Year 3 Flashcards
What is the most common cause of bacterial meningitis in neonates?
Listeria monocytogenes
What is a cross-sectional design?
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
What factor is deficient in haemophilia B?
Factor IX
Interpretation of CSF sample - is this viral or bacterial meningitis?
Appearance: clear
Protein: mildly raised or normal
Glucose: low
WCC: high, lymphocytes
Viral
What is the recommended first-line treatment option for Philadelphia chromosome positive CML?
Imatinib
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
Histrionic personality disorder
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
Parovirus B16
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)
ALL
Which antibiotics inhibit folic acid synthesis?
Sulfamethoxazole
Trimethoprim
Co-trimoxazole
What is the most common motor neurone disease phenotype in adults?
Amyotrophic lateral sclerosis
Which pathway is affected by heparin?
Intrinsic pathway - measured by APTT
Describe the clinical presentation of placental abruption
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
A lesion in which area of the brain would produce the following features?
Homonymous hemianopia (with macula sparing)
Cortical blindness
Visual agnosia
Occipital lobe
Which factors are measured by PT?
7, 10, 5 & 2 (the extrinsic and common pathways)
Describe the typical findings of lymphoma
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
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?
Absence seizure
Ethosuximide or sodium valproate first-line; avoid Carbamazepine as it worsens seizures
Describe the management of a cluster headache
Acute attack: high flow O2 100% for 20 mins with a subcutaneous or nasal triptan, steroids (reducing course over 2 weeks)
Prophylaxis: verapamil
What is the ‘cheese reaction’ and what drug causes it?
MAO inhibitors - hypertensive crisis caused by inhibition of MAO-A in gut (and liver) by irreversible inhibitors preventing breakdown of dietary tyramine
Describe the management of trigeminal neuralgia
Medical - carbamazepine first line, gabapentin, phenytoin
Surgical - ablation, decompression
What are the 7 cardinal movements of labour?
Engagement
Descent
Flexion
Internal Rotation
Extension
Restitution and external rotation
Expulsion
Describe the management of Lambert Eaton Myasthenic Syndrome
Amifampridine - K+ channel blocker to increase ACh release
Appropriate management of underlying SCLC
If autoimmune only - immunosuppression
Which artery is usually damaged in an extradural haemorrhage?
Middle meningeal artery
Name the leukaemia:
Most common leukaemia in adults overall. Associated with warm haemolytic anaemia, Richter’s transformation into lymphoma and smudge / smear cells.
Chronic lymphocytic leukaemia
What is the mechanism of action of SSRIs?
Selectively inhibit the reuptake of serotonin (5-HT) from the synaptic cleft
What coagulation test results are associated with von Willebrand’s disease?
APTT may be normal or may be prolonged if factor VIII deficiency is present, PT will be normal
Describe the clinical presentation of hemicrania continua
Severe unilateral headache
Unilateral autonomic features
Constant duration
Which cranial nerves arise from the cerebrum?
CN I and II
What is the difference between postpartum blues and postpartum depression?
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
Which antipsychotics are most likely to cause EPSE and increased PRL side effects?
Typical antipsychotics e.g. haloperidol, prochloperazine
Of the atypicals - rispridone
A seizure in which lobe of the brain would produce the following symptoms:
Visual symptoms such as spots and lines in the visual field
Occipital lobe
Typical antipsychotics act on the _______ pathway, leading to hyperprolactinaemia
Tuberoinfundibular
Which antibiotic inhibits nucleic acid synthesis?
Metronidazole
All expectant women should be offered a vaginal examination and _____ _____ at 40 weeks gestation
Membrane sweep
Describe the clinical features of neuroleptic malignant syndrome
Onset of pyrexia and muscle stiffness over hours (24-72)
Increasing muscle tone, pyrexia, changing pulse/BP → rhabdo → ARF → coma → death
What is the mechanism of action of tricyclic antidepressants?
Block the reuptake of monoamines (mainly noradrenaline and 5-HT) into presynaptic terminals
List the criteria for a total anterior circulation infarct
Contralateral hemiplegia or hemiparesis, AND
Contralateral homonymous hemianopia, AND
Higher cerebral dysfunction (e.g. aphasia, neglect)
In which age group is the most common cause of meningitis Neisseria meningitidis?
