YSKT compile SH Flashcards
1
Q
Well’s score - used for PE?
A
Previous PE or DVT (1.5) Clin features of DVT (3) HR > 100 (1.5) Immobilisation for 3 days or surgery in last 4 weeks (1.5) Haemoptysis (1) Cancer (1) PE more likely than any other test (3)
2
Q
Alcoholic patient with solid mass on liver imaging - 4cm, vascular?
A
Hepatocellular carcinoma
3
Q
Guy who leans on the table gets ulnar neuropathy, where is lesion?
A
Cubital canal
4
Q
What is the definition of critical limb ischemia?
A
Critical limb ischaemia (CLI) is a manifestation of peripheral arterial disease (PAD) that describes patients with chronic ischaemic rest pain, or patients with ischaemic skin lesions, either ulcers or gangrene
5
Q
What is the management for relapsing-remitting MS?
A
beta interferon (glatiramer, teriflunomide)
6
Q
55 year old new onset gastritis - treatment?
A
Test for H Pylori
7
Q
Lady had a loss of sensation up to umbilicus and bad cough and significant pack years
A
Chest xray and thoraco-lumbar MRI
8
Q
Pregnant women with Mania and presenting to A&E?
A
Olanzapine IM Stop depression
9
Q
tonic clonic/ partial seizure rx?
A
carbamezapine lamotrigine
10
Q
Vascular patient intermittent claudication. No pain at rest. Pulses are not palpable on right hand side but present on Doppler. How would you best manage this patient?
A
Risk modification (e.g. diabetes, obesity, smoking, hypertension) + Statin + Clopidogrel
11
Q
Infective endocarditis antibiotics: Non prosthetic? Prosthetic? MRSA? Staph Aureus?
A
Non prosthetic: Amoxicillin + Gentamicin (>1wk) [<1wk is flucox and gentamicin] Prosthetic: Vancomycin, Rifampicin + Gentamicin MRSA: Vancomycin + Gentamicin
12
Q
Which drug would you give old man who was not sleeping + depressive symptoms?
A
Mirtazapine
13
Q
Simple humeral fracture presented 5 days after fracture, what next?
A
immobilisation collar and cuff
14
Q
Risk factor of downs syndrome
A
Advanced maternal age Previous child with DS Parental karyotype
15
Q
What symptom most likely to be found in meningococcal septicaemia?
A
Non-blanching rash
16
Q
Small Bowel obstruction treatment.
A
Drip and suck - nasogastric decompression plus fluid resus
17
Q
Management of Cervical spine fracture with pain?
A
NSAID and Follow Up can add temporary opioid
18
Q
Section 3 Used for? Recommendation? Apply? Condition? Duration?
A
Used for treatment Two Section 12 doctors or One section 12 patient’s GP Apply by nearest relative or AMHP (health professional) Appropriate treatment available of condition or protect public Duration is 6 months –> Elongate or discharge (Patients can appeal once every 6 months)
19
Q
Patient has fit, seen to have jerking movements, loses continence and bites tongue - what is it?
A
Generalised tonic clonic seizure
20
Q
Parathyroid blood results: Raised calcium Very raised PTH decreased or normal phosphate Normal/low Vit D High ALP
A
Tertiary hyperparathyroidism
21
Q
Patient with +ve HbsAg , +ve anti-HBc, -ve IgM anti HBc, -ve anti HBs. Management?
A
chronic infection entecavir or peginterferon
22
Q
Side effects of diazepam?
A
drowsiness tiredness or fatigue muscle weakness inability to control muscle movements (ataxia) headache tremor dizziness dry mouth or excessive saliva nausea constipation
23
Q
Osteopenia vs Osteoporosis
A
Male vs female Age (Younger = penia)
24
Q
Section 35
A
remand for hospital for assessment
25
Man has Pancoast tumour, miosis, ptosis, clubbing, chest pain. What sign indicates extra-thoracic growth?
Thoracic outlet syndrome causes pain, in horner’s shouldn’t normally have pain. Pain characteristically is around the shoulder/scapula, but can also move to arm/hand if brachial plexus is affected.
26
Presentation of posterior humeral fracture
Wrist extension (wrist drop) Radial nerve fracture Loss of sensation in dorsal aspect of 1st+2nd
27
Paeds pneumonia - management?
Penicillin V or amoxycillin (In pneumonia associated with influenza, co-amoxiclav is recommended)
28
Acne treatment causing blue patch?
Minocycline
29
Cause of urticaria due to autoimmunity
Complement Phagocytes Immune deficiency (HIV)
30
Sinusitis management?
Abx - Amoxicillin Steroids nasal spray (budesonide) Decongestant spray (oxymetazoline)
31
What are Cluster C PD?
avoidant, OCD, dependent
32
33 year old comes for random test - has +ve RF, +ve anti-CCP, but no sx
RA
33
80 year old patient with hip fracture and normal bloods (pretty much). What management (if needed) should you initiate for osteoporosis? Treatment?
Assess risk by FRAX Oral alendronate (biphosphonate) All patients starting steroids for \>3 months should have an osteoporosis assessment \*All patients age \>65 starting steroids should be commenced on Adcal D3 + alendronate\*
34
Causes of early decelerations
Increased foetal intracranial pressure During labour Reduced amniotic volume Umbilical cord compression
35
What is the common cause for dilated left ventricle in old ladies?
HTN
36
Treatment of cervical cancer with lymph node involvement?
Chemotherapy + Radiotherapy
37
Section 4 Recommendation? Apply? Condition? Duration?
Emergency admission by any doctor Apply by nearest relative or AMHP (health professional) Mental disorder Duration 72 hours --\> Discharge, convert to S2/3, Elongate (can't appeal)
38
Patient presents 35 weeks pregnant - bp 140/90 Diagnosis? Management?
Gestational hypertension B-blockers - labetalol
39
How to diagnose Hirschsprung's? First line?
Rectal biopsy Plain abdo XR Contrast enema
40
Pt with FHx of hypertension or PET, but has DM and is obese. What is most likely risk factor of her getting pet/what makes you want to investigate further?
First baby Hx of pre-eclampsia FHx of pre-eclampsia BMI\>30 Maternal age \>35
41
Management of schizophrenia
Atypical antipsychotics (Respiradone, olanzapine, quetiapine, apriprazole)
42
11yr-old girl with 3mths hx of bloody diarrhoea, urgency to defacate, tenesmus?
UC
43
Patient comes in she has urethretis, iritis, and joint pain. What investigation will you do?
ESR, CRP HLA-B27 "can't pee, can't see. can't climb a tree - Reiter's syndrome"
44
CT show calcification in alcoholic patient?
Chronic pancreatitis
45
Bacterial vaginosis
Metronidazole
46
Has had 2 vasoocclusive crises in a Sickle Cell Disease patient. Also takes penicillin, spleen enlargement with abdo pain + circulatory collapse. What treatment is best?
Splenectomy
47
Parameters in acute asthma
Moderate - PEFR - 50-75% Speech normal Resp \<25 Pulse \<110 Severe - PEFR - 33-50% Can't complete sentences RR \> 25 Pulse \>110 Life-threatening - PEFR - \< 33% O2 SATS \< 92% Silent chest Cyanosis Feeble resp effort Pulse \<80 HTN Exhaustion
48
Wernicke’s- Guy had confusion, nystagmus and ataxia
pabrinex
49
Parathyroid blood results: High/normal calcium Normal/low PTH High phosphate Normal Vit D High ALP
Familial hypocalciuric hypercalcemia
50
Rheumatoid arthritis lung changes
Both restrictive and obstructive (fibrosis)
51
Treatment of IgA nephropathy - Whats the other name for it?
Berger's disease Most common GN Management: 1.Conservative if mild 2.Supportive therapy – ACE-I to control BP (\<140/90) 3.If risk of high progression (persisting proteinuria + preserved renal function) – Prednisolone 4.If RPGN/AKI involved – Immunosuppression -\> Prednisolone + Azathioprine
52
Down syndrome with failure to thrive
Coeliac disease
53
Urinary retention and pain in back of legs where was the lesion?
S234
54
ADHD - what would aid in the diagnosis?
Report from the teacher
55
Child presents with bruising, high lymphocytes
ALL
56
Bilateral glue ear, hearing loss, speech deficit?
Grommet
57
Dialysis patient 3day/week complains of tingling sensation, low power reflex, had diarrhea 2 weeks ago, which condition needs to be exclude?
Guillain Barre
58
XRay of rheumatoid
Early x-ray findings ● loss of joint space ● juxta-articular osteoporosis ● soft-tissue swelling Late x-ray findings ● Periarticular erosions ● Subluxation
59
Primary ovarian failure presentation
Low progesterone High LH
60
Epistaxis Telangiectasis Visceral lesions FHx (first degree)
3 or more - hereditary haemorrhagic telangiectasia
61
Risk factors for gestational diabetes screening?
BMI \>30 previous macrosomic baby previous GDM 1st degree relative with DM ethnicity of high DM prevalence (South Asia, black carribean, middle eastern)
62
Imaging ACL tear
MRI
63
Prostate symmetrically enlarged smooth on exam, raised PSA (1.0 over normal range), what do u do next?
Repeat PSA in 6 months
64
Test before starting azathioprine?
Thiopurine methyltransferase (TPMT)
65
What antibiotics do u give in pyelonephritis
Co amox +- IV gent
66
Trichomonas vaginalis treatment?
Metronidazole
67
Diet of patient with diabetic nephropathy already on ace-I, hypertensive
low salt diet
68
8 year-old that need emergency appendectomy, comes with patient. Can child consent? If not, who can?
Child cannot consent because Gillick non-competent; grandparents do not have parental decision making Can act on patient's best interest (Beneficence)
69
Pt with right sided stroke with legs\>arms and vision loss. What blood supply is affected?
ACA
70
Long term MI management?
Aspirin, B blockers (bisoprolol, metoprolol), Statin (atorvastatin)
71
The patient comes in with manic episode what treatment should you give him?
Olanzapine Lithium Sodium valproate
72
2 week of haematuria post URTI
Post Strep Glomerulonephritis
73
Patient with constant worries going out. Diagnosis?
Agorophobia
74
Patient with weight loss and UC. Primary sclerosing cholangitis or cholangiocarcinoma?
Primary sclerosing cholangitis
75
35 yr-old female with eye pain and vision problems, numbness and pain on limbs, headache and coordination problems?
Multiple Sclerosis
76
Pericarditis ECG changes?
ECG changes: • Widespread ST elevation (saddle shapes) • PR depression (most sensitive marker!)
77
Bulimia vs AN?
Bulimia= normal BMI -more impulsive than AN -weight fluctuation -parotid hypertrophy (sialadenosis)
78
Hypokalaemia, hypernatremia, headache, muscle weakness
Conns (primary hyperaldosteronism)
79
Baby with asymmetrical gluteal creases, what investigation do you do?
Ultrasound Developmental dysplasia of the hip
80
Pelvic X ray of osteoarthritis acetabulum, what do you do?
Total hip replacements
81
What is the acute management of mild/moderate asthma?
nebulise salbutamol
82
A woman is on epidural. What is her/her baby most at risk of?
Severe hypotension, leakage of spinal fluid (mom) severe respiratory depression & bradycardia (fetus)
83
MS patient on low dose baclofen, not experiencing side effects. How would you treat her pain?
Increase baclofen
84
70 year old patient with muscle aching, difficulty combing hair (i.e. raising arm) with raised ESR and normal CK and EMG normal. Diagnosis? Treatment?
Polymyalgia rheumatica Prednisolone
85
Causes of Akathesia
SSRIs, CCBs, anti-emetics (metoclopramide), anti-vertigo
86
Management of pelvic inflammatory disease
Oral Ofloxacin AND metronidazole OR IM ceftriaxone + oral doxy + oral metronidazole
87
What is the management of aspiration pneumonia in post stroke + swallowing problem patient?
SALT referral Metronidazole
88
Glaucoma - lady used to wear glasses, had vomitted. Definitive test?
Gonioscopy (slit lamp examination)
89
What blood test do you do before prescribing retinoids for acne?
B-hcg LFTs and serum lipids before treatment, 1 month after starting and then every 3 months
90
At what gestation stage does the sucking reflex manifest?
32 weeks Therefore premature babies \<31 wks old need ng tube
91
Patient comes in with periorbital pain, loss of visual acuity with scotoma (blind spot), loss of color vision, and rapid afferent pupillary defect. Diagnosis?
Optic neuritis
92
Side effects of respiridone
Depression Anaemia Anxiety Abnormal appetite Chest discomfort/Cough Conjunctivitis
93
What are Cluster B PD?
antisocial, borderline, histrionic, narcissistic
94
Diabetic brought into hospital hypernatremic, what will be given to him next?
NaCl Insulin IV (Glucose if low)
95
Causes of menorrhagia
PID Dysfunctional uterine bleeding Fibroids Anovulatory cycles Hypothyroid IUD
96
Section 136 Recommendation? Apply? Condition? Duration?
From public place police powers to remove to place of safety (A&E, police station) someone who appears to be suffering from a mental disorder 72 hrs requested by AMHP and granted by magistrate
97
What are the causes of anterior shoulder dislocation?
falling in outstretched arm
98
What are the symptoms of paranoid PD?
SUSPECT Sensitive Unforgiving Suspicious Possessive and jealous Excessive self-importance Conspiracy theories Tenacious sense of rights
99
Baby has vomiting than diarrhoea? What is the likely organism?
Rotavirus Campylobacter Salmonella Shigella E coli Ebola - Guinea, Liberia, Sierra-leone
100
6wks pregnant woman with light bleeding, HCG 100,000, and TVU showing no fetus, intrauterine mass with small cystic spaces (honeycomb)?
Hyaditiform mole (complete)
101
Cystocele first line management
Bladder training, Kegel exercises
102
Patient wakes up after anaesthesia. Headache and vertigo on standing up. Relieved completely on lying down. What is the diagnosis?
BPPV
103
Most common cause pyelonephritis
E.Coli
104
Child with purpuric rash + splenomegaly
ALL
105
ABPI doppler criteria for critical limb ischemia
• \>0.9 = normal • 0.4 – 0.9 = intermittent claudication • \< 0.4 = critical limb and pain at rest
106
Milestones of 3 yrs
can ride a tricycle (9 bricks), 3 word sentence, count to 10
107
Lady trying to conceive with low progesterone, oligomenorrhoea, normal fsh and LH, normal TSH. What is the cause?
