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MBChB Y1-3 > Year 3 > Flashcards

Year 3 Flashcards

1
Q

What is the most common cause of bacterial meningitis in neonates?

A

Listeria monocytogenes

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2
Q

What is a cross-sectional design?

A

Carried out at a single point in time, so exposure and outcome measured at same time

Most frequently takes the form of a survey e.g. census

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3
Q

What factor is deficient in haemophilia B?

A

Factor IX

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4
Q

Interpretation of CSF sample - is this viral or bacterial meningitis?

Appearance: clear
Protein: mildly raised or normal
Glucose: low
WCC: high, lymphocytes

A

Viral

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5
Q

What is the recommended first-line treatment option for Philadelphia chromosome positive CML?

A

Imatinib

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6
Q

Name the personality disorder:

  • Characterised by attention-seeking behaviours and excessive displays of emotions
  • Often sexually inappropriate
  • Shallow and self-dramatising
  • Relationships are considered to be more intimate than they really are
A

Histrionic personality disorder

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7
Q

Maternal infection with ________ during pregnancy can result in the following features in the fetus:

Miscarriage or fetal death
Severe fetal anaemia
Hydrops fetalis (fetal heart failure)
Maternal pre-eclampsia-like syndrome

A

Parovirus B16

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8
Q

Name the leukaemia:

Common presentations include symptoms caused by marrow failure (symptoms of anaemia including fatigue, abnormal bleeding/bruising caused by low platelets, and infections caused by low white cells)

Symptoms may also be caused by organ infiltration, such as bone pain

Signs include painless lymphadenopathy, hepatosplenomegaly, CNS involvement (e.g. cranial nerve palsies, meningism) or testicular infiltration (resulting in painless unilateral testicular enlargement)

A

ALL

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9
Q

Which antibiotics inhibit folic acid synthesis?

A

Sulfamethoxazole

Trimethoprim

Co-trimoxazole

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10
Q

What is the most common motor neurone disease phenotype in adults?

A

Amyotrophic lateral sclerosis

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11
Q

Which pathway is affected by heparin?

A

Intrinsic pathway - measured by APTT

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12
Q

Describe the clinical presentation of placental abruption

A

Sudden onset severe abdominal pain that is continuous

Vaginal bleeding (antepartum haemorrhage)

Shock (hypotension and tachycardia)

Abnormalities on the CTG indicating fetal distress

Characteristic ‘woody’ abdomen on palpation, suggesting a large haemorrhage

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13
Q

A lesion in which area of the brain would produce the following features?

Homonymous hemianopia (with macula sparing)
Cortical blindness
Visual agnosia

A

Occipital lobe

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14
Q

Which factors are measured by PT?

A

7, 10, 5 & 2 (the extrinsic and common pathways)

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15
Q

Describe the typical findings of lymphoma

A

Lymphadenopathy - characteristically non-tender and feel ‘rubbery’, some patients will experience pain in the lymph nodes when they drink alcohol

‘B’ symptoms are the systemic symptoms of lymphoma - fever, night sweats, weight loss

Itch without rash

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16
Q

Name the seizure: Patients, often children, pause briefly, for less than 10 seconds, and then carry on where they left off

What is the treatment?

A

Absence seizure

Ethosuximide or sodium valproate first-line; avoid Carbamazepine as it worsens seizures

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17
Q

Describe the management of a cluster headache

A

Acute attack: high flow O2 100% for 20 mins with a subcutaneous or nasal triptan, steroids (reducing course over 2 weeks)

Prophylaxis: verapamil

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18
Q

What is the ‘cheese reaction’ and what drug causes it?

A

MAO inhibitors - hypertensive crisis caused by inhibition of MAO-A in gut (and liver) by irreversible inhibitors preventing breakdown of dietary tyramine

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19
Q

Describe the management of trigeminal neuralgia

A

Medical - carbamazepine first line, gabapentin, phenytoin

Surgical - ablation, decompression

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20
Q

What are the 7 cardinal movements of labour?

A

Engagement
Descent
Flexion
Internal Rotation
Extension
Restitution and external rotation
Expulsion

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21
Q

Describe the management of Lambert Eaton Myasthenic Syndrome

A

Amifampridine - K+ channel blocker to increase ACh release

Appropriate management of underlying SCLC

If autoimmune only - immunosuppression

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22
Q

Which artery is usually damaged in an extradural haemorrhage?

A

Middle meningeal artery

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23
Q

Name the leukaemia:

Most common leukaemia in adults overall. Associated with warm haemolytic anaemia, Richter’s transformation into lymphoma and smudge / smear cells.

A

Chronic lymphocytic leukaemia

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24
Q

What is the mechanism of action of SSRIs?

