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mock exam Flashcards

1
Q

when to give DC cardioversion in context of tachyarrhythmia

A

systolic BP < 90mmHg

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2
Q

most common cause of infective exacerbations of COPD

A

Haemophilus influenzae

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3
Q

the equivalent parenteral dose of morphine (subcutaneous, intramuscular, or intravenous) is about _____ of the oral dose.

A

half

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4
Q

management of seborrhoeic dermatitis

A

ketoconazole

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5
Q

investigation in suspected endometriosis

A

laparoscopy

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6
Q

medication given before fibroid surgery

A

Gonadotrophin-releasing hormone analogue

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7
Q

medical management of large fibroids

A

ullipristal acetate (progesterone receptor modulator)

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8
Q

treatment of primary dysmenorrhoea

A

1st line- NSAIDs (mefanamic acid)

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9
Q

charcot’s triad

A

cholangitis

  1. fever
  2. RUQ pain
  3. jaundice
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10
Q

acute heart failure not responding to treatment

A

consider CPAP

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11
Q

when is BiPAP used?

A

T2 respiratory failure

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12
Q

flashers and floaters

A

vitreous/retinal detachment

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13
Q

why are patients given nimodipine in SAH

A

prevent vasospasm in aneurysmal subarachnoid haemorrhages

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14
Q

preceding influenza predisposes to ______ pneumonia

A

staphylococcus aureus

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15
Q

management of whooping cough

A

if admission is not needed, prescribe an antibiotic if the onset of cough is within the previous 21 days. A macrolide antibiotic is recommended first-line:

> Prescribe clarithromycin for infants less than 1 month of age.
Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
Prescribe erythromycin for pregnant women.

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16
Q

acute migraine management

A

triptan + NSAID or triptan _ paracetamol

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17
Q

migraine prophylaxis

A

topiramate or propanolol

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18
Q

features suggestive of steroid responsiveness?

A

eosinophilia

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19
Q

management of COPD

A

SABA/SAMA

LABA (salmeterol) + ICS

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20
Q

inguinal hernia in infants

A

urgent surgery

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21
Q

umbilical hernia in infants

A

wait and see

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22
Q

potassium per day fluids

A

1 mmol/kg/day

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23
Q

water requirements per day

A

25-30ml/kg/day

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24
Q

adjuvant hormonal therapy for ER +ve breast cancer

A

anastrozole in post-menopausal women

tamoxifen in premenopausal women

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25
Q

how does anastrozole work?

A

aromatase inhbitor that reduces peripheral oestrogen synthesis

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26
Q

features of wernicke’s encephalopathy

A 
C- onfusion
A- ataxia
N- ystagmus
O- phthalmoplegia
PE- ripheral neuropathy
N- europathy
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27
Q

managment of symptomatic bradycardia

A

VI doses of atropine

external pacing

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28
Q

third nerve palsy

A

pupil down and out and fixed and dilated pupil

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29
Q

causes of third nerve palsy

A
  • trans-tentorial or uncal herniation
  • posterior communicating artery aneurysm
  • cavernous sinus thrombosis
  • webers (contralateral hemiplegia)
  • diabetes
  • vasculitis
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30
Q

what occurs in cereberllar tonsilar herniation

A

terminal event- cardio-respiratory arrest

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31
Q

hyper/hypocalcaemia in pancreatitis

A

hypercalcaemia= can cause pancreatitis

hypocalcaemia= indicator of pancreatitis severity

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32
Q

why do you get hypocalcaemis in pancreatitis

A

saponification of fats, lipase leaks out of damaged pancreas, breakdown fat into triglycarides and fatty acid. fatty acids combine with calcium to produce soap.

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33
Q

why are ACEi bad in AKI

A

actively reduce the GFR by causing vasodilation of the efferent arteriole and reducing the glomerular filtration pressure

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34
Q

drugs to continue in AKI

A 
paracetamol
Warfarin
statins
aspirin (at cardioprotective dose of 75mg)
clopidogrel
beta-blockers
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35
Q

drugs to stop in AKI

A 
NSAIDs
aminoglycosides
ACEi
AR2RB
diuretics
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36
Q

drugs that may have to be stopped in AKI as increased risk of toxicity

A

metformin
lithium
digoxin

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37
Q

Management of hyperkalaemia

A

Stabilisation of cardiac membrane- IV Ca gluconate

Short-term shift in potassium from extracellular to intracellular fluid department- combined insulin/dextrose infusion, nebulised salbutamol

removal of potassium from the body- calcium resonium (orally or enema),loop diuretics, dialysis