Age 10-21
What does the Adults With Incapacity Section 47 Certificate do?
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
What is a prospective cohort design?
Cohort followed forward in time from present
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
Schizotypal personality disorder
A lesion in Broca’s area will result in ________ aphasia
Expressive - Broca’s area is responsible for fluent speech
Describe the physiology of Lambert Eaton Myasthenic Syndrome
Antibodies against voltage activated Ca2+ channels in the motor neuron terminal result in reduced Ca2+ entry in response to depolarisation → reduced ACh release
Describe the clinical presentation of a subarachoid haemorrhage
Sudden, very severe headache, often occipital
Headache is usually followed by vomiting and often by coma and death
Which cranial nerves arise from the medulla oblongata?
CN IX-XII
What is the mechanism of action of mirtapine?
Mixed receptor effects - blocks ⍺2, 5-HT2 and 5-HT3
Name the leukaemia:
Most common acute adult leukaemia. It can be the result of a transformation from a myeloproliferative disorder. Associated with Auer rods.
Acute myeloid leukaemia
What is placental abruption?
Refers to when the placenta separates from the wall of the uterus during pregnancy; it is a significant cause of antepartum haemorrhage
What finding on a coagulation screen is associated with von Willebrand disease?
Isolated prolonged APTT
_______ in pregnant women has a high rate of miscarriage or fetal death; it can also cause severe neonatal infection
Listeriosis
Describe the CT findings associated with a subdural haematoma
Classically shows a crescent of blood around the brain tissue, and midline shift
What is placenta praevia/low lying placenta?
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
Describe the genetics of CML
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
Describe the management of EPSE (acute dystonic reaction, Parkinsonism, tardive dyskinesia)
Anticholinergic drugs e.g. procyclidine PO/IM, consider changing antipsychotic
Describe the neurological features of Wilson’s disease
An akinetic-rigid syndrome similar to Parkinson’s disease
Pseudosclerosis dominated by tremor
Ataxia
A dystonic syndrome, which often leads to severe contractures
Which cranial nerves arise from the pontine-medulla junction?
CN VI-VIII
Describe the clinical presentation of paroxysmal hemicrania
Severe unilateral headache
Unilateral autonomic features
10-30 mins duration
1-40 a day
Which arteries are involved in a PACI?
Anterior OR middle cerebral arteries on the affected side
What is the mechanism of action of lithium?
May block phosphatidylinositol pathway or inhibit glucogen synthase kinase 3β or modulate NO signalling
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
Antisocial personality disorder
What factor is deficient in haemophilia A?
Factor VIII
Describe the management of paroxysmal hemicrania
Absolute response to indomethicin
Auer rods are associated with which form of leukaemia?
AML
Describe the management of SUNCT
Lamotrigine, gabapentin
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
Congenital cytomegalovirus
What is a short term detention order?
Up to 28 days for assessment/treatment
What are the clinical features of Brown Sequard syndrome?
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
Which form of antipsychotic is linked to orthostatic hypotension?
Typical antipsychotics
Describe the clinical presentation of placenta praevia
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)
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)
Varicella zoster (chickenpox)
Thrombin (factor II) activates fibrinogen (factor I) into ___ and _______
Fibrin and factor XIII
Name the kinase mutation present in over 95% of PV patients
JAK2 mutation
What is covered by Clause E of a HSA1 form?
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
What blood results are associated with bulimia nervosa?
Metabolic alkalosis, hypokalemia and hypochloraemia
CLL can cause _____ autoimmune haemolytic anaemia
Warm
Name the key finding from lymph node biopsy in patients with Hodgkin’s lymphoma
Reed-Sternberg cell
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)
Temporal lobe
What is a case-control design?
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
List the metabolic abnormalities see in tumour lysis syndrome
Hyperkalaemia, hyperphosphataemia, hyperuricaemia, hypocalcaemia
Describe the clinical presentation of vasa praevia
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.
Which atypical antipsychotic is most likely to cause metabolic syndrome?