Premature menopause
108
Treat oligomenorrhoea in patient with BMI 30 with PCOS who desires fertility after advising weight loss?
Metformin
109
Hospital acquired pneumonia: Most common causes - Gram stain?
Pseudomonas aeruginosa primarily ... gram -ve bacilli Staph aureus ... gram +ve cocci also common cause of HAP
110
HELLP?
Haemolysis (H), elevated liver enzymes (EL) and low platelet count (LP) . It's a serious but rare pregnancy complication.
111
60 year old Migraine lady had really severe headache, neck stiffness, subjective lateral gaze diplopia, CT normal - Management?
Temporal arteritis
112
Presentation in anorexic patient that requires hospitalisation?
BMI \<13 or \>1kg/ week amenorrhoea abnormally low potassium abnormally low temperature infection of any kind HR \<40bpm
113
Management of Cervical spine fracture, developed neurological symptoms?
immobilise + analgesia and immediate neurosurgical referral + IV methlyprednisolone
114
Presentation of intussusception
Vomiting, colicky abdo px, male, 6-12mths, lethargy, red-currant jelly stool
115
What is the management of endometrial cancer?
Complete treatment: total hysterectomy+ salphingoophorectomy+ node dissection
116
What to do before inducing labor
Cervical sweep
117
Patient who is 70, hx of MI, with AF -Initial management?
Beta-blockers (Propanolol) or CCB
118
Pregnant 2nd or 3rd trimester UTI rx?
trimethoprim-sulfamethoxazole
119
Placenta retained
Placenta oxytocin or ergometrine injection into the umbilical vein with 20 IU of oxytocin in 20 ml of saline is recommended, followed by proximal clamping of the cord
120
COPD, on salbutamol and ipratropium. FEV1 was 40%. What do start?
LABA + ICS combination inhaler (Seretide - salmeterol + fluticasone
121
Placenta praevia (placenta is low) - when do you do elective C section?
37-38 weeks
122
Child age 1-5 UTI - symptoms?
•dysuria and frequency •abdominal pain and loin tenderness fever +/- rigors •lethargy and anorexia •vomiting, diarrhoea •haematuria •offensive or cloudy urine •febrile convulsions
123
Lady is mad depressed, feels dead inside, her organs are rotting. What do you give?
Cotard syndrome fluoxetine + olanzapine
124
ABO incompatibility jaundice test?
Coombs test
125
55 year old new onset gastritis
1) Refer to urgent endoscopy
126
Child with red rash on Flexor aspects of elbows and on wrist
Atopic eczema
127
USS shows echogenicity (more dense) and hepatomegaly, ALT\>AST
NAFLD
128
Prolonged (\>3 wks) hoarse voice guy who is alcoholic, fat, and ugly. What is first line ix?
CT neck and chest
129
Rx for acute anxiety/ panic?
reassurance and benzo
130
Patient with migraines, experiencing them 2x a week, stressed with new job - what would you start?
Acute: triptan + NSAID/paracetamol Prophylaxis: propanolol
131
33 year old comes for random test - has +ve RF but no sx?
Doesn't have RA
132
How to diagnose Hirschsprung's? First line? Screening tool?
Rectal biopsy Plain abdo XR Contrast enema (most valuable)
133
HPV - high risk types and low risk types?
16&18 - high risk 6&11 - low risk
134
What is the most common injury with anterior dislocation of shoulder?
Axillary nerve and artery 95% Presentation in examination: humeral head visible, flattened deltoid
135
Same day STI test?
trichomonas
136
St elevation in leads 1 to 4. After troponin what would you do next?
PCI or thrombolysis
137
Pt with PET and has HELLP. 39 weeks pregnant, what is the best step in Rx?
Delivery + IV Dexamethasone MgSO4 If hypertensive: IV Labetolol
138
Pt with rh arthritis, on methotrexate with 6 month hx of SOB. Both fev1 and FVC reduced with ratio @ 86%. Diagnosis? Cause?
Pulmonary fibrosis Methotrexate
139
Baby born 36 weeks, good apgars - what is it?
Respiratory distress
140
Paeds severe life threatening asthma, silent chest sats 88%?
O2 + admission + nebulised SABA (salbutamol) and anticholinergic (ipaproprium) + prednisolone
141
Prodromal fever and malaise. Lesions start on the head, then spread to trunk and peripheries. Lesions as papules → Vesicles → Pustules → Crusting Diagnosis? Treatment?
Analgesia and go home
142
CHA2DS2-VASc score
C Congestive heart failure (or Left ventricular systolic dysfunction) - 1 H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) - 1 A2 Age ≥75 years - 2 D Diabetes Mellitus - 1 S2 Prior Stroke or TIA or thromboembolism - 2 V Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque) - 1 A Age 65–74 years - 1 Sc Sex category (i.e. female sex) - 1
143
Respiratory Distress Syndrome. After giving surfactant. Next treatment?
Another surfactant dose
144
Crohn's - Drugs used to maintain remission?
- Azathioprine (1st line) - Methotrexate (2nd line)
145
Impetigo advice to miss school-
This practice is implemented by many schools as they exclude children from attending until until the affected child no longer has crusty or bullous lesions
146
Patient is delirious with diagnosis 80. Squamous cell lung cancer with liver mets diagnosed?
Hepatic encephalopathy
147
Child presents with bruising, high lymphocytes Reddish purple dots on the ankles and feet (petechia)
Immune Thrombocytic Purpura
148
Pain at site, malaise and fatigue, local swelling, low grade fever with reduced range of movement and tenderness Diagnosis? Management?
Osteomyelitis Flucloxacillin (6 weeks)
149
Pt started on clozapine and is told to come back on a weekly basis for Ix. Why?
Agranulocytosis
150
HBeAg - what does it mean?
This means the person infected with Hepatitis B can likely transmit the virus on to another person
151
ENT what is associated with polyps & post nasal drip
asthma & aspirin allergy
152
Lady comes in who use to be heavy alcoholic has ‘echogenic liver’ what test do you do to confirm the diagnosis?
Biopsy liver - to identify why its dense
153
Man couldn’t close eye, facial and unilateral hearing loss - Investigation?
MRI Cerebellopontine angle
154
11yr-old girl with 3mths hx of recurrent diarrhoea, abdo pain, delayed puberty, and malnutrition?
Crohn's
155
Parkinsons off symptom management
Levodopa + Entacapone
156
IgA nephropathy diagnosis
Renal biopsy - diffuse mesangial IgA deposition Urine analysis MC&S U&Es eGFR Renal USS CT KUB (normal) C3 and c4 complement (normal)
157
Type of miscarriage? minimal pain; bleeding \< bleeding equivalent to menstruation; cervix closed; uterine size = dates; ultrasound = Fetal Heart visualised
Threatened miscarriage
158
What further test do you need to do to make sure LP is safe?
•Cardiorespiratory instability •Focal neurological signs •Signs of raised ICP → coma, Cushing’s response (high BP and bradycardia due to compression of the brainstem) •Coaguloapthy •Thrombocytopenia •Local infection at the site of LP •Performing and LP would delay antibiotic therapy
159
CURB-65 - Score 3 management?
- Confusion (abbreviated Mental Test Score \<=8) (1 point) - Urea (BUN \> 19 mg/dL or 7 mmol/L) (1 point) - Respiratory Rate \> 30 per minute (1 point) - Blood Pressure: diastolic \< 60 or systeolic \< 90 mmHg (1 point) - Age \>= 65 years (1 point) Admit and Ben Pen IV and doxycycline PO
160
Types of ovarian tumours?
high serous carcinoma clear cell endometrioid low grade serous mucinous teratoma fibroma
161
Women presents with mixture of distal sensory and motor signs after having gastroenteritis 1 week ago. What is the worst thing you want to rule out first? Triggered by?
Guillain Barre syndrome Immune mediated demyelination often triggered by Campylobacter jejuni.
162
Guy fell from climbing frame, snapping sound heard and had haematoma on sole of foot. He can't stand on the toes or push off. Diagnosis?
Achilles tendon rupture
163
Surveillance for 4.8cm aaa
3 monthly
164
Placental abruption risk factors
Chronic HTN Pre-eclampsia Smoking Cocaine Trauma Choreamnionitis
165
Child abuse - investigations?
FBCs Clotting Dilated fundoscopy Photodocumentation Skeletal survey CT brain LFTs and amylase Serum calcium, phophate, ALP Parathyroid 25-hydroxy D3
166
Characteristic cystic fibrosis features?
Failure to pass meconium (meconium ileus), Failure to thrive, voracious apetite
167
What are CI for induction of labour?
-acute fetal compromise -abnormal lie -placenta praevia -pelvic mass/deformity -cephalopelvic disproportion
168
Pt with nose bleed which has now become bilateral with blood leakage into the mouth. Bleeding hasn’t stopped after holding onto nose. Next step?
Topical anaesthetic and cotton wool soaked in vasoconstrictor (oxymetazoline) Then cauterise with silver nitrate sticks
169
Antibodies for SLE - Most sensitive? Most specific?
Anti-nuclear antibodies (ANA) are autoantibodies to the nuclei of your cells. dsDNA and anti-smith antibodies
170
Milestones of 4 yrs
can hop on one leg, plays with other children, asks W questions
171
Hyperkalaemia. Tented T waves. First line treatment?
1. 10% Calcium gluconate (and repeat until ECG normal) 2. Dextrose/insulin infusion (and repeat until normokalaemia) 3. Consider sodium bicarb if acidosis 4. Consider nebulised salbutamol
172
DVLA laws for stroke patient?
6months
173
30 year old Abdominal distension, diarrhoea, vomiting. Doctor gives a list of differentials including appendicitis, crohns, mesenteric adenitis etc. What is the next line of investigations?
CT abdo pelvis
174
Renal artery stenosis imaging?
Angiography
175
What are the side effects of oxybutynin?
anti-cholinergic -dry mouth, dizziness, drowsiness, blurred vision, dry eyes, N&V, constipation, diarrhea, weakness, runny nose
176
IgA nephropathy and post strep - a difference in urine dip
IgA has 2+ blood while post strep has 3/4+ IgA has 3+/4+ protein while post strep has 2+
177
CHADsVASC2 - criteria
• CHF • Hypertension • Age \> 75 (2) • Diabetes • Stroke (2) • Vascular – ischaemic heart disease and peripheral arterial disease • Age 65 -74 • Sex - female (If male then consider at 1, and if 2 offer anticoag - stop aspirin)
178
Guy had something that looked like psoriasis after coming back from Africa, what do you give?
Seborrheic dermatitis ketoconazole (steroid for flareups)
179
The most common cause of LV dysfunction
IHD
180
Patient with varicose veins with a single bleeding episode from vein. What should you do after seeing the patient in the clinic? Ix?
Refer pt to vascular team Duplex
181
When hip is posteriorly dislocated- described as?
ANS = shortened, flexed, internally rotated, ADDucted
182
What medication for induction of dead fetus?
Misoprostal
183
Baby (8 months) with crying episodes where baby brings legs to tummy. Mother opened nappy to find red current stool
Intersussception
184
Vascular surgery man is awaiting angioplasty for intermittent claudication revascularisation, what do u give him in mean time?
Statin
185
Lady with pregnancy-induced HTN with bp at 146/something. Why do you control her bp?
To prevent superimposed pet
186
Guy has posterior triangle irregular lumps, and some other symptoms of cancer – where is his cancer?
Nasopharynx Other things that can be caused: -temporal bone -ear -skull base
187
Management for Open comminuted fracture of tibia?
wash out in theatre and give abx immobilise, IV ABx, tetanus vaccine (everyone gets, if not fully immunised--\> 3 vaccines and 2 boosters 10 years apart), debride and lavage, fixation if indicated
188
Patient with psoriasis – tried emollients and wants to avoid oral meds. What next?
1st line mod-severe = narrow band UVB. (Phototherapy)
189
Sudden chest pain Increased JVP SOB Low BP Tachypnea Discomfort relieved by sitting or leaning forward
Cardiac tamponade
190
5 year old girl wants pill, she threatens she is about to start shagging, what to do?
Give her the damn pill and do not tell her parents or social services cuz Gillick competent and Fraser guidelines
191
Simple pain management already on nsaids, what next?:
Weak opioids - codiene, dyhydracodeine, tramadol Strong opioids - diamorphine, fentanyl
192
Goserelin - mechanism of action? side effects?
GnRH agonist - Synthetic hormone. In men, it stops the production of the hormone testosterone, which may stimulate the growth of cancer cells. In women, goserelin decreases the production of the hormone estradiol (which may stimulate the growth of cancer cells) to levels similar to a postmenopausal state. Alopecia; arthralgia; bone pain; breast; depression; gynocomastia; headache; hot flushes
193
Biggest risk factor for completed suicide?
Age \>65 Postnatal status Personal/FHx of depression Steroids IFN male
194
Focal neurological seizure followed by secondary generalisation lasted for 20 seconds - Next step?
Refer to neurologist
195
Acute glaucoma managment?
urgent refer+ acetazolamide + pilocarpine
196
Mechanism of urticaria due to IgE
Mast cell degranulation
197
Patient who has had a stroke -Is thrombocytopenic and has haematoma Management?
Give FFP/prothrombin complex AND cryoprecipitate Platelet transfusion
198
Minimal change disease - Presentation? Kidney biopsy?
More common in children Nephrotic syndrome - normotension, proteinuria Serum albumin loss Fusion of podocytes
199
Mechanism of action of COCP?
Suppress the secretion of gonadotropins (follicle stimulating hormone, FSH and luteinizing hormone, LH) through negative feedback inhibition.
200
Risk factors for suicide
male Hx of self harm Alcohol or drug misuse Hx of mental illness Hx of chronic disease Advancing age Unemployment or social isolation/living alone Being unmarried, divorced or widowed
201
Common diazepam side effect?
Allertness decreased Anxiety Confusion Depression Dizzy Drowsy GI disorder Resp depression
202
Signs of physical abuse (non-accidental injury) including bruises, burns, fractures?
Bruises: -symm. bruised eyes -mouth, eyes, soft tissues on face -finger marks on legs, arms, chest -linear buttock or back -uncommon sites: chest, stomach, genitalia, neck Burns, scalds -cigarettes -backs of hands, soles of feet -glove and stocking distribution Human bite mark Fractures: -long bones (arms, legs, ribs) -multiple fractures in various bones -fractures of different ages
203
Main advantage of breast milk over formula
Reduces risk of sudden infant death syndrome
204
Milestones of 6mths
6 months – palmar grasp, can pass objects from one hand to another, coos
205
What is the scoring system ABCD2 used for?