A

Selectively inhibit the reuptake of serotonin (5-HT) from the synaptic cleft

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25
Q

What coagulation test results are associated with von Willebrand’s disease?

A

APTT may be normal or may be prolonged if factor VIII deficiency is present, PT will be normal

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26
Q

Describe the clinical presentation of hemicrania continua

A

Severe unilateral headache

Unilateral autonomic features

Constant duration

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27
Q

Which cranial nerves arise from the cerebrum?

A

CN I and II

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28
Q

What is the difference between postpartum blues and postpartum depression?

A

Postpartum blues usually presents within 3-7 days following giving birth and usually resolves in 10 days, symptoms of postpartum depression typically start within a month and peak at 3 months

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29
Q

Which antipsychotics are most likely to cause EPSE and increased PRL side effects?

A

Typical antipsychotics e.g. haloperidol, prochloperazine

Of the atypicals - rispridone

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30
Q

A seizure in which lobe of the brain would produce the following symptoms:

Visual symptoms such as spots and lines in the visual field

A

Occipital lobe

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31
Q

Typical antipsychotics act on the _______ pathway, leading to hyperprolactinaemia

A

Tuberoinfundibular

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32
Q

Which antibiotic inhibits nucleic acid synthesis?

A

Metronidazole

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33
Q

All expectant women should be offered a vaginal examination and _____ _____ at 40 weeks gestation

A

Membrane sweep

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34
Q

Describe the clinical features of neuroleptic malignant syndrome

A

Onset of pyrexia and muscle stiffness over hours (24-72)

Increasing muscle tone, pyrexia, changing pulse/BP → rhabdo → ARF → coma → death

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35
Q

What is the mechanism of action of tricyclic antidepressants?

A

Block the reuptake of monoamines (mainly noradrenaline and 5-HT) into presynaptic terminals

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36
Q

List the criteria for a total anterior circulation infarct

A

Contralateral hemiplegia or hemiparesis, AND
Contralateral homonymous hemianopia, AND
Higher cerebral dysfunction (e.g. aphasia, neglect)

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37
Q

In which age group is the most common cause of meningitis Neisseria meningitidis?

A

Age 10-21

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38
Q

What does the Adults With Incapacity Section 47 Certificate do?

A

Authorises practitioner to provide reasonable interventions related to the treatment authorised

Does not authorise force unless immediately necessary and only for as long as is necessary

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39
Q

What is a prospective cohort design?

A

Cohort followed forward in time from present

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40
Q

Name the personality disorder:

  • Characterised by a pattern of extreme difficulty interacting socially, bizarre or magical thinking and distorted perceptions
  • Inappropriate behaviour and strange speech and affect can cause others to perceive them as strange
  • They share some features with schizophrenics, but maintain a better grasp on reality
A

Schizotypal personality disorder

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41
Q

A lesion in Broca’s area will result in ________ aphasia

A

Expressive - Broca’s area is responsible for fluent speech

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42
Q

Describe the physiology of Lambert Eaton Myasthenic Syndrome

A

Antibodies against voltage activated Ca2+ channels in the motor neuron terminal result in reduced Ca2+ entry in response to depolarisation → reduced ACh release

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43
Q

Describe the clinical presentation of a subarachoid haemorrhage

A

Sudden, very severe headache, often occipital

Headache is usually followed by vomiting and often by coma and death

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44
Q

Which cranial nerves arise from the medulla oblongata?

A

CN IX-XII

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45
Q

What is the mechanism of action of mirtapine?

A

Mixed receptor effects - blocks ⍺2, 5-HT2 and 5-HT3

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46
Q

Name the leukaemia:

Most common acute adult leukaemia. It can be the result of a transformation from a myeloproliferative disorder. Associated with Auer rods.

A

Acute myeloid leukaemia

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47
Q

What is placental abruption?

A

Refers to when the placenta separates from the wall of the uterus during pregnancy; it is a significant cause of antepartum haemorrhage

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48
Q

What finding on a coagulation screen is associated with von Willebrand disease?

A

Isolated prolonged APTT

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49
Q

_______ in pregnant women has a high rate of miscarriage or fetal death; it can also cause severe neonatal infection

A

Listeriosis

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50
Q

Describe the CT findings associated with a subdural haematoma

A

Classically shows a crescent of blood around the brain tissue, and midline shift

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51
Q

What is placenta praevia/low lying placenta?

