3A MCQ/SBA Flashcards by Flick Burton

Boy comes in with sore throat, petechiae on his soft palate, exudates on tonsils, tender lymphadenopathy. What is the most diagnostic investigation you can do?

Glandular fever = Monospot.

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2 day old full term baby comes in, looks cyanotic. You examine him and on auscultation hear no additional heart sounds or murmurs, his femoral pulses are normal. Oxy sats on his right hand are 78%

Transposition of the great arteries = cyanotic heart defect.

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10 day old boy comes in. For the last 3 days he’s been lethargic and has had poor feeding. His temperature is 36.5degC. Blood gas reveals that he has metabolic acidosis, and these are some of his lab results too: Glucose 3.1mmol/L, Na 118mmol/L, K 7.1mmol/L. (they don’t give normal ranges) What does this boy have

I think CAH 🧐🤨 with salt wasting crisis as low sodium, potassium

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2 year old boy comes in and you do a developmental assessment. How many cubes is he supposed to stack for his age

6-8 😶

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Parents bring their 3y/o son in to see you regarding his short stature– he was small-for-dates and has been on the lower range of the centile for height since. When you see him you notice he has a triangular-shaped face and a carp shaped mouth. What is his short stature most likely due to?

Russel silver 💠🔼

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15m old boy comes in with a barking cough and stridor. He has moderate intercostal and subcostal recessions. His sats are 94%. What is the most appropriate treatment to give him?

Oral dexamethasone for croup

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3y/o boy is breathless, bilateral wheeze. No significant past medical history. No interval symptoms. His mum has eczema and hayfever. What is this boy most likely to have?

Viral induced wheeze as asthma is over 5yrs.

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9y/o girl comes in because she’s been feeling puffy and having swollen ankles and some other body parts… you diagnose nephrotic syndrome. What are you most likely to see on microscopy?

I think minimal change as its the most common…

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9y/o boy comes in for abdominal cramps. Gets a scope and duodenal biopsy which reveals villous atrophy, increase in intraepithelial lymphocytes and crypt hyperplasia. No PR bleeding. What would you recommend for management?

Coeliac = villous atrophy, lymphocytes and crypt hyperplasia so gluten free diet.

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Baby comes in with prolonged jaundice, what is the first most important investigation to do?

Bilirubin that 👶

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9y/o Boy comes in to A&E with painless limp, has no previous medical history of any illnesses or colds/infections recently. U/S shows effusion. What is he most likely to have?

Perthes… transient synovitis follows viral infection

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Boy recently treated for severe strep throat, and now has developed nodules on his shin which are tender. What are these called?

Erythema nodosum
Also seen in IBD.
Erythema marginatum = rheumatic fever.

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Newborn baby has purulent discharge from both his eyes. His eyelids are oedematous. There is chemosis and proptosis of both his eyes. Culture of the discharge reveals gram negative diplococci. What could it be?

Neisseria gonorrhoea.

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Male comes in – recently his chest has been tender and both his breasts have been increasing in size. Which medication can be responsible for this?

Spironolactone

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Best test for gonorrhoea presentation and sensitivity

Urethral swab for culture - avoid resistance and do before describing ABx.

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Tender uterus, hard abdo

Placenta abruption

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Test for Downs @ 12weeks

Combined test and then do chorionic villous sample

15 weeks + do quadruple and then amniocentesis

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Lady comes in at Week 41 gestation. Bishop score 0. Which is the safest and most appropriate way to induce labour in her?

Membrane sweep first then offer PEG-E2

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Safe drugs for DM in pregs

Metformin and insulin

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Infertility tests. How do you test if she’s ovulating?

21 day progesterone

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Which medication is contraindicated in the first trimester? Daltaparin, Warfarin, Ace-inhibitor

Warfarin.

Ace inhibitor only in 2nd and 3rd trimester.

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Name a med which causes orthostatic hypotension

Ace inhibitor

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Type of study looking at population

Ecological

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Population level intervention for primary prevention

Vaccinations

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What type of prevention prevents MI REoccurrence.