TIA Age: \>/= 60 =1 BP: \>/= 140/90=1 Clinical features: -unilateral weakenss= 2 -speech impairment without weakenss= 1 Duration: \>/= 60min= 2 10-59min: 1 Diabetes= 1
206
Good prognosis MI medication (low ejection)
ACEi/ARBs B-blocker Hydralazine Spironolactone Vasodilators and Nitrates
207
Fraser guidlines
1. He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment 2. He/she cannot be persuaded to tell her parents or to allow the doctor to tell them 3. He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment 4. His/her physical or mental health is likely to suffer unless he/she received the advice or treatment 5. The advice or treatment is in the young person’s best interests.
208
Pt comes in with left sided weakness which lasts for 60 minutes. Treatment?
If 0-3 = Specialist assessment within 1 week of symptom onset +/- brain imaging 4 or more = Aspirin 300mg immediately, specialist assessment within 24 hours, address RFs
209
Most common viral meningitis in children cause?
herpes
210
Management of stone that couldn’t be ERCP?
Emergency CBD exploration + Abx
211
Patient with signs consistent with encephalopathy (liver failure) on the background of alcoholic cirrhosis and being alcohol independent. What is the first step in Mx?
20 degree head tilt, A-E, lactulose, treat sepsis, +/- Abx (rifaxilline), +/- Mannitol
212
Child with UTI. You do a USS. Parent asks why you chose to do USS?
vesicoureteric reflux
213
Chronic heart failure - management?
ACEi B blocker
214
Psoriasis question, gentleman doesn't want to take anything oral, which of options has good evidence?
Topical corticosteroid (mild) Phototherapy (moderate to severe)
215
What is the gold standard investigation for endometriosis ?
Laproscopy
216
Girl with primary nocturnal enuresis - First line management?
Behavioural
217
Better prognosis for SZ
female acute onset of symptoms older age of first episode positive\> negative symptoms presence of new symptoms good pre-illness function
218
Features of innocent murmurs
Seven S: -sensitive (changing position) -short duration (jot holosystolic) -single -small (non-radiating) -soft -sweet -systolic
219
What more likely to cause endometrial cancer?
Obesity Nulliparity Early menarche Late menopause Unopposed estrogen
220
Pt with T2 diabetes and keeps having hypos. What is the cause?
Glimeperide (Insulin/sulfonylureas (gliclazide and glimepiride)
221
Not passing meconium, put finger in and stool is expelled
Hirschprungs
222
Guy had surgery, complaining of decreased visual acuity, double vision and nystagmus in left eye. - next line?
Patch
223
RTA broken nose, abnormal chest movement, weirdly displaced leg, leg bleeding management?
C-spine/ airway/ chest drain
224
Rx for VZV in pregnant woman?
IVIG immediately
225
Migraine lady had really severe headache, neck stiffness, CT normal, photophobia
LP because meningitis
226
Man had nose bleed and INR of 4.5 and metallic heart valve what do you do?
Give vitamin K
227
Reasons for referral to psychiatry
superficial self-harm
228
What is rehabilitation?
the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness.
229
SLE - pathophys
Cell apoptosis
230
Definition of Privacy
Privacy refers to freedom from intrusion and relates to all information and practice that is personal or sensitive in nature to an individual Dignity is being worthy of respect
231
Psoriasis question, gentleman doesn't want to take anything oral, which of options has good evidence?
Topical corticosteroid
232
Necrotizing enterocolitis biggest risk factor
Preterm
233
Blood results showing HELLP syndrome.
Total Bili \>1,2 LDH \>600 GGT \>70 Platelets \<100,000
234
What are the signs of community acquired pneumonia?
increased vocal fremitus
235
41 week gestation, unremarkable pregnancy, 2cm dilated, station 0, cervix position anterior, soft consistency, almost fully effaced. What do you do?
Membrane sweep Intravaginal prostaglandins Breaking of waters (amniotomy with amnihook) Oxytocin
236
Dyskaryosis
Multi nucleation Increased cytoplasm:nucleic ratio
237
Acute heart failure management
O2 therapy Loop diuretics - furosemide GTN spray
238
Child age \>5 UTI - symptoms?
have symptoms that are classically described in the adult: •LUTI → dysuria, frequency, supra-pubic pain. Fever may be mild •UUTI → fever, loin pain
239
Frequent barking cough with prominent inspiratory (and occasionally, expiratory) stridor at rest. Marked sternal wall retractions. Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia). Tachycardia occurs with more severe obstructive symptoms and hypoxaemia.
Severe croup
240
Child born at term and starts to seize. Weight is 4.8kg, what is the first investigation that should be done?
Glucose and electrolytes
241
What is the ix for 51yr-old woman, 14 months amenorrhoea, hot flushes?
menopause- none
242
APGAR score 0-3 management?
ABCDE on baby High flow O2 Adrenaline Compressions Monitor glucose
243
MS relapse management ?
IV methylprednisolone
244
What is the most common cancer is HIV patients
Kaposi sarcoma and lymphoma
245
Patient comes in with UMN weakness, behavioural abnormalities, where is the lesion?
ACA
246
Breast cancer, liver lung and 70% bone cortex in tibia mets – treatment? Post menopausal - HER2 -ve? Post-menopausal - HER2 +ve? Pre-menopausal - HER2 +ve?
a.If post-menopausal (HER2 –ve) – anatrozole+ palbociclib + bisphos+ calcium and vit d b.If post-menopausal (HER2 +ve) – pertuzumab+ trastuzumab+ docetaxel + bisphosphonates+ calcium and vit d c.If pre-menopausal – tamoxifen (and mab if HER2 +ve) ; then ovarian ablation ++bisphosphonates+ calcium and vit d
247
Sudden loss of vision ddx
Stroke TIA acute glaucoma retinal detachment anterior uveitis retinal occulsion
248
Patient who is 50 with AF and CHF - Initial management?
Sotalol Amiodarone Flecainide
249
Lung ca central tumour on x-ray - Next investigation?
Bronchoscopy+biopsy
250
Causes of infertility?
age \>35 hx of STD BMI extremes smoking
251
Paediatric non accidental injury
Bruising on back Mid-shaft transverse femoral fracture
252
Meningitis CSF - Opaque High pressure Mostly neutrophils Decreased glucose High protein Acid fast bacillus stain PCR
TB
253
Patient with past mitral valve replacement presenting with new pan systolic murmur and fever. What is most important investigation?
Blood cultures
254
Sickle cell kid with temp of 39 - management?
Ceftriaxone (Vancomycin if meningitis)
255
Features of parkinson plus
Vertical gaze palsy +- falls Impotence/Incontinence Visual hallucinations Interfering activity by affected limb (Alien limb syndrome) Diabetic/HTN patient who falls
256
Patient on risperidone and has oligo-menorrhea which hormone?
Hyperprolactinemia
257
HbsAg - positive Anti-Hbc - positive IgM anti-Hbc - negative anti HbS - negative
Chronic hepatitis
258
Paeds clavicle fracture, macrosomic 4-week old baby, CXR of chest showed clavicle fracture /w callus, examination (for other signs of abuse) was unremarkable?
If in ED then send to GP Fracture clinic - if it doesn't heal in 6 weeks
259
Baby born developed grunting and subcostal recession - Diagnosis?
RDS
260
Guy had hep c and hep b - management?
Treat hep c interferon alfa and ribavirin.
261
Mechanism of Baclofen
Muscle relaxant and antispastic inhibiting both monosynaptic and polysynaptic reflexes at the spinal level
262
CURB-65 - Score 0 management?
Community care Doxycycline PO 200mg STAT then 100mg OD
263
Diagnosis of asthma
Reversibility
264
DM Type 1 nephropathy – patient has high hba1c and high protein in urine. What do you do?
Increase insulin
265
Teenager RTA with bruising on the chest and hypovolaemia. Resp exam is ok - first step?
Cannula Bloods - FBC, U&Es, crossmatch, clotting Fluid resus
266
Hernia that doesn’t go into scrotum. Medial and superior to pubic tubercle. What type of hernia?
Inguinal hernia – medial and superior to pubic tubercle Femoral hernia – lateral and inferior to pubic tubercle
267
Patient jaundice, fever, RUQ pain?
Ascending cholangitis (Charcot's triad)
268
Pt had surgery 3 days prior and has dropped in renal output with increased creatinine. He was on amox, met and gent. What is the most immediate step in management?
Stop gent
269
Pregnant first trimester UTI rx?
Nitrofuratoin
270
Commonest cause of preterm babies
Pregnancy with multiple babies Hx of preterm labour/birth Infection Diabetes/HTN
271
Treatment for glaucoma?
Medical - pilocarpine Surgical - Iridoplasty
272
Type of miscarriage? pain +/-; bleeding \>\>bleeding equivalent to menstruation; cervix = open; uterine size = or \< dates; ultrasound = retained products/no fetal heart
Incomplete miscarriage
273
How to aid women with External cephalic version?
Tocolytic (Terbutaline) in primiparous women
274
Boy comes in. Upper respiratory tract infection followed by red scaling plaques (salmon scaly plaques on back)
guttate psoriasis
275
Schizotypal characteristics
●Indifference to praise and criticism ●Preference for solitary activities ●Lack of interest in sexual interactions ●Lack of desire for companionship ●Emotional coldness ●Few interests ●Few friends or confidants other than family
276
Patient wakes up after anaesthesia. Headache and vertigo on standing up. Relieved completely on lying down. What is the diagnosis?
Post lumbar puncture headache (common in females with low BMI)
277
Progressive hip pain (over weeks), Limp, stiffness and reduced range of movement in 7 year old, trendelenburg +ve - Diagnosis?
Perthes disease
278
Patient presents with one red eye that are: pain or photophobia no itching poorly reactive pupil irregularity of the pupil Diagnosis?
Anterior uveitis
279
What is oxybutinin?
Antimuscarinic
280
Guy had AKI after surgery - what do you assess?
saline bolus 250ml
281
myoclonic seizures rx?
clonazepam lamotrigine
282
Patient with post op, PE and calf swelling. What is the best IX?
CTPA
283
6wks pregnant woman with vaginal bleeding, shoulder tip pain, abdominal pain, bHCG \>1500
Ectopic pregnancy
284
Pt after stoke suffers from double vision, he is very upset by this what do tell him to do?
Optometrists
285
What are the signs of community acquired pneumonia?
Increased vocal fremitus
286
DDx for fresh, red rectal blood
anal fissures, haemorrhoids, cancers and polyps of the rectum and colon diverticulosis
287
Patient with Graves – Whats the treatment? Side effects?
Carbimazole SE: Rashes, pruiritus. Serious SE: Agranulocytosis
288
57 year old male trips on pavement falls onto outstretched arm. X ray shows midshaft humeral fracture and osteolytic lesion on head of humerus. Fracture was opened and fixed. How would you describe this?
Pathological fracture due to mets
289
Tia abcd2 calculation & management, if u worked it out he had a score of 6?
Admission + MRI
290
When do you give anti-D to non-sensitised Rh-ve mothers? When would you give ASAP?
28 and 34 weeks ● delivery of a Rh +ve infant, whether live or stillborn ● any termination of pregnancy ● miscarriage if gestation is \> 12 weeks ● ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required) ● external cephalic version ● antepartum haemorrhage ● amniocentesis, chorionic villus sampling, fetal blood sampling
291
SLE with Antiphospholipid syndrome, what do you need to warn them about ?
Miscarriage
292
Pain in the abdomen- the pain is located either in the centre of the abdomen, or in the lower right-hand side of the abdomen (known as the ‘right iliac fossa’ area) - Fever (high temperature) \>38.5 - Feeling generally unwell - Nausea and/or diarrhoea - Sore throat/ symptoms of a cold
Mesenteric adenitis
293
Patient with acute ischaemic limb. No pulses past femoral pulse and cold limp up till below knee. What is Rx?
Thrombolise from femoral down 6Ps: pain, pallor, perishingly cold, pulseless, paralysis, parasethesia
294
Pt with TB signs – what type of stain should be done on sputum?
Ziehl Nielsen
295
1 core and 4 minor depressive management?
Cbt, anti-depressant
296
What is the management of Guillain-Barre syndrome?
IVIg or plasma exchange
297
Loss of deterioration of central vision (can be sudden or gradual) Flashes of light
Retinal detachment
298
Treatment of small cell lung cancer
multidrug platinum-based chemotherapy limited-stage SCLC then offer thoracic irradiation concurrently with the first or second cycle of chemotherapy or after completion of chemotherap
299
Meningitis CSF - Cloudy Pressure increase Neutrophils Decreased glucose High protein Gram stain culture
Bacterial
300
What are the signs of Hospital acquired pneumonia
Decreased vocal resonance
301
Man presents as worried because dad died of colorectal ca – what screening should he be offered?
If strong fhx -\> genetic testing for FAP or HNPCC; if -ve but strong hx then colonoscopy 35-45 (If 60-74 every two yrs offer fecal occult blood testing 55 one off flexi sigmoid -\> full colonoscopy if polyp found)
302
New born baby and tests done. Levels of immunoreactive trypsin were found to be high. What does this point to?
Cystic fibrosis
303
Age \<70 Patient has a fall and fractures hip - Displaced intracapsular fracture. Cardiac problems, the fall was due to an MI, how do you manage?
Internal fixation (if possible), hip arthroplasty if not
304
What is the next line ix for BPH?
USS CT abdo/pelvis
305
Numbness half face, post nasal drip and other signs, when is the investigation is most appropriate: Nasal endoscopy? CT? MRI?
Considering CSF leakage OR cancer CT Scan is good for identifying breaks in bones/skull or if cancer has spread to bone. MRI is better to see the type and size of the cancer
306
Nicotine replacement that is most effective and reduces cravings?
varenicline
307
Police picks up crazy guy from home. What section can they detain on? Time?
Section 135 Upo 24 hours
308
Guy couldn’t find the right words for things, what is this?
Anomic aphasia
309
Patient with Phalen's sign, thenar wasting, weakness of thumb?
Carpal tunnel
310
COPD ladder
Vaccinations - influenza and pneumococcal Rehab Step 1: Inhaled therapy (SABA or SAMA) (Salbutamol + Ipratropium) Step 2: Without asthmatic features - LABA (Salmeterol) + LAMA (Tiotropium) Step 2: With asthmatic features - LABA + ICS (Budesonide/Beclomethasone) Step 3: If still breathless then LAMA + LABA + ICS
311
Jaundice in first 24 hours - cause, FH and spherocytic blood film
Spherocytosis
312
Melena and microcytic hypochromic anemia in older guy?