Olanzapine
Describe the management of akathesia/restless legs caused by typical antipsychotics
β-blocker e.g. propranalol first line, benzodiazepines e.g. clonazepam second line
Describe the CT findings associated with a subarachnoid haemorrhage
Irregular shaped bleed
Name the leukaemia:
Most common leukaemia in children. Associated with Down syndrome.
Acute lymphoblastic leukaemia
Describe the difference in presentation between Parkinsonism and Lewy Body dementia
Parkinsonism and fluctuations in cognitive impairment and visual hallucinations, often before Parkinsonian features occur
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
CML
Describe the clinical presentation of spinal muscular atrophy
Muscle wasting and weakness, LMN signs WITHOUT sensory signs
Describe the clinical presentation of placenta accreta
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
Aquagenic puritis is associated with which
Polycythaemia vera
Thrombin (factor II) activates ______ into fibrin and factor XIII.
Fibrinogen (factor I)
Which cranial nerve arises from the midbrain?
CN IV
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
Schizoid personality disorder
How would you manage a patient with an ischaemic stroke who has contraindications to thrombectomy/thrombolysis?
Aspirin 300 mg orally once daily for two weeks
What is a a compulsory treatment order
Initially up to 6 months, treatment authorised for up to 2 months of detention
Which antibiotics inhibit cell wall synthesis?
Antibiotics with a beta-lactam ring:
Penicillin
Carbapenems such as meropenem
Cephalosporins
Antibiotics without a beta-lactam ring:
Vancomycin
Teicoplanin
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
Narcissistic personality disorder
Describe the clinical presentation of myasthenia gravis
Fatiguable weakness of skeletal muscle
Most common presentation with extraocular weakness (60%), facial and bulbar weakness
Describe the clinical presentation of cortico-basal degeneration
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
Which dopaminergic areas does haloperidol act on?
Mesolimbic and mesocortical areas
Which anti-epileptic drug is better for absence seizures?
Ethosuximide
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)
Congenital toxoplasmosis
Name the seizure: Sudden loss of muscle tone, causing the patient to fall, whilst retaining consciousness
What is the treatment?
Atonic seizure
Sodium Valproate or Lamotrigine is first-line
What is the most common form of muscular dystrophy in children?
Duchenne muscular dystrophy
List the criteria for a partial anterior circulation infarct
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
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
Frontal lobe
Which pathway is affected by warfarin?
Extrinsic pathway - measured by PT
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
Obsessive-compulsive/anakastic personality disorder
Which anti-epileptic drugs are good for all seizure types?
Lamotrigine, levetiracetam and valproate
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?
Alteplase
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
AML
Describe the clinical presentation of motor neurone disease
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
What is the role of thrombin?
Activates fibrinogen (factor I) into fibrin and factor XIII.
How would you manage a prolonged second stage of labour?
Possible interventions include:
Changing positions
Encouragement
Analgesia
Oxytocin
Episiotomy
Instrumental delivery
Caesarean section
Describe the clinical presentation of multiple system atrophy
Parkinsonism and early autonomic clinical features such as postural hypotension, incontinence, and impotence
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
Parietal lobe
How does encephalitis present differently to menigitis?
Personality and behavioural change
Seizures and focal neurological deficits e.g. speech disturbance
May not be photophobia or headache
Describe the clinical presentation of a cluster headache
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
Describe the acute management of migraine
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
Describe the management of placenta praevia
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
Describe the acute management of myasthenia gravis
ACh inhibitor - pyridostigmine
IV immunoglobin or plasma exchange
Thymectomy
Describe the CT findings associated with an extradural haemorrhage
Lens shaped lesion (biconvex)
Describe the management of hemicrania continua
Absolute response to indomethicin
Why is bedside spirometry (FVC) monitoring essential in Guillain-Barré Syndrome?
Risk of respiratory failure
Which cranial nerve arises from the pons?
CN V
Which arteries are involved in a TACI?
Anterior AND middle cerebral arteries on the affected side
Interpretation of CSF sample - is this viral or bacterial meningitis?
Appearance: cloudy
Protein: high
Glucose: low
WCC: high, neutrophils
Bacterial
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
Paranoid personality disorder
Which anti-epileptic drugs are better for focal seizures?
