE events?
What is the treatment of this condition? (2)
Antiphospholipid syndrome
Aspirin & LMWH
What are the 3 criteria needed for a diagnosis of learning difficulty?
What are the 3 main causes of learning difficulty?
1) Intellectual impairment (IQ < 70)
2) Social/ adaptive dysfunction
(eg deficits in communication/ self-care, social skills etc)
3) Onset before 18y (whilst brain is still developing)
1) Head injury
2) Chromosomal abnormalities (eg Downs)
3) Congenital abnormalities (eg infection/ abnormal brain development)
Explain what tolerance (in regards to addiction) means:
Name the 2 types of tolerance & explain the physiological process behind each type:
How can tolerance result in dependence?
Tolerance: Reduced responsiveness to a drug caused by the body adapting to previous physiological effects of the drug
~ body tries to maintain homeostasis
Dispositional tolerance
~ less drug reaches the drug receptors
Pharmacodynamic tolerance
~ drug has less action on the drug receptors
Tolerance = body physiologically adapts each time drug is taken → stopping drug causes withdrawal symtpoms which are often unpleasant → drug is repeatedly taken to avoid withdrawal symptoms
What is Neurofibromatosis Type 1 (NF1)?
What mode of inheritance is seen in NF1?
List some common symptoms/ signs of NF1: (5)
A genetic condition that causes cancers to grow along the nerves (often benign but can turn malignant)
Autosomal dominant
• Cafe au lait spots (coffee colour patches on the skin) - see below
• Axilliary freckling
• Neurofibromas (small nodular tumours on the skin)
• Brown patches on the iris
• Learning difficulties/ epilepsy
What is Neurofibromatosis Type 1 (NF1)?
What mode of inheritance is seen in NF1?
List some common symptoms/ signs of NF1: (5)
A genetic condition that causes cancers to grow along the nerves (often benign but can turn malignant)
Autosomal dominant
• Cafe au lait spots (coffee colour patches on the skin) - see below
• Axilliary freckling
• Neurofibromas (small nodular tumours on the skin)
• Brown patches on the iris
• Learning difficulties/ epilepsy