Tertiary

Limitations of comparative approach to needs assessment

•May not yield what the most appropriate level e.g. of provision or utilisation should be •􏰀 Data may not be available •􏰀 Data may be of variable quality • 􏰀May be difficult to find a comparable population

Who do you notify and when do you notify notifiable diseases?

Proper office of health protection unit = public health england. Send the form to the proper officer within 3 days, or notify them verbally within 24 hours. Don’t wait for laboratory confirmation of a suspected infection before notification.

2 blood borne hepatits

B and C

First line treatment for trigeminal neuralgia

Carbamazepine

First line treatment for essential tremor

Propranolol

Guy experiences a sudden sharp pain in his neck while on a rollercoaster a

Carotid artery dissection. A typical picture of local pain, headache, and ipsilateral Horner’s syndrome. Doppler ultrasound, MRI/MRA, and CT angiography are useful non-invasive diagnostic test

Pregnant lady with bilateral wrist pain and tingling, worst at night. What is this?

Carpel tunnel syndrome

Guy comes in after a car accident, loss of sensation in middle finger. He can flex his elbow but cannot extend it. Where is the site of the lesion?

C7. Triceps =C7

Lady has been prescribed fluoxetine a few weeks ago and it’s working, now she asks whether she can stop it. What would your advice be

Continue treatment for at least 6 months following remission

Lady arrives at A&E having taken an overdose of tricyclics. What is one important investigation you must do?

ECG cause arrythmia

1st line drug in OCD

SSRI

Guy has depressive symptoms. Found to have moderate depression. He also complains of insomnia. Which medication would be the most suitable for him?

Mirtazipine as sedative

Alcohol acute withdrawal treatment

Chlordiazepoxide

Treatment for overdose of diazepam

Flumanezil

Boy comes in with hypoalbuminaemia, peripheral oedema and proteinruia (Sx of minimal change). He has already been started on prednisolone. What else would you give until his oedema disappears?

IV furosemide

Boy comes in with a limp on his left leg. He previously had an episode of coryzal symptoms. He was fairly cooperative during the physical examination, only complaining of some discomfort of the leg. o/e there was reduced range of movement of the left hip. What would be the next management?

USS

Girl comes with high fever (aroundm 39 degrees Celsius)......She was in severe discomfort during the examination of her hip.

Admit

Unknown age of child that comes presenting with a murmur that is best heard at the left lower sternal edge (2/6). Does not radiate to the back. Murmur is significantly softer when the child is lying down. What would be the next step?

Apparently innocent murmurs need no follow up

2-day old child has bilious vomiting…..A CT scan of the abdomen shows meconium pellets in the ileum and microcolon involving the entire colon. What would you want to rule out?

Cystic fibrosis

Boy comes in with fever for more than 5 days and cervical adenopathy and strawberry tongue. What investigation would you like to order?

ECHO

A primivada 23-year old pregnant lady attends the booking visit. She has a history of depression. She also mentions that she has lost touch with most of her friends as she does not like to go out. During the time that she has been pregnant, she and her partner have been angry at each other and the partner has, at times, flown off the hook. What is the most important issue to address at this presentation?

Domestic abuse I think

Africo-Carribean lady comes with menorrhagia and dysmenorrhoea. You gave tranexamic acid and mefanamic acid. Uterus palpable over the symphysis. However, she has come back a number of weeks later saying that they won’t work and the bleeding has gotten worse. What is the menorraghia likely due to? She was anaemic

Fibroids

Young female adult comes in (i can’t remember symptoms...sorry) and she was given a nexplanon implant. 6 weeks later, she comes in to say that her bleeding is lighter and brisk but it is still ongoing and this is interfering with her sex life. What would be your advice?

Come back in 6 months and then consider COCP to help bleeding I think...

A lady (over 55) was started on 3 anti-hypertensive medication as part of the NICE guideline. She started to develop flushing on her face. Which medication is likely to cause this?