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38
Q

criteria for AAA surgery

A
  • asymptomatic aneurysm larger than 5.5cm in diameter
  • asymptomartic aneurysm enlarging by more than 1cm per year
  • a symptomatic aneurysm (urgent not elective)
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39
Q

what kind of ileostomy can be used to defunction the colon to protect an anastamosis

A

loop ileostomy

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40
Q

what distinguishes scleritis from episcleritis

A

pain

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41
Q

management of TIA in GP

A

if patient presents within 7 days of a clinically suspected TIA= aspirin 300mg immediately and specialist review within 24hr

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42
Q

similar pain after cholecystectomy

A

gallstones present in the CBD

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43
Q

presentation of acute lymphoblastic leukaemia

A

anaemia, neutropenia, thrombocytopenia

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44
Q

management of AHTR

A

general fluid resuscitation and termination of the transfusion

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45
Q

what cannot be prescribed with methotrexate

A

trimethoprim

folate antagonist= myelosuppression and pancytopaenia

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46
Q

liver failure

A

triad

  1. encephalopathy
  2. jaundice
  3. coagulopathy
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47
Q

key differentiating factor between chronic liver disease and acute failure

A

raised prothrombin time, very high bilirubin, presence of encephalopathy

48
Q

cause of wernickes

A

thiamine deficiency

49
Q

signs of DIC

A

serious coagulopathy which would cause raised PT time and low platelets

50
Q

what is hepatorenal syndrome

A

acute liver failure preceding acute renal failure, high creatinine

51
Q

caput succedaneum

A

crossed suture line

52
Q

where to check pulse paediatric BLS

A

brachial/femoral artery

53
Q

women aged >30 with an unexplained breast lump

A

suspected cancer pathway referral

54
Q

management of alcohol withdrawal

A

1st line- long-acting benzo e.g. chlordiazepoxide or diazepam. lorazepam may be preferable in patients with hepatic failure.

Carbamazepine is also effective

55
Q

neurogenic shock cause

A

loss of sympathetic outflow resulting in hypotension and bradycardia as well as warm peripheries due to vasodilatation and inability to constrict

56
Q

complications of thyroid surgery

A

damage to parathyroid glands= hypocalcaemia

57
Q

acute reactive arthritis management

A

NSAIDs

58
Q

signs of acute reactive arthritis

A

can’t see, can’t pee, can’t climb a tree/bend the knee’

59
Q

when can miscarriage not be managed expectantly?

A

increased risk of bleeding, previous adverse experiences associated with pregnancy, increased risk from the effects of haemorrhage or evidence of infection

60
Q

medical management of miscarriage

A

vaginal misoprostol
antiemetics
pain relief

61
Q

how does misoprostol work?

A

prostaglandin analogue, binds to myometrial cells to cause strong myometrial contractions leading to the expulsion of tissue

62
Q

how is TPN given?

A

through central line- strongly phlebitic and can irritate peripheral veins

63
Q

symptoms of hypomania in primary care

A

routine referral to CMHT

64
Q

cord prolapse positioning

A

on all fours

65
Q

management of neoplastic spinal cord compression

A

> high-dose oral dexamethasone

> urgent oncological assessment for consideration of radiotherapy or surgery

66
Q

hypercalcaemia ECG change

A

shortening of QT interval

osborne (J) waves

67
Q

hyperkalaemia ECG change

A

Tenting of T waves

wide QRS complexes

68
Q

hypokalaemia ECG change

A

prominent U waves

69
Q

how to step down asthma treatment

A

25-50% reduction in the dose of ICS

70
Q

medical indications for circumcision

A

phimosis
recurrent balanitis
balanitis xerotica obliterans
paraphimosis

71
Q

what must be excluded before circumcision?

A

hypospadias

72
Q

diagnosis of confirmed miscarriage

A

TVUSS demonstrating a no cardiac activity and

  • crown-rump length is greater than 7mm
  • gestational sack is greater than 25mm
73
Q

management for intertrochanteric proximal femoral fracture

A

DHS

74
Q

facial pain worse on leaning forward

A

sinusitis

75
Q

management of sinusitis

A

analgesia and decongestants in acute phase

if chronic then intranasal corticosteroids are often beneficial

76
Q

If C. difficile does not respond to first line metronidazole….