Anemia of chronic disease (cancer)
313
Dehydrated baby, poor feeding, irritable, dry nappies, what to do?
rehydration therapy
314
Management of Primary 8mm pneumothorax?
Aspiration
315
Patient has a fall and fractures hip - Extracapsular fracture (non special type). Cardiac problems, the fall was due to an MI, how do you manage?
Dynamic hip screw
316
Patient comes in intermenstrual bleeding. Smear is fine done two years ago. Speculum is normal. Next investigation?
Endocervical swab
317
Diabetic drug that causes hypoglycemia
Insulin, sulfonylureas (Glucoside)
318
70 year old man comes in with chronic back pain, leg and thighs. Dull pain that feels cramping. Also has numbness and tingling with claudication.
Lumbar spinal stenosis
319
Milestones of 12 mths
12 months – cruises, walks with one hand held (refer if cannot walk at 18 months), good pincer, bangs toys, knows 2 to 6 words (refer at 18 months)
320
B-hcG of 650 in 5-week pregnant woman, can pick up heartbeat but can't see anything on USS, what is this?
Pregnancy of unknown location
321
Jaundice in first 24 hours - cause? Mother is O+ve?
ABO incompatibility
322
Wells criteria - What is it for?
Pulmonary embolism clinical signs and symptoms of DVT = 3 an alternative diagnosis is less likely than PE = 3 heart rate more than 100 = 1.5 immobilisation for 3 or more consecutive days or surgery in the previous 4 weeks = 1.5 previous objectively diagnosed PE or DVT = 1.5 haemoptysis = 1 malignancy (on treatment, treatment in last 6 months or palliative) = 1
323
First line management of angina
Exercise Diet Nitrates Antiplatelet therapy
324
A woman who smokes 10/d has started getting regular painful contractions at 31weeks and a bloody vaginal discharge.
Placental rupture
325
Haematuria 1 year ago, then painless haematuria
Renal cell carcinoma
326
Q of a guy who hit his head and had symptoms the next day in a rugby match?
CT scan
327
Secondary PPh, what initial investigation will show retained placenta?
TVUS--\> will show endometrial thickness \>10mm
328
ACL tear bare co-morbidities (T2DM un-controllable, CABG) Risk factors?
Acute trauma Female sex (after puberty) Hx of previous ACL injury Use of cleats
329
Which following features would suggest Lewy body dementia?
In LWB, get visual hallucinations, parkinsonism and fluctuating cognition. Do a DaTSCAN
330
Section 36
remand to hospital for treatment
331
Worse prognosis for SZ
Early onset FHX structural brain abnormalities
332
Spirometry asthma vs COPD; FEV1/FVC
COPD \<70% Asthma \<80%
333
Pt with stroke that occurred 1 hr ago. What is the best Rx?
tpA intravenous
334
Pt had surgery 3 days prior and has dropped in renal output with increased creatinine. He was on amox, met and gent. What is the most immediate step in management?
Stop gent
335
Sensory lost on medial 1 and a half finger, where is the lesion?
cubital tunnel syndrome
336
Scleroderma affects trunk and proximal limbs predominately Associated with scl-70 antibodies Hypertension, lung fibrosis and renal involvement seen
Diffuse cutaneous systemic sclerosis
337
What are Cluster A PD?
paranoid, schizoid, schizotypal
338
Non Paracetamol OD - liver transplant criteria?
INR \>6.5 (PT \>100 seconds), or any 3 of the following: age \<10 or \>40 years; aetiology non-A, non-B hepatitis, or idiosyncratic drug reaction; duration of jaundice before hepatic encephalopathy \>7 days; INR \>3.5 (PT \>50 seconds); serum bilirubin \>300 micromol/L (\>17.6 mg/dL)
339
Keratitis appearance fluorescein stain showed branch like appearance so management? Diagnosis?
HSV Gancyclovir
340
GCA management
Steroids
341
Depression admission criteria
Severe agitation Psychotic Suicidal Catatonia
342
Pt with severe unilateral headache, especially around one eye, lacrimation ?
Cluster headache
343
Section 17a
supervised community treatment -compulsory treatment for community patients -apply to patients under section 3 -last for 6 mths
344
Patient has anatomical snuffbox tenderness and bait scaphoid fracture but no obvious signs on x ray. How do you manage?
Cast and return for x ray in 2-3 weeks
345
What's Duke criteria used for and what does it consist of?
Infective endocarditis Major: +ve blood culture evidence in ECHO Minor: predisposition (IVDU, previous heart) fever microbiology vascular phenomenon (janeaway lesions, etc)
346
Patient had symptoms of raised ICP (early morning headache and change in personality, and headache worse on movement) mx?
Urgent referral to neurologist CT/MRI scanning to determine any underlying lesion.
347
What is a somatic feature of depression?
headaches, backaches, general muscle pain and digestive pain like stomach pain, dizziness, dyspnea [Take, for example, a red and tender joint. The joint is objectively red. It's a sign everyone can objectively measure or assess. But the pain (the symptom) is only something you can experience and put into context, and is therefore subjective.]
348
What are the croup ddx?
epiglottis foreign body peritonsilar abscess
349
Patient with renal transplant, lesion on lip - diagnosis?
Immunosuppression due to the transplant -\> increased risk of SCC.
350
Patient with raynauds and anticentromere - Diagnosis?
Limited cutaneous systemic sclerosis Scleroderma affects face and distal limbs predominately – hardening of the connective tissue.
351
What to check before starting COCP?
Blood pressure
352
Child with seizure going on for 20 minutes. Has been given lorazepam, what should you give him now?
Lorazepam 0.1 mg/kg intravenously (Benzo)
353
what does anti tissue transglutaminase indicate?
Coeliac
354
Patient has long term catheter. Patient does not want catheter anymore. What would you do?
Trial without catheter
355
Patient comes in with ear pain, itch and discharge. Otoscopy shows red, swollen canal. What is the management?
Otitis externa Hydrocortisone Rx: topical antifungal (clotrimazole)
356
baby was feeding well for the first 6 hrs of life and then deteriorated - diagnosis?
Cyanotic heart disease
357
2y old know only few words, but understands clearly, no motor delay what is the next step?
• assessment → audiological, neurodevelopmental and SALT • medical treatment → correction of hearing loss, correct cleft lip/palate • social → support at school
358
Patient with NSTEMI, what to do?
O2 Nitrates Metoclopramide Aspirin + Clopidogrel/Ticagrelol LMWH B-blocker - diltiazam/verapamil (Tirofiban in high risk patients)
359
Management of Pelvic Inflammatory disease (PID)
Ceftriaxone + doxycycline
360
Cause of Intermenstrual bleeding in woman with COCP
Missed COCP pill Alternative remedies taken Clotting drugs Tamoxifen Cervical pathology, vaginal or uterine causes Smear tests
361
Child with otitis media. Treatment?
Abx (amoxicillin) if: Child with systemic features and no improvement \> 4 days Immunocompromised Age \<2 with bilateral otitis media Discharge from ear
362
How does oxybutinin work?
used to treat incontinence 1st line by decreasing muscle spasms. (anti-cholinergic) But avoid in frail older women
363
Patient with muscle weakness, difficulty combing hair (i.e. raising arm) with raised ESR and raised CK and Anti-Jo1 antibody, positive rheumatoid factor. Diagnosis?
Polymyositis Symmetrical, proximal muscle weakness Elevated skeletal muscle enzyme levels Symmetrical, proximal muscle weakness with insidious onset Muscles usually painles
364
Hypothyroid in children treatment
Levothyroxine
365
2yr Baby boy with bloody stools?
Shigella (\<5 + bloody)
366
2nd degree prolapse management?
Asymp - lifestyle and pelvic floor Symp - pessary
367
lifetime prevalence of schizophrenia
1%
368
Cervical screening – why do you not screen people under 25?
high false positive rate
369
Marfans presents with severe tearing chest pain radiating to back – TTE showed aortic dissection. Next investigation?
CT angiography
370
COPD on Salbutamol and comes into clinic, breathless, FEV \<40% (acute) - management?
Salbutomal and Ipratropium Nebulised and Prednisolone
371
Which feature of CTG implies fetal hypoxia?
late deceleration
372
Patient has vasoocclusive crisis in a SCD patient. Also takes penicillin, 1cm palpable spleen. What treatment is best?
Hydroxyurea (prevent future crisis) Acutely - NSAIDs, antihistamine
373
Patient has a fall and fractures hip - Extracapsular fracture (reverse oblique, transverse or sub trochanteric). Cardiac problems, the fall was due to an MI, how do you manage?
Intramedullary device
374
Cyclist comes in with hypothenar wasting, tingling of fourth and fifth finger?
Guyon's canal syndrome; ulnar nerve entrapment
375
Menorrhagia treatment - 1st line? 2nd line?
1st line: Mirena Coil (IUS) 2nd line: Tranexamic Acid (or if want kid)
376
COPD on Salbutamol and comes into clinic, breathless, FEV \<40% (chronic) - management?
Oral pred ICS
377
What are the symptoms of avoidant PD?
AFRAID Avoids social contact Fears Criticism Restricted lifestlye Apprehensive Inferiority Doesn't involve unless sure of acceptance
378
Patient with rheumatoid + steroid use and methotrexate with swollen elbow for past 1 week. She felt hot (but didn’t tell us there was fever) - Ddx? Microscopy?
Gout, Septic arthritis (but its not cause 1 wk hx) Long needle-shaped crystals which are negatively birefringent under polarised light.
379
What is the management of ABCD2 score \>4?
carotid imaging within 24hrs of initial assessment -CT/ MRI
380
Child misbehaving at home, but fine at school. What meds will help?
Nothing ADHD is worse in school
381
Meningitis CSF - Clear Normal pressure Lymphocytes mostly Normal glucose High protein PCR-assay
Viral
382
Patient who hit his head lost consciousness and then had consciousness right away and was normal. Now presents with headache and confusion. What is it?
Extradural haemorrhage
383
Lady has self harm, fight with boyfriend, history of child abuse. How do you treat?
DBT
384
Presents frequently to healthcare Intense but unstable relationships Persistent feelings of boredom and emptiness with uncertainty Unstable mood - Anger, low tolerance of stress Impulsive (and damaging behaviour) Diagnosis?
Emotionally unstable personality disorder
385
11yr-old girl with 3mths hx of abdo distention, weightloss, no blood or mucus in stool, mouth ulcers and dermatitis herpetiformis?
Coeliac
386
Women comes in with incontinecne which occurs when she is laughing and also has urgency.
Mixed incontinence
387
What is the presentation of patient with Bipolar that stopped taking medication?
anxiety, mania, headaches, pressured speech, irritability, depression
388
Patient in Ventricular Tachycardia arrests?
DC cardiovert Stable – pharmacological cardioversion with Amiodarone, Lidocaine, Procainamide
389
What change occurs in proliferative diabetic retinopathy and not in nonproliferative?
New vessel formation
390
How to reduce risk of kidney stones?
● high fluid intake Reduce high purine foods such as red meat, organ meats, shell fish ● low animal protein, low salt diet ● thiazides diuretics (increase distal tubular calcium resorption)
391
Pregnancy induced hypertension why given labetalol?
Prevent superimposed pre-eclampsia
392
Diarrheoa Lacrimation Vomiting Rhinorrhea Dysphoria Nausea Fevers Sweating Insomnia Agitation and aches Dilated pupils
Heroine withdrawal
393
Lady spontaneously changed from speaking English to fluent polish and was delusional shouting that Lady gaga wanted to kill her, whats the diagnosis?
transient psychosis
394
Neonate that’s grunting and 92 sats after 20hr premature rupture of membrane labour, what do you do next?
O2/CPAP or Intubate, surfactant
395
Patient wanted contraception. When is it advised to start?
First day of period
396
Pronounced claw hand and motor symptoms, normal back of hand sensation?
guyon's canal syndrome
397
Cholesystitis treatment
IV co-amoxiclav lap chole
398
Rheumatoid features - most likely RA?
Swan neck deformity Boutonnieres deformity \*Ulnar deviation\* Nodules on elbow (Morning stiffness)
399
41 week gestation, unremarkable pregnancy, 2cm dilated, station 0, cervix position anterior, soft consistency, almost fully effaced. What do you do?
Membrane sweep Intravaginal prostaglandins If doesn't work: Do CTG monitoring Breaking of waters (amniotomy with amnihook) Oxytocin
400
Baby with asymmetrical gluteal creases, what investigation do you do?
Ultrasound and then hip XR Developmental dysplasia of the hip
401
Patient has pcos. What investigative ratio is most suggestive of diagnosis?
testosterone/ SHBG --\> baseline test for evaluation of hyperandrogenism
402
Why do you give Anti D?
Stop mother making antibody Prevent maternal sensitisation
403
Occasional barking cough and no audible stridor at rest. No or mild suprasternal and/or intercostal recession. The child is happy and is prepared to eat, drink, and play.
Mild croup
404
Man returning from india with jaundice had diarrhoea?
Hepatitis A
405
DKA – once patient has been put on saline, what else do you give?
(Potassium if \<3.5 then add potassium chloride to NaCl) Insulin
406
Complications of cataract surgery?
Posterior capsule opacity (PCO) Intraocular lens dislocation. Eye inflammation. Light sensitivity. Photopsia (perceived flashes of light) Macular edema (swelling of the central retina) Ptosis (droopy eyelid) Ocular hypertension (elevated eye pressure)
407
Everything normal pretty much and endometrial tissue is 5mm in woman with bleeding
Dysfunctional uterine bleeding
408
Endometriosis symptom most indicative
Deep dyspareunia
409
Pt has ptosis slightly weak medial eye movement, whats caused this?
Subarachnoid haemorrhage
410
Chronic demyelinating neuropathy
Progressive weakness and impaired sensory function in the legs and arms. Caused by damage to the myelin sheath of the peripheral nerves. CIDP is more common in young adults, and in men Tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. Diabetes HIV SLE
411
Sudden onset headache and third nerve palsy - Differentials?
Mid brain strokes Cavernous sinus thrombosis Posterior communicating artery aneurysm SAH - due to uncal herniation
412
Tests before starting Vit D and alendronate?
Serum 25-hydroxy VitD (D1) Serum ALP Serum calcium Fasting phosphorus PTH
413
CREST syndrome What does it stand for?
Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
414
Sudden onset severe headache. Ct scan normal. Next investigation?