CCB

Man has various comorbidities Aortic stenosis (including heart failure) frothy sputum.....o/e find bibasal crackles on the lungs.

Pulmonary oedema rx =m furosemide

Infertility due to male factor, which of the following is the most likely pathogenesis?

Inguinal hernia surgery

Health needs assessment- what do you call a need where the professionals decide what the need is..?

Normative

Patient has been referred with a movement disorder. CT scan showed atrophy of caudate nucleus and putamen and generalised atrophy. What is this likely to be the reason for this?

Huntingtons

Older lady was in the toilet when she fell. She has AF. O/E notice that she has bilateral paraparesis of her legs, no reflexes (i think). Lost spinothalamic but dorsal columns spared.

Infarction. Trauma causes UMN symptoms below lesion and she has LMN symptoms with no reflexes.

Carpenter comes in with increasing tingling and numbing sensation on his thumb and the 2 adjacent fingers. It is worse at night and goes away when he shakes his hand. You are able to replicate the symptoms when you tap on his wrists. Which nerve is likely to cause this symptoms?

Median

Med for aggressive old folk 👵 👴

Haloperidol

Luria’s motor tests

Fronto temporal dementia I think (not 💯)

Paraphrenia

Old people mostly female, like schizophrenia but no negative symptoms. Just wacky and psychotic.

Tricyclic OD Ix

ECG

Best psychotherapy for borderline

Dialectical

What can you give a premature baby to prevent resp distress syndrome

Surfactant.

Premature baby is bradycardia, no breathe sounds on right side of chest and chest transilluminates, cardiac apex beat is deviated to left. What is Dx?

Right pneumothorax.

Day 31 of life for a prem baby and they get apnoea, bradycardia, distended and discoloured abdomen, bilious vomiting

Necrotising enterocolitis.

What causes Eisenmenger's syndrome

Pulmonary HTN causes reversal of shunt to right to left.

12 year old girl from Somalia with Hx of ventricular septal defect comes into A&E with worsening of her symptoms. Her father says that she has had some temperatures for the last two weeks. Increasing malaise and eating less than usual. On examination, she is pyrexial. She is quite short of breath, looks cyanosed and pale. She now has a murmur. Investigations reveal a haemoglobin concentration of 8g/dl (11- 14g/dl) and a white cell count of 15 x 109/L (4-9 x 109/L). 1) Whats the Dx? 2) What Ix? 3) Why is urine +ve for blood?

1) Subacute bacterial endocarditis 2) Blood cultures 3) Immune-complex nephritis.

Findings on examination of polyhydramnios

Fluid thrill Indistinct fetal heart sounds Overdistended uterus Symphyseal-fundal height is large for dates.

