year 4 cap test Flashcards
muscle rigidity , pyrexia, agitation, autonomic instability. when atyipical antipsychotics have been used (+ physical restraint needed)
neuroleptic malignant syndrome
parkinsinonsim is a common side effect of
antiphsychotics
average onset of biploar
21
first place affected in alzheimers
nucleus basalis of meynert
paraproteins is a tumour marker for what
myeloma
ovarian cancer tumour marker
CA 125
aversive and defence systems
seretonin
aqueous humour drains via what
trabecular meshwork
otosclerosis- type of hearing loss?
conductive
type of hearing loss for gentamicin , loud noise exposure, vestibular shwannoma?
sensorineural
what bloods do you need to monitor for metformin
U&E and HbA1c
pain out of proportion
compartment syndrome
small bleed after rupture of membranes with severe fetal distres
vasa praevia
IQ of 45
moderate learning disability
most abundant antibody
IgG
antobody in breast milk and saliva
IgA
pentemeric antibody
IgM
what to do for a choking conscious baby
do chest thrusts
in polymalgia rheumatica, is there power loss
no - power is normal
in polymyositis , is there power loss.
yes- will have muscle weakness
appettitive anf approach systems
dopamine
cardio drug causing blurred vision
digoxin
what bloods do you check if going on lithium
U&E
gram neg diplococcus
gonorrhoea
used IV drip goes in which bag
organge
80 year old lady with hx of falls. rigth knee gives way when walking and she is waiting for a knee replacement. she has been struggling to climb stairs due to her knee. she takes paracetamol and was started on codeine 2 weeks ago. what is the most appropriate action?
strength and balance training before knee replacement
doing this before and after surgyer improves quad strength and stability of knee joint. they should be encouraged to exercise whilst waiting on surgery.
NSAIDS would increase risk of renal impairment
is this change correct when ageing?
body weight may remain normal despite reduction in muscle mass?
true
68 year old man recently discharged from an MI. does not understand his meds or his conditon.
who does he need to see?
specialist nurse
42 year old insulin dependent diabetic has a painful left toe . who should he see?
podiatrist
28 year old lady with 4 kids. struggling with their behavioir and has concerns about the youngest one’s growth.
who should she see?
health visitor
contraction results in elevation of the section of the resp tract containing the vocal cords
longitudinal muscles of the pharynx
located immediately superficial to the transversus abdominus muscle
internal oblique
can act as an accessor muscle to respiration due to its attachment to rib 1
scalenus
which has the highest mortality- depression, bipolar, schizoaffective disirder, anorxia, or bulimia ?
anorexia
brief episodes of vertigo. no tinnitus or hearing loss. usuually occuring on turning in bed
BPPV
6 month old infant seen by GP unwell with mild fever, cough, reduced oral intake and noisy breathing for 2 days. on exam there are mild signs of resp distress and sats are 92%. good air entry bilaterally and widely scattered high pitch rhonchi and fine crepitations
need to admit for supportive therapy.
this is a classic presentation of bronchilotis caused by RSV
preterm neonate born at 32 weeks becomes floppy and cyanosed. meningitis is suspected. CSF shows gram positive cocci in chains. mum was noticied to be carrying this in her vag.
group B strep
40 year old man admitted with confusion and fever. CT scan performed prior to LP shows inflamed temporal lobes.
herpes simplex- most common cause of encephalitis. it usually affects the temporal lobes
60 year old immunocompromised patient is admitted with fever and headache. he consumed soft cheese in france about 1 week ago. gram stain of CSF shows gram postive bacilli
listeria
patient in neuro clinic complaining of abnormal head movements and neck pain. he notes that his head has a tendency to turn to the left and he finds it uncomfortable
cervical dystocia
delay in femoral pulses suggest what
congential CVS disease in newborn infant e.g coarctation of aorta
30 year old lady with itchy blisters on extensor surfaces. immunofluorescence reveals granular IgA at dermal papillae
dermatitis herpetaformis
most appropriate drug for a 3 year old undergoing squint surgery who becomes bradycardic and hypotensive during surgical traction
atropine
most appropriate drug for a 71 year old who suddenly develops AF with rate of 150. BP 125/70. has a hx of COPD and is on regular inhalers
amiodarone.