MRI or LP
415
Given vancomycin antibiotic for chest infection then gets erythroderma, what is cause?
drug reaction
416
Investigating for retained products of miscarriage?
USS
417
Open fracture of tibia - how do you manage?
Abx & dress
418
Ischemic stroke management
Alteplase - only is before 4.5 hrs Aspirin Endovascualr intervention SALT assessment
419
UTI kid why do USS?
To show dilated calyces
420
Indications for CT head in children?
-LOC -vomiting, headache -post traumatic seizure (no hx epilepsy) - GCS \< 14 - suspected fracture - any signs of fracture - focal deficits
421
Milestones of 2 yrs
plays near others (not with them) (6 bricks), 2 word sentence, 200 words
422
Hospital acquired pneumonia: Treatment before MC&S in mind and severe?
If mild – Doxycycline PO + Metronidazole PO If severe or can’t take oral – Benzylpenicillin IV + gentamycin IV
423
Guy that wants to stop getting depressed, how do u treat him, hes tried to OD on pills in the past
CBT
424
Mitral valve replacement and low arterial BP, distended neck veins, muffled heart sounds. Next step?
(Beck's triad) Refer to CT surgeon immediately for pericardiocentesis.
425
Cancers that cause osteoporosis
multiple myeloma breast cancer prostate cancer lung cancer
426
Pt with signs of endometriosis and a 4mm endometrioma on USS. What is the best way to manage? Investigation?
COCP TVUS
427
woman with monochromic (one placenta) diamniotic twins (diagnosed at 1st US scan) suddenly gets intense abdo pain and is large for dates. What is cause?
Twin to twin transfusion polhydro
428
Dyskaryosis
Multi nucleation Increased cytoplasm:nucleic ratio Irregular chromatin distribution Hyperchromasia
429
DVLA laws for epilepsy?
12 months since last seizure
430
Cerebral oedema - CT scan
Ventricle disappears
431
Girl fell over, incontinent of urine, biting of tongue etc. - Investigation before leaving hospital?
EEG
432
Lady with gallstones, presenting with acute pancreatitis because of gallstones, after stabilization, how would you manage?
Cholecystectomy
433
Treatment of thyrotoxicosis
Propylthiouracil
434
What is the presentation of opiate/ heroin withdrawal?
sweating, muscle aches, sleep problems, runny nose, irritability -later: dilated pupils, vomiting, diarrhoea, abdo pain, tachy/brady, cramping goose bumps
435
Jaundice in first 24 hours - cause? Mediterranean/African Americans/ Middle Eastern Male infant
G6PD deficiency
436
Paeds urticaria management, the boy forgot his blue inhaler?
IM adrenaline
437
Section 5(4) Recommendation? Apply? Condition? Duration?
Emergency of detention of information patient Nurse in charge of patient No application Mental disorder Duration 4 hours --\> Discharge, convert to S5(2), Elongate (can't appeal)
438
section 48/49
transfer of a remanded prisoner from prison to hospital
439
Lady positive pregnancy test (\<5 weeks) , LIF pain and bleeding, what is most appropriate investigation?
quantitative serial b-HCG
440
Risk factors for vaginal prolapse
Vaginal delivery (forceps delivery) Older age High BMI Previous surgery for prolapse Genetic factors
441
Pt with light bleeding and lower abdominal pain @ 9 weeks gestation. What is definitive investigation to find out whats happening?
TV USS
442
Neonate premature at 30 with intermittent apnea, what is the management options include Corticosteroid, diuretics, and caffeine?
Caffeine
443
Young girl one eye facing inwards towards nose. What lesion?
CN IV esotropia
444
Schizo acute dystonia treatment?
Procyclidine Hydrochloride
445
Old ladies husband has passed away what features tell us that she is suffering from depression as opposed to normal grief: diurnal mood variation, agitation, auditory hallucinations of her dead husband
Diurnal mood variation
446
The patient gets dizzy every time he turns his head. Presents with left lateral gaze and nystagmus Diagnosis? Investigation? Treatment?
Benign paroxysmal positional vertigo Dix-halpike Epley
447
Neuro rehab: purpose of rehab
Re-learn lost functionality Reduce symptoms and improve the wellbeing of people with diseases
448
Asthma not well controlled, told about a wheeze and other signs. What would you like to know next?
Peak flow
449
Epistaxis management after pressure attempted, what next?
Packing (children/not well tolerated) Cauterise sphenopalatine
450
Indication to below the knee amputation.
If all other methods have failed/Unsuitable for revascularisation
451
Endometrial cancer, what type of cancer is it?
Adenocarcinoma
452
Patient comes in 2 months old Turkish parents. Jaundiced and anaemic. Diagnosis? Blood film?
G6PD deficiency Heinz body
453
Women comes in with incontinence that happens only when she laughs or coughs. What does she have?
stress incontinence
454
Haematuria, smoker, ct found multiple lesions in lungs and renal kidney lesion - Diagnosis?
RCC
455
Taking anti epileptics, taking antidepressants has tremor. Reduced facial movements. What drug is causing side effect?
Carbamazepine Gabapentin Pregabalin Levoterazatam
456
Rx for abscence seizures?
clonazepam ethosuximide
457
Man had AF and raised amylase(very slightly)
Mesenteric ischaemia
458
Milestones of 18 mths
plays alone (3 bricks)
459
What is Akathisia?
Restlessness
460
Patient stage 3 and wanted to naturally deliver placenta. What is the best way to ensure she does not loose any extra blood?
Syntometrine - is a combination of oxytocin + ergometrine. Carboprost Used in combination for delivery of placenta and prevention of PPH.
461
How to prevent diabetic nephropathy progression in long term diabetic?
ACE-i to stop progression according to BMJ BP Keep BP below 130/80
462
Patient has hypomania. What is the first line treatment?
olanzapine
463
Pt with signs of endometriosis and a 4mm endometrioma on USS. What is the best way to manage? Investigation?
COCP GnRH analogues - reduce the size Laprascopic laser to reduce complications TVUS
464
Patient with stroke symptoms, regain movement after 45min - management?
Alteplase then start aspirin 300mg 24 hours later.
465
Chinese guy with conductive hearing loss?
nasopharyngeal carcinoma
466
RLQ pain sudden onset and constant pain, N+V, increased CRP, but normal WBC.
Ovaian torsion
467
Round opacification of paediatric XR
Pneumonia
468
Management of OCD
CBT SSRI
469
Old lady has confusion and fluctuating consciousness. Her son says that she bumped her head a few weeks ago. What is it?
subdural haemorrhage
470
Patient presents 38 weeks pregnant - bp 140/90 and protein ++ Diagnosis? Management?
Pre-eclampsia Deliver the baby
471
Kid has hypovolemic shock weighed 12kg: how much fluid do you give them?
20ml/kg bolus over 10 mins.
472
Treatment of hypercalcaemia?
First record the patient’s weight. Stop drugs known to cause hypercalcaemia. Give 0.9% NaCl to render the patient euvolaemic, aiming to increase urine volume to 200 mL/hr.
473
Builder comes in with tingling of hands whats differential, previous hx of neck trauma?
Cervical radiculopathy
474
3 day history of feeling tired/ill, in last few days suddenly urine output drops, proteinuria, bp is normal: what is cause?
membranous
475
Afebrile paed with wheeze and expiratory crackles 9 weeks old with recession
exacerbation of asthma
476
Man had a fall, loss of motor on one side and loss of proprioception on same side. Loss of sensory on opposite. What is the diagnosis?
Brown-Sequard syndrome is a spinal cord hemisection. On the ipsilateral side there will be loss of motor function (Corticospinal tract) and loss of proprioception & vibration sense (dorsal column). On the contralateral side there will be loss of pain, temperature and crude touch.
477
Endometriosis - lady wants to have kids in future -management?
Laparoscopic ovarian cystectomy with excision Can do laparoscopic surgery if severe disease if \>3cm
478
62, increasingly withdrawn, few words used, finding it difficult to name things. Mmse 28/30. What was likely cause?
Primary progressive aphasia the language capabilities slowly and progressively become impaired. (Caused by alzheimers)
479
Melanoma - what's the most prognostic factor?
Breslow
480
Thoraco-lumbar Kyphosis investigations?
XRay
481
Downs, healthy at birth no cardiac signs. Parents have been told of complications. What do you do next?
Echo
482
Crohn's - Drugs used to induce remission?
1st line: Steroids (use mesalazine if can’t use steroids) Adjunct: Azathioprine/mercaptopurine
483
What is amount of blood loss is considered post partum haemorrhage?
Over 500 mL
484
What are the signs for Parkinson's disease?
TRAPD Tremor Rigidity Postural instability bradykinesia
485
ENT what is associated with polyps & post nasal drip
asthma, hay fever & aspirin allergy
486
FSH high, LH high, Prolactin normal, TSH high, Testosterone normal.
Premature ovarian failure
487
What is the best ix to rule out causes of oligomenorrhoea/ amenorrhoea in PCOS?
LH/FSH ratio
488
Disulfiram use
Inhibits acetaldehyde dehydrogenase - leading to accumulation
489
DDx sudden onset RAPD?
optic neuritis severe glaucoma retinal detachment severe macular degeneration
490
Patient had lucid interval secondary to trauma, fell off step ladder?
extradural haematoma
491
Difficulty having kids, trying 14 months, hubby fine, periods every 2-3 months. Normal testosterone and SHBG, FSH:LH ratio raised, normal progesterone and prolactin - Diagnosis?
PCOS
492
Pt has food poisoning and develops loss of sensation in legs. Whats diagnosis?
Guilian barre secondary to campylobacter
493
Most likely cause of PPH?
Atonic uterus
494
Indications for induction of labour?
-prolonged pregnancy (\>12 days EDD) -prelabour premature rupture of the membranes without labour starting -DM mother \>38weeks -Rh incompatibility
495
Large Bowel obstruction treatment.
Drip and suck - nasogastric decompression plus fluid resus
496
Migraine prophlyaxis patient previous depression
Venlafaxine (SNRIs)/Amitryptilline Duloxetine Milnacipran
497
Painless jaundice ddx
Pancreatic cancer
498
What is the management of alcohol withdrawal?
chlordiazapoxide 300mg
499
Subfertility, cycles 35-48 days, causes of why she can’t get pregnant?
Smoking
500
Uteric calculus, currently has infection. WCC raised. Treatment?
Hydration and pain killers Nephrostomy (\>0.5 cm) Gent IV
501
Parathyroid blood results: Low/normal calcium High PTH High phosphate Low Vit D High ALP
Secondary hyperparathyroidism (gland hyperplasia)
502
Patient with gangrenous toe and ulcer under foot with leg pain at rest. What is the next step?
Revascularisation (critical limb ischaemia)
503
Psychotic symptoms with suicidal ideation want to leave a&e, which law would you use?
Mental health act
504
Haemorrhagic stroke management
Beta blocker (Labetalol) DVT prophylaxis - heparin
505
Diabetic proliferative retinopathy and macular oedema in one eye. How best to manage?
Anti-vegf injection +/- panretinal photocoagulation (if significant then photocoag first then, intravitreol anti vegf, macular laser)
506
Best schizophrenia prognosis
Paranoid
507
Hep B treatment
Pegylated INF-a - tenofovir and entecavir
508
2/5 palpable occipital posterior – which forceps to use?
Kielland forceps
509
Frequent barking cough and easily audible stridor at rest. Suprasternal and sternal wall retraction at rest. No or little distress or agitation. The child can be placated and is interested in its surroundings
Moderate croup
510
Patient with sensorineural unilateral hearing loss, vertigo and on MRI found to have an abnormal lesion leaving the internal auditory meatus. Diagnosis?
Acoustic neuroma aka vestibular schwannoma, arising from vestibular nerve
511
Diabetic with hyperlipidaemia and high cholesterol and raised Hba1c. How to control cholesterol levels?
Atorvastatin 80 mg
512
Man, smoker, alcohol drinker, lost weight. Picture of a lesion at the back of the throat?
Squamous cell
513
When to give oxytocin in 3rd stage of labor?
10iu of oxytocin as anterior shoulder of baby is out and then double clamp cord -in delay of clamping cord= higher haematocrit levels in neonates
514
Death certificate 1a - what to write as reason of death?
WHO defines the underlying cause of death as “a) the disease or injury which initiated the train of morbid events leading directly to death, or b) the circumstances of the accident or violence which 5 produced the fatal injury”. From a public health point of view, preventing this first disease or injury will result in the greatest health gain.
515
Patient with normal weight but having a problem binge eating. Patient uses laxatives to vomit after feeling bad. Diagnosis?
Bulimia
516
Patient with hx of macular degeneration was agitated and delirious but was not a threat to anyone - how would you manage?
Reassurance patients Reduce noise and distraction (Side room)
517
Endometrial cancer staging investigations?
FIGO staging (surgical) Pelvic USS Biopsy and histology
518
Short term management of Gout
1. NSAIDs- diclofenac or indomethacin 50mg/8h for up to 8 days (strong NSAIDs) 2. Colchicine 0.5mg/6h until pain resolves. Also use if NSAIDs are contraindicated
519
UC - Drugs used to induce remission?
1st line: Aminosalycate (Mesalazine) 2nd line: Steroids (pred)
520
11yr-old girl with 3mths hx of abdo distention, loose, watery stools after drinking milk?
Lactose intolerance
521
Investigating for retained products of pregnancy?
USS (TVS)
522
Bilateral conjunctivitis itchy eyes - management?
Anti-histamine - epinastine, azelastine, pheniramine, alcaftadine
523
Boy who had delayed puberty, said father also was delayed.
Constitutional delay
524
Bronchiolitis, a premature baby born 24 weeks, what do you give the baby?
Oxygen
525
Osteoarthritis drug management
LA Diclofenac (with omeprazole) Steroid injection (methylpred)
526
Infected bile duct obstruction (ascending cholangitis) - management?
IV abx (tazobactam or piperacillin) + ERCP
527
Endometrial cancer. Risk factor?
Obesity \>50 yrs Endometrial hyperplasia Unopposed oestrogen (early menarchy, late menopause, HRT) Tamoxifen FH
528
Patient with weight loss, dysphagia and occult blood - next investigation?
Upper OGD
529
Colectomy of crohns pt, 2 days post-op asks nurse about feeding?
eat and drink normally to get gut moving
530
Minimal change disease management?
Steroids - Prednisolone Fluid restriction and low salt diet (Steroid resistant - cyclophosphamide)
531
Leg claudication on exercise, pulses palpable and obs stable – what management?