A

Placenta praevia is where the placenta is attached in the lower portion of the uterus, lower than the presenting part of the fetus

Low-lying placenta is used when the placenta is within 20mm of the internal cervical os

Placenta praevia is used only when the placenta is over the internal cervical os

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52
Q

Describe the genetics of CML

A

The cytogenetic change that is characteristic of CML is the Philadelphia chromosome - t(9:22) translocation

Results in a new gene - BCR-ABL1

The gene product is a tyrosine kinase which cause abnormal phosphorylation leading to the haematological changes in CML

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53
Q

Describe the management of EPSE (acute dystonic reaction, Parkinsonism, tardive dyskinesia)

A

Anticholinergic drugs e.g. procyclidine PO/IM, consider changing antipsychotic

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54
Q

Describe the neurological features of Wilson’s disease

A

An akinetic-rigid syndrome similar to Parkinson’s disease

Pseudosclerosis dominated by tremor

Ataxia

A dystonic syndrome, which often leads to severe contractures

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55
Q

Which cranial nerves arise from the pontine-medulla junction?

A

CN VI-VIII

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56
Q

Describe the clinical presentation of paroxysmal hemicrania

A

Severe unilateral headache

Unilateral autonomic features

10-30 mins duration

1-40 a day

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57
Q

Which arteries are involved in a PACI?

A

Anterior OR middle cerebral arteries on the affected side

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58
Q

What is the mechanism of action of lithium?

A

May block phosphatidylinositol pathway or inhibit glucogen synthase kinase 3β or modulate NO signalling

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59
Q

Name the personality disorder:

  • Characterised by a pattern of disregard and violation of the rights of others
  • Individuals lack empathy and are often manipulative and impulsive
  • Aggressive and unremorseful
  • Consistently irresponsible with failure to obey laws and social norms
A

Antisocial personality disorder

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60
Q

What factor is deficient in haemophilia A?

A

Factor VIII

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61
Q

Describe the management of paroxysmal hemicrania

A

Absolute response to indomethicin

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62
Q

Auer rods are associated with which form of leukaemia?

A

AML

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63
Q

Describe the management of SUNCT

A

Lamotrigine, gabapentin

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64
Q

Maternal infection with ________ during pregnancy can result in the following features in the fetus:

Fetal growth restriction
Microcephaly
Hearing loss
Vision loss
Learning disability
Seizures

A

Congenital cytomegalovirus

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65
Q

What is a short term detention order?

A

Up to 28 days for assessment/treatment

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66
Q

What are the clinical features of Brown Sequard syndrome?

A

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

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67
Q

Which form of antipsychotic is linked to orthostatic hypotension?

A

Typical antipsychotics

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68
Q

Describe the clinical presentation of placenta praevia

A

The 20-week anomaly scan is used to assess the position of the placenta and diagnose placenta praevia

Many women with placenta praevia are asymptomatic

May present with painless vaginal bleeding in pregnancy (antepartum haemorrhage)

Bleeding usually occurs later in pregnancy (around or after 36 weeks)

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69
Q

Maternal infection with ________ during pregnancy can result in the following features in the fetus:

Fetal growth restriction
Microcephaly, hydrocephalus and learning disability
Scars and significant skin changes located in specific dermatomes
Limb hypoplasia (underdeveloped limbs)
Cataracts and inflammation in the eye (chorioretinitis)

A

Varicella zoster (chickenpox)

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70
Q

Thrombin (factor II) activates fibrinogen (factor I) into ___ and _______

A

Fibrin and factor XIII

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71
Q

Name the kinase mutation present in over 95% of PV patients

A

JAK2 mutation

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72
Q

What is covered by Clause E of a HSA1 form?

A

Termination with no gestational limit, there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

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73
Q

What blood results are associated with bulimia nervosa?

A

Metabolic alkalosis, hypokalemia and hypochloraemia

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74
Q

CLL can cause _____ autoimmune haemolytic anaemia

A

Warm

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75
Q

Name the key finding from lymph node biopsy in patients with Hodgkin’s lymphoma

A

Reed-Sternberg cell

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76
Q

A lesion in which area of the brain would produce the following features?

Wernicke’s aphasia (lesions result in word substituion, neologisms but speech remains fluent)
Superior homonymous quadrantanopia
Auditory agnosia
Prosopagnosia (difficulty recognising faces)

A

Temporal lobe

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77
Q

What is a case-control design?

A

Group of subjects with disease or condition are identified (cases)

A suitable control group is identified without the condition (controls)

Frequency of exposure or risk factor extracted and compared in cases and controls

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78
Q

List the metabolic abnormalities see in tumour lysis syndrome

A

Hyperkalaemia, hyperphosphataemia, hyperuricaemia, hypocalcaemia

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79
Q

Describe the clinical presentation of vasa praevia

A

Ideally diagnosed by ultrasound during pregnancy.