CVS is stable and she doesnt require immediate cardioversion and rate control is more appropriate
beta blockers are contraindicated
most appropriate 1st line choice for 42 year old man with acute central chest pain, nausea and sweating for 1 hour. ST elevation ins V1-3
clopidogrel
most appropraite first line for a 45 year old man with intermittent palpitations and light headedness . on arrival pulse is 100 irreg irreg but after 20 mins is settles to 56 regular
bisoprolol is first line
this is paraoxysmal AF
gradual vision loss in both eyes. diminished red reflexes
cataract
sudden painless loss of central vision in right eye. has been aware of distorted vision for past few days. large solitary haemorrhage at the fovea of affected eye
wet age related macular degeneration
a long sighted 52 year old male presents with sudden loss of vision in left eye with is red and painfil. he has noticed halos around lights and feels nauseated and has vomited once. pupil is mid-dilated and non reactive
acute closed angle glaucoma
18 year old girl. tired and dizzy. has heavy periods. Hb is low. MCV is 72 and ferritin is low
iron def anaemia
38 year old man present to AMU with painless jaundice and exterional SOB. he is anaemic with MCV 115. retic ount is high. direct antiglobulin test is strongly positive. blood film shows spherocytes and polychromasia
autoimmune haemolytic anaemia
anaemia and jaundice should make you think of hameolysis. bone marrow is working hard to make new red cells
62 year old man presents feeling non-specifically unwell and found to be in renal failure with creatinine of 43. he was noted to have back pain for 2 months has a corrcted calcium of 3.6 and IgA paraprotein
myeloma!!
bone pain
anaemia
hypercalcaemia
renal failure
75 year olf got a dynamic hip screw for a intertrochanteric fracture 9 months ago. she returns to clinic complaining of discomfort on walking . CRP is normal b ut X rays show a somewhat back out dynamic screw
trochanteric bursitis from prominant mental work
describe innveration to the detrusor muscle
sympatethic innerviation is via beta adrengeric recepotos. this relaxes the detrusor whilst contracting the urethral sphincter thereby inhibiting urge to void.
parasympathetic excite the bladder and relax the urethral sphincter, aiding voiding.
a patient with fever and cough who you suspect to have TB but lab confirmation awaits.
need single room and surgical masks for staff
patient with legionella
no special precautions needed and not transmissionable from person to person
term infant aged 4 days delovered by C section due to pre-eclampsia is noted to be jaundiced. he is breast feeding well
physiological jaundice
how does lamotrigine work
blocks voltage sensitive sodium channels and reduces release of glutamate
legal course of action for a woman with severe dementia unable to make finance decisons. her nephew is financial power of attorney but is discovered to be taking her money to pay his morgage
adults with incapacity guardianship order
legal course of action for a patient reported to A&E with mania. he has no insight and attempts to leave the department. on call psych is held up.
section 36- emergency detention.
this can be done with a doctor who is fully registered by GMC (FY2 up?)
legal course of action for a man withy severe depression who is detained under short term detention. he still has no insight but doesnt think he need more ECT as he thinks he will die under the anaesthetic. the psych doctor still thinks he needs more ECT.
certificate of the designated medical practioner
change from one mature cell type to another
metaplasia
increase in number of cells
hyperplasia
abnormal cell proliferation
neoplasia
how to treat MODY?
sulphonylurea- glicizide
30 year old man with change in personality, peripheral neuropathy, atxia and tremor. eye doctors notices somethin interesting
wilsons disease
42 year old man presents with abnormal movements in his limbs that he cant control. his dad died young with similar issues
huntingsons
80 year old man with tremor, visual hallucination and decline in cogntion with falls. these symptoms fluctuate
lewy body dementia
6 month old baby. funny breathing and cough for last 2 days. subcostal recession and widespread wheeze. big bro had runny nose recently
bronchiolitis
2 day old infant started vomiting. non projectile, mild and green colour.