Aspirin/clopidogrel+ exercise + risk factor modification (statin, b-blocker +/-ACEi)
532
Bacterial vaginosis
metronidazole twice a day for 5 to 7 days.
533
Male have sexual tendency towards underage girl what would indicate that she not is at immediate risk?
Been less than 6 months of these tendencies
534
Patient been on sertraline for 18 months, not getting on with it, what is the next management?
Switch to other SSRI (fluoxetine)
535
Shoulder dystopia. Most likely cause to get shoulder dystocia?
Macrosomic baby
536
Stroke guy, why can't he drive?
if stroke or TIA: 1 month off driving may not need to inform DVLA if no residual neruological deficit if multiple TIA over short period times: 3 months off driving and inform DVLA
537
Rx for lumbar spinal stenosis?
Drugs: NSAIDs, PGE1, gabapentin and vit B1. Physio may have epidrual steroid injections Surgical: traditional laminectomy, bilateral laminotomies
538
Patient had depression, had core symptoms + extras - 6 in total - Management?
Antidepressant (Sertraline) + CBT
539
Woman BMI\>40 and previous macrosomic baby - when do you test for GDM in pregnancy?
28 weeks
540
6wks pregnant woman with light bleeding, HCG 650, and TVU showing no fetus?
miscarriage
541
Pt with weakness and dizziness alongside changing colour in palmar creases. What is best test? Top differential?
SynACTH. Addison’s – palmar crease pigmentation, weakness, abdo pain. Short synacthen test is best diagnostic + 1st line in diagnosing
542
HRT contraindications
Breast cancer Estrogen sensitive cancer Undiagnosed vaginal bleedings Endometrial hyperplasia
543
Baby jaundiced 6 weeks high unconjugated bilirubin and pale stool?
Biliary atresia
544
Milestones of 3 months
3 months – good head control (e.g. no head lag, able to lie with head up, can be held sitting), laughs, reaches for objects
545
Migraine prophlyaxis patient previous depression
Venlafaxine (SNRIs) Duloxetine Milnacipran
546
Cancer patient presents acutely with cord compression?
1) Steroids - Dexamethasone 2) MRI spine and review
547
not passing meconium, put finger in and stool is expelled
Hirschprungs
548
What are varicose ulcer signs?
Lipodermatosclerosis, swollen, achy legs, shallow red sore with irregular edges
549
Child with seizure going on for 20 minutes. Has been given lorazepam, what should you give him now?
Lorazepam 0.1 mg/kg intravenously Benzo
550
Type of miscarriage? pain; bleeding \> bleeding equivalent to menstruation; cervix = open; uterine size = dates; ultrasound Fetal heart may/may not be visualised
Inevitable miscarriage
551
Causes of prolonged jaundice in newborns
Biliary atresia Hyperthyroid Galactossemia UTI Breast milk jaundice (unconjugated bilirubin) CMV/Toxoplasmosis
552
Patient has retinal detachment. What feature in history predisposes him the most?
Increasing age, previous retinal detachment, family history of retinal detachment, myopia, diabetes, vitreous haemorrhage, previous eye surgery (e.g. cataract).
553
Pt diagnosed with open angle glaucoma. Which piece of advice should patient be given?
Pt’s eyesight is irreversible Damage to the optic nerve is likely to be prevented or delayed. Sadly treatment cannot restore any sight that has already been lost.
554
Patient diagnosed with angina but also has asthma. Already on aspirin – what is the first drug pt should be put on?
Verapamil
555
Started someone on ACEi, he had a small creatinine rise what do you do?
Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% Treat with NaCl fluid
556
What are the common symptoms peripheral vascular disease in diabetics?
Venous ulcer
557
Chronic demyelinating neuropathy
Progressive weakness and impaired sensory function in the legs and arms. Caused by damage to the myelin sheath of the peripheral nerves. CIDP is more common in young adults, and in men Tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. Diabetes HIV SLE
558
Wife has manic symptoms on a background of depression, currently on SSRI, what do you do?
Bipolar Stop SSRI, swap to Lithium
559
Women couldn’t dorsiflex - nerve damage
Common peroneal nerve
560
7y year old still bedwetting, father has history of bedwetting until 8. Nothing in the hx about previous treatment What is the next treatment?
Lifestyle Eneursis alarm
561
33 year old comes for random test - has +ve ANCA, CRP, ESR
Most likely connective tissue disorder
562
Patient presented with stroke within 1hr- which treatment provide best possible outcome?
Thrombolysis
563
Lady has progressive weakness, subdued deep tendon reflexes and normal tone, had URTI a week ago?
Guillain-Barre syndrome
564
Osteochandroma (patient with swelling) investigation?
CXR, x-ray pelvis
565
Patient with t2 diabetes mellitus (on metformin) with high cholesterol, high BMI (31) and poor glucose control. How should the pt control their cholesterol?
Statin
566
What are the symptoms of dependent PD?
SUFFER Subordinate Undemanding Feels hopeless when alone Fears abandonment Encourages others to make decisions Reassurance needed
567
Red painful eye with decreased visual acuity - what to do next?
Pupillary light reflex - Glaucoma (acute)
568
What is the ix for 42yr-old woman, 14 months amenorrhoea, hot flushes?
FSH
569
Management of PTSD
Watchful waiting for mild symptoms Trauma focussed CBT Severe - Eye movement desensitisation and reprocessing (Paroxetine if drugs being used)
570
Peripheral artery disease management
Quit smoking Atorvastatin Clopidogrel Endovascular revascularisation
571
What is the management of ABCD2 score 0-3?
Need other indication for hospital observation
572
Diabetic what is the BEST investigation for eyes
digital retinal imaging (put tropicamide first to dilate)
573
Treatment of viral meningitis
Ceftriaxone IV and acyclovir If immunocompromised or \>55 add amoxicillin
574
Section 5(2) Recommendation? Apply? Condition? Duration?
Emergency of detention of information patient Doctor in charge of patient No application Mental disorder Duration 72 hours --\> Discharge, convert to S2/3, Elongate (can't appeal)
575
90. Impetigo advice to miss school-
This practice is implemented by many schools as they exclude children from attending until until the affected child no longer has crusty or bullous lesions
576
1st rank symptoms of schizo
Auditory hallucinations, somatic hallucinations, thought withdrawal or inserting, broadcasting, delusional perception, delusions of control
577
Squamous cell carcinoma arises from?
Arises from actinic keratosis (pre-cancer)
578
Patient doesn’t respond to anything apart from opening eyes a tiny bit and moves them. What is the diagnosis?
Locked in syndrome/ Pseudocoma/ brain stem infarct
579
Acute management of depression with psychosis?
antipsychotics- olanzapine/ haloperidol
580
man presents with pain in epigastrium. blood pressure is 200/100, what is it?
Hypertensive crises because bp is \>180/110 Rx is labetalol
581
Labour, mention of repeated late decelerations over last 40 mins, what do u do next?
Fetal blood sampling
582
Stroke patient has face and arm UM weakness, sensory loss and Broca's aphasia where is the stroke?
MCA
583
Pt with melaena, altered bowel habit and weight loss, no lesions anywhere on body. What is Dx?
Colon cancer
584
2-3 week history of feeling tired/ill, in last few days suddenly urine output drops, haematuria, proteinuria, bp is normal: what is cause?
post-strep glomerulonephritis
585
Pt with proximal myopathy-ish symptoms - and low Na and high K. Diagnosis?
Addisons
586
Treatment for pregnancy induced HTN?
labetalol Methyldopa for asthmatic
587
Patient with schizophrenia with high BMI and cholesterol. What medication should the pt be started on?
Amisulpiride, \*Aripiprazole\*, Ziprasidone - least weight gain
588
Patient has anterior uveitis. What medication is contraindicated?
Pilocarpine - irritates ocular surface
589
Thyroxine, long-term DM, control recently deteriorated thyroxine effects on diabetes.
Increase glucose in thyroxine
590
Carpal tunnel definitive sign
Phalen's test/Tinnels
591
New born. Doctor says more likely to get UTI. Patient asks what symptoms to look out for if he gets UTI?
Irritability, fever, foul smelling urine, poor feeding
592
Giant cell arteritis treatment
High dose prednisolone Emergency opthamology review (if confirmed give aspirin additionally) (Allergic/relapsing then give methotrexate)
593
TIA prevention?
lifestyle modification statins BP control carotid endarterectomy or stenting clopidogrel
594
BPH + LUTS management?
tamsulosin + finasteride
595
Lady is bleeding after birth 4500 ml of blood what radiological intervention would you do?
intrauterine balloon
596
Kid wanted to sleep but couldn’t due to rash
Eczema (itching at night)
597
Pt with 2 weeks hx of frank haematuria and varicoceale. What is most likely Dx?
Renal cell carcinoma
598
RTA patient with open book fracture pelvis, scaphoid fracture. stable but absent bowel sounds?
ABCDE and then CT TAP Internal fixation
599
Spasticity on 5mg bd baclofen. Management?
increase baclofen (100mg/d is maximum)
600
Patient with sensorineural hearing loss, tinnitus, vertigo and aural fullness. Diagnosis?
Menieres
601
Most common cause of Pelvic Inflammatory Disease
Chlamydia Gonorrhoea
602
What week gestation for GDM screening?
booking appointment (8-10wk) and 24-8 weeks
603
Insomnia Anxiety Tremor Loss of appetite Tinnitus Perspiration Perceptual disturbances and seizures
Diazepam/Benzo withdrawal
604
CXR with ground glass appearance
Respiratory distress syndrome
605
section 47/49
transfer of a sentenced prisoner to hospital for treatment
606
Ulnar neuropathy first line Ix/
EMG/NCS
607
Upper motor neurone lesions symptoms
Weakness, spasticity, clonus, and hyperreflexia
608
Paediatric epilepsy - protocol for status epilepticus
Time 0 mins (1st step) - Seizure starts Check ABC, high flow O2 if available Check blood glucose 5 mins (2nd step) - Midazolam 0.5 mg/kg buccally Or Lorazepam 0.1 mg/kg if intravenous access established 15 mins (3rd step) Lorazepam 0.1 mg/kg intravenously 25 mins (4th step) Phenytoin 20 mg/kg by intravenous infusion over 20 mins or (if on regular phenytoin) Phenobarbital 20 mg/kg (if known heart block or already on phenytoin)intravenously over 5 mins 45 mins (5th step) Rapid sequence induction of anaesthesia using thiopental sodium 4 mg/kg intravenously
609
Man with nocturnal back pain, high ESR. Obvious myeloma – what do you do next?
1st Ix: Serum/Urine electrophoresis - to identify paraprotein / light chain urinary excretion Confirm with BM aspirate Imaging (in order of preference) - MRI, CT, skeletal survey (X-Rays)
610
Goserelin - What is it? Mechanism of action?
GNRH receptor agonist Inhibition of pituitary gonadotropin secretion
611
Newborn baby from mother with polyhydramnios, having difficulty breathing, difficulty swallowing secretions
Esophageal atresia
612
Causes of menorrhagia, no intermenstrual bleed, multiparous, abdo exam normal, didn’t want to have bimanual?
Fibroids
613
Patient with osteoarthritis - mild sx and managed with analgesia. How would you manage?
Physiotherapy
614
Young patient pain in hands. Stiff in the morning. What is the diagnosis? Management?
Juvenile Idiopathic arthritis MDT + lifestyle NSAIDs Long term - methotrexate and folic acid
615
Which medication causes memory problems - bisphosphantes, bisoprolol, oxybutynin , rivoraxaban
Oxybutynin
616
Lady with recurrent UTI and scarring. Reflux nephropathy - chronic pyelonephritis + vesico-ureteric reflux: Presentation? Investigations?
Dysuria Frequency Pyrexia Urinary incontinence at night 1.MCUG: contrast is used to see the reflux of urine during voiding 2.IVU: show scarring with thin cortex overlying a distorted calyx. Clubbing of calyx: normal cupping of calyx is reversed. 3.DMSA scan: show renal scarring due to reflux.
617
Ovarian cancer commonest type?
Serous
618
Patient comes in with generalised weakness, leg cramps and nausea?
HHS (hyperosmolar hyperglycaemic state)
619
What are the presentations for acoustic neuroma?
vertigo, unilateral hearing loss, tinnitus, absent corneal reflex, facial palsy MRI of CPA
620
Alcoholic man with chronic pancreatitis?
Creon
621
Patient has a fall and fractures hip. Cardiac problems, the fall was due to an MI, how do you manage?
Hemiarthroplasty, Dynamic hip screw, intramedullary device
622
Long term management of Gout
Long term therapy – Allopurinol. Do not start within 1 month of an attack, and NSAIDs/ Colchicine given for 4 weeks before and after starting allopurinol. 2nd line is Probenecid.
623
Patient has really high BP, low platelets and a bruise after an injection. Which of these is a relative contraindication to heparin?
Elderly Low platelets / thrombocytopenia are absolute CI to heparin, recent cerebral haemorrhage, severe hypertension; peptic ulcer; after major trauma or recent surgery to eye or nervous system; acute bacterial endocarditis
624
Guy had cataract surgery came back 3 days later with eye pain
endopthalmitis
625
Definitive management of endometriosis
Hysterectomy with bilateral salpingo.
626
Diplegic spastic child already had baclofen+ physio. Next mx?
Surgery, physio, more baclofen, cast Baclofen 40mg/day max if still no improvement give botulin toxin type A injection
627
Where do you place grommet?
Anterior inferior
628
Baby has vomiting then diarrhoea? What is the likely organism?
Rotavirus (non bloody diarrhoea) Oral immunisation at 2 and 3 months
629
Treatment of woman who comes in contact with check pox unsure if chicken pox in childhood.
Treat with IVIG
630
Acamprosate use
Acts on NMDA and GABAa Reduces Cravings and risk of relapse
631
Anti-d – why don’t you give it before 12 weeks?
Blood transferred during that time is not significant
632
How does gout present in a 60 old year old hypertensive who has had it for 2 years?
Cyclical flares of joint pain, swelling and erythema 12 hours - several days (Predisposed by diuretics)
633
Antepartum haemorrhage: 8 weeks pregnant investigation
Pregnancy test FBC Rhesus Serum BHCG TVUS
634
Homonymous hemianopia and hemisensory loss in both upper and lower limbs where is the lesion?
PCA
635
Contraception for adolescents
Gillick competencies Under 16s having sex call police Recommend the use of condoms both as a contraceptive, and to prevent sexually transmitted infections (STIs).