It may present with antepartum haemorrhage, with bleeding during the second or third trimester of pregnancy.

It may be detected by vaginal examination during labour, when pulsating fetal vessels are seen in the membranes through the dilated cervix.

Finally, it may be detected during labour when fetal distress and dark-red bleeding occur following rupture of the membranes. This carries a very high fetal mortality, even with emergency caesarean section.

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80
Q

Which atypical antipsychotic is most likely to cause metabolic syndrome?

A

Olanzapine

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81
Q

Describe the management of akathesia/restless legs caused by typical antipsychotics

A

β-blocker e.g. propranalol first line, benzodiazepines e.g. clonazepam second line

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82
Q

Describe the CT findings associated with a subarachnoid haemorrhage

A

Irregular shaped bleed

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83
Q

Name the leukaemia:

Most common leukaemia in children. Associated with Down syndrome.

A

Acute lymphoblastic leukaemia

84
Q

Describe the difference in presentation between Parkinsonism and Lewy Body dementia

A

Parkinsonism and fluctuations in cognitive impairment and visual hallucinations, often before Parkinsonian features occur

85
Q

Name the leukaemia:

Usually presents with weight loss, tiredness, fever, and sweating

Common signs include massive splenomegaly (>75%), bleeding (due to thrombocytopenia), and gout

Usually presents in middle-aged adults

A

CML

86
Q

Describe the clinical presentation of spinal muscular atrophy

A

Muscle wasting and weakness, LMN signs WITHOUT sensory signs

87
Q

Describe the clinical presentation of placenta accreta

A

Ideally, placenta accreta is diagnosed antenatally by ultrasound

Often causes no signs or symptoms during pregnancy, although vaginal bleeding during the third trimester might occur

It may be diagnosed at birth, when it becomes difficult to deliver the placenta - it is cause of significant postpartum haemorrhage

88
Q

Aquagenic puritis is associated with which

A

Polycythaemia vera

89
Q

Thrombin (factor II) activates ______ into fibrin and factor XIII.

A

Fibrinogen (factor I)

90
Q

Which cranial nerve arises from the midbrain?

A

CN IV

91
Q

Name the personality disorder:

  • Characterised by a lack of interest in others, apathy and a lack emotional breadth
  • They tend to have few friends and do not form relationships, preferring solitary activities
A

Schizoid personality disorder

92
Q

How would you manage a patient with an ischaemic stroke who has contraindications to thrombectomy/thrombolysis?

A

Aspirin 300 mg orally once daily for two weeks

93
Q

What is a a compulsory treatment order

A

Initially up to 6 months, treatment authorised for up to 2 months of detention

94
Q

Which antibiotics inhibit cell wall synthesis?

A

Antibiotics with a beta-lactam ring:

Penicillin
Carbapenems such as meropenem
Cephalosporins

Antibiotics without a beta-lactam ring:

Vancomycin
Teicoplanin

95
Q

Name the personality disorder:

  • Involves a pattern of grandiosity, need for admiration of others and a lack of empathy
  • Has a sense of entitlement and will take advantage of others to achieve their own wants
  • Arrogant and preoccupied by their own fantasies and desires
A

Narcissistic personality disorder

96
Q

Describe the clinical presentation of myasthenia gravis

A

Fatiguable weakness of skeletal muscle

Most common presentation with extraocular weakness (60%), facial and bulbar weakness

97
Q

Describe the clinical presentation of cortico-basal degeneration

A

Parkinsonism and involves spontaneous activity by an affected limb, or akinetic rigidity of that limb - ‘alien hand syndrome’

Patients sometimes present with apraxia - the inability to conceptulise movement i.e. description of not being able to follow instructions, but being able to do them automatically

98
Q

Which dopaminergic areas does haloperidol act on?

A

Mesolimbic and mesocortical areas

99
Q

Which anti-epileptic drug is better for absence seizures?

A

Ethosuximide

100
Q

Maternal infection with ________ during pregnancy can result in the following features in the fetus:

Intracranial calcification
Hydrocephalus
Chorioretinitis (inflammation of the choroid and retina in the eye)

A

Congenital toxoplasmosis

101
Q

Name the seizure: Sudden loss of muscle tone, causing the patient to fall, whilst retaining consciousness

What is the treatment?

A

Atonic seizure

Sodium Valproate or Lamotrigine is first-line

102
Q

What is the most common form of muscular dystrophy in children?

A

Duchenne muscular dystrophy

103
Q

List the criteria for a partial anterior circulation infarct

A

2 of:

Contralateral hemiplegia or hemiparesis, OR
Contralateral homonymous hemianopia, OR
Higher cerebral dysfunction (e.g. aphasia, neglect)

OR

Higher cerebral dysfunction (e.g. aphasia, neglect) ALONE

104
Q

A lesion in which area of the brain would produce the following features?