RFx for polyhydramnios

``` Fetal infection Macrosomia Maternal diabetes Fetal cardiac failure Fetal duodenal atresia ```

Ix for polyhydramnios

Detailed USS HbA1c TORCH screen

Complications of polyhydramnios

Pre-term labour Malpresentation Cord prolapse

3 conditions, what is tested and a complication of each in new-born heel prick

Cystic fibrosis = immunoreactive trypsin, malabsorption. Phenylketonuria = Phenylalanine, seizures. Congenital hypothyroidism = TSH, developmental delay.

2 non-heel prick newborn screening programmes

Hip examination | Hearing test.

LP for bacterial meningitis

Leukocytes Raised protein Low Glucose

2 childhood immunisations to prevent meningitis

H.influenza B | Meningitis C

ABx for prophylaxis of meninigitis

Rifampicin | Ciprofloxacin

Test for illicit drug use

Urine screen

1) Why do you get EPS with anti-psychotics. 2) Why does it cause gynaecomastia. 3) What other Male SE can this cause?

1) Dopamine receptor binding. 2) Dopamine regulates prolactin release. Dopamine block with anti-psychotics leads to increased prolactin release and development of breast tissue. 3) Impotence due to gonadal hormone production negative effect.

What lobe does schizophrenia affect the most

Temporal

3 complications of pre-eclampsia

Eclampsia HELLP Placenta abruption Fetal death

3 blood tests for alcoholism at admission

MCV Gamma-GT Blood alcohol levels

Alcohol gets acute abdo pain what Ix and what could be Dx?

Serum amylase due to acute pancreatitis.

1) Antabuse drug 2) A side effect 3) Mechanism of action

1) Disulfiram 2) Hypotension 3) Inhibit alcohol dehydrogenase and increase acetaldehyde.

How do amphetamines act

Bind to dopamine and increase its levels.

The man agrees to start oral anti-psychotic medication. He takes this for two weeks. Suddenly over a period of six hours he becomes disorientated, sweats profusely and develops a very high temperature. 1. What is the condition that he has developed? 2. 2 blood tests which will be raised in this condition? 3. 4 causes of death in this condition?

1. Neuroleptic malignant syndrome 2. Raised creatinine kinase, WCC 3. Pyrexia, renal failure, PE and aspiration pneumonia.

1. Delusion in paranoid schiz | 2. Delusion in depressive psychosis?

1. Persecutory delusion | 2. Nihilistic delusion

Patient saw and traffic light turn red then realised he was being followed. What is this and why is it relevant?

Delusion of perception. | 1st rank symptom of schiz, differentiate between schiz and psychotic depression.

On antipsychotic and get neck stiffness, what is it and how to treat?

Acute dystonic reaction. IM procyclidine.

How to antipsychotics work

Dopamine antagonist.

On antipsychotic and get 1. Restless 2. Thirsty and skin infection

1. Akathisia | 2. DM type 2.

2 Ix before starting lithium

TSH and renal function

On lithium and get cold peripheries and constipation. 1. What is happening? 2. what would you see on examination?

1. Hypothyroidism. | 2. Dry skin, bradycardia, relayed reflex relaxation, alopecia.

3 features on neuro exam of lithium toxicity

Hyperreflexia Ataxia Coarse tremor Muscle twitching

2 ways to induce labour

Membrane sweep | Prostaglandin pessary

3 features of a Bishop's score

Position, dilation and consistency of cervix

3 reassuring signs on CTG

FHR 110-160bom No decelerations Variability of up to 25bpm Accelerations present.

1. Name 3 Ix for ectopic 2. 3 treatments for ectopic 3. 3 Rfx for ectopic 4. Incidence of ectopic and rate of recurrence.

1. betahCG, USS, lapropscopy. 2. Expectant, methotrexate, surgical - salpingectomy. 3. increased maternal age, IVF, previous Hx. 4. 1%, 10%.

A haematological, biochemical and microscopic Ix for neonatal jaundice

``` Haem = Coombs' test Biochem = unconjugaed and conjugated bilirubin Micro = peripheral blood film. ```

3 nursing strategies in a confused old patient

``` Quiet environment Good lighting Continuity of care providers Able to see relatives Have glasses, hearing aids etc Large clock ```

4 things on discharging an old patient

Medication list Physio and OT review Contact details for them and for Dr Care package needed?

5 criteria for screening programme

- caught in early stage - appropriate test - available Rx - important health matter - cost-effective

4 chronic conditions causing ED and 2 Ix

``` hypothyroid prolactinaemia depression DM drug addiction ``` Ix = TSH, testosterone.

What is a never event and give an example

Recognised catastrophic event which should have had the appropriate control and procedures in place to avoid it from happening. e.g. wrong surgical site.

What is the personal and system approach for investigating a never event and which is better?

``` Personal = focus on unsafe acts of an individual e.g. Dr, nurse, porter. Results of aberrant behaviour. Systems = focus on multi-level system weakness which contributed to event. Able to put measure/barriers in place to prevent event. ``` System is better.

1. Most common neonatal infection? 2. RFx? 3. How could it be prevented?

1. Group B streptococcus. 2. Prematureity, prolonged rupture of membranes, previous baby who developed GBS infection, maternal pyrexia. 3. IV Benzylpenicillin to mum

3A MCQ/SBA Flashcards

(103 cards)