volvulus.
bile coloured vomit is always abnormal. do plain AXR first line
2 week old infant born at term started vomiting at day 4 of age. infant has been breastfed . vomiting is projectile and associated with constipation. they appear well and eager to feed
pyloric stenosis
-classical projectile vomit and hungry child
3 week old infant born at term. started vomting on day 7. vomit is of small amount and is effortless. and almmost after every feed. appears well and is gaining weight
reflux
perecentage of children that will have height within 2 standard deviations of the mena
95%
the age in months that it is recommended that a childs height should be measured rather than length
24 months ( 2 years)
ST elevation in V2-5
anterior MI
ST elevation in V1-3
anteroseptal
ST elevation in V4-6, aVL, I
anterolateral
ST elevation in II, III, aVF
inferior
ST elevation iN V1-2 (reciprocal)
posterior MI
is this a true adpation to pregnancy?
BP decreases in second trimester and returns to pre-preg levels by 3rd trimester
45 year old female with red hot swolleb joints symmetrically in hands and feet . inflam markers are raised
this is rheumatoid- check anti-ccp
middle aged woman, complains of fingers turning blue int he cold as well as bad heart burn. echo shows increased pulmonary artery pressure.
check anti-centromere
this is limited systemic slcerosis
first line for C diff
oral metronidazol
23 year old as abdo cramps and diarrhoea following a BBQ. vital signs are fine. temp 38. campylobacter is isolated in the stool… do you trear
in an otherwise fit person, the treatment is supportive
45 year old travelller from pakistan presents with abdo pain and loose stools and fever, faint rash over abdo and chest. temp of 40 degrees, ,he is hypotensive and tachycardic. blood cultures are posiitve for gram neg rod and typhoid seems likely diagnosis,
this is salmonella typhi. usually resistant to ciprolfoxacin so give IV ceftriaxone
60 year old man complains on 6 week history of sore throat and haorse voice. what is this likely to be?
laryngopharyngeal reflux
preffered measure of central tendency in a normally distributed data set
the mean
a measurement of how spread out data values are
standard deviation
measures the degree to which individuals differ from the sample mean
a level of variable which is exceeded by 10% of the population
90th centile
foul smelling discharge and microspopy shows flagellated protozoa
trichomonas vaginalis
30 year old man presents to GP with painful red eye for a few days. he also complains of right knee piain and stinging on peeing. which test may identify the cause?
urine PCR
this is chlamydia
50 year old man with fever, cough and right sided chest pain. CXR shows right sided consolidation. blood cultures are positive. likely bug?
this is strep. pneumoniae
gram positive diplocccci
is the surgeons knot more secure than a reef knot?
yes
elderly lady with peripheral vascular disease presents with PR bleed. abdo pain and high lactate.
ischaemic bowel
common in old folk with known vascular disease
30 year old female, abdo pain, weight loss, change in bowel habit and itcy rash on elbow
coeliac
associated with dermaitits herpetiformis
24 year old male operning his bowels 10 times a day with blood and mucous, he has lost weight and has mouth ulcers
IBD
does pheytoin reduce efficacy of the pill
yes
complication of thyroidectomy due to damaging the laryngeal nerve?
hoarse voice
75 year old man with COPD, IHD and hypertension has a painful ulcer on top of right foot. ABPI’s are 0.76 (L) and 0.68(R) which are reduced.
what type opf ulcer?
arterial
85 year old woman with undiagnosed connective tissue disease has many superficial ulcers over both lower legs from knee down. pupura is evident onn intact skin
vascualitis
82 year old lady with ulcers on both malleoli of left leg and lipodermatsclerosis of surrounding skin. ABPI left is 1.13 and 0.96 on right.
what type of ucler
venous