Expressive (Broca’s) aphasia (speech is non-fluent, laboured, and halting)
Disinhibition
Perseveration
Anosmia
Inability to generate a list

A

Frontal lobe

105
Q

Which pathway is affected by warfarin?

A

Extrinsic pathway - measured by PT

106
Q

Name the personality disorder:

  • Preoccupied by rules, details and organization to the detriment of
    other aspects of their life
  • Perfectionist, often eliminating leisure activities to ensure work is
    completed
  • In contrast to Obsessive-compulsive disorder, these activities are
    seen as pleasurable and desirable, rather than distressing and anxiety
    inducing
A

Obsessive-compulsive/anakastic personality disorder

107
Q

Which anti-epileptic drugs are good for all seizure types?

A

Lamotrigine, levetiracetam and valproate

108
Q

What is the name of the drug given to patients with an ischaemic stroke presenting within 4.5 hours of symptom onset and with no contraindications to thrombolysis?

A

Alteplase

109
Q

Name the leukaemia:

Typically presents with symptoms of bone marrow failure (anaemia, bleeding, infections) and signs of infiltration, including hepatomegaly, splenomegaly, and gum hypertrophy

Most common acute leukaemia in adults; associated with myelodysplastic syndromes

A

AML

110
Q

Describe the clinical presentation of motor neurone disease

A

Classically, there is a combination of upper motor neuron and lower motor neuron signs.

Upper motor neuron signs include spasticity, hyperreflexia and upgoing plantars (though they are often down going in MND)

Lower motor neuron signs include fasciculations, and later atrophy

111
Q

What is the role of thrombin?

A

Activates fibrinogen (factor I) into fibrin and factor XIII.

112
Q

How would you manage a prolonged second stage of labour?

A

Possible interventions include:

Changing positions
Encouragement
Analgesia
Oxytocin
Episiotomy
Instrumental delivery
Caesarean section

113
Q

Describe the clinical presentation of multiple system atrophy

A

Parkinsonism and early autonomic clinical features such as postural hypotension, incontinence, and impotence

114
Q

A lesion in which area of the brain would produce the following features?

Sensory inattention
Apraxias
Astereognosis (tactile agnosia)
Inferior homonymous quadrantanopia
Gerstmann’s syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation

A

Parietal lobe

115
Q

How does encephalitis present differently to menigitis?

A

Personality and behavioural change

Seizures and focal neurological deficits e.g. speech disturbance

May not be photophobia or headache

116
Q

Describe the clinical presentation of a cluster headache

A

Recurrent attacks of sudden-onset unilateral periorbital pain, associated with a watery and bloodshot eye, lacrimation, rhinorrhoea, miosis, ptosis, lid swelling, and facial flushing

Headaches last 15 minutes to 3 hours, occur once or twice a day, over a period of 4-12 weeks, and are followed by a pain-free period of months before the next cluster begins

117
Q

Describe the acute management of migraine

A

NSAID (aspirin, naproxen, ibuprofen) taken as early as possible

If gastroparesis consider antiemetic

Triptans (5HT agonist) e.g. rizatriptan, eletriptan, sumatriptan - take at start of headache

118
Q

Describe the management of placenta praevia

A

Consider delivery at 34-36 weeks if history of PVB or other risk factors for preterm delivery; for uncomplicated placenta praevia consider delivery between 36 and 37 weeks

C section if placenta covers os or <2cm from os

Vaginal delivery if placenta >2cm from os and no malpresentation

Steriods 24-35+6 weeks

119
Q

Describe the acute management of myasthenia gravis

A

ACh inhibitor - pyridostigmine

IV immunoglobin or plasma exchange

Thymectomy

120
Q

Describe the CT findings associated with an extradural haemorrhage

A

Lens shaped lesion (biconvex)

121
Q

Describe the management of hemicrania continua

A

Absolute response to indomethicin

122
Q

Why is bedside spirometry (FVC) monitoring essential in Guillain-Barré Syndrome?

A

Risk of respiratory failure

123
Q

Which cranial nerve arises from the pons?

A

CN V

124
Q

Which arteries are involved in a TACI?

A

Anterior AND middle cerebral arteries on the affected side

125
Q

Interpretation of CSF sample - is this viral or bacterial meningitis?

Appearance: cloudy
Protein: high
Glucose: low
WCC: high, neutrophils

A

Bacterial

126
Q

Name the personality disorder:

  • Characterised by irrational suspicion and mistrust of others
  • Often hypersensitive to criticism
  • Reluctant to confide and preoccupied with perceived conspiracies against themselves
A

Paranoid personality disorder

127
Q

Which anti-epileptic drugs are better for focal seizures?