Carbamazepine, gabapentin and phenytoin
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
CLL
Describe the pathophysiology of myasthenia gravis
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
A lesion in which area of the brain would produce the following features?
Gait and truncal ataxia
Intention tremor, past pointing, dysdiadokinesis, nystagmus
Cerebellar lesion
______ activates fibrinogen (factor I) into fibrin and factor XIII
Thrombin (factor II)
What is the mechanism of action of typical antipsychotics?
Non-selectively block D2 and other receptors
What is the most common form of muscular dystrophy seen in adults?
Myotonic dystrophy
Which clotting factors require vitamin K?
II, VII, IX and X
Describe the pathophysiology of botulism
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
Describe the clinical presentation of SUNCT
Unilateral neuralgiaform headache
Short-lived (15-120 secs)
Conjunctival injections
Tearing
What other investigation could you perform in suspected subarachnoid hemorrhage or subdural haematoma where CT brain is negative?
Lumbar puncture - blood in CSF
What is vasa praevia?
The fetal vessels are within the fetal membranes (chorioamniotic membranes) and travel across the internal cervical os
What is placenta accreta?
Refers to when the placenta implants deeper, through and past the endometrium, making it difficult to separate the placenta after delivery of the baby
Describe the management of neuroleptic malignant syndrome
Stop antipsychotic, rapid cooling, renal support, skeletal muscle relaxants e.g. dantroline, dopamine agonists e.g. bromocriptine
Typical antipsychotics act on the _______ pathway, which results in neuroleptic malignant syndrome
Hypothalamic pathway
A seizure in which lobe of the brain would produce the following symptoms:
Motor features such as Jacksonian features, dysphasia, or Todd’s palsy.
Frontal lobe
What is the mechanism of action of atypical antipsychotics?
Work on D2 and 5HT-3 (serotonin) to reduce side effect profile
Also work on H1, alpha and cholinergic
Typical antipsychotics act on the _______ pathway, which results in side effects such as acute dystonic reaction, Parkinsonism, and tardive dyskinesia
Nigrostriatal
A lesion in Wernicke’s area will result in ________ aphasia
Receptive - Wernicke’s area is responsible for the understanding of speech
Describe the clinical presentation of a subdural haematoma
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
Describe the extrinsic pathway of the coagulation cascade
The extrinsic pathway occurs in response to tissue damage. Tissue damage releases factor III which begins this pathway.
What are the 3 features of Parkinsonism?
Triad of resting tremor, hypertonia, and bradykinesia
Which atypical antipsychotic is most likely to cause sedation and weight gain?
Quetiapine
What does the HSA1 form certify?
Abortion
Which antipsychotic is linked with prolonged QT?
Haloperidol
Describe the presentation of progressive supranuclear palsy
Parkinsonism and vertical gaze palsy (dysfunction of the muscles involved in looking upwards)
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
Rubella
What is the most common cause of meningitis overall?
Viruses e.g. enteroviruses
Name the seizure: Sudden jerk of a limb, trunk, or face
What is the treatment?
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
Describe the general presentation of a leukaemia
Fatigue
Fever
Failure to thrive (children)
Pallor due to anaemia
Petechiae and abnormal bruising due to thrombocytopenia
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly
Describe the long term management of myasthenia gravis
Steroids and steroid-sparing agents (e.g. azathioprine)
What is covered by Clause C of a HSA1 form?
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
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.
Temporal lobe
What is the most common form of breast cancer?
Invasive ductal carcinoma (75-85%)
Name the seizure: Patients lose consciousness; their limbs stiffen (tonic) and start jerking (clonic). Post-ictal confusion is common
What is the treatment?
Tonic-clonic seizure
Sodium Valproate or Lamotrigine is first-line
Describe the clinical presentation of von Willebrand disease
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
Describe the intrinsic pathway of the coagulation cascade
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
What is an emergency detention order?
72 hour assessment, does not authorise treatment
Which cranial nerve arises from the midbrain-pontine junction?
CN III
Describe the clinical presentation of botulism
Rapid onset (over hours) motor weakness, without sensory loss
Typically ascending paralysis
What is the most common cause of bacterial meningitis over the age of 21?