636
Bilateral conjunctivitis + itchy eyes
Topical antihistamines
637
Woman trying to conceive for 18m periods 28-70 day cycle, partner ok, no past hx, all blood result normal except for low 21day progesterone
Early menopause
638
Patient diagnosed and has mild cervical Dyskariosis. Next investigation?
HPV status If positive - Colposcopy
639
SZ vs schizotypal disorder?
retained insight in schizotypal -odd beliefs and magical thinking, odd, eccentric behaviour
640
Treatment for PTSD
Trauma focussed CBT FOR EXAMPLE eye movement desensitisation and processing
641
UC - Drugs used to maintain remission?
1st line: oral Aminosalicyates – Mesalazine 2nd line: Azothioprine / Mercaptopurine
642
When do you refer depressed woman?
Agitation
643
UPM hemiparesis and apahsia where is the lesion?
MCA
644
Baby born 6 hours at term, fed well 45mls, developed grunting and subcostal recession - Diagnosis?
Transient tachypnoea of newborn
645
Patient post stroke, has IT job and 5th floor flat with lift. Has quite a few problems. - what would you do?
Full OT assessment and home visit before discharge
646
6wks pregnant woman with light bleeding, HCG 100,000, and TVU showing fetal tissue?
Hydatidiform mole (incomplete)
647
patient long time immunosuppression, post-transplant. What dermatological condition is in the highest risk?
SCC
648
Milestones of 6 wks?
– can smile (refer if cannot smile at 10 weeks)
649
Failure to pass meconium – does a pr exam and lots of faeces come out. Investigations?
Meconium plug syndrome CF blood sample Rectal suction biopsy Contrast enema
650
Vocal nerve damage investigation?
Laryngoscopy
651
Pt with sensory and motor signs peripherally. Vitamin?
Vitamin B12 (Vitamin E)
652
What is Bishop score used for and what does each mean?
Assess the necessity of induction in prolonged pregnancy (\>12days after EDD or 41 (+3)) \<5= induction 5-9= ARM \>9= spontaneous labour Call PEDS C: consistent P: position E: effacement D: dilatation S: station
653
Venous leg ulcer management
Compression bandaging (4 layer), moisturiser, oral pentoxifylline (reduces platelet aggregation and inflammation)
654
chronic pelvic pain dysmenorrhoea - pain often starts days before bleeding deep dyspareunia subfertility tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen
Endometriosis
655
Commonest cause of preterm labour?
hx of premature labour hx cervical trauma hx of induced abortion maternal infections multiple pregnancies
656
Treatment of dysmenorrhagia
Mefanamic acid COCP
657
Back pain with irregular prostate, and urinary symptoms
Prostate cancer
658
Woman with late decelerations on CTG, what next?
Do another foetal investigation - foetal blood sampling with pH. Late decelerations = deceleration starts at peak of uterine contraction, recovers after. Requires foetal blood sampling with pH. If acidotic -\> Emergency c section.
659
18m old child, can’t walk, crawls. Alert to strangers - where is delay?
Gross motor delay
660
Down syndrome conditions risk
- An abdominal x-ray is indicated in infants with DS, as they may be born with a GI defect such as duodenal or anal stenosis, or duodenal or anal atresia (30%). - Hearing screen and thyroid tests are required in all newborns in general. - Vision should be examined in the newborn period because some infants with DS are born with ophthalmic problems. - Haemoglobin for anemia - Dental due to caries - Obstructive sleep apnea
661
School exclusion for chicken pox?
5 days after first skin eruption
662
Heart condition baby goes blue when feeds? What is likely diagnosis
Transposition of great arteries Tetralogy of Fallot
663
Treatment of compartment syndrome with trauma
Fasciotomy Amputation (With rhabdo --\> hydration and bicarb)
664
Pt in alcohol outreach team has a convulsion what treatment do you give him?
Treat DT with Diazepam
665
Hep B Immune marker to indicate Hepatitis division/multiplying
HbsAg
666
Stroke affecting vision weakness in arm\>leg – which territory is affected?
MCA
667
section 37
hospital order
668
Guy arrested carrying knives, said paert of religious beliefs. Is ‘aloof’, what is likely diagnosis?
Schizotypal
669
What is the management for MS relapse?
IV methylprednisolone 3 days
670
Bone pain with fragility fractures, depression and renal stones
Primary hyperparathyroidism
671
What further test do you need to do to make sure lp is safe?
CT only done if contraindications
672
Has an afferent pupillary defect. What nerve is it? Differential?
Optic
673
New born gets UTI - symptoms?
•fever •vomiting •lethargy or irritability •poor feeding or failure to thrive •jaundice •septicaemia or shock •offensive smelling urine •febrile convulsions
674
Trichomonas vaginalis microscopy
Motile trophozoites in vaginal discharge smears.
675
Newborn sob, grunting, 6 hours after birth. Normal delivery, was fine before. What is likely cause?
Acute respiratory distress syndrome
676
Boy with developmental delay....thick calves - Diagnosis?
Duchenne's
677
NSTEMI with normal troponin
Unstable angina
678
Patient comes in been treated. Got necrotising fasciitis. Next line of treatment?
Urgent surgical debridement 2) IV antibiotics (normally MRSA therefore give Vanc).
679
Patient comes in with fever with new heart murmur? Treatment?
Infective endocarditis Flucloxacillin + Gentamicin
680
High lipid, which drug to treat dyslipidemia?
Atorvastatin
681
Patient comes in been to GP several times complaining of hand pain, tummy aches, urinary problems etc. Diagnosis?
Somatisation disorder (multiple physical symptoms present for at least 2 years, patients refuses to accept reassurance or negative tests)
682
What is the immediate and prophylaxis management of cluster headache?
Acute: 100% O2 + subcut triptan Prophylaxis: verapamil
683
CURB-65 - Score 3 management?
- Confusion (abbreviated Mental Test Score \<=8) (1 point) - Urea (BUN \> 19 mg/dL or 7 mmol/L) (1 point) - Respiratory Rate \> 30 per minute (1 point) - Blood Pressure: diastolic \< 60 or systeolic \< 90 mmHg (1 point) - Age \>= 65 years (1 point)
684
Raynaud's, positive Scl-70, DsDNA negative?
Systemic sclerosis (diffuse cutaneous)
685
Section 2 Used for? Recommendation? Apply? Duration?
Used for assessment Two Section 12 doctors or One section 12 patient's GP Apply by nearest relative or AMHP (health professional) 28 days --\> Discharged or convert to S3 (Patients can appeal in first 14 days)
686
Meningitis CSF - Clear High pressure High lymphocytes Decreased glucose Moderately high protein India ink stain
Cryptococcal
687
Paracetamol OD - liver transplant criteria?
pH \< 7.3 or INR \> 6.5 AND creatinine \> 300 AND encephalopathy III or IV
688
Guy had AKI after surgery do you assess his fluid balance or saline over 1 hr or calcium gluconate?
Assess fluid balance
689
Drugs that cause restrictive lung disease?
amiodarone methotrexate nitrofuratoin
690
Parathyroid blood results: Raised calcium Raised PTH Low phosphate High ALP Serum Ca:Cr clearance \>0.01
Primary hyperparathyroidism
691
Patient with signs consistent with encephalopathy (liver failure) on the background of alcoholic cirrhosis and being alcohol independent. What is the first step in Mx?
Lactulose Phosphate enemas Stop diuretics if low potassium
692
Other name for guillan barre syndrome?
Acute inflammation demyelinating polyradiculoneuropathy
693
Repeat key differentiating thing between stress & urge?
Nocturia
694
Bilirubin in a neonate is high, baby has gone home, mom phones GP and mentions the baby was jaundiced at aged 14 hours. Management?
phototherapy (exchange transfusion only in encephalopathy or hypotonia or bilirubin \>95%)
695
Patient with RUQ pain, hepatomegaly, jaundice, distension/ascites, early satiety, weight loss/cachexia, hepatic encephalopathy –which biochemical marker do you use?
HCC Alpha fetoprotein
696
How does the COCP protect against PID?
Thickens cervical mucus – making it difficult for both sperm and bacteria to enter.
697
Pt has a ‘nettle rash’ episodes lasting for 6h for the last 12 months. Most likely pathogenesis?
Allergy
698
Pt with STEMI – Immediate management?
Morphine + metoclopramide Oxygen GTN – sublinhual/IV Aspirin 300mg Ticagrelor Anticoag – enoxaparin/abciximab
699
Schizophrenic guy, police bring in under 136
MHA assessment and admit
700
Indian baby who was bought in with mum looking pale. Hb done and found to be low. Baby is 1 years old and is on cows milk. What is the reason for anaemia?
Low iron in cows milk.
701
Child with purpuric rash Bloody diarrhoea and abdo pain Rash on buttocks, legs and feet
Henloch Schonlein purpura
702
What is the bitchy snaky name for GBS?
acute inflammatory demyelinating polyradiculoneuropathy
703
Treatment of mastitis
Continue breastfeeding The first-line antibiotic is flucloxacillin for 10-14 days (Staph aureus)
704
Milestones of 9 mths
– pulls to standing, crawls, shy but plays peek a boo, takes everything to the mouth (pincer), babble (inc mama, dada(
705
GCS
Eyes Spontaneous To sound To pressure None Verbal Orientated Confused Words Sounds None Motor Obey commands Localising Normal flexion Abnormal flexion Extension None
706
Patient comes in with periorbital pain, loss of visual acuity with scotoma (blind spot), loss of color vision, and rapid afferent pupillary defect. Normal optic disc on examination. Diagnosis?
Retrobulbar neuritis
707
How do you prevent diabetic proliferative retinopathy?
Laser treatment
708
Depression Anxiety Fatigue Decreased conc Cravings (increased appetite) Excess sleep Vivid dreams CRASH - suicide ideation, N&V, formication
Cocaine withdrawal
709
Old lady saw spiders, incontinent, not looking after herself for last few days - Differentials?
Delirium tremens Lewy body dementia
710
Painful eye movements, Swollen fingers + eosophageal
Myasthenia gravis
711
XR of colles fracture
Horizontal across radius
712
Pitting in nails and swelling in 3 DIP joints and dactylitis - Diagnosis?
Psoriatic arthritis (Hx of psoriasis is common)
713
Patient stage 1 and needs augmentation. What is best way?
Oxytocin
714
left Hemineglect and behavioural abnormalities where is the lesion?
ACA
715
10 year old, limp, knee pain, no fever -groin or knee pain -bilateral hip px -trendelenburg’s gait -weight \>90th ; obesity -endocrine disorders that cause obesity -puberty (12-13.5 boys) Diagnosis?
SUFE (Slipped capital femoral epiphysis
716
Acute HF management?
Freusemide
717
Man has replaced hip and is hallucinating and has long QT - Drug that's causing it? lorazepam, risperidone, tamazepam, quetiapine and benzo, haloperidol
Haloperidol
718
Increased prolactin Increased GH Normal/low LH+FSH Normal/low testosterone+estradiol
Pituitary adenoma
719
Sickle cell disease with chest syndrome - management?
O2 (sats \>94%)+ incentive spirometry+ fluids+analgesia (sc morphine 0.1mg/kg)
720
Malaysian girl, persistent jaundice (\>2 weeks), yellow/brown urine, pale stools, hepatosplenomegaly after 3rd/4th week. High conjugate bilirubin Diagnosis?
Biliary atresia (rare) → absence of bile ducts. (Immediate Kasai procedure hepatoportoenterostomy → Drain bile) Ddx - neonatal hepatitis
721
18 month of a child has respiratory distress that came on suddenly. Biphasic wheeze + afebrile. Investigations? Asthma emergency management?
SABA and PEFR Inhaled SABA, ICS, abx if needed, O2
722
Coryzal symptoms Dry cough Increasing breathlessness Wheezing Fine inspiratory crackles Feeding difficult
Bronchiolitis (Respiratory syncytial virus)
723
Best investigation for multiple sclerosis?
s MRI. (Sagittal)
724
Patient with 3 month history with bowel troubles and campylobacter infection prior to this. Abdo pain relieved by defacation. Altered stool passage (straining, urgency, incomplete evacuation) abdominal bloating (more common in women than men), distension, tension or hardness symptoms made worse by eating and passage of mucus Normal bloods, no fever and negative stool. What is most likely dx?
IBS
725
Haloperidol. What drug gets rid of side effects of haloperidol?
procyclidine
726
Red painful eye with normal visual acuity - what to do next?
Look at the surface of the eye Snellen chart Inspection of lid and brow Inspection of the ocular surface and subtarsal surface, pupillary reactions
727
Infections with Argyll-Robertson?
Occurs in neurosyphilis and diabetes
728
Boy leaning forward, taking deep breaths epiglottitis? Next line of treatment.
Oxygen and abx (ceftriaxone and ampicillin)
729
Main advantage of breast milk over formula?
Reduces risk of sudden infant death syndrome, reduces infections, reduced DM1, reduced asthma, eczema
730
Young lady with polydipsia and urea. Had DKA – which fluids do you give?
0.9% NaCl 1L – over 1st hour, 0.9% NaCl 1L – over next 2 hours, etc
731
In GUM clinic which infections can you test for and get results the same day?
HIV Chylamidia Gonorrhea
732
Drugs that cause depression
Vigabtrin, topiramte, primidone, phenobarbital, lacosamide, gabapentin
733
Cystic fibrosis on xray
Consolidation, hyperinflation, dilatation
734
Sensorineural hearing loss (unilateral), tinnitus, headache, CN palsies (trigeminal/facial/vestibulocochlear nerve), vertigo (late sign), signs of raised ICP Diagnosis? Investigation?
Acoustic neuroma (vestibuloschwannoma) MRI brain - gadollinium enhanced
735
Patient with painful ankle and negatively birifringent crystals – what is dx?
Gout
736
Cholangiocarcinoma investigations? Tumour markers?
CT abdo CA 19-9
737
she was feeling hot then cold and yawning and dilated pupils
Opioid withdrawal
738
Skier - knee swelling that is delayed by one day
Meniscal tear
739
Pt with light bleeding and crampy pain @ 7 weeks. Has a closed OS but on USS there is something which looks like a gestational sac?
Threatened miscarriage - presents with a closed cervical OS, normal uterus size, mild / light bleeding.
740
Old man comes in because he has been leaking urine and feeling of incomplete emptiness.