A

Carbamazepine, gabapentin and phenytoin

128
Q

Name the leukaemia:

Typically presents asymptomatically

Patients may present with non-tender lymphadenopathy, hepatosplenomegaly, or B symptoms (weight loss, night sweats, and fever)

Features of marrow failure (infection, anaemia, and bleeding) are less common than in the acute leukaemias

Usually presents > 60 years, more common in males

A

CLL

129
Q

Describe the pathophysiology of myasthenia gravis

A

Autoimmune origin in many cases - autoantibodies against nAChr in the endplate results in a reduction in the number of functional channels → amplitude of endplate potential decreases

130
Q

A lesion in which area of the brain would produce the following features?

Gait and truncal ataxia
Intention tremor, past pointing, dysdiadokinesis, nystagmus

A

Cerebellar lesion

131
Q

______ activates fibrinogen (factor I) into fibrin and factor XIII

A

Thrombin (factor II)

132
Q

What is the mechanism of action of typical antipsychotics?

A

Non-selectively block D2 and other receptors

133
Q

What is the most common form of muscular dystrophy seen in adults?

A

Myotonic dystrophy

134
Q

Which clotting factors require vitamin K?

A

II, VII, IX and X

135
Q

Describe the pathophysiology of botulism

A

Extremely potent exotoxin that acts at motor neurone terminals to irreversibly inhibit ACh release

Enters presynaptic terminals to enzymatically modify proteins involved in the docking of vesicles containing ACh to the presynaptic membrane, which prevents exocytosis

136
Q

Describe the clinical presentation of SUNCT

A

Unilateral neuralgiaform headache

Short-lived (15-120 secs)

Conjunctival injections

Tearing

137
Q

What other investigation could you perform in suspected subarachnoid hemorrhage or subdural haematoma where CT brain is negative?

A

Lumbar puncture - blood in CSF

138
Q

What is vasa praevia?

A

The fetal vessels are within the fetal membranes (chorioamniotic membranes) and travel across the internal cervical os

139
Q

What is placenta accreta?

A

Refers to when the placenta implants deeper, through and past the endometrium, making it difficult to separate the placenta after delivery of the baby

140
Q

Describe the management of neuroleptic malignant syndrome

A

Stop antipsychotic, rapid cooling, renal support, skeletal muscle relaxants e.g. dantroline, dopamine agonists e.g. bromocriptine

141
Q

Typical antipsychotics act on the _______ pathway, which results in neuroleptic malignant syndrome

A

Hypothalamic pathway

142
Q

A seizure in which lobe of the brain would produce the following symptoms:

Motor features such as Jacksonian features, dysphasia, or Todd’s palsy.

A

Frontal lobe

143
Q

What is the mechanism of action of atypical antipsychotics?

A

Work on D2 and 5HT-3 (serotonin) to reduce side effect profile

Also work on H1, alpha and cholinergic

144
Q

Typical antipsychotics act on the _______ pathway, which results in side effects such as acute dystonic reaction, Parkinsonism, and tardive dyskinesia

A

Nigrostriatal

145
Q

A lesion in Wernicke’s area will result in ________ aphasia

A

Receptive - Wernicke’s area is responsible for the understanding of speech

146
Q

Describe the clinical presentation of a subdural haematoma

A

The interval between injury and symptoms can be days, or may extend to weeks or months

Headache, drowsiness, confusion

Focal deficits, such as hemiparesis or sensory loss, develop

Epilepsy occasionally occurs

Stupor, coma and coning may follow

147
Q

Describe the extrinsic pathway of the coagulation cascade

A

The extrinsic pathway occurs in response to tissue damage. Tissue damage releases factor III which begins this pathway.

148
Q

What are the 3 features of Parkinsonism?

A

Triad of resting tremor, hypertonia, and bradykinesia

149
Q

Which atypical antipsychotic is most likely to cause sedation and weight gain?

A

Quetiapine

150
Q

What does the HSA1 form certify?

A

Abortion

151
Q

Which antipsychotic is linked with prolonged QT?

A

Haloperidol

152
Q

Describe the presentation of progressive supranuclear palsy

A

Parkinsonism and vertical gaze palsy (dysfunction of the muscles involved in looking upwards)

153
Q

Maternal infection with ________ during pregnancy can result in the following features in the fetus:

Congenital deafness
Congenital cataracts
Congenital heart disease (PDA and pulmonary stenosis)
Learning disability

A

Rubella

154
Q

What is the most common cause of meningitis overall?