A

oral vancomycin should be used next, except in life-threatening infections

77
Q

Management of secondary pneumothorax <1cm

A

admit and give oxygen for 24 hours and review

78
Q

scans used to assess the presence of fluid in the abdomen and thorax

A

FAST

79
Q

management of myxoedemic coma

A

Hydrocortisone and Levothyroxine

80
Q

Thyrotoxic storm treatment

A

beta blockers, propylthiouracil and hydrocortisone

81
Q

when are ectopics managed surgically

A

presence of foetal heart beat

82
Q

management of IHCP

A

IOL at 37-38 weeks

83
Q

causes of drug-induced urinary retention

A

Opioid analgesia (such as tramadol) alongside anticholinergic

84
Q

management of DKA

A

Insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin

85
Q

What does +ve HBsAG show?

A

currently infected with HBV

86
Q

absence of anti-HBcAg IgM

A

chronic infection

87
Q

HBV vaccine non-responder

A

HBsAg = -ve
Anti- HBsAg = -ve
Anti-HBcAg IgM= -ve
Anti-HBcAg IgG= -ve

88
Q

HBV vaccine responder

A

HBsAg = -ve
Anti- HBsAg = +ve
Anti-HBcAg IgM= -ve
Anti-HBcAg IgG= -ve

89
Q

HBV acute infection

A

HBsAg = +ve
Anti- HBsAg = -ve
Anti-HBcAg IgM= +ve
Anti-HBcAg IgG= +ve/-ve

90
Q

HBV chronic infection

A

HBsAg = +ve
Anti- HBsAg = -ve
Anti-HBcAg IgM= -ve
Anti-HBcAg IgG= +ve

91
Q

previous HBV infection, now immune

A

HBsAg = -ve
Anti- HBsAg = +ve
Anti-HBcAg IgM= -ve
Anti-HBcAg IgG= +ve

92
Q

for a diagnosis of PTSD how long should symptoms be present?

A

one month

93
Q

what should patients with CD4 count lower than 200/mm3 recieve

A

prophylaxis against pneumocystis jiroveci= co-trimoxazole

94
Q

what should all men with ED have checked

A

testosterone level

95
Q

A second drug should be added in type 2 diabetes mellitus if the HbA1c is

A

> 58 mmol/mol

96
Q

which SSRI is most likely to cause QT prolongation

A

citalopram

97
Q

Patient >= 60 years old with new iron-deficiency anaemia →

A

urgent colorectal cancer pathway

98
Q

intervention of choice in malignant distal obstructive jaundice

A

biliary stenting

99
Q

patients with ascities secondary to liver cirrhosis should get

A

an aldosterone antagonist= spironolactone

100
Q

what does a high SAAG suggest?

A

non-peritoneal cause of ascites = cirrhosis, budd-chiari syndrome, nephrotic syndrome

101
Q

what does low SAAG suggest?

A

peritoneal cause of ascites= tuberculous pertonitis, peritoneal mesothelioma

102
Q

what is SAAG

A

serum albumin ascites gradient

103
Q

management of anterior uveitis

A

steroids drops + cycloplegic (mydriatic) drops

104
Q

what distinguishes vestibular neuronitis from labyrinthitis

A

unaffected hearing

105
Q

Hyponatraemia correction

A

osmotic demyelination syndrome

106
Q

Hypernatreamia correction

A

cerebral oedema

107
Q

Acute dystonia secondary to antipsychotics is usually managed with

A

procyclidine

108
Q

management of bronchiolitis

A

Supportive measures such as maintaining oxygenation and hydration

109
Q

treatment of suspected or confirmed shock in children (fluids)

A

Start IV fluid resuscitation in children or young people with a bolus of 20 ml/kg over less than 10 minutes

110
Q

what must be done before starting biologics for rheumatoid

A

CXR- look for TB, can cause reactivation

111
Q

medications causing hyponatraemia

A

PPIs

omeprazole

112
Q

management of human/animal bites

A

co-amoxiclav

113
Q

what to do if metformin is not tolerated

A

try a modified-release formulation before switching to a second-line agent

114
Q

side effect of aromatase inhibitors

A

osteoporosis

115
Q

prescribing in CMPI

A

Consider prescribing calcium supplements for breastfeeding mothers whose babies have, or are suspected to have, CMPI, to prevent deficiency whilst they exclude dairy from their diet

116
Q

If investigating a suspected DVT, and either the D-dimer or scan cannot be done within 4 hours, then start a …

A

DOAC

Finals Revision (29 decks)

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