Overflow incontinence
741
Pt with frank haematuria. He had this before and took Abx and it went away. But now it has returned. Smokes 30 ciggs a day since he was born. Bladder cancer, UTI
UTI (Be aware Penicillin can cause haematuria)
742
Schizoid characteristics
●Ideas of reference (differ from delusions in that some insight is retained) ●Odd beliefs and magical thinking ●Unusual perceptual disturbances ●Paranoid ideation and suspiciousness ●Odd, eccentric behaviour ●Lack of close friends other than family members ●Inappropriate affect ●Odd speech without being incoherent
743
Type of miscarriage? no pain; bleeding \< bleeding equivalent to menstruation; cervix = closing; uterine size = dates; ultrasound = empty uterus
Complete miscarriage
744
Patient has come in. One vocal cord isn’t moving properly. What is the next investigation?
Layngoscopy
745
Jaundice in first 24 hours - Mother was infected during pregnancy Treat?
Growth restriction Hepatosplenomegaly TTP (Congenital infections) Exchange transfusion
746
What are the developmental milestones for 2.5 yrs old?
use 250 words walk, run, turn doorknob, selfish and self-centered
747
Newborn baby from C-Section having difficulty breathing, cyanosis, CXR shows hyperinflated lungs and fluid in horizontal fissure
Transient tachypneoa of the new born--\> usually gets better in 1-2 days
748
Glasgow scale - Which parameter indicates worse outcome?
P - PO2 \<8 A - age \>55 N - WCC \>15 C - Calcium \<2 R - renal urea \>16 E - AST \>200 A - Albumin \<32 S - Sugar \>10 (3 or more is pancreatitis)
749
CTPA vs d-dimer
Bait PE: CTPA unsure: d-dimer
750
Parathyroid blood results: High Calcium Normal/low PTH Low phosphate High ALP
Parathyroid malignancy
751
Type of miscarriage? no pain; bleeding = minimal brown; cervix = closed; uterine size = small; ultrasound = no fetal heart
Missed miscarriage
752
Third stage of labour management
Oxytocin/Syntocinon and then Ergometrine Immediate cord clamping
753
section 37/41
hospital order with restriction order
754
Lady with lower abdominal pain, painful VE in fornices, pyrexial
PID
755
8. PV bleed, LMP 6 weeks ago, BHCG high, US shows no sac – Dx?
pregnancy of unknown location
756
Patient with low TSH, normal t3 and t4, oligomenorrhoea, low FSH and LH, and exercises a lot. What is the most likely Dx?
Levothyroxine misuse
757
Management of croup
Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity - prednisolone is an alternative if dexamethasone is not available - Advise paracetemol or ibuprofen for fever/pain Emergency treatment ● high-flow oxygen ● nebulised adrenaline
758
Solid mass on liver imaging, diabetes, women taking estrogen-containing oral contraceptive medication - 4cm, vascular?
Hepatic adenoma
759
A child presents with severe anaemia, pale, poor growth - recently stopped having breastmilk. What is the cause for the anaemia?
Beta thalassemia trait
760
Milestones of 7 months
can sit without support (Refer if cannot sit at 12 months)
761
Melanoma - key factor for prognosis?
Thickness (depth)
762
Pt has migraine which are getting more frequent. What is the best prophylactic measure?
Propanolol - Beta Blocker.
763
14 year boy comes in asking for contraception to have sex with 15year old.
Both are below age of 16 and above age 13 Underage sexual activity should always be seen as a possible indicator of child sexual exploitation.
764
Lady positive pregnancy test (7weeks) , LIF pain and bleeding, what is most appropriate investigation?
TVUS
765
Patient presents, after vomiting for past few days, with a little bleed - cause?
Mallory Weis tear
766
Patient comes in had a TIA. Blind in the eye temporarily. Doppler show one artery stenosed 40% and one 80%? What is the treatment?
Carotid endarterectomy
767
Migraine lady had really severe headache, neck stiffness, subjective lateral gaze diplopia, CT normal
MRI because SAH
768
Acute asthma, already on salbumatol nebs and steroid, no improvement, what do you give next?
1. Oxygen (if \<94%) 2. Salbutamol - also consider IV 3. Ipratropium bromide 4. Oral steroids = prednisolone 3-5 days 5. Aminophylline/theophylline (OSHIMT) Magnesium sulphate IV is an adjuvent that can be given if no response after step 4.
769
What does endomysial and anti-gliadin indicate?
Coeliacs
770
Dermoid cyst - Cell type?
aka mature cystic teratoma germ cell Epithelioid cell
771
After operation become hypertensive, \<38C temp ?normal sats, what is the cause of fever
Atelectasis
772
6 week child with congenital dysplasia -
Most unstable hips spontaneously stabilise by 3-6 weeks Pavlik harness – if child \<5 months If older than – surgery
773
Kid hits her head bad and vomits 2 times what do you do?
Skull XR if suspected fracture 3 or more for CT MRI
774
Hepatitis B treatment for positive surface antigen, + anti-HBc, + IgM, -antiHB, - anti HBe, +HBeAg
acute infection supportive care
775
These white rashes found in newborn on the sole of hands and feet. What is this?
Congenital syphilis (rare in UK now)
776
Newborn with hydropcephalus, intracranial calcification, acute fundal chorioretinitis as shown below. What is this?
Congenital toxoplasmosis
777
A 35-year-old female patient presents to you in the cardiology department with a sharp, stabbing chest pain behind the breastbone. The pain does not radiate to any other region of the body and on questioning she refutes feeling sweaty and has not experienced any nausea and vomiting. She explains the pain is worse at night when she is lying flat in bed and improves somewhat once she sits up. She discloses that she has been diagnosed with systemic lupus and is taking regular medication for this. On auscultation you note scratchy, rubbing sounds loudest during systole.
Pericarditis
- widespread saddle shaped ST elevation
- PR depression: **_most specific ECG marker_**
\*note that SLE or any rhematic disease is a risk of getting pericarditis
778
what is this?
Inferolateral STEMI
## Footnote
ST elevation in leads II, III and aVF
Progressive development of Q waves in II, III and aVF
Reciprocal ST depression in aVL (± lead I)
779
Mongolian Blue spot
780
A 4-year-old boy develops multiple tear-drop papules on his trunk and limbs. He is otherwise well.
Hx of streptococcal infection 3 wks ago.
Guttate psoriasis
-Most cases resolve spontaneoulsy within 2-3mths
781
A middle aged man develops a non-pruritic rash after starting allopurinol therapy for gout. The rash develop within 24 hours and started on the back of his hands.
Erythema multiforme
- target lesions that starts in the back of hands and feet then spread to torso
- upper limbs affected more commonly
782
A 30-year-old man presents with a two-week history of a productive cough. Whilst examining him you notice a large number of atypical naevi over his torso. On his back you count between 20-25 moles. He reports no change in any of his moles, no bleeding and no itch. One particular mole is noted due to the irregular border. It is 6 \* 4 mm in size.
Superficial melanoma
- mostly affects arms, legs, back and chest
- more in young people
\*Remember changes in size, shape and color
783
Squamous cell carcinoma
-characterised: raised, keratotic (scaly, crusty), ill-defined nodule, may be ulcerated
784
Basal Cell carcinoma
- nodular is most common
- characterised: skin-colored, surface telangiectasia, pearly rolled edge, ulcerated center
785
Actinic keratosis
\*premalignant lesion--\> SCC
-characterised:
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present
786
Bowen's disease
\*intradermal SCC
-characterised:
red, scaly patches
often occur on sun-exposed areas such as the lower limbs
-more common in older females
787
Erythema nodosum
- seen in IBD (crohn's, UC)
- characterised:
inflammation of subcutaneous fat
typically causes **tender, erythematous, nodular lesions**
usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
usually resolves within 6 weeks
lesions heal without scarring
788
Patient comes in with persistent ulceration of the mouth, pain and sore throat.
O/E: neck lymphadenopathy and inside mouth (pic below)
Oropharyngeal cancer
789
Systemic sclerosis
-Characterised: sclerodactyly, skin thickening, raynaud's phenomenon, swelling of hands and feet
805
806
807
These white rashes found in newborn on the sole of hands and feet. What is this?
Congenital syphilis (rare in UK now)
808
Newborn with hydropcephalus, intracranial calcification, acute fundal chorioretinitis as shown below. What is this?
Congenital toxoplasmosis
809
A 35-year-old female patient presents to you in the cardiology department with a sharp, stabbing chest pain behind the breastbone. The pain does not radiate to any other region of the body and on questioning she refutes feeling sweaty and has not experienced any nausea and vomiting. She explains the pain is worse at night when she is lying flat in bed and improves somewhat once she sits up. She discloses that she has been diagnosed with systemic lupus and is taking regular medication for this. On auscultation you note scratchy, rubbing sounds loudest during systole.
Pericarditis
- widespread saddle shaped ST elevation
- PR depression: **_most specific ECG marker_**
\*note that SLE or any rhematic disease is a risk of getting pericarditis
810
what is this?
Inferolateral STEMI
## Footnote
ST elevation in leads II, III and aVF
Progressive development of Q waves in II, III and aVF
Reciprocal ST depression in aVL (± lead I)
811
Mongolian Blue spot
812
A 4-year-old boy develops multiple tear-drop papules on his trunk and limbs. He is otherwise well.
Hx of streptococcal infection 3 wks ago.
Guttate psoriasis
-Most cases resolve spontaneoulsy within 2-3mths
813
A middle aged man develops a non-pruritic rash after starting allopurinol therapy for gout. The rash develop within 24 hours and started on the back of his hands.
Erythema multiforme
- target lesions that starts in the back of hands and feet then spread to torso
- upper limbs affected more commonly
814
A 30-year-old man presents with a two-week history of a productive cough. Whilst examining him you notice a large number of atypical naevi over his torso. On his back you count between 20-25 moles. He reports no change in any of his moles, no bleeding and no itch. One particular mole is noted due to the irregular border. It is 6 \* 4 mm in size.
Superficial melanoma
- mostly affects arms, legs, back and chest
- more in young people
\*Remember changes in size, shape and color
815
Squamous cell carcinoma
-characterised: raised, keratotic (scaly, crusty), ill-defined nodule, may be ulcerated
816
Basal Cell carcinoma
- nodular is most common
- characterised: skin-colored, surface telangiectasia, pearly rolled edge, ulcerated center
817
Actinic keratosis
\*premalignant lesion--\> SCC
-characterised:
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present
818
Bowen's disease
\*intradermal SCC
-characterised:
red, scaly patches
often occur on sun-exposed areas such as the lower limbs
-more common in older females
819
Erythema nodosum
- seen in IBD (crohn's, UC)
- characterised:
inflammation of subcutaneous fat
typically causes **tender, erythematous, nodular lesions**
usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
usually resolves within 6 weeks
lesions heal without scarring
820
Patient comes in with persistent ulceration of the mouth, pain and sore throat.
O/E: neck lymphadenopathy and inside mouth (pic below)
Oropharyngeal cancer
821
Systemic sclerosis
-Characterised: sclerodactyly, skin thickening, raynaud's phenomenon, swelling of hands and feet
822
What is it?
Lentigo melanoma
823
what is it?
Acanthosis nigricans
824
what is it?
cause?
Red man syndrome
Vancomycin
825
What is it?
Subungal melanoma
826
Diagnosis?
Central Retinal Vein Occlusion
827
Diagnosis?
Central retinal artery occlusion
828
Diagnosis?
Papilloedema
829
Diagnosis?
Diabetes retinopathy
830
What is it?
Hypermetropia
Eye turn upwards
831
What is it?
Exotropia
Eye turns outward
832
What is it?
Anterior uveitis
833
What is it?
Diabetic non proliferative retinopathy
834
Diagnosis?
Signs?
Respiratory distress syndrome - ground glass
835
Diagnosis?
GI perforation
836
What is it?
Gottrons papules
837
Diagnosis?
Lupus pernio
838
CD4+ AIDS infections
:)
839
Identify bleed?
Vessel Affected?
MCA
Ischemic stroke
840
Identify bleed?
Vessels affected?
Subdural haematoma
Bridging veins
841
Identify type of bleed?
Vessel?
Extradural/Epidural haematoma
Middle meningeal artery
842
Identify the type of bleed?
Subarachnoid haemorrhage
843
Identify the type of bleed?
Intracerebral haemorrhage
844
Bilirubin graph for newborn
:)
845
Staging for colorectal cancer
Dukes criteria
846
Staging for colorectal cancer
Dukes criteria
847
Bilirubin graph for newborn
:)
848
Identify the type of bleed?
Intracerebral haemorrhage
849
Identify the type of bleed?
Subarachnoid haemorrhage
850
Identify type of bleed?
Vessel?
Extradural/Epidural haematoma
Middle meningeal artery
851
Identify bleed?
Vessels affected?
Subdural haematoma
Bridging veins
852
Identify bleed?
Vessel Affected?
MCA
Ischemic stroke
853
CD4+ AIDS infections
:)
854
Diagnosis?
Lupus pernio
855
What is it?
Gottrons papules
856
Diagnosis?
GI perforation
857
Diagnosis?
Signs?
Respiratory distress syndrome - ground glass
858
What is it?
Diabetic non proliferative retinopathy
859
What is it?
Anterior uveitis
860
What is it?
Exotropia
Eye turns outward
861
What is it?
Hypermetropia
Eye turn upwards
862
Diagnosis?
Diabetes retinopathy
863
Diagnosis?
Papilloedema
864
Diagnosis?
Central retinal artery occlusion
865
Diagnosis?
Central Retinal Vein Occlusion
866
What is it?
Subungal melanoma
867
what is it?
cause?
Red man syndrome
Vancomycin
868
what is it?
Acanthosis nigricans
869
What is it?
Lentigo melanoma
870
Interpret this CTG
Late decelerations
871
Interpret the CTG
Early decelerations
872
Interpret this ECG
Inferolateral STEMI
873
Interpret this ECG
Pericarditis
874
Identify this ECG
1st degree Heart block
875
Identify this ECG
Type 2 Heart Block
Mobitz I
876
Identify this ECG
Type 2 Heart Block
Mobitz II
877
Identify this ECG
Complete heart block
878
Identify this ECG
Slow AF
879
Identify this ECG
Atrial fibrillation
880
Identify this ECG
Pulmonary Embolism
881
Identify this ECG
Ventricular Tachycardia
882
Identify this ECG
Torsades
883
Identify this ECG
AVNRT
884
Identify this ECG
Ventricular fibrillation
885
Identify this ECG
hyperkalaemia
886
Identify this ECG
Atrial flutter
887
Identify this ECG
Unstable angina
888
Identify this ECG
Atrial fibrillation