A

Viruses e.g. enteroviruses

155
Q

Name the seizure: Sudden jerk of a limb, trunk, or face

What is the treatment?

A

Myoclonal seizure

Sodium Valproate is first-line unless the patient is a female of childbearing age where Levetiracetam or Topiramate should be used instead as first-line; avoid Carbamazepine as it worsens seizures

156
Q

Describe the general presentation of a leukaemia

A

Fatigue
Fever
Failure to thrive (children)
Pallor due to anaemia
Petechiae and abnormal bruising due to thrombocytopenia
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly

157
Q

Describe the long term management of myasthenia gravis

A

Steroids and steroid-sparing agents (e.g. azathioprine)

158
Q

What is covered by Clause C of a HSA1 form?

A

Termination up to 23+6 weeks, the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman

159
Q

A seizure in which lobe of the brain would produce the following symptoms:

Automatisms (eg. lip-smacking); déjà vu or jamais vu, emotional disturbance (eg. sudden terror); olfactory, gustatory, or auditory hallucinations.

A

Temporal lobe

160
Q

What is the most common form of breast cancer?

A

Invasive ductal carcinoma (75-85%)

161
Q

Name the seizure: Patients lose consciousness; their limbs stiffen (tonic) and start jerking (clonic). Post-ictal confusion is common

What is the treatment?

A

Tonic-clonic seizure

Sodium Valproate or Lamotrigine is first-line

162
Q

Describe the clinical presentation of von Willebrand disease

A

A deficiency will, therefore, presents like a platelet disorder with mucocutaneous bleeding: minor cuts, epistaxis, bruising, menorrhagia, gum bleeding

Formation of the platelet plug will also be delayed, causing an increased bleeding time

163
Q

Describe the intrinsic pathway of the coagulation cascade

A

The intrinsic factor is activated when the body is exposed to a damaged blood vessel and the collagen is exposed (an intrinsic bleed). It begins with activation of factor XII

164
Q

What is an emergency detention order?

A

72 hour assessment, does not authorise treatment

165
Q

Which cranial nerve arises from the midbrain-pontine junction?

A

CN III

166
Q

Describe the clinical presentation of botulism

A

Rapid onset (over hours) motor weakness, without sensory loss

Typically ascending paralysis

167
Q

What is the most common cause of bacterial meningitis over the age of 21?

A

Streptococcus pneumoniae

168
Q

Describe the management of uterine rupture

A

Emergency caesarean section is necessary to remove the baby, stop any bleeding and repair or remove the uterus (hysterectomy)

169
Q

A seizure in which lobe of the brain would produce the following symptoms:

Sensory symptoms such as tingling and numbness; motor symptoms - due to spread of electrical activity to the pre-central gyrus in the frontal lobe.

A

Parietal lobe

170
Q

Describe the pathophysiology of von Willebrand’s disease

A

As VWF has a critical role as an adhesive protein in the platelet vessel wall interaction, the absence of VWF leads to impaired platelet adhesion to the subendothelium

Reduced VWF levels also lead to factor VIII deficiency, as factor VIII is not protected from premature degradation

171
Q

Describe the management of status epilepticus

A

ABCDE approach

Pre-hospital - diazepam PR or midazolam PB

Early status - lorazepam IV usually 4 mg bolus

Established status - phenytoin infusion

Refractory status - GA + propofol/midazolam/thiopental sodium

172
Q

What is the mechanism of action of SNRIs?

A

Block the reuptake of monoamines (noradrenaline and 5-HT) into presynaptic terminals - block SERT and NET

173
Q

Which factors are measured by APTT?

A

9-12, 5 & 2 (the intrinsic and common pathways)

174
Q

What drugs are used in the prophylais of migraine?

A

Amitriptyline, propranalol (CI: asthma), topiramate (CI: woman of childbearing age)

175
Q

What is the role of factor X?

A

Activates prothrombin to thrombin

176
Q

What is a retrospective cohort design?

A

Cohort formed in the past and followed up to the present

177
Q

Describe the clinical presentation of an extradural haemorrhage

A

A characteristic picture is that of a head injury with a brief duration of unconsciousness, followed by improvement (lucid interval)

The patient then becomes stuporose; there is an ipsilateral dilated pupil and contralateral hemiparesis, with rapid transtentorial coning

Bilateral fixed, dilated pupils, tetraplegia and respiratory arrest follow

178
Q

What is the most common cause of bacterial meningitis in infants and young children?

A

H. influenza

179
Q

How would you manage a prolonged third stage of labour?