Streptococcus pneumoniae
Describe the management of uterine rupture
Emergency caesarean section is necessary to remove the baby, stop any bleeding and repair or remove the uterus (hysterectomy)
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.
Parietal lobe
Describe the pathophysiology of von Willebrand’s disease
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
Describe the management of status epilepticus
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
What is the mechanism of action of SNRIs?
Block the reuptake of monoamines (noradrenaline and 5-HT) into presynaptic terminals - block SERT and NET
Which factors are measured by APTT?
9-12, 5 & 2 (the intrinsic and common pathways)
What drugs are used in the prophylais of migraine?
Amitriptyline, propranalol (CI: asthma), topiramate (CI: woman of childbearing age)
What is the role of factor X?
Activates prothrombin to thrombin
What is a retrospective cohort design?
Cohort formed in the past and followed up to the present
Describe the clinical presentation of an extradural haemorrhage
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
What is the most common cause of bacterial meningitis in infants and young children?
H. influenza
How would you manage a prolonged third stage of labour?
Intramuscular oxytocin and controlled cord traction
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
Borderline personality disorder
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
Dependent personality disorder
Which type of drugs can induce parkinsonism or worsen symptoms in affected patients, and may precipitate symptoms in elderly patients in the presymptomatic phase?
Dopamine-blocking or depleting drugs
When would the third stage of labour be considered prolonged?
More than 30 minutes with active management
More than 60 minutes with physiological management
What is the difference between Duchenne Muscular Dystrophy and Becker’s Muscular Dystrophy?
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)
Typical antipsychotics act on the ________ pathway, which results in akathesia
Hypothalamospinal
What are the features of Korsakoff’s syndrome?
Anterograde amnesia, retrograde amnesia, and confabulation
Describe the management of vasa praevia
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
When would the second stage of labour be considered prolonged in a nulliparous women?
In nulliparous women it is considered prolonged if it exceeds 3 hours if there is regional analgesia, or 2 hours without
Describe the common pathway of the coagulation cascade
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.
What is the mechanism of action of monoamine oxidase inhibitors?
Irreversible (phenelzine) or reversible (moclobemide) inhibitors of MAO-A and B
Which atypical antipsychotic is most likely to cause agranulocytosis, neutropenia, seizures, metabolic syndrome, weight gain and sedation
Clozapine
What is the mechanism of action of benzodiazepines?
Increase the Cl- entering the GABA-a receptors, resulting in membrane hyperpolarisation producing an inhibitory postsynaptic potential → reduced neuronal firing
When would the second stage of labour be considered prolonged in a multiparous women?
In multiparous women it is considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without
Which anti-epileptic drug is preferred in women of childbearing age?
Lamotrigine
Why do patients on clozapine require FBC monitoring?
Agranulocytosis/neutropenia is a life-threatening side effect of clozapine
Whch antibiotics inhibit protein synthesis by targeting the ribosome?
Macrolides such as erythromycin, clarithromycin and azithromycin
Clindamycin
Tetracyclines such as doxycycline
Gentamicin
Chloramphenicol
Name the leukaemia:
Has three phases including a 5 year ‘asymptomatic chronic phase’. Associated with the Philadelphia chromosome.
Chronic myeloid leukaemia
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
Avoidant/anxious personality disorder
What is uterine rupture?
Complication of labour, where the muscle layer of the uterus (myometrium) ruptures
Which spinal tract conveys pain and temperature?
Spinothalamic tract
Which spinal tract conveys motor neuronal signals relating to posture?
Vestibulospinal tract
Which spinal tract conveys fine touch, pressure and proprioception?
Dorsal column-medial lemniscus pathway
T6 and above - fasciculus cuneatus
Below T6 - fasciculus gracilis
Which spinal tract is responsible for fine, precise movement, particularly of distal limb muscles?
Corticospinal (pyramidal) tract
Which spinal tract mediates head and neck movement due to visual stimuli?
Tectospinal
Which spinal tract has many functions, including the influencing of voluntary movement (flexors and extensors)?
Reticulospinal tract
Which spinal tract carries excitatory input to ‘antigravity’ extensor muscles?
Vestibulospinal tract