A

Intramuscular oxytocin and controlled cord traction

180
Q

Name the personality disorder:

  • Pattern of abrupt mood swings, unstable relationships and instability in self-image
  • Self-harm is common
  • Relationships alternate between idealization and devaluation (splitting)
  • Inability to control temper and general affect
A

Borderline personality disorder

181
Q

Name the personality disorder:

  • Characterised by an intense psychological need to be cared for by
    others
  • Lack initiative and need others to make decisions on their behalf
  • Urgently search for new relationships as soon as one ends to provide
    care and support
A

Dependent personality disorder

182
Q

Which type of drugs can induce parkinsonism or worsen symptoms in affected patients, and may precipitate symptoms in elderly patients in the presymptomatic phase?

A

Dopamine-blocking or depleting drugs

183
Q

When would the third stage of labour be considered prolonged?

A

More than 30 minutes with active management

More than 60 minutes with physiological management

184
Q

What is the difference between Duchenne Muscular Dystrophy and Becker’s Muscular Dystrophy?

A

In DMD there is an absence of dystrophin - essential for cell membrane stability

In Becker’s dystrophy, dystrophin is present but levels are low - progresses much more slowly (but is less common)

185
Q

Typical antipsychotics act on the ________ pathway, which results in akathesia

A

Hypothalamospinal

186
Q

What are the features of Korsakoff’s syndrome?

A

Anterograde amnesia, retrograde amnesia, and confabulation

187
Q

Describe the management of vasa praevia

A

If diagnosed antenatally - steroids from 32 weeks, deliver by elective c/section 34-36 weeks

In the presence of bleeding vasa praevia (APH), delivery should be achieved by emergency caesarean section

188
Q

When would the second stage of labour be considered prolonged in a nulliparous women?

A

In nulliparous women it is considered prolonged if it exceeds 3 hours if there is regional analgesia, or 2 hours without

189
Q

Describe the common pathway of the coagulation cascade

A

The intrinsic and extrinsic pathway both will eventually activate factor X. From this point, the pathway is the same in both. This is known as the common pathway and will ultimately end in formation of the clot.

190
Q

What is the mechanism of action of monoamine oxidase inhibitors?

A

Irreversible (phenelzine) or reversible (moclobemide) inhibitors of MAO-A and B

191
Q

Which atypical antipsychotic is most likely to cause agranulocytosis, neutropenia, seizures, metabolic syndrome, weight gain and sedation

A

Clozapine

192
Q

What is the mechanism of action of benzodiazepines?

A

Increase the Cl- entering the GABA-a receptors, resulting in membrane hyperpolarisation producing an inhibitory postsynaptic potential → reduced neuronal firing

193
Q

When would the second stage of labour be considered prolonged in a multiparous women?

A

In multiparous women it is considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without

194
Q

Which anti-epileptic drug is preferred in women of childbearing age?

A

Lamotrigine

195
Q

Why do patients on clozapine require FBC monitoring?

A

Agranulocytosis/neutropenia is a life-threatening side effect of clozapine

196
Q

Whch antibiotics inhibit protein synthesis by targeting the ribosome?

A

Macrolides such as erythromycin, clarithromycin and azithromycin

Clindamycin

Tetracyclines such as doxycycline
Gentamicin

Chloramphenicol

197
Q

Name the leukaemia:

Has three phases including a 5 year ‘asymptomatic chronic phase’. Associated with the Philadelphia chromosome.

A

Chronic myeloid leukaemia

198
Q

Name the personality disorder:

  • Involves strong feelings of inadequacy and fear of social situations
    where they may be criticised
  • Patients are extremely sensitive to criticism
  • Often self impose isolation while craving acceptance and social
    contact
A

Avoidant/anxious personality disorder

199
Q

What is uterine rupture?

A

Complication of labour, where the muscle layer of the uterus (myometrium) ruptures

200
Q

Which spinal tract conveys pain and temperature?

A

Spinothalamic tract

201
Q

Which spinal tract conveys motor neuronal signals relating to posture?

A

Vestibulospinal tract

202
Q

Which spinal tract conveys fine touch, pressure and proprioception?

A

Dorsal column-medial lemniscus pathway

T6 and above - fasciculus cuneatus

Below T6 - fasciculus gracilis

203
Q

Which spinal tract is responsible for fine, precise movement, particularly of distal limb muscles?

A

Corticospinal (pyramidal) tract

204
Q

Which spinal tract mediates head and neck movement due to visual stimuli?

A

Tectospinal

205
Q

Which spinal tract has many functions, including the influencing of voluntary movement (flexors and extensors)?

A

Reticulospinal tract

206
Q

Which spinal tract carries excitatory input to ‘antigravity’ extensor muscles?

A

Vestibulospinal tract

MBChB Y1-3 (3 decks)